Relation between increasing attachment security and weight gain: a clinical study of adolescents and their parents at an outpatient ward.

PURPOSE: We wanted to evaluate the impact of a relational focus in the treatment of adolescent ED-patients and their parents at an intensive outpatient ward, based on attachment theory, combined with a family approach and psychodynamic principles. Our aim was to investigate the distribution of different attachment styles among the adolescent ED-patients and their parents, and to find out if they could change by the treatment. METHODS: Swedish adolescents (n = 33; 3 boys, 30 girls) and their parents (n = 60; 34 mothers, 26 fathers) participated. MEASURES: Attachment Style Questionnaire (ASQ), Body Mass Index (BMI) and Children's Global Assessment Scale (CGAS) before and after treatment. RESULTS: The adolescents were high on Need for Approval (ASQ4) of the Insecure/Anxious scale before treatment (in contrast to the parents). The patients had a significant decrease in ASQ4 after treatment, which correlated inversely to the increase in BMI but not to CGAS. The mothers showed features of the Secure/Confident style, fathers of the Insecure/Avoidant with elevated Relationships as Secondary (ASQ2). CONCLUSIONS: Treatment with a relational and a family focus has impact on attachment insecurity in adolescent ED-patients and outcomes in terms of BMI. It is important to engage the parents, who need to help the adolescents to separate at that developmental stage. A secure therapeutic context, which enables mentalizations and allows new relational experiences, is essential. The ASQ-instrument is useful in indicating how the treatment of ED-adolescents is proceeding. LEVEL OF EVIDENCE: Level IV: evidence obtained from multiple time series with the intervention.

Adolescent patients with eating disorders and their parents: a study of self-image and outcome at an intensive outpatient program.

PURPOSE: The main aim of this clinical study was to explore how adolescent patients with eating disorders and their parents report their perceived self-image, using Structural Analysis of Social Behavior (SASB), before and after treatment at an intensive outpatient program. Another aim was to relate the self-image of the young patients to the outcome measures body mass index (BMI) and Children's Global Assessment Scale (C-GAS) score. METHODS: A total of 93 individuals (32 adolescents, 34 mothers, and 27 fathers) completed the SASB self-report questionnaire before and after family-based treatment combined with an individual approach at a child and youth psychiatry day care unit. The patients were also assessed using the C-GAS, and their BMI was calculated. RESULTS: The self-image (SASB) of the adolescent patients was negative before treatment and changed to positive after treatment, especially regarding the clusters self-love (higher) and self-blame (lower). A positive correlation between change in self-love and in C-GAS score was found, which rose significantly. Increased self-love was an important factor, explaining a variance of 26 %. BMI also increased significantly, but without any correlation to change in SASB. The patients' fathers exhibited low on the cluster self-protection. Mothers' profiles were in line with a non-clinical group. CONCLUSIONS: Results indicate that the self-image of adolescent patients change from negative to positive alongside with a mainly positive outcome of the ED after treatment. Low self-protection according to SASB among fathers suggests the need for greater focus on their involvement.

Functional and structural alterations in the cingulate motor area relate to decreased fronto-striatal coupling in major depressive disorder with psychomotor disturbances.

Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.

Motor imagery in bipolar depression with slowed movement.

We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre-executive stages of motor production. We used functional magnetic resonance imaging to investigate neural activity during motor imagery and motor execution to elucidate whether brain regions that mediate planning, preparation, and control of movement are activated differently in subjects with bipolar depression (n = 9) compared with healthy controls (n = 12). We found significant between-group differences. During motor imagery, the patients activated the posterior medial parietal cortex, the posterior cingulate cortex, the premotor cortex, the prefrontal cortex, and the frontal poles more than the controls did. Activation in the brain areas involved in motor selection, planning, and preparation was altered. In addition, limbic and prefrontal regions associated with self-reference and the default mode network were altered during motor imagery in bipolar depression with motor retardation.

The neural correlates of self-paced finger tapping in bipolar depression with motor retardation.

