The relationship between emotional intelligence and quality of life in schizophrenia and bipolar I disorder.

PURPOSE: Social cognitive skills, both psychosocial functioning and well-being of patients with schizophrenia (SZ) or bipolar disorder (BD), have consistently been shown to be interrelated. While previous research mainly focused on emotion perception, the present study investigates the impact of the other subdomains of emotion processing on a subjective Quality of Life (QoL) estimate and objective QoL indicators. We hypothesized that patients with better performance in the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) report better QoL; and assumed that SZ and BD patients report comparable subjective QoL, whereas BD patients show higher levels of objective QoL. METHODS: Patients diagnosed with either SZ (n = 63) or BD (n = 60), as well as 80 healthy controls, were included into a cross-sectional study. Emotional Intelligence (EI) and QoL were assessed using the MSCEIT and the German version of the Lancashire Quality of Life Profile. RESULTS: The two patient groups were comparable with regard to overall EI, as well as subjective and objective QoL, but indicated significantly lower levels of EI and QoL than healthy controls. Whereas EI was not associated with both patient groups' subjective QoL, a significant correlation of EI with objective QoL was only observed in SZ. However, overall effect sizes were small. CONCLUSION: Our findings point to a difference in the interrelation between EI and QoL in patients suffering from SZ and BD, and suggest that they may have different needs to achieve recovery. It will be critical to develop training programs targeting EI in SZ, and to examine their impact on objective QoL in these patients.

[Social cognition in patients with mood disorders: part I: major depressive disorder : a comprehensive review of the literature]. / Soziale Kognition bei PatientInnen mit affektiven Störungen: Teil I: Unipolar Depressive Störung : Eine selektive Literaturübersicht.

OBJECTIVE: Overview on the current knowledge regarding social cognition in patients with major depressive disorder. METHODS: Selective literature research on deficits in social cognition intrinsic to major depressive disorders, their occurrence and effects. RESULTS: Deficits in social cognition are considered to be core features of major depressive disorder. They are apparent during acute episodes of the disorders, endure when patients are in remission and have a significant negative impact on the patients' psychosocial outcomes. CONCLUSIONS: It is important to consider deficits in social cognition as an integral part of a treatment approach to achieve mental stabilization in patients with major depressive disorder.

[Psychotherapeutic interventions in bipolar disorder: a review]. / Psychotherapeutische Interventionen bei Bipolaren Erkrankungen: Eine Ubersicht der Literatur!

The treatment of bipolar disorders is a demanding task involving patients, therapists and relatives. As bipolar disorders are associated to multiple psychosocial disturbances, the management of a bipolar disease should focus on psychosocial interventions. Despite an exploding literature on this topic, psychopharmacological interventions applied as a monotherapy have shown unsatisfactory outcomes. In order to enhance outcome, psychotherapy, such as cognitive behavioural therapy (CBT), psychoeducation, a modified form of interpersonal psychotherapy (IPSRT) or family focussed psychotherapy (FFT) were investigated. When used in conjunction with pharmacotherapy, these interventions may prolong time to relapse, reduce symptom severity, and increase medication adherence. These combinations are currently considered being the golden standard in the treatment of bipolar disorders. Psychotherapeutic interventions as an add-on strategy exert better effects when patients are euthymic at entry. Prevention of manic episodes seems to be more successful as compared to the prevention of depressive episodes. There are currently no hints for a method specific efficacy. Efficacy of psychoeducation seems to be rather short lived. Currently not yet evaluated booster-sessions might help. More data are needed in order to identify patients with a putative good response to psychotherapeutic interventions.

[Are there substantial reasons for contraindicating antidepressants in bipolar disorder? Part II: facts or artefacts?]. / Sind Antidepressiva in der Behandlung der bipolaren Depression obsolet? Teil II: Harte Fakten oder Artefakte?

