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PubMed1995

[Children of parents with mood disorders].

In recent years, child and adolescent psychiatry has recognized a high prevalence rate of mental disorders in affective disorders' offsprings. These can vary in their nature and severity. What is important is to bare in mind this risk condition. Many times prevention is possible, or early treatment is available. In an investigation that is actually being carried out in the Department of Psychiatry, University of Chile, that searches for understanding factors that severely deviate child and adolescent development, we found it is not unusual for the parents of the proband group to have affective disorders. In order to illustrate the discussion we describe three clinical histories.

Adult↗

PubMed2002

Cell pathology in mood disorders.

In new, exciting, neuroanatomic studies on postmortem tissues from patients with mood disorders, quantitative cytomorphologic differences can be shown at the microscopic level. These investigations provide direct evidence that mood disorders are characterized by marked reductions in glial cell number and density in addition to subtle alterations in the density and size of cortical neurons in frontolimbic brain regions. Importantly, this corresponds with clinical neuroimaging studies and preclinical animal studies that suggest cell atrophy, cell loss, or impairments in neuroplasticity and cellular resilience may underlie the neurobiology of major depressive disorder and bipolar manic-depressive disorder. Because this represents a departure from modern efforts to understand mood disorders, published reports are scarce and based on rather small sample sizes. This article reviews the current findings from postmortem studies on glial and neuronal cell counts in primary mood disorders and discusses a possible link between cellular changes and the action of psychotherapeutic drugs.

Brain↗

PubMed2000

Serotonin-2C and serotonin-1A receptor genes are not associated with psychotic symptomatology of mood disorders.

The serotonergic system is involved in both pathophysiology and treatment of mood disorders. In the present study we investigated the possible influence of the polymorphisms of the serotonin-1A and 2C receptor genes on the symptomatology of mood disorders. Eighty-four inpatients affected by mood disorders (72 bipolar and 12 major depressive disorder) were assessed by the Operational Criteria Checklist for Psychotic Illness to score their lifetime psychotic symptomatology. The subjects were also typed for 5HT1A and 5HT2C variants using polymerase chain reaction techniques. No association was found between 5HT2C and psychopathology as defined by the four symptomatologic factors used as phenotype definition (mania, depression, delusion, and disorganization) even when bipolar subjects were analyzed separately. Only one subject with the 5HT1A variant was observed. Genetic variation at the 5HT1A and 5HT2C receptor genes does not, therefore, play a major role in the pathogenesis of mood disorders symptomatology. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:161-166, 2000.

Adult↗

PubMed2000

Evaluation of expressed emotion (EE) status in mood disorders in japan: inter-rater reliability and characteristics of EE.

The reliability of expressed emotion (EE) ratings by the Camberwell Family Interview (CFI) and characteristics of EE were evaluated in families of patients with mood disorders in Japan. The subjects were 27 patients with mood disorders and 31 members of their families. The CFI was carried out with the family members. EE was rated by two raters independently, and the inter-rater reliability was evaluated according to Spearman's correlation coefficient by ranks and the kappa-value. The distribution of subscales of EE in these subjects was compared with that in families of patients with schizophrenia in Japan and families of patients with mood disorders abroad. Concerning critical comments (CC), hostility (H), and emotional over-involvement (EOI), which are important for EE rating, Spearman's correlation coefficient and the kappa-values were 0.4-0.8, and the reliability of EE ratings in mood disorders was not high. The proportion of positive agreement was particularly low in H and EOI. CCs were fewer in families of Japanese patients with mood disorders than in those with schizophrenia or families of American or European patients with mood disorders. Re-evaluation of the inter-rater reliability of EE ratings in mood disorders is needed. Expressed emotion was more suppressed in families of patients with mood disorders than in those of patients with schizophrenia. Expressed emotion was also more reserved in the Japanese subjects than in their Western counterparts.

Adult↗

PubMed2002

Volumetric MRI studies of mood disorders: do they distinguish unipolar and bipolar disorder?

The authors reviewed magnetic resonance imaging volumetric imaging results in major mood disorders, particularly comparing similarities and differences from studies of bipolar disorder and unipolar major depression. Abnormalities of cerebral brain regions appear inconsistently in mood disorders and, when present, typically consist of decreased frontal or prefrontal cortical volumes in both unipolar depression and bipolar disorder. In contrast, subcortical and medial temporal abnormalities are more commonly observed and are different between these two major classes of affective illness. Specifically, whereas structural enlargement of the basal ganglia and amygdala have been observed in bipolar disorder, in unipolar depression, these structures appear to be smaller in patients than healthy subjects. These findings suggest that affective illnesses may share in common an underdeveloped or atrophied prefrontal region, leading to loss of cortical modulation of limbic emotional networks. The effect of this loss results in unipolar depression or cycling (mania with depression) depending on the abnormalities of the subcortical structures involved. The cerebellum may also play a role in the presentation of mood disorders. This hypothesis remains speculative as much more research is needed to specifically examine how morphometric brain abnormalities translate into the neurophysiologic deficits that produce mood disorders.

