Sex differences in affective disorder: genetic transmission

Epidemiological studies have consistently found women to be at greater risk than men for affective disorders. This sex effect may help clarify genetic transmission and heterogeneity. Data from eight family studies of unipolar and eight family studies of bipolar probands were used to calculate family resemblance sex ratios. These observed sex ratios were then compared to sex ratios predicted by X-linked and nonfamilial effects models. Maximum likelihood estimation of competing models revealed that X linkage was not a good fit to the unipolar data. The bipolar studies were not consistent with either the X-linked or the nonfamilial effects model.     

Familial correlates of risk: application to the Gershon and Goldin NIMH pedigree data

Survival analysis of familial covariates of risk for affective illness demonstrated a significant effect on the proband's diagnosis when affection status included bipolar illness, but not major depressive disorder. A cohort effect was indicated only when broad spectra (including bipolar II and major depressive disorder) of illness were defined. Multifactorial analyses of familial correlations for affective illness evidenced neither sex-specific correlations nor prevalences. We suggest the examination of risk variables prior to undertaking familial analysis.     

Analysis of the Toronto-Rochester Depression Study follow-up data confirms an HLA-region gene contribution to susceptibility to affective disorder

Analysis of HLA haplotype distributions in relation to major affective disorder in affected sibling pairs and affected aunt or uncle and niece or nephew pairs confirmed that HLA-region genes do contribute to susceptibility to affective disorder. The data indicated that this effect may be greater in unipolar than in bipolar disorder, and more apparent in families with few affected members than in heavily loaded families. Nonrandom assortment of HLA haplotypes to affected and unaffected offspring in "low load" families occurred principally for the haplotype transmitted from the side of the family without affective disorder. We conclude that HLA-region genes contribute to but are not the only factor in susceptibility to major depression.     

Bipolar disorder differences between genders: special considerations for women

The objective of this article is to review clinical differences between men and women with bipolar disorder. The secondary objective is to analyze the differences in adherence to medication between genders. Men usually present with manic episodes and have comorbid drug abuse, while women usually present with major depressive episode, the onset is often later, comorbidity of physical pathology is common and adherence to medication is greater than in men. In women who have an earlier onset of the illness and are single, the risk of nonadherence is higher than in other groups of women. There are two time periods that are very important in women: pregnancy and postpartum. Both are critical periods and a relapse or recurrence of symptoms at either stage can have serious consequences for the woman and/or her baby. In addition, the effect of medication on the fetus is unclear. In conclusion, there is a clear need for more studies on gender differences in bipolar disorder and how to improve adherence to treatment. Moreover, a better understanding of how to treat women with bipolar disorder during pregnancy and lactation will undoubtedly lead to improved outcomes for both the mother and her child.     

Bipolar illness in primary care: an overview

Primary care providers are in the front line of detecting and diagnosing psychiatric illness. Managed care barriers to direct psychiatric treatment have made it necessary for primary care providers to increase their sophistication in the recognition of psychiatric disorders. Primary care providers often formulate provisional diagnoses and initiate treatment or specialty referral in spite of the time constraints of the primary care setting. The patient presenting in primary care with an affective disturbance must be evaluated for a major mood disorder, which includes unipolar and bipolar illness. Research has shown that more patients than previously estimated have milder forms of bipolar illness disorder, such as bipolar type II and cyclothymia. Patients with these milder forms of bipolar are less likely to present for treatment in a psychiatric setting and more likely to share symptoms of the illness in a primary care setting. This article provides an overview for the primary care provider in the detection, assessment, and treatment of bipolar patients with an emphasis on the differentiation of unipolar and bipolar depression.     

Somatotyping of schizophrenic and affective disorder patients

INTRODUCTION: Constitutional traits have been found to show a distinct relevance to major psychiatric disorders. Syndromal modified expressivity is also closely related to somatotypic constitution. In this view somatotyping appears valuable in diagnosis and prognosis of mental disorders. AIM: The present study was conducted in an attempt to outline somatotypic characteristics of schizophrenia and affective disorders with the aim of providing a logical basis for diagnosis of these major psychiatric disorders. MATERIAL AND METHODS: The somatotype of 54 schizophrenic and 68 affective disorder inpatients who fulfil the DSM-IV criteria for schizophrenia (subjects with schizophreniform, schizoaffective, schizoid and schizotypal personality disorders were excluded from the sample) and affective disorder (bipolar and unipolar) was assessed using the Health-Carter anthropometric method. RESULTS: The overall assessment of the somatotypes determined both groups as endomorphs mesomorphs with somatotype components 4.50-4.44-1.90 for schizophrenic patients and 5.87-5.40-0.36 for affective disorder patients. The difference between the two groups was statistically significant for any of the somatotype components. CONCLUSION: It is suggested that the constitutional and somatotypic characterization appears reasonable element in the multifactorial analysis of diagnostic decisions in these major psychiatric disorders.     

