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Bipolar depression: the importance of being on remission
Gazalle, Fernando Kratz;Andreazza, Ana Cristina;Hallal, Pedro Curi;Kauer-Sant'Anna, Márcia;Ceresér, Keila Maria;Soares, Jair C;Santin, Aida;Kapczinski, Flávio;
Revista Brasileira de Psiquiatria , 2006, DOI: 10.1590/S1516-44462006000200004
Abstract: objective: the aim of the present study is to compare quality of life among currently depressed, subsyndromal and remitted patients with bipolar disorder (bd) and to assess whether the level of depression correlates with the scores of quality of life in bd patients. method: sixty bipolar outpatients diagnosed using the structured clinical interview for dsm-iv who met criteria for diagnosis of bd type i, ii or not otherwise specified (bd-nos), and who were not currently on a manic or mixed episode were included. the main variables of interest were quality of life (qol) assessed using the 26-item world health organization qol instrument (whoqol-bref) and depression assessed using the 17-item hamilton depression rating scale (hdrs). results: a linear trend test showed a dose response association between patients' current mood state and all domains of quality of life. higher quality of life scores were found among remitted patients, followed by subsyndromal patients; depressed patients presented lower scores of quality of life, except for the social domain. the four domains of the whoqol scale correlated negatively with the hdrs. conclusions: our findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with qol in bd patients.
Depression vs. Dementia: A comparative analysis of neuropsychological functions  [PDF]
Ivana Leposavi?,Ljubica Leposavi?,Predrag Gavrilovi?
Psihologija , 2010,
Abstract: Previous studies concerned with neuropsychological aspect of depression, detected comparatively specific profile of cognitive deficiencies, including the disorders of attention, memory and executive functions. Although the classical depression is recognized as psuedodementia, or reversible dementia, these two entities frequently overlap in the elder population. Many patients who are at first depressive, become demented later, and the initial stages of dementia are not rarely accompanied with mood changes. The aim of this study is the establishing of differences between neuropsychological profiles of depression and dementia. The sample included three groups: the first group represented the patients with endogenous depression, the second – the patients with dementia, and the third one – healthy individuals. The participants have been tested by a neuropsychological battery. Two patient groups were tested during the stage of remission/adequate mood. Abilities most susceptible to depression are: attention, executive functions and memory. Cognitive flexibility and general cognitive ability are preserved in depressive patients. Depressive patients express cognitive disorders of moderate degree during the remission stage. Impairment pattern in the group of depressive patients does not indicate intellectual degradation of the dementia type. Neuropsychological deficiencies of the patients with endogenous depression suggest frontal limbic dysfunction. Еxcesses in cognitive functioning of demented patients are more serious and massive in comparison with cognitive difficulties in depressive patients.
Effects of erythropoietin on depressive symptoms and neurocognitive deficits in depression and bipolar disorder
Kamilla W Miskowiak, Maj Vinberg, Catherine J Harmer, Hannelore Ehrenreich, Gitte M Knudsen, Julian Macoveanu, Allan R Hansen, Olaf B Paulson, Hartwig R Siebner, Lars V Kessing
Trials , 2010, DOI: 10.1186/1745-6215-11-97
Abstract: The trial has a double-blind, placebo-controlled, parallel-group design. 