Adherence to Physical Distancing and Health Beliefs About COVID-19 Among Patients With Cancer.

BACKGROUND: This study aimed to validate questionnaires on adherence to physical distancing and health beliefs about coronavirus disease 2019 (COVID-19) among patients with cancer and explore their interaction with depression or viral anxiety among them. METHODS: Through an online survey, data from 154 cancer patients (female: 82.5%, breast cancer: 66.2%, current cancer treatment, presence: 65.6%) were collected from March to June 2022. The survey gathered responses to questionnaires on adherence to physical distancing, health beliefs about COVID-19, perceived social norms, Stress and Anxiety to Viral Epidemics-6 items, and Patient Health Questionnaire-2. Confirmatory factor analysis (CFA) for construct validity and structural equation model (SEM) were performed. RESULTS: The CFA showed a good model fit for adherence to physical distancing (comparative fit index [CFI] = 1.000, Tucker-Lewis index [TLI] = 0.930, root-mean-square-error of approximation [RMSEA] = 0.000, and standardized root-mean-square residual [SRMR] = 0.050) and a satisfactory model fit for health beliefs about COVID-19 (CFI = 0.978, TLI = 0.971, RMSEA = 0.061, and SRMR = 0.089). Through SEM, we found that personal injunctive norms were the main mediators linking health beliefs with physical distancing in patients with cancer. Depression also mediated the effects of viral anxiety and perceived severity on physical distancing (χ² = 20.073, df = 15, P = 0.169; CFI = 0.984; RMSEA = 0.047). CONCLUSION: The questionnaires are reliable and valid. Patients with cancer may be able to adhere to physical distancing by addressing perceived severity, viral anxiety, perceived benefits, self-efficacy, perceived barriers, as well as personal injunctive norms.

What is the impact of one's chronic illness on his or her spouse's future chronic illness: a community-based prospective cohort study.

BACKGROUND: Integrating a joint approach to chronic disease management within the context of a couple has immense potential as a valuable strategy for both prevention and treatment. Although spousal concordance has been reported in specific chronic illnesses, the impact they cumulatively exert on a spouse in a longitudinal setting has not been investigated. We aimed to determine whether one's cumulative illness burden has a longitudinal impact on that of their spouse. METHODS: Data was acquired from a community-based prospective cohort that included Koreans aged 60 years and over, randomly sampled from 13 districts nationwide. Data from the baseline assessment (conducted from November 2010 to October 2012) up to the 8-year follow-up assessment was analyzed from October 2021 to November 2022. At the last assessment, partners of the index participants were invited, and we included 814 couples in the analysis after excluding 51 with incomplete variables. Chronic illness burden of the participants was measured by the Cumulative Illness Rating Scale (CIRS). Multivariable linear regression and causal mediation analysis were used to examine the longitudinal effects of index chronic illness burden at baseline and its change during follow-up on future index and spouse CIRS scores. RESULTS: Index participants were divided based on baseline CIRS scores (CIRS < 6 points, n = 555, mean [SD] age 66.3 [4.79] years, 43% women; CIRS ≥ 6 points, n = 259, mean [SD] age 67.7 [4.76] years, 36% women). The baseline index CIRS scores and change in index CIRS scores during follow-up were associated with the spouse CIRS scores (ß = 0.154 [SE: 0.039], p < 0.001 for baseline index CIRS; ß = 0.126 [SE: 0.041], p = 0.002 for change in index CIRS) at the 8-year follow-up assessment. Subgroup analysis found similar results only in the high CIRS group. The baseline index CIRS scores and change in index CIRS scores during follow-up had both direct and indirect effects on the spouse CIRS scores at the 8-year follow-up assessment. CONCLUSIONS: The severity and course of one's chronic illnesses had a significant effect on their spouse's future chronic illness particularly when it was severe. Management strategies for chronic diseases that are centered on couples may be more effective.

Psychometric properties of the Korean version of questionnaires on adherence to physical distancing and health beliefs about COVID-19 in the general population.

