Occurrence of psychiatric conditions, use of psychotropic medications and its relationship with postural balance in subjects with dizziness. / Ocorrência de condições psiquiátricas, uso de psicotrópicos e sua relação com o equilíbrio postural em sujeitos com tontura.

PURPOSE: to analyze the occurrence of psychiatric diagnosis and the use of psychotropics medications in subjects with vestibular complaints and to relate the presence of these conditions to the results of vestibulometry. METHODS: quantitative, observational, cross-sectional study with 131 patients, treated in a university hospital. They were submitted to anamnesis, visual inspection of the external ear canal, static and dynamic balance tests, Foam laser dynamic posturography and Computerized Vectoelectronystagmography. RESULTS: sample composed of 109 women and 22 men, with average age of 55 years and nine months. The most common type of dizziness was vertigo, with the presence of neurovegetative signals. A significant percentage of psychiatric complaint/diagnosis was observed, as well as the use of psychotropic medications, mainly serotonin uptake inhibitors, followed by benzodiazepines. There was a relation between the presence of psychiatric complaints with the female gender, alterations of the static balance and alterations in the Sensorial Organization Test positions III and VI. In the Vectoelectronystagmography, there was a relation between age and the presence of spontaneous nystagmus. CONCLUSION: There was a high occurrence of psychiatric complaint/diagnosis among patients with dizziness, with use of psychotropic medications substantially greater than the general population. The evaluation of postural balance revealed an association between anxiety/depression and alterations visual overload positions in the foam laser dynamic posturography. However, no relationship was found between these conditions and alterations in the Vectoelectronystagmography tests.

OBJETIVO: analisar a ocorrência do diagnóstico psiquiátrico e o uso de psicotrópicos em sujeitos com queixas vestibulares e relacionar a presença dessas condições aos resultados da vestibulometria. MÉTODO: estudo quantitativo, observacional, transversal, com 131 pacientes, atendidos em um hospital universitário. Foram submetidos à anamnese, inspeção visual do meato acústico externo, provas de equilíbrio estático e dinâmico, Posturografia dinâmica foam laser e vectoeletronistagmografia computadorizada. RESULTADOS: amostra composta por 109 mulheres e 22 homens, com média de idade de 55 anos e nove meses. O tipo de tontura mais frequente foi vertigem, com presença de sintomas neurovegetativos. Observou-se expressiva porcentagem de queixa/diagnóstico psiquiátrico, bem como uso de psicotrópicos, sendo principalmente inibidores seletivos da recaptação da serotonina, seguidos dos benzodiazepínicos. Houve relação entre a presença de condições psiquiátricas e mulheres, alterações do equilíbrio estático e alterações nas posições III e VI do Teste de Organização Sensorial. Na vectoeletronistagmografia, houve relação entre a idade e a presença de nistagmo espontâneo de olhos fechados. CONCLUSÃO: Constatou-se alta ocorrência de condições psiquiátricas entre pacientes com tontura, com uso de psicotrópicos maior que na população geral. Destaca-se a associação entre ansiedade/depressão e alterações nas posições de sobrecarga visual da posturografia dinâmica foam laser. No entanto, não foi observada relação entre essas condições e alterações nas provas da vectoeletronistagmografia.

Ocorrência de condições psiquiátricas, uso de psicotrópicos e sua relação com o equilíbrio postural em sujeitos com tontura / Occurrence of psychiatric conditions, use of psychotropic medications and its relationship with postural balance in subjects with dizziness