40 patients with treatment-resistant major depression and 40 patients with bipolar disorder in remission are recruited and randomised to receive weekly infusions of Epo (Eprex; 40,000 IU) or saline (NaCl 0.9%) for 8 weeks. Randomisation is stratified for age and gender. The primary outcome parameters for the two studies are: depression severity measured with the Hamilton Depression Rating Scale 17 items (HDRS-17) [1] in study 1 and, in study 2, verbal memory measured with the Rey Auditory Verbal Learning Test (RAVLT) [2,3]. With inclusion of 40 patients in each study we obtain 86% power to detect clinically relevant differences between intervention and placebo groups on these primary outcomes.The trial is approved by the Local Ethics Committee: H-C-2008-092, Danish Medicines Agency: 2612-4020, EudraCT: 2008-04857-14, Danish Data Agency: 2008-41-2711 and ClinicalTrials.gov: NCT 00916552.Depression and bipolar disorder are associated with neurodegenerative processes, reduced neuroplasticity and neuropsychological dysfunction, which often persist even after clinical remission. Current pharmacological treatment strategies have several limitations including a significant treatment-onset-response delay, only partial or no response in a large group of patients and limited effects on their cognitive deficits, which often persist into periods of remission [4-9]. These enduring cognitive impairments affect patients' psychosocial and occupational function, quality of life and prognosis [7,8,10,11]. Better treatment options are thus required to improve the onset of efficacy, address patients who are treatment resistant and remediate neurocognitive deficits. Converging evidence suggests that neural atrophy and reduced neuroplasticity are involved in depression and bipolar disorder, while restoration of synaptic plasticity may be an important mechanism of chronic antidepressant and mood stabilising drug trea
The study protocol of the Norwegian randomized controlled trial of electroconvulsive therapy in treatment resistant depression in bipolar disorder
Ute Kessler, Arne E Vaaler, Helle Sch?yen, Ketil J Oedegaard, Per Bergsholm, Ole A Andreassen, Ulrik F Malt, Gunnar Morken
BMC Psychiatry , 2010, DOI: 10.1186/1471-244x-10-16
Abstract: A prospective, randomised controlled, multi-centre six- week acute treatment trial with seven clinical assessments. Follow up visit at 26 weeks or until remission (max 52 weeks). A neuropsychological test battery designed to be sensitive to changes in cognitive function will be used. Setting: Nine study centres across Norway, all acute psychiatric departments. Sample: n = 132 patients, aged 18 and over, who fulfil criteria for treatment resistant depression in bipolar disorder, Montgomery ?sberg Depression Rating Scale Score of at least 25 at baseline. Intervention: Intervention group: 3 sessions per week for up to 6 weeks, total up to 18 sessions. Control group: algorithm-based pharmacological treatment as usual.This study is the first randomized controlled trial that aims to investigate whether electroconvulsive therapy is better than pharmacological treatment as usual in treatment resistant bipolar depression. Possible long lasting cognitive side effects will be evaluated. The study is investigator initiated, without support from industry.NCT00664976Bipolar disorder (BD) is a psychiatric disorder with a prevalence of 1.7 to 3.7 percent in the adult population [1], characterized by periods of severe affective symptoms with normal periods in between. BD often has an unfavourable outcome [2]. There are two subtypes, Bipolar I and Bipolar II, and depression is arguably a more important facet of both types [3,4]. Depressive episodes are more numerous, last longer, and most suicides occur during these periods [5].In contrast to the manic phases the treatment options for the depressive phases are poor. Antidepressants have small if any effect in bipolar depression [6], lithium is not very effective [7], there are a few antipsychotics with effect [8,9], but there are some indications for effect of mood stabilizers [10]. The mainstay of current specialist treatment in Norway is a combination of a mood stabilizer, antipsychotic and/or an SSRI or an SNRI. In the last few ye
Offspring of Patients with Bipolar Disorder Type I from the ‘Paisa' Population: Psychopathological and Neuropsychological Profile Hijos de pacientes con trastorno afectivo bipolar tipo I de una población paisa: perfil psicopatológico y neuropsicológico  [cached]
Juan David Palacio,Ana María Zapata-Barco,Daniel Camilo Aguirre-Acevedo,Santiago Estrada-Jaramillo
Revista Colombiana de Psiquiatría , 2011,
