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PubMed2001

Changes in the regression slope correlating between urinary contents of alpha-1-microglobulin and ulinastatin and its relation to severity in mood disorders.

With mood disorders, clinical portrayals alone do not always reflect the exact state and progress of the disease. The present study attempted to evaluate whether changes in regression slope correlating between urinary contents of alpha-1-microglobulin and ulinastatin provided objective information on the severity of mood disorders, based on our previous findings that the regression slope was more steeply inclined in patients with mood disorders than in age-matched healthy subjects. As a result, a close association between scores of the Hamilton Rating Scale for Depression and the regression slopes was found: the more inclined the slope, the greater the severity of symptoms of depression. These results suggest that changes in the slope of the regression plot correlating between urinary contents of alpha 1 M and UT may afford a useful objective index when monitoring the state of patients with mood disorders.

Alpha-Globulins↗

PubMed2000

Neuroplasticity and cellular resilience in mood disorders.

Although mood disorders have traditionally been regarded as good prognosis diseases, a growing body of data suggests that the long-term outcome for many patients is often much less favorable than previously thought. Recent morphometric studies have been investigating potential structural brain changes in mood disorders, and there is now evidence from a variety of sources demonstrating significant reductions in regional CNS volume, as well as regional reductions in the numbers and/or sizes of glia and neurons. Furthermore, results from recent clinical and preclinical studies investigating the molecular and cellular targets of mood stabilizers and antidepressants suggest that a reconceptualization about the pathophysiology and optimal long-term treatment of recurrent mood disorders may be warranted. It is proposed that impairments of neuroplasticity and cellular resilience may underlie the pathophysiology of mood disorders, and further that optimal long-term treatment for these severe illnesses may only be achieved by the early and aggressive use of agents with neurotrophic/neuroprotective effects. It is noteworthy that lithium, valproate and antidepressants indirectly regulate a number of factors involved in cell survival pathways including CREB, BDNF, bcl-2 and MAP kinases, and may thus bring about some of their delayed long-term beneficial effects via underappreciated neurotrophic effects. The development of novel treatments which more directly target molecules involved in critical CNS cell survival and cell death pathways have the potential to enhance neuroplasticity and cellular resilience, and thereby modulate the long-term course and trajectory of these devastating illnesses.

Animals↗

PubMed1995

Clinical predictors of acute risperidone response in schizophrenia, schizoaffective disorder, and psychotic mood disorders.

BACKGROUND: In studies of patients with schizophrenia, the atypical antipsychotic risperidone has been shown to be comparable in efficacy to haloperidol and, at dosages of 4 to 8 mg/day, to have a lower rate of extrapyramidal side effects. However, little is known about the efficacy of risperidone in patients with schizophrenia refractory to treatment with typical antipsychotics, schizoaffective disorder, and psychotic mood disorders. The purpose of this study was to assess the efficacy of risperidone in the treatment of these disorders and to identify clinical factors associated with risperidone response. METHOD: By surveying treating clinicians and chart data, we assessed response to risperidone and factors associated with response to risperidone in 144 consecutive patients treated with the drug for at least 2 weeks at a regional state psychiatric hospital. RESULTS: Patients displaying a moderate-to-marked response to risperidone were more likely to be younger; receive diagnoses of bipolar disorder or schizoaffective disorder, depressive type; and have a shorter duration of illness and shorter length of stay prior to risperidone treatment. Response to risperidone was sufficient to allow discharge in 26% of patients with treatment-refractory schizophrenia hospitalized for at least 10 weeks prior to risperidone and in 11% of patients with treatment-refractory schizophrenia hospitalized for greater than 1 year. CONCLUSION: Risperidone may be a useful alternative or adjunctive treatment for patients with schizophrenia refractory to treatment with standard antipsychotic agents, schizoaffective disorder (especially the depressive type), and bipolar disorder when used in conjunction with mood stabilizers.

Adult↗

PubMed2004

Social disability of Brazilian mood disorder patients.