RESUMO Objetivo analisar a ocorrência do diagnóstico psiquiátrico e o uso de psicotrópicos em sujeitos com queixas vestibulares e relacionar a presença dessas condições aos resultados da vestibulometria. Método estudo quantitativo, observacional, transversal, com 131 pacientes, atendidos em um hospital universitário. Foram submetidos à anamnese, inspeção visual do meato acústico externo, provas de equilíbrio estático e dinâmico, Posturografia dinâmica foam laser e vectoeletronistagmografia computadorizada. Resultados amostra composta por 109 mulheres e 22 homens, com média de idade de 55 anos e nove meses. O tipo de tontura mais frequente foi vertigem, com presença de sintomas neurovegetativos. Observou-se expressiva porcentagem de queixa/diagnóstico psiquiátrico, bem como uso de psicotrópicos, sendo principalmente inibidores seletivos da recaptação da serotonina, seguidos dos benzodiazepínicos. Houve relação entre a presença de condições psiquiátricas e mulheres, alterações do equilíbrio estático e alterações nas posições III e VI do Teste de Organização Sensorial. Na vectoeletronistagmografia, houve relação entre a idade e a presença de nistagmo espontâneo de olhos fechados. Conclusão Constatou-se alta ocorrência de condições psiquiátricas entre pacientes com tontura, com uso de psicotrópicos maior que na população geral. Destaca-se a associação entre ansiedade/depressão e alterações nas posições de sobrecarga visual da posturografia dinâmica foam laser. No entanto, não foi observada relação entre essas condições e alterações nas provas da vectoeletronistagmografia.

ABSTRACT Purpose to analyze the occurrence of psychiatric diagnosis and the use of psychotropics medications in subjects with vestibular complaints and to relate the presence of these conditions to the results of vestibulometry. Methods quantitative, observational, cross-sectional study with 131 patients, treated in a university hospital. They were submitted to anamnesis, visual inspection of the external ear canal, static and dynamic balance tests, Foam laser dynamic posturography and Computerized Vectoelectronystagmography. Results sample composed of 109 women and 22 men, with average age of 55 years and nine months. The most common type of dizziness was vertigo, with the presence of neurovegetative signals. A significant percentage of psychiatric complaint/diagnosis was observed, as well as the use of psychotropic medications, mainly serotonin uptake inhibitors, followed by benzodiazepines. There was a relation between the presence of psychiatric complaints with the female gender, alterations of the static balance and alterations in the Sensorial Organization Test positions III and VI. In the Vectoelectronystagmography, there was a relation between age and the presence of spontaneous nystagmus. Conclusion There was a high occurrence of psychiatric complaint/diagnosis among patients with dizziness, with use of psychotropic medications substantially greater than the general population. The evaluation of postural balance revealed an association between anxiety/depression and alterations visual overload positions in the foam laser dynamic posturography. However, no relationship was found between these conditions and alterations in the Vectoelectronystagmography tests.

Meta-analyses of cavum septum pellucidum in mood disorders in comparison with healthy controls or schizophrenia.

The cavum septum pellucidum (CSP) is a neurodevelopmental abnormality significantly more prevalent in subjects with schizophrenia (SCZ) than in healthy controls (HC). Using meta-analyses, we tested the hypotheses whether CSP would be more frequent in subjects with mood disorders when compared with HC or SCZ. We performed a search in MEDLINE and EMBASE followed by 10 meta-analyses of magnetic resonance imaging studies which examined the association of CSP in bipolar disorders (BD), major depressive disorder (MDD) or mood disorders (MD; considering MDD and BD combined) with either HC or SCZ. Nine studies were included, comprising 692 cases (363 with BD, 182 with MDD and 147 with MD), 463 with SCZ and 630 HC. CSP of any size was significantly associated with BD (OR = 2.07, 95% CI: 1.48-2.90) when compared with HC. Large CSP showed a trend to be associated with BD when compared with HC, but the association was not statistically significant (OR = 1.92, 95% CI 0.64-5.78). Large CSP was significantly associated with subjects with SCZ when compared with subjects with MD (OR = 0.57, 95% CI: 0.36-0.92). There was no association between CSP and MDD in comparison to HC or subjects with SCZ. Cortical structures are known to be altered in mood disorders. The present metanalysis found that certain midline brain abnormalities, such as CSP, are also associated with BD.

Clinically Oriented Subtyping of Chronic Insomnia of Childhood.