Abstract: Objective: To characterize the main psycho pathological findings and neuropsychological profiles in a group of offspring of parents with Bipolar Disorder of Antioquia-Colombian ancestry. Methods: 20 children of parents with bipolar disorder type I were assessed using the K-SADS-PL in order to establish their diagnosis according with DSM-IV-TR criteria. Neuropsychological assessment was done by using subtests of the "Evaluación Neuropsicológica Infantil (ENI)" and the abbreviated version of WISC III. Bipolar parents and biological co-parents were evaluated with the Diagnostic Interview for Genetic Studies (DIGS). Results: The most common psychiatric disorders found were separation anxiety disorder (35%), simple phobia (20%), attention deficit hyperactivity disorder (50%), and oppositional defiant disorder (20%). This group of offspring also presented subsyndromal anxiety and ADHD symptoms as a common psychopathological finding. None of the children assessed had bipolar disorder and only two cases presented major depressive disorder. However, subsyndromal symptoms for mania were found in a quarter of the sample. The main neuropsychological findings in the offspring were difficulties in memory evocation, memory recall, and long term memory. Conclusions: This group of children and adolescents of parents with BD type I from paisa population (Colombia) genetic isolate presents DSM-IV-TR diagnoses of anxiety and disruptive disorders and subsyndromal symptoms of several psychiatric disorders including BD. Some neuropsychological measures show low performance in memory and attention tests. Objetivo: Caracterizar los principales hallazgos psicopatológicos y los perfiles neuropsicológicos de un grupo de hijos de pacientes adultos con TAB de ascendencia antioque a. Métodos: 20 sujetos hijos de pacientes con TAB tipo I se evaluaron por medio de la entrevista diagnóstica K-SADS-LP para establecer sus diagnósticos según criterios del DSM-IV-TR. También se les aplicaron varias subpruebas de la Evaluación Neuropsicológica Infantil (ENI) y una versión abreviada de la Escala de Inteligencia para ni os WISC III. Los padres bipolares y los copadres biológicos fueron evaluados con la Entrevista Diagnóstica para Estudios Genéticos (DIGS). Resultados: Los trastornos psiquiátricos más frecuentes fueron los de ansiedad de separación (35%), fobia simple (20%), trastorno por déficit de atención con hiperactividad (50%) y trastorno oposicionista y desafiante (20%). Como un hallazgo psicopatológico frecuente, este grupo presentó, además, síntomas subsindromáticos de ansiedad y trast
Antidepressant Treatment for Acute Bipolar Depression: An Update  [PDF]
Ben H. Amit,Abraham Weizman
Depression Research and Treatment , 2012, DOI: 10.1155/2012/684725
Abstract: While studies in the past have focused more on treatment of the manic phase of bipolar disorder (BD), recent findings demonstrate the depressive phase to be at least as debilitating. However, in contrast to unipolar depression, depression in bipolar patients exhibits a varying response to antidepressants, raising questions regarding their efficacy and tolerability. Methods. We conducted a MEDLINE and Cochrane Collaboration Library search for papers published between 2005 and 2011 on the subject of antidepressant treatment of bipolar depression. Sixty-eight articles were included in the present review. Results. While a few studies did advocate the use of antidepressants, most well-controlled studies failed to show a robust effect of antidepressants in bipolar depression, regardless of antidepressant class or bipolar subtype. There was no significant increase in the rate of manic/hypomanic switch, especially with concurrent use of mood stabilizers. Prescribing guidelines published in recent years rely more on atypical antipsychotics, especially quetiapine, as a first-line therapy. Conclusions. Antidepressants probably have no substantial role in acute bipolar depression. However, in light of conflicting results between studies, more well-designed trials are warranted. 1. Introduction Bipolar disorder (BD) is a devastating illness, carrying an immense burden of both morbidity [1] and all-cause mortality [2], including high rates of completed suicide [3]. With a lifetime prevalence of 1.5–2% in Europe [4] and a similar prevalence in the USA [5], much attention has been drawn to assessing potential treatments for alleviating the symptoms of this condition, manic and depressive alike. However, while clinical focus in the past tended to be more on the manic phase of the disorder, recent findings illustrate the need to focus on effective treatment strategies for the depressive phase, for several reasons. First, observations of the natural course of BD show the considerable amount of time spent in the depressive phase compared to the manic phase (30% on average compared to 10% in bipolar 1 disorder) [6], leading to severe morbidity, including a marked occupational impairment [7]. Second, the depressive phase of BD is more prone to suicide [8]. Incomplete remission, with enduring subsyndromal depressive symptoms, has been demonstrated both to cause functional impairment [9] and increase the risk of relapse [10], emphasizing the importance of optimizing the treatment for the depressive phase of BD. Since their conception, antidepressants have been the mainstay of