Mood disorders cause many social problems, often involving family relationships. Few studies are available in the literature comparing patients with bipolar, unipolar, dysthymic, and double depressive disorders concerning these aspects. In the present study, demographic and disease data were collected using a specifically prepared questionnaire. Social adjustment was assessed using the Disability Adjustment Scale and family relationships were evaluated using the Global Assessment of Relational Functioning Scale. One hundred patients under treatment for at least 6 months were evaluated at the Psychiatric Outpatient Clinic of the Botucatu School of Medicine, UNESP. Most patients were women (82%) more than 50 (49%) years old with at least two years of follow-up, with little schooling (62% had less than 4 years), and of low socioeconomic level. Logistic regression analysis showed that a diagnosis of unipolar disorder (P = 0.003, OR = 0.075, CI = 0.014-0.403) and dysthymia (P = 0.001, OR = 0.040, CI = 0.006-0.275) as well as family relationships (P = 0.002, OR = 0.953, CI = 0914-0.992) played a significant role in social adjustment. Unipolar and dysthymic patients presented better social adjustment than bipolar and double depressive patients (P < 0.001), results that were not due to social class. These patients, treated at a teaching hospital, may represent the severest mood disorder cases. Evaluations were made knowing the diagnosis of the patients, which might also have influenced some of the results. Social disabilities among mood disorder patients are very frequent and intensive.

Adult↗

PubMed1994

Challenges in conceptualizing psychotic mood disorders.

Psychotic mood disorders represent a complex group of syndromes in which depression and/or mania are accompanied by delusions, hallucinations, or both. The presence of psychotic features has a profound influence on the course and treatment response of mood disorders, and psychotic disorders in turn are influenced by coexisting dysregulation of mood. Psychosis and mood, along with other features such as severity, a high rate of recurrence, psychomotor changes, dissociation, and mental states reflecting a history of trauma, appear to interact to alter each other's expression. The treatment of psychotic mood disorders, regardless of coexisting conditions, requires pharmacotherapy--usually a combination of an antipsychotic drug and a medication for mood--or electroconvulsive therapy. The results of treatment are usually positive.

Affect↗

PubMed1984

Eating disorders: a variant of mood disorders?

Symptoms of mood disorders, particularly depression, are frequently associated with both anorexia nervosa and bulimia although the nature of this relationship is unclear. This article reviews the relevant studies in this area and examines evidence for two hypotheses regarding the relationship between mood disorders and eating disorders.

Anorexia Nervosa↗

PubMed2000

A family study of outpatients with borderline personality disorder and no history of mood disorder.

While several studies have examined psychiatric disorders in the relatives of individuals with borderline personality disorder, many of these studies have not employed a family study methodology and suffer from other methodological shortcomings. Thus, the conclusions from family data addressing the validity of borderline personality disorder, its relation to other conditions, and its distinction from mood disorders, continue to be debated. The present investigation employed a family study design with direct interviews with relatives, structured diagnostic interviews with both probands and relatives, and blind assessment of relatives. Rates of psychiatric disorders were examined in 563 relatives of outpatients with mood disorders (n = 119), 54 relatives of outpatients with borderline personality disorder and no history of mood disorder (n = 11), and 229 relatives of never psychiatrically ill controls (n = 45). Results indicate increased rates of mood disorders and personality disorders in the relatives of borderline probands compared with never psychiatrically ill controls. Familial aggregation of psychiatric disorders was generally similar for borderline personality and the mood disorder comparison group. The results suggest there may be common etiological factors between borderline personality disorder and mood disorders.

Adult↗

PubMed2005

Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: trouble at the borders.

Psychiatry has long struggled with the problem of how to understand the relationship between psychotic symptoms and mood symptoms. In the past, these debates were over conceptualizations of categories based on syndromal definitions of mental illnesses. Ample data now exists that provide insight into the biologic basis for syndromal distinctions. We examine the syndromes of mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features, reviewing their classification, clinical features, course, and treatment. We provide evidence that, clinically, mood disorders and schizophrenia do not separate neatly. We will also review data arising from studies in brain imaging, molecular neurobiology, and genetics. Evidence is accumulating that overlap across diagnostic boundaries for both pathologic and etiologic factors exist, along with disorder-specific factors. The nosology that will carve the reality of psychotic illness at the joints awaits further advances in genetics and neurobiology. Or, alternatively, carving out categories may turn out to be less useful for some purposes than considering dimensions.