OBJECTIVES: To identify different profiles of pediatric insomnia, based on the most frequent clinical presentations (nocturnal awakenings, difficulty in falling asleep, nocturnal restlessness, early morning awakenings). STUDY DESIGN: A structured parent interview was conducted in 338 children (mean age 21.29 months, SD 10.56) referred by pediatricians because of insomnia resistant to behavioral approaches and common drug treatments. The aim was to assess the characteristics of insomnia in children, together with family sleep-related history. A latent class analysis was run to identify profiles of insomnia. ANOVA and the χ2 test were used to examine differences between profiles. RESULTS: A 3-class model was built by latent class analysis: 17% (n = 58) of children constituted the first class, characterized by difficulties in falling asleep, with restlessness, nocturnal restlessness, and awakenings during the night; the second class, characterized by early morning awakenings, comprised 21% (n = 71) of children; 62% (n = 209) of children fell within the third class because of their high frequency of nocturnal awakenings and difficulties in falling asleep. The first class reported longer sleep latency and the presence of restless legs syndrome and anemia in the family history; depression and/or mood disorders were more frequent in class 2 and allergies and/or food intolerance were more frequent in class 3. CONCLUSIONS: Our study suggests the existence of 3 different phenotypes of insomnia in children, based on clinical, personal, and familial data. The identification of these different phenotypes might help to optimize the assessment and treatment of insomnia in young children.

Genetic polymorphisms associated with circadian rhythm dysregulation provide new perspectives on bipolar disorder.

OBJECTIVES: The objective of this study was to present a broad view of how genetic polymorphisms in genes that control the rhythmicity and function of circadian rhythm may influence the etiology, pathophysiology and treatment of bipolar disorder (BD). METHODS: A bibliographic search was performed to identify and select papers reporting studies on variations in circadian genes and BD. A search of Medline, Google Scholar, Scopus, and Web of Science was carried out to review the literature. RESULTS: Several studies provide evidence of contributions of variations in circadian genes to disease etiology, pathophysiological variations and lithium drug response. Dysfunction of the sleep-wake cycle, an important brain function regulator, is indicated as the primary means by which circadian gene variations act in mood disorders. CONCLUSIONS: Investigations of the effects of circadian genes have suggested that the chronotype offers hope for guiding and improving management of patients with BD. However, BD is a disease of a complex nature and presents multiple endophenotypes determined by different associations between genetics and the environment. Thus, new genomic studies to delimit variations that may help improve the clinical condition of these patients are extremely important.

Medical comorbidity in bipolar disorder: The link with metabolic-inflammatory systems.

BACKGROUND: Bipolar disorder (BD) is associated with chronic low-grade inflammation, several medical comorbidities and a decreased life expectancy. Metabolic-inflammatory changes have been postulated as one of the main links between BD and medical comorbidity, although there are few studies exploring possible mechanisms underlying this relationship. Therefore, the aims of the current narrative review were 1) synthesize the evidence for metabolic-inflammatory changes that may facilitate the link between medical comorbidity and BD and 2) discuss therapeutic and preventive implications of these pathways. METHODS: The PubMed and Google Scholar databases were searched for relevant studies. RESULTS: Identified studies suggested that there is an increased risk of medical comorbidities, such as autoimmune disorders, obesity, diabetes and cardiovascular disease in patients with BD. The association between BD and general medical comorbidities seems to be bidirectional and potentially mediated by immune dysfunction. Targeting the metabolic-inflammatory-mood pathway may potential yield improved outcomes in BD; however, further study is needed to determine which specific interventions may be beneficial. LIMITATIONS: The majority of identified studies had cross-sectional designs, small sample sizes and limited measurements of inflammation. CONCLUSIONS: Treatment and prevention of general medical comorbidities in mood disorders should include preferential prescribing of metabolically neutral agents and adjunctive lifestyle modifications including increased physical activity, improved diet and decreased substance abuse. In addition, the use of anti-inflammatory agents could be a relevant therapeutic target in future research.

Risk of Suicide Attempt among Adolescents with Conduct Disorder: A Longitudinal Follow-up Study.

OBJECTIVE: To assess the independent or comorbid effect of conduct and mood disorders on the risk of suicide. STUDY DESIGN: The Taiwan National Health Insurance Research Database was used to derive data for 3711 adolescents aged 12-17 years with conduct disorder and 14 844 age- and sex-matched controls between 2001 and 2009. The participants were followed up to the end of 2011, and those who attempted suicide during the follow-up period were identified. RESULTS: Adolescents with conduct disorder had a higher incidence of suicide (0.9% vs 0.1%; P <.001) and attempted suicide at a younger age (17.38 ± 2.04 vs 20.52 ± 1.70 years of age) than did the controls. The Cox proportional hazards regression model, after adjustment for demographic data and psychiatric comorbidities, determined that conduct disorder was an independent risk factor for subsequent suicide attempts (hazard ratio, 5.17; 95% CI, 2.29-11.70). The sensitivity after those with other psychiatric comorbidities were excluded revealed a consistent finding (hazard ratio, 10.32; 95% CI, 3.71-28.71). DISCUSSION: Adolescents with conduct disorder had an increased risk of suicide attempts over the next decade. Future studies are required to clarify the underlying pathophysiology and elucidate whether prompt intervention for conduct disorder could reduce this risk.