Soft Bipolar Depression Progress in China  [PDF]
Weidong Jin
Open Journal of Depression (OJD) , 2015, DOI: 10.4236/ojd.2015.44006
Abstract: Object: To introduce soft bipolar progress in China. Methods: We introduced soft bipolar concept into Chinese psychiatry and some studies about soft bipolar had been carried out by Chinese psychiatrist according to our soft bipolar criteria. Results: These studies include as following: 1) the proportion of bipolar disorder with depressive episode for the first time; 2) unipolar depression and bipolar depression compared in psychopathology; 3) the difference in personality and temperament between unipolar and bipolar; 4) family history of bipolar disorder; 5) antidepressants and soft bipolar. All these were used for establishing Chinese advising diagnostic criteria of soft bipolar disorder. It indicated that concept of soft bipolar was not only receipted, but also studied. Conclusion: Some progress of soft bipolar in China has been done.
Quetiapine monotherapy for bipolar depression  [cached]
Michael E Thase
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Michael E ThaseDepartments of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; and the University of Pittsburgh Medical Center, Pittsburgh, PA, USAAbstract: Bipolar depression is more common, disabling, and difficult-to-treat than the manic and hypomanic phases that define bipolar disorder. Unlike the treatment of so-called “unipolar” depressions, antidepressants generally are not indicated as monotherapies for bipolar depressions and recent studies suggest that - even when used in combination with traditional mood stabilizers – antidepressants may have questionable value for bipolar depression. The current practice is that mood stabilizers are initiated first as monotherapies; however, the antidepressant efficacy of lithium and valproate is modest at best. Within this context the role of atypical antipsychotics is being evaluated. The combination of olanzapine and the antidepressant fluoxetine was the first treatment to receive regulatory approval in the US specifically for bipolar I depression. Quetiapine was the second medication to be approved for this indication, largely as the result of two pivotal trials known by the acronyms of BOLDER (BipOLar DEpRession) I and II. Both studies demonstrated that two doses of quetiapine (300 mg and 600 mg given once daily at bedtime) were significantly more effective than placebo, with no increased risk of patients switching into mania. Pooling the two studies, quetiapine was effective for both bipolar I and bipolar II depressions and for patients with (and without) a history of rapid cycling. The two doses were comparably effective in both studies. Although the efficacy of quetiapine monotherapy has been established, much additional research is necessary. Further studies are needed to more fully investigate dose-response relationships and comparing quetiapine monotherapy to other mood stabilizers (lithium, valproate, and lamotrigine) in bipolar depression, both singly and in combination. Head-to-head studies are needed comparing quetiapine to the olanzapine-fluoxetine combination. Longer-term studies are needed to confirm the persistence of response and to better gauge effects on metabolic profiles across months of therapy. A prospective study of patients specifically seeking treatment for rapid cycling and those with a history of treatment-emergent affective shifts also is needed. Despite the caveats, as treatment guidelines are revised to incorporate new data, the efficacy and tolerability of quetiapine mo
Poorer sustained attention in bipolar I than bipolar II disorder
Chian-Huei Kung, Sheng-Yu Lee, Yun-Hsuan Chang, Jo Wu, Shiou-Lan Chen, Shih-Heng Chen, Chun-Hsien Chu, I-Hui Lee, Tzung-Lieh Yeh, Yen-Kuang Yang, Ru-Band Lu
Annals of General Psychiatry , 2010, DOI: 10.1186/1744-859x-9-8