Bipolar Disorder↗

PubMed2000

Melancholic features and response to lithium prophylaxis in mood disorders.

Clinical predictors of the efficacy of lithium prophylaxis in mood disorders have great potential value. Melancholic features during depressive phases have been both proposed and rejected as valid predictors of favorable outcome. The aim of the present study is to describe the validity of melancholic features during depressive phases as predictors of the prophylactic efficacy of lithium. Sixty-one subjects affected by bipolar (n = 51) and major depressive (n = 10) disorder were followed prospectively for an average of 53 months. All subjects were evaluated as a lifetime perspective at intake, by the Operational Criteria checklist for psychotic illness (OPCRIT). Melancholic features were correlated with outcome only when controlling for time of first lithium administration. These two variables accounted for more than 30% of the total variance in lithium response. Others clinical factors such as polarity, delusions, gender, onset, personality disorders, and family history of mood disorders did not influence the observed association. Our preliminary findings suggest that melancholic features may be associated with favorable lithium prophylactic outcome in mood disorders.

Adult↗

PubMed2006

Catechol-O-methyltransferase gene variants in mood disorders in the Italian population.

Dysfunctions of dopaminergic transmission have been implicated in the pathogenesis of mood disorders and variants at the catechol-O-methyltransferase (COMT) gene have been recently reported to be associated with bipolar disorder. In this study, we tried to replicate this finding in an independent sample of participants affected by mood disorders. Eight hundred and five psychiatric in-patients affected by bipolar (n=446) and major depressive (n=359) disorder were included. All patients and 116 controls were typed for the COMT variants using polymerase chain reaction techniques. A subsample of 458 patients was assessed for their lifetime symptomatology. The sample was analyzed alone and pooled with 111 participants and 127 controls collected in the center of Pisa and previously reported. COMT variants were not associated with mood disorders in our sample, a trend was observed toward an excess of COMT*A allele in the pooled sample. The analysis of symptomatology factors did not show any significant difference as well. Possible stratification factors such as sex, current age and age of onset did not affect the observed results. Control subjects from the two centers showed a similar genotype distribution. In conclusion, COMT variants were not a major liability factor for mood disorder and for mood disorder symptomatology in the present sample; however, we could not subdivide our sample on the basis of panic comorbidity as in the original paper and this could be considered a possible reason for the discrepant finding.

Case-Control Studies↗

PubMed1998

Tyrosine hydroxylase gene in linkage disequilibrium with mood disorders.

We studied tyrosine hydroxylase (TH) gene variants in mood disorders using linkage disequilibrium techniques. One hundred and forty-five inpatients affected by bipolar (n = 88) and unipolar (n = 57) disorders, and 84 healthy controls, were typed for TH variants using polymerase chain reaction (PCR) amplification. TH was associated with mood disorder, with all affected subjects presenting an excess of TH*2 allele (chi 2 = 8.30, d.f. = 1; P = 0.004) and lack of the TH*1 allele (chi 2 = 6.90, d.f. = 1, P = 0.009). Linkage disequilibrium analyses confirmed the association. Our results suggest a moderate linkage disequilibrium of TH variants with mood disorders.

Adult↗

PubMed2001

Suicide in mood disorders.

A selective literature review was conducted to determine the link between mood disorders and suicide in children and adolescents. On-line searches of Medline and PubMed were performed and research articles from 1978 to 2001 were reviewed. Mood disorders are reported to be the most common psychiatric illnesses in children and adolescents who attempt or commit suicide. Reports suggest that depression co-morbid with any other psychiatric illness, externalizing disorders, or substance abuse further increases the risk for suicide completion. Mood disorders in children and adolescents are frequently underdiagnosed, misdiagnosed, and undertreated. Data suggest that very early identification combined with aggressive and sustained treatment of mood disorders in youth may actually lessen the risk for suicide.

Adolescent↗

PubMed2003

Risk factors and outcome of mood disorders in epilepsy: a case-control study.

BACKGROUND: This case-control study investigated both the risk factors and outcome of mood disorders in epilepsy. METHODS: For this study, 44 patients with both epilepsy and a mood disorder (study group) were compared with 44 randomly selected patients of epilepsy without a mood disorder (control group). Psychiatric diagnosis was made as per ICD-10 Diagnostic Criteria for Research (ICD-10 DCR). International classification for seizure types (1981) was used for classification of seizure types. RESULTS: Of the patients in the study group, a majority were educated up to at least primary level, had later onset of seizures, longer duration of epilepsy and cluster attacks. The outcome of mood disorders in epilepsy was found good in most. CONCLUSIONS: Educated patients who develop epilepsy at a later age and patients with poorly controlled epilepsy are more likely to experience mood disorders. In most patients with epilepsy, mood disorders remit completely; notably, in some patients affective symptoms resolve spontaneously.

Adolescent↗

PubMed1995

Attempted suicide predicts suicide risk in mood disorders.

Suicide risk was studied in a sample of 346 mood disorder inpatients, 92 of whom were admitted after a current suicide attempt. The overall suicide mortality after a mean observation period of 6 years was 8%. The potential of attempted suicide to predict suicide risk in hospitalized patients with mood disorders was studied by survival analysis after subgrouping on the basis of whether a current suicide attempt had occurred or not. The suicide risk the first year after attempting suicide was 12% (11/92), compared with 2% (4/254) in the mood disorder subgroup with no current suicide attempt. The long-range suicide risk after a current suicide attempt in depression was 15% (14/92) as compared with 5% (13/254) among those without a current suicide attempt. It is concluded that a current suicide attempt in mood disorder inpatients predicts suicide risk particularly within the first year and should be taken very seriously.

Adult↗

PubMed2004

Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China.

This study evaluated the characteristics of suicidal behavior (suicide attempt or suicidal ideation) among 230 consecutively admitted inpatients with schizophrenia and mood disorders in a university hospital in China. The rate of lifetime suicidal behavior was found to be significantly higher in patients with mood disorders (62.4%) than in patients with schizophrenia (38.6%). The rate of suicidal behavior was significantly higher in patients with major depressive disorder (86.8%) than those with bipolar disorders (42.6%). Patients with schizophrenia attempted suicide for the first time earlier in life than the patients with mood disorders. Mood disorder patients, especially those with major depressive disorder, had more and more serious suicide attempts than the patients with schizophrenia.

Adolescent↗

PubMed2005

Managing mood disorders and comorbid personality disorders.

PURPOSE OF REVIEW: To examine the influence of personality disorder comorbidity on the general treatment of mood disorders. RECENT FINDINGS: Personality disorders generally have a negative influence on outcome of mood disorders, both unipolar and bipolar. When the personality features are addressed, however, the outcome is less negative. Recent studies suggest a special role for psychological and educational therapies in the treatment of these comorbid disorders. SUMMARY: The assessment of, and attention to, the management of personality disorder as well as concurrent mood disorder may improve outcome.

Journal Article↗

PubMed2006

Relationship between parental bonding and mood disorder in six European countries.

The linkage between adverse parental child-rearing styles and the occurrence of mood disorders in adulthood has been investigated in a number of studies from different countries and cultural backgrounds. However, as direct cross-cultural comparisons hardly exist, little is known about cultural variations of this relationship. The European Study of the Epidemiology of Mental Disorders (ESEMeD) is a cross-sectional study in a stratified multi-stage random sample of 21,425 adults (18 years or older) from the general population of six European countries (Belgium, France, Germany, Italy, Netherlands, and Spain). Parental child-rearing styles were measured by means of a short form of the Parental Bonding Instrument (PBI) in 8,232 of the respondents. Based on the extraction and confirmation of a three-factor model of the PBI in a previous study, the association between parental bonding and mood disorders was studied by computing hierarchical nested multiple logistic regression models. The relationship between parental child-rearing styles and mood disorders was mostly homogeneous across the six countries. The PBI dimensions maternal and paternal care had the strongest associations with mood disorders. A significant association of overprotection was observable only for the mother. There was no significant relationship between authoritarianism and the occurrence of mood disorders. In the European countries studied, the association between parental child-rearing styles and the occurrence of mood disorders appears not to be culture-dependent. It would be of interest to assess whether this also holds for the rest of Europe and non-European countries.

Adolescent↗

PubMed2003

Differential effects of antipsychotic agents on the risk of development of type 2 diabetes mellitus in patients with mood disorders.