Insight in bipolar mania: evaluation of its heterogeneity and correlation with clinical symptoms.

BACKGROUND: Studies on insight in bipolar mania are not numerous and usually consider insight as a unitary construct. OBJECTIVE: Evaluate how different facets of insight are affected in bipolar mania and investigate correlations between insight for each specific object in bipolar disorder and manic symptomatology. METHOD: A group of 165 bipolar patients were followed during a year, with 51 patients having manic episodes according to DSM-IV-TR criteria. Patients underwent a clinical assessment and insight was evaluated through the Insight Scale for Affective Disorders. RESULTS: The study found that insight regarding symptoms is worse than insight of having bipolar disorder, social relationships and self esteem. Moreover, poor global insight (total ISAD) correlates with more severe changes in mood, speech and thought structure, with worse insight about symptoms correlating with the same alterations and also with more severe symptoms of agitation/energy. LIMITATIONS: Although a large sample of bipolar patients was followed up, the final sample composed of patients with at least one manic episode was relatively smaller. Moreover, the fact that the study was performed in a university hospital may have led to selection biases. CONCLUSION: Results suggest that patients with BD are reasonably capable of identifying that their condition implies consequences but have more impaired awareness of their energy and activity levels. A lower level of insight specifically about symptoms correlates with more severe symptoms of agitation/energy, which suggests a psychomotor nucleus able to impair insight in mania.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors.

OBJECTIVES: To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. SUBJECTS AND METHODS: A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. RESULTS: Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. CONCLUSIONS: Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients. .

Serum triglycerides, but not cholesterol or leptin, are decreased in suicide attempters with mood disorders.

BACKGROUND: Many peripheral biomarkers, including low cholesterol and its fractions, have been examined to identify suicidal behavior. Herein, we assessed serum lipid profile and some proteins putatively associated with suicidal behavior in subjects with mood disorder (bipolar disorder or major depressive disorder) with a recent suicide attempt and with no lifetime history of suicide attempts. METHODS: Fifty subjects had presented an episode of attempted suicide during the last 15 days, and 36 subjects had no history of any suicide attempt. We measured total cholesterol, HDL, LDL and triglycerides as well as serum leptin, brain-derived neurotrophic factor (BDNF), S100B and C-reactive protein (CRP). RESULTS: Individuals that had attempted suicide presented decreased body mass index (BMI) and waist circumference. After adjusting for these confounders, we found that triglycerides were decreased in attempted suicide subjects. We found no differences among total cholesterol, LDL, and HDL or leptin, S100B, CRP and BDNF. LIMITATIONS: This is a cross-sectional study, and we cannot therefore assess whether a decrease in triglycerides caused a mood episode with suicidal ideation that led to a suicide attempt or if the presence of a mood episode originated a loss of appetite and consequent loss of weight, therefore decreasing triglyceride levels. CONCLUSIONS: These results do not support the hypothesis that lower levels of cholesterol are associated with suicidal behavior in a mood disorder sample. However, our data support the idea that adiposity is differentiated in these patients (reduced BMI, waist circumference and serum triglycerides), which could lead to an altered communication between the adipose tissue and brain.

Validation of the Impulsive/Premeditated Aggression Scale in Mexican psychiatric patients.