Introduction: We aimed to examine the psychometric properties of the Korean version of the questionnaires on adherence to physical distancing and health beliefs about COVID-19 in the general population in South Korea. In addition, we investigated how the various sections interacted with each other and with viral anxiety and depression, and ultimately affected adherence to physical distancing. Methods: An anonymous online survey was conducted among members of the general population in South Korea between 10 and 18 January 2022. We recruited 400 respondents and measured their demographic information, symptoms, and responses to questions about COVID-19. First, we examined the reliability and validity of the questionnaires, which included questions about people's adherence to physical distancing guidelines and COVID-19-related health beliefs. Second, we examined the relationship between physical distancing and viral anxiety or depression, as assessed using the six-item Stress and Anxiety to Viral Epidemics (SAVE-6) scale and the Patient Health Questionnaire-9 (PHQ-9). Results: All 400 participants (204 men, age 41.6 ± 10.8) completed the survey. Confirmatory factor analysis revealed a good model fit for adherence to physical distancing (CFI = 1.000, TLI = 1.019, RMSEA = 0.000, and SRMR = 0.034) and health beliefs about COVID-19 (CFI = 0.993, TLI = 0.991, RMSEA = 0.030, and SRMR = 0.052). It also showed good reliability for Factor I (Cronbach's α = 0.826) and Factor II (α = 0.740). Four categories of the COVID-19 health beliefs questionnaire also showed good reliability for perceived susceptibility (α = 0.870), perceived severity (α = 0.901), perceived benefit (α = 0.935), and barriers to following physical distancing (α = 0.833). Structural equation models showed that the effects of health beliefs and viral anxiety and depression were mediated mostly by personal injunctive norms. Goodness-of-fit measures indicated a good fit. (Chi-square = 24.425, df = 7, p < 0.001; CFI = 0.966; RMSEA = 0.079). Conclusion: The Korean version of the COVID-19 adherence to physical distancing and health beliefs questionnaires showed good reliability and validity in the Korean general population. In addition, the effects of health beliefs, along with viral anxiety and depression, were mainly mediated by personal injunctive norms.

Mood disorders increase mortality mainly through dementia: A community-based prospective cohort study.

OBJECTIVE: The effects of mood disorders on mortality may be mediated by their effects on the risk of dementia, and interventions to reduce the occurrence of dementia may reduce their overall mortality. This study aimed to investigate the direct effects of depressive and bipolar disorders on the 6-year risk of mortality and also their indirect effects on mortality due to their effect on the risk of dementia. METHODS: A total of 5101 Koreans were selected from a community-based prospective cohort study, and 6-year risks of mortality and dementia in participants with depressive and bipolar disorders were estimated by Cox proportional hazard analysis. The direct and indirect effects of depressive and bipolar disorders on the risk of mortality were estimated using structural equation modeling. RESULTS: The depressive and bipolar disorder groups showed 51% and 85% higher 6-year mortality, and 82% and 127% higher risk of dementia, respectively, compared to euthymic controls. The effects of depressive and bipolar disorders on mortality were mainly mediated by their effects on the risk of dementia in a structural equation model. The direct effects of each mood disorder on mortality were not significant. CONCLUSION: Both depressive and bipolar disorders increased the risks of mortality and dementia, and the effects of mood disorders on mortality were mainly mediated through dementia. As dementia occurs later in life than mood disorders, measures to prevent it may effectively reduce mortality in individuals with a history of mood disorders, as well as being more feasible than attempting to control other causes of death.

Novel Alzheimer's disease risk variants identified based on whole-genome sequencing of APOE ε4 carriers.

Alzheimer's disease (AD) is a progressive neurodegenerative disease associated with a complex genetic etiology. Besides the apolipoprotein E ε4 (APOE ε4) allele, a few dozen other genetic loci associated with AD have been identified through genome-wide association studies (GWAS) conducted mainly in individuals of European ancestry. Recently, several GWAS performed in other ethnic groups have shown the importance of replicating studies that identify previously established risk loci and searching for novel risk loci. APOE-stratified GWAS have yielded novel AD risk loci that might be masked by, or be dependent on, APOE alleles. We performed whole-genome sequencing (WGS) on DNA from blood samples of 331 AD patients and 169 elderly controls of Korean ethnicity who were APOE ε4 carriers. Based on WGS data, we designed a customized AD chip (cAD chip) for further analysis on an independent set of 543 AD patients and 894 elderly controls of the same ethnicity, regardless of their APOE ε4 allele status. Combined analysis of WGS and cAD chip data revealed that SNPs rs1890078 (P = 6.64E-07) and rs12594991 (P = 2.03E-07) in SORCS1 and CHD2 genes, respectively, are novel genetic variants among APOE ε4 carriers in the Korean population. In addition, nine possible novel variants that were rare in individuals of European ancestry but common in East Asia were identified. This study demonstrates that APOE-stratified analysis is important for understanding the genetic background of AD in different populations.

