Suicidal behavior in bipolar and unipolar affective disorders: a meta-analysis

Manual ventilation (MAV) or handbagging is a frequent and often life-saving procedure for neonates; however, few studies allow for an objective evaluation of techniques or possible risks. We compared parameters of ventilation and pulmonary mechanics obtained during routine pressure-limited MAV to those obtained during spontaneous breathing (SPB) in the same infant at approximately the same time. We selected 20 preterm neonates in the recovery phase of respiratory distress syndrome who received periodic MAV and were capable of optimum spontaneous minute ventilation (> 300 mL/kg/min). During MAV compared to SPB we measured higher tidal volume (8.1 +/- 0.5 SE vs. 5.4 +/- 0.4 SE mL/kg, P < 0.001), lower total pulmonary compliance (0.65 +/- 0.05 vs. 1.16 +/- 0.11 SE mL/cmH2O, P < 0.001), end-inspiratory compliance, higher pulmonary resistance (121 +/- 11 vs. 61 +/- 7 SE cmH2O/L/s, P < 0.001) and higher peak inspiratory airflow (2.8 +/- 0.2 vs. 1.6 +/- 0.1 L/s, P < 0.001). Inspiratory time (Ti) was consistently longer during MAV (0.49 +/- 0.02 vs. 0.36 +/- 0.02 SE, P < 0.001) such that during MAV the difference between actual Ti and minimal effective Ti (fivefold inspiratory time constant) was larger (0.29 +/- 0.03 vs. 0.13 +/- 0.03 s, P < 0.05). Our study suggests that operator-dependent ventilatory variables such as tidal volume, inspiratory time, frequency, and airflow need to be further evaluated in order to develop standardized guidelines for the safe administration of MAV. Until then the ventilator used for brief or augmented ventilatory support is a reasonable alternative to administering MAV by inconsistent standards.     

The unipolar–bipolar distinction in the depressive disorders.

Reviews studies concerned with symptomatic behavior, clinical characteristics, genetic factors, and pharmacological response in relation to the unipolar–bipolar distinction in depressive disorders. The findings suggest that differences among some forms of the larger polar disorders do exist in the above areas. However, heterogeneity of results remains evident, indicating that finer subdivisions within the larger polar groups are necessary. Accordingly, research within the guidelines of a genetic taxonomy of polar groups is assessed and recommended as the most productive framework for future investigation of the depressive disorders. (4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociotropy/autonomy and vulnerability to specific life events in patients with unipolar depression and bipolar disorders.

Followed samples of unipolar and bipolar patients for a 6-month period, with independent assessment of symptoms and life events. Patients were initially categorized into subtypes using Beck's Sociotropy/Autonomy Scale, with the prediction that onset or exacerbation of symptoms, as well as more total symptoms, would occur for sociotropic individuals experiencing more negative interpersonal events than achievement events, and for autonomous-achievement patients experiencing more achievement events than interpersonal events. Results were confirmed for unipolars, indicating that the course of disorder was associated with the occurrence of personally meaningful life events, but not for bipolars. Further research is recommended to examine whether the effect is equally robust for both subtypes of unipolars, whether longer study duration may be required for bipolars, and whether a cognitive self-schema mechanism may account for the specific vulnerability to a subset of stressful events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General Behavior Inventory identification of unipolar and bipolar affective conditions in a nonclinical university population.

Validated the General Behavior Inventory (GBI), revised to identify unipolar as well as bipolar affective conditions, in a nonclinical sample (n?=?201) against naive, interview-derived diagnoses. For bipolar and unipolar conditions, respectively, the GBI had high positive (.94, .87) and negative (.99, .93) predictive power with the effect of prevalence considered, adequate sensitivity (.78, .76), high specificity (.99, .99), and adequate selection ratios for sampling of affective and nonaffective subjects from nonclinical populations for research purposes. The utility of the GBI in several different research contexts is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subsyndromal unipolar and bipolar disorders: Comparisons on positive and negative affect.