INTRODUCTION: Aggression has been linked to several psychiatric disorders. None of the available instruments validated in Mexico is able to classify aggression as impulsive or premeditated. The Impulsive/Premeditated Aggression Scale (IPAS) is a self-report instrument designed to characterize aggressiveness as predominately impulsive or premeditated. OBJECTIVE: The aim of the study was to determine the validity and reliability of the IPAS in a sample of Mexican psychiatric patients. METHOD: A total of 163 patients diagnosed with affective, anxiety or psychotic disorder were included. A principal-component factor analysis was performed to obtain construct validity of the IPAS impulsive and premeditated aggression subscales; convergent validity as well as internal consistency of subscales were also determined. RESULTS: The rotated matrix accounted for 33.4% of the variance. Significant values were obtained for convergent validity and reliability of the IPAS subscales. CONCLUSION: The IPAS is an adequate instrument, which might be used to differentiate the type of aggressive behavior in Mexican psychiatric patients.

Exacerbation of mood symptoms associated to primary and secondary carnitine deficiency: a case report.

Rarely screened in psychiatric patients, primary and/or secondary Carnitine deficiency could be influencing and/or mimicking the mood symptoms of our patient population. The brain and specifically neurons are highly vulnerable to impairments in oxidative metabolism, which can lead to neuronal cell death and disorders of neurotransmitters causing changes in cognition and behavior. For this reason, identification of this disorder is important since its treatment could result in symptom improvement and better quality of life of our patients. We present a case where exacerbation of mood symptoms was associated to primary and secondary Carnitine deficiency.

Comorbidity between bipolar disorder and cluster B personality disorders as indicator of affective dysregulation and clinical severity.

INTRODUCTION: Several lines of evidence have well established a relationship between Bipolar Disorder and Cluster B Personality Disorders. The study compares mood spectrum and temperamental symptoms, personality traits and clinical characteristics among outpatients (n = 63) diagnosed with major depression (MD), bipolar disorder (BD), cluster B personality disorders (PD-B) and comorbidity of BD + PD-B. METHOD: The diagnosis was determined with structured interviews (MINI and SCID II) and symptom assessments with evaluation and diagnostic instruments (MOODS-SR, BI, TEMPS-A and IPDE). Differences between groups were explored with post hoc analysis and analysis of variance. RESULTS: Patients with BD+PD-B comorbidity presented an earlier onset and more severity in suicide attempts, hospitalizations and self-harm behaviors. They showed more characteristics of cyclothymic and irritable temperament and more cluster A and B personality traits, than patients with BD only. PD-B patients obtained intermediate scores in manic like symptoms: higher than patients with depression and lower than patients with bipolar disorder. However, the Bipolarity Index clearly distinguished patients with BD or with comorbidity (BD+PD-B) from the other diagnostic groups (PD-B and MD). CONCLUSIONS: BD+PD-B comorbidity presents a more severe type of emotional dysregulation compared to the other diagnostic groups, including BD and PD-B alone. Assessing temperament, personality traits, emotional dysregulation in mania and depression, self-harm and hospitalizations severity and age onset could facilitate differential diagnosis and enhance effectiveness of treatments for BD, PD-B and their comorbidity.

Symptoms of anxiety and mood disturbance alter cardiac and peripheral autonomic control in patients with metabolic syndrome.

Previous investigations show that metabolic syndrome (MetSyn) causes sympathetic hyperactivation. Symptoms of anxiety and mood disturbance (AMd) provoke sympatho-vagal imbalance. We hypothesized that AMd would alter even further the autonomic function in patients with MetSyn. Twenty-six never-treated patients with MetSyn (ATP-III) were allocated to two groups, according to the levels of anxiety and mood disturbance: (1) with AMd (MetSyn + AMd, n = 15), and (2) without AMd (MetSyn, n = 11). Ten healthy control subjects were also studied (C, n = 10). AMd was determined using quantitative questionnaires. Muscle sympathetic nerve activity (MSNA, microneurography), blood pressure (oscillometric beat-to-beat basis), and heart rate (ECG) were measured during a baseline 10-min period. Spectral analysis of RR interval and systolic arterial pressure were analyzed, and the power of low (LF) and high (HF) frequency bands were determined. Sympatho-vagal balance was obtained by LF/HF ratio. Spontaneous baroreflex sensitivity (BRS) was evaluated by calculation of α-index. MSNA was greater in patients with MetSyn + AMd compared with MetSyn and C. Patients with MetSyn + AMd showed higher LF and lower HF power compared with MetSyn and C. In addition, LF/HF balance was higher in MetSyn + AMd than in MetSyn and C groups. BRS was decreased in MetSyn + AMd compared with MetSyn and C groups. Anxiety and mood disturbance alter autonomic function in patients with MetSyn. This autonomic dysfunction may contribute to the increased cardiovascular risk observed in patients with mood alterations.

