Matteo Vismara

Age at onset in patients with bipolar i and II disorder : A comparison of large sample studies

BACKGROUND Bipolar Disorder (BD) is a leading cause of disability worldwide and factors contributing to its burden include chronic relapsing course, comorbidity, suicide risk, and early age at onset (AAO). In particular, recent investigation has shown that BD onset may occur earlier than previously believed, even though whether BDI and II are different in such regard is still debated. Reduced samples may, moreover, limit the confidence in the published studies, with geographic issues, in turn, representing potentially conditioning factors. The present review was aimed to select and analyze large sample studies comparing AAO in BDI vs II patients. METHODS A PubMed literature search was performed, considering English-written articles published up to December 2015, comparing AAO in BDI vs II patients with sample size≥100 subjects per group. RESULTS Seventeen studies were considered suitable for revision, with 8 studies reporting statistically significant differences and 9 not. Among studies reporting statistically significant differences, mostly conducted in Europe, 6 showed an earlier AAO in BDI, while 2 in BDII subjects. LIMITATIONS Only studies with large samples included, considering AAO as a continuous variable, and providing a comparison between the bipolar subtypes. CONCLUSIONS Our findings suggest that AAO per se does not seem to reliably differentiate BDI from BDII patients and that such variable should likely be investigated in the context of other clinical characteristics, in order to assess its overall influence over BD course. Geographic factors may, in turn, play a potential role with future investigation warranted to further explore this specific issue.

Onset polarity in bipolar disorder: A strong association between first depressive episode and suicide attempts

BACKGROUND The role of onset polarity (OP) in patients with bipolar disorder (BD) has been increasingly investigated over the last few years, for its clinical, prognostic, and therapeutic implications. The present study sought to assess whether OP was associated with specific correlates, in particular with a differential suicidal risk in BD patients. METHODS A sample of 362 recovered BD patients was dichotomized by OP: depressed (DO) or elevated onset (EO: hypomanic/manic/mixed). Socio-demographic and clinical variables were compared between the subgroups. Additionally, binary logistic regression was performed to assess features associated with OP. RESULTS DO compared with EO patients had older current age and were more often female, but less often single and unemployed. Clinically, DO versus EO had a more than doubled rate of suicide attempts, as well as significantly higher rates of BD II diagnosis, lifetime stressful events, current psychotropics and antidepressants use, longer duration of the most recent episode (more often depressive), but lower rates of psychosis and involuntary commitments. LIMITATIONS Retrospective design limiting the accurate assessment of total number of prior episodes of each polarity. CONCLUSIONS Our results support the influence of OP on BD course and outcome. Moreover, in light of the relationship between DO and a higher rate of suicide attempts, further investigation may help clinicians in identifying patients at higher risk of suicide attempts.

Italian patients with more recent onset of Major Depressive Disorder have a shorter duration of untreated illness

Previous investigation on the duration of untreated illness (DUI) in patients with Major Depressive Disorder (MDD) revealed a different latency to first antidepressant treatment, with adverse consequences in terms of outcome for individuals with a longer DUI. Recent reports, moreover, documented a reduced DUI, as observed with the passage of time, in patients with different psychiatric disorders. Hence, the present study was aimed to assess DUI and related variables in a sample of Italian patients with MDD as well as to investigate potential differences in subjects with onset before and after 2000.

Generalized Anxiety Disorder, Somatization, and Emotional Dysregulation: A Possible Link

In clinical practice, it is quite common to deal with patients who primarily express somatic symptoms. They can be distinctive features of depressive disorders, of anxiety disorders, in particular general anxiety disorder, and, less commonly, of somatic symptom disorders. Nonetheless, in several patients, these three conditions could coexist and delineate a clinical picture driven by emotional dysregulation (ED). ED is an emotional response to external stimuli that is poorly modulated and does not fall within the conventionally accepted range of emotive response, which can be characterized by marked and rapid fluctuation of mood, mood lability, weeping crisis, eating problems, and up to behavior outbursts. In our clinical case, a female patient came to our attention reporting headache, gastrointestinal disturbance, hyporexia, and leg restlessness. The diagnostic approach is pictured, and a correct pharmacological treatment is shown in this chapter.