The Burden of Sleep/Wake Disorders: Excessive Daytime Sleepiness and Insomnia Project.

Excessive daytime sleepiness (EDS) and insomnia (IN) complaints represent the most common sleep/wake disorders. Currently, the specific needs of these patients and their relatives, as well as the overall socio-economic burden of IN and EDS remains widely unexplored. This pilot study to be carried out in Switzerland is a retro- and prospective, national, one-center cohort observational study for the systematic evaluation of the burden of EDS and IN and its evolution 12 months after the first assessment. Patient recruitment will be organized through 7-8 primary care providers (primary/general care practitioners and pharmacies). Primary outcomes are the prevalence of EDS/IN in the primary care setting and the association between EDS/IN with health-related quality of life (QOL) as assessed with the established instruments. Secondary outcomes are the association between EDS/IN with the presence of comorbidities, number of injuries/accidents, and number of sick/leave days for the subgroup of working subjects. Calculation of direct per-patient costs will be undertaken to analyze the economic implications of sleep/wake disorders, providing valuable insights into the financial burden experienced by affected individuals within the healthcare system. This research will provide information on the feasibility of such a study and inform on aspects of the QOL most associated with EDS/IN. Based on this pilot project, a European multicenter study on the burden of sleep/wake disorders will be conducted by the European Academy of Neurology.

Outcome predictors of post-COVID conditions in the European Academy of Neurology COVID-19 registry.

Several neurological manifestations are part of the post-COVID condition. We aimed to: (1) evaluate the 6-month outcome in the cohort of patients with neurological manifestations during the COVID-19 acute phase and surviving the infection, and find outcome predictors; (2) define the prevalence and type of neurological symptoms persistent at six months after the infection. Data source was an international registry of patients with COVID-19 infection and neurological symptoms, signs or diagnoses established by the European Academy of Neurology. Functional status at six-month follow-up was measured with the modified Rankin scale (mRS), and defined as: "stable/improved" if the mRS at six months was equal as or lower than the baseline score; "worse" if it was higher than the baseline score. By October 30, 2022, 1,003 lab-confirmed COVID-19 patients were followed up for a median of 6.5 months. Compared to their pre-morbid status, 522 patients (52%) were stable/improved, whereas 465 (46%) were worse (functional status missing for 16). Age, hospitalization, several pre-COVID-19 comorbidities, and COVID-19 general complications were predictors of a worse status. Amongst neurological manifestations, stroke carried the highest risk for worse outcome (OR 5.96), followed by hyperactive delirium (2.8), and peripheral neuropathies (2.37). On the other hand, hyposmia/hypogeusia (0.38), headache (0.40), myalgia (0.45), and COVID-19 vaccination (0.52) were predictors of a favourable prognosis. Persisting neurological symptoms or signs were reported by 316/1003 patients (31.5%), the commonest being fatigue (n = 133), and impaired memory or concentration (n = 103). Our study identified significant long-term prognostic predictors in patients with COVID-19 and neurological manifestations.

Comparative features and outcomes of major neurological complications of COVID-19.

BACKGROUND AND PURPOSE: The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations. METHODS: The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors. RESULTS: By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome. CONCLUSIONS: Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.

Short- and long-term outcome and predictors in an international cohort of patients with neuro-COVID-19.

BACKGROUND AND PURPOSE: Despite the increasing number of reports on the spectrum of neurological manifestations of COVID-19 (neuro-COVID), few studies have assessed short- and long-term outcome of the disease. METHODS: This is a cohort study enrolling adult patients with neuro-COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro-covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as 'stable/improved' if the modified Rankin Scale score was equal to or lower than the pre-morbid score, 'worse' if the score was higher than the pre-morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months. RESULTS: From July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non-hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow-up. CONCLUSIONS: Neuro-COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.

Comparative Efficacy and Tolerability of Antipsychotics for Juvenile Psychotic Disorders: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Psychotic disorders produce important morbidity and disability in children and adolescents. There have been few relevant treatment trials, encouraging assessment of research aimed at testing efficacy and safety of antipsychotics for juveniles. We aimed to compare the short- and long-term efficacy and safety of antipsychotics to treat psychotic disorders among children and adolescents. METHODS: Four major bibliographic databases (PubMed, MEDLINE, PsycINFO, and EMBASE) were searched for clinical trials of antipsychotics in children or adolescents, from database inception to May 2021. We searched for clinical trials comparing antipsychotics with control conditions for juvenile psychosis based on blinded review by 2 independent investigators (C.S.Y. and M.L.). We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and applied the Cochrane risk-of-bias tool to appraise study quality. One reviewer (A.B.) performed data abstraction which was confirmed by 2 independent, blinded reviewers (C.S.Y. and M.L.). Primary outcomes were scores rating psychosis symptoms and dichotomized retention in treatment protocols versus dropouts because of adverse events. Effect sizes were pooled using frequentist random-effects network meta-analysis modeling to generate summary rate ratios (RRs) and Cohen d standardized mean differences. RESULTS: Systematic searching generated 1330 unique records. Of these, short-term (n = 15, for 6 [3-12] weeks) and long-term (n = 10, for 12 [6-60] months) treatment trials involved 2208 (39.2% females; median age, 15.3 years), and 1366 subjects (35.0% females; median age, 15.6 years), respectively. Short-term reduction of psychosis scores ranked clozapine (d = -1.35; 95% confidence interval [CI], -1.97 to -0.73]), molindone (-1.22; 95% CI, -1.68 to -0.75), olanzapine (-1.12; 95% CI, -1.44 to -0.81), and risperidone (-0.93; 95% CI, -1.22 to -0.63) as the most effective agents. In longer-term treatment, only lurasidone was effective. Clozapine (RR, 12.8) and haloperidol (RR, 5.15) led to more all-cause and adverse event-related dropouts. There were few trials/drug (1 each for aripiprazole, asenapine, lurasidone, molindone, paliperidone, and ziprasidone, short term; aripiprazole, clozapine, haloperidol, lurasidone, and molindone, long-term). Heterogeneity and inconsistency were high, especially in long-term trials, without evidence of publication bias. CONCLUSIONS: Some antipsychotics were effective and tolerated short term, but longer-term evidence was very limited. The overall paucity of trials and of adequate controls indicates that more well-designed randomized controlled trials are required for adequate assessment of antipsychotic drug treatment for juveniles. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021232937.

Suicidal Risk and Affective Temperaments, Evaluated with the TEMPS-A Scale: A Systematic Review.

BACKGROUND: Among risk factors for suicidal behavior, there is growing interest in associations with stable affective temperament types, particularly based on assessment with the TEMPS-A self-rating scale. AIM: As research on this topic has not been reviewed systematically, we synthesized relevant, reported research findings. METHODS: Systematic searching identified peer-reviewed reports pertaining to associations of suicidal behavior or ideation with affective temperament types evaluated with TEMPS-A. We summarized available findings and applied quantitative meta-analytic methods to compare scale scores in suicidal versus nonsuicidal subjects. RESULTS: In 21 of 23 TEMPS-A studies meeting inclusion criteria, anxious, cyclothymic, depressive, or irritable temperament scores were significantly higher with previous or recent suicide attempts or ideation in both psychiatric and general population samples compared to nonsuicidal controls, whereas hyperthymic temperament scores were lower in 9 of 11 reports. These findings were synthesized by random-effects meta-analyses of standardized mean differences in TEMPS-A temperament scores in suicidal versus nonsuicidal subjects. Associations ranked: depressive ≥ irritable > cyclothymic > anxious > hyperthymic (negative). CONCLUSIONS: Affective temperaments, especially depressive and irritable, were strongly associated with suicidal risk, whereas hyperthymic temperament appeared to be protective.

Mixed symptoms in major depressive and bipolar disorders: A systematic review.

