Albumin decrement in depression and cholesterol decrement in mania

Within all psychiatric inpatients over a 4-year period, on admission depressives showed serum albumin 5.4% lower (P less than 0.001) than non-psychiatric controls. Similarly, manics showed cholesterol 10% lower (P less than 0.0005) and serum calcium/protein ratio 2.2% higher (P less than 0.05) than controls. These deviations suggest a tendency towards dietary aberrations in these patients of potential medical significance. These tests had shown the most distinct variation with diagnosis on split-half discriminant function analysis of routine chemistry and hematology tests of 107 patients with mania, 132 with depression, 67 with schizophrenia, 18 with schizoaffective illness, and 83 non-psychiatric controls admitted for elective surgery.     

Emotional bias and inhibitory control processes in mania and depression

BACKGROUND: Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. The disinhibited behaviour characteristic of mania and evidence that subgenual prefrontal cortex is differentially activated in mania and depression both suggest that dissociable deficits will emerge on tasks that require inhibitory control and are subserved by ventromedial prefrontal cortex. METHODS: Manic patients and controls undertook computerized neuropsychological tests of memory and planning ability. In addition, manic and depressed patients were directly compared with controls on a novel affective shifting task that requires inhibitory control over different components of cognitive and emotional processing. RESULTS: Manic patients were impaired on tests of memory and planning. Importantly, affective shifting performance of manic patients differed from that of depressed patients. Manic patients were impaired in their ability to inhibit behavioural responses and focus attention, but depressed patients were impaired in their ability to shift the focus of attention. Depressed patients exhibited an affective bias for negative stimuli, and we believe this to be the first demonstration of an affective bias for positive stimuli in manic patients. CONCLUSIONS: Observed impairments on tests of memory and planning suggest a global pathology for mania consistent with previous profiles for this disorder and similar to established profiles for depression. The results on the affective shifting task demonstrate the presence of mood-congruent bias and dissociable components of inhibitory control in mania and depression. Against a background of memory and planning impairments in the two groups, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood-cognition relationships.     

Attitudes of young people towards depression and mania

Objectives . Despite the known effects of stigma on people suffering from affective disorders, no study so far has investigated and compared attitudes of the general public towards depression and mania. Furthermore, we were interested if it makes a difference if one asks a sample about its own attitudes or the assumed opinions of ‘others’. Design . We used an experimental and randomized design. Methods . People were faced either with a case vignette describing a man with current symptoms of depression or mania. Randomly people (N=387, age 16–34 years) were asked for their own attitudes or for the attitudes of the public in general. Results . Attitudes towards an individual with a current manic episode turned out to be significantly more negative than towards a person with current depression. Interestingly, the attitudes of the general public were reported to be more negative than the personal attitudes. Conclusions . While depression is still associated with negative attitudes, this first study looking at manic symptoms as well finds that this seems to be even more so for manic episodes indicating bipolar disorder. It seems recommended to concentrate efforts to reduce stigmatization of the mentally ill more intensively on the bipolar spectrum of affective disorders. Furthermore, testable hypotheses have to be derived why individuals attribute less favourable attitudes to the general public when compared with their own attitudes. The question is if there is a general bias towards social desirability when people are asked for their opinion.     

Individual differences in plasma cortisol changes during mania and depression

Daytime plasma cortisol levels in four rapid cycling bipolar affective disorder patients were measured longitudinally over multiple affective episodes, and changes in levels with mood state assessed for each individual patient. While three of the four patients had, as expected, increased cortisol levels during depression, higher cortisol levels were also found in the days immediately preceding depressive episodes. Daytime cortisol levels in mania were more variable but were lower in mania for two of the patients. It is hypothesized that in the early stages of mania decreased cortisol levels reflect early neurochemical changes, but that, as manic episodes become dysphoric and/or severe, elevated cortisol levels occur.     

Dimensions of depression, mania and psychosis in the general population

BACKGROUND: In order to investigate whether correlated but separable symptom dimensions that have been identified in clinical samples also have a distribution in the general population, the underlying structure of symptoms of depression, mania and psychosis was studied in a general population sample of 7072 individuals. METHOD: Data were obtained from the three measurements of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Symptoms of depression, mania and the positive symptoms of psychosis were assessed using the Composite International Diagnostic Interview. Confirmatory factor-analysis was used to test statistically the fit of hypothesized models of one, two, three or seven dimensions. RESULTS: The seven-dimensional model comprising core depression, sleep problems, suicidal thoughts, mania, paranoid delusions, first-rank delusions and hallucinations fitted the data best, whereas the unidimensional model obtained the poorest fit. This pattern of results could be replicated at both follow-up measurements. The results were similar for the subsamples with and without a lifetime DSM-III-R diagnosis. The seven dimensions were moderately to strongly correlated, with correlations ranging from 0.18 to 0.73 (mean 0.45). CONCLUSIONS: In the general population, seven correlated but separable dimensions of experiences exist that resemble dimensions of psychopathology seen in clinical samples with severe mental illness. The substantial correlations between these dimensions in clinical and non-clinical samples may suggest that there is aetiological overlap between the different dimensions regardless of level of severity and diagnosable disorder.     