Risk of recurrence of occupational back pain over three year follow up.

A random sample including 2342 cases representative of all occupational back injuries in Quebec (1981) was followed up prospectively over three years to assess the recurrence rate of back problems (lumbar, thoracic, and cervical). Each medical and accident report was reviewed to obtain the site of symptoms and occupation. Age, sex, industrial sector, and number of episodes of absence from work were abstracted from the computerised Quebec Compensation Board files. The recurrence rate was 20.0% at one year follow up and 36.3% at three years. A multivariate analysis using a Poisson regression, was performed to model the risk of recurrence over time. Men had a higher chance of recurrence (risk ratio = 1.85, 95% CI = 1.50-2.27) but among recurrent cases, the average total number of episodes was comparable between men and women. Age showed a protective effect on the probability of recurrence (10 years: RR = 0.93, 95% CI = 0.88-0.98) due to the lower recurrence rate in the 45-64 year old group (31.8%). Cervical and lumbar symptoms had identical recurrence profiles whereas thoracic symptoms had a significantly lower recurrence rate. Drivers had the highest recurrence rate (42.1%) and nurses had the highest average number of recurrences (2.03) among recurrent cases. Both occupations had statistically significant excesses after controlling for the other variables.     

Side Effects and toxicity of lithium

Although lithium remains the most specific treatment for bipolar affective disorder, it should be cautiously prescribed and used only when clinically indicated. The main indications for lithium are the manic phase of bipolar affective disorder and prophylaxis of both manic and depressive episodes. Lowering serum lithium levels will markedly reduce the incidence of side effects, and patients should be maintained at the lowest possible serum level. The serum level may be as low as 0.4 mEq/L and as high as 1.5 mEq/L, depending on the clinical response of the patient and the presence of side effects. The most controversial areas are the possibility of renal toxicity and the concomitant use of lithium with neuroleptics, especially haloperidol.     

Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records

ObjectiveTo evaluate association of first- or second-generation antipsychotic (AP) drugs with fracture risk at different levels of frailty over the age of 80 years.DesignPopulation-based cohort study.Setting and ParticipantsUnited Kingdom Clinical Practice Research Datalink including 153,304 patients aged 80 years and older between 2006 and 2015.MethodsRates of fracture and adjusted rate ratios (RR) were estimated by AP drug exposure category, adjusting for age, sex, frailty, number of deficits, and dementia diagnosis.ResultsData were analyzed for 165,726 treatment episodes (153,304 patients; 61.3% women; mean age 83 years; 21,365 fractures; 681,221.1 person-years of follow-up). AP exposure was associated with increasing age, frailty, and dementia diagnosis. After adjusting for frailty and covariates, first-generation AP exposure was associated with risk of any fracture, RR 1.24 (95% confidence interval 1.07–1.43, P = .003). Second-generation AP exposure was associated with femur fracture (RR 1.41, 1.22–1.64, P < .001) but less strongly with any fracture (RR 1.12, 1.01–1.24, P = .033). Fracture incidence increased with frailty level. The number of person-years of first-generation AP treatment associated with 1 additional fracture at any site was 75 (42–257) for severely frail patients but 187 (95% confidence interval 104–640) for ‘fit’ patients. For second-generation AP, 1 additional femur fracture might result from 173 (111–323) person-years treatment in severe frailty but 365 (234–681) person-years treatment for ‘fit’ patients.Conclusions and ImplicationsFrail patients are more likely to receive AP drug treatment, but their absolute risk of AP-associated fracture is substantially greater than for nonfrail patients.     

Implications of genetic risk information in families with a high density of bipolar disorder: an exploratory study

While major susceptibility genes for bipolar disorder are yet to be identified, the opportunity exists to systematically ascertain the important issues and societal implications of genetic risk determination for bipolar disorder prior to these technological advances becoming widely available. This study explores, in a sample of families with a high density of bipolar disorder: (i) attitudes to predictive genetic and prenatal testing, using different risk frames; (ii) attributions for bipolar disorder, in particular the degree to which a genetic model is endorsed; and (iii) the impact of these attributions on the perceived stigma of bipolar disorder. A qualitative methodology was selected as most appropriate as no previous research has examined this issue. Participants were ascertained through a molecular genetics study of bipolar disorder. In-depth interviews were conducted with 21 members of families with a high density of bipolar disorder. Most participants reported being interested in genetic testing if it gave a definitive answer, while expressed interest in testing was lower if it gave a probable answer only. Almost all stressed that a genetic susceptibility and environmental factors interacted. Most participants felt that a genetic explanation was likely to decrease the stigma associated with bipolar disorder as it shifted the locus of control and responsibility away from the individual towards the role of heredity. Findings indicate that expressed interest in genetic testing depends on the certainty imparted by the test. Results suggest that families with bipolar disorder are likely to benefit psychologically from information about the genetic basis of bipolar disorder.     

