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Journal of affective disorders [journal]
- Decreased plasma levels of brain-derived neurotrophic factor (BDNF) during mixed episodes of bipolar disorder. [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 28.:167-170.
Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in neurogenesis and neuroplasticity. Decreased blood levels of BDNF have been found during acute manic and depressive states. BDNF has been proposed as a biomarker in illness phases of mood disorders. No information is available regarding BDNF levels during the mixed states of bipolar disorder (BD). The aim of this study was to evaluate BDNF levels during mixed episodes of BD patients and compare them with those of healthy subjects and depressed patients.Plasma BDNF levels were measured by an ELISA assay in 18 patients with major depressive episode (MDE), 19 patients with mixed episode (ME) and 15 healthy subjects (HS).BDNF levels were significantly higher in HS, as compared with patients׳ samples (HS vs. MDE patients: p<001; HS vs. ME patients: p=.022). No significant differences were found between BDNF levels of ME and MDE patients. The severity of illness as assessed by CGI-S was significantly higher in ME than in MDE patients (p=.01).The small sample size may have weakened the power of statistical analyses. All patients received mood-stabilizing and antidepressant treatments which have been reported to influence peripheral BDNF levels.Our results are consistent with previous studies showing reduced BDNF during both manic and depressive episodes. This finding supports the role of BDNF as a state-marker of mood episodes, and may represent a contribution to a unitary approach model between unipolar and BDs, as well as to the manic-depressive spectrum model.
- Prevalence and determinants of depressive symptoms among university students in Ghana. [JOURNAL ARTICLE]
- J Affect Disord 2014 Oct 8.:161-166.
Over two million Ghanaians suffer from moderate to mild mental disorders but prevalence levels and determinants among university students remains fairly unknown. A better understanding of depression and its determinants is necessary in developing appropriate interventions in this population group.A convenient sample of 270 students from a public university (132 males and 138 females) were interviewed using a questionnaire to record socio-demographic variables, HIV risk behaviours. Depressive symptoms were measured using Centre for Epidemiological Studies Short Depression Scale (CES-D 10). Multiple logistic regression was used to identify the determinants.The mean age was 22 (SD=2.39). Using a cut-off point of 10 of the CES-D10, the overall prevalence of depression was 39.2%; with 31.1% of mild to moderate depression and 8.1% severe depressive symptoms. Significant predictors included lack of social support, religion not having an impact on life, heavy alcohol consumption and traumatic experiences such as being forced to have sex, physically and sexually abused as a child, and beaten by a sex partner.Given the cross-sectional nature of the research, the findings are limited highlighting the need for further research. Also, relying on self-report of symptoms could have influenced the outcome. The use of a single university means that there could be regional differences in depression in other universities.Depression occurs in a significant number of students. An appropriate intervention must be implemented to help reduce the burden of depression, especially to those found to be at risk.
- Short-term antidepressant treatment of bipolar depression: Are ISBD recommendations useful in clinical practice? [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 28.:155-160.
The study aimed to test the effectiveness of the ISBD Guidelines for short-term AD treatment of BP depression.The study sample included 255 patients with mood disorders (154 UP, 49 BP-I, 52 BP-II). Response was defined as a HDRS21 total score<7 at 12 weeks of treatment and remission as a ≥50% reduction of baseline HDRS21 total score sustained for 8 weeks.Response was achieved by 64.9% of patients with UP disorder, 75.5% of patients with BP-I disorder and 75.0% with BP-II disorder without significant differences (χ²=3.0, p=0.219). The remission rate did not differ significantly among groups (χ²=3.8, p=0.151). The dropout rate was significantly higher for patients with UP (18.2%) than for patients with BP-I (2%) and BP-II (7.7%) disorder (χ²=10.1, p=0.006). Concerning AD safety, one patient with BP-I depression committed a suicide attempt and AD-emerging switch was observed in 2.9% of patients, 2 with BP-I and 1 with BP-II disorder.The observational nature of the study and unblinded outcomes assessment.Our findings confirm the usefulness of ISBD Guidelines for short-term AD treatment of BP depression. These patients appear to have similar response and remission rate to those observed in UP depression and do not exhibit significant switch rates or risk of suicide. Our results are limited to patients with pure bipolar depression (excluding those with broadly defined mixed states), treated with ADs-mood stabilizers combination. We suggest to partially modify ISBD Recommendations 1 and 4, to include potential responders and to improve safety.
- Breastfeeding and depression: A systematic review of the literature. [REVIEW]
- J Affect Disord 2014 Sep 28.:142-154.
Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression.An electronic search in three databases was performed using the keywords: "breast feeding", "bottle feeding", "depression", "pregnancy", and "postpartum". Two investigators independently evaluated the titles and abstracts in a first stage and the full-text in a second stage review. Papers not addressing the association among breastfeeding and pregnancy or postpartum depression, non-original research and research focused on the effect of anti-depressants were excluded. 48 studies were selected and included. Data were independently extracted.Pregnancy depression predicts a shorter breastfeeding duration, but not breastfeeding intention or initiation. Breastfeeding duration is associated with postpartum depression in almost all studies. Postpartum depression predicts and is predicted by breastfeeding cessation in several studies. Pregnancy and postpartum depression are associated with shorter breastfeeding duration. Breastfeeding may mediate the association between pregnancy and postpartum depression. Pregnancy depression predicts shorter breastfeeding duration and that may increase depressive symptoms during postpartum.The selected keywords may have led to the exclusion of relevant references.Although strong empirical evidence regarding the associations among breastfeeding and pregnancy or postpartum depression was separately provided, further research, such as prospective studies, is needed to clarify the association among these three variables. Help for depressed pregnant women should be delivered to enhance both breastfeeding and postpartum psychological adjustment.
- Risk factors for treatment resistance in unipolar depression: A systematic review. [REVIEW]
- J Affect Disord 2014 Oct 8.:137-141.
Treatment resistant depression is a complex disorder and an important source of morbidity and mortality. Identification of risk factors of resistance may be useful to improve early recognition as well as treatment selection and prediction of outcome in patients with depression.The aim of this paper was to review the current status of knowledge regarding risk factors of treatment resistance in unipolar depression, in patients who failed to respond to at least two successive and adequate antidepressant treatments.Systematic literature search yielded 8 publications exploring clinical and biological factors. Specific psychiatric comorbidities, psychosocial factors, clinical characteristics of the depressive episode and biological markers emerge as possible risk factor for treatment resistant depression.Due to the lack of objective definition and diagnostic criteria for treatment resistant depression, and the paucity of reports on risk factors, our review only summarized a small number of studies.Future investigations of risk factors should help to improve the understanding of the mechanisms underlying resistance in mood disorders and contribute to improve their therapeutic management.
- Is maternal smoking during pregnancy associated with bipolar disorder in offspring? [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 28.:132-136.
Prenatal smoking exposure affects fetal growth and development and is associated with increased risk of various neurodevelopmental disorders. Only one previous study has examined the association between maternal smoking during pregnancy and the risk of bipolar disorder (BPD).In this nested case control study derived from all singleton live births in Finland between January 1st 1987 and December 31st 1998, we identified 724 children diagnosed and/or treated with BPD until 2008 and 1419 matched controls from four nationwide registers. Conditional logistic regression was used to examine the association between maternal smoking during pregnancy and BPD adjusting for potential confounding due to parental psychiatric history, maternal age and education level.18.5% of offspring were exposed to maternal smoking during pregnancy. In the unadjusted analysis, smoking during pregnancy was associated with a 1.41-fold (95% CI 1.12-1.79, P=0.004) increased risk of BPD. In the final model adjusting for potential covariates, the risk was 1.14-fold (95% CI 0.88-1.49, P=0.323).The limitations of this study include: hospital based clinical diagnosis for case ascertainment, inclusion of early onset BPD cases, and lack of information on alcohol or other substance abuse during pregnancy.This study demonstrated that, in this sample, an increased risk of BPD among offspring of mothers who smoked during pregnancy is most likely due to confounding by familial background factors. Future studies including information on serological measures of smoking exposure in pregnancy e.g. cotinine are warranted to further clarify this association.
- Hypoesthesia of the malleolus as a soft sign in depression. [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 30.:128-131.
Physical signs often are present in many psychiatric conditions, making up a fundamental part of them and accompanying the psychiatric manifestations themselves. Identifying minor neurological signs is especially of interest due to they are easily accessible through simple neurological examination and could be a useful if underused tool for the diagnostic process and patient therapy.A group of depressed patients (n=85) and group of healthy individuals (n=101) that served as control were examined using the Wartenberg wheel, a medical device for neurological use, in order to determine the presence of hypoesthesia on both sides of their ankles.The data revealed: i) patients with depression are generally more likely to present malleolar hypoesthesia than healthy participants; and ii) participants who presented malleolar hypoesthesia presented greater depressive symptomatology as well as greater anxiety symptomatology at the time of assessment.Although all patients in this study were taking psychotropic medication, anxiolytics and antidepressants are not associated with skin sensitivity. As is usual, the categorization of hypoesthesia is based on participant subjectivity. However, this subjectivity cannot explain the differences between depressed patients and healthy individuals.The present findings corroborate that localized tactile sensitivity is altered in depression and correlates with anxiety-depressive symptomatology, even on a subclinical level. The observation of neurological soft signs such as the detection of malleolar hypoesthesia in patients with depressive symptomatology is easily accessible using a simple neurological examination, and it could became a powerful tool that could provide objective information on affective disorders.