Parasympathetic predominance is a risk factor for future depression: A prospective cohort study.

BACKGROUND: Changes in parasympathetic activity have been associated with depression; however, it is not well understood whether these changes are a result of depression, or represent a compensatory mechanism protecting against it. We examined the association of autonomic nervous system activity with the risk of depression in euthymic individuals and those with subsyndromal depression using heart rate variability (HRV) analysis. METHODS: From a community-based longitudinal cohort, 464 subjects from the baseline assessment and 253 who completed the 5-year follow-up visit were included in the cross-sectional and prospective analyses, respectively. Linear regression analysis was used to investigate the association of HRV measures with the current and future GDS scores. Logistic regression analysis examined the effect of HRV on future risk of SSD. RESULTS: Low-frequency power (LFN), high-frequency power (HFN), and the LFN/HFN ratio at the baseline assessment were associated with the GDS score at the 5-year follow-up assessment; however, they were not associated with the GDS score at the baseline assessment. High HFN indicated an increased risk of depression at the 5-year follow-up assessment in euthymic subjects (OR = 3.025, 95% CI = 1.184 - 7.726, p = 0.021). LIMITATIONS: HRV was not measured at the follow-up assessment and the interval between the assessments was comparatively long. Five-minute ECG recordings were used, and all participants were 65 years old or older. CONCLUSIONS: Parasympathetic predominance may precede the onset of depression in older adults.

Orexin Impairs the Phagocytosis and Degradation of Amyloid-ß Fibrils by Microglial Cells.

BACKGROUND: Intracranial accumulation of amyloid-ß (Aß) is a characteristic finding of Alzheimer's disease (AD). It is thought to be the result of Aß overproduction by neurons and impaired clearance by several systems, including degradation by microglia. Sleep disturbance is now considered a risk factor for AD, but studies focusing on how sleep modulates microglial handling of Aß have been scarce. OBJECTIVE: To determine whether phagocytosis and degradation of extracellular Aß fibrils by BV2 microglial cells were impaired by treatment with orexin-A/B, a major modulator of the sleep-wake cycle, which may mimic sleep deprivation conditions. METHODS: BV2 cells were treated with orexin and Aß for various durations and phagocytic and autophagic processes for degradation of extracellular Aß were examined. RESULTS: After treatment with orexin, the formation of actin filaments around Aß fibrils, which is needed for phagocytosis, was impaired, and phagocytosis regulating molecules such as PI3K, Akt, and p38-MAPK were downregulated in BV2 cells. Orexin also suppressed autophagic flux, through disruption of the autophagosome-lysosome fusion process, resulting in impaired Aß degradation in BV2 cells. CONCLUSIONS: Our results demonstrate that orexin can hinder clearance of Aß through the suppression of phagocytosis and autophagic flux in microglia. This is a novel mechanism linking AD and sleep, and suggests that attenuated microglial function, due to sleep deprivation, may increase Aß accumulation in the brain.

Renal function affects hippocampal volume and cognition: The role of vascular burden and amyloid deposition.

AIM: We determined if differences in renal function, even within normal levels, influenced hippocampal volume (HCV) and cognition. METHODS: Cognitively normal (CN) and mild cognitive impairment (MCI) subjects with eGFR ≥ 60 ml/min/1.73m2 were selected from the ADNI database (N = 1,269) and divided into three groups (eGFR 60-75, 75-90 and ≥90). Associations between eGFR, HCV and cognition scores were examined using regression methods, and random-coefficient models. The relationship between various factors, such as vascular burden and brain amyloid deposition, were investigated using path analysis. RESULTS: Higher eGFR was associated with larger HCVs and better cognition in all subjects at baseline. In MCI subjects, hippocampal atrophy in the eGFR ≥ 90 group progressed at just half the rate of the eGFR 75-90 group (P = .006), and was also somewhat slower than the eGFR 60-75 group (P = .08). A comprehensive path model linking eGFR, HCV and cognition, and integrating vascular burden and amyloid deposition, is proposed. CONCLUSIONS: Higher renal function was associated with slower hippocampal atrophy and cognitive decline even within normal levels of renal function. This relationship was mediated mainly through cardiovascular risk burden and amyloid deposition. Further studies examining neuroinflammation are needed. Geriatr Gerontol Int 2017; 17: 1899-1906.

An International Comparative Study on Driving Regulations on People with Dementia.

