Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms : a naturalistic study

Background: A number of data show the negative role of duration of untreated illness (DUI) on outcome in mood disorders, but no investigation has been carried out about the impact of this variable in bipolar disorder (BD) with psychotic symptoms. Clinical experience shows that many bipolar patients with psychotic symptoms receive other diagnoses and often are chronically treated with first generation antipsychotics, with the effect to reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI. Purpose of the study was to define the rate of misdiagnosis and the impact of DUP/DUI on outcome of bipolar patients with psychotic symptoms. Method: Clinical information (DUP. DUI, first received diagnosis) about bipolar outpatients with psychotic symptoms (N=240) were extrapolated through a retrospective review of the clinical charts, Lombardy database and, if necessary, through clinical interviews with patients and their relatives. Outcome measures included psychiatric and substance abuse comorbidity, occupational status, Global Assessment of Functioning (GAF), number of hospitalizations and of suicidal attempts, number of depressive/manic recurrences. Patients were divided in two groups according to the DUP (1 year) and DUl (8 years) median, and the groups were compared through analyses of variance (ANOVAs) for continuous variables or chi(2) tests for dichotomous ones. Multivariate analysis of variance (MANOVA) with duration of illness as covariate was then performed to eliminate the effect of this variable. Finally, binary logistic regressions were performed considering age at onset, DUI, DUP as independent variables and outcome variables as dependent ones (presence of hospitalizations/suicidal attempts, GAF scores < 50, occupational status). Results: Most of patients (61.5%) received a first diagnosis different horn BD with the most frequent DSM-diagnosis being delusional disorder (17.9%). Patients with longer DUP were not different in outcome measures with respect to patients with shorter DUP. Patients with a DUI >8 years presented higher number of hospitalizations (F=6.04, p=0.015), higher number of manic recurrences (F=5.25, p=0.023), higher number of depressive recurrences (F=7.13, p=0.008) and lower GAF scores (F=17.74, p < 0.001). Statistical significance persisted for number of hospitalizations (p < 0.001) and GAF scores (p=0.003) after MANOVA. Finally binary logistic regression showed that a longer DUl was predictive of GAF scores < 50 (F=1774, p < 0.001). Discussion: More than half of bipolar patients with psychotic symptoms receive a different diagnosis at first contact with psychiatric services. DUI (but not DUP) is a predictor of outcome in bipolar patients with psychotic symptoms. This indicates that an early diagnosis and proper treatment with a mood stabilizer (or an atypical antipsychotic with mood stabilizing effects) may improve long-term outcome of these patients. In the light of the naturalistic design of the present paper, these results have to be considered as preliminary and have to be confirmed by prospective controlled studies

White Matter Hyperintensities and Their Association With Suicidality in Major Affective Disorders: A Meta-Analysis of Magnetic Resonance Imaging Studies

Introduction: Individuals who have deep and periventricular white matter hyperintensities may have a higher risk for suicidal behavior. There are mixed results in the literature regarding whether unipolar or bipolar patients who have attempted suicide have more deep white matter hyperintensities (DWMH) or periventricular hyperintensities (PVH) relative to those who have no history of suicide attempts. Methods: A meta-analysis of studies examining white matter hyperintensities (WMH) in mood disorder patients with and without a history of suicide attempts was performed. Results: Four studies, including a total of 173 patients who attempted suicide and 183 who did not attempt suicide, were included. A significantly higher number of attempters were found to have WMH than non-attempters. Unipolar depressed patients who had attempted suicide had 1.9 times more DWMH and 2.1 times more PVH than those who did not. Bipolar patients who had attempted suicide had 5.4 times more PVH than those who had not. Taken together, unipolar and bipolar patients who had attempted suicide had 2.8 times more DWMH and 4.5 times more PVH than those who had never attempted suicide. Conclusion: These findings raise the possibility that WMH are biological substrates of symptoms that lead to suicidal behavior. CNS Spectr. 2010;15(6):375-381

Is cerebellar volume related to bipolar disorder?