罗伊适应模式护理在重复经颅磁刺激治疗双相情感障碍稳定期女性患者中的应用

目的 探讨罗伊适应模式护理在重复经颅磁刺激治疗双相情感障碍稳定期女性患者中的应用效果.方法 95例采用重复经颅磁刺激治疗的双相情感障碍稳定期女性患者随机分为两组,对照组47例给予常规护理,观察组48例在对照组基础上给予罗伊适应模式护理,比较两组的BMRS评分和生存质量.结果 干预后,观察组的BMRS评分低于对照组,环境...     

Rehospitalization rates of patients with bipolar disorder discharged on a mood stabilizer versus a mood stabilizer plus an atypical or typical antipsychotic

One-year rehospitalization rates of patients with bipolar disorder discharged on a mood stabilizer alone, a mood stabilizer plus a typical antipsychotic, or a mood stabilizer plus an atypical antipsychotic were examined. Time to rehospitalization was measured by using the product-limit (Kaplan-Meier) formula. Twenty-three percent of patients on a mood stabilizer alone, 27% of patients on a mood stabilizer plus a typical antipsychotic, and 25% of patients on a mood stabilizer plus an atypical antipsychotic were rehospitalized within 1 year of discharge. There were no significant differences in rehospitalization rate or time to rehospitalization between groups. One-year rehospitalization rates for patients on a mood stabilizer plus olanzapine or risperidone were 25%. The number of previous psychiatric hospitalizations contributed to the risk of readmission. Risk factors and medication costs should be considered when designing the optimal treatment plan for an individual patient. Long-term prospective studies are needed to better delineate the effectiveness of different pharmacotherapeutic regimens on the long-term treatment outcomes in patients with bipolar disorder.     

Bipolar Disorder in Women

This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.     

基于微信群的延续护理在稳定期双相情感障碍患者中的应用

目的探讨基于微信群的延续护理在稳定期双相情感障碍患者中的应用效果。方法选取2018年3月至2019年3月我院收治的稳定期双相情感障碍患者91例,随机分为两组。对照组45例予以常规护理,观察组46例在对照组基础上予以基于微信群的延续护理,比较两组的认知功能(WMS-Ⅳ、 WAIS-RC评分)、社会功能(SDSS评分)及功能失调性状况(DAS评分)。结果护理6个月后,两组的WMS-Ⅳ各项评分及WAIS-RC各项评分均高于护理前,且观察组显著高于对照组(P <0.05)。护理6个月后,两组的SDSS评分、 DAS评分均低于护理前,且观察组显著低于对照组(P <0.05)。结论基于微信群的延续护理可有效提高稳定期双相情感障碍患者的认知功能和社会功能,促进其功能失调性状况的改善。     

Repeated events and total time on test

We adopt the total time on test procedure to investigate monotone time trends in the intensity in a repeated event setting. The correct model is assumed to be a proportional hazards model, with a random effect to account for dependence within subjects. The method offers a simple routine for testing relevant hypotheses for recurrent event processes, without making distributional assumptions about the frailty. Such assumptions may severely affect conclusions concerning regression coefficients and cause bias in the estimated heterogeneity. The method is illustrated by re-analyzing Danish registry data and a long-term Swiss clinical study on recurrence in affective disorder. Copyright (c) 2008 John Wiley & Sons, Ltd.     

情境式交往训练在双相情感障碍患者中的应用效果观察

目的 分析情境式交往训练对双相情感障碍缓解期患者的治疗效果。方法 选择本院2016年12月—2018年6月收治的85例双相情感障碍缓解期患者为研究对象,根据随机数表法将所有患者分为对照组(43例)与观察组(42例)。对照组采用常规护理,观察组在常规护理基础上辅以情境式交往训练,干预前、后分别评估2组患者的躁狂、抑郁以及生存质量状况。结果 干预前,2组的生存质量量表、抑郁量表、躁狂量表的评分对比,差异均无统计学意义(P>0.05);干预后,对照组的生存质量评分低于观察组,差异有统计学意义(P<0.05),对照组的躁狂评分(3.57±1.16)、抑郁评分(12.26±3.75),明显高于观察组的(2.77±1.22)分、(9.22±3.16)分,差异有统计学意义(P<0.05)。结论 将情境式交往训练应用于双相情感障碍缓解期患者,能有效改善患者的心绪体验与情感表达能力,能提高治疗效果,建议推广。     

