Angela Miranda-Scippa

Is cerebellar volume related to bipolar disorder

BACKGROUND Recent data suggest that cerebellum influences emotion modulation in humans. The findings of cerebellar abnormalities in bipolar disorder (BD) are especially intriguing given the link between the cerebellum emotional and behavioral regulation. The purpose of this study was to evaluate cerebellar volume in patients with euthymic BD type I compared to controls. Moreover, we investigated the possible relationship between cerebellar volume and suicidal behavior. METHODS Forty-patients with euthymic BD type I, 20 with and 20 without history of suicide attempt, and 22 healthy controls underwent an MRI scan. The participants were interviewed using the Structured Clinical Interview with the DSM-IV axis I (SCID-I), the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS) and the Barratt Impulsiveness Scale (BIS-11). RESULTS Groups were age, gender and years of schooling-matched. The left cerebellum (p=0.02), right cerebellum (p=0.02) and vermis (p<0.01) were significantly smaller in the BD group; however, there were no volumetric differences between the BD subjects with and without suicidal attempt. There was no correlation between cerebellar measurements and clinical variables. LIMITATIONS The main strength is that our sample consisted of patients with euthymic BD type I without any comorbidities, however, these results cannot establish causality as the cross-sectional nature of the study. CONCLUSIONS Our findings suggest that the reduction in cerebellar volumes observed in BD type I might be a trait-related characteristic of this disorder. Additional studies with larger samples and subtypes of this heterogeneous disorder are warranted to determine the possible specificity of this cerebellar finding.

Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis

BACKGROUND Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients. METHODS In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls. RESULTS Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls. CONCLUSIONS Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.

Risperidone versus haloperidol in the treatment of schizophrenia: a meta‐analysis comparing their efficacy and safety

The aim of this study was to compare the shortterm clinical efficacy and safety of risperidone with haloperidol and placebo. A meta‐analysis of seven published randomized double‐blind controlled trials was carried out. Study quality was assessed. The proportion of patients failing to reach at least 20% improvement on the positive and negative syndrome scale (PANSS) or brief psychiatric rating scale (BPRS), the proportion of patients discontinuing treatment because of adverse effects and the number of patients who needed antiparkinsonian medication were abstracted for use as outcome measures.

White matter hyperintensities and their association with suicidality in major affective disorders: a meta-analysis of magnetic resonance imaging studies.

INTRODUCTION Individuals who have deep and periventricular white matter hyperintensities may have a higher risk for suicidal behavior. There are mixed results in the literature regarding whether unipolar or bipolar patients who have attempted suicide have more deep white matter hyperintensities (DWMH) or periventricular hyperintensities (PVH) relative to those who have no history of suicide attempts. METHODS A meta-analysis of studies examining white matter hyperintensities (WMH) in mood disorder patients with and without a history of suicide attempts was performed. RESULTS Four studies, including a total of 173 patients who attempted suicide and 183 who did not attempt suicide, were included. A significantly higher number of attempters were found to have WMH than non-attempters. Unipolar depressed patients who had attempted suicide had 1.9 times more DWMH and 2.1 times more PVH than those who did not. Bipolar patients who had attempted suicide had 5.4 times more PVH than those who had not. Taken together, unipolar and bipolar patients who had attempted suicide had 2.8 times more DWMH and 4.5 times more PVH than those who had never attempted suicide. CONCLUSION These findings raise the possibility that WMH are biological substrates of symptoms that lead to suicidal behavior.

Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: results from the Brazilian Bipolar Research Network.

