Relationships and attraction among individuals with autism spectrum disorder

This research investigated attraction among individuals with autism. We found that those with autism prefer partners who assist them to meet their social and cognitive needs. Partners of those with autism chose to trade-off emotional and social skills for other traits. Lastly, those with autism had lower self-perceived mate value.

Reliability of the mood disorder questionnaire : comparison with the structured clinical interview for the DSM-IV-TR in a population sample

Objective: The Mood Disorder Questionnaire (MDQ) is a widely used self-report screening instrument for the detection of bipolar disorder in clinical populations. The aim of the present study was therefore to investigate the reliability of this instrument.

Methods: Screening results using the MDQ were compared with results obtained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID) in a community-based sample of 1066 women. Trained personnel, who were blind to the results of the MDQ screen, conducted clinical interviews.

Results: Using the MDQ, 21 women screened positive for bipolar disorder, and using the SCID diagnoses, 24 women were confirmed with a diagnosis of bipolar disorder. Six women were detected on both instruments. Compared to the SCID, the sensitivity for the MDQ was 25%, specificity 99%, positive predictive value 28%, negative predictive value 98%, and a demonstrated kappa of 0.25. The MDQ failed to detect any of the 11 participants in the study with bipolar II disorder and missed seven of 13 participants with bipolar I disorder or bipolar not otherwise specified. Of the 21 women who screened positive using the MDQ, 19 had current or past psychopathologies other than bipolar disorder.

Conclusion: The MDQ has substantial limitations for detection of bipolar disorder, in particular bipolar II disorder, in non-clinical populations.

Obesity is associated with previous suicide attempts in bipolar disorder

Objective: There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder.

Methods: Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese.

Results: Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06–3.69, p = 0.03) as likely to have a history of suicide attempt(s).

Conclusion: Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.

Diet quality in bipolar disorder in a population-based sample of women

Background : Recent epidemiological evidence has indicated a role for diet quality in unipolar depressive illness. This study examined the association between diet quality and bipolar disorder (BD) in an epidemiological cohort of randomly selected, population-based women aged 20–93 years.

Methods : An a priori diet quality score was derived from food frequency questionnaire data, a factor analysis identified habitual dietary patterns and glycemic load was assessed. Mental health was assessed using the SCID-I/NP.

Results : BD was identified in 23 women and there were 691 participants with no history of psychopathology. Compared to those with no psychopathology, those with BD had a higher glycemic load (p = 0.06) and higher scores on a ‘western’ dietary factor (p = 0.03) and the ‘modern’ dietary factor (p = 0.02). For each standard deviation increase in a ‘western’ and ‘modern’ dietary pattern and glycemic load, the odds ratios for BD were increased (‘western’ OR = 1.88, 95% CI 1.33–2.65; ‘modern’ OR = 1.72, 95% CI 1.14–2.39; GL OR = 1.56, 95% CI 1.13–2.14). Conversely, a ‘traditional’ dietary pattern was associated with reduced odds for BD (OR = 0.53 95% CI 0.32–0.89) after adjustments for overall energy intake.

Limitations : The small sample size did not allow for multivariate analyses and the cross-sectional study design precludes any determinations regarding the direction of the relationships between diet quality and BD.

Conclusion : These data are largely concordant with results from dietary studies in unipolar depression. However, clinical recommendations cannot be made until the direction of the relationship between diet quality and BD is determined. Longitudinal studies are warranted.

Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women

Background Irritable bowel syndrome (IBS) is commonly regarded as a functional disorder, and is hypothesized to be associated with anxiety and depression. This evidence mainly rests on population-based studies utilising self-report screening instruments for psychopathology. Other studies applying structured clinical interviews are generally based on small clinical samples, which are vulnerable to biases. The extant evidence base for an association between IBS and psychopathology is hence not conclusive. The aim of this study was therefore to re-examine the hypothesis using population-based data and psychiatric morbidity established with a structured clinical interview.

Methods Data were derived from a population-based epidemiological study (n = 1077). Anxiety and mood disorders were established using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) and the General Health Questionnaire (GHQ-12). Current and lifetime IBS was self-reported. Hypertension and diabetes were employed as comparison groups as they are expected to be unrelated to mental health.

Results Current IBS (n = 69, 6.4%) was associated with an increased likelihood of current mood and/or anxiety disorders (OR = 2.62, 95%CI 1.49 - 4.60). Half the population reporting a lifetime IBS diagnosis also had a lifetime mood or anxiety disorder. Exploratory analyses demonstrated an increased prevalence of IBS across most common anxiety and mood disorders, the exception being bipolar disorder. The association with IBS and symptoms load (GHQ-12) followed a curved dose response pattern. In contrast, hypertension and diabetes were consistently unrelated to psychiatric morbidity.

Conclusions IBS is significantly associated with anxiety and mood disorders. This study provides indicative evidence for IBS as a disorder with a psychosomatic aspect.

Tobacco smoking as a risk factor for major depressive disorder : a population-based study

Background : Smoking is disproportionately prevalent among people with psychiatric illness.

Aims : To investigate smoking as a risk factor for major depressive disorder.

Method : A population-based sample of women was studied using case–control and retrospective cohort study designs. Exposure to smoking was self-reported, and major depressive disorder diagnosed using the Structured Clinical Interview for DSM–IV–TR (SCID–I/NP).

Results : Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder (age-adjusted odds ratio (OR)=1.46, 95% CI 1.03–2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers (>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developed de novo major depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI 1.02–3.69); this was not explained by physical activity or alcohol consumption.

Conclusions : Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.

Coping strategies and social support as predictors and mediators of eating disorder carer burden and psychological distress

Purpose Caring for someone with an eating disorder is associated with a high level of burden and psychological distress. While models for the prediction of carer burden have previously been investigated, these have typically neglected the role of coping strategies and social support. Thus, the current study will examine predictors of both carer burden and carer psychological distress in eating disorder carers. Further, the mediating roles of coping strategies and social support will be investigated.
Methods Fifty-six carers completed a self-report questionnaire assessing burden, psychological distress, needs, expressed emotion, coping strategies and social support.
Results Use of maladaptive coping strategies was a unique predictor of both burden and psychological distress. Further, maladaptive coping was a consistent mediator on the outcome of carer burden. Social support, however, did not significantly predict, or mediate, carer burden.
Conclusions Interventions focusing on teaching appropriate coping strategies would benefit carers.

Randomized placebo controlled trials of n-acetyl cysteine as adjunct therapy for schizophrenia and bipolar disorder

Glutathione is the principal antioxidant of the brain. There is evidence of oxidative stress, lowered brain glutathione and genetic linkage involve glutathione metabolic genes in schizophrenia and bipolar disorder. N-acetyl cysteine (NAC) is a safe, orally bioavailable, precursor of glutathione. NAC has been shown to reverse animal models of oxidative stress, and raises brain glutathione levels.

N-acetyl cysteine for depressive symptoms in bipolar disorder - a double blind, randomized, placebo-controlled trial

Background: Treatment-resistant subthreshold depression is a major problem in bipolar disorder. Both depression and bipolar disorderare complicated by glutathione depletion. We hypothesized that treatment with N-acetyl cysteine (NAC), a safe, orally bioavailable precursor of glutathione, may improve the depressive component of bipolar disorder.

Methods: A randomized, double-blind, multicenter, placebo-controlled study of individuals (n 75) with bipolar disorder in the maintenance phase treated with NAC (1 g twice daily) adjunctive to usual medication over 24 weeks, with a 4-week washout. The two primary outcomes were the Montgomery Asberg Depression Rating Scale (MADRS) and time to a mood episode. Secondary outcomes included the Bipolar Depression Rating Scale and 11 other ratings of clinical status, quality of life, and functioning.

Results: NAC treatment caused a significant improvement on the MADRS (least squares mean difference [95% confidence interval]: 8.05 [13.16, 2.95], p .002) a n d most secondary scales at end point. Benefit was evident by 8 weeks on the Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale and at 20 weeks on the MADRS. Improvements were lost after washout. There was no effect of NAC on time to a mood episode (log-rank test: p .968) and no significant between-group differences inadverse events. Effect sizes at end point were medium to high for improvements in MADRS and 9 of the 12 secondary readouts.

Conclusions: NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar  disorder.

A role for glutathione in the pathophysiology of bipolar disorder and schizophrenia? Animal models and relevance to clinical practice.

The tripeptide, glutathione (glutamylcysteinylglycine) is the primary endogenous free radical scavenger in the human body. When glutathione (GSH) levels are reduced there is an increased potential for cellular oxidative stress, characterised by an increase and accruement of reactive oxygen species (ROS). Oxidative stress has been implicated in the pathology of schizophrenia and bipolar disorder. This could partly be caused by alterations in dopaminergic and glutamatergic activity that are implicated in these illnesses. Glutamate and dopamine are highly redox reactive molecules and produce ROS during normal neurotransmission. Alterations to these neurotransmitter pathways may therefore increase the oxidative burden in the brain. Furthermore, mitochondrial dysfunction, as a source of oxidative stress, has been documented in both schizophrenia and bipolar disorder. The combination of altered neurotransmission and this mitochondrial dysfunction leading to oxidative damage may ultimately contribute to illness symptoms. Animal models have been established to investigate the involvement of glutathione depletion in aspects of schizophrenia and bipolar disorder to further characterise the role of oxidative stress in psychopathology. Stemming from preclinical evidence, clinical studies have recently shown antioxidant precursor treatment to be effective in schizophrenia and bipolar disorder, providing a novel clinical angle to augment often suboptimal conventional treatments.