Andrzej Kiejna

Risk factors of treatment resistance in major depression: Association with bipolarity

BACKGROUND An undiagnosed and therefore inadequately treated bipolarity may be an important cause of drug resistance in depression diagnosed as unipolar. The study aimed to detect clinical and demographic characteristics, with a special interest in bipolarity features which could be risk factors for treatment resistance in unipolar depression. METHOD One-thousand and fifty-one patients recruited from 150 outpatient psychiatric clinics and fulfilling DSM-IV criteria for major depressive episodes, single or recurrent, were studied. Among them, 569 patients with treatment-resistant depression (TR) were compared with 482 patients with non-treatment-resistant depression (NTR). All patients were assessed using the structured demographic and clinical data interviews, Mood Disorder Questionnaire (MDQ) and Hypomania Checklist (HCL-32). RESULTS Independent risk factors of treatment resistance were: scoring 6 or higher on MDQ, scoring 14 or higher in HCL-32, age at first onset < or = 20 years, more than three previous depressive episodes, and lack of remission or partial remission after the previous depressive episode. LIMITATION A retrospective assessment of treatment resistance. CONCLUSIONS Bipolarity features as assessed by MDQ and HCL-32 were identified as significant factors of treatment resistance. Some other clinical variables connected with treatment resistance may be also be associated with bipolarity features.

The utility of Mood Disorder Questionnaire for the detection of bipolar diathesis in treatment-resistant depression.

BACKGROUND Treatment-resistant depression is a heterogeneous entity. There are many variables associated with poor response to antidepressants, one of which is missed bipolarity. Therefore, the present study investigated the bipolar diathesis between patients with treatment-resistant (TR) depression and non-treatment-resistant (NTR) depression as assessed with the Mood Disorder Questionnaire (MDQ). METHOD The population studied included 1051 patients diagnosed with single or recurrent major depressive disorder. They were classified into a non-treatment-resistant group (481 patients) and a treatment-resistant group (570 patients). The psychiatrist, using information from the patients medical history, psychiatric examination and available documentation, assessed each eligible patient. The symptoms of bipolarity were additionally assessed by the Mood Disorder Questionnaire. RESULTS A positive screen on the MDQ defined as endorsement of at least 6 of the 13 yes or no questions was an independent risk factor for treatment resistance.The total MDQ score was significantly higher in TR vs NTR (4.33 vs 2.66 points p<0.001) and the percentage of patients screened positive was significantly higher in TR than in NTR (13.7% vs 5.6% p<0.001). Factor analysis resulted in 2 factors with eigenvalues >1 explaining 91.5% of total variance. CONCLUSIONS Using the MDQ scale we confirmed the association between bipolarity and worse response to antidepressant drugs in patients with major depressive disorder.

Use of the Hypomania Checklist-32 and the Mood Disorder Questionnaire for detecting bipolarity in 1,051 patients with major depressive disorder

PURPOSE To use the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ), for detecting bipolarity in depressed patients. PATIENTS One thousand and fifty-one patients fulfilling ICD-10 criteria for unipolar major depressive episode, single or recurrent, were studied. Patients were assessed using a structured demographic and clinical data interview, and by the Polish versions of the HCL-32 and MDQ questionnaires. RESULTS Hypomanic symptoms exceeding cut-off criteria for bipolarity by HCL-32 were found in 37.5% of patients and, by MDQ, in 20% of patients. Patients with HCL-32 (+) or MDQ (+) differed significantly from patients with HCl-32 (-) and MDQ (-) respectively, by being less frequently married, having more family history of depression, bipolar disorder, alcoholism and suicide, earlier onset of illness, and more depressive episodes and psychiatric hospitalizations. The percentage of patients resistant to treatment with antidepressant drugs was significantly higher in HCL-32 (+) vs. HCL-32 (-) and in MDQ (+) vs. MDQ (-): 43.9% vs. 30.0%, and 26.4% vs. 12.4%, respectively. CONCLUSIONS The results confirm a substantial percentage of bipolarity in major depressive disorder. Such patients have a number of clinical characteristics pointing on a more severe form of the illness and their depression is more resistant to treatment with antidepressants.

Differences between suicide and non-suicidal self-harm behaviours: a literary review

The World Health Organization (WHO) states that suicide is one of the 20 most common causes of death – almost 1 million people across the globe die by suicide every year (data from 21 July 2014) [1]. Suicide is one of the most common causes of death among teenagers [2,3]. Another significant but much less known phenomenon is non-suicidal self-injury (self-harm). Despite the fact that we know much less about self-harm than about suicide, research during the past 10 years has indicated that self-harm occurs more frequently in the population of adolescents – whereas suicides affect 10% of teenagers, 7–14% of young people report to have performed a self-harming act at least once in their lives [4]. The most recent international research shows that the frequency of self-destructive behaviours in adolescents is at the level of 24% of the whole population, which might indicate an intensification of this phenomenon [5]. In some cases self-injury takes place with a clear intention of committing an act of suicide, or it can be a self-destructive act which often precedes a suicidal attempt, sometimes long before the final decision to carry it out. Nevertheless, in the majority of cases self-injuary is not performed with the intention of death. Therefore, the following question might be posed: do self-harm acts constitute a separate category of behaviours, or do they inevitably lead to suicidal death? When answering, we ought to take a closer look at both phenomena to have a better understanding of their aetiology, risk factors and frequency, and to understand when they co-occur and when they belong to different categories of self-aggressive behaviours.

