Ângela Miranda-Scippa

The impact of comorbid posttraumatic stress disorder on bipolar disorder patients

BACKGROUND Available data regarding posttraumatic stress disorder (PTSD) in bipolar disorder (BD) are scarce and usually from a limited sample size. The present report was carried out using the Brazilian Research Consortium for Bipolar Disorders and aimed to examine whether patients with BD and comorbid PTSD are at an increased risk for worse clinical outcomes. METHODS A consecutive sample of bipolar I outpatients from two teaching hospitals in Brazil was recruited. Patients were assessed using the Structured Clinical Interview for DSM-IV, Young Mania Rating Scale, 17-item Hamilton Rating Scale for Depression, and quality of life instrument WHOQOL-BREF. Participants were divided into three groups: a. bipolar patients with PTSD, b. bipolar patients exposed to trauma without PTSD, and c. bipolar patients with no trauma exposure. RESULTS Of the 405 patients who consented to participate, 87.7% completed the survey. All three groups were similar in terms of demographic parameters. The group with comorbid PTSD reported worse quality of life, more rapid cycling, higher rates of suicide attempts, and a lower likelihood of staying recovered. LIMITATIONS The cross-sectional design excludes the opportunity to examine causal relationships among trauma, PTSD, and BD. CONCLUSIONS The findings indicate that PTSD causes bipolar patients to have a worse outcome, as assessed by their lower likelihood to recover, elevated proportion of rapid cycling periods, increased risk of suicide attempts, and worse quality of life.

Validade da escala hospitalar de ansiedade e depressão em pacientes com dor crônica

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.

Incidence of psychiatric side effects during pegylated interferon- α retreatment in nonresponder hepatitis C virus-infected patients

Objective: Evaluate the incidence of mental disorders using pegylated interferon plus ribavirin retreatment in nonresponder hepatitis C virus‐infected patients.

High frequency of unrecognized mental disorders in HCV-infected patients

OBJECTIVE This study indexed the frequency of psychiatric disorders among hepatitis C virus (HCV)-infected patients. METHOD HCV-infected patients treated at a university hospital in the northeastern region of Brazil were evaluated in a cross-sectional study using the Mini International Neuropsychiatric Interview. RESULTS Ninety HCV-infected outpatients were included in the study and 44 (49%) had at least one psychiatric diagnosis. Among the 26 patients (59.1%) with a current psychiatric morbidity, 22 (84.6%) had gone undiagnosed. CONCLUSIONS HCV-infected patients have a high frequency of unrecognized psychiatric comorbidity.

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.

Religiosity as a protective factor in suicidal behavior: a case-control study.

Abstract The impact of religiosity in suicidal behavior was evaluated in Brazil through a case-control study in which 110 subjects who had attempted suicide through the use of toxic substances were compared with 114 control subjects with no history of suicide attempts. Religiosity was measured in three aspects: organizational religious activities (ORAs), nonorganizational religious activities (NORAs), and intrinsic religiosity (IR). Multivariate logistic regression was used to evaluate the impact of religiosity on suicide attempts, controlling for sociodemographic variables, impulsivity, and mental illness. Religiosity, in its three dimensions, was shown to be an important protective factor against suicide attempts, even after controlling for relevant risk factors associated with suicidal behavior: ORA: odds ratio (OR), 0.63 (95% confidence interval [CI], 0.45–0.89); NORA: OR, 0.56 (95% CI, 0.42–0.75); and IR: OR, 0.59 (95% CI, 0.49–0.70). These data have important implications for understanding religiosity factors that might protect against suicide.