Background: Recent data suggest that cerebellum influences emotion modulation in humans. the findings of cerebellar abnormalities in bipolar disorder (BD) are especially intriguing given the link between the cerebellum emotional and behavioral regulation. the purpose of this study was to evaluate cerebellar volume in patients with euthymic BD type I compared to controls. Moreover, we investigated the possible relationship between cerebellar volume and suicidal behavior.Methods: Forty-patients with euthymic BD type I, 20 with and 20 without history of suicide attempt, and 22 healthy controls underwent an MRI scan. the participants were interviewed using the Structured Clinical Interview with the DSM-IV axis I (SCID-I), the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS) and the Barratt Impulsiveness Scale (BIS-11).Results: Groups were age, gender and years of schooling-matched. the left cerebellum (p = 0.02), right cerebellum (p = 0.02) and vermis (p<0.01) were significantly smaller in the BD group; however, there were no volumetric differences between the BD subjects with and without suicidal attempt. There was no correlation between cerebellar measurements and clinical variables.Limitations: the main strength is that our sample consisted of patients with euthymic BD type I without any comorbidities, however, these results cannot establish causality as the cross-sectional nature of the study.Conclusions: Our findings suggest that the reduction in cerebellar volumes observed in BD type I might be a trait-related characteristic of this disorder. Additional studies with larger samples and subtypes of this heterogeneous disorder are warranted to determine the possible specificity of this cerebellar finding. (C) 2011 Elsevier B.V. All rights reserved.Mood and Anxiety Disorders Program (CETHA), Salvador-Bahia, BrazilConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Lab Interdisciplinar Neurociencias Clin LiNC, UNIFESP, BR-04039032 São Paulo, BrazilUniv Fed Tocantins, Tocantins, BrazilUniv Fed Bahia, CETHA, Salvador, BA, BrazilMed Diagnost, Image Mem, Salvador, BA, BrazilUniversidade Federal de São Paulo, Lab Interdisciplinar Neurociencias Clin LiNC, UNIFESP, BR-04039032 São Paulo, BrazilCNPq: 480918/2007-4Web of Scienc

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51%) patients did not have any psychiatric diagnosis, while 44 (49%) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1%) had a current mental disorder, out of which 22 (84.6%) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis

Clinical and Socio-Demographic Characteristics of College Students Exposed to Traumatic Experiences: A Census of Seven College Institutions in Northeastern Brazil

Background Epidemiological studies show that most of the adult population will be exposed to at least one potentially traumatic event in the course of his/her life; adolescence and early adulthood are the most vulnerable periods of life for exposure to traumatic experiences (70% of their deaths are due to external causes). Posttraumatic Stress Disorder is characterized by the development of dysfunctional symptoms that cause distress or social, academic, or occupational impairment, as result of exposure to a traumatic event. The aim of this multicentric study is to establish the proportion of college students, within seven institutions in Northeastern Brazil, who were exposed to traumatic experience and met PTSD criteria. Methods/Design A one-phase census protocol of seven college institutions in three metropolitan regions in Northeastern Brazil was performed (April to July 2011). All students aged 18 years or older, matriculated and attending their first or final semester were eligible. The self-applied protocol consisted of a socio-demographic questionnaire and the following scales adjusted to Brazilian Portuguese standards Trauma History Questionnaire (THQ), PTSD Checklist-Civilian (PCL-C), Impulsivity Scale (BIS-11). Data were entered into SPSS 17.0. Results 2213 (85.5%) students consented to participate, and completely filled in the protocols. Of these, 66.1% were woman, mean age 23.9 (SD 6.3), 82.7% were single, and 57.3% attended university outside their native cities. The total PTSD prevalence was 14%, and the median for frequency of trauma exposure was 5 events. Conclusion A high frequency of exposure to violence, as well as a high rate of PTSD, suicide attempts, and high-risk sexual behavior was found in Brazilian college students. This highlights the importance of effective public health actions in relation to the prevention and treatment of PTSD and other dysfunctional behaviors resulting from traumatic exposure in young individuals, usually an at risk population for violence and traumatic situations

