Nicolas Hoertel

Subthreshold bipolar disorder in a U.S. national representative sample: Prevalence, correlates and perspectives for psychiatric nosography

OBJECTIVE There is growing clinical and epidemiological evidence that undiagnosed bipolar features are source of clinical heterogeneity in major depressive disorder (MDD). This study examined and compared the prevalence and correlates of lifetime major depressive episode plus subthreshold hypomania D(m) with pure MDD, bipolar II disorder, and bipolar I disorder. METHOD Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large cross-sectional survey (n=43,093) representative of the U.S. population. RESULTS The lifetime prevalences were 2.53% for D(m), 1.12% for bipolar II disorder, 2.19% for bipolar I disorder and 10.70% for pure MDD. All bipolar disorders (i.e., D(m), BP-II, and BP-I) were half as frequent as MDD. Lifetime and 12-month psychiatric comorbidity, course and clinical characteristics, symptoms, health status and treatment-seeking rates were significantly different in participants with lifetime D(m) when compared to participants with pure MDD, but not when compared to participants with bipolar II disorder. LIMITATIONS Subthreshold hypomania diagnostic was based on the lifetime presence of at least one of the three screening questions for criterion A for hypomania, without a lifetime history of manic or hypomanic episode. This narrow definition, both in terms of the choice of hypomanic symptoms and their duration, could have led to an underestimation of the proportion of participants with a lifetime history of D(m). In addition, the cross-sectional nature of this study does not allow causal associations to be drawn. CONCLUSIONS Our data confirm and extend evidence of the clinical significance and validity of a subthreshold bipolarity-specifier applied to individuals with DSM-IV MDD. Major depression with subthreshold hypomania could be more accurately incorporated into the bipolar II disorder diagnosis.

GENERALIZABILITY OF CLINICAL TRIAL RESULTS FOR GENERALIZED ANXIETY DISORDER TO COMMUNITY SAMPLES

There has been little research on the generalizability of clinical trials for generalized anxiety disorder (GAD). The present study examines the generalizability of pharmacological and psychotherapy clinical trials’ results of individuals with DSM‐IV GAD to a large community sample.

Personality Disorders in Older Adults: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVES To examine the prevalence, sociodemographic correlates, psychiatric and medical comorbidities, and the disability of personality disorders among adults age 65 years and older. METHODS Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, focusing on a subsample of 8,205 adults age 65 years and older. RESULTS A total of 8.07% (SE: 0.37) of American adults age 65 years and older presented at least one personality disorder. The most prevalent personality disorder was the obsessive-compulsive personality disorder. The overall pattern of associations between each personality disorder and lifetime psychiatric comorbidity correlates was statistically significant. Participants with a personality disorder show a lower quality of life than their counterparts. CONCLUSIONS Personality disorders in older adults are highly associated with disability, medical, and psychiatric disorders. These findings highlight the need to develop more effective prevention and intervention programs in this specific population.

Novel routes to bipolar disorder drug discovery

Introduction: Bipolar disorder (BD) is a severe and chronic medical condition typified by episodic recurrent mania (or hypomania) in addition to major depression. BD is associated with a number of negative outcomes including premature death, reduced quality of life and can also lead to other complications including impaired cognitive function. Unfortunately, the currently available pharmacological treatments for BD are insufficient for many with the condition. Areas covered: This review focuses on known therapeutic targets of mood stabilizing drugs including: the glycogen synthase kinase-3 (GSK-3), the phosphoinositide pathway and protein kinase C (PKC), the brain-derived neurotrophic factor (BDNF), and histone deacetylases (HDACs). This article also presents new promising therapeutic targets including: the glutamatergic pathway, mitochondrial modulators, neuropeptide-converting endopeptidases, the insulin transduction pathway, the purinergic system and the melatoninergic system. Expert opinion: Challenges in improving methods and tools to generate, integrate and analyze high-dimensional data are required to allow opening novel routes to BD drug discovery. Through the application of systems biology approaches and the use of bioinformatical tools to integrate all omics data, it will be possible in the near future to gain deeper insights into pathophysiology of BD. This will in turn lead to the identification and exploitation of new potential therapeutic approaches.

Gender effects in bullying: Results from a national sample

This study presents gender effects in sociodemographics and psychiatric correlates of bullying in the United States. Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults. Face-to-face interviews of more than 43,000 adults were conducted during the 2001-2002 period. The present study compared 2460 respondents who ever bullied with 39,501 respondents who did not, stratified by gender. The prevalence of this behavior in the U.S. was significantly higher in men (8.5%) than in women (4.2%). Multivariate logistic regression analyses indicated strong associations in both genders with numerous psychiatric and addictive disorders with significant gender effects. Following adjustments for sociodemographic characteristics and other antisocial behaviors, women who ever bullied were significantly more likely to have any lifetime externalizing, including conduct disorder, as well as any lifetime internalizing spectrum disorder compared to men with such behavior. Bullying in women may be a symptom of a broader syndrome than in men, including more prevalent impairment of impulse control and more frequent affective disorders.