OBJECTIVE: Motor retardation is a characteristic feature of bipolar depression, and is also a core feature of Parkinson's disease. Within the framework of the functional deafferentiation theory in Parkinson's disease, we hypothesised that motor retardation in bipolar depression is mediated by disrupted subcortical activation, leading to decreased activation of cortical motor areas during finger tapping. METHODS: We used functional magnetic resonance imaging to investigate neural activity during self-paced finger tapping to elucidate whether brain regions that mediate preparation, control and execution of movement are activated differently in subjects with bipolar depression (n = 9) compared to healthy controls (n = 12). RESULTS: An uncorrected whole-brain analysis revealed significant group differences in dorsolateral and ventromedial prefrontal cortex. Corrected analyses showed non-significant differences in patients compared to controls: decreased and less widespread activation of the left putamen and left pallidum; increased activity in the left thalamus and supplementary motor area; decreased activation in the left lateral pre- and primary motor cortices; absence of activation in the pre-supplementary motor area; activation of the bilateral rostral cingulate motor area. CONCLUSION: Both movement preparation and execution may be affected in motor retardation, and the activity in the whole left-side motor circuit is altered during self-initiated motor performance in bipolar depression.

Electroconvulsive therapy in Norway: rates of use, clinical characteristics, diagnoses, and attitude.

OBJECTIVES: The aim of the study was to describe the rate of use and demographic distribution of electroconvulsive therapy (ECT) in Norway in 2004, as well as the attitudes among Norwegian psychiatrists about ECT. METHODS: A 42-item questionnaire on the practice of ECT was sent to 125 Norwegian psychiatric hospitals, district psychiatric centers, and child and adolescent psychiatric units in 2004. RESULTS: A total of 67 (54%) psychiatric units responded, including 26 (67%) of 39 psychiatric hospitals, 32 (46%) of 69 district psychiatric centers, and 9 (53%) of 17 child and adolescent units. There were 672 patients who received ECT during 2004, which gives a yearly incidence of 2.4 of 10,000 inhabitants. A total of 5.3% of all inpatients received ECT.The rate of ECT use varied from 1.83 to 3.44 per 10,000 inhabitants per year between the different health regions.Of the 672 patients, 394 reported their sex (59%), of which 135 were men and 259 were women (male-female ratio, 1:2). The most common diagnosis treated with ECT was depression, followed by bipolar disorder and schizoaffective disorder.The responders expressed generally positive attitudes toward ECT. Almost all considered ECT important, that hospitals should offer ECT, and that there are solid indications for such treatment. Most of the responders expressed concern about the underuse of ECT. CONCLUSIONS: Electroconvulsive therapy is widely available in Norway but its use is unevenly distributed between health regions. The attitudes toward ECT are generally positive among psychiatrists.

Questionnaire study about the practice of electroconvulsive therapy in Norway.

OBJECTIVES: The aim of the study was to describe the contemporary practice of electroconvulsive therapy (ECT) in Norway. METHODS: A 42- item questionnaire on the practice of ECT was sent to all the 125 Norwegian psychiatric hospitals, district psychiatric centers, and child and adolescent psychiatric units in 2004. RESULTS: A total of 67 (54%) psychiatric units responded, including 26 (67%) of 39 psychiatric hospitals, 32 (46%) of 69 district psychiatric centers, and 9 (53%) of 17 child and adolescents units. Trainee psychiatrists mostly administered ECT, with or without supervision, but underwent a training program before administering ECT. Written informed consent was used in 50% of institutions providing ECT. Right unilateral electrode placement was preferred but with variations in dosage strategies. The practice in most of the departments was to discontinue some classes of psychotropics before ECT, mostly benzodiazepines and anticonvulsants. Antidepressants and antipsychotics were most often continued. Continuation/maintenance and ambulatory ECT were used. Most patients benefited from ECT. Headache and memory impairment were frequent but seldom were serious adverse effects. CONCLUSIONS: The administration of ECT in Norway in 2004 was mostly in accordance with international guidelines. All institutions used modified ECT and brief pulse machines, and unilateral ECT was the preferred electrode placement. National guidelines should be developed, as there were great variations in practice among the hospitals.