Over 40% of people with dementia drive, with a two to five times greater accident risk than controls. This has fueled public concerns about the risk of traffic accidents by drivers with dementia (DWD). We compared driving regulations on seniors and DWD between ten European and Asia-Pacific countries to identify key implications for national strategies. Moderate to severe dementia was a reason for driver's license revocation in all countries. However, regulations on mild dementia varied considerably, with most basing their decisions on severity, rather than simply the presence of dementia. Most used validated assessments, but responsibility for triggering the administrative process fell on drivers in some countries and on physicians in others. Administrations should consider the following when developing driving policies: 1) ideal regulations on DWD should ensure that restrictions are implemented only when needed; 2) fitness to drive should be assessed using validated instruments; 3) the use of processes that automatically initiate driving competency examinations following a diagnosis of dementia should be explored; and 4) restrictions should be delicately tailored to a range of driving competence levels, and assistive incentives compensating for lost driving privileges should be provided.

The Effect of Escitalopram on Mood and Cognition in Depressive Alzheimer's Disease Subjects.

BACKGROUND: Effective treatments to alleviate depression in Alzheimer's disease (AD) have been scarce. OBJECTIVE: To investigate the efficacy and tolerability of escitalopram in the treatment of depression in AD. METHODS: In this 12-week randomized, double-blind, placebo-controlled trial with open-label, 12-week extension, AD subjects over 50 years of age, with depression defined by Olin's provisional diagnostic criteria, were enrolled. The Cornell Scale for Depression in Dementia (CSDD), and other measures of depression and cognition were repeated. RESULTS: 91 subjects were screened, and 84 were randomized into either the study group or placebo group (n = 42 for both groups). Twenty-four subjects (29%) were unable to finish the study, yielding a per protocol population of 60 subjects (study group: n = 27; placebo group: n = 33). At week 12, differences in measures of depression and cognition between the two groups were not statistically significant. However, exploratory analysis suggested that further research on a subset of subjects with 'definite major depression' (baseline CSDD score ≥18) is needed. The number of treatment-related adverse-events (AE) did not differ between groups (p = 0.83) and no serious treatment-related AE were observed. CONCLUSION: The use of escitalopram was well tolerated in depressive dementia patients. Future studies focusing on subjects with more severe levels of depression, and with more statistical power, will be needed.

Large intracranial volume accelerates conversion to dementia in males and APOE4 non-carriers with mild cognitive impairment.

BACKGROUND: It is unclear how brain reserve interacts with gender and apolipoprotein E4 (APOE4) genotype, and how this influences the progression of Alzheimer's disease (AD). The association between intracranial volume (ICV) and progression to AD in subjects with mild cognitive impairment (MCI), and differences according to gender and APOE4 genotype, was investigated. METHODS: Data from subjects initially diagnosed with MCI and at least two visits were downloaded from the ADNI database. Those who progressed to AD were defined as converters. The longitudinal influence of ICV was determined by survival analysis. The time of conversion from MCI to AD was set as a fiducial point, as all converters would be at a similar disease stage then, and longitudinal trajectories of brain atrophy and cognitive decline around that point were compared using linear mixed models. RESULTS: Large ICV increased the risk of conversion to AD in males (HR: 4.24, 95% confidence interval (CI): 1.17-15.40) and APOE4 non-carriers (HR: 10.00, 95% CI: 1.34-74.53), but not in females or APOE4 carriers. Cognitive decline and brain atrophy progressed at a faster rate in males with large ICV than in those with small ICV during the two years before and after the time of conversion. CONCLUSIONS: Large ICV increased the risk of conversion to AD in males and APOE4 non-carriers with MCI. This may be due to its influence on disease trajectory, which shortens the duration of the MCI stage. A longitudinal model of progression trajectory is proposed.

Phentermine, sibutramine and affective disorders.

A safe and effective way to control weight in patients with affective disorders is needed, and phentermine is a possible candidate. We performed a PubMed search of articles pertaining to phentermine, sibutramine, and affective disorders. We compared the studies of phentermine with those of sibutramine. The search yielded a small number of reports. Reports concerning phentermine and affective disorders reported that i) its potency in the central nervous system may be comparatively low, and ii) it may induce depression in some patients. We were unable to find more studies on the subject; thus, it is unclear presently whether phentermine use is safe in affective disorder patients. Reports regarding the association of sibutramine and affective disorders were slightly more abundant. A recent study that suggested that sibutramine may have deleterious effects in patients with a psychiatric history may provide a clue for future phentermine research. Three explanations are possible concerning the association between phentermine and affective disorders: i) phentermine, like sibutramine, may have a depression-inducing effect that affects a specific subgroup of patients, ii) phentermine may have a dose-dependent depression-inducing effect, or iii) phentermine may simply not be associated with depression. Large-scale studies with affective disorder patients focusing on these questions are needed to clarify this matter before investigation of its efficacy may be carried out and it can be used in patients with affective disorders.

