Stamatia Magiria

Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder.

BackgroundManic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment.MethodsThis article summarizes the current status of our knowledge and practice of its treatment.ResultsIt is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling.ConclusionThe first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.

Obesity and smoking in patients with schizophrenia and normal controls: a case-control study.

Cardiovascular risk factors, especially obesity and smoking are highly prevalent in patients with schizophrenia. Central obesity and the metabolic syndrome are conditions mostly attributed to the use of antipsychotic medication and lifestyle habits, and they constitute a significant health concern. Our study sample included 105 patients suffering from schizophrenia aged 36.25+/-10.03 and 156 normal control subjects aged 36.03+/-11.33. All patients were in- or out-patients of a private hospital. Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWise Body Fat Analyzers No 63-1525. The results of analysis of variance suggested a significant main effect regarding diagnosis and sex as well as for their interaction. There were significant differences between patients and controls regarding body weight, waist circumference, BMI, BSA and % body fat, with patients, especially females, being more obese than controls. The results of the present study corroborate the increased prevalence of obesity in schizophrenia. The interpretation of this finding remains unclear.

Development of a standardized scoring method for the Graphic Sequence Test suitable for use in psychiatric populations.

Although the graphic version of the Alternating Sequences Test which was introduced by Luria exists for years little has been done to standardize it. The aim of the current study was to develop a novel and detailed standardized method of administration and scoring. The study sample included 93 normal control subjects (53 women and 40 men) aged 35.87±12.62 and 127 patients suffering from schizophrenia (54 women and 73 men) aged 34.07±9.83. The psychometric assessment included the Positive and Negative Symptoms Scale the Young Mania Rating Scale, and the Montgomery-Asberg Depression Rating Scale. A scoring method was developed and was based on the frequencies of responses of healthy controls. Cronbach α and test-retest and interrater reliability were very good. Two indices and 6 subscales of the Standardized Graphic Sequence Test were eventually developed. The Standardized Graphic Sequence Test seems to be a reliable, valid, and sensitive to change instrument based on Lurias graphic sequence test. The great advantage of this instrument is the fact that it is paper and pencil, easily administered and little time consuming. Further research is necessary to test its usefulness as a neuropsychologic test.

Preliminary data concerning the reliability and psychometric properties of the Greek translation of the 20-item Subjective Well-Being Under Neuroleptic Treatment Scale (SWN-20)

BackgroundThe 20-item Subjective Well-Being Under Neuroleptic Treatment Scale (SWN-20) is a self-report scale developed in order to assess the well-being of patients receiving antipsychotic medication independent of the improvement in their psychotic symptoms. The current study reports on the reliability and the psychometric properties of the Greek translation of the SWN-20.MethodsA total of 100 inpatients or outpatients with schizophrenia (79 males and 21 females, aged 42.6 ± 11.35 years old) from 3 different facilities were assessed with the Positive and Negative Symptoms Scale (PANSS), the Calgary Depression Scale and the Simpson-Angus Scale, and completed the SWN-20. The statistical analysis included the calculation of Pearson product moment correlation coefficient, the Cronbach α and factor analysis with Varimax normalised rotation.ResultsThe SWN-20 had an α value equal to 0.79 and all the items were equal. The factor analysis revealed the presence of seven factors explaining 66% of total variance. The correlation matrix revealed a moderate relationship of the SWN-20 and its factors with the PANSS-Negative (PANSS-N), PANSS-General Psychopathology (PANSS-G), the Simpson-Angus and the Calgary scales, and no relationship to age, education and income class.DiscussionThe Greek translation of the SWN-20 is reliable, with psychometric properties close to the original scale.

Evidence Based Combination Therapy for Bipolar Disorder

The treatment of bipolar illness is complex and full of caveats for the clinician, and it seems that at least some aspects of the disorder are rather refractory to treatment. While some agents are efficacious as monotherapy, the overall outcome is unsatisfactory. However, only specific combinations have solid evidence supporting their efficacy. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/or rapid cycling when utilized as monotherapy however only fluoxetine in combination with olanzapine has data supporting its usefulness for the treatment of bipolar depression. Adding an antipsychotic to acutely manic patients who are partial responders to lithium/valproate/carbamazepine is a reasonable choice. The combination with best data in acute bipolar depression is lithium plus lamotrigine. Patients stabilized on combination treatment might do worse if shifted to monotherapy during maintenance, and patients refractory to monotherapy could benefit with add on treatment with olanzapine, valproate, an antidepressant or lamotrigine, depending on the index acute phase. Combination therapy may improve treatment outcome but it also carries more side-effect burden. Further research is necessary as well as the development of better guidelines and algorithms for the step-by-step rational treatment.

