Maria Luísa Figueira

Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview

Dias VV, Balanzá‐Martinez V, Soeiro‐de‐Souza MG, Moreno RA, Figueira ML, Machado‐Vieira R, Vieta E. Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview.

Symptomatic remission in schizophrenia patients: Relationship with social functioning, quality of life, and neurocognitive performance

PURPOSE To investigate whether symptomatic remission relates to better outcomes in schizophrenia. METHODS Seventy-six schizophrenia patients were assessed using measures of cross-sectional symptomatic remission, social functioning, subjective quality of life (QoL), and cognition. RESULTS Most patients (53; 69.7%) were not in remission. Remitted patients presented significantly better social functioning, better self-reported QoL, insight, and lower levels of depressive symptoms. They also showed a non-significant trend for better executive function, processing speed and verbal memory. CONCLUSIONS Symptomatic remission may be a good indicator of better clinical status, social functioning and QoL, but not so much for cognitive functioning.

Fighting stigma of mental illness in midsize European countries.

PurposeStigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published.MethodsThe review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible.ResultsThe anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country.ConclusionsAlthough much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Schizophrenia patients with predominantly positive symptoms have more disturbed sleep-wake cycles measured by actigraphy

Sleep disturbances are widespread in schizophrenia, and one important concern is to determine the impact of this disruption on self-reported sleep quality and quality of life (QoL). Our aim was to evaluate the sleep-wake cycle in a sample of patients with schizophrenia (SZ), and whether sleep patterns differ between patients with predominantly negative versus predominantly positive symptoms, as well as its impact on sleep quality and QoL. Twenty-three SZ outpatients were studied with 24 h continuous wrist-actigraphy during 7 days. The quality of sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and the self-reported QoL was evaluated with the World Health Organization Quality of Life - Abbreviated version (WHOQOL-Bref). About half of the studied population presented an irregular sleep-wake cycle. We found a trend for more disrupted sleep-wake patterns in patients with predominantly positive symptoms, who also had a trend self-reported worse quality of sleep and worse QoL in all domains. Overall, patients with worse self-reported QoL demonstrated worse sleep quality. Our findings suggest that SZ patients are frequently affected with sleep and circadian rhythm disruptions; these may have a negative impact on rehabilitation strategies. Moreover, poor sleep may play a role in sustaining poor quality of life in SZ patients.

Translating neurotrophic and cellular plasticity: from pathophysiology to improved therapeutics for bipolar disorder.

Soeiro‐de‐Souza MG, Dias VV, Figueira ML, Forlenza OV, Gattaz WF, Zarate Jr CA, Machado‐Vieira R. Translating neurotrophic and cellular plasticity: from pathophysiology to improved therapeutics for bipolar disorder.

Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE-bd).

Bipolar disorder is a mood disorder which requires complex treatment. Current treatment guidelines are based on the results of published randomized clinical trials and meta-analyses which may not accurately reflect everyday clinical practice. This multi-national, multi-centre, observational cohort study describes clinical management and clinical outcomes related to bipolar disorder in real-life settings, assesses between-country variability and identifies factors associated with clinical outcomes. Adults from 10 countries in Europe and South America who experienced at least one mood episode in the preceding 12 months were included. Overall, 2896 patients were included in the analyses and followed for at least 9 months across a retrospective and prospective study phase. Main outcome measures were the number and incidence rate of mood episodes (relapses and recurrences) and healthcare resource use including pharmacological treatments. Relapses and recurrences were reported in 18.2 and 40.5% of patients, respectively; however, the reported incidence rate of relapses was higher than that of recurrences [1.562 per person-year (95% CI 1.465-1.664) vs. 0.691 per person-year (95% CI 0.657-0.726)]. Medication use was high during all episode types and euthymia; the percentage of patients receiving no medication ranged from 11.0% in mania to 6.1% in euthymia. Antipsychotics were the most commonly prescribed drug class in all disease phases except for patients with depression, where antidepressants were more frequently prescribed. Visits to the psychiatrist were the most frequently used healthcare resource. These results provide a description of treatment patterns for bipolar disorder across different countries and indicate factors related to relapse and recurrence.

