Investigations of the cellular immunity during depression and the free interval: evidence for an immune activation in affective psychosis

1. Results of investigations of the immune function in affective disorders are conflicting. Some authors described an immune suppression, others an immune activation in major depression. The authors performed a study of cellular immunity in the MDD subtype endogenous depression. 23 patients suffering from endogenous depression were investigated during the depressive state, the results were compared with a group of 14 patients during the free interval and 51 healthy controls. 2. The lymphocyte proliferation after incubation with diphtheria- and tetanus toxoid, mainly stimulating T-cells, was reduced but after incubation with an antigen-cocktail, stimulating both, T- and B-cells, was increased in patients during depression and during the free interval compared to controls. 3. The CD3(+)- and CD4(+)-cells were significantly enhanced in both groups of patients while the CD8(+)-cells showed no differences to the controls. The ratio CD4+/CD8+ was increased in patients, too, as described in some autoimmune disorders. 4. The suppressor cell activity was significantly reduced in the PWM-assay and in the PHA-assay. The mixed lymphocyte culture showed a tendency to reduced suppressor cell activity as well. 5. The results point to an immune activation and to a disturbed control of the proliferative activity in affective psychosis. A T-cell related defect, not compensated by an increased number of CD3+- and CD4+ -cells is discussed. 6. From our point of view, the conflicting results of psychoneuroimmunological investigations in depressive disorders may be related to etiologically different subgroups of depression. The diagnostic category of MDD is possibly one of the traps in psychoneuroimmunology.     

Psychoanalytic and biological perspectives on depression: Contradictory or complementary?

The emergence of biological psychiatry as a major mental health movement and theoretical point of view presents important issues for psychoanalytic psychology in conceptualizing and treating psychopathology. Psychoanalytic and biological perspectives on depression, as well as other disorders, are often seen as representing contradictory and mutually exclusive theoretical models. This paper critically reviews some of the primary research evidence for the biological psychiatric diagnosis of endogenous depression, and challenges the tendency to construe findings as a basis for discounting the role of psychogenic factors or the value of psychological treatment approaches. Brief attention is given to philosophical issues of reductionism and mind-body dualism, which pose serious conceptual problems for a biological model of psychopathology. The potential for viewing biological and psychological factors as complementary is considered. Freud's early effort to devise a psychogenic model of psychopathology recognized this potential and is reflected in his attempt to build a metapsychological bridge between physiological and mental phenomena. Psychoanalytic theory may provide the essential framework for incorporating both biological and psychological perspectives on depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variants of psychosomatic personality development in diseases of the gastrointestinal tract

612 patients with different psychosomatic disorders of gastrointestinal tract (GIT) were examined. They included either 200 patients with organic stomach disease or with duodenal ulcer as well as 412 individuals with various functional disorders of GIT such as psychogenic vomiting, dysphagia, gastralgia and colon irritability syndrome. In 70% of all cases patientc relatives (1-3 degree of relationship) had also some psychosomatic diseases. All the patients suffered in childhood from so-called GIT-variant of children's neuropathia. Being adults they all met intensive or moderate stress and developed psychogenic depression. Two ways of psychosomatic disorders cristallization on the background of depression were observed, exactly reactivation of children's neuropathia symptomes or rapid affect somatization which were followed by psychosomatic cycles formation and by stress tolerance decrease. Several types of psychosomatic development were described: hypochondrial (78.8%), asthenic (12.4%), obsessive (2.3%), hysterical (4.4%) and paranoial (2.1%).     

The psychopathology of a depressive somato-autonomic symptom complex

The investigation is based on the hypothesis about psychopathological heterogeneity of the somatovegetative (biological) symptom complex of depression. To testify this statement the results of the analysis of the somatovegetative component of depressive syndrome in randomized selection (20 adult patients) were presented. Somatovegetative symptoms (disorders of sleep and appetite mainly) defined the pattern of debut and preceded manifestations of other signs of affective disorder in this group. Psychopathological qualification of disorders belonging to such symptom complex was presented as the phenomena of alienation of the most deep vital psychic functions, exactly somato-vegetative drives. The main psychopathological statements were argued by the data about dynamics of such states, which were followed by transformation into typical vital depressions. The results obtained were interpreted in accordance with traditional K. Schneider's conception of "depression without depression".     

