The mood spectrum: improving the diagnosis of bipolar disorder

Although the distinction between bipolar and unipolar disorders served our field well in the early days of psychopharmacology, in clinical practice it is apparent that their phenotypes are only partially described by current diagnostic classification systems. A substantial body of evidence has accrued suggesting that clinical variability needs to be viewed in terms of a broad conceptualization of mood disorders and their common threshold or subthreshold comorbidity. The spectrum model provides a useful dimensional approach to psychopathology and is based on the assumption that early-onset and enduring symptoms shape the adult personality and establish a vulnerability to the subsequent development of Axis-I disorders. To obtain a clearer understanding of the depressive phenotype, it is pivotal that we increase our detection of hypomanic symptoms so that clinicians can better distinguish bipolar II disorder from unipolar depression. Diagnostic criteria sensitive to hypomanic symptoms have been identified that suggest bipolar II disorder is at least as prevalent as major depression. Moreover, the comorbidities of these illnesses are very different and alcoholism in particular appears to be a greater problem in bipolar II disorder than in unipolar depression. Structured clinical interviews and patient self-report questionnaires have also successfully identified the presence of hypomanic symptoms in patients with unipolar disorder and support the concept of a spectrum of bipolar illness. In conclusion, the importance of subthreshold syndromes should not be underestimated as failure to recognize bipolar spectrum disorder could delay treatment and worsen prognosis.     

Ergebnisse eines offenen und eines Doppelblindversuches von Nomifensin im Vergleich zu Imipramin

Zusammenfassung In einer offenen Studie wurden 20 Depressive mit täglich 50–100mg Nomifensin und in einem anschließenden Doppelblindversuch je 15 depressive Patienten mit 150 mg Nomifensin oder 150 mg Imipramin behandelt. Die Behandlung dauerte maximal 30 Tage. Beide Präparate wurden gut vertragen, vegetative Nebenwirkungen traten nur in geringerem Maße auf.Beide Substanzen haben eine gesicherte antidepressive Wirkung. Die Wirkungsprofile von Nomifensin und Imipramin lassen sich statistisch nicht voneinander unterscheiden. Bei der Analyse auf Symptomebene ist der Wirkungseintritt von Nomifensin schon am 10. Behandlungstag nachweisbar; am 20. Tag unterscheiden sich die Präparate kaum, und am 30. Tag deutet sich eine bessere Wirkung von Imipramin an; diese letzte Aussage wird aber durch die kleine Fallzahl in ihrer Bedeutung eingeschränkt. Beide Substanzen zeigen eine identische antidepressive Wirkung auf folgende AMP-Syndrome: apathisches Syndrom, somatisch-depressives Syndrom, gehemmt-depressives Syndrom, hypochondrisches Syndrom und psychoorganisches Syndrom. Der Wirkungseintritt ist gleich rasch und in der Regel nach 10 Behandlungstagen statistisch signifikant.Beide Substanzen dürfen als wirkungsvolle Antidepressiva bezeichnet werden.     

The zurich study

Summary A representative sample of 456 persons from the normal population aged 22 and 23 years was used to study the overlap of depression with anxiety disorders. The 1-year prevalence rate for major depression (DSM-III), minor depression, and anxiety disorder together was 16.4%. The observed cases of major depression cooccurred in 36% with anxiety disorder, the cases with minor depression in 60%. On the level of symptoms assessed by a semistructured clinical interview and on the level of self-assessed items of the symptom check list SCL-90, the overlap was even greater. The main finding was that subjects with both diagnoses, depression and anxiety disorder, were more severely affected in general. Discriminant analyses of the SCL-90 scales together with the qualitative distribution of SCL items characterizing depression, anxiety, or phobia, did not disprove the hypothesis of a continuum.Project supported by grants 3.804.76 and 3.956.80 from the Swiss National Science Foundation     

Recovery from depression: risk or reality?

Depression is a serious condition associated with a high rate of recurrence in all populations of depressed patients. Research studies in the past have focused more on the criteria for onset of depressive disorder than on consistent criteria for outcome. However, the issue of concern to the patient is whether their depression is a lifelong condition or a condition from which they can reasonably expect to make a complete recovery. The issues surrounding recovery from depression are reviewed in the following article. The lifetime prognosis of depression is examined with reference to the Zurich follow-up study, and outcome criteria and the importance of assessing recovery in terms of quality of life as well as symptomatic improvement are considered. The relevance of clinical trial results to the clinical management of depression is also addressed.     

The Zurich study —A prospective epidemiological study of depressive,neurotic and psychosomatic syndromes

Summary The purpose and methodology of a 4-year longitudinal study based on a cohort aged 20 years are presented. A two-stage procedure was chosen; in 1978, 2201 males and 2346 females, aged 19–20, were examined. This sample was representative of the respective age group in the Canton of Zurich. From high and low-scorers (SCL-90), 292 males and 299 females were randomly selected for interview and for a prospective study. Subsequent investigations were carried out by questionnaires and by a personal interview. The instruments chiefly consisted of a semi-structured interview (SPIKE), a clinical syndrome list (SL), a90-item symptom checklist (SCL-90R), a life-event-inventory, scales measuring coping behavior and dissimulation, and an extensive sociological interview dealing with sociodemographic characteristics and social adjustment.This paper gives an account of the methodological aspects of the study.Project supported by grants 3.804.76 and 3.956.80 from the Swiss National Science Foundation     

Onset of action of escitalopram compared with other antidepressants: results of a pooled analysis

In general, antidepressant drugs are regarded as too slow acting. Most patients who benefit from treatment require more than 2 weeks of therapy to respond to treatment. An efficacious and well-tolerated antidepressant drug with an earlier onset of effect would be of greater interest to clinicians and patients. To study the onset of effect of escitalopram, a selective serotonin reuptake inhibitor (SSRI), data were pooled from controlled randomized clinical double-blind trials comparing this drug with other antidepressant drugs (SSRIs and venlafaxine XR) in major depressive disorder (MDD), with assessments of the primary efficacy parameter [mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) total score from baseline, using last observation carried forward]. The mean change in MADRS total scores was significantly higher for escitalopram-treated patients than for patients treated with the comparators on day 7 (-3.9 versus -3.4, respectively, P = 0.029). This difference remained significant and in favour of escitalopram at all subsequent assessments. Using secondary outcomes (Clinical Global Impression of Improvement and Severity scales and early improvement), the results consistently showed a statistically significantly faster onset of effect of escitalopram compared to other antidepressants. In conclusion, by using the MADRS scale and pooling data from the escitalopram clinical trials in MDD comparing escitalopram with other active antidepressant drugs, escitalopram was shown to be a fast-acting antidepressant with a more rapid onset of effect than the comparators, particularly other SSRIs.     

Die Psychiatrie des Diabetes insipidus

Ohne Zusammenfassung