The authors examined the mood patterns of young adults with cyclothymia, intermittent depression, or no affective disorder in a nonclinical population. In a conceptual replication and extension of R. A. Depue et al. (see PA, Vol 67:1362, Study 5), participants completed a trait measure of mood and then completed daily mood ratings for 28 days. Individuals in the intermittent depression and cyclothymia groups were characterized by high levels of negative affect on trait and daily ratings. Both groups were also characterized by high variability of negative affect across days. Individuals with cyclothymia reported higher levels of trait and daily positive affect than individuals with intermittent depression and also exhibited high between-day variability on positive affect. Similarities and differences with R. A. Depue et al. are described and the results are discussed in terms of the common and differentiating features of the subsyndromal affective disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders.

Evaluated the efficacy of a preventive compliance intervention based on cognitive therapy principles with 11 male and 17 female 24–60 yr old newly admitted lithium outpatients. Half of the Ss received standard medication clinic care; the rest also received the compliance intervention. Global medical regimen adherence at postintervention and at 3- and 6-mo follow-up assessments was assessed by self- and informant reports, physicians' ratings, chart notations, and serum lithium blood levels. Results show that the intervention significantly enhanced compliance at both postintervention and 6-mo follow-up assessment. In addition, intervention Ss significantly less often terminated lithium against medical advice, were hospitalized during the course of the study, or had noncompliance-precipitated episodes. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial processes of remission in unipolar depression: Comparing depressed patients with matched community controls.

Investigated the posttreatment phase of unipolar depression by examining the personal and social-environmental characteristics of remitted, partially remitted, and nonremitted depressed patients. The sample was based on a 12-mo follow-up of 424 depressed persons who received psychiatric treatment and a comparable follow-up of demographically matched, nondepressed community controls. 98.8% of the Ss were located at 12-mo follow-up. Analyses were based on 380 Ss. At follow-up, the 138 Ss whose depressive symptoms remitted also reported improvement in other aspects of their adjustment as well as in personal resources such as self-esteem and coping responses to posttreatment stressors. In contrast, the 133 nonremitted Ss continued to report deficits in each of these domains. 124 Ss were categorized as partially remitted. Remitted Ss approached normal levels of life stressors and social resources, whereas nonremitted Ss continued to report heightened stressors and lower levels of support. Risk factors identified at treatment intake were predictive of these Ss' subsequent outcome at follow-up. These findings imply that many successfully treated depressed patients can resume near-normal patterns of functioning and that remission is linked to normalization of personal and social context factors. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal interactions in the families of schizophrenic and bipolar affective patients.

Do verbal interactions between psychiatric patients and family members covary with the diagnosis of the patient? This study compared relatives (usually parents) of schizophrenic (n?=?42) and bipolar (n?=?22) patients on affective style (AS) or emotional-verbal behavior toward patients in family interaction. Patients were compared on coping style or verbal interactional behavior toward relatives. Relatives of schizophrenic patients made more negative AS (particularly intrusive) statements to patients than relatives of bipolar patients. Schizophrenic patients made fewer supportive statements and more self-denigrating statements to relatives than bipolar patients. Among families of bipolar patients, negative AS in relatives was associated with oppositional, "refusing" styles in patients. Implications for psychosocial interventions with these disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tryptophan depletion in stable lithium-treated patients with bipolar disorder in remission

Cleft sternum is a rare malformation due to partial or total failure of sternal fusion at an early stage of embryonic development. Sternal clefts can be classified as superior, inferior, or complete. Here we report on a 2-year-old boy with inferior sternal cleft and complex cardiac malformation. We review a series of 9 children with sternal clefts, referred to us over a 10-year period. Hypothetical mechanisms for this developmental anomaly are discussed.     

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)     

Social desirability and bipolar affective disorder.

Investigated whether the conforming and conventional attitudes of 30 bipolar depressed inpatients were coping mechanisms for their depressions. These Ss were compared on several measures (including the MMPI D and Si scales) to 29 unipolar depressed inpatients. Results show that the 2 groups were significantly different on all 5 of the measures used. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The chronometry of affective startle modulation in unipolar depression.

