Dolores Jurado

Quality of life in bipolar disorder patients: a comparison with a general population sample.

OBJECTIVES To compare the Quality of Life (QoL) of bipolar disorder (BD) patients with that of the general population; and, within the BD patients, to find the demographic and clinical variables associated with low QoL, controlling for the effects of potential confounders. METHODS Based on the 25th percentile of the physical (PCS) and the mental (MCS) component scores (PCS <53 and MCS < 50, respectively) of the Medical Outcomes Survey 36-item Short-Form Health-Survey (SF-36) of a general population representative sample (n = 1,210), we compared by logistic regression the QoL of 48 euthymic and 60 non-euthymic BD outpatients and the general population. Within BD patients, we analyzed the clinical and course-of-illness variables associated with low physical and mental QoL, including manic and depressive symptoms and consumption of addictive substances; in addition, we calculated the partial correlation of the different variables with the dimensional PCS and MCS through multiple linear regression. RESULTS Low physical QoL was significantly more frequent among both euthymic [odds ratio (OR) = 3.5; 95% confidence interval (CI): 1.9-6.5] and non-euthymic (OR = 4.0; 95% CI: 2.3-7.0) BD patients than in the general population; the respective values for low mental QoL were OR = 2.2; 95% CI: 1.2-4.0 and OR = 8.5; 95% CI: 4.6-15.7. Low mental QoL was more frequent among non-euthymic than euthymic BD patients (OR = 3.9; 95% CI: 1.6-9.1). Within BD patients, low mental QoL was associated with the length of illness (or early onset), the presence of depressive symptoms, nicotine dependence and the lack of social support. CONCLUSIONS Among the BD patients, who experience lower physical and mental QoL even in a euthymic period, the optimal control of depressive symptoms as well as the availability of social support may enhance their well-being.

Exploring brief measures of nicotine dependence for epidemiological surveys.

A score > or = 6 in the Fagerström Test for Nicotine Dependence (FTND), identifying high nicotine dependence, was compared with three briefer classifications: (1) Item 4: heavy smoking (more than 30 cigarettes per day); (2) Item 1: high early smoking (smoking within 30 min of waking up); and (3) a score > or = 4 by combining Items 1 and 4. The FTND scores from 1642 smokers from five samples in the US and Spain were analyzed. Heavy smoking had low sensitivity. High early smoking had low specificity. A score > or = 4 by combining Items 1 and 4 had relatively good sensitivity (94%) and specificity (88%). Researchers needing definition of nicotine dependence briefer than FTND may want to only use Items 1 and 4 of FTND with a cutting score > or = 4.

Personality traits associated with caffeine intake and smoking.

OBJECTIVES Some studies find a relationship between certain personality traits, as impulsivity or sensation seeking, and caffeine consumption, but these studies do not consider the potential confounding effect of smoking on caffeine intake, a co-occurrence that has been well demonstrated in epidemiological and clinical studies. The main objective of this cross-sectional study was to analyze the association of personality with caffeine intake controlling for the effects of smoking; a secondary objective was to explore the effect of caffeine intake on the previously known relationship between personality and smoking. METHODS A sample of 498 adults answered a self-questionnaire including socio-demographic variables, and items regarding consumption of tobacco and caffeine. Personality was measured by the Temperament and Character Inventory (TCI-125). We analyzed the association of personality traits with both caffeine intake and smoking, controlling the possible confounding effects of sex, age and each substance with the other one. RESULTS Logistic regression analyses showed that the temperamental dimension of novelty seeking was associated with heavy caffeine consumption (>200 mg/day) (adjusted OR=2.0; 95% CI: 1.1-3.9), controlling for the effect of smoking. Moreover, novelty seeking was associated with both smoking (adjusted OR=1.8; 95% CI: 1.1-2.9) and heavy smoking (>20 cigarettes/day) (adjusted OR=1.8; 95% CI: 1.0-3.7), after controlling for the effect of caffeine intake. CONCLUSION Our study offers an epidemiological evidence of the relationship of novelty seeking, considered to be associated with low basal dopaminergic activity, with both nicotine consumption and heavy caffeine intake, two substances that enhance dopaminergic neurotransmission.

Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample.

