A preliminary investigation of symptom pattern and prevalence before and up to 6?months after implantation of a left ventricular assist device

Despite increased use of left ventricular assist devices (LVAD) in patients with advanced or end-stage heart failure; little is known about the reoccurrence of common heart failure symptoms (e.g., fatigue) after LVAD implantation. The objective of this study was to investigate the prevalence and pattern of selected heart failure symptoms and identify changes in symptom patterns before and up to 6 months after LVAD implantation. We used self-report questionnaires to collect data from patients (n = 12) and measure symptoms at baseline, 1 and 2 weeks, and 1, 3, and 6 months after LVAD. We found that high levels of fatigue, anxiety, depression, and sleep disturbance were prevalent during these periods. However, we did not find any significant changes in symptom pattern over time. The preliminary findings set the starting point for large-scale studies fundamental to advances in symptom-management research in LVAD and for other patients living with artificial organs.     

Is episodic obsessive compulsive disorder bipolar? A report of four cases

Several reports have noted cases of OCD which were unusual in showing an abrupt remission. We report longitudinal clinical observation of four cases of acute onset OCD without major depression through a variety of treatments. These patients had prominent feelings of shamefulness; compared to patients with typical OCD they were ill for months rather than years and were older. Two had previous episodes of psychiatric illness with full recovery. Full and persistent recovery occurred in response to lithium or an acute course of ECT but not to tricyclic or SSRI antidepressants. The generalizability of these observations is limited by its uncontrolled nature and the small numbers. The courses observed were consistent with episodic OCD as a possible expression of bipolar disorder and consideration of corresponding treatments. This perspective offers a new rationale for reported observations of remissions of acute onset OCD in response to lithium without lithium effectiveness for typical OCD.     

Is blunted cardiovascular reactivity in depression mood-state dependent? A comparison of major depressive disorder remitted depression and healthy controls

Prior work has repeatedly demonstrated that people who have current major depression exhibit blunted cardiovascular reactivity to acute stressors (e.g., Salomon et al., 2009). A key question regards the psychobiological basis for these deficits, including whether such deficits are depressed mood-state dependent or whether these effects are trait-like and are observed outside of depression episodes in vulnerable individuals. To examine this issue, we assessed cardiovascular reactivity to a speech stressor task and a forehead cold pressor in 50 individuals with current major depressive disorder (MDD), 25 with remitted major depression (RMD), and 45 healthy controls. Heart rate (HR), blood pressure and impedance cardiography were assessed and analyses controlled for BMI and sex. Significant group effects were found for SBP, HR, and PEP for the speech preparation period and HR, CO, and PEP during the speech. For each of these parameters, only the MDD group exhibited attenuated reactivity as well as impaired SBP recovery. Reactivity and recovery in the RMD group more closely resembled the healthy controls. Speeches given by the MDD group were rated as less persuasive than the RMD or healthy controls' speeches. No significant differences were found for the cold pressor. Blunted cardiovascular reactivity and impaired recovery in current major depression may be mood-state dependent phenomena and may be more reflective of motivational deficits than deficits in the physiological integrity of the cardiovascular system.     

Prevalence and correlates of overweight in drug-naïve patients with bipolar disorder

BACKGROUND: Patients with bipolar disorder may be at greater risk for overweight and obesity than individuals in the general population. This risk may be due to the illness itself, to mediating factors (diet, life style) and/or to medications used to treat the disorder. This investigation explores the association between body weight and bipolar illness in drug-na?ve patients. METHODS: Weight and height were retrospectively obtained from 76 clinical charts of drug-na?ve patients with bipolar disorder (DSM-IV-TR). A reference group for comparison was then selected from another psychiatric population (65 patients with obsessive-compulsive disorder) and investigated with the same methodology to estimate their BMI. A second focus was to examine the differences in baseline demographic and clinical characteristics between overweight and non-overweight bipolar patients. RESULTS: A total of 40.8% of the patients with bipolar disorder met criteria for obesity or overweight with significant difference in comparison with obsessive-compulsive patients (10.8%). The highest proportions of depression at index episode were in the overweight group (83.3%) with significant difference with the non-overweight patients (58.1%). LIMITATIONS: Retrospective study. Weight measurement not in euthymic period. CONCLUSIONS: Overweight is significantly more prevalent in drug-na?ve patients with bipolar disorder than in another drug-na?ve psychiatric patients (OCD). In agreement with previous studies, the number of patients experiencing a depressive episode was significantly higher in the overweight than in the non-overweight group. These results suggest that the prevalence of overweight in bipolar patients is also influenced by the illness itself or mediating factors such as diet and life style than by pharmacologic treatment.     

