Odd Lingjærde

Bimodal Distribution of Polyunsaturated Fatty Acids in Schizophrenia Suggests Two Endophenotypes of the Disorder

BACKGROUND There is conflicting evidence of whether polyunsaturated fatty acids (PUFA) in red blood cells are bimodally distributed in schizophrenia. The purpose of this study was to examine the distribution of PUFA, as well as its links to plausible causal factors. METHODS A 16-week cohort study and a case-control study as part of a randomized controlled trial. Ninety-nine patients with DSM-IV schizophrenia, schizoaffective disorder, or schizophreniform disorder, aged 18 to 39, were consecutively included at admission to psychiatric departments of nine Norwegian hospitals. Fatty acids were measured in 97 of these patients and in 20 healthy control subjects. The primary outcome measure was the bimodality test statistic T, assessed by a χ(2) test of the likelihood of one or two normal distributions of PUFA. RESULTS At baseline, levels of polyunsaturated fatty acids were highly significantly bimodally distributed among patients. One third of patients constituted a group (low PUFA) who had PUFA levels at one fifth (p < .001) of those in high PUFA patients and healthy control subjects, which did not differ. Bimodality was mainly accounted for by docosahexaenoic acid and arachidonic acid. Bimodality was confirmed after 16 weeks. α-tocopherol was a robust predictor of PUFA at both occasions. Desaturase and elongase indexes differed between PUFA groups. Smoking, gender, antipsychotic medication, and dietary factors did not explain the bimodal distribution. CONCLUSIONS Red blood cell PUFA were bimodally distributed among acutely ill patients with schizophrenia and schizoaffective disorder. Endogenous deficiencies of redox regulation or synthesis of long-chain PUFA in the low PUFA group may explain our findings.

Response to light therapy in seasonal affective disorder: personality disorders and temperament as predictors of outcome.

Outcome after 6 days of morning light therapy in subjects fulfilling criteria for winter seasonal affective disorder (SAD) was examined. Responders had significantly fewer previous episodes of SAD. Patients with a diagnosis of any DSM-III-R, axis II personality disorder, were significantly less likely to respond to light therapy than patients without axis II pathology. Poor treatment outcome was also significantly associated with: one or more personality disorders in cluster C, avoidant personality disorder, high number of positive criteria for self-defeating personality disorder and high score on the harm avoidance scale of the Tridimensional Personality Questionnaire. Temperament accounted for 25% of the variance in treatment outcome.

Platelet monoamine oxidase activity in patients with winter seasonal affective disorder

The aim of the present study was to examine whether high or low levels of platelet monoamine oxidase (MAO) activity were associated with an increased risk of winter seasonal affective disorder (SAD) or of developing characteristic vegetative symptoms during episodes of the disorder. We also investigated the relationship between MAO activity and the Global Seasonality Scale (GSS), a measure of seasonal variation in sleep length, social activity, mood, weight, appetite, and energy level. Patients with SAD (n = 49), patients with subsyndromal SAD (n = 11), and normal volunteers (n = 25) participated in the study. We found significantly higher levels of platelet MAO activity in females but did not observe significant differences across age groups or between groups of patients tested in different seasons or mood states. MAO activity (whether high or low) was not associated with a significant increase in risk of SAD or of developing hypersomnia, hyperphagia, or carbohydrate craving during episodes of winter depression. We found no significant relationship between GSS and MAO activity. Patients who had made suicide attempts during an episode of SAD had significantly lower mean levels of platelet MAO activity than other patients.

Relatives’ emotional warmth towards patients with schizophrenia or related psychoses: demographic and clinical predictors

Despite the importance of relatives’ emotional warmth for outcome in schizophrenia, no studies to date have addressed demographic and clinical predictors of warmth. We examined a Norwegian sample of 47 recently hospitalized patients (with schizophrenia or schizophreniform disorder) and 72 key relatives. Relatives’ emotional warmth was assessed by means of the Camberwell Family Interview. Regression analyses showed that no substance abuse (especially amphetamines), better premorbid adjustment (12–15 years), a chronic social security status, and the relative not being a parent were the strongest predictors of emotional warmth. Emotional warmth was not related to patients’ symptoms.

DSM-III-R personality disorders in seasonal affective disorder: Change associated with depression

Forty-five patients with winter Seasonal Affective Disorder (SAD) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R) in a depressed state before starting therapy (light or medication), and again 14 weeks later when the scores on the Montgomery Asberg Depression Rating Scale (MADRS) had been reduced by an average of 74%. Prevalence and pattern of personality disorders (PDs) before treatment were similar to that found in patients with nonseasonal major depressive disorder (MDD) during a depressive episode. Number of categorical diagnoses were lower at follow-up for most PDs, but differences were not statistically significant. However, for dimensional scores (number of positive DSM-III-R criteria) significant changes were found for schizotypal, histrionic, narcissistic, and obsessive-compulsive PD, and for total dimensional score in cluster B and total score for all PDs. These changes differ from findings in similar studies of outpatients with nonseasonal MDD. Whether this indicates a specific pattern of change for patients with SAD is discussed. Multiple regression analysis showed a significant association between changes in positive PD criteria between the depressed and nondepressed state and change in depression score. No significant relationship was found between changes in PD criteria and Global Seasonality Score (GSS), a measure reflecting the sum of ratings of seasonal variation in sleep length, social activity, mood, weight, appetite, and energy level.

Personality disorders in patients with winter depression

Sixty‐six patients satisfying the criteria for seasonal affective disorder (SAD) winter depression type (n= 57) or subsyndromal SAD (n= 9), were interviewed in a nondepressed state with the Structured Interview for DSM‐III‐R Personality Disorders (SIDP‐R). Twenty‐three percent of the patients in the SAD sample met DSM‐III‐R criteria for one or more categorical diagnosis of personality disorder (PD). Disorders in cluster C occurred in 18% of the sample, while 12% had cluster B PDs and 5% a cluster A disorder. The relative number of positive criteria, as a dimensional measure of PD, were higher for all cluster C disorders than for any PD in the other clusters. Our data indicate that the pattern of personality disorders in patients with winter SAD are similar to that previously reported for outpatients with non‐SAD major depression. We explored the relationship between lifetime severity and clinical manifestation of SAD and dimensional measures of PD with multiple regression analyses. No significant association was found. This is in accordance with the hypothesis that the two disorders are distinct conditions with independent causes.

Winter Depression with Spring Exacerbation: A Frequent Occurrence in Women with Seasonal Affective Disorder

Winter depression (WD) usually starts in October/November and remits in February/March, but some experience a relatively short depressive exacerbation in spring. To further characterize this spring exacerbation (SE), 84 previously diagnosed WD patients rated in retrospect whether they had experienced SE after their otherwise typical WD in the years before receiving active treatment. Thirty-nine percent of the women and 12% of the men reported to have experienced SE many times or practically every year; another 28 and 29%, respectively, had experienced SE a few times. In general, the symptomatology during SE was about the same as during WD. Female patients who had experienced SE many times or practically every year were marginally older (p = 0.05) and had suffered many more previous WD episodes (p = 0.0005) than female patients having experienced SE only a few times or never.