[Screening for metabolic syndrome in older patients with severe mental illness]. / Metabole screening bij oudere patiënten met een ernstige psychiatrische aandoening1.

BACKGROUND: Diabetes, cardiovascular disease and metabolic syndrome are more prevalent in older patients with severe mental illness (smi) than in healthy older persons in the same age-group as the smi patients. Compared to the general population, smi patients are often in a poorer state of (physical) health and have a shorter life expectancy.
AIM: To assess the value of screening older smi patients (≥ 60) for metabolic syndrome.
METHOD: We performed a prospective evaluation of the metabolic screening outcome data relating to 100 older smi patients and 124 healthy older patients and compared the results.
RESULTS: In our smi patients (average age 69 years; 52% bipolar disorder, 48% schizophrenia) the frequency of metabolic syndrome (43%) was no higher than in healthy older persons (39.5%, p = 0.60). However, in 51% of the smi sample, metabolic screening detected at least one metabolic abnormality in a patient with no previous history for that specific parameter.
CONCLUSION: By making routine metabolic screening available to a greater number of older smi patients, we should be able to identify substantial numbers of metabolic abnormalities that have been previously overlooked.

Childhood abuse, family history and stressors in older patients with bipolar disorder in relation to age at onset.

OBJECTIVES: The aim of this study is to explore the family history of psychiatric disorders, childhood abuse, and stressors in older patients with Bipolar Disorder (BD) and the association of these variables with the age at onset of BD. METHODS: The Questionnaire for Bipolar Disorder (QBP) and the Mini International Neuropsychiatric Interview (MINI-Plus) were obtained from 78 patients aged 60 and over to determine diagnosis, age at onset of the first affective episode, childhood abuse, family history of psychiatric disorders and past and recent stressful life events. RESULTS: Increased family history of psychiatric disorders was the only factor associated with an earlier age at onset of BD. Less family history of psychiatric disorders and more negative stressors were significantly associated with a later age at onset of the first (hypo)manic episode. LIMITATIONS: Age at onset, history of childhood abuse, and past stressful life events were assessed retrospectively. Family members of BD patients were not interviewed. CONCLUSIONS: Our findings suggest that age at onset can define distinct BD phenotypes. More specifically there was a stronger heredity of BD and other psychiatric disorders in patients with an early age of onset of BD. Negative stressors may play a specific role in patients with a late age at onset of a first (hypo)manic episode.

[Obsessive-compulsive disorder]. / Obsessieve-compulsieve stoornis.

Obsessive-compulsive disorder is a complex psychiatric disorder characterised by obsessions and/or compulsions. Obsessive-compulsive disorder has a relatively high prevalence and is a highly disabling disease. The disorder is associated with shame, which causes long delays in accessing treatment. Obsessive-compulsive disorder is caused by a complex interplay between genetic and environmental factors. Effective treatments exist in the form of either pharmacotherapy--clomipramine or selective serotonin reuptake inhibitors--or cognitive behaviour therapy.

Marital resemblance for obsessive-compulsive, anxious and depressive symptoms in a population-based sample.

BACKGROUND: Resemblance between spouses can be due to phenotypic assortment, social homogamy and/or marital interaction. A significant degree of assortment can have consequences for the genetic architecture of a population. We examined the existence and cause(s) of assortment for obsessive-compulsive (OC), anxious and depressive symptoms in a population-based twin-family sample. METHOD: OC, anxious and depressive symptoms were measured in around 1400 twin-spouse pairs and >850 parent pairs. Correlations of twins and their spouse, twin and co-twin's spouse, spouses of both twins and parents of twins were obtained to consider phenotypic assortment versus social homogamy as possible causes of marital resemblance. The association of length of relationship with marital resemblance was also investigated. Finally, we examined whether within-trait or cross-trait processes play a primarily role in marital resemblance. RESULTS: Small but significant within-trait correlations of between 0.1 and 0.2 were seen for spouse similarity in OC, anxious and depressive symptoms. Cross-correlations were significant but lower. There was no correlation between length of relationship and marital resemblance. From the pattern of correlations for twin-spouse, co-twin-spouse and spouses of both twins, phenotypic assortment could not be distinguished from social homogamy. Both within- and cross-assortment processes play a role in marital resemblance. CONCLUSIONS: Small within- and across-trait correlations exist for OC, anxious and depressive symptoms. No evidence for marital interaction was found. Spouse correlations are small, which makes it difficult to distinguish between social homogamy and phenotypic assortment. It is unlikely that correlations of this size will have a large impact on genetic studies.

Sex differences in depression after widowhood. Do men suffer more?

BACKGROUND: This study focuses on sex differences in depression of the widowed. Previous research showed different results in sex differences and in depression after bereavement. We assessed the effects of widowhood on depressive symptoms for men and women and examined whether environmental strain like social support, finances and housekeeping concerns explain these effects. METHODS: Data were used from a large community-based study of older people in three regions of the Netherlands. Our study sample consists of 2626 widowed and married subjects in the age group of 55-85 years. Depression was measured using the CES-D scale; the various strains were obtained by structured interviews. Multiple linear regression, performed for men and women separately, were used. RESULTS: The results show that widowhood is associated with higher levels of depressive symptoms and that this association is stronger for men than for women. The effect of widowhood is mediated by different types of environmental strain for men and women. However, a strong direct main effect of widowhood on depression remains. The difference in depression rates between men and women is most evident among those widowed for a longer period of time. CONCLUSIONS: It appears that, over time, women adapt to widowhood more successfully than men. From a clinical point of view this is important, as it suggests that men who remain alone after losing their partner are at a higher risk of developing symptoms of chronic depression.