Diagnosis, Differential↗

PubMed2001

A slow wave investigation of working memory biases in mood disorders.

Mood-congruent working memory biases were examined in a delayed matching to sample paradigm using the slow wave (SW) event-related brain potential (ERP) component. Mood-congruent working memory biases, indexed by SW amplitudes, were demonstrated among individuals experiencing a major depressive episode (MDE) and nondepressed controls but not individuals with dysthymia. However, analyses of symptom severity demonstrated that those with dysthymia exhibited significantly less negative SW amplitudes with increasing depressive mood severity, whereas individuals with major depression demonstrated more negative SW amplitudes with increasing depressive mood severity. These results are discussed in the context of diagnostic specificity for cognitive biases associated with working memory of mood-disordered individuals.

Adult↗

PubMed2002

Membrane Na(+)-K+ ATPase mediated cascade in bipolar mood disorder, major depressive disorder, and schizophrenia--relationship to hemispheric dominance.

The isoprenoid pathway produces digoxin, an endogenous membrane Na(+)-K+ ATPase inhibitor and regulator of neurotransmitter transport. The objective of the study was to relate digoxin status and hemispheric dominance to the pathogenesis of psychiatric disorders--bipolar mood disorder, major depressive disorder, and schizophrenia. The following parameters were assessed in bipolar mood disorder during the manic phase and depressive phase of the illness as well as in major depressive disorder, and schizophrenia: HMG CoA reductase activity, tryptophan and tyrosine catabolic patterns, red blood cell (RBC) Na(+)-K+ ATPase activity, and serum magnesium. These parameters were compared to individuals of differing hemispheric dominance. The levels of serum digoxin and HMG CoA reductase activity were found to be decreased in the depressive phase of bipolar mood disorder and major depressive disorder with a corresponding increase in RBC Na(+)-K+ ATPase activity and serum magnesium levels. There was increase in tyrosine and tyrosine catabolites, and a reduction in tryptophan and its catabolites, in the serum in the depressive phase of bipolar mood disorder and major depressive disorder. The neurotransmitter patterns and digoxin levels in the depressive phase of bipolar mood disorder/major depressive disorder correlated with those in right-handed/left hemisphere dominant individual. The neurotransmitter patterns and digoxin levels in the manic phase of bipolar mood disorder and schizophrenia correlated with those in left-handed/right hemisphere dominant individuals. Digoxin status and hemispheric dominance could correlate with the pathogenesis of psychiatric disorders--schizophrenia, major depressive disorder, and bipolar mood disorder.

Adult↗

PubMed2005

Heterogeneity of irritability in attention-deficit/hyperactivity disorder subjects with and without mood disorders.

BACKGROUND: We hypothesized that irritability is a heterogeneous symptom distinguished by severity and that attending to this heterogeneity would impact the relationship between irritability and bipolar disorder. METHODS: A total of 274 ADHD children were administered the Kiddie Schedule for Affective Disorders and Schizophrenia (Epidemiologic Version) structured diagnostic interview. Three measures of irritability were identified: oppositional defiant disorder (ODD)-type irritability, mad/cranky irritability, and super-angry/grouchy/cranky irritability. Subjects were stratified as having bipolar disorder (n = 30), unipolar depression (n = 100), and no history of depression or bipolar disorder (non-mood-disordered, n = 144). RESULTS: Oppositional defiant disorder-type irritability was very common in all ADHD subjects, was the least impairing, and did not increase the risk of mood disorder. Mad/cranky irritability was common in only ADHD children with a mood disorder, was more impairing than the ODD-type irritability, and was predictive of unipolar depression. Super-angry/grouchy/cranky irritability was common only in ADHD children with bipolar disorder, was the most impairing, and was predictive of both unipolar depression and bipolar disorder. Two percent of the subjects with ODD-type irritability only, 6% of subjects with mad/cranky irritability, and 46% of subjects with super-angry/grouchy/cranky irritability were diagnosed with bipolar disorder. CONCLUSIONS: These results challenge the conclusion that irritability is necessarily a poor diagnostic indicator of bipolar disorder in children.