Novelty-seeking and avoidant coping strategies are associated with academic stress in Korean medical students.

High levels of stress and depression in medical students is raising concern. In this study, we sought to identify coping strategies and other factors influencing academic stress in medical students. We enrolled 157 students from the University of Ulsan College of Medicine, Korea, in November, 2010. We used the Medical Stress Scale, Temperament and Character Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Coping Response Inventory to assess psychological parameters. We used Pearson's correlation and linear regression analyses to analyze the data. Novelty-seeking, self-directedness, cooperativeness, coping strategy, and depression scale scores all correlated significantly with stress level. Linear regression analysis indicated that students who are novelty-seeking, likely to use avoidant coping strategies, and unlikely to use active-cognitive and active-behavioral strategies tend to have higher stress levels. Reduction of stress in medical students may be achieved through evaluation of coping strategies and personality features and use of interventions to promote active coping strategies.

A structural model of stress, motivation, and academic performance in medical students.

OBJECTIVE: The purpose of the present study was 1) to identify factors that may influence academic stress in medical students and 2) to investigate the causal relationships among these variables with path analysis. METHODS: One hundred sixty medical students participated in the present study. Psychological parameters were assessed with the Medical Stress Scale, Minnesota Multiphasic Personality Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Academic Motivation Scale. Linear regression and path analysis were used to examine the relationships among variables. RESULTS: Significant correlations were noted between several factors and Medical Stress scores. Specifically, Hamilton Depression Scale scores (ß=0.26, p=0.03) and amotivation (ß=0.20, p=0.01) and extrinsically identified regulation (ß=0.27, p<0.01) response categories on the Academic Motivation Scale had independent and significant influences on Medical Stress Scale scores. A path analysis model indicated that stress, motivation, and academic performance formed a triangular feedback loop. Moreover, depression was associated with both stress and motivation, and personality was associated with motivation. CONCLUSION: The triangular feedback-loop structure in the present study indicated that actions that promote motivation benefit from interventions against stress and depression. Moreover, stress management increases motivation in students. Therefore, strategies designed to reduce academic pressures in medical students should consider these factors. Additional studies should focus on the relationship between motivation and depression.

The influence of personality and dysfunctional sleep-related cognitions on the severity of insomnia.

Previous findings suggest that personality traits and dysfunctional sleep-related cognitions may perpetuate insomnia, but findings concerning this have been scarce. Thus, we hypothesized that personality and sleep-related cognitions influence the severity of insomnia, and investigated the association personality and sleep-related cognitions had with various sleep-related parameters, including severity of insomnia. Forty-four patients with psychophysiological insomnia were assessed using The Temperament and Character Inventory, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Dysfunctional Belief and Attitudes toward Sleep Scale, the Pre-Sleep Arousal Scale and the Hospital Anxiety and Depression Scale. Insomnia severity was significantly and positively correlated with harm avoidance, self-transcendence and sleep-related cognitions, and negatively correlated with novelty seeking, reward dependence, and cooperativeness. Dysfunctional sleep-related cognitions were positively correlated with insomnia severity and sleep quality. Stepwise multiple regression analysis showed that sleep-related cognitions, depression and reward dependence scores were significant determinants of insomnia severity, and that sleep-related cognitions and self-transcendence were significant positive determinants of sleep quality. Reward dependence, depression and sleep-related cognitions were associated with insomnia severity, and comparison with previous findings implied that 'internalizing behavior' and depression may be more plausible candidates for the link between personality and insomnia than anxiety. Considering the major role of cognitive-behavioral treatment (CBT) in the treatment of insomnia, assessment of these factors and management of sleep-related cognitions may help alleviate symptoms in patients with insomnia.

The impact of temperament and character on the efficacy of nonpharmacologic treatment of primary insomnia.