Is the risk of bipolar disorder in twins equal to the risk in singletons? A nationwide register-based study

BACKGROUND: A previous study demonstrated a higher rate of schizophrenia in dizygotic twins than in the general population, and a higher rate of schizophrenia in siblings of dizygotic twins than in siblings of monozygotic twins and singletons, pointing to a common genetic predisposition for dizygotic twinning and schizophrenia. The aim of the present study was to investigate whether these findings also apply to bipolar disorder. METHODS: Through record linkage between The Danish Twin Register, The Danish Psychiatric Central Register and The Danish Civil Registration System, the rate of bipolar disorder (diagnosed for the first time during admission to hospital) in dizygotic and monozygotic twins was compared with the rate in singletons, and the rate in siblings and parents of twins was compared with the rate in siblings and parents of singletons. RESULTS: The rate of bipolar disorder was the same in dizygotic twins, monozygotic twins and singletons as well as for parents and siblings of dizygotic twins, monozygotic twins and singletons. LIMITATIONS: The study is a register-based study, only including hospitalized patients. CONCLUSION: This study shows that there is an equal rate of bipolar disorder in twins and in singletons. Assuming that DZ twinning is under some genetic influence, a differential relationship between schizophrenia and DZ twinning on one hand and bipolar disorder and DZ twinning on the other hand may suggest differences in the genetic basis of the two diseases. The finding that the rate of bipolar disorder in monozygotic twins is the same as the rate of bipolar disorder in singletons supports studies finding no association between bipolar disorder and obstetric complications.     

Earlier onset of bipolar disorder in children by antidepressants or stimulants? An hypothesis

Among adults and adolescents, bipolar disorder (BD) has a similar prevalence in the US and in the Netherlands. However, among pre-pubertal children, BD is frequently diagnosed in the US and seldomly in the Netherlands. This suggests that, among children, the prevalence of BD is lower in the Netherlands than in the US, indicating an earlier onset of BD in the US than in the Netherlands. It is hypothesized that this may be related to the greater use of antidepressants and stimulants for depression or attention deficit disorder with hyperactivity by US children. In those children who are genetically at risk to develop BD, these drugs may lead to a switch into mania.     

Are self-rated and behavioural measures of impulsivity in bipolar disorder mainly related to comorbid substance use problems?

Introduction: Impulsivity is a multidimensional feature observed in bipolar disorder (BD) and substance use disorder (SUD). We previously found a relationship between SUD and risk taking in BD. It is still unclear whether self-rated and behavioral impulsivity measures differ between BD with and without comorbid SUD, or are specific to BD.

Methods: 93 adults with BD with comorbid SUD, 91 BD without SUD, and 93 healthy controls (HC) were administered the Barratt Impulsivity Scale (BIS), the Behavioral Inhibition/Behavioral Activation System Scale (BIS/BAS), and the Cambridge Neuropsychological Test Automated Battery. Analyses compared impulsivity measures across groups controlling for age. Discriminant function analyses (DFA) assessed the combination of variables effectively predicting group membership.

Results: BD displayed increased BIS, BIS/BAS scores, reduced performance on the Cambridge Gambling and Rapid Visual Processing, and Affective Go/No-Go tasks compared to HC. Comparisons between BD with and without SUD showed increased BIS Motor impulsiveness. The overall predictive power of DFA was weak.

Conclusions: Some facets of impulsivity are a core trait of BD and are partially independent from the presence of SUD. Motor impulsiveness may be distinctive of BD+SUD. More research is needed to understand the role of impulsive behaviors as risk factors for relapse in SUD.     