- Inter-informant agreement and prevalence estimates for mood syndromes: Direct interview vs. family history method. [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 18.:120-127.
The use of the family history method is recommended in family studies as a type of proxy interview of non-participating relatives. However, using different sources of information can result in bias as direct interviews may provide a higher likelihood of assigning diagnoses than family history reports. The aims of the present study were to: 1) compare diagnoses for threshold and subthreshold mood syndromes from interviews to those relying on information from relatives; 2) test the appropriateness of lowering the diagnostic threshold and combining multiple reports from the family history method to obtain comparable prevalence estimates to the interviews; 3) identify factors that influence the likelihood of agreement and reporting of disorders by informants.Within a family study, 1621 informant-index subject pairs were identified. DSM-5 diagnoses from direct interviews of index subjects were compared to those derived from family history information provided by their first-degree relatives.1) Inter-informant agreement was acceptable for Mania, but low for all other mood syndromes. 2) Except for Mania and subthreshold depression, the family history method provided significantly lower prevalence estimates. The gap improved for all other syndromes after lowering the threshold of the family history method. 3) Individuals who had a history of depression themselves were more likely to report depression in their relatives.Low proportion of affected individuals for manic syndromes and lack of independence of data.The higher likelihood of reporting disorders by affected informants entails the risk of overestimation of the size of familial aggregation of depression.
- Clustering of health risk behaviours and the relationship with mental disorders. [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 28.:111-119.
Health risk behaviours tend to co-occur and are found to be related to mental health symptoms. This is the first study to identify health behaviour clusters in relation to mental disorders.Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a nationally representative sample of adults (n=5303). Latent class analysis was performed to identify clusters based on four health risk behaviours (smoking, heavy drinking, physical inactivity, and unhealthy diet). Concurrently, we examined the relationship between the identified clusters and a range of DSM-IV diagnoses, assessed with the Composite International Diagnostic Interview 3.0.Four distinct health behaviour clusters were identified: most healthy (mainly non-smokers, moderate drinkers, active, healthy diet; class 1: 79.3%); smokers, moderate drinkers, inactive, unhealthy diet (class 2: 13.2%); smokers, heavy episodic drinkers, active, unhealthy diet (class 3: 3.8%); Smokers, frequent heavy drinkers, active, low fruit (class 4: 3.6%). Despite their different lifestyles, individuals in all three unhealthy clusters had double the risk of depression. Unhealthy behaviour clusters were strongly associated with drug dependence (classes 2 and 3), alcohol abuse and dependence (classes 3 and 4), and social phobia (class 4).Due to the cross-sectional design, no conclusions about the causality of the relationship between HRB clusters and mental disorders can be drawn from the current study.Health behaviour clusters are strongly associated with mental disorders. This co-existence of behaviours and disorders emphasises the importance of an integrative approach in the prevention of mental illnesses.
- Subjective memory and concentration deficits in medication-free, non-elderly Asians with major depressive disorder: Prevalence and their correlates. [JOURNAL ARTICLE]
- J Affect Disord 2014 Sep 16.:105-110.
Subjective cognitive impairment (SCI) in major depressive disorder (MDD) is prevalent and correlated with disability. This study aimed to examine the prevalence rates and correlates of subjective memory deficit (SMD) and subjective concentration deficit (SCD) in medication-free, non-elderly Asians with MDD.The SMD and SCD were assessed by using two items of the Symptom Checklist-90-Revised (SCL-90-R). Other measurements of interest included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the Sheehan Disability Scale (SDS), and the Short Form Health Survey (SF-36). Adjusted odds ratios with 95% confidence intervals were calculated.Of 515 participants from China, Korea, Malaysia, Singapore, Taiwan, and Thailand, 347 (67.4%) and 377 (73.2%) had SMD and SCD, respectively. In total, 420 participants (81.6%) had SMD alone, SCD alone, and both deficits. Severe depression and poor mental health were significant correlates of SMD. Severe depression, clinically significant disability, poor physical health, and poor mental health were significantly independent correlates of SCD. Compared with young adults (18-34 years), older adults aged 50-65 years had a significantly lower risk of SCD (OR=.33, 95% CI: .19-.57).Only two SCL-90-R items were used to assess the SMD and SCD. The exclusion of MDD patients treated with psychotropic medications eliminated many patients commonly seen in typical clinic settings.SMD and SCD are prevalent in medication-free, non-elderly Asians with MDD. Both deficits are correlated with depression and mental health status. The independent correlation between SCD and disability underscores the crucial role of SCI in MDD.