Manuel Gurpegui

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.

Smoking initiation and schizophrenia: a replication study in a Spanish sample

In a prior US study, schizophrenia vulnerability was associated with higher risk of initiating daily smoking after 20 years of age. A survival analysis of onset age of daily smoking compared 290 controls with 250 consecutive DSM-IV schizophrenia patients from outpatient facilities at an urban catchment area in Spain. After controlling for gender and education, the cumulative hazard curves for smoking initiation age of controls and schizophrenia patients were significantly different. After age 20, smoking initiation rates were higher in all schizophrenia patients (and in 107 schizophrenia patients who started daily smoking at least 5 years before illness onset).

Oxidative stress and antioxidant parameters in patients with major depressive disorder compared to healthy controls before and after antidepressant treatment: results from a meta-analysis.

OBJECTIVE To investigate the role of oxidative stress and antioxidants in depression. DATA SOURCES We searched the literature without language restrictions through MEDLINE/PubMed, Cochrane Library, Fisterra, and Galenicom from database inception until December 31, 2013, supplemented by a hand search of relevant articles. Search terms included (1) oxidative stress, antioxidant*, nitrosative stress, nitrative stress, nitro-oxidative stress, free radical*, and names of individual oxidative stress markers/antioxidants and (2) depression and related disorders and antidepressant. STUDY SELECTION Included were studies in patients with depression comparing antioxidant or oxidative stress markers with those in healthy controls before and after antidepressant treatment. DATA EXTRACTION Two authors independently extracted the data for antioxidant or oxidative stress markers. Standardized mean differences (SMDs) ± 95% confidence intervals (CIs) for results from ≥ 3 studies were calculated. DATA SYNTHESIS Altogether, 29 studies (N = 3,961; patients with depression = 2,477, healthy controls = 1,484) reported on the oxidative stress marker malondialdehyde (MDA) and total nitrites, the antioxidants uric acid and zinc, or the antioxidant-enhancing enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX). When patients with depression were compared with healthy controls, depression was associated with higher oxidative stress MDA levels (8 studies; n = 916; SMD = 1.34; 95% CI, 0.57 to 2.11; P < .001), lower antioxidant uric acid (4 studies; n = 512; SMD = -0.64; 95% CI, -1.22 to -0.06; P = .030) and zinc levels (13 studies; n = 2,002; SMD = -0.66; 95% CI, -0.98 to -0.34; P < .0001), and higher antioxidant-enhancing enzyme SOD levels (11 studies; n = 902; SMD = 0.62; 95% CI, 0.07 to 1.17; P = .028), while differences in total nitrites and CAT and GPX were nonsignificant. Antidepressant treatment, which significantly reduced Hamilton Depression Rating Scale scores (24.6 ± 0.7 to 16.2 ± 1.6; SMD = 2.65; 95% CI, 1.13 to 4.15; P = .00065), reduced MDA (4 studies; n = 194; SMD = -1.45; 95% CI, -2.43 to -0.47; P = .004) and increased uric acid (3 studies; n = 212; SMD = 0.76; 95% CI, 0.03 to 1.49; P = .040) and zinc levels (3 studies; n = 65; SMD = 1.22; 95% CI, 0.40 to 2.04, P = .004), without differences in MDA (P = .60), uric acid (P = .10), and zinc (P = .163) levels compared to healthy controls. CONCLUSIONS Results suggest that oxidative stress plays a role in depression and that antidepressant activity may be mediated via improving oxidative stress/antioxidant function.

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.

Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review

We performed an updated review of the available literature on weight gain and increase of body mass index (BMI) among children and adolescents treated with antipsychotic medications. A PubMed search was conducted specifying the following MeSH terms: (antipsychotic agents) hedged with (weight gain) or (body mass index). We selected 127 reports, including 71 intervention trials, 42 observational studies and 14 literature reviews. Second-generation antipsychotics (SGAs), in comparison with first-generation antipsychotics, are associated with a greater risk for antipsychotic-induced weight gain although this oversimplification should be clarified by distinguishing across different antipsychotic drugs. Among SGAs, olanzapine appears to cause the most significant weight gain, while ziprasidone seems to cause the least. Antipsychotic-induced BMI increase appears to remain regardless of the specific psychotropic co-treatment. Children and adolescents seem to be at a greater risk than adults for antipsychotic-induced weight gain; and the younger the child, the higher the risk. Genetic or environmental factors related to antipsychotic-induced weight gain among children and adolescents are mostly unknown, although certain genetic factors related to serotonin receptors or hormones such as leptin, adiponectin or melanocortin may be involved. Strategies to reduce this antipsychotic side effect include switching to another antipsychotic drug, lowering the dosage or initiating treatment with metformin or topiramate, as well as non-pharmacological interventions. Future research should avoid some methodological limitations such as not accounting for age- and sex-adjusted BMI (zBMI), small sample size, short period of treatment, great heterogeneity of diagnoses and confounding by indication.

Temporal relationship of first-episode non-affective psychosis with cannabis use: A clinical verification of an epidemiological hypothesis

BACKGROUND We analyzed the association of age at onset of psychosis treatment (AOPT) with having a history of cannabis use in patients with a first episode of non-affective psychosis. We also investigated the impact on the AOPT of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine. METHOD We recruited 112 consecutive patients (66 men and 46 women; age range, 18-57years) with a first psychotic episode. The composite international diagnostic interview (CIDI) was used to assess drug use and to define the age at onset of heaviest use (AOHU) of a drug, defined as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOPT was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOPT of patients with and without a history of cannabis use, or associated cocaine use. RESULTS We found that the AOPT was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOPT: the earlier the AOHU the earlier the AOPT. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first-episode psychosis than the rest of the patients (sex-adjusted log-rank chi(2)=23.43, df=1, p<0.001). Their respective median AOPT (25th, 75th percentiles) were 23.5 (21, 28) and 33.5years (27, 45) (for log-transformed AOPT, t=5.6, df=110, p<0.001). The sex-adjusted hazard ratio of psychosis onset comparing both groups was 2.66 (95% CI, 1.74-4.05). CONCLUSIONS Our results are in favor of a catalytic role for cannabis use in the onset of psychosis.

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.