Psychiatric and physical illness, sociodemographic characteristics, and the use of psychotropic drugs in the community: results from the Upper Bavarian Field Study

In the Upper Bavarian Field Study a total of 1536 persons (15 years and older) were interviewed by research psychiatrists. 8.1% of all respondents took a psychotropic drug during the 7 days prior to the interview. The consumption rate among women was about three times as high as that for men. The use of psychotropic drugs increased with age. No consistent pattern was found with respect to social class. According to psychiatric/physical health status the highest consumption rate (29.4%) was found among those suffering solely from psychiatric disorders. The simultaneous occurrence of both psychiatric and physical disorder did not increase the risk of drug taking (21.4%). Less than 5% of the healthy respondents and of those suffering solely from a physical disorder used psychotropic drugs. A large proportion (63.0%) of those with previous psychiatric in- and outpatient treatment received psychotropic medication, as well as those suffering from schizophrenia (66.7%), affective psychoses (52.6%) and anxiety disorders (50.0%). The higher consumption of psychotropic drugs among women could not be explained by higher psychiatric or physical morbidity or the fact that women consult primary care physicians more frequently than do men. Controlling for co-morbidity and annual consultation of family physicians, significant sex differences in the consumption of psychotropic drugs persist.     

Risk of Early Rehospitalization for Non-Behavioral Health Conditions Among Adult Medicaid Beneficiaries with Severe Mental Illness or Substance Use Disorders

The goal was to examine risk factors and expenditures for early rehospitalization (within 30 days of discharge) for non-behavioral health conditions among Medicaid-enrolled Floridians over 8 years. There were 1,689,797 hospitalization episodes with 19% (N?=?314,742) resulting in early rehospitalization. Total gross charges for early rehospitalization were over 13 billion dollars. In Cox proportional hazards regression adjusted for demographic and health covariates, drug use disorder was associated with 50% increased risk of early rehospitalization. Having major depressive disorder increased risk by 17%; psychotic disorder, bipolar disorder, and alcohol use disorder increased risk of early rehospitalization slightly by 10, 6, and 6% respectively. The effect of dementia on risk was minimal at 2%. Risk of early rehospitalization decreased by 3.5% per year over the 8 years of the study. Attention to mental health problems, especially drug use disorder, may help further reduce rates of early readmission for non-behavioral health conditions.     

A study of familial aggregation of depression, dementia and Parkinson's disease

Depression is often accompanied by other disorders including Alzheimer's disease and Parkinson's disease. We studied the familial aggregation of these disorders in order to examine the possibility of a shared genetic origin. In a population-based study of 6596 subjects, we studied the association of self-reported depression, which required treatment by a psychiatrist, to family history of psychiatric disease, dementia, and Parkinson's disease. A family history of psychiatric disease was significantly associated with overall depression as well as with unipolar (n = 303 patients) and bipolar (n = 27 patients) depression. The risk of unipolar depression was associated with the presence of two or more demented individuals among their first degree relatives (e.g. parents, siblings and children). Since there was no evidence for familial aggregation in subjects with only one demented relative, our study suggests that unipolar depression may be associated specifically to a strongly familial, form of dementia. The risk of bipolar depression was increased for those with one or more relatives with dementia and, perhaps, for those with relatives with Parkinson's disease. The familial aggregation of depression with dementia and perhaps Parkinson's disease suggests that there may be shared susceptibility gene(s) underlying these diseases. Our study indicates further that there may be differences in the genetic etiology between unipolar and bipolar depression.     

睡眠质量对社区老年人认知衰弱影响的归因分析

目的 探究睡眠质量和睡眠时长对社区老年人认知衰弱的作用大小。方法 采用现况调查方法,利用匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index, PSQI)评估老年人的睡眠质量,中文版AscertainDementia-8(AD-8)量表评估认知状态,Frail衰弱量表评估躯体衰弱。采用logistic回归分析和多因素调整的人群归因危险度分析睡眠对认知衰弱的作用大小。结果 本研究共调查955名社区老人受试者,男性425名(44.5%),女性530名(55.5%)。认知衰弱的检出率为8.7%,睡眠障碍的检出率为24.5%。在调整性别、年龄、BMI、婚姻、体育锻炼、午睡、慢性病、身体疼痛、抑郁、焦虑等混杂因素后,睡眠障碍(OR=1.891,95%CI:1.087～3.291)和睡眠时间<6 h(OR=1.859, 95%CI:1.044～3.312)的老年人更易发生认知衰弱,认知衰弱的发生风险随着PSQI得分增加而逐渐上升。睡眠质量和睡眠时长对于认知衰弱人群归因危险度分别为25.53%和23.95%。结论 社区老年人睡眠质量与认知衰弱程度相关,睡眠质量差...