The syndrome of depressive depersonalization

Nineteen patients (9 men, 10 women aged 22--38 years) with depressions were examined. The phenomena of anesthesia of ideatoric functions dominated in clinical picture of such depression. This depression is defined as the depression of estrangement. Psychopathologic differentiation of mental estrangement in the structure of depression and in similar disorders of self-consciousness which were formed in depressions under conditions of "transitional syndrome" (according to G.Gross) is outlined. This syndrome is characterised by irreversible negative disorders of "defective depersonalization". The following signs permit to distinguish depression of estrangement from "transitional syndrome": partiality of the estrangement's phenomenon; connection between psychopathologic formations and pathology of imagination (figurative expressiveness, demonstrativity, lability to psychogenic and medical actions); conformity of the syndrome's structure and characteristics of premanifested personality's structure (combination of hyperthymic features with histrionic and/or narcissic ones). "Apperceptive anesthesia" is suggested for designation of the variant of the depression described.     

Clinical characteristics of unipolar and bipolar depression

INTRODUCTION: In the last decades affective disorders were divided into unipolar and bipolar and this division has been generally accepted. The bipolar type is manifested by mania or by both mania and depression. On the other hand, unipolar affective disorders are manifested only by depression. In numerous investigations authors have noticed that there are very distinctive differences between these two types of depressive disorders such as: course of illness, personality disorders, sex, family history etc. Nevertheless, in practice it is often very difficult to make the right diagnosis. The bipolar type often starts with a few pure depressive episodes and sometimes mania occurs a few years later so only at that point the psychiatrist can make the right diagnosis and treat the patient correctly. MATERIAL AND METHODS: This investigation comprised 50 patients hospitalized at the Psychiatric Clinic in Novi Sad during 1992-1995. The experimental group consisted of 20 patients with a bipolar affective disorder (according to ICD-X), while the control group consisted of 30 patients with clinical diagnosis of unipolar depression (intensive, without psychiatric features). Both groups of patients were weekly evaluated by Hamilton Depression Rating Scale (HDRS), whereas the initial score for all patients had to be higher than 16. RESULTS: Patients suffering from unipolar depression were older than patients with bipolar depression and there were more females in this group. There were no differences in demographic characteristics (level of education, migration, etc.), but the experimental group had a greater genetic loading for affective disorders. Unipolar depressive patients had more agitation and they were more anxious than patients with bipolar depression. DISCUSSION AND CONCLUSION: The fact that unipolar depressive patients were older than bipolar is similar to most of the results gained in this kind of investigation. On the other hand, we did not find statistical differences in the intensity of disorders, and in the literature these results are contraindicating. Numerous investigators report that bipolar depressives had a stronger genetic loading for affective disorders and our study confirms the same. All these results can help us to make the right diagnosis of unipolar and bipolar affective disorders.     

Anxiety disorders and marital quality.

Compared perceived marital quality among couples in which neither, one, or both spouses met criteria for an anxiety disorder. Phobic husbands and their wives reported poorer marital quality than did other spouses. Husbands' panic disorders had similar but weaker effects on perceived marital quality, and wives' panic disorders predicted poor perceived marital quality by husbands. Wives with generalized anxiety disorder perceived their marriages to be less satisfying than did other wives. The effects of husbands' generalized anxiety disorders were strongest in the presence of comorbid depression or alcohol or drug dependence but the effects of husbands' phobias and of panic disorders did not vary with comorbidity. Spouse concordance for phobias was related to more favorable marital reports but concordance for other anxiety disorders was unrelated to marital quality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of pharmacotherapy of affective disorders on the psycho-semantics of alcoholic patients