OBJECTIVES To investigate prevalence rates and clinical correlates of alcohol use disorders (AUD) among bipolar disorder (BD) patients in a large sample from the Brazilian Bipolar Research Network. METHODS Four hundred and eighty-three DSM-IV BD patients, divided according to the presence or absence of a lifetime AUD diagnosis (BD-AUD vs. BD-nonAUD), were included. Demographic and clinical characteristics of these two groups were compared. Logistic regression was performed to identify which characteristics were most strongly associated with a lifetime AUD diagnosis. RESULTS Nearly 23% presented a lifetime AUD diagnosis. BD-AUD patients were more likely to be male, to present rapid cycling, post-traumatic stress disorder (PTSD), anorexia, other substance use disorders (SUD), family history of SUD, any substance misuse during the first mood episode, history of psychosis, suicide attempts, and younger age at onset of illness than BD-nonAUD patients. Logistic regression showed that the variables most strongly associated with a lifetime AUD diagnosis were SUD (non-alcohol), any substance misuse during the first mood episode, PTSD, male gender, suicide attempt, family history of SUD, and younger age at onset of BD. CONCLUSIONS BD-AUD patients begin their mood disorder earlier and present more suicidal behaviors than BD-nonAUD patients. Personal and family history of SUD may be good predictors of comorbid AUD among BD patients. These variables are easily assessed in the clinical setting and may help to identify a particularly severe subgroup of BD patients.

Lower rates of comorbidities in euthymic bipolar patients.

Objective. This study assessed the frequency of axis I psychiatric comorbidities in euthymic bipolar patients and the clinical differences between patients with and without comorbidities. Method. In this study, 62 euthymic bipolar outpatients assessed using a clinical questionnaire underwent a structured diagnostic interview (SCID/CV – DSM-IV) as well as a symptoms evaluation (YMRS and HAM-D-17). Results. The lifetime frequency of patients with comorbidities was 27.4%. The most frequent comorbidities were anxiety disorders (33.7%), and the positive associated variables were more advanced age, the presence of a steady partner, a first episode of the depressive type and lifetime attempted suicide. Conclusions. The lower frequency of comorbidities found in our study in comparison with those described in the literature may be due to the evaluation restricted only to euthymic patients. This suggests the importance of assessing psychiatric comorbidity in bipolar individuals while not in acute phases of the disorder.

A neuropsychological study comparing patients infected with HCV and HBV without psychiatric comorbidities.

Hepatitis C is one of the most common chronic infectious diseases worldwide, with well‐documented extra‐hepatic manifestations, such as a broad number of cognitive deficits. These impairments may be explained by psychiatric comorbidities, which have not been investigated properly in the literature. In order to elucidate a specific hepatitis C virus (HCV) induced cognitive impairment not related to mental disorders, neuropsychological performance of patients infected with HCV was compared with that of patients infected with hepatitis B virus cognitive impairment, especially psychiatric comorbidities. A total of 33 patients infected with HCV and 22 patients infected with HBV were included in the study. There were no significant differences between the two groups with regard to age or years of education. The group of patients infected with HCV performed significantly worse on visuo‐spatial memory tasks after adjusting for years of education and age. There were no significant differences between patients infected with HCV and patients infected with HBV with regards to other neuropsychological functions. The data indicate that patients infected with HCV patients have poorer visuo‐spacial memory performance than patients infected with HBV, suggesting that the cognitive deficit may be specific to HCV infection and not to secondary comorbid psychiatric disorders. J. Med. Virol. 81:1184–1188, 2009.

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51%) patients did not have any psychiatric diagnosis, while 44 (49%) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1%) had a current mental disorder, out of which 22 (84.6%) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

Validity of the hospital anxiety and depression scale in patients with chronic pain

