Predicting functional impairment in euthymic patients with mood disorder: A 5-year follow-up.

Major Depressive Disorder and Bipolar Disorder are psychiatric disorders associated with psychosocial impairment. Despite clinical improvement, functional complaints usually remain, mainly impairing occupational and cognitive performance. The aim of this study was to use machine learning techniques to predict functional impairment in patients with mood disorders. For that, analyzes were performed using a population-based cohort study. Participants diagnosed with a mood disorder at baseline and reassessed were considered (n = 282). Random forest (RF) with previous recursive feature selection and LASSO algorithms were applied to a training set with imputed data by bagged trees resulting in two main models. Following recursive feature selection, 25 variables were retained. The RF model had the best performance compared to LASSO. The most important variables in predicting functional impairment were sexual abuse, severity of depressive, anxiety, and somatic symptoms, physical neglect, emotional abuse, and physical abuse. The model demonstrated acceptable performance to predict functional impairment. However, our sample is composed of young participants and the model may not generalize to older individuals with mood disorders. More studies are needed in this direction. The presented calculator has clinical, sociodemographic, and environmental data, demonstrating that it is possible to use such information to predict functional performance.

Early illness progression in mood disorders: A population-based longitudinal study.

This study is aimed at assessing changes in functioning among young people from the general population with bipolar disorder and major depressive disorder over a period of five years. Specifically, we hypothesized that significant illness progression would take place during euthymia over time in bipolar disorder. We conducted a longitudinal study with 231 people, assessed at baseline and again at a five-year follow-up. A structured clinical interview was used to diagnose participants with mood disorders. A control group without mood disorders was also included. Functioning was assessed with the Functioning Assessment Short Test, and linear mixed models were used to analyze the effect of psychopathology on change in functioning. Mood disorders were associated with significant functional impairment, but functioning significantly improved in both groups over the 5-year follow-up period. Depressive episodes, however, were associated with worse functioning at follow-up, independently of depression severity. In contrast to our initial hypothesis, we found a worsening of functioning in a five-year period associated only with depressive episodes. This suggests that interventions focused on the prevention of mood episodes early in the course of illness may be particularly promising to reduce adverse functioning outcomes.

Incidence and Risk Factors for Suicide Attempts in Patients Diagnosed with Major Depressive Disorder.

OBJECTIVE: This study seeks to investigate the cumulative incidence and risk factors of suicide attempts in an outpatient sample of adults diagnosed with major depressive disorder (MDD). MATERIALS AND METHODS: This is a longitudinal study with 377 patients aged between 18 and 60 years. Those were diagnosed with MDD with no history of suicide attempts when they sought care at the Mental Health Outpatient Clinic of the Catholic University of Pelotas and evaluated again 3 years after. Participants were evaluated with the Mini International Neuropsychiatric Interview (MINI Plus) and answered instruments of clinical investigation and a sociodemographic questionnaire. RESULTS: The cumulative incidence of suicide attempts in the sample was 10.1%. Youths aged up to 29 years (OR 2.23; 95% CI 1.13 to 4.64), with low schooling (OR 2.35; 95% CI 1.15 to 4.80), who suffered intense physical abuse during childhood (OR 2.77; 95% CI 1.31 to 5.84) and were at prior suicide risk (OR 3.39; 95% CI 1.56 to 7.37) were more likely to attempt suicide. CONCLUSION: The findings of this study may help health professionals identify depressed patients at greater risk for a first suicide attempt, supporting clinical decision and therapeutic planning.

Is Narrative Cognitive Therapy as Effective as Cognitive Behavior Therapy in the Treatment for Depression in Young Adults?