90 alcoholic patients (II stage of alcoholism) with secondary affective disorders (anxiety, depression) were divided into 4 groups. The patients of the first group received the GABA receptor ligand baclofen during 3 weeks. Sybazon preparation was used in the second group, while the patients of the third group were treated with amitriptyline. Placebo was applied in the forth group. The clinical psychological tests demonstrated that all drugs caused quite effective relief of affective disorders. Psychosemantic tests application showed that the pharmacotherapy caused positive changes in patients of 1-3 groups. These changes touched on both system of personal estimations and relations of personality to himself and to the world around i.e. psychosemantic sphere. Such changes in psychosemantic sphere were not observed in the 4-th group of patients (placebo). Besides it was revealed that each drug caused some specific changes in psychosemantic sphere. The result obtained were supposed to have some theoretical value in comprehension of brain-psychics relations as well as the applied significance for adequate choice of affective disorders pharmacotherapy of alcoholic patients.     

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.     

Effect of thymoleptics in aspects of new clinical systematics of depressive syndrome

Analysis of present concepts of clinico-pharmacological correlations in depression shows the necessity of search for new approaches to the problem. The original clinical model of depression, based on the idea of positive and negative affectivity in its structure is discussed. When applied to therapeutical strategy these principals elucidate new clinical signs for choice of appropriate class of antidepressants. The correlation between predominance of positive or negative appearance of depression and efficacy of antidepressants with selective and non-selective neurochemical action is suggested. A new clinical classification of antidepressants based on their influence on the negative or positive appearance of affective disorder is suggested. The speculations on certain neurochemical specificity of negative and positive disorders are presented.     

Co-occurrence and contransmission of affective disorders and alcoholism in families

The analysis of patterns of co-occurrence and cotransmission of affective disorders and alcoholism in families may provide clues for understanding the excess comorbidity between these conditions in clinical settings and in the general population. This paper reports the results of a family study of the relatives of patients with bipolar disorder, unipolar depression and alcoholism, and combinations thereof. Excess comorbidity between affective disorders and alcoholism was observed in all groups of relatives. However, the sharing of familial aetiological components was not a major contributor to the excess comorbidity between affective disorders and alcoholism. Unipolar depression and alcoholism segregated independently in families, whereas a modest correlation between familial components of alcoholism and bipolar disorder was observed.     

Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders

BACKGROUND: The co-occurrence of anxiety disorders with other mental, addictive, and physical disorders has important implications for treatment and for prediction of clinical course and associated morbidity. METHOD: Cross-sectional and prospective data on 20,291 individuals from the Epidemiologic Catchment Area (ECA) study were analysed to determine one-month, current disorders, one-year incidence, and one-year and lifetime prevalence of anxiety, mood, and addictive disorders, and to identify the onset and offset of disorders within the one-year prospective period. RESULTS: Nearly half (47.2%) of those meeting lifetime criteria for major depression also have met criteria for a comorbid anxiety disorder. The average age of onset of any lifetime anxiety disorder (16.4 years) and social phobia (11.6 years) among those with major depression was much younger than the onset age for major depression (23.2 years) and panic disorder. CONCLUSIONS: Anxiety disorders, especially social and simple phobias, appear to have an early onset in adolescence with potentially severe consequences, predisposing those affected to greater vulnerability to major depression and addictive disorders.     

Calcium antagonistic actions of drugs used in treatment of affective disorders

Disturbances of intra- and extracellular calcium levels are often reported during the course of affective disorders. In this review calcium antagonistic properties of drugs used in the treatment of affective disorders are discussed. The effects of calcium channel blockers in animal models of depression and in clinical trials are compared to established treatment strategies. Knowledge on changes in calcium homoeostasis during the treatment of affective disorders may increase the scope of therapeutic options.     

Seasonal affective disorder and phototherapy: A critical review.