The effect of early virological response in health-related quality of life in HCV-infected patients

Twenty-nine HCV-infected patients were treated with pegylated interferon alpha. Diagnosis was based on serum HCV RNA-PCR positive results and liver biopsy. All patients had elevated serum levels of alanine aminotransferase at the time of the study, but liver disease was compensated. Patients were evaluated at baseline treatment and after 4 and 12 weeks of antiviral treatment with the Medical Outcomes Study 36-item Short-Form Health Survey. The Mini-International Neuropsychiatric Interview was used to exclude previous or current psychiatric diagnoses. Both patients and psychiatrists were blind to the HCV RNA status, and serum HCV RNA test results only became available after the visit at week 12. After antiviral treatment, 16 patients (55.2%) were classified as nonresponders and 13 (44.8%) were classified as responders. When compared to nonresponders, responders had a greater improvement in the HRQOL scores for the mental health domain (P<.019). Differences in other domains were not significant. The present study confirms that active viral infection is one possible reason for the poor Health-Related Quality of Life in this population

Impulsivity is relevant for trauma exposure and PTSD symptoms in a non-clinical population

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-03-06T16:59:30Z No. of bitstreams: 1 Liana Netto Impulsivity is relevant....pdf: 486339 bytes, checksum: b7e71e78e8c7def116bdd0de1f916ab7 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-03-06T17:19:15Z (GMT) No. of bitstreams: 1 Liana Netto Impulsivity is relevant....pdf: 486339 bytes, checksum: b7e71e78e8c7def116bdd0de1f916ab7 (MD5)Made available in DSpace on 2017-03-06T17:19:15Z (GMT). No. of bitstreams: 1 Liana Netto Impulsivity is relevant....pdf: 486339 bytes, checksum: b7e71e78e8c7def116bdd0de1f916ab7 (MD5) Previous issue date: 2016Institutional Review Boards of Bahia (CEP/COM/UFBA – process number 227/2010) and Paraíba(CEP/Fac. Sta. Maria,17-02-2011), BrazilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / Universidade Estadual de Feira de Santana. Feira de Santana, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / Universidade Federal do Rio Grande do Norte. Escola Multicampi de Ciências Médicas. Natal, RGN, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilUniversidade Estadual de Feira de Santana. Feira de Santana, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilMailman School of Public Health Columbia University. Department of Epidemiology.NewYork, NY, USAUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Departamento de Neurociências e Saúde Mental. Salvador, BA, BrasilImpulsivity is a relevant construct for explaining both normal individual differences in personality and more extreme personality disorder, and is often investigated within clinical populations. This study aims to explore the college students' impulsivity patterns and to investigate the association across levels of impulsivity with trauma exposure and PTSD development in a non-clinical population. A one-phase census survey of seven college institutions assessed 2213 students in three metropolitan regions of Northeastern Brazil. All subjects anonymously completed a self-applied protocol consisting of: a socio-demographic questionnaire, Trauma History Questionnaire (THQ), PTSD Checklist (PCL-C), and Barratt Impulsiveness Scale (BIS-11). The median for frequency of trauma exposure was 4 events for people with low and normal impulsivity, and 6 for highly impulsive ones. Individuals with higher impulsivity presented earlier exposition than non-impulsive ones, and worst outcome: 12.4% with PTSD, against 8.4% and 2.3% (normal and low impulsivity). Of the three factors of impulsivity, the Attentional factor conferred the strongest association with PTSD development. Results suggest that impulsivity is also a relevant trait in a non-clinical population and is associated with trauma exposure and PTSD. Strategies to promote mental health in adolescents may be pertinent, especially with the aim of managing impulsivity

Open Repository - Esketamine for unipolar major depression with psychotic features: a retrospective chart review and comparison with non-psychotic depression

Article link: https://journals.lww.com/psychopharmacology/Abstract/2022/07000/Esketamine_for_Unipolar_Major_Depression_With.15.aspx?context=LatestArticle