After having dedicated the first part of this article to the prevalence and impact of depressive symptoms in the context of bipolar disorders, the authors now delineate advantages and disadvantages of antidepressants in bipolar depression. A literature search was performed using PubMed, and Mesh Database using the keywords, bipolar disorder, antidepressants and depression. Additional information was gained by cross-referencing from papers found in the data base. Data from controlled studies as well as supplementary information from review articles and psychiatric manuals pertinent to the topic were used. In contrast to the worldwide uniformly used guidelines in the treatment of mania, there is a controversial discussion, on the use of antidepressants in bipolar disorder. Whereas European guidelines exert a more allowing attitude towards the use of antidepressants, currently published US-guidelines do explicitly not recommend antidepressants in the treatment of bipolar depression, unless depression is severe. In fact, antidepressants are yielded to destabilize the disease by triggering switches into mania and to increase cycle acceleration. Despite that, antidepressants, in addition to, or without mood-stabilizers, are broadly used in clinical practice in acute or maintenance therapy. Literature of the use antidepressants as first line treatment in bipolar depression is too sparse to favour or to refute such a therapy. In order to prevent from affective side effects, antidepressant substances like tricyclics should be avoided. Instead substances like SSRI or bupropion with less affective side effects should be used. If antimanics are added, SSRI or bupropion seem to exert switch rates on placebo level. Specific subtypes of bipolar disorder, such as mixed episodes, rapid cycling courses, seem to be extensively associated to antidepressants induced switch phenomena. Antidepressants should be avoided in this sample of patients. Bipolar-II-subtype seems to be associated with low switch-rates, independent from the used substance class. Patient-specific features, such as comorbidities, a history of mania, early beginning, psychotic features, a positive genetic load) seem to negatively influence the onset of antidepressant induced affective side-effects. An extended assessment of the individual medical history is therefore warranted. Literature on the use of antidepressants in maintenance is virtually absent. The authors present current literature and guidelines of recent treatment recommendations in bipolar depression.

[Are there substantial reasons for contraindicating antidepressants in bipolar disorder? Part III. The alternatives!]. / Sind Antidepressiva in der Behandlung der bipolaren Depression obsolet? Teil III: Die Alternativen!

After having described depressive symptoms along the course and different subtypes of bipolar disorder the authors focus on pharmacological alternatives to antidepressant medication in bipolar depression. In doing so, they review the newest literature on efficacy of antidepressants and compare effect size of the different alternatives like antipsychotics and mood stabilizers to those of antidepressants. Efficacy of antidepressants in bipolar depression is still discussed controversially, as scientific evidence, is as far as available, weak. Severity of depressive symptoms should define, wether or not antidepressants in comparison to alternative agents like antipsychotics or mood stabilizers should be implemented. According to a balanced analysis of pro's and con's antidepressants may be used in minor to medium depressive symptoms as well. For clinical safety reasons, and not due to scientific evidence, an antimanic agent should be implemented in addition to an antidepressant. Because of clinical wisdom, in patients with mixed episodes or rapid cycling antidepressants should be avoided.

Treatment patterns in inpatients with bipolar disorder at a psychiatric university hospital over a 9-year period: focus on mood stabilizers.

The increasing number of pharmacological treatment options for bipolar disorder seems to be paralleled by the number of evidence-based guidelines published previously. The aim of this study was to systematically examine the adherence to published guidelines and any change in prescription habits over time in a psychiatric hospital setting. This is a retrospective study of 531 bipolar in patients who were consecutively admitted to the Department for Psychiatry and Psychotherapy in Innsbruck. Their complete medical histories were evaluated for psychotropic medications, with a special focus on mood stabilizers (MSs). To compare the use of individual MSs or combinations with other psychotropic medications in two preselected observation periods (1999-2003 and 2004-2007), we used Fisher's exact test. Overall, the proportion of patients receiving at least one MS increased significantly from 1999-2003 to 2004-2007 (74.1 vs. 83.1%, P=0.011). Among the individual MSs, valproate was used most frequently in both time periods, showing a significant increase (P<0.001). Prescriptions of quetiapine (P<0.001) and lamotrigine (P=0.033) increased significantly, carbamazepine showed a significant decrease (P<0.001). Prescriptions of lithium and olanzapine decreased without reaching significance. The significant increase in the prescription of MS reflects the increasing awareness and implementation of recent evidence-based medicine guidelines into clinical practice. Clinical decision making, usually made on the basis of individual clinical experience, should always be reevaluated using periodically updated evidence-based medicine guidelines.