Dorota Łojko

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.

Atypical features in depression: Association with obesity and bipolar disorder.

OBJECTIVES Depression with atypical features amounts to a significant proportion of depressed patients. Studies have shown its association with bipolarity and, recently, with obesity. In this study, we investigated atypical features of depression in relation to overweight/obesity in three diagnostic categories: unipolar depression, bipolar depression and dysthymia. METHODS Out of 512 depressed patients screened, we recruited 182 research subjects, consisting of 91 pairs, matched by age, gender and diagnosis, in which one member of the pair was within the normal weight range (BMI≤25) and the other was either overweight or obese (BMI>25). There were 35 pairs with unipolar depression, 27 with bipolar depression and 29 with dysthymia. Symptoms of atypical depression, such as increased appetite, hypersomnia, leaden paralysis, longstanding pattern of interpersonal rejection sensitivity, and, a significant weight gain in the past 3 months, were assessed. RESULTS All the symptoms of atypical depression were significantly more pronounced in those depressed patients with a BMI>25, compared with depressed subjects with a normal weight. Except for hypersomnia, these symptoms scored significantly higher in women compared to men. Among the diagnostic categories, symptoms of atypical depression were significantly higher in patients with bipolar disorder compared with both major depressive disorder and dysthymia. LIMITATIONS The preponderance of women, the assessment of atypical depression by adaptation of the DSM criteria, entirely Polish population, specificity of selection criteria. CONCLUSIONS The results demonstrated a higher intensity of atypical depressions symptoms in overweight/obese depressed patients. They also confirm the association between obesity and bipolarity.

Sex Dependence of Cognitive Functions in Bipolar Disorder

The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions.

Analgesic use among nursing homes residents, with and without dementia, in Poland.

Many age-associated diseases are accompanied by pain. There is no doubt that pain is underrecognized among elderly nursing home residents and the diagnosing of pain is a real challenge in subjects with dementia. The aim of the study was to characterize analgesic use among nursing home residents and to delineate the putative associations between pain management and cognitive functions of elderly persons. The study involved 392 subjects (males:females – 81:311) with a mean age of 83.6±5.9 years. The residents’ medical files in relation to diagnoses and drug consumption were analyzed, and the screening of cognitive functions was performed using the Mini-Mental State Examination (MMSE). One hundred and thirteen residents (28.8%) received some analgesics. Among them 84 (21.4%) used them routinely, 25 (6.4%) – pro re nata (PRN) and four (1.0%) – both routinely and PRN. Non-opioid analgesics were taken routinely by 53 residents, weak opioids by nine subjects, and one person was receiving strong opioids. Additionally, three individuals were taking a combination preparation of tramadol and acetaminophen. The rate of subjects who were not receiving any pain treatment was higher in residents with MMSE between 0 and 9 points than in those with MMSE between 24 and 30 points (P=0.0151). Furthermore, ten residents (9.1%) with severe dementia were treated with analgesics PRN. The results of our study point to a remarkably low use of analgesics in nursing home residents in Poland and indicate a need to introduce pain evaluation and monitoring of drug treatment appropriateness as a standard procedure in the geriatric assessment in nursing homes.

Medical students and stigma of depression. Part I. Stigmatization of patients

The stigmatization of the mentally ill is called the first barrier hampering their treatment and recovery: it leads to the rejection of such individuals, their discrimination and exclusion from participation in various areas of social life. It becomes particularly significant if the patients encounter this attitude among doctors, nurses and others healthcare professionals. The literature describes stigmatizing attitudes towards the mentally ill and it transpires that stigmatization and a negative approach can be found even among medical students, despite the fact that in the course of their studies they receive information on psychiatric disorders and their treatment. The attitude stigmatizing mental illnesses as presented by medical students may be related to their subsequent similar views as physicians, thus adversely affecting the quality of care offered to patients and cause self-stigmatization and its consequences. The paper presents a review of the literature on the stigmatization of patients suffering from depression by medical students and a review of the interventions proposed to-date, as well as a discussion of their effectiveness.

Symptoms of depression among adults in rural areas of western Poland

OBJECTIVE To measure the intensity of depressive symptoms in the populations residing in rural areas of western Poland, and to delineate the putative association between the intensity of depression and selected socio-demographic and clinical factors. MATERIALS AND METHOD The study covered 445 adults recruited from one family physician practice in the rural area of Wielkopolska region. The following tools were applied: Beck Depression Inventory (BDI), the WHO WHOQoL-Bref quality of life assessment scale, and a socio-demographic and clinical questionnaire elaborated by the authors. RESULTS Depressive symptoms were observed in approx. 30% of the patients. The intensity of symptoms correlated with age, female gender, and inversely correlated with the quality of life. There was no association between depressive symptoms and level of education (counted as years of education), number of somatic illnesses, and family burden of psychiatric disorders. CONCLUSION Symptoms of depression were noted in approx. 30% of patients who consulted their family physician. The Beck questionnaire is a simple tool whose application could decidedly improve the recognition of depression. It is worth taking note of factors that may be connected with the intensity of depressive symptoms - gender, the number of diagnosed somatic illnesses, and the quantity of drugs administered.

