Autonomic response in the perception of disgust and happiness in depersonalization disorder

Patients with depersonalization disorder have shown attenuated responses to emotional unpleasant stimuli, hence supporting the view that depersonalization is characterised by a selective inhibition on the processing of unpleasant emotions. It was the purpose of this study to establish if autonomic responses to facial emotional expressions also show the same blunting effect. The skin conductance responses (SCRs) of 16 patients with chronic DSM-IV depersonalization disorder, 15 normal controls and 15 clinical controls with DSM-IV anxiety disorders were recorded in response to facial expressions of happiness and disgust. Patients with anxiety disorders were found to have greater autonomic responses than patients with depersonalization, in spite of the fact that both groups had similarly high levels of subjective anxiety as measured by anxiety scales. SCR to happy faces did not vary across groups. The findings of this study provide further support to the idea that patients with depersonalization have a selective impairment in the processing of threatening or unpleasant emotional stimuli.

Elevated amygdala activity to sad facial expressions:a state marker of bipolar but not unipolar depression

Background - Difficulties in emotion processing and poor social function are common to bipolar disorder (BD) and major depressive disorder (MDD) depression, resulting in many BD depressed individuals being misdiagnosed with MDD. The amygdala is a key region implicated in processing emotionally salient stimuli, including emotional facial expressions. It is unclear, however, whether abnormal amygdala activity during positive and negative emotion processing represents a persistent marker of BD regardless of illness phase or a state marker of depression common or specific to BD and MDD depression. Methods - Sixty adults were recruited: 15 depressed with BD type 1 (BDd), 15 depressed with recurrent MDD, 15 with BD in remission (BDr), diagnosed with DSM-IV and Structured Clinical Interview for DSM-IV Research Version criteria; and 15 healthy control subjects (HC). Groups were age- and gender ratio-matched; patient groups were matched for age of illness onset and illness duration; depressed groups were matched for depression severity. The BDd were taking more psychotropic medication than other patient groups. All individuals participated in three separate 3T neuroimaging event-related experiments, where they viewed mild and intense emotional and neutral faces of fear, happiness, or sadness from a standardized series. Results - The BDd—relative to HC, BDr, and MDD—showed elevated left amygdala activity to mild and neutral facial expressions in the sad (p < .009) but not other emotion experiments that was not associated with medication. There were no other significant between-group differences in amygdala activity. Conclusions - Abnormally elevated left amygdala activity to mild sad and neutral faces might be a depression-specific marker in BD but not MDD, suggesting different pathophysiologic processes for BD versus MDD depression.

Abnormally increased effective connectivity between parahippocampal gyrus and ventromedial prefrontal regions during emotion labeling in bipolar disorder

Emotional liability and mood dysregulation characterize bipolar disorder (BD), yet no study has examined effective connectivity between parahippocampal gyrus and prefrontal cortical regions in ventromedial and dorsal/lateral neural systems subserving mood regulation in BD. Participants comprised 46 individuals (age range: 18-56 years): 21 with a DSM-IV diagnosis of BD, type I currently remitted; and 25 age- and gender-matched healthy controls (HC). Participants performed an event-related functional magnetic resonance imaging paradigm, viewing mild and intense happy and neutral faces. We employed dynamic causal modeling (DCM) to identify significant alterations in effective connectivity between BD and HC. Bayes model selection was used to determine the best model. The right parahippocampal gyrus (PHG) and right subgenual cingulate gyrus (sgCG) were included as representative regions of the ventromedial neural system. The right dorsolateral prefrontal cortex (DLPFC) region was included as representative of the dorsal/lateral neural system. Right PHG-sgCG effective connectivity was significantly greater in BD than HC, reflecting more rapid, forward PHG-sgCG signaling in BD than HC. There was no between-group difference in sgCG-DLPFC effective connectivity. In BD, abnormally increased right PHG-sgCG effective connectivity and reduced right PHG activity to emotional stimuli suggest a dysfunctional ventromedial neural system implicated in early stimulus appraisal, encoding and automatic regulation of emotion that may represent a pathophysiological functional neural mechanism for mood dysregulation in BD.