Adolescent↗

PubMed2007

Mood disorders and migration: meta-analysis.

BACKGROUND: Migration is a risk factor for the development of schizophrenia. AIMS: To examine whether migration is also a risk factor for bipolar affective disorder, unipolar depressive disorder and mood disorders in general. METHOD: Medline was searched for population-based incidence studies concerning mood disorders among migrants and mean relative risks were computed using a mixed-effects statistical model. RESULTS: Only a few studies of unipolar depressive disorder were retrieved. The mean relative risk of developing bipolar affective disorder among migrants was 2.47 (95% CI 1.33-4.59). However, after excluding people of African-Caribbean origin in the UK this risk was no longer significantly increased. The mean relative risk of mood disorders of unspecified polarity was 1.25 (95% CI 1.04-1.49) and that of any mood disorder was 1.38 (95% CI 1.17-1.62). CONCLUSIONS: There is no conclusive evidence for a large increase in the risk of mood disorders associated with migration.

Anthropology, Cultural↗

PubMed2006

The validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Mood Disorders Section.

BACKGROUND: Mood disorders are one of the most prevalent psychiatric disorders that have early onset, are chronic and can cause functional impairment. It is therefore crucial to establish an accurate diagnosis for treatment and research purposes. OBJECTIVES: The authors aimed to test the validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Mood Disorders Section. MATERIAL AND METHOD: First, psychiatrists competent in the use of the schedules and their underlying objectives tests the linguistic clarity of the Thai psychiatric schedules in four regions of the country. Then between October 2003 and August 2004, Reliability of SCAN: mood disorder section was tested among 30 participants, including mood disordered patients and normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was established. The duration of interviews for the mood disorder sections averaged 63.6 min (SD = 17.1). The inter- and intra-rater reliability kappa were 0.80 (0.77-0.83) and 0.86 (0.84-0.88), respectively. The reliability of the majority of items reached substantial to almost perfect agreement; however, 1 item (1%) had only slight agreement and 15 items (12%) had moderate agreement, and needed clarification of the scoring method CONCLUSION: The Mood Disorders Sections of the WHO Neuropsychiatry Schedules for Clinical Assessment (SCAN Thai Version) were effective tools for diagnosing mood disorders among Thais.

Female↗

PubMed2006

Child comorbidity, maternal mood disorder, and perceptions of family functioning among bipolar youth.

OBJECTIVE: To examine the association between youth comorbid psychiatric disorders, maternal mood disorder, and perceptions of family cohesion and conflict among youth diagnosed with pediatric bipolar disorder (PBD). METHOD: Three hundred eighty-nine bipolar youths and their parents completed a diagnostic interview and instruments assessing family psychiatric history and functioning. Family functioning was assessed with the Family Adaptability and Cohesion Scales-II and the Conflict Behavior Questionnaire. RESULTS: The presence of a maternal mood disorder was associated with lower family cohesion. The presence of a youth externalizing disorder with or without a co-occurring anxiety disorder was also associated with lower family cohesion as well as higher family conflict. Furthermore, the negative relationship between maternal mood disorder and family functioning was stronger in the presence of a youth externalizing disorder. CONCLUSIONS: Youth comorbidity and maternal mood disorders appear to be associated with worse family functioning among bipolar youths. Family-based treatments with bipolar youths may need to integrate treatment of youth comorbidity and address maternal mood disorder for optimal results.

Adolescent↗

PubMed2000

Which temperamental characteristics are associated with substance use in subjects with psychotic and mood disorders?

