DEPRESSIVE DISORDERS AND COMORBIDITY: SOMATIC ILLNESS VS. SIDE EFFECT

Background: The rate of comorbid depression and medical illness varies from 10 to 40%. Patients with depressive disorder compared to general population more often have cardiovascular and cerebrovascular disorders, diabetes, irritable bowel syndrome, and some types of tumor. Side effects of mental health medications may appear in a form that is very similar to clinical presentation of somatic illness. Side effects that appear during treatment of depressive disorder, e. g. cardiovascular, gastrointestinal, movement disorders, etc., may provoke certain diagnostic issues regarding origin of such symptoms (somatic illness vs. side effect). The aim of this article is to review literature regarding comorbidity of depressive disorder and somatic illness and to point at possible diagnostic problems in diferentiating comorbid somatic illness and side effects of antidepressants. Content analysis of literature: Literature research included structured searches of Medline and other publications on the subject of comorbidity of depressive disorder and somatic disorders and possible diagnostic problems in differentiating comorbid somatic illnesses from side effects of antidepressants. Conclusion: Comorbidity between depressive disorder and various somatic disorders appears often. Investigations suggest that depressive disorder is underdiagnosed in such cases. Side effects of antidepressants are sometimes very hard to diferentiate from symptoms of somatic illness, which may lead to diagnostic issues. Bearing in mind frequent comorbidity between of depressive and somatic disorders, early recognition of such comorbidity is important, as well as the selection of antidepressant. It is improtant to recognize depressive disorder in patients with somatic illnesses, as well as somatic illness in patients primarily treated because of depressive disorder

Psychiatric Aspects of Cardiovascular Diseases / Patients

Psihokardiologija posljednjih godina postaje sve aktualnije područje integrativne i holističke psihosomatske medicine. Brojna istraživanja pokazuju da kardiovaskularne (KV) bolesti i psihijatrijski poremećaji često koegzistiraju te da su komorbidna stanja između ova dva entiteta visokoprevalentna. Određeni psihijatrijski poremećaji, poglavito anksiozni i depresivni, osim što bitno utječu na oporavak i prognozu bolesti srčanih bolesnika, važni su rizični čimbenici u nastanku KV bolesti. Rano prepoznavanje i uspješno liječenje duševnih poremećaja u kardiovaskularnih bolesnika može značajno pridonijeti sveukupnom uspjehu i povoljnom ishodu liječenja.Psychocardiology has become an increasingly interesting area of integrative and holistic psychosomatic medicine. Numerous studies show that cardiovascular (CV) diseases and psychiatric disorders often coexist, and that comorbid conditions between these two entities are highly prevalent. Some psychiatric disorders, especially anxiety and depression, significantly affect the recovery and prognosis of cardiac patients. They are also important risk factors in the development of CV diseases. Early recognition and successful treatment of mental disorders in cardiovascular patients can significantly contribute to the overall success and favorable treatment outcome

THE ROLE OF PERSONALITY TRAITS IN POSTTRAUMATIC STRESS DISORDER (PTSD)

Background: A number of studies have shown that although exposure to potentially traumatic events is common, development of PTSD is relatively rare, which is one of the reasons PTSD still remains a controversial psychiatric entity. The aim of this article was to provide an overview of the research on the role of personality traits in the vulnerability, resilience, posttraumatic growth and expressions associated with PTSD. Personality based approach represents a dimensional aspect of the transdisciplinary integrative model of PTSD. Methods: We conducted a systematic search on PubMed, PsycINFO, and Academic Search Complete from 1980 (the year PTSD was first included in the DSM) and 2012 (the year the literature search was performed). Manual examination of secondary sources such as the reference sections of selected articles and book chapters were also conducted. Results: Most of the reviewed studies dealing with personality traits as vulnerability and protective factors for PTSD examined the relationship between basic personality dimensions and severity of symptoms of PTSD. These studies have applied three types of methodological designs: cross-sectional, post-trauma and pre-trauma longitudinal studies, with latter being the least common option. Conclusion: Finding that appears relatively consistent is that PTSD is positively related to negative emotionality, neuroticism, harm avoidance, novelty-seeking and self-transcendence, as well as to trait hostility/anger and trait anxiety. On the other hand, PTSD symptoms are negatively associated with extraversion, conscientiousness, self-directedness, the combination of high positive and low negative emotionality, as well as with hardiness and optimism, while posttraumatic growth shows inverse relation to most of these traits. Furthermore, a number of studies have confirmed the existance of three distinct personality-based subtypes of PTSD: internalizing, externalizing and low pathology PTSD. These findings may help in further uncovering etiological mechanisms and in building new strategies for prevention, identification and reduction of health risks among this trauma population, as well as facilitating potential posttraumatic growth. However, focusing on just a single dimensional perspective will unable us to generate comprehensive knowledge of the etiology, course and treatment of PTSD

Mental disorders and metabolic syndrome: A fatamorgana or warning reality?