This study aimed to compare the effectiveness of narrative cognitive therapy (NCT) and cognitive behavior therapy (CBT) in the improvement of perception of quality of life in young adults with depression at 12-month follow-up. This was a randomized clinical trial conducted using seven sessions of NCT or CBT. Quality of life was measured using the Medical Outcomes Survey Short-Form General Health Survey. The sample included 97 patients. Considering only completers to be samples, CBT was more effective than NCT for improvement of physical functioning (p = 0.031), vitality (p = 0.013), and mental health (p = 0.002) at 12-month follow-up. However, in the intention-to-treat analysis, we found no difference between groups. Regardless of model, we found a significant improvement in all domains from baseline to postintervention and 6- and 12-month follow-ups, except for the bodily pain domain. In conclusion, both models were effective in the improvement of perception of quality of life.

Biological Rhythm and Bipolar Disorder: Twelve-Month Follow-Up of a Randomized Clinical Trial.

The objective was to evaluate the effect of psychoeducation on biological rhythm and in the reduction of depressive, anxious, and manic symptoms at 12 months' follow-up. This was a randomized clinical trial with young adults aged 18 to 29 years, diagnosed with bipolar disorder. Biological rhythm was assessed with the Biological Rhythm Interview Assessment in Neuropsychiatry (BRIAN). Participants were randomized for combined intervention (psychoeducation plus medication) or treatment-as-usual (medication alone). The sample consisted of 61 patients (29 TAU; 32 combined intervention). Although it failed to separate by a marginal difference, the combined intervention seems to be more effective than TAU in relation to improvement of depressive symptoms at post-intervention (p = 0.074) and regulation of sleep/social domain at 6 months' follow-up (p = 0.057). Improvement of depressive symptoms as well as regulation of sleep and social activities are known to prevent episode onset and thus improve long-term outcomes.

Biological rhythms in bipolar and depressive disorders: A community study with drug-naïve young adults.

AIM: To assess biological rhythm disruptions among drug-naïve young adults with bipolar disorder (BD), major depressive disorder (MDD), and community controls. METHODS: This was a cross-sectional study nested in a population-based study. BD and MDD were diagnosed using the Structured Clinical Interview for DSM-IV. Biological rhythm disruptions were assessed using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). RESULTS: Two hundred seventeen subjects were assessed (49 BD, 74 MDD, and 94 community controls). Biological rhythm disruption was higher in subjects with BD (40.32±9.92; p<0.001) and MDD (36.23±8.71; p<0.001) than community controls (27.67±6.88). Subjects with BD had a higher BRIAN total score (p=0.028) and higher disruption in sleep/social domains (p=0.018) as compared to MDD. In addition, the BRIAN scores were higher in current MDD, euthymic BD, and BD in current episode group, as compared to community controls. LIMITATION: Cross-sectional design. Absence of assessment of biomarkers of biological rhythms. CONCLUSION: Bipolar disorder and major depressive disorder are associated with disruption in biological rhythm. In addition, disruption in sleep/social rhythms is higher in subjects with BD when compared to subjects with MDD. We also verified biological rhythm disruption in subjects with BD during euthymic status, but not in remitted MDD. Regulation of biological rhythm may be a means to identify patients with mood disorders and potentially differentiate MDD from BD.

Quality of life and mood disorder episodes: community sample.

OBJECTIVE: To assess quality of life among Brazilian young adults who are 18-24 years old and who experience depressive, manic/hypomanic, and mixed episodes. METHOD: This is a cross-sectional population-based study. The sample was selected in clusters. Mood disorders were assessed using a short, structured diagnostic interview-the Mini International Neuropsychiatric Interview (MINI) for DSM-IV and ICD-10 psychiatric disorders. Quality of life was assessed by the MOS 36-item Short-form General Health Survey (SF-36). RESULTS: The sample comprised 1560 young adults. The prevalence ratio of mood disorder episodes were as follows: 10.0% depressive episode, 2.3% manic/hypomanic episode, and 2.4% mixed episode. Lower scores were found in all domains of quality of life among young adults who experience mood disorder episodes when compared to the general population (p<0.001 in the eight domains of the SF-36). Moreover, the impact on quality of life was higher among young adults with mixed episodes, followed by depressive episodes. CONCLUSION: Young adults with mood disorders, even without a previous diagnosis of bipolar disorder, have an impaired quality of life in comparison to the general population.