Cognitive Functions in Euthymic Bipolar Patients and Lithium

Based on Kraepelin’s works we had for many years been distinguishing between manicdepressive illness (bipolar disorder) and dementia praecox (schizophrenia) based on the assumption that bipolar patients tended to experience full remission, whereas the schizo‐ phrenic did not. Since the late 1990s, the evidence has been accumulated that the recovery in bipolar disorder is not complete [1]. Persistent psychosocial difficulties and cognitive deficits are common in patients with the bipolar disorder even in euthymic or asymptomatic states [2, 3]. After two decades of scientific work the nature of the cognitive impairments is still the focus of research and debate. The extent and pattern of cognitive impairment in euthymic patients remain uncertain [4]. A meta-analysis of the studies revealed widespread cognitive deficits in patients with schizophrenia and affective disorders in cognitive functioning, speed of infor‐ mation processing, encoding and retrieval, rule discovery, as well as response generation and response inhibition [5]. There is a growing need for clarification regarding the extent and clinical relevance of cognitive impairment in bipolar patients [6].

Medical students and stigma of depression. Part 2. Self-stigma

Up to 30% of medical students suffer from depression. They have better access to healthcare, but still receive appropriate treatment less frequently than people with depression in the general population. Most of them do not seek medical help as depression is perceived as a stigmatizing disorder, which leads to self-stigma and hampers early diagnosis and treatment. Thus, self-stigma means less effective therapy, unfavorable prognosis and relapses. According to the literature, self-stigma results in lowered self-esteem and is a major obstacle in the performance of social roles at work and in personal life. Stigmatization and self-stigma of depression among medical students are also associated with effects in their later professional life: they can lead to long-term consequences in the process of treating their patients in the future. Currently there are no unequivocal research results indicating the most effective ways of reducing stigmatization and self-stigma. It is necessary to educate about the symptoms and treatment of depression and to implement diverse intervention techniques to change behaviors and attitudes as early as possible.

Atypical depression: current perspectives

The history and present status of the definition, prevalence, neurobiology, and treatment of atypical depression (AD) is presented. The concept of AD has evolved through the years, and currently, in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, the specifier of depressive episode with atypical feature is present for both diagnostic groups, that is, depressive disorders and bipolar and related disorders. This specifier includes mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Prevalence rates of AD are variable, depending on the criteria, methodology, and settings. The results of epidemiological studies using DSM criteria suggest that 15%–29% of depressed patients have AD, and the results of clinical studies point to a prevalence of 18%–36%. A relationship of AD with bipolar depression, seasonal depression, and obesity has also been postulated. Pathogenic research has been mostly focused on distinguishing AD from melancholic depression. The differences have been found in biochemical studies in the areas of hypothalamic–pituitary–adrenal axis, inflammatory markers, and the leptin system, although the results obtained are frequently controversial. A number of findings concerning such differences have also been obtained using neuroimaging and neurophysiological and neuropsychological methods. An initial concept of AD as a preferentially monoamine oxidase inhibitor-responsive depression, although confirmed in some further studies, is of limited use nowadays. Currently, despite numerous drug trials, there are no comprehensive treatment guidelines for AD. We finalize the article by describing the future research perspectives for the definition, neurobiology, and treatment. A better specification of diagnostic criteria and description of clinical picture, a genome-wide association study of AD, and establishing updated treatment recommendations for this clinical phenomenon should be the priorities for the coming years.

Depression with atypical features in various kinds of affective disorders.

OBJECTIVES Assessment of atypical symptoms in various types of depressive disorders, using the authors questionnaire for symptoms of atypical depression. METHODS The study involved 70 patients with a diagnosis of depressive episode in the course of recurrent depression, 54 patients with a diagnosis of depressive episode in bipolar disorder (BD) and 58 patients with a diagnosis of dysthymia. To assess the severity of atypical symptoms, the special questionnaire has been elaborated. In each diagnostic group, half of patients had normal body weight, and half were overweight or obese (BMI > 25). RESULTS Patients with various types of depression did not differ significantly in terms of clinical and demographic factors. Symptoms of atypical depression such as increased appetite, weight gain and leaden paralysis were more common in women. Patients with bipolar depression had significantly increased symptoms such as hypersomnia (compared with dysthymia), and leaden paralysis (vs. recurrent depression and dysthymia). In overweight and obese patients, the severity of atypical symptoms correlated with body mass index and intensity of depression score on the 17-items Hamilton Depression Rating Scale. In this group, all symptoms of atypical depression were significantly more intense in patients with depression in the course of bipolar disorder. CONCLUSIONS The results indicate higher prevalence of symptoms of atypical depression in bipolar disorder compared with recurrent depression and dysthymia. They also suggest the interdependency between the symptoms of atypical depression, bipolar disorder and obesity.