OBJECTIVE Multiple studies suggest an association of overweight and obesity with bipolar disorder (BD) and schizophrenia. The goal of this paper was to determine the magnitude of this association and its relationship with previous course-of-illness and other variables of clinical interest. METHODS The prevalence of overweight and obesity was compared among patients with BD (n=108), patients with schizophrenia (n=250) and a non-psychiatric control group (n=290). Moreover, within each group we analyzed the variables associated with overweight [including obesity, i.e., body mass index (BMI) ≥25] and obesity (BMI≥30) adjusting for a possible confounding effect of sex, age and educational level by logistic regression. RESULTS In comparison with the non-psychiatric sample, a strong association of both BMI≥25 and obesity was observed with BD and schizophrenia (adjusted odds ratios between 3.4 and 4.6; P-values <0.001). Overweight was significantly associated with male sex and increasing age in both control and BD groups; and with female sex among schizophrenia patients. Moreover, for BD patients, earlier onset of first BD symptoms, presence of a non-psychiatric illness, current use of mood-stabilizing medication, and being a non-smoker were significantly associated with overweight; and male sex and the presence of a non-psychiatric illness, with obesity. Within the schizophrenia patients, obesity was significantly associated with female sex, intermediate age range and lower PANSS score. CONCLUSIONS Among patients with BD or schizophrenia, the chronic course of their illness and their current treatment with psychotropic medication might be more relevant for becoming overweight or obese than the specific psychiatric illness.

Factors associated with work, social life and family life disability in bipolar disorder patients

We analyzed the presence of work, social life and family life disability in 108 outpatients with a Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) diagnosis of bipolar disorder and their association with previous course-of-illness variables and current psychopathology. Work disability was pragmatically defined as being on a disability pension or in the process of obtaining it; social life or family life disability was defined by a score ≥ 7 in the respective subscales of the Sheehan Disability Scale. At least one type of disability (for work, social life or family life) affected 52-54% of the patients; and two types, 37%. By logistic regression and multiple linear regression analyses we determined the variables independently associated with each type of disability: 1) Work disability was significantly associated with previous repeated manic episodes, three or more hospitalizations, with current depressive symptoms and inversely with the educational attainment. 2) Social life disability significantly increased with the number of hospitalizations and was associated with previous repeated depressive episodes and current depressive symptoms. In alternative models, nicotine dependence and lack of social support were significantly associated with work and social life disability respectively. And 3) family life disability significantly increased with number of hospitalizations, CAGE questionnaire score and age; and was associated with previous repeated manic episodes and current depressive symptoms. In conclusion, previous course-of-illness variables, particularly a high number of manic episodes, and current psychopathology - as indicated by the presence of nicotine dependence or depressive symptoms - may be indicators of disability; previous manic episodes appear to affect disability at work or at family life whereas previous depressive episodes seem to be related with social life disability.

Fewer but heavier caffeine consumers in schizophrenia: A case-control study

According to the literature, there is an association between schizophrenia and caffeine consumption, but it is not clear whether schizophrenia is associated with either higher prevalence of daily caffeine intake or the amount consumed. In this study we compared our previously published schizophrenia patients (n=250) with a control sample (n=290) after controlling for demographic variables and tobacco and alcohol consumption. Current caffeine intake was less frequent in schizophrenia patients (59%, 147/250) than in controls (70%, 204/290). In the multivariate analyses, caffeine intake was less frequent at an older age and in schizophrenia patients, and more frequent in smokers and alcohol users. Among caffeine consumers, heavy caffeine intake (> or =200 mg/day) was significantly associated with schizophrenia (64%, 94/147 in schizophrenia versus 36%, 73/204 in controls), as well as older age and smoking. Daily amount of caffeine intake and smoked cigarettes correlated significantly in the schizophrenia group but not in the control group; the correlation of caffeine intake with nicotine dependence was low and non-significant in both groups. The association between current smoking and heavy caffeine intake may be partly explained by a pharmacokinetic effect: tobacco smoke compounds induce caffeine metabolism by the cytochrome P450 1A2. Although schizophrenia by itself may be associated with heavy caffeine intake in caffeine users, part of this association was explained by the association between schizophrenia and smoking. The relationship between caffeine and alcohol intake appeared to be more complex; alcohol and caffeine use were significantly associated, but within caffeine users alcohol was associated with less frequent heavy caffeine consumption among smokers. In future studies, the measurement of plasma caffeine levels will help both to better define heavy caffeine intake and to control for smoking pharmacokinetic effects.

Personality profiles and minor affective psychopathology in a non-clinical sample: an empirical verification of Cloninger's theoretical model.