Nonpharmacologic treatment, also known as cognitive behavioral treatment, is a first-line treatment of primary insomnia. We aimed to assess factors, including temperament and character, that were associated with responses to nonpharmacologic treatments of primary insomnia, that may assist physicians to recommend appropriate treatment. Outpatients diagnosed with psychophysiological insomnia (n = 99) were recruited between May 2009 and January 2010. Among 69 patients who consented to participate, 44 completed treatment and all assessment measures. In addition, 37 normal control subjects were also recruited. Baseline characteristics were assessed using the Temperament and Character Inventory, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Dysfunctional Beliefs and Attitudes about Sleep scale, and the Hospital Anxiety and Depression Scale. After treatment, all assessment scales excluding the Temperament and Character Inventory were repeated. All patients received nonpharmacologic treatments, including sleep restriction, cognitive therapy, and sleep hygiene education. Novelty seeking, harm avoidance, reward dependence, cooperativeness, and self-transcendence scores were significantly different between normal controls and study subjects. Participants were divided into treatment responders (n = 23) and nonresponders (n = 21). Responders were significantly younger (50.3 ± 12.8 vs 58.7 ± 9.6 years, P = .02) and had significantly higher reward dependence scores (51.7 ± 5.9 vs 42.9 ± 6.9, P < .01) compared with nonresponders. The difference in reward dependence scores remained significant after controlling for other factors (odds ratio, 1.23; 95% confidence interval, 1.08-1.40; P = .01). Among personality dimensions, reward dependence was significantly associated with response to nonpharmacologic treatment in patients with primary insomnia.

A case of obstructive sleep apnea syndrome presenting as paradoxical insomnia.

A 63-year-old female with obstructive sleep apnea syndrome (OSAS) presented with clinical features indistinguishable from paradoxical insomnia (PI). Her main complaint was chronic insomnia. Her subjective sleep latency was 2-3 h, subjective sleep time was less than 3 h, despite spending 8 h in bed, and she reported near constant awareness of her surroundings while lying in bed. Her body mass index (BMI) was 22.67 kg/m(2), and her neck circumference was 34.5 cm. Nocturnal polysomnography (NPSG) findings indicated severe OSAS. Her total sleep time (TST) was 359 min, sleep latency 13 min, and her apnea/hypopnea index (AHI) was 74.6/h. The aim of this report is to evaluate the association between PI and OSAS cases confirmed by NPSG.

The association of psychosocial and familial factors with adolescent suicidal ideation: A population-based study.

We aimed to compare the influence of various parental factors on adolescent suicidal ideas from a population-based sample of 2965 adolescents between 15 to 18 years-old, and their parents. Among the subject variables, gender, satisfaction with one's health, having an illness, and satisfaction with family; and among parental variables, fathers' satisfaction with health; mothers' insufficient sleep; parents' history of suicidal ideation, and satisfaction with family were significantly different in adolescents who reported suicidal ideation compared to those who reported none. Odds ratios indicated increased risk of adolescent suicidal ideation was associated with the subject factors female gender, insufficient sleep, dissatisfaction with one's health, dissatisfaction with family, and with maternal data showing insufficient sleep and a positive history of suicidal impulse. A path analysis model (comparative fit index (CFI)=0.907; root mean square error of approximation (RMSEA)=0.047), indicated psychosocial factors (beta=0.232) had a greater influence on adolescent suicidal ideation than did genetic factors (beta=0.120). These results show psychosocial factors have an almost two-fold greater influence on adolescent suicidal ideation than genetic factors. Assessment and modification of these factors would greatly assist future interventions.

Treatment response and duration of maintenance treatment with adjunctive antidepressants in bipolar depression: A retrospective chart review.

Objective. The aim of this study was to investigate the treatment response and optimal maintenance period of antidepressants to minimize the risk of switching in bipolar depression in clinical practice. Methods. In a retrospective chart review, 78 bipolar patients, treated for a depressive episode by adding antidepressant to ongoing mood-stabilizing medications and had been followed for at least 6 months were identified. We determined recovery to euthymia and/or switching into mania during the 6-month follow-up period and estimated the time from antidepressant initiation to mood change. Results. Antidepressants treatment responses were classified into four groups. In one group, depression was sustained for 6 months despite continuous antidepressant treatment (poor-response group, 10.3%). In the second, abrupt switch into mania occurred during antidepressant treatment (acute-switch group, 19.2%). In the third, the depression improved to euthymia without manic switching (good-response group, 50%). In the fourth, the depression improved to euthymia but manic switching occurred during maintenance with antidepressants (delayed-switch group, 20.5%), and the mean duration of antidepressants maintenance was 54.6±38.9 days. Conclusions. Bipolar depression has heterogeneous treatment responses to adjunctive antidepressant. Antidepressants should be discontinued within 8 weeks after improvement to euthymia to minimize the risk of manic switching.