Stress coping mechanisms in patients with chronic dermatoses

Summary Objective. The results of numerous studies of today confirm that persons suffering from psychosomatic disorders are not able to effectively cope with stress. The experience of stress is also frequently combined with the occurrence or aggravation of various skin diseases. The goal of our study was to identify the predominant ways of coping with stress in the group of patients with chronic dermatoses. Methods. The group under study included patients receiving treatment in the Dermatology Clinic of Collegium Medicum, Jagiellonian University. They were either hospitalized patients or those who came for control examinations at the Outpatient Clinic. Evaluation of the forms of coping with stress was conducted with the help of the Endler and Parker Questionnaire – CISS. Results . They significantly more often apply the style of coping focused on avoiding (p-value= 0.0056). It also turned out that the patients in the dermatological groups manifested a constant tendency to get involved in vicarious activities (p-value=0.0247). Discussion. The results of the presented study indicate that there is a statistically significant difference between the patients with dermatological disorders and those in the control group as regards their ways of coping with stress. Conclusion . The results obtained in the discussed study may be a starting point for designing a complex support for the patients with skin diseases. The therapeutic technique that may prove helpful for this group of patients is the cognitive-behavioral therapy (CTB). psoriasis / stress coping mechanisms / connective tissue diseases / rosacea

PW01-30 - Increased scores on the hypomania check list-32 and on the mood disorder questionnaire in treatment-resistant depression: polish TRES-DEP study

Objective An undiagnosed bipolarity may be one of the reasons connected with treatment resistance in major depressive disorder. In recent years, the tools have been introduced helping to assess the bipolarity such as the Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ). The objective of the study was to compare scores of bipolarity measured with these scales between patients with treatment-resistant and treatment non-resistant depression within the framework of all-Poland multi-center study TRES-DEP. Methods One-thousand and fifty-one patients recruited from 150 outpatient psychiatric clinics in Poland and fulfilling DSM-IV criteria for single or recurrent major depressive episode were studied. Five-hundred and sixty-nine patients were identified as having treatment-resistant depression on account of non-obtaining remission in recent depressive episode after minimum of two courses of adequate treatment with antidepressant drugs. They were compared with 482 patients with non-treatment-resistant depression. All patients were assessed using the structured demographic and clinical data interview, as well as the Polish version of HCL-32 and MDQ Results Patients with treatment-resistant depression scored significantly higher compared with non-resistant depression both on HCL-32 and MDQ (11.9+8.3 vs 8.5±7.7 and 4.3±3.5 vs 2.7±2.9, respectively). Independent risk factors of treatment resistance were scoring of14 or higher on HCL-32, and 6 or higher on MDQ. Conclusions Higher scoring by patients with treatment-resistant depression on both HCL-32 and MDQ may suggest a possible association between bipolarity and worse response to antidepressant drugs in patients with major depressive disorder.

P01-290 Clinical and demographic characteristics and bipolarity features in treatment-resistant depression - preliminary results from polish TRES-DEP study

Aim The Polish multicenter Treatment Resistant Depression Project (TRES-DEP) has aimed to study a number of demographic, clinical and psychometric characteristics comparing patients with treatment-resistant (TR) and treatment non-resistant depression (TNR). Fifty patients with TR depression (group 1) and 50 patients with TNR depression (group 2) were included in this preliminary analysis. Method Treatment-resistant depression was recognized on account of lack of significant improvement following at least two adequate courses of antidepressant treatment. The exclusion criteria were treatment with mood stabilizers, diagnosis of substance misuse, dementia or severe somatic disease. The presence of bipolarity features was assessed by Polish version of Mood Disorder Questionnaire (MDQ). Results Significantly more patients with TR depression compared with TNR had family history of mental disorders, especially alcohol dependence (24% vs 8%, p=0,03), had more previous depressive episodes (8.5±5.0 vs 5.1±3.8; p=0.001), and reported shorter time from the last hospitalization (14.8±26.5 vs 41.9±71.1 months, p Conclusion Our preliminary results point to clinical differences between patients with TR and TNR depression, including higher scores on bipolarity scale in TR. The features of bipolarity may be an important reason for non-response during antidepressant treatment of depression and worse clinical course and outcome.