Delirium in acute stroke: a preliminary study of the role of anticholinergic medications

The pathogenesis of delirium in acute stroke is incompletely understood. The use of medications with anticholinergic (ACH) activity is associated with an increased frequency of delirium. We hypothesized that the intake of medications with ACH activity is associated with delirium in acute stroke patients. Delirium was assessed using the DSM‐IV‐TR criteria and the Delirium Rating Scale, in a sample of consecutive patients with an acute (≤4 days) cerebral infarct or intracerebral haemorrhage (ICH). We performed a gender and age matched case–control study. Twenty‐two delirious stroke patients (cases) and 52 non‐delirious patients (controls) were compared concerning the intake of ACH medications (i) before stroke, (ii) during hospitalization but before the assessment. The variables associated with delirium on bivariate analysis were entered in a stepwise logistic regression analysis. The final regression model (Nagelkerke R2 = 0.65) retained non‐neuroleptics ACH medication during hospitalization (OR = 24.4; 95% CI = 2.18–250), medical complications (OR = 20.8; 95% CI = 3.46–125), ACH medication taken before stroke (OR = 17.5; 95% CI = 1.00–333.3) and ICH (OR = 16.9; 95% CI = 2.73–100) as independent predictors of delirium. This preliminary result indicates that drugs with subtle ACH activity play a role in the pathogeneses of delirium in acute stroke. Medication with ACH activity should be avoided in acute stroke patients.

Apathy in acute stroke patients.

Background and purpose:  Apathy is a frequent disturbance in stroke patients. The aim of this case–control study was to elucidate whether apathy: (i) was secondary to stroke or related to hospitalization, (ii) was related to thalamic and striatocapsular stroke lesions, (iii) was independent from cognitive impairment and depression in the acute phase of stroke, (iv) was associated with clinical and demographical variables and (v) was associated with a worse functional outcome at discharge.

Association between deliberate self-harm and coping in adolescents: a critical review of the last 10 years' literature.

Coping is commonly associated with deliberate self-harm (DSH) in adolescents. This article reviews the published literature from 2000 to 2010, aiming to highlight the current evidence supporting this association. Eighteen studies met the inclusion criteria, a total sample of 24,702 subjects was obtained and 17% were DSH cases. Emotion-focused coping style and in particular avoidant coping strategies have consistently been associated with DSH in adolescents. Problem-focused coping style seems to have a negative relation. Most studies were cross-sectional, which seriously limits our conclusions on causality. There is a clear need for more systematic studies, performed in accordance with consensual methodology.

Is personal and social functioning associated with subjective quality of life in schizophrenia patients living in the community

Subjective quality of life (QoL) and psychosocial functioning constitute important treatment outcomes in schizophrenia. We aimed to investigate the relationship between them in schizophrenia patients living in the community. Symptom severity and insight were assessed with the Positive and Negative Syndrome Scale (PANSS) in 76 community schizophrenia patients. Social functioning was measured with the Portuguese version of Personal and Social Performance (PSP) scale, and subjective QoL was measured with the Portuguese version of the WHO Quality of Life Measure–Abbreviated Version (WHOQOL–Bref). The majority of patients were single (78%) and unemployed/inactive (74%). Mean PSP total score was 55.5, and mean scores on WHOQOL-Bref domains ranged from 54.1 to 63.0. Greater symptom severity and worse insight were significantly associated with worse functioning in all PSP domains. Symptoms were more moderately correlated with QoL, with no significant correlations between QoL and positive symptoms and insight levels. Partial correlations controlling for symptom severity revealed no significant associations between social functioning and subjective QoL. Symptom severity may exert a greater influence on social functioning than on subjective QoL; however, social functioning was not associated with subjective QoL. The results suggest these constructs might be independent and should be assessed separately. A broader research approach, with increased attention to social and psychological factors, may help identify treatment targets to improve schizophrenia patients’ social functioning and QoL.