Seasonal affective disorder and phototherapy have had little exposure to clinicians and researchers in the field of psychology. Past research is critically reviewed, the prevalence of seasonal affective disorders is discussed, and the characteristics of 2 types of seasonal affective disorders, winter depression and summer depression, are described. The effectiveness of phototherapy as well as research on a number of important characteristics of phototherapy, such as light intensity, duration, time of administration, and spectral qualities, are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DSM-III classification of the anxiety disorders: A psychometric study.

89 patients meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for anxiety disorders were administered a battery of self-report inventories, including the State-Trait Anxiety Inventory, the Beck Depression Inventory, an obsessive-compulsive inventory, the Cornell Medical Index—Health Questionnaire, and the Fear Survey Schedule. The validity of the DSM-III subgroups of anxiety states and phobias was substantiated. However, the results indicate that agoraphobia was more similar to the anxiety state than the phobia group, where it is presently classified. The anxiety state group was highly homogenous. On the other hand, the phobia group showed some degree of heterogeneity. Findings are discussed in terms of the validity of DSM-III subcategories of phobias and anxiety states, the reclassification of agoraphobia as an anxiety state, and whether phobias should be included in the anxiety disorders category. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysthymia in the offspring of parents with primary unipolar affective disorder.

This study examined whether there is a familial relation between primary early-onset dysthymia and major affective disorder. In addition, it explored the prevalence of other forms of psychopathology and social impairment in the adolescent and young adult offspring of patients with primary unipolar affective disorder. Subjects included 47 offspring of patients with primary unipolar depression, 33 offspring of patients with chronic orthopedic and rheumatological conditions, and 38 offspring of randomly selected community controls with no personal or family history of psychiatric disorder. All offspring received structured diagnostic interviews. Diagnoses were derived blind to parental group by using multiple sets of diagnostic criteria. The offspring of unipolar patients exhibited significantly higher rates of affective disorder, major depression, and dysthymia than did the offspring of medical and normal controls. The groups did not differ on rates of nonaffective disorders. Parental characteristics associated with dysthymia in offspring included chronic depression, age of onset of major depression, number of hospitalizations, and multiple family members with major affective illness. These results support the view that at least some forms of early-onset dysthymia are variants of major affective illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disorders of the sleep-wake cycle in adults

Adults have an intrinsic body clock which regulates a complex series of rhythms including sleep and wakefulness, fatigue and cognitive ability. This endogenous clock naturally runs more slowly than the solar day and is entrained to a 24-h rhythm primarily by the alternation of light and darkness. Jet lag, shift-work sleep disorder, and some of the chronic insomnias are caused by a temporal discrepancy of the body clock relative to the surrounding environment and social network. The underlying mechanisms and general management are described. Both bright light and melatonin therapy have potential in the management of these disorders. Traditionally, bright light therapy has been used to alleviate the depression associated with seasonal affective disorder. Melatonin has received much ill-formed publicity, it being claimed that it is a panacea and an 'antiageing' treatment. Both of these treatment approaches are reviewed.     

Manic-depressive disease

Manic-depressive illness (MDI) is a periodic major affective disorder defined by successive depressive and manic episodes, separated by free intercritic periods. Unipolar manic-depressive illness is defined by successive depressive episodes, whereas bipolar manic-depressive illness is defined by successive depressive and manic episodes. Clinical, familial and biological studies have demonstrated the heterogeneity of unipolar depression and its relationship with bipolar depression leading to questions about common etiopathogeny of those two disorders. Manic-depressive heterogeneity led to the identification of several subgroups defining "manic-depressive spectrum". The reunion of these different clinical entities is based on phenomenological, clinical and familial arguments. MDI is an endogenous pathology, as vulnerability to this disorder is mostly determined by genetic and/or biological factors. Treatment consist first on treatment of major episodes, based on curative and consolidation treatment and secondly on prophylactic treatment.