Affective startle eyeblink modulation by unipolar depressed and nondepressed participants was assessed during the anticipation and viewing of emotional pictures. Anticipatory startle probes were presented at 2,000 ms and 750 ms before picture onset. Startle probes during picture viewing were presented at 300 ms and 3,500-4,500 ms after picture onset. Although nondepressed participants demonstrated the predicted quadratic and linear patterns of responding in the 2,000-ms anticipatory and 3,500-4,500-ms viewing conditions, respectively, depressed participants were not significantly responsive to differences among picture valence categories at these probe conditions. There were no between-groups differences in startle modulation at the other two probe intervals, in picture ratings, or in behavioral responses to pictures. There was also little evidence of hyperresponsivity to negatively valenced stimuli in the depressed group. These results indicate that depression-related affective hyporesponsivity extended to startle modulation but that the nature and magnitude of the differences between depressed and nondepressed individuals were conditional on the specific cognitive and motivational processes recruited at different points in time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical judgment and affective disorders.

Addresses 3 limitations of previous work on counselor clinical judgment by the 1st author et al (see record 1983-11141-001) and R. F. Haase et al (see record 1983-26503-001). Results of the study of 20 practicing counselors suggest that the judgment process used by experienced counselors to make diagnoses of affective disorders differs depending on the type of diagnostic judgment and that attributions may play a role in at least certain types of judgments. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Labial herpes in patients with affective disorders receiving long-term lithium carbonate

Lithium carbonate has been administered to 69 patients (45 women and 24 men) for 1-17 years as affective disorders prevention. Its effect on the recurrence and clinical course of labial herpes infection has been analysed both prior to and after the administration of lithium carbonate. Labial herpes has been diagnosed in 28 patients before lithium prophylaxis. The drug significantly decreased virus infection recurrence incidence in this group. No labial herpes recurrence has been noted in 13 patients after the treatment. Lithium efficiency has not been dependent on patients' age, duration of therapy, and lithium levels in both blood serum and erythrocytes. These results suggest, that lithium salts may be effective in certain herpes simplex infections at doses used for prevention affective disorders.     

Social adjustment and the course of affective illness: a one-year controlled longitudinal study involving bipolar and unipolar outpatients

The association between social adjustment and recurrent affective episodes was examined in 27 recovered bipolar patients and 24 recovered unipolar patients who had been receiving maintenance treatment for at least 1 year. Social adjustment variables and psychiatric status were assessed by bimonthly interviews over the 1-year period using the Social Adjustment Scale (SAS) and the Research Diagnostic Criteria (RDC). Variations in the social adjustment scores were analyzed in the 2 months preceding the onset of a recurrent affective episode. Furthermore, social adjustment variables at entry into the study were assessed to investigate whether there was any association between these and the potential timing of a recurrent episode. Results revealed no significant deterioration in social adjustment during the 2 months preceding a recurrent affective episode. However, it was demonstrated that there was a relationship between a patient's overall social adjustment score at entry into the study and the onset of recurrent affective episodes, independent of any residual depressive symptomatology. Specifically, impaired work adjustment in bipolar and unipolar patients was associated with recurrent episodes. Impaired social and leisure activities adjustment in bipolar patients was also associated with recurrent episodes, and impaired marital adjustment in unipolar patients was associated with recurrent episodes. These results suggest that social maladjustment could be a risk factor for both unipolar and bipolar recurrent affective episodes and that impairment in specific areas of social functioning could be used to predict outcome.     

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.     

Cyclothymia in the adolescent offspring of parents with bipolar affective disorder.

Explored the prevalence and types of psychopathology exhibited by the adolescent and young adult offspring (n?=?37, aged 15–21 yrs) of 24 patients (mean age 48.4 yrs) with bipolar affective disorder and by the age-matched offspring (n?=?22) of 14 patients (mean age 46.7 yrs) with nonaffective psychiatric disorders. It was hypothesized that the offspring of bipolar Ss would be characterized by an increased rate of cyclothymia. Offspring received structured diagnostic interviews conducted by interviewers unaