A biopsychosocial model of interferon-alpha-induced depression in patients with chronic hepatitis C infection.

BACKGROUND: The aim of this prospective study was to gain a more comprehensive picture of the biopsychosocial effects of interferon-α (IFN-α) treatment of patients with chronic hepatitis C (HCV). The predictors of depressive development and changes in health-related quality of life, life satisfaction and cognitive ability were measured with the inclusion of the social context. Furthermore, the effects of IFN-α treatment on indoleamine 2,3-dioxygenase, the level of tryptophan supply in the brain, the development of neurotoxic kynurenine metabolites and the thyroid glands were investigated. Therefore, for the first time the conditions for the development of depressive episodes in HCV patients treated with IFN-α were examined over the entire period of treatment as well as 3 months later, applying a holistic biopsychosocial model. METHOD: Psychiatric and biological assessments were carried out at 6 different times: before, during (at 1, 3, 6 and 9 months) and after the end of IFN-α treatment. RESULTS: During IFN-α treatment 22 (53.7%) of 41 patients fulfilled the criteria for a treatment-related depressive disorder at least once during treatment. Contributing factors are tryptophan depletion (tryptophan to competing amino acids quotient), increased neurotoxic challenge (kynurenine to kynurenic acid quotient), less social support, female gender, preexisting psychiatric vulnerability, means of transmission, low financial security, impaired sexual satisfaction, small circle of friends, impaired physical role, strong body pain, low general health and vitality, reduced social functioning, impaired mental health and impaired emotional role. CONCLUSIONS: The awareness of relevant risk factors of IFN-α treatment-induced depression is essential to develop preventative treatment strategies.

[Areas of work of a biopsychosocial oriented psychiatric consultation-liaison service: results from a prospective 2-year survey]. / Arbeitsfelder eines biopsychosozial ausgerichteten psychiatrischen Konsiliardienstes: Ergebnisse einer prospektiven 2-Jahres-Erhebung.

BACKGROUND: Since the establishment of the European Association of Consultation-Liaison Psychiatry and Psychosomatics in 1992, C/L psychiatry in European countries has been increasingly recognized as a subspecialty of clinical psychiatry and psychosomatic medicine. The study explored the areas of work of the biopsychosocial oriented psychiatric consultation - liaison (C/L) service at the university hospital LKH Graz (Austria). METHODS: We conducted two prospective 1-year surveys over two years of observation. Survey I comprised 1,505 consecutive new consultations, and the more recent Survey II extended over 1,478 consecutive new referrals to our C/L service. Psychiatric referrals were analyzed with regard to demographic characteristics, referring departments, principal reasons for referral, diagnostic characteristics, and intervention patterns. RESULTS: In both surveys, the most common patient to be referred was a middle-aged woman. Internal medicine consistently accounted for almost one third of all referrals, followed by neurology. The most prominent reasons for biopsychosocial referral were any signs of abnormal mood, behaviour, psychotic symptoms or cognitive impairments. The most common mental disorders according to ICD-10 were adjustment disorders, depressive disorders, and delirium. Psychopharmacotherapy and combined psycho- and pharmacotherapy were the most frequent actions in both surveys, followed by biopsychosocial evaluation pretransplant. CONCLUSIONS: To ameliorate the provision of biopsychosocial care for general hospital patients, the need for specially planned biopsychosocial C/L services with equal involvement of specialists in medical psychology, C/L psychiatry, and clinical psychology should be underscored.

[Psychoeducation and quality of life: an amplification of the evaluation study in Graz (Part 2). A comparison of psychoeducation with psychotic and depressive patients]. / Psychoedukation und Lebensqualität: Eine Erweiterung der Grazer Evaluationsstudie (Teil 2). Psychoedukation bei psychotischen und depressiven PatientInnen im Vergleich.

BACKGROUND: This study aimed at comparing psychoeducation (PE) on depressive and psychotic patients, describe differences and identify variables fostering patients' satisfaction with PE. METHODS: 75 patients (49 depressive and 26 psychotic patients) participated in nine PE-group sessions and observer as well as self-rating scales were completed before and after PE. RESULTS: Depressive patients were able to improve their mental health quality and reduce their general psychic pressure in a greater extent than psychotic patients. Both samples improved their illness-related knowledge at the same amount. In general both samples were highly satisfied with PE but still depressive patients were still more satisfied. Using regression and discrimination analyses further differentiating variables could be found. CONCLUSIONS: Psychotic patients are an inhomogeneous sample and adaption of the PE contents is required. Depressive patients show more enhancement than psychotic patients. Nevertheless both samples benefit from PE. Compared to depressive patients psychotic patients experienced better subjective life quality but less objective life quality. The results underline the relevance of PE in an inpatient psychiatric setting. Individual preliminary information adjusted to the patients' sample is essential.

[Psychoeducation and quality of life: an amplification of the evaluation study in Graz (Part 1). Psychoeducation with psychotic patients]. / Psychoedukation und Lebensqualität: Eine Erweiterung der Grazer Evaluationsstudie (Teil 1). Psychoedukation bei PatientInnen mit psychotischen Störungen.

BACKGROUND: This study is an amplification of the evaluation study in Graz and aimed at evaluating the effects of psychoeducation (PE) on psychotic patients. METHODS: 26 psychotic patients participated in nine PE-group sessions and observer as well as self-rating scales were completed before and after PE. RESULTS: A significant increase in psychological wellbeing, in psychosis-related knowledge and a reduction of psychopathology was found. The degree of psychopathology influenced life-quality and psychosis - related knowledge but still patients with severe psychopathology benefit from PE. Using regression analyses further variables fostering the PE-success were tried to be identified. CONCLUSION: A multidimensional consideration of the lifequality-concept is necessary for evaluation of PE. In clinical practice PE groups with patients suffering from different psychotic diseases can be well implemented and are very effective. The results underline the relevance of PE in an inpatient psychiatric setting.

[The effect of psychoeducation on quality of life in depressive disorders - results of an evaluation study in Graz]. / Psychoedukation und Lebensqualität bei depressiven Erkrankungen - Ergebnisse einer Grazer Evaluationsstudie.

INTRODUCTION: This study aimed to evaluate the effect of psychoeducation (PE) on quality of life in depressive patients at the Department of Psychiatry, University of Medicine of Graz. METHOD: We tested 49 depressive patients who participated in 9 PE group sessions at twice weekly intervals. Psychometric observer-rating and self-rating scales were conducted before and after PE completion. RESULTS: Our evaluation study found significant improvement in mental health status, life satisfaction, psychopathology, specific knowledge about depression and compliance. Using multiple regression analyses, we identified variables predicting a more favourable outcome in the participating patients. The vast majority of our sample would highly recommend PE to other depressive patients, and found an increase in knowledge about depression to be supportive. CONCLUSION: Our results with PE for depressive patients are encouraging, but the inclusion of appropriate control groups needs to be considered in forthcoming studies. Future research should also focus on comparison studies of PE in depressive patients with PE in schizophrenic patients, particularly as PE has proven to be an effective treatment in schizophrenia.

Patterns of psychiatric consultation in an Austrian tertiary care center - results of a systematic analysis of 3,307 referrals over 2 years.

OBJECTIVE: The purpose of this study was to investigate the phenomenology of a newly structured Austrian tertiary - care hospital consultation - liaison (C - L) psychiatry service. SUBJECTS AND METHODS: We compared two 1 - year surveys over two years of observation (2003 - 2005). Survey A (August 1, 2003, until July 31, 2004) comprised 1474 consecutive new consultations, and the more recent Survey B (August 1, 2004, until July 31, 2005) extended over 1833 consecutive new referrals to our C - L service. Psychiatric referrals were analyzed with regard to consultation rate, demographic characteristics, referring departments, principal reasons for referral, diagnostic characteristics, and intervention patterns. RESULTS: The consultation rate increased by 0.61% from 2.69% in Survey A to 3.30% in Survey B. Internal medicine consistently accounted for almost 31% of all referrals in both surveys. In Survey A, the most common psychiatric diagnoses were adjustment disorders (21.4%), depressive disorders (18.5%), and delirium (18.1%). The most prevalent diagnoses in Survey B were adjustment disorders (24.5%), delirium (18.8%), and depressive disorders (14.3%). Pharmacotherapy was the most frequent action in both surveys and accounted for between 45% and 49% of all actions. CONCLUSION: This study underscores the need for specially planned C - L services in Austria that provide both psychiatric and psychosocial care for patients who are medically ill.

[Atypical antipsychotics and metabolic syndrome]. / Atypische Neuroleptika und metabolisches Syndrom.

The introduction of atypical antipsychotics in psychopharmacology represented a major advance in the treatment of psychotic disorders. However, there have been numerous studies that certain atypical antipsychotics may be associated with a greater risk of metabolic abnormalities than others, including weight gain, hyperlipidemia and new-onset typ 2 diabetes mellitus. A G-Protein beta3 subunit Gen (C825T) polymorphism, an increased carbohydrate metabolism and dyshormonism are discussed as pathogenetic mechanisms. High risk patients (adiposity, hyperlipidaemia, hyperglycaemia, preexisting diabetes) should maintain an antipsychotic agent with a favourable side effect profile. In these cases a periodical diabetes screening and blood lipid controls are required. Clinicans must balance the significant benefits of atypical antipsychotics against the risk of metabolic disturbances. In this article recent findings are reviewed.

Soluble interleukin 2 receptor levels, temperament and character in formerly depressed suicide attempters compared with normal controls.

An imbalance of the immune system and mixed personality profiles in suicide attempters have been reported. As suicidal behavior is common in patients with psychiatric disorders within the spectrum of depressive features, in this study we measured soluble interleukin-2 receptor concentrations in plasma (sIL-2R) and investigated temperament and character profile and their potential correlation in formerly depressed patients with a history of suicide attempt. We studied sIL-2R levels in plasma and personality characteristics (using Cloninger's Temperament and Character Inventory [TCI]) of formerly depressed patients who had attempted suicide a mean of 3 years previously (n = 25), and age and gender matched normal controls (n = 25). There was no significant difference in sIL-2R levels between formerly depressed suicide attempters and age and gender matched normal controls (0.23 ng/ml +/- 0.25 vs. 0.19 ng/ml +/- 0.16). When compared to normal controls, suicide attempt patients had a significantly higher score on the temperament dimension "harm avoidance" and a lower score on the character dimension "self-directedness." No significant correlation was found between sIL-2R values and TCI dimensions. We propose that the liability to suicidal behavior among suicide attempters susceptible to depressive symptomatology may be related to high harm avoidance and low self-directedness.

Lacrimal gland involvement in graft-versus-host disease: a murine model.

PURPOSE: To describe lacrimal gland involvement in a murine model of acute graft-versus-host disease (GVHD). METHODS: Histopathologic examination was performed on lacrimal glands of mice affected by GVHD at 1, 2, 4, and 6 weeks after allogeneic bone marrow transplantation (BMT). Histopathologic scoring, based on characteristic GVHD findings in human disease involved evaluation of periductal inflammation, apoptosis, ductal stasis, ductal debris, and fibrosis. CD3, CD4, CD8, CD20, and CD68 antibodies were used to stain leukocyte subsets in GVHD lacrimal gland infiltrates. Lacrimal glands from syngeneic BMT mice were used in control experiments. RESULTS: Patchy periductal inflammation and focal fibrosis were significantly elevated as early as 2 weeks after allogeneic BMT. Histopathologic scoring of lacrimal glands after allogeneic BMT was significantly different at 4 (P = 0.005) and 6 (P < 0.0001) weeks when compared with scores in syngeneic control mice. The leukocytes in lacrimal gland GVHD infiltrates were predominately CD3+ T lymphocytes, most of which were CD8+, with fewer CD4+ cells present. CONCLUSIONS: This study describes the first murine model of lacrimal gland GVHD with features that closely mimic those described in human disease and indicates that lacrimal involvement occurs in acute GVHD.