Elevated left and reduced right orbitomedial prefrontal fractional anisotropy in adults with bipolar disorder revealed by tract-based spatial statistics

Context - Diffusion tensor imaging (DTI) studies in adults with bipolar disorder (BD) indicate altered white matter (WM) in the orbitomedial prefrontal cortex (OMPFC), potentially underlying abnormal prefrontal corticolimbic connectivity and mood dysregulation in BD. Objective - To use tract-based spatial statistics (TBSS) to examine WM skeleton (ie, the most compact whole-brain WM) in subjects with BD vs healthy control subjects. Design - Cross-sectional, case-control, whole-brain DTI using TBSS. Setting - University research institute. Participants - Fifty-six individuals, 31 having a DSM-IV diagnosis of BD type I (mean age, 35.9 years [age range, 24-52 years]) and 25 controls (mean age, 29.5 years [age range, 19-52 years]). Main Outcome Measures - Fractional anisotropy (FA) longitudinal and radial diffusivities in subjects with BD vs controls (covarying for age) and their relationships with clinical and demographic variables. Results - Subjects with BD vs controls had significantly greater FA (t > 3.0, P = .05 corrected) in the left uncinate fasciculus (reduced radial diffusivity distally and increased longitudinal diffusivity centrally), left optic radiation (increased longitudinal diffusivity), and right anterothalamic radiation (no significant diffusivity change). Subjects with BD vs controls had significantly reduced FA (t > 3.0, P = .05 corrected) in the right uncinate fasciculus (greater radial diffusivity). Among subjects with BD, significant negative correlations (P < .01) were found between age and FA in bilateral uncinate fasciculi and in the right anterothalamic radiation, as well as between medication load and FA in the left optic radiation. Decreased FA (P < .01) was observed in the left optic radiation and in the right anterothalamic radiation among subjects with BD taking vs those not taking mood stabilizers, as well as in the left optic radiation among depressed vs remitted subjects with BD. Subjects having BD with vs without lifetime alcohol or other drug abuse had significantly decreased FA in the left uncinate fasciculus. Conclusions - To our knowledge, this is the first study to use TBSS to examine WM in subjects with BD. Subjects with BD vs controls showed greater WM FA in the left OMPFC that diminished with age and with alcohol or other drug abuse, as well as reduced WM FA in the right OMPFC. Mood stabilizers and depressed episode reduced WM FA in left-sided sensory visual processing regions among subjects with BD. Abnormal right vs left asymmetry in FA in OMPFC WM among subjects with BD, likely reflecting increased proportions of left-sided longitudinally aligned and right-sided obliquely aligned myelinated fibers, may represent a biologic mechanism for mood dysregulation in BD.

Health of entrepreneurs versus employees in a national representative sample

Prior research has found entrepreneurs to experience significantly higher job control and job demands compared with employees. This suggests that entrepreneurs have so-called active jobs and thus may benefit from positive health consequences. The present research compared entrepreneurs' health with employees' health in a national representative sample with regard to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnoses of somatic diseases, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of mental disorders, blood pressure, well-being (life-satisfaction) as well as behavioural health indicators (sick days, physician visits). Entrepreneurs showed significantly lower overall somatic and mental morbidity, lower blood pressure, lower prevalence rates of hypertension, and somatoform disorders, as well as higher well-being and more favourable behavioural health indicators. The results are discussed with regard to the active job hypothesis and recommendations for future research are provided.

Definitions and factors associated with subthreshold depressive conditions:a systematic review

BACKGROUND: Subthreshold depressive disorders (minor and subthrehold depression) have been defined in a wide range of forms, varying on the number of symptoms and duration required. Disability associated with these conditions has also been reported. Our aim was to review the different definitions and to determine factors associated with these conditions in order to clarify the nosological implications of these disorders. METHODS: A Medline search was conducted of the published literature between January 2001 and September 2011. Bibliographies of the retrieved papers were also analysed. RESULTS: There is a wide heterogeneity in the definition and diagnostic criteria of minor and subthreshold depression. Minor depression was defined according to DSM-IV criteria. Regarding subthreshold depression, also called subclinical depression or subsyndromal symptomatic depression, between 2 and 5 depressive symptoms were required for the diagnosis, and a minimum duration of 2 weeks. Significant impairment associated with subthreshold depressive conditions, as well as comorbidity with other mental disorders, has been described. CONCLUSIONS: Depression as a disorder is better explained as a spectrum rather than as a collection of discrete categories. Minor and subthreshold depression are common conditions and patients falling below the diagnostic threshold experience significant difficulties in functioning and a negative impact on their quality of life. Current diagnostic systems need to reexamine the thresholds for depressive disorders and distinguish them from ordinary feelings of sadness.

Group cognitive -behavioral therapy for heterogeneous anxiety disorders in children and adolescents: A multiple baseline study

This study investigated the efficacy of Group Cognitive-Behavioral Therapy (GCBT) in the treatment of heterogeneous anxiety disorders in children. A partially nonconcurrent multiple baseline across groups design was used to assess the effects of the treatment on 12 clinically referred children and adolescents between 6 and 16 years of age who met DSM-IV criteria for an anxiety disorder. Targeted diagnoses included Obsessive Compulsive Disorder, Simple Phobia, Separation Anxiety Disorder, Social Phobia, and Generalized Anxiety Disorder, with three of the children also presenting with school refusal behavior. Duration of baseline for each of the three groups varied and ran for one, two, or three weeks. Dependent measures included diagnostic status, child and parent-completed reports, and daily child and parent ratings of child anxiety severity. Results indicated that GCBT was efficacious in reducing anxious symptoms in children and adolescents treated in diagnostically heterogeneous groups, and that gains were generally maintained at 6 and 12 month follow-ups. Findings are discussed in terms of their theoretical and practical implications for the efficient treatment of children and adolescents with anxiety disorders. ^

Hispanic Adolescents With Severe Substance Abuse Issues: Parental Involvement, Acculturation-Related Factors and Attachment

The main objective of the study was to investigate the relationship between parent-related, acculturation-related, and substance use-related variables found within individual, familial/parental, peer and school adolescent ecological domains, in a clinical sample (i.e. adolescents who met criteria for a Diagnostic Statistical Manual-IV [DSM-IV] clinical diagnosis of substance abuse/dependence) of Hispanic adolescents from Miami, Florida. The sample for this study consisted of 94 adolescent-mother pairs. The adolescent sample was 65% male, and 35% female, with a mean age of 15 years. More than half of the adolescents were born in the United States (60%) and had resided in the U.S. for an average of 12 years; 80% of the caregivers (primarily mothers) were foreign-born and lived in the U.S. for an average of 21 years. Correlation and hierarchical regression were used to answer the research questions. The findings indicate that the hypothesized model and corresponding anticipated effect of the relationship between parental school and peer involvement on adolescents’ frequency of alcohol, marijuana and cocaine use was not supported by the data. Parental “acculturation-related” variables did not explain any of the variance in adolescent substance use frequency in this sample. Mediation and moderation models were not supported either. However, some interesting relationships were found: The larger the acculturation gap, the lower the parental involvement in school tended to be (r = -.21, p < .05). Adolescents who experienced a greater acculturation gap with their parents (-.81, p >.01) had an earlier onset of marijuana (-.33, p < .01) and cocaine use (r = -.24, p .05), they also reported using marijuana more frequently than females (.21, p >.05).

Efeito do topiramato sobre o craving em usuários de crack

The study aims to analyze the effects of topiramato on the craving of crack users. It is an open crossover clinical trial involving users from the Psychosocial Care Center for Alcohol and Drugs (CAPSad) in city of Parnamirim, RN, approved by the CEP CAAE: 38710614.1.0000.5537, respecting the norms of the resolution n. 466/2012/CNS. The study produced preliminary two scientific papers: a theoretical essay and an integrative review, as a way of seeking the state of art. The first paper was based in the theoretical framework of Hinds, Chaves and Cypress, which focuses different contexts, from the issues of individual use to the coping policies in Brazil, highlighting that the situation and the complexity of the phenome requires coping strategies for the full attention to the user, family and society. As a result of the integrative review, among the 902 retrieved records, eight of them presented therapeutic schemes with positive effects for the craving of cocaine. They used nine different drugs. It is important to spot out that there was no result for the craving of crack. The data collection was conducted from December 2014 to July 2015 and has as sample predominantly single males. The sample was composed of 30 subjects who met the inclusion criteria: adults, age from 18 years, diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for cocaine/crack; cognitive capacity preserved; attendance to the service, participated at least three visits in the 12 months prior to data collection; and accepted to be monitored in the proposed treatment. Data was analyzed using descriptive statistics from the Statistical Package of Support for Social Sciences (SPSS) on the instruments: 1) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), pointing out, among other results, that only 14% used crack/cocaine weekly during treatment, while 83% used daily or weekly after the washout period; 2) Barratt Impulsiveness Scale, with an average of 80.23 and 77.47 with and without drug treatment, respectively. An analysis from the Student t test show no significant differences in impulsivity with or without the drug; and 3) Cocaine-Craving Questionnaire-Brief (CCK-B), indicating that the number of users with craving intensity level is significantly higher without drug treatment (86%) than with treatment (33%). The analysis between craving and level of impulsivity showed that there is a low correlation (Pearson) between these two variables during treatment and after the washout, demonstrating that impulsivity has low influence on the outcome of drug therapy. As conclusion, it was noted that the topiramate produces positive effect on reducing the craving for crack users and their use is a relevant strategy for efficacy in the treatment of crack users.

Efeito do topiramato sobre o craving em usuários de crack

The study aims to analyze the effects of topiramato on the craving of crack users. It is an open crossover clinical trial involving users from the Psychosocial Care Center for Alcohol and Drugs (CAPSad) in city of Parnamirim, RN, approved by the CEP CAAE: 38710614.1.0000.5537, respecting the norms of the resolution n. 466/2012/CNS. The study produced preliminary two scientific papers: a theoretical essay and an integrative review, as a way of seeking the state of art. The first paper was based in the theoretical framework of Hinds, Chaves and Cypress, which focuses different contexts, from the issues of individual use to the coping policies in Brazil, highlighting that the situation and the complexity of the phenome requires coping strategies for the full attention to the user, family and society. As a result of the integrative review, among the 902 retrieved records, eight of them presented therapeutic schemes with positive effects for the craving of cocaine. They used nine different drugs. It is important to spot out that there was no result for the craving of crack. The data collection was conducted from December 2014 to July 2015 and has as sample predominantly single males. The sample was composed of 30 subjects who met the inclusion criteria: adults, age from 18 years, diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for cocaine/crack; cognitive capacity preserved; attendance to the service, participated at least three visits in the 12 months prior to data collection; and accepted to be monitored in the proposed treatment. Data was analyzed using descriptive statistics from the Statistical Package of Support for Social Sciences (SPSS) on the instruments: 1) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), pointing out, among other results, that only 14% used crack/cocaine weekly during treatment, while 83% used daily or weekly after the washout period; 2) Barratt Impulsiveness Scale, with an average of 80.23 and 77.47 with and without drug treatment, respectively. An analysis from the Student t test show no significant differences in impulsivity with or without the drug; and 3) Cocaine-Craving Questionnaire-Brief (CCK-B), indicating that the number of users with craving intensity level is significantly higher without drug treatment (86%) than with treatment (33%). The analysis between craving and level of impulsivity showed that there is a low correlation (Pearson) between these two variables during treatment and after the washout, demonstrating that impulsivity has low influence on the outcome of drug therapy. As conclusion, it was noted that the topiramate produces positive effect on reducing the craving for crack users and their use is a relevant strategy for efficacy in the treatment of crack users.

Household "ethnoscapes" and rite of passage: meaning and chronicity of the diagnosis in schizophrenia

Based on the results of an ethnographic study with people diagnosed with schizophrenia and their relatives in Barcelona and Tarragona along one year, I problematize the transformation of roles and relationships inside the household from the first burst and the assignation of a diagnosis as rite of passage. I appeal to a cultural interpretation of family, understanding the family group as a specific ethnoscape. I analyze the chronicity meaning, and its consequences in the conformation of the “role of sick person” in the context of parental relationships. I also discuss the paradoxes in terms of autonomy for the affected persons because of the projection of cultural connotation of chronicity.

Adverse Childhood Life Events and Postpartum Psychosis in Bipolar Disorder

Background Women with bipolar disorder are at increased risk of postpartum psychosis. Adverse childhood life events have been associated with depression in the postpartum period, but have been little studied in relation to postpartum psychosis. In this study we investigated whether adverse childhood life events are associated with postpartum psychosis in a large sample of women with bipolar I disorder. Methods Participants were 432 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.BDRN.org). Diagnoses and lifetime psychopathology, including perinatal episodes, were obtained via a semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry; Wing et al., 1990) and case-notes. Adverse childhood life events were assessed via self-report and case-notes, and compared between women with postpartum psychosis (n=208) and those without a lifetime history of perinatal mood episodes (n=224). Results There was no significant difference in the rate of any adverse childhood life event, including childhood sexual abuse, or in the total number of adverse childhood life events between women who experienced postpartum psychosis and those without a lifetime history of perinatal mood episodes, even after controlling for demographic and clinical differences between the groups. Limitations Adverse childhood life events were assessed in adulthood and therefore may be subject to recall errors. Conclusions We found no evidence for an association between adverse childhood life events and the occurrence of postpartum psychosis. Our data suggest that, unlike postpartum depression, childhood adversity does not play a significant role in the triggering of postpartum psychosis in women with bipolar disorder.