Signatures of depression in non-stationary biometric time series.

This paper is based on a discussion that was held during a special session on models of mental disorders, at the NeuroMath meeting in Stockholm, Sweden, in September 2008. At this occasion, scientists from different countries and different fields of research presented their research and discussed open questions with regard to analyses and models of mental disorders, in particular depression. The content of this paper emerged from these discussions and in the presentation we briefly link biomarkers (hormones), bio-signals (EEG) and biomaps (brain-maps via EEG) to depression and its treatments, via linear statistical models as well as nonlinear dynamic models. Some examples involving EEG-data are presented.

Seizure (Ictal)--EEG characteristics in subgroups of depressive disorder in patients receiving electroconvulsive therapy (ECT)--a preliminary study and multivariate approach.

OBJECTIVES: Examine frequency distributions of ictal EEG after ECT stimulation in diagnostic subgroups of depression. METHODS: EEG registration was consecutively monitored in 33 patients after ECT stimulation. Patients were diagnosed according to DSM IV and subdivided into: (1) major depressive disorder with psychotic features (n = 7), (2) unipolar depression (n = 20), and (3) bipolar depression (n = 6). RESULTS: Results indicate that the diagnostically subgroups differ in their ictal EEG frequency spectrumml: (1) psychotic depression has a high occurrence of delta and theta waves, (2) unipolar depression has high occurrence of delta, theta and gamma waves, and (3) bipolar depression has a high occurrence of gamma waves. A linear discriminant function separated the three clinical groups with an accuracy of 94%. CONCLUSION: Psychotic depressed patients differ from bipolar depression in their frequency based on probability distribution of ictal EEG. Psychotic depressed patients show more prominent slowing of EEG than nonpsychotic depressed patients. Thus the EEG results may be supportive in classifying subgroups of depression already at the start of the ECT treatment.

Alterations in serum melatonin and sleep in individuals in a sub-arctic region from winter to spring.

METHODS: In a sub-arctic region at 69 degrees N, seven individuals with self-reported insomnia during the 'dark period' and seven without, were followed with repeated measures of melatonin and questioned on ten different sleep variables, from the beginning of January to the vernal equinox in March. RESULTS: The distribution of melatonin over a 24-hour period (five time points) indicated an increase in melatonin levels in both groups in the middle of January and a decrease at the time of year when the sun first rises over the horizon (23rd-24th of January). Moreover, an indication of a delayed phase shift of melatonin secretion was found during the dark period, which returned to "normal" secretion during the night at the equinox in March. Individuals with sleep problems had a slower return to "normal" melatonin secretion than those without sleep problems. A positive correlation between morning tiredness and morning levels of melatonin was found among individuals with sleep disturbances, but not in controls. CONCLUSION: This study indicates changes in the internal circadian rhythm in humans at the end of the annual dark period of winter when there is a rapid increase in the number of hours of sunlight. For vulnerable individuals, the disturbance in sleep, and in particlar morning tiredness, lasts at least until the vernal equinox in March.

ECT of major depressed patients in relation to biological and clinical variables: a brief overview.

The knowledge that spontaneous or induced convulsions can improve mental disorders has been present for several centuries. electroconvulsive therapy (ECT) has undergone fundamental changes since its introduction, and in the last 15-20 years there has been a legitimate renewal of interest for this therapy. Today the indications for use of ECT seem well codified, and its technique and practices have evolved considerably. It is now firmly established as an important and effective method of treating certain severe forms of depression. However, still very little is known about the mechanism of ECT. In this paper, first, we will give a short overview as to how far we have got concerning ECT in relation to various clinical and biological variables. Second, we will describe ECT in relation to electroencephalographic (EEG) technique and clinical outcome as well as give some proposals as to how to go on with the data analysis of EEG. In conclusion, the superior effect of ECT compared to other antidepressives in severe depression may depend on neurochemical and neurobiological cascade effects initiated by repeated treatments. Above all, ECT offers a unique experimental opportunity to study how neuromodulation of the major transmitter systems may be involved in brain dynamics and alteration of connectivity.