BACKGROUND: The DSM-5 mixed features specifier for mood disorders encourages renewed interest in mixed states and led us to pool research findings regarding prevalence of mixed features in episodes of major depressive (MDD) and bipolar disorders (BD). METHODS: We systematically searched to July 2017 for reports on mixed symptoms in depressive episodes of MDD and in depression and mania or hypomania in types I and II BD. For primary mood-states and diagnostic groups we compared rates of the presence of mixed symptoms: as defined by DSM-5 (≥3 features opposite to the dominant mood-polarity but not overlapping those of the primary disorder) or as having any ≥3 features of opposite polarity. RESULTS: We identified 17 reports, from 13 world regions involving 19,198 participants meeting standard diagnostic criteria for an index major depressive or [hypo]manic episode. Prevalence of cases with ≥3 features of opposite polarity averaged 27.8% [CI: 27.2-28.5] overall, and differed significantly between BD and MDD disorders, ranking: BD-depressed (35.2% [33.8-36.5]) = BD-[hypo]manic (35.1% [32.9-37.3]) > MDD-depressed (23.8% [23.0-24.5]). LIMITATIONS: Available findings were limited to mood disorders with mixed features by particular criteria, with few comparisons to other criteria or to their prognostic or therapeutic implications. CONCLUSIONS: Prevalence of ≥3 features of opposite polarity ranked: depressive = [hypo]manic episodes of BD > depression in MDD.

Perfiles fenomenológicos de evocación autobiográfica en individuos con depresión / Perfis fenomenológicos da evocação autobiográfica em indivíduos com depressão

Los recuerdos autobiográficos se encuentran en íntima relación con los procesos de regulación emocional y con la concepción del sí mismo. Por otro lado, el acceso a los componentes fenomenológicos específicos se vería disminuido de ocurrir alteraciones afectivas. Se llevó a cabo un muestro no probabilístico intencional de 94 individuos con depresión mayor y de 188 individuos sanos de la ciudad de Buenos Aires, Argentina. Fueron comparados los componentes fenomenológicos de los recuerdos autobiográficos significativos en cuanto a su cantidad e intensidad. Asimismo, se comparó el rendimiento dentro del grupo depresivo, de acuerdo a la presencia o ausencia de episodios depresivos previos, tratamiento psicofarmacológico y severidad sintomatológica. Se encontraron diferencias significativas en la Cantidad e Intensidad Total de los componentes fenomenológicos evocados, presentando el grupo clínico una evocación reducida (p<.001). Las dimensiones Valencia, Imaginería Visual, Sensorialidad, Intersubjetividad y Claridad también presentaron diferencias significativas. No se encontraron diferencias al realizar los análisis secundarios de acuerdo a las variables clínicas. Los individuos con depresión manifestaron un patrón distintivo de evocación fenomenológica de sus recuerdos en comparación a individuos sanos. Considerar las modalidades fenomenológicas de evocación autobiográfica a la luz de los modelos cognitivos en Mindfulness e Imaginería posee implicancias clínicas de relevancia.(AU)

Os registos autobiográficos encontram-se em relação íntima com os procesoss de regulação emocional e com a concepção de si mesmo. Por outro lado, os procesos de acesso aos componentes fenomenológicos específicos estariam alterados durante a ocorrência de alterações afetivas. A amostra não probabilística intencional foi constituída por 94 indivíduos com depressão maior e 188 indivíduos sãos, provenientes da cidade de Buenos Aires, Argentina. Foram comparados os componentes fenomenológicos das memorias autobiográficas significativas quanto à sua quantidade e intensidade. Ao mesmo tempo, comparou-se o rendimento do grupo depressivo de acordo com a presença ou ausência de episódios depressivos prévios, tratamento psicofarmacológico e severidade dos sintomas. Encontraram-se diferenças significativas na Quantidade e Intensidade Totais dos componentes fenomenológicos evocados, apresentando o grupo clínico uma evocação reduzida (p<0,001). Ao mesmo tempo, as dimensões Valencia, Imagem Visual, Sensorialidade, Intersubjetividade e Claridade também apresentaram diferenças significativas. Contudo, não se encontraram diferenças significativas ao realizar as análises secundárias de acordo com as variáveis clínicas. Os individuos com depressão mostraram um padrão distintivo de evocação fenomenológica de suas memórias em comparação com os controles. Considerar as modalidades fenomenológicas de evocação autobiográfica à luz dos modelos cognitivos em Mindfulness e Imagem tem implicações clínicas relevantes.(AU)

Perfiles fenomenológicos de evocación autobiográfica en individuos con depresión / Phenomenological profiles of autobiographical memories in individuals with depression / Perfis fenomenológicos da evocação autobiográfica em indivíduos com depressão

Los recuerdos autobiográficos se encuentran en íntima relación con los procesos de regulación emocional y con la concepción del sí mismo. Por otro lado, el acceso a los componentes fenomenológicos específicos se vería disminuido de ocurrir alteraciones afectivas. Se llevó a cabo un muestro no probabilístico intencional de 94 individuos con depresión mayor y de 188 individuos sanos de la ciudad de Buenos Aires, Argentina. Fueron comparados los componentes fenomenológicos de los recuerdos autobiográficos significativos en cuanto a su cantidad e intensidad. Asimismo, se comparó el rendimiento dentro del grupo depresivo, de acuerdo a la presencia o ausencia de episodios depresivos previos, tratamiento psicofarmacológico y severidad sintomatológica. Se encontraron diferencias significativas en la Cantidad e Intensidad Total de los componentes fenomenológicos evocados, presentando el grupo clínico una evocación reducida (p<.001). Las dimensiones Valencia, Imaginería Visual, Sensorialidad, Intersubjetividad y Claridad también presentaron diferencias significativas. No se encontraron diferencias al realizar los análisis secundarios de acuerdo a las variables clínicas. Los individuos con depresión manifestaron un patrón distintivo de evocación fenomenológica de sus recuerdos en comparación a individuos sanos. Considerar las modalidades fenomenológicas de evocación autobiográfica a la luz de los modelos cognitivos en Mindfulness e Imaginería posee implicancias clínicas de relevancia.

Autobiographical memories are deeply linked with emotional regulation processes and self-concept. Conversely, in case of affective disorders, the access to specific phenomenological components would be impaired. Intentional non-probabilistic sampling was carried out, involving 94 individuals with major depression and 188 healthy individuals in the city of Buenos Aires, Argentina. The phenomenological components of significant autobiographical recollections were contrasted, considering their quantity and intensity. In addition, the depressive individuals' performances were compared according to the presence or absence of previous depressive episodes, psychopharmacological treatment and severity of symptoms. Statistically significant differences were found in the total amount and intensity of the recalled phenomenological components, in which the clinical group presented reduced memory (p< .001). Besides, the dimensions: Valence, Visual Imagery, Sensoriality, Inter-subjectivity and Clarity also presented significant differences. Notwithstanding, non-significant differences were observed during the secondary analysis in relation to the clinical variables. Individuals with depression showed a distinctive phenomenological memory pattern in comparison to controls. Considering phenomenological memory modalities in the light of cognitive models of Mindfulness and Imagery entails relevant clinical implications.

Os registos autobiográficos encontram-se em relação íntima com os procesoss de regulação emocional e com a concepção de si mesmo. Por outro lado, os procesos de acesso aos componentes fenomenológicos específicos estariam alterados durante a ocorrência de alterações afetivas. A amostra não probabilística intencional foi constituída por 94 indivíduos com depressão maior e 188 indivíduos sãos, provenientes da cidade de Buenos Aires, Argentina. Foram comparados os componentes fenomenológicos das memorias autobiográficas significativas quanto à sua quantidade e intensidade. Ao mesmo tempo, comparou-se o rendimento do grupo depressivo de acordo com a presença ou ausência de episódios depressivos prévios, tratamento psicofarmacológico e severidade dos sintomas. Encontraram-se diferenças significativas na Quantidade e Intensidade Totais dos componentes fenomenológicos evocados, apresentando o grupo clínico uma evocação reduzida (p<0,001). Ao mesmo tempo, as dimensões Valencia, Imagem Visual, Sensorialidade, Intersubjetividade e Claridade também apresentaram diferenças significativas. Contudo, não se encontraram diferenças significativas ao realizar as análises secundárias de acordo com as variáveis clínicas. Os individuos com depressão mostraram um padrão distintivo de evocação fenomenológica de suas memórias em comparação com os controles. Considerar as modalidades fenomenológicas de evocação autobiográfica à luz dos modelos cognitivos em Mindfulness e Imagem tem implicações clínicas relevantes.

Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II.

Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains.

[Evaluation of Significant Autobiographical Memories Scale: Design and structural validation at an exploratory level]. / Escala de Evaluación de Recuerdos Autobiográficos Significativos: diseno y validación estructural a nivel exploratorio.

Personal memories are multimodal cognitive representations. Nowadays, psychometric instruments which aim to assess signifcant memories phenomenological features are scarce. Consequently, the Evaluation of Signifcant Autobiographical Memories Scale was constructed and structural validated at an exploratory level. A total of 404 individuals from Buenos Aires city (Argentina) participated in the research. Initially, an expert judgment and a pilot study administration were carried out. Next, a homogeneity and a principal components analysis were implemented. To assess the scale reliability, Cronbach's alphas coefficients were analyzed. The fnal version has 30 Likert response items gathered in 8 dimensions. Satisfactory psychometric proprieties were obtained - internal consistency of .892 and a total explained variance of 65.78%. The scale provides two main scores regarding the total quantity and intensity of the phenomenological components as well as a partial score per each dimension. It is stated that the test will prove to be useful in the research feld as well as in the clinical area.

[Neuroprogression and cognition in Bipolar Disorders: A systematic review of cognitive performance in euthymic patients]. / Neuroprogresión y cognición en los trastornos bipolares: una revisión sistemática del rendimiento cognitivo en pacientes eutímicos.

In recent years, investigators have begun to consider the possibility of explaining the physiopathology of bipolar disorder from a neuroprogressive perspective. The evidence that supports the feasibility of such an approach is varied, and arises from neuroimaging studies, batteries of neurocognitive evaluations, and tests to identify the specific biomarkers of the disorder. The present article seeks to perform a review of the research that investigates the cognitive deficits in bipolar disorder. A bibliographic revision was performed of articles published between 1990 and 2015. Levels of cognitive performance were explored in both cross-sectional and longitudinal studies. The compiled studies signal the presence of altered cognitive function, even during periods of euthymia. However, there are contradictory results as to whether bipolar disorder presents a degenerative course. New lines of investigation suggest that only a percentage of individuals with bipolar disorder are affected in a progressive manner. It is of paramount importance to perform new longitudinal studies in high-risk populations, so as to validate or refute a neuroprogressive model of cognitive deficits in patients with bipolar disorder.

Recurrence rates in bipolar disorder: Systematic comparison of long-term prospective, naturalistic studies versus randomized controlled trials.

Bipolar disorder (BD) is a recurrent, lifelong illness with high risks of disability and excess mortality. Despite many treatment options with demonstrated short-term efficacy, evidence concerning long-term treatment effectiveness in BD remains limited and the relative value of naturalistic studies versus randomized, controlled trials (RCTs) in its assessment, uncertain. Systematic computer-searching yielded 10 naturalistic studies and 15 RCTs suitable for analysis of recurrence rates and their association with treatments and selected clinical factors. In naturalistic studies (3904 BD subjects, 53.3% women, 85.8% BD-I, mean onset age 29.1, followed up to 2.1 years), the pooled recurrence rate was 55.2% (26.3%/year). In RCTs (4828 subjects, 50.9% women, 96.0% BD-I, mean onset age 23.1, followed up to 1.9 years), the pooled recurrence rate was 39.3% (21.9%/year) with mood-stabilizing drug-treatment versus 60.6% (31.3%/year) with placebo; drug-versus-placebo outcomes favored antipsychotics over lithium, and disfavor an approved anticonvulsant. Depressive episode-polarity increased from 27.7% at intake to 52.0% at first-recurrence (p<0.0001). Recurrence rate (%/year) did not differ by study-type, was greater with younger onset and rapid-cycling, and paradoxically declined with longer observation. In short, recurrences of major affective episodes up to two years during putative mood-stabilizing treatment of BD patients in prospective, naturalistic studies and RCTs were substantial and similar (26.3 vs. 21.9%/year). Episode-polarity shifted strongly toward depressive first-recurrences. These findings support the value of naturalistic studies to complement long-term RCTs, and add to indications that control of depression in BD remains particularly unsatisfactory.

Clinical characteristics of bipolar disorder: a comparative study between Argentina and the United States.

BACKGROUND: Bipolar disorder presents with diverse clinical manifestations. Numerous investigators have sought to identify variables that may predict a more severe illness course. METHODS: With the objective of studying the clinical characteristics of bipolar patients between South and North America, a comparison was performed between a sample from Argentina (n = 449) and a sample from the United States (n = 503) with respect to demographics and clinical characteristics, including presence of comorbidities. RESULTS: The Argentinian sample had more unfavorable demographics and higher rates of prior psychiatric hospitalization and prior suicide attempt but a better social outcome. However, the sample from the United States had a higher rate of prior year rapid cycling, as well as younger bipolar disorder onset age (mean ± SD, 17.9 ± 8.4 vs. 27.1 ± 11.4 years) and more severe clinical morbidity, though there was no significant difference in terms of the total duration of the illness. Argentinian compared to American patients were taking more mood stabilizers and benzodiazepines/hypnotics, but fewer antipsychotics and other psychotropic medications, when considering patients in aggregate as well as when stratifying by illness subtype (bipolar I versus bipolar II) and by illness onset age (≤21 vs. >21 years). However, there was no significant difference in rate of antidepressant prescription between the two samples considered in aggregate. CONCLUSIONS: Although possessing similar illness durations, these samples presented significant clinical differences and distinctive prescription patterns. Thus, though the Argentinian compared to North American patients had more unfavorable demographics, they presented a better social outcome and, in several substantive ways, more favorable illness characteristics. In both samples, early onset (age ≤ 21 years) was a marker for poor prognosis throughout the illness course, although this phenomenon appeared more robust in North America.

Affective temperaments in tango dancers.

BACKGROUND: Links between affective temperaments and folk culture have been infrequently explored systematically. Creativity and personality and temperament studies, conversely, have reported several associations. Tango is one of the most typical Argentinean folk dance-musical repertoires. The main purpose of this study is to compare affective temperaments between Argentinean professional tango dancers and the general population. METHODS: TEMPS-A was administered to a sample of 63 professional tango dancers and 63 comparison subjects from the general population who did not practice tango. Subscale median scores and total median scores with non-parametric statistics were analyzed. RESULTS: Median scores on hyperthymic subscale (p ≤ 0.001), irritable subscale (p=0.05) and total median score were significantly higher among tango dancers compared to controls (p ≤ 0.001). LIMITATIONS: Self-report measures were used. A larger sample size would have provided greater statistical power for data analysis. Besides, the naturalistic study design did not allow controlling for other clinical variables and limited the generalization of results to broader populations. CONCLUSIONS: Our data adds new evidence for the hypothesis that artistic performance is related to one's temperament. Tango passionata, which has both melancholic and vigorous (including "upbeat") features, seems to impart tango dancers' hyperthymic and irritable temperament features. Our study supports the increasing literature on the validity of utilizing temperament as a sub-affective traits in relation to artistic creativity and performing arts.

Theory of mind and functionality in bipolar patients with symptomatic remission.

INTRODUCTION: Functional deficits are commonly observed in bipolar disorder after symptomatic remission. Social cognition deficits have also been reported, which could contribute to dysfunction in patients with bipolar disorder in remission. MATERIAL AND METHODS: Twelve bipolar disorder patients in symptomatic remission (7 patients with bipolar disorder type I and 5 with bipolar disorder type II) and 12 healthy controls completed the Reading the Mind in the Eyes Test and the Faux Pas Test to evaluate theory of mind (ToM). Both groups also completed the Functional Assessment Short Test (FAST). RESULTS: The performance of the bipolar patients in the cognitive component of ToM was below normal, although the difference between the control group was not statistically significant (P=.078), with a trend to a worse performance associated with a higher number of depressive episodes (P=.082). There were no statistically significant differences between groups for the emotional component of ToM. Global functionality was significantly lower in bipolar patients compared to the control group (P=.001). Significant differences were also observed between both groups in five of the six dimensions of functionality assessed. No significant correlation was found between functionality and theory of mind. CONCLUSIONS: Bipolar patients in symptomatic remission exhibit impairments in several areas of functioning. Cognitive ToM appears more affected than emotional ToM. Deficits in ToM were not related to functional impairment.

Psychosocial interventions in bipolar disorder: a review.

INTRODUCTION: Multiple psychosocial interventions for bipolar disorder have been proposed in recent years. Therefore, we consider that a critical review of empirically validated models would be useful. METHODS: A review of the literature was conducted in Medline/PubMed for articles published during 2000-2010 that respond to the combination of "bipolar disorder" with the following key words: "psychosocial intervention", "psychoeducational intervention" and "psychotherapy". RESULTS: Cognitive-behavioral, psychoeducational, systematic care models, interpersonal and family therapy interventions were found to be empirically validated. All of them reported significant improvements in therapeutic adherence and in the patients' functionality. CONCLUSIONS: Although there are currently several validated psychosocial interventions for treating bipolar disorder, their efficacy needs to be specified in relation to more precise variables such as clinical type, comorbid disorders, stages or duration of the disease. Taking into account these clinical features would enable a proper selection of the most adequate intervention according to the patient's specific characteristics.

Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients.

Early onset in bipolar disorder (BPD) has been associated with greater familial risk and unfavorable clinical outcomes. We pooled data from seven international centers to analyze the relationships of family history and symptomatic as well as functional measures of adult morbidity to onset age, or onset in childhood (age <12), adolescence (12-18), or adulthood (19-55 years). In 1,665 adult, DSM-IV BPD-I patients, onset was 5% in childhood, 28% in adolescence, and 53% at peak ages 15-25. Adolescent and adult onset did not differ by symptomatic morbidity (episodes/year, percentage of months ill, co-morbidity, hospitalization, suicide attempts) or family history. Indications of favorable adult functional outcomes (employment, living independently, marriage and children, and a composite measure including education) ranked, by onset: adult > adolescent > child. Onset in childhood versus adolescence had more episodes/year and more psychiatric co-morbidity. Family history was most prevalent with childhood onset, similar over onset ages 12-40 years, and fell sharply thereafter. Multivariate modeling sustained the impression that family history and poor functional, but not symptomatic, outcomes were associated with younger, especially childhood onset. Early onset was more related to poor functional outcomes than greater symptomatic morbidity, with least favorable outcomes and greater family history with childhood onset.

[Screening for symptoms of depression during postpartum and the long term follow up: temporal stability and associated factors]. / Detección de síntomas depresivos durante el postparto inmediato y el seguimiento a largo plazo: estabilidad temporal y factores asociados.

AIMS: To describe the frequency of depressive symptoms compatible with a postpartum depression diagnosis, the associated factors and the temporal stability. METHODS: During 2006-2007 398 hospitalized puerperal women who attended CEMIC were interviewed 5 days after childbirth using the Edinburgh Postnatal Depression Scale and a socio-demographic questionnaire. A logistic regression analysis was performed to identify associated factors with a positive screening. During the following 6-12 months a follow up was carried with two groups of similar characteristics. RESULTS: The frequency of depressive symptoms at post partum was 17.8% (cut off = 10). Depressive history and neonatal intensive care were significantly related to a positive screening. From the 110 interviewed women, 24 were positive in the follow-up. CONCLUSION: The prevalence of risk for postpartum depression in the sample of patients surveyed is within the parameters reported in international literature. At the 6 month follow up, 6 previously asymptomatic women during the first screening turned on positive. It is theorize the existence of potential postpartum depression cases that can manifest up to a year after childbirth.

Depression: point-prevalence and sociodemographic correlates in a Buenos Aires community sample.

BACKGROUND: Since the current epidemiology of depression is not well documented in Latin America, we conducted a community-based survey study in Argentina. METHODS: The Beck Depression Inventory (BDI) and a general health questionnaire were completed by 1335 adult participants, representing most of the neighborhoods of Buenos Aires. RESULTS: Prevalence of high total BDI scores (≥13) indicating probable current clinically significant depression was 20.0% (women: 20.6%; men: 19.6%). Probable depression was associated with being unmarried and older, less educated, reporting recent stressors and significant medical illness. LIMITATIONS: Sampling was cross-sectional and by convenience; probable depression was not verified by clinical assessment. CONCLUSIONS: Within methodological limits, probable current clinically significant depression was highly prevalent in an urban community sample in Argentina, at rates and with risk factors similar to those found in other world regions.