Comorbid Migraine in Major Depressive Disorder Suggests a Subgroup Related to Bipolar Disorder

Aims: Previous small-scale studies suggest presence of migraine in major depressive disorder (MDD) is associated with specific clinical characteristics that may overlap with those of bipolar disorder. We aimed to compare a broad range of characteristics in participants who have MDD with and without migraine, and to explore possible similarities between those characteristics associated with the presence of migraine in MDD and those in bipolar disorder in a large UK sample. Methods: Lifetime and episodic clinical characteristics and affective temperaments in DSM-IV MDD with (n=134) and without (n=218) migraine were compared. Characteristics associated with the presence of migraine were then compared with a sample of participants with DSM-IV bipolar disorder (n=407). All participants were recruited into the Bipolar Disorder Research Network (www.bdrn.org). Results: The presence of migraine in MDD was associated with female gender (76.9% vs 56.9%, p<0.001), younger age of onset (23 vs 27 years, p=0.002), history of attempted suicide (38.3% vs 22.7%, p=0.002), and more panic/agoraphobia symptomatology (6 vs 4, p<0.001). Female gender (OR=2.44, p=0.006) and younger age of onset (OR=0.97, p=0.013) remained significant in a multivariate model. These clinical characteristics were not significantly different to those of our participants with bipolar disorder. Conclusions: The presence of migraine in MDD delineates a subgroup of individuals with a more severe illness course. The clinical presentation of this subgroup more closely resembles that of bipolar disorder than that of MDD without migraine. The presence of migraine in major depression may be a marker of a specific subgroup that could be useful in future research.

History of Premenstrual Mood Change and Postpartum Episodes are Associated with Perimenopausal Episodes in Women with Bipolar Disorder

Background and Aims: Reproductive life events are potential triggers of mood episodes in women with bipolar disorder. We aimed to establish whether a history of premenstrual mood change and postpartum episodes are associated with perimenopausal episodes in women who have bipolar disorder. Methods: Participants were 339 post-menopausal women with DSM-IV bipolar disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). Women self-reported presence (N = 200) or absence (N = 139) of an illness episode during the perimenopausal period. History of premenstrual mood change was measured using the self-report Premenstrual Symptoms Screening Tool (PSST), and history of postpartum episodes was measured via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry, SCAN) and inspection of case-notes. Results: History of a postpartum episode within 6 months of delivery (OR = 2.13, p = 0.03) and history of moderate/severe premenstrual syndrome (OR = 6.33, p < 0.001) were significant predictors of the presence of a perimenopausal episode, even after controlling for demographic factors. When we narrowed the definition of premenstrual mood change to premenstrual dysphoric disorder, it remained significant (OR = 2.68, p = 0.007). Conclusions: Some women who have bipolar disorder may be particularly sensitive to reproductive life events. Previous mood episodes in relation to the female reproductive lifecycle may help clinicians predict individual risk for women with bipolar disorder approaching the menopause. There is a need for prospective longitudinal studies of women with bipolar disorder providing frequent contemporaneous ratings of their mood to overcome the limitations of retrospective self-report data.

Identifying Risk Factors for Postpartum Mood Episodes in Bipolar Disorder – A UK Prospective Study

Background and Aims: Women with bipolar disorder are vulnerable to episodes postpartum, but risk factors are poorly understood. We are exploring risk factors for postpartum mood episodes in women with bipolar disorder using a prospective longitudinal design. Methods: Pregnant women with lifetime DSM-IV bipolar disorder are being recruited into the Bipolar Disorder Research Network (www.BDRN.org). Baseline assessments during late pregnancy include lifetime psychopathology and potential risk factors for perinatal episodes such as medication use, sleep, obstetric factors, and psychosocial factors. Blood samples are taken for genetic analysis. Perinatal psychopathology is assessed via follow-up interview at 12-weeks postpartum. Interview data are supplemented by clinician questionnaires and case-note review. Potential risk factors will be compared between women who experience perinatal episodes and those who remain well. Results: 80 participants have been recruited to date. 32/61 (52%) women had a perinatal recurrence by follow-up. 16 (26%) had onset in pregnancy. 21 (34%) had postpartum onset, 19 (90%) within 6-weeks of delivery: 11 (18%) postpartum psychosis, 5 (8%) postpartum hypomania, 5 (8%) postpartum depression. Postpartum relapse was more frequent in women with bipolar-I than bipolar-II disorder (45% vs 17%). 62% women with postpartum relapse took prophylactic medication peripartum and almost all received care from secondary psychiatric services (95%). Conclusions: Rate of postpartum relapse is high, despite most women receiving specialist care and medication perinatally. A larger sample size will allow us to examine potential risk factors for postpartum episodes, which will assist in providing accurate and personalised advice to women with bipolar disorder who are considering pregnancy.