JUSTIFICATIVA E OBJETIVOS: Diversos estudos sugerem forte associacao entre a ansiedade e a depressao com dor cronica, o que pode ser evidenciado pela utilizacao de escalas padronizadas para a deteccao desses sintomas. O objetivo deste estudo foi estimar a sensibilidade e a especificidade da Escala Hospitalar de Ansiedade e Depressao (HAD), em pacientes portadores de sindromes dolorosas cronicas acompanhados no Centro de Dor do Hospital Universitario Professor Edgard Santos. METODO: Foi realizado um estudo descritivo transversal em pacientes que procuraram o Centro de Dor entre marco de 2002 e julho de 2003, que constou de entrevistas utilizando a Escala HAD e o M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTADOS: Foram avaliados 91 pacientes. A utilizacao da HAD evidenciou que 61 pacientes (67%) apresentaram ansiedade e 42 pacientes (46,2%) apresentaram depressao. Os resultados da HAD mostraram que dos pacientes deprimidos, 38 (90,5%) eram tambem ansiosos; enquanto dos ansiosos, 38 (62,3%) tambem estavam deprimidos, sendo esta uma associacao considerada como significativa pela analise estatistica (p < 0,001). O M.I.N.I. PLUS revelou 40,7% de transtorno do humor atual e 47,3% de transtorno de ansiedade. Quanto a sensibilidade e a especificidade da HAD foram encontrados os seguintes resultados: sensibilidade 73,3% para depressao e 91,7% para ansiedade. Especificidade 67,2% para depressao e 41,8% para ansiedade. CONCLUSOES: A escala HAD mostrou boa sensibilidade para avaliar sintomas de ansiedade e depressao, porem nao evidenciou boa especificidade para diagnosticos de depressao e ansiedade.BACKGROUND AND OBJECTIVES Several studies suggest a strong association between anxiety and depression with chronic pain. That can be demonstrated using standard scales to detect these symptoms. The objective of this study was to determine sensibility and specificity of the Hospital Anxiety and Depression Scale (HAD) in patients with chronic pain syndromes followed at the Pain Center of the Hospital Universitário Professor Edgard Santos. METHODS A transversal, descriptive study was conducted with patients who sought to the Pain Center between March 2002 and July 2003. It was composed of interviews using the HAD Scale and the M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTS Ninety-one patients were evaluated. The HAD demonstrated that 61 patients (67%) presented anxiety, while 42 patients (46.2%) presented depression. HAD results showed that among patients with depression, 38 (90.5%) also had anxiety; while among those with anxiety, 38 (62.3%) also had depression. Statistical analysis showed that this association was statistically significant (p < 0.001). M.I.N.I. PLUS revealed an incidence of 40.7% in current mood changes and 47.3% of anxiety. As for HADs sensibility and specificity, we found the following results: sensibility of 73.3% for depression and 91.7% for anxiety, and a specificity of 67.2% for depression and 41.8% for anxiety. CONCLUSIONS The HAD scale showed good sensibility to evaluate anxiety and depression symptoms, but did not demonstrate good specificity for the diagnosis of depression and anxiety.

Effectiveness of antidepressants in the treatment of major depressive disorder in Latin America.

Objective. Painful physical symptoms occur frequently in patients with major depressive disorder (MDD), and although numerous studies report the effect of antidepressants on emotional aspects of depression, few focus on their effect on physical symptoms. This observational study was conducted, in a clinical practice setting, to determine antidepressant treatment decisions and their outcome on the physical and emotional symptoms of MDD. Methods. Patients with a mean score ≥2 for pain-related items on the Somatic Symptom Inventory (SSI) were classified with painful physical symptoms (PPS +) and differentiated from the remaining patients (PPS −). Severity of depression and physical pain were determined using the 17-item Hamilton Depression Rating Scale (HAMD17) and Clinical Global Impressions of Severity Scale (CGI-S), and Visual Analog Scale (VAS), respectively. Results. At baseline, 72.6% of patients were PPS+. Compared to PPS- patients, PPS +patients were, on average, significantly more depressed at baseline (mean difference [95% CI]: HAMD17 4.6 [3.6, 5.5] and CGI-S 0.3 [0.2, 0.4]; all p<0.0001), and remained more depressed and in greater pain at endpoint (HAMD17p=0.0074, CGI-S P =0.0151, and VAS P <0.0001). In addition, fewer PPS+ patients (65.8%) achieved remission (total HAMD17≤7) compared to PPS- patients (74.6%, P =0.0180). Conclusions. Painful physical symptoms are prevalent in MDD patients, highlighting the importance of addressing both the physical and emotional symptoms of depression.