The aim of this study was to assess the associations between substance use disorders and temperamental characteristics in subjects with non-affective psychotic disorders or mood disorders. Consecutively hospitalized patients were interviewed with a structured diagnostic interview to define DSM-IV diagnoses, including those of substance use. Temperamental characteristics were measured using the Sensation-Seeking Scale (SSS), the Barratt Impulsivity Scale (BIS) and the Physical Anhedonia Scale. Inpatients (n=103) with non-affective psychotic disorders (n=45) or mood disorders (n=58) were included. Among these patients, 25.2% presented with a lifetime (LT) history of alcohol abuse/dependence and 23.3% presented with a LT history of cannabis abuse/dependence. A LT history of alcohol misuse was independently associated with higher scores at the 'experience seeking' and 'disinhibition' subscales of the SSS. A LT history of cannabis misuse was independently associated with higher scores on the 'disinhibition' subscale of the SSS and on the 'non-planning activity' subscale of the BIS. These results suggest that sensation-seeking and impulsivity are temperamental characteristics that may favor substance use in patients with psychotic or mood disorders, independently from categorical diagnoses.

Adolescent↗

PubMed2000

Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders. A study of women with random sample population controls.

BACKGROUND: We compared ICD-10 psychiatric disorders in female patients with fibromyalgia (n=45) or functional dyspepsia (n=18) with age-matched random sample controls (n=49). METHOD: Version 2 of The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used for present state examination and lifetime diagnoses. RESULTS: Current psychiatric disorders (somatoform pain disorder and specific phobia omitted) were diagnosed in 80% of fibromyalgia patients (OR=8.3), 83% of functional dyspepsia patients (OR=10.3) and 33% controls. Among fibromyalgia patients 27% had lifetime panic disorder. Lifetime mood disorders were found in 83% of functional dyspepsia patients. First-degree relatives with psychiatric disorder were found in 16% of the fibromyalgia patients, 50% of functional dyspepsia patients and 20% of controls. CONCLUSIONS: Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders in substantial subgroups. Psychiatric symptoms and somatic complaints are closely related in these disorders.

Adolescent↗

PubMed2002

Brain development and the onset of mood disorders.

Research in mood disorder pathophysiology has stimulated considerable interest in clinical and biologic aspects of mood disorders among children and adolescents. From the clinical perspective, developmental aspects of psychiatric disorders have crystallized in the relatively new theoretical school known as developmental psychopathology. This school attempts to understand the nature of developmental changes in behavior, with the goal of differentiating normal from abnormal stage-related behavior. This perspective has exerted major impact on conceptualizations of psychiatric disorders. From the basic science perspective, biologic findings in emotion have stimulated an integration of basic and clinical approaches to mood disorders. The term emotion is often used to refer to brain states elicited by stimuli for which an organism will extend effort to obtain (rewards) or avoid (punishments). Imaging studies suggest that brain regions engaged by rewarding and punishing stimuli in lower mammals are also implicated in mood disorders. Other studies suggest that environmental factors exert profound effects on the development of these brain regions. The impact of 4 areas of research on our understanding of depression pathophysiology is reviewed: (1) mood disorder onset, (2) structural magnetic resonance imaging (MRI), (3) behavioral or cognitive correlates of major depression, and (4) functional MRI of brain regions engaged across development. This is a US government work. There are no restrictions on its use.

Adolescent↗

PubMed1997

Postpartum mood disorders: clinical perspectives.

Mood disorders are common in women. A prepregnancy personal history of mood disorder (bipolar or major depression), premenstrual syndrome, or (possibly) postpartum blues places a woman at high risk for a postpartum exacerbation of symptoms. Untreated or unrecognized postpartum mood disorders can lead to serious psychologic and social consequences, in some cases even leading to suicide or infanticide. Women at risk for postpartum mood disorders need to be referred for psychiatric consultation before pregnancy and parturition. Informed, professional collaboration offers the best opportunities for prevention, as well as the earliest recognition and treatment of emergent symptoms.

Affective Disorders, Psychotic↗