BACKGROUND Psychopathological vulnerability may be related to certain personality traits. The aim of this study was to explore the association of minor affective psychopathology and the regular use of psychotropic medication with temperament and character profiles from Cloningers personality model, in a sample of active professional people. METHODS This cross-sectional study included 498 non-clinical subjects, teachers in a local school system. Instruments used included the self-administered General Health Questionnaire (GHQ-28) to measure psychiatric morbidity; the Center for Epidemiologic Studies Depression scale (CES-D) to measure depressive symptoms; documentation of regular use of psychotropic medication; and the Temperament and Character Inventory (TCI-125) for personality traits self-assessment. RESULTS The proportion of subjects presenting psychiatric morbidity (GHQ-28>6) or depressive symptoms (CES-D>20) was significantly higher among explosive, passive-aggressive, and obsessional temperament profiles, and among schizotypal, moody, melancholic and dependent character profiles. Similar results were observed with the scores on each of the four GHQ-28 subscales (depression, anxiety, social dysfunction, and somatic symptoms). The regular use of psychotropic medications was significantly higher among the passive-aggressive and explosive temperament types, and among the schizoptypal and moody character types. LIMITATIONS Being a cross-sectional study, no causal attributions can be inferred. Subjects on sick leave were excluded, so the sample was not representative of the general population. The data were collected using self-reporting questionnaires, and no specific psychiatric diagnoses were obtained. CONCLUSIONS It is possible to identify certain personality configurations associated with minor psychopathology and concomitant use of psychotropics, among active professional people.

Nicotine dependence vs. daily smoking as a meaningful variable: Implications for clinical and epidemiological psychiatric studies

OBJECTIVE As an indication of potential psychopathology, our aim was to compare, in a non-psychiatric sample, the variables associated to daily smoking with those associated to nicotine dependence. We also compared dependent and non-dependent smokers on these variables and on the age of onset of daily smoking (AODS). METHOD A sample of 290 persons aged 18 or older, recruited in a family medical clinic, were interviewed to inquire about their tobacco, caffeine, alcohol, and illegal drugs consumption, and on their practice of physical exercise. Psychiatric morbidity was assessed with the General Health Questionnaire (GHQ-28) and defined by a score>6. They also were questioned on their use of psychotropic medication and previous suicide attempt. The smokers answered the Fagerström Test for Nicotine Dependence (FTND) and the question on their age of onset of daily smoking (AODS). RESULTS In comparison with non-dependent smoking, nicotine dependence was associated with current use of psychotropic medication, psychiatric morbidity, previous suicide attempt, and earlier AODS. Logistic regression analyses showed that nicotine dependence was associated with antecedents of suicide attempt and primary or lower education as well as with high caffeine use and the regular use of illegal drugs; in contrast, daily smoking showed a significant association with high caffeine use, the regular use of illegal drugs and lack of physical exercise. CONCLUSIONS In terms of psychopathology or behavioral disturbance-particularly attempting suicide-nicotine dependence adds significant information as opposed to the simple daily smoking, with important implications in clinical and epidemiological psychiatric studies.

School setting and teaching experience as risk factors for depressive symptoms in teachers.

A representative sample of teachers working at the primary or secondary grade level in both public and private schools answered an anonymous questionnaire on sociodemographic information and completed the Center for Epidemiologic Studies Rating Scale for Depression (CES-D). The teachers were classified as depressed when they scored 16 on the CES-D; 27.5% of the subjects were above this cut-off score. Logistic regression was used to calculate a multivariate model with the variables school ownership, grade level and teaching experience. Working in a public school, teaching at the primary level and longer teaching experience all increased the risk of depressive symptomatology.

Factors associated with frequent psychiatric admissions in a general hospital in Spain

Objectives: To identify demographic or clinical factors associated with frequent admissions in a sample of patients admitted to an acute psychiatric hospitalization unit, controlling for potentially confounding factors. Methods: Socio-demographic variables, diagnosis, and the legal status, date and length of admission were collected for 1,722 consecutively admitted psychiatric patients during a period of up to eight years (1998–2005). Frequently admitted patients were defined as undergoing one or more admissions per year on average. Results: After controlling for potential confounding factors, logistic regression showed that being a frequently admitted patient was significantly associated with diagnoses of schizoaffective disorder, personality disorder or schizophrenia; an involuntary commitment at first admission; and younger age. Conclusions: Factors associated with frequently admitted patients should be identified in order to establish more effective strategies for preventing relapse.