Background: There has been a growing interest in the effect that comorbid mental and somatic disorders may have on each other. Metabolic syndrome is an important risk factor for the development of diabetes mellitus, cardiovascular disease and premature mortality. Objectives: To examine the association between various mental disorders (schizophrenia, schizoaffective disorder, bipolar disorder, depression, posttraumatic stress disorder and other mental disorders) and metabolic syndrome and discuss the possible pathophysiologic mechanisms that may link specific mental disorders and metabolic syndrome. Method: A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to identify studies included (1) English language, (2) published studies with original data in peer-reviewed journals. Results: Clinical investigation of the metabolic syndrome in patients with mental disorders, except schizophrenia, has been surprisingly scarce. Metabolic syndrome was reported in 19-63% of schizophrenic patients, in 42.4% of patients with schizo-affective disorder, in 24.6-50% of bipolar patients, in 12-36% of the patients with recurrent depression and in 31.9-35% of patients with combat posttraumatic stress disorder. Conclusion: Metabolic syndrome can contribute to significant morbidity and premature mortality and should be accounted for in the treatment of mental disorders. No definite or reliable insight into the pathophysiological link between metabolic syndrome and mental disorders is available

Mental disorders and metabolic syndrome: A fatamorgana or warning reality?

Background: There has been a growing interest in the effect that comorbid mental and somatic disorders may have on each other. Metabolic syndrome is an important risk factor for the development of diabetes mellitus, cardiovascular disease and premature mortality. Objectives: To examine the association between various mental disorders (schizophrenia, schizoaffective disorder, bipolar disorder, depression, posttraumatic stress disorder and other mental disorders) and metabolic syndrome and discuss the possible pathophysiologic mechanisms that may link specific mental disorders and metabolic syndrome. Method: A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to identify studies included (1) English language, (2) published studies with original data in peer-reviewed journals. Results: Clinical investigation of the metabolic syndrome in patients with mental disorders, except schizophrenia, has been surprisingly scarce. Metabolic syndrome was reported in 19-63% of schizophrenic patients, in 42.4% of patients with schizo-affective disorder, in 24.6-50% of bipolar patients, in 12-36% of the patients with recurrent depression and in 31.9-35% of patients with combat posttraumatic stress disorder. Conclusion: Metabolic syndrome can contribute to significant morbidity and premature mortality and should be accounted for in the treatment of mental disorders. No definite or reliable insight into the pathophysiological link between metabolic syndrome and mental disorders is available

Somatic comorbidity, metabolic syndrome, cardiovascular risk, and CRP in patients with recurrent depressive disorders

Aim To investigate the association between depression, metabolic syndrome (MBS), somatic, particularly cardiovascular comorbidity, and low-grade chronic inflammation assessed using C-reactive protein (CRP). Methods This cross-sectional study included 76 patients with recurrent depressive disorder (RDD) and 72 non-depressed medical staff controls from the Department of Psychiatry, University Hospital Center Zagreb between January 2011 and June 2012. Results Seventy-five percent of patients had somatic comorbidity. The most common comorbid conditions were cardiovascular disorders (46.1%), locomotor system diseases (35.5%), carcinoma (15.8%), thyroid diseases (9.2%), and diabetes (9.2%). MTB was more common in RDD patients (31.6%) than in controls (23.6%), but the difference was not significant. Elevated CRP was found to be significantly more frequent in patients with recurrent depressive disorders (RDD) (35.5%; χ2 test, P = 0.001, Cramer V = 0.29) than in controls (12.5%) and was associated with lowered highdensity lipoprotein and overweight/obesity. Conclusion We found some intriguing links between stress, depression, metabolic syndrome, and low grade inflammation, which may be relevant for the prevalence of somatic comorbidity in patients with RDD, but further studies are needed to confirm our results

Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with SGA

There is accumulating evidence for an increased prevalence of metabolic syndrome (MetS) in bipolar patients, which is comparable to the prevalence of MetS in patients with schizophrenia. Hyperhomocysteinaemia has emerged as an independent and graded risk factor for the development of cardiovascular disease (CVD), which is, at the same time, the primary clinical outcome of MetS. The aim of this study was to ascertain if the presence of MetS was associated with hyperhomocysteinaemia in patients with bipolar disorder (N=36) and schizophrenia (N=46) treated with second-generation antipsychotics (SGA). MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria and the cut-off point for hyperhomocysteinaemia was set up at 15μmoll(-1). Results of the study indicated that the presence of the MetS is statistically significantly associated with the elevated serum homocysteine in all participants. As hyperhomocysteinaemia has emerged as an independent risk factor for psychiatric disorder and CVD, it could be useful to include fasting homocysteine serum determination in the diagnostic panels of psychiatric patients to obtain a better assessment of their metabolic risk profile