Is there an association between suicide attempt and delay of initiation of mood stabilizers in bipolar I disorder

BACKGROUND Little is known about the extent to which delay of initiation of mood-stabilizing treatment may influence outcomes in bipolar patients (BP). In this study, our aim was to investigate the association between delay of mood stabilizer treatment in bipolar patients and lifetime history of suicide attempts. METHOD A consecutive sample of 268 bipolar I outpatients from two teaching hospitals in Brazil was recruited. The assessment included a socio-demographic history form, a clinical interview regarding clinical variables and the Structured Clinical Interview for DSM-IV. Participants were divided into three groups: BP that initiated the first mood stabilizer in the same year of the first episode of the disease (FMS≤1), between 1 and 5 years after the first episode of the disease (15). RESULTS The mean time from the first episode until the first mood stabilizer medication was 8.6 years (SD 9.8 years). The FMS>5 group, showed a higher lifetime prevalence of suicide attempts than the other two groups (PR=1.75, 95% CI: 1.24-2.47), p=0.001. These results remained significant after adjusting for potential confounders, (PR=1.82, 95% CI: 1.29-2.60), p=0.001. LIMITATIONS This study evaluated patients retrospectively and does not permit a cause-effect relationship. CONCLUSION The present study supports the importance of early diagnosis and early intervention for BP in order to limit the potentially lethal impact of the disease.

Post-traumatic stress disorder as a comorbidity: impact on disease outcomes

Post-traumatic stress disorder (PTSD) is associated with many psychiatric and nonpsychiatric comorbidities. Growing evidence suggests that PTSD as a comorbidity may impair drug adherence, quality of life and sleep quality, as well as increase rehospitalization rates, disease relapses, intensity of symptoms, morbidity and mortality. The aim of this article is to examine the literature regarding the effects of PTSD comorbidity on physical and mental health.

Relapse in patients with schizophrenia: a comparison between risperidone and haloperidol

OBJECTIVES To compare rates of rehospitalization and time to relapse in risperidone vs. haloperidol-treated schizophrenic patients discharged from the hospital. METHODS Randomized controlled trial comparing risperidone and haloperidol regarding relapse in patients with schizophrenia treated with flexible doses during one year. RESULTS Twenty patients were assigned to risperidone and 13 to haloperidol. One patient from each group withdrew consent and one patient in the risperidone group was lost for follow-up. Six (30.0%) patients in the risperidone group and 3 (23.1%) in the haloperidol group relapsed (p=1.00). However, time to relapse was shorter in the later (logrank =4.2; p=.04). When rehospitalized, patients in the risperidone group stayed 34.5 days (median) at hospital as compared to the haloperidol group (median of 61 days) (p=.61). CONCLUSION The proportion of schizophrenic patients who relapsed was similar in both groups; However, time to relapse was shorter in the haloperidol-treated patients.

Lack of association of indoleamine 2,3-dioxygenase polymorphisms with interferon-alpha-related depression in hepatitis C

BACKGROUND Major depression is a frequent adverse effect of interferon-alpha (IFN-α) therapy. Although the indoleamine 2,3-dioxygenase (IDO) enzyme seems to be involved in the pathophysiology of IFN-α-induced depression, no pharmacogenetic study has investigated whether variation in the IDO gene modifies vulnerability to this adverse effect. METHODS A cross-sectional study assessing 277 hepatitis C patients recruited in two specialized outpatient clinics of Brazil. They were interviewed with the Mini International Neuropsychiatric Interview (MINI) approximately 1 month after the end of IFN-α plus ribavirin therapy. Genomic DNA of individuals was extracted from venous blood. Three IDO single-nucleotide polymorphisms (SNPs) were genotyped (rs3824259; rs10089084 and rs35099072). RESULTS MINI indicated that 21.3% of the sample met criteria for a major depressive episode during the course of IFN-α therapy. No association with the diagnosis of a major depressive episode during the course of IFN-α therapy was observed genotype or allele-wise (p>0.05). Current major depression and/or current anxiety disorder was significantly associated with IFN-α-related depression (p<0.005). However, gender, age, route of infection, result of the antiviral treatment, past history of substance use disorders, depression or any other psychiatric disorder showed no association with IFN-α-related depression (p>0.05). CONCLUSIONS Our results suggest no influence of the variants in the IDO gene and the diagnosis of interferon-α-related depression in the Brazilian population. Interferon-α-related depression may impose persistent psychopathology on at least 15% of the depressed patients even 2 years after antiviral therapy termination. The cross-sectional design is a limitation of our study, predisposing memory bias. Prospective pharmacogenetic studies are warranted to continue investigation of the impact of IDO polymorphisms on the development of IFN-α-induced depression.