How can the study of physiological reactivity contribute to our understanding of adversity and resilience processes in development?

The focus of this article is to present current progress in understanding the interplay among adversity, physiological sensitivity to context, and adaptive functioning, with an emphasis on implications and future directions for resilience researchers. It includes a review of current literature that demonstrates (a) links between various levels of adversity exposure and variability in physiological reactivity, (b) how the interplay between children's physiological reactivity and different sources of risk and adversity relates to variability in adaptive functioning, and (c) various approaches for capturing a more dynamic nature of physiological reactivity and related processes. Throughout, important conceptual and empirical issues are highlighted.     

High insulin-like growth factor-1 in patients with bipolar I disorder: A trait marker?

Objectives

Neurotrophic factors exert substantial effects on the central nervous system. The present study investigates the roles of insulin-like growth factor-1 (IGF-1), β-nerve growth factor (β-NGF), and brain-derived neurotrophic factor (BDNF) in bipolar disorder.

Methods

Baseline levels of culture-stimulated IGF-1, β-NGF, and BDNF were compared in 116 patients with bipolar I disorder and 123 healthy controls. Neurotrophic factors were also compared in patients before and after 6 weeks of pharmacotherapy. A multivariate logistic regression analysis was used to investigate the influence of the neurotrophic factors analyzed in quartile form, in relation to confounding variables, such as age, sex, and body mass index.

Results

IGF-1 was significantly higher in patients (mean=514.57, SD=259.78) than in healthy controls (mean=316.82, SD=270.00, p<0.0001) at baseline. Furthermore, higher levels of IGF-1 substantially increased the risk for bipolar I disorder. IGF-1 level was not significantly changed at 6-weeks (mean=506.41, SD=313.66). No changes in BDNF or β-NGF-1 levels were found following the 6-week treatment period. IGF-1 and β-NGF were negatively correlated in healthy controls, but not in patients. Severity of manic symptoms was not associated with any of the neurotrophic factors.

Limitations

We did not measure cortisol, growth hormone, or IGF-1 receptors. This study is cross-sectional in design.

Conclusions

Elevated IGF-1 levels may be a trait marker for bipolar disorder. Further studies are needed to thoroughly investigate the role of IGF-1 in relation to other neuroendocrine factors and biological markers for bipolar disorder.     

In your eyes: Does theory of mind predict impaired life functioning in bipolar disorder?

Background

Deficits in emotion perception and social functioning are strongly implicated in bipolar disorder (BD). Examining theory of mind (ToM) may provide one potential mechanism to explain observed socio-emotional impairments in this disorder. The present study prospectively investigated the relationship between theory of mind performance and life functioning in individuals diagnosed with BD compared to unipolar depression and healthy control groups.

Methods

Theory of mind (ToM) performance was examined in 26 individuals with remitted bipolar I disorder (BD), 29 individuals with remitted unipolar depression (UD), and 28 healthy controls (CTL) using a well-validated advanced theory of mind task. Accuracy and response latency scores were calculated from the task. Life functioning was measured during a 12 month follow-up session.

Results

No group differences for ToM accuracy emerged. However, the BD group exhibited significantly shorter response times than the UD and CTL groups. Importantly, quicker response times in the BD group predicted greater life functioning impairment at a 12-month follow-up, even after controlling for baseline symptoms.

Limitations

The stimuli were static representations of emotional states and do not allow for evaluating the appropriateness of context during emotional communication; due to sample size, neither specific comorbidities nor medication effects were analyzed for the BD and UD groups; preliminary status of theory of mind as a construct.

Conclusions

Results suggest that quickened socio-emotional decision making may represent a risk factor for future functional impairment in BD.     

What are relative scales and how can they be used in evaluation of Croatian science?

The most appropriate way of evaluating the quality of scientific research is peer review by competent and objective colleagues. An objective review, however, is practically impossible within a small scientific community like the Croatian one, and the only solution in this case is internationalization of the process. In order to upgrade the objectivity of the evaluation, bibliometric/scientiometric indicators can be used, provided they are interpreted by experts in the field. The author believes that relative scales based on these indicators are of particular relevance for such small scientific communities. They enable determination of relative positions of a scientist, or a group of scientists, within a given scientific discipline, and for a given indicator, both at the international and/or national level. Such relative positions can often serve better for more objective evaluation than absolute values of the same indicators. An example of relative scales and their use is presented.     

Co-occurrence of Marfan syndrome and schizophrenia: What can be learned?

We report on a young female patient diagnosed with Marfan syndrome upon admission to the psychiatric hospital for a first psychosis. Mutation analysis of FBN1 identified a de novo nonsense mutation (p.Glu178X). This finding implies co-occurrence of schizophrenia and Marfan syndrome, an observation that has been reported several times in the past. Although, this co-occurrence can be coincidental, several arguments provide strong evidence that Marfan syndrome and schizophrenia might share common etiological pathways. This observation can be important in light of both the etiology of schizophrenia and the diagnosis of Marfan syndrome.     

What can cytologists learn from 25 years of investigations in visual search?

This review aims to provide an insight into the nature and mechanisms of the visual screening of cytological preparations and to discuss the implications for current practice. Visual perception in cytology is under-researched and deserves further investigation. Fundamental issues to be addressed include the mechanisms of visual scanning of cytological preparations and the factors affecting search performance. Answers to these questions will have wide reaching impact on issues such as liquid-based technology, automated screening, training, quality assurance, recruitment and selection of staff, and medico-legal problems.     

Excess beta activity in the EEG of children with attention-deficit/hyperactivity disorder: A disorder of arousal?

Past research has reported that a small proportion of children with attention-deficit/hyperactivity disorder (AD/HD) have excess beta activity in their EEG, rather than the excess theta typical of the syndrome. This atypical group has been tentatively labeled as hyperaroused. The aim of this study was to determine whether these children have a hyperaroused central nervous system. Participants included 104 boys aged 8 to 13 years old, with a diagnosis of either the Combined or Inattentive type of AD/HD (67 combined type), and 67 age-matched male controls. Ten and a half minutes of EEG and skin conductance (SCL) were simultaneously recorded during an eyes-closed resting condition. The EEG was Fourier transformed and estimates of total power, and relative power in the delta, theta, alpha, and beta bands, and the theta/beta ratio, were calculated. AD/HD patients were divided into an excess beta group and a typical excess theta group. Relative to controls, the typical excess theta group had significantly increased frontal total power, theta and theta/beta ratio, with reduced alpha and beta across the scalp. The excess beta group had significantly reduced posterior total power, increased centro-posterior delta, globally reduced alpha, globally increased beta activity, and globally reduced theta/beta ratio. Both AD/HD groups had significantly reduced SCL compared to the control group, but the two groups did not differ from each other on SCL. These results indicate that AD/HD children with excess beta activity are not hyperaroused, and confirm that the theta/beta ratio is not associated with arousal. This is the first study of arousal measures in AD/HD children with excess beta activity, and has implications for existing models of AD/HD.     

Polysymptomatic conversion disorder in childhood and adolescence in Japan. Early manifestation or incomplete form of somatization disorder?

BACKGROUND: In conversion disorder in childhood and adolescence, polysymptomatic (PS) presentations are reportedly commoner than monosymptomatic (MS) ones. Somatization disorder is also associated with pseudoneurological symptoms, but is extremely rare in childhood. This occurs despite the age of onset peaking in the teens among adult somatization disorder patients. METHOD: We reviewed the records of 44 children and adolescents with pseudoneurological symptoms. They were categorized as MS cases (19) or PS cases (25), and their psychological backgrounds and clinical courses were compared. RESULTS: PS patients had a poorer prognosis and more past psychiatric and family problems. While none met the DSM-IV criteria for somatization disorder, 2 PS patients met all but the sexual symptoms criteria. CONCLUSION: PS conversion disorder in childhood and adolescence may constitute a different entity from MS conversion disorder and may be an early manifestation or incomplete form of somatization disorder.