Risperidone-induced sialorrhea responsive to biperiden treatment.

Materials and methods The patient was an 18 year old female suffering from schizophrenia, paranoid type. She had no history of any medical condition. The onset of her psychiatric condition was at the age of 17. Due to low adherence, she had never taken any medications and had no previous hospitalizations. During her hospitalization, she was started on 1mg/ d lorazepam and 2mg/d risperidone (with a gradual increase up to 6mg/d on day 3, due to lack of response and progressive thought disorganization). On day 4 the patient exhibited hypersalivation and a concomitant mild speech disturbance. No signs of EPS where present except for mildly impaired postural reflexes that could be considered as a sign of imminent EPS. Subsequently, risperidone was tapered to 3mg/d along with oral biperiden 2mg/d resulting to full remission of hypersalivation by day 5.

Comparison of body fat in patients with schizophrenia and normal controls

Materials and methods The study sample included 105 patients suffering from schizophrenia (44 females−41.91% and 61 males− 58.09%) aged 36.25±10.03 (range 19-69) and 156 normal control subjects (65 females−41.66% and 91 males− 58.34%) aged 36.03±11.33 (range 19-68). Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWiseTM Body Fat Analyzers No 631525. Results The ANOVA results suggested a significant main effect regarding diagnosis and gender as well as for their interaction. Scheffe post hoc test demonstrated significant differences between patients and controls regarding body weight (women only, p=0.002), waist circumference (men p=0.002, women p<0.0001), BMI (women only, p<0.001), BSA (women only, p<0.01) and % body fat (women only, p=0.033), with patients being more obese. The patients also smoked more cigarettes daily (men p=0.002, women p=0.016)

Advances in the treatment of geriatric depression

Late-life depression is a rather difficult and complicated issue. Although there have been significant advances in our knowledge in this area, a large number of questions still remain unanswered. The aim of this review is a critical presentation of the current evidence for treatment of depression in the elderly. We summarize the evidence for the effectiveness and safety of a range of proposed treatments, including pharmacological, psychological and alternative therapies and lifestyle changes. The treatments with best evidence of effectiveness are antidepressant pharmacotherapy, electroconvulsive therapy, cognitive–behavioral therapy, psychodynamic psychotherapy, reminiscence therapy, problem-solving therapy and exercise. Implications for future research are discussed.

The relationship of Body Mass Index to aspects of neurocognitive functioning in patients with schizophrenia and normal controls: a pilot study

Materials and methods The study sample included 100 patients suffering from schizophrenia (42 females and 58 males) aged 34±9.82 and 80 normal control subjects (48 females and 32 males) aged 35.87±12.62. The clinical diagnosis was made according to DSM-IV-TR criteria. Age, height, weight, parental and maternal age at birth and level of education were recorded. Body Mass Index (BMI) was calculated. The psychometric assessment included the PANSS, the YMRS and the MADRS, while the neuropsychologic assessment included the Random Letter Test (RLT), the Graphic Sequence Test (GST), the Copy of Diamonds test (CDT), the Ray Figure and the Clock Drawing Test.

Successful and steady response to a combination of lamotrigine and quetiapine of an extremely refractory bipolar I patient previously published as a case report: a seven years follow-up of the case report

Materials and methods During the 6 years that followed the patient manifested her first manic episode while for the rest of the time she was continuously depressed and attempted suicide three times. She received ECT without any benefit. She presented to us again after her last attempt. The diagnosis changed to Bipolar I disorder, current episode depressive. She was put on quetiapine 1500 mg, lamotrigine 300 mg and topiramate 50 mg daily. For the next 7 months the patient was normothymic with no residual symptoms.