Abstract: In all, 51 interepisode BP patients (22 with BP I and 29 with BP II) and 20 healthy controls participated in this study. The severity of psychiatric symptoms was assessed by the 17-item Hamilton Depression Rating Scale and the Young Mania Rating Scale. All participants undertook Conners' Continuous Performance Test II (CPT-II) to evaluate sustained attention.After controlling for the severity of symptoms, age and years of education, BP I patients had a significantly longer reaction times (F(2,68) = 7.648, P = 0.001), worse detectability (d') values (F(2,68) = 6.313, P = 0.003) and more commission errors (F(2,68) = 6.182, P = 0.004) than BP II patients and healthy controls. BP II patients and controls scored significantly higher than BP I patients for d' (F = 6.313, P = 0.003). No significant difference was found among the three groups in omission errors and no significant correlations were observed between CPT-II performance and clinical characteristics in the three groups.These findings suggested that impairments in sustained attention might be more representative of BP I than BP II after controlling for the severity of symptoms, age, years of education and reaction time on the attentional test. A longitudinal follow-up study design with a larger sample size might be needed to provide more information on chronological sustained attention deficit in BP patients, and to illustrate clearer differentiations between the three groups.The prevalence of bipolar disorder (BP) is estimated at 3.5% to 6.4% of the general population [1,2], and 30% to 50% of those in remission will not achieve premorbid psychosocial function levels [3]. Accordingly, evidence has shown that poor functional outcome is highly associated with cognitive impairment, and may persist through the remission period [4].However, most previous studies only focused on type I bipolar disorder (BP I) with regard to neuropsychological aspects, mainly because type II bipolar disorder (BP II) was often underdiagn
Características neuropsicológicas del trastorno bipolar I Neuropsychological Characteristics of the Bipolar Disorder I.  [cached]
Mercedes Jiménez-Benítez,Sara Fernández,Ignacio Robles,Sonia Moreno-Másmela
Revista Colombiana de Psiquiatría , 2003,
Abstract: La neuropsicología es la disciplina que estudia la relación cerebro-mente-conducta por medio del analisis de la estructura y los procesos cerebrales que están en la base de las funciones psicológicas superiores como la conciencia, la atención, el aprendizaje, la memoria, el pensamiento, el lenguaje, la motivación y la afectividad. Las alteraciones neuropsicológicas en los pacientes con trastorno bipolar han sido poco evaluadas en comparación con otros trastornos psiquiátricos como la esquizofrenia. Sin embargo, se ha incrementado el interés por las implicaciones etiológicas, de tratamientos, de prevención y de pronóstico, como predictores de ajuste, competencia social y de calidad de vida en estos pacientes. En este artículo se pretende hacer una revisión de las investigaciones que se han realizado hasta la fecha, y que relacionan el trastorno bipolar con anormalidades neuropsicológicas. Se revisaron investigaciones realizadas en diferentes fases del trastorno, como manía, depresión o eutimia, así como estudios comparativos con pacientes esquizofrénicos, y además se discute la posible influencia de los psicofármacos. Neuropsychology is the discipline that studies the mind-brain-behavior relationship through the analysis of the brain structure and brain processes supporting superior psychological functions such as consciousness, attention, learning, memory, thought, motivation and affection. Neuropsychological disturbances on bipolar disorder patients have been poorly studied when compared to other psychiatric disorders like schizophrenia. However, increasing interest has developed due to it’s implications on the etiology, treatment, prevention, prognosis, adjustment predictors, social competence and quality of life of such patients. This article intends to review the research published relating bipolar disorder with neuropsychological abnormalities up to date. A review of research on different phases was done, including mania, depression or euthymia; comparative studies with schizophrenic patients and the likely influence of psychotropic medication are also discussed.
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