BACKGROUND: Atypical antipsychotics are being used increasingly in the management of mood disorders. OBJECTIVE: The objective of this study was to investigate the association between exposure to antipsychotic therapy and newly reported type 2 diabetes mellitus in patients with mood disorders. METHODS: Claims data for the period January 1996 through December 1997 were analyzed for patients with mood disorders in 2 large US health plans. Logistic regression models were used to determine the odds of reporting diabetes in patients exposed to risperidone, olanzapine, or high- or low-potency conventional antipsychotics compared with untreated patients, taking into account duration of treatment and dosage. Some of the covariates used in the models were concurrent use of antipsychotics, use of other psychotropic drugs, age, sex, and length of observation. RESULTS: Based on the claims data, 849 patients were exposed to risperidone, 656 to olanzapine, 785 to high-potency conventional antipsychotics, and 302 to low-potency conventional antipsychotics; 2644 patients were untreated. The odds of newly reported type 2 diabetes in patients who received risperidone were not significantly different from those in untreated patients (12-month odds ratio [OR] = 1.024; 95% CI, 0.351-3.015). The odds in patients treated with high-potency conventional antipsychotics also did not differ significantly from those of untreated patients (12-month OR = 1.945; 95% CI, 0.794-4.786). Unlike patients who received risperidone or high-potency conventional antipsychotics, patients who received olanzapine (12-month OR = 4.289; 95% CI, 2.102-8.827) and low-potency conventional antipsychotics (12-month OR = 4.972; 95% CI, 1.967-12.612) had significantly higher odds for the development of type 2 diabetes compared with untreated patients. CONCLUSIONS: These findings suggest that some antipsychotics may increase the risk for the development of type 2 diabetes in patients with mood disorders and that the effect may vary by drug. In contrast to olanzapine and low-potency conventional antipsychotics, risperidone and high-potency conventional antipsychotics were not associated with an increased risk for development of type 2 diabetes in this patient population.

Adult↗

PubMed1996

Mood Disorders in Neurodegenerative Diseases.

Mood disorders constitute a significant clinical problem in patients with a wide range of neurodegenerative disorders. This article reviews recent empirical studies examining depression, anxiety, and mania/disinhibition in patients with focal lesions (stroke), primary subcortical degeneration (Parkinson's disease), and primary cortical degeneration (Alzheimer's disease). Although each neuropsychiatric condition has unique clinical correlates, several common themes can be identified and include similarities in prevalence, neuroanatomic substrate, neurochemistry, and treatment response. Depression, for example, is associated with frontal lobe (primarily left hemisphere) dysfunction in stroke, Parkinson's disease, and Alzheimer's disease, whereas mania and dishinhibition are associated with dysfunction of ventral frontal and ventral temporal structures in both stroke and Alzheimer's disease. These similarities across distinctly different neuropathological conditions can provide important validation of fundamental neuroanatomical, as well as possible psychosocial pathways for the development of mood syndromes in neurological disease. The study of neuropsychiatric syndromes represents an important but relatively understudied area of research, that may ultimately help to illuminate the causes and specific treatments of these important clinical disorders.

Journal Article↗

PubMed2000

Divalproex sodium in substance abusers with mood disorder.

BACKGROUND: Substance abuse is a common comorbid illness in patients with mood disorders. Little has been written about the pharmacologic treatment of patients with affective lability and co-occurring substance abuse, however. The following report will describe clinical experience using divalproex sodium in substance-abusing patients with mood disorder. METHOD: Twenty patients admitted to an intermediate-care inpatient substance abuse program were diagnosed with comorbid mood disorder (according to DSM-IV criteria) and treated with divalproex sodium in an open-label, naturalistic trial with no blind. All patients were followed clinically and were assessed using the Clinical Global Impressions scale (CGI) and laboratory studies. RESULTS: Seven patients referred while on divalproex treatment continued to exhibit improved mood. Eleven others had at least 1 week of follow-up, and 10 of these also showed improvement. In 13 cases, divalproex was used safely with other psychiatric medications. Two patients complained of slight tremor, 1 of whom was also taking fluoxetine. Fifteen of 17 patients in whom biochemistry and hematology laboratory studies were completed had unremarkable results; 2 other patients had pretreatment abnormalities, which worsened over the course of treatment. Mean plasma valproate level was 58.53 microg/mL. Mean length of follow-up was 38 days. Mean period of abstinence prior to starting medication was 48 days. Some patients reported decreased cravings, and, by self-report, all patients remained abstinent. CONCLUSION: This report suggests that divalproex sodium is efficacious and safe, both alone and in combination with other psychiatric medications, in treating substance-abusing patients with mood disorder.

Adult↗

PubMed2004

[Mood disorders, psychopharmacology and thyroid hormones].

For more than 40 years thyroid hormones and mood disorders have been associated. Some psychiatric symptoms are produced by thyroid illnesses and there is a frequent association of thyroid dysfunction with mood disorders. Therefore, routine thyroid function assessment in patients with mood disorders and the treatment of sub-clinical thyroid dysfunctions is recommended. The usefulness of adding thyroid hormones to antidepressive treatment in euthyroid patients to obtain a potentiation effect has been probed repeatedly. The most common strategy is potentiation with T3, but high doses of T4 have been also used in patients with resistant depression. Thyroid hormones exert their action in the central nervous system through a variety of mechanisms: modulation of gene expression of several groups of proteins, some of them with known physiopathological implications in mood disorders and the influence over serotonin and noradrenergic neurotransmission, known to be one of the modes of action of antidepressants. Finally, it is also important to stress the complex relationship between psychiatric drugs, deiodinases and thyroid hormones, that can potentially help to understand the mechanisms of action of these drugs.

Central Nervous System↗