Estimated cost of a factitious disorder with 6-year follow-up

Long-term follow up is rarely described for patients with Factitious Disorder, mainly because of the lack of access to patients confidential information. In addition, the financial burden of multiple uses of health care system has not been examined so far. We report a 6-year follow-up for a patient with Factitious Disorder who first reported neurological then psychiatric symptoms, and investigate the cost of his detected hospitalizations.

Mental healthcare in older adults with schizophrenia: results from 118 French public psychiatric departments.

The increased life expectancy in people with severe and persistent psychiatric illness, such as schizophrenia or bipolar disorder, has been predicted to substantially affect mental healthcare system (Bartels et al., 2002) that must adapt to meet the needs of older adults (Jeste et al., 1999). Development of specialized geriatric psychiatry services is thus needed. In France, public mental health departments are organized into “sectors,” i.e. catchment areas defining mutually independent geographical areas, each of them comprising a mean population of 72,000 inhabitants. Catchment area healthcare teams cover all levels of service provision, i.e. primary, secondary, and tertiary care, and are responsible for the provision of healthcare services for all the inhabitants of the areas concerned. Apart from the planning and budgeting advantages of this method of organizing service, this approach leads to enhanced likelihood of providing continuity of care. However, it also implies that each sector healthcare team have the knowledge and the means required to adequately manage all mental disorders, limiting thus the development of services specialized in the care of specific disorders and in geriatric psychiatry (Verdoux and Tignol, 2003). In this report, we sought to give an overview on the global provision of psychiatric care for older adults in France and examine the proportion of older patients with schizophrenia among psychiatric patients followed up in France between 2008 and 2009. Data were collected in 118 public-sector psychiatric departments between 2008 and 2009. Each department was questioned about the total number of patients aged over 18 years old they had followed up during this period, their age, and the number of patients with an International Classification of Diseases, 10th Revision (ICD10) diagnosis of schizophrenia or schizoaffective disorder (F20–F25). Lastly, all departments were asked whether they offer specialized services for elderly patients. Study results indicate that one out of five (n = 376±303; 21%) patients was aged 60 years or older. Patients with a diagnosis of schizophrenia represented nearly 13% (n = 236±147) of the total number of patients, while the percentage of patients with schizophrenia aged 60 years and older was 1.5% (n = 26±15) of the total number of patients. More than one out of ten patients with schizophrenia was aged 60 years and older (11.1%). Less than four out of ten mental health departments (39.8%) provided specialized services for elderly patients. In these departments, 76% reported ambulatory care services, 42% consultation-liaison, 36% full-time hospitalization with an average of five beds dedicated to the elderly, and 19% day hospitalization. Mental health in older people has become a major issue in the European Union (EU) (Jané-Llopis and Gabilondo, 2008). The EU stresses the importance of promoting autonomy and independence for older people with mental health diseases by privileging community-based care and maintaining elderly subjects in their own environment. However, our results, in line with those of a recent study (Tucker et al., 2007), suggest that despite substantial improvements during the last decades, the development of mental health departments offering specialized services for older patients is insufficient to meet the impending crisis in geriatric mental health. Mental healthcare for older adults with mental illness, and particularly those with schizophrenia, needs to be accessible, affordable, culturally appropriate, and integrated into a comprehensive system of mental health services that ensures continuity and coordination of care. Despite evidence for the efficacy of a variety of interventions for mental disorders in the elderly, implementation of these interventions in usual care settings remains limited (Bartels et al., 2002). The main objectives for the next few years are to ensure equitable access to appropriate assessment and treatment of mental disorders in older individuals, develop the interface between specialist mental health services and generic services caring for older people, and provide adequate training to young psychiatrists and mental health staff. In France, the National Health Strategy plan recently presented by the government seeks to diminish care provision disparities, with a particular focus on the older population. In conclusion, although elderly patients represent one out of five psychiatric patients in France, only one-third of French public mental health departments provide services specialized in geriatric psychiatry. Given the rapid growth of

P02-246 - Comorbidity of Current Depression Among the Elderly

Introduction Depression in later life is a major public heath issue. Few studies to date examined the psychiatric correlates of depression in elderly surveys in the general population. Objective To provide nationally representative data on the prevalence, sociodemographic correlates and comorbidity of current major depressive disorder in late life. Methods This study is based on a nationally representative survey, the National Epidemiologic Survey on Alcohol and Related Conditions, of the noninstitutionalized household population (8,205 respondents aged 65 and above). The past 12-months prevalence of major depressive disorder was estimated, and logistic regression analyses were used to examine the relationship between 12-months major depressive disorder and sociodemographic characteristics, general medical condition and psychiatric disorder. Diagnoses were made according to the of DSM-IV criteria. Results Among the respondents, 3.2% individuals with a past 12-months diagnosis of major depressive disorder were identified. Women and individuals living in urban areas were more likely to be diagnosed with a major depressive disorder. Significant associations between major depressive disorder and cardiovascular, gastrointestinal diseases, arthritis were found. Several psychiatric disorder were associated with past 12-months major depressive disorder, including dysthymia, bipolar disorder, panic disorder, specific phobia, generalized anxiety disorder, nicotine and alcohol dependence, and histrionic personality disorder. Conclusion Recent Major depressive disorder in the elderly was associated with a large number of psychiatric disorders. This study highlights the need to develop effective and targeted intervention initiatives to detect major depressive disorder in elderly.