Impulsivity: differential relationship to depression and mania in bipolar disorder

INTRODUCTION: Impulsivity, a component of the initiation of action, may have a central role in the clinical biology of affective disorders. Impulsivity appears clearly to be related to mania. Despite its relationship to suicidal behavior, relationships between impulsivity and depression have been studied less than those with mania. Impulsivity is a complex construct, and it may be related differently to depression and to mania. METHODS: In subjects with bipolar disorder, we investigated impulsivity in relationship to affective symptoms. Trait-like impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Affective symptoms were measured using the Change version of the Schedule for Affective Disorders and Schizophrenia (SADS-C). Measures were compared using analysis of variance, multiple regression and factor analysis. RESULTS: Impulsivity, as measured by the BIS, was related differentially to measures of depression and mania. Total and attentional impulsivity correlated independently with depression and mania scores. Motor impulsivity correlated with mania scores, while nonplanning impulsivity correlated with depression scores. These relationships were strongest in subjects who had never met criteria for a substance use disorder. Among manic symptoms, visible hyperactivity correlated most strongly with BIS scores, regardless of clinical state. Among depressive symptoms, hopelessness, anhedonia, and suicidality correlated most strongly with BIS scores. CONCLUSIONS: Depression and mania are differentially related to impulsivity. Impulsivity is related more strongly to measures of activity or motivation than to depressive or manic affect. The relationship between impulsivity and hopelessness may be an important factor in risk for suicide.     

Seasonal variation in suicides and in admissions to hospital for mania and depression

BACKGROUND: The influence of seasons on mood disorders is controversial. OBJECTIVE: To examine monthly variations in admissions for mania and depressions including variations with sex and age and correlations with frequencies of suicides. METHODS: All admissions for mania or depression (N=4341) in a population of 1,800,000 with 35,285 admissions in the years 1992-1996 were analysed. All 14,503 suicides in Norway the years 1969-1996 were also analysed. RESULTS: Admissions for depression had a significant monthly variation for women (chi(2)=29.78, df=11, P<0.005) with the highest peak in November and for men (chi(2)=19.69, df=11, P<0.05) with the highest peak in April. Among women increasing age correlated negatively with the range of monthly observed/expected ratios (r(s)=-0.943, N=6, P<0.01) and with a of maximal monthly observed/expected ratio (r(s)=-0.943, N=6, P<0.01). Among men suicides correlated with admissions for depression (r=0.647, N=12, P<0.05) and mania (r=0.678, N=12, P<0.05). LIMITATIONS: The time of admission to hospital are not identical to onset of affective episode. The study was done retrospectively. No sociocultural or physical environmental data were investigated. CONCLUSION: A hypothesis of an influence of seasons on mood disorders is supported. Younger women seem to be especially vulnerable.     

Social support and self-esteem predict changes in bipolar depression but not mania

INTRODUCTION: Our own and other research has suggested that social support predicts course of bipolar disorder, with particularly strong effects on depressive symptoms. Within this paper, we examine which components of social support appear most powerful. METHODS: Thirty-one individuals with Bipolar I disorder were followed longitudinally for 9 months. Participants completed a standardized symptom severity interview monthly, and at a 2-month follow-up, they completed the Interpersonal Support Evaluation List. At a 6-month follow-up, they completed the Rosenberg Self-Esteem Inventory. RESULTS: Self-esteem support appeared to the most important predictor of change in depression across a 6-month follow-up, and multiple regression analyses suggested that social support effects were mediated through self-esteem. LIMITATIONS AND IMPLICATIONS: Although the small sample size suggests a need for replication, current results highlight the importance of psychosocial variables in the course of bipolar depression. Self-esteem may be a particularly important target for clinical interventions.     

Antidepressant treatment and the occurrence of mania in bipolar patients admitted for depression

We examined the records of 33 patients who had 70 inpatient admissions with a diagnosis of bipolar affective disorder, depressed. During 14 of these admissions, a switch occurred from depression into mania. We compared the treatment patients were on at the time of their switch to treatment during the 56 admissions where there was no switch. We conclude that clinicians must be prepared for depressed bipolar patients to switch to mania regardless of treatment status.     