Reduced posterior corpus callosum area in suicidal and non-suicidal patients with bipolar disorder.

BACKGROUND: Impulsivity is a characteristic of bipolar disorder (BD) that can contribute to the risk for suicidal behavior. Evidence suggests that gray and white matter abnormalities are linked with impulsivity, but little is known about the association between corpus callosum (CC) and impulsivity in BD. We examined the CC area and impulsivity in euthymic bipolar I patients, with and without lifetime history of suicide attempts, and in healthy controls. METHODS: Nineteen bipolar patients with a suicide attempt history (BP-S), 21 bipolar patients without suicide attempt history (BP-NS), and 22 healthy controls (HC) underwent clinical assessment by the Structured Clinical Interview with the DSM-IV axis I (SCID-I), the Barratt Impulsiveness Scale (BIS-11), and MRI scan. RESULTS: No differences were observed for any CC subregion between BP-S and BP-NS groups. There was a significant reduction in the genu (p=0.04) and isthmus areas (p=0.01), in bipolar patients compared with HC. In the BP-S group, the BIS-11 total (p=0.01), attention (p=0.001) and non-planning (p=0.02) impulsivity scores were significantly higher than in the BP-NS and HC groups. LIMITATIONS: These results cannot establish causality because of the cross-sectional nature of the study. CONCLUSION: This report potentially provides evidence that a reduction in the CC area is present even in non-symptomatic bipolar patients, which may be evidence of a biological trait marker for BD. Furthermore, the study demonstrated that BP-S group had higher impulsivity even during euthymia, which points to a sustained association between lifetime history of suicide attempts and impulsivity in BD.

The effects of sildenafil on rectal sensitivity and tone in patients with the irritable bowel syndrome.

BACKGROUND: Visceral tone supposedly affects gut sensitivity in irritable bowel syndrome (IBS). Sildenafil increases nitric oxide and influences visceral compliance. AIM: To evaluate the effects of sildenafil tone inhibition on rectal sensitivity. METHODS: Eight controls and 21 IBS patients (Rome II) were enrolled in a double-blind study, after dosing with placebo or sildenafil (50 mg p.o.). Thresholds for first sensation, first desire to defecate, pain and supraliminar pain were the sensory endpoints, measured with a barostat and 600-mL rectal bag. Pain (100-mm VAS) and depression-anxiety (Hamilton questionnaire) were scored. RESULTS: Irritable bowel syndrome rectal compliance and sensory-endpoint thresholds were similar to controls. Five IBS patients had pain threshold lower than controls 95% confidence interval (hypersensitive). Depression score was greater in IBS than controls (11.9 ± 1.3 vs. 6.3 ± 2.5, P = 0.036). In IBS, pain intensity was nonsignificantly higher (37.6 ± 5.3 mm vs. 23.4 ± 8.5 mm, P = 0.064) and supraliminar pain intensity was greater (45.6 ± 5.4 mm vs. 25.9 ± 5.1 mm, P = 0.044) than controls. IBS rectal relaxation increased volume (155.4 ± 41.3 mL vs. 118.8 ± 47.7 mL, P = 0.004) and tension (193.1 ± 118.6 mmHg mL(-1) vs. 133.2 ± 98.1 mmHg mL(-1) , P = 0.019) for triggering first desire to defecate but not for other perceptions. Sildenafil increased volume for both first desire to defecate and pain in the hypersensitive IBS patients. Sildenafil increased rectal compliance only in diarrhoea-IBS. Mixed-IBS obtained higher anxiety (12.9 ± 1.3 vs. 5.9 ± 3.1, P < 0.05) and depression scores (13.9 ± 1.9 vs. 6.3 ± 2.5, P < 0.05) and reported more intense supraliminar pain (53.6 ± 9.8 mm vs. 25.9 ± 5.1 mm, P < 0.05) than controls. CONCLUSIONS: Rectal relaxation following dosing with sildenafil 50 mg increased the first desire to defecate threshold in IBS as a whole, but decreased pain only in the hypersensitive subset. Mixed-IBS presented higher supraliminar pain and anxiety-depression scores.