Statistical quantitative EEG studies of depression, mania, schizophrenia and normals

The EEG characteristics of 63 depressive psychotics, 75 manics and 53 schizophrenic patients, consecutive admissions satisfying research criteria, are presented. Statistical comparisons between the psychotic groups and of each psychotic group against 60 normal controls (all dextral) were undertaken for power, coherence and phase characteristics in the 8-13 Hz frequency band. The characteristic EEG-myogenic power spectra for frequencies up to 60 Hz, expressed as the log of the right/left parietal and temporal power ratios for the four groups are also graphically displayed. The results suggest the presence of increasing disorganization of the right hemisphere (least in depression, intermediate in mania and maximal in schizophrenia) together with left hemisphere disorganization (in both mania and schizophrenia; again maximal in schizophrenia).     

The experience of depression,anxiety, and mania among perinatal women

We assessed differential item functioning (DIF) based on computerized adaptive testing (CAT) to examine how perinatal mood disorders differ from adult psychiatric disorders. The CAT-Mental Health (CAT-MH) was administered to 1614 adult psychiatric outpatients and 419 perinatal women with IRB approval. We examined individual item-level differences using logistic regression and overall score differences by scoring the perinatal data using the original bifactor model calibration based on the psychiatric sample data and a new bifactor model calibration based on the perinatal data and computing their correlation. To examine convergent validity, we computed correlations of the CAT-MH with contemporaneously administered Edinburgh Postnatal Depression Scales (EPDS). The rate of major depression in the perinatal sample was 13 %. Rates of anxiety, mania, and suicide risk were 5, 6, and 0.4 %, respectively. One of 66 depression items, one of 69 anxiety items, and 15 of 53 mania items exhibited DIF (i.e., failure to discriminate between high and low levels of the disorder) in the perinatal sample based on the psychiatric sample calibration. Removal of these items resulted in correlations of the original and perinatal calibrations of r?=?0.983 for depression, r?=?0.986 for anxiety, and r?=?0.932 for mania. The 91.3 % of cases were concordantly categorized as either “at-risk” or “low-risk” between the EPDS and the perinatal calibration of the CAT-MH. There was little evidence of DIF for depression and anxiety symptoms in perinatal women. This was not true for mania. Now calibrated for perinatal women, the CAT-MH can be evaluated for longitudinal symptom monitoring.     

The activity of the lithium—sodium countertransport system in erythrocytes in depression and mania

The activity of the lithium-sodium countertransport system in erythrocytes was estimated in 16 control subjects and 28 patients suffering from affective disorders (11 bipolar, 17 unipolar) during depression, mania and remission. In all the patients studied, mean estimates of countertransport were significantly lower during an episode than after remission, with low values occuring more frequently in mania than in depression in bipolar patients. The mean values in patients with affective disorders but who were in remission remained lower than those of control subjects. Lowest values occured more frequently in patients with bipolar than in those with unipolar illness. The possible physiological significance of reductions in the activity of the lithium-sodium countertransport mechanism in red cells was discussed.     

Hemispheric asymmetry in depression and mania. A longitudinal QEEG study in bipolar disorder.

BACKGROUND: previous research has been inconclusive about the nature of hemispheric asymmetry in emotional processing. METHOD: 13 patients with DSM-IV bipolar disorder received repeated QEEGs over 2 years in different mood states. Z-score measures of asymmetry were assessed. RESULTS: asymmetry in frontotemporal slow-wave activity appeared to be in opposite directions in depression compared to mania/hypomania. CONCLUSIONS: mood change in bipolar disorder is associated with change in QEEG asymmetry. LIMITATIONS: study of larger numbers of more homogenous patients under similar conditions is needed. CLINICAL RELEVANCE: study of mood state-dependent asymmetry changes in bipolar disorder may lead to better understanding of hemispheric processing of emotion.     

Gender differences in rating stressful events, depression, and depressive cognition

Assessed gender differences in the ratings of stressful events, depression, and cognitive distortion. Responses of 70 males and 70 females (N = 140) to the Life Stress Questionnaire, the Beck Depression Inventory, and the Automatic Thought Questionnaire were studied. Statistical analyses revealed significant differences between sexes on all dependent measures. Men reported experiencing more stressful life change. However, women rated the impact of stressors more severely. Women had higher depression ratings, and men exhibited greater distortions in cognitive content. It is proposed that cognitive distortion may insulate men from depressive moods. Research on coping mechanisms used by men and women in dealing with similar stressful life events may be helpful in clarifying the relationship among gender, stress, and depression.