The burdened life of adults with ADHD: impairment beyond comorbidity.

Since approximately 70% of adult patients with attention-deficit/hyperactivity disorder (ADHD) have at least one comorbid disorder, rating of impairment specifically attributable to ADHD is a hard task. Despite the evidence linking environmental adversities with negative outcomes in ADHD, life events measures have not been used to rate the disorder impairment. The present study tested for the first time the hypothesis that increased ADHD severity is associated with an increase in negative recent life events, independently of comorbidity status. The psychiatric diagnoses of 211 adult ADHD outpatients were based on DSM-IV criteria assessed through structured interviews (K-SADS-E for ADHD and ODD, MINI for ASPD and SCID-IV-R for other comorbidities). ADHD severity was evaluated with the Swanson, Nolan and Pelham rating scale (SNAP-IV) and recent life events with the Life Experience Survey. Higher SNAP-IV inattention and hyperactivity scores, female gender, lower socioeconomic status and the presence of comorbid mood disorders were associated with negative life events. Poisson regression models with adjustment for possible confounders confirmed the effect of inattention and hyperactivity severity on negative life events. Our results suggest that the negative life events experienced by these patients are associated to the severity of ADHD independently from comorbid psychiatric disorders.

Post-traumatic stress disorders, mood disorders, and quality of life in transplant recipients with acute liver failure.

OBJECTIVE: The objective of this study was to assess post-traumatic stress disorder (PTSD), depression, anxiety, and quality of life among acute hepatitis patients undergoing liver transplantation. METHOD: Twenty-four patients underwent transplantation due to acute liver failure. After a brief anamnestic interview to gather demographic and clinical information, each participant underwent a psychological assessment using the SF-36 Health Survey (SF-36), Impact of Events Scale-Revised (IES-R), Hospital Anxiety and Depression (HAD) Scale, as well as Beck Depression Inventory (BDI). RESULTS: The average age of the patients was 41.17 years (±17.03); the mean time after transplantation was 13.50 ± 13.80 months; 83% of the subjects were women. Anxiety symptoms were observed in 33.2% of the participants and depression in 16.7% by HAD and 45.8% by BDI. By IES-R 46.2% of patients presented high to severe levels of stress. The majority of participants (54.2%) showed good quality of life scores. A correlation analysis indicated a significant negative association between SF-36 score and other scales (from -0.514 to -0.681). Upon a comparative analysis, a significant difference between groups was only noted in SF-36 score (P = .032). CONCLUSION: The results led us to conclude that anxiety, depression, and PTSD were negatively associated with quality of life in this population. These symptoms also contributed directly to determine well-being among these patients.

Severe depression, suicide attempts, and ideation during the use of interferon beta by patients with multiple sclerosis.

BACKGROUND: Interferon (IFN) beta is a safe and efficient drug for treating multiple sclerosis (MS). It is widely accepted that previously depressed patients may get worse when using IFN-beta. There are few reports on the association of IFN-beta and severe depression among patients without previous psychiatric history. METHODS: Discussion of a case of a patient with MS who developed severe depression and attempted suicide while using IFN-beta encouraged us to review the subject. A group of neurologists in Brazil retrospectively gathered together their similar cases for the present paper. RESULTS: The present paper reports on 11 cases of severe depression with suicide attempts or ideation among patients with MS who were using IFN-beta. These patients had no previous history of any psychiatric disease. Nine patients developed the symptoms over a relatively short period (4 months, on average). Two patients developed severe depression after more than 1 year of treatment with IFN-beta. Phobic, aggressive, behavioral, psychotic, and manic symptoms also were observed in these patients, thus suggesting the existence of a complex mood-behavior disorder associated with this drug. Interferon beta withdrawal led to complete remission of symptoms. The Naranjo algorithm established a highly probable association between IFN-beta and this adverse reaction in these patients. CONCLUSIONS: Although uncommon, severe depression with suicide ideation or attempts may be observed during treatment of MS with IFN-beta. This association should not discourage the use of this drug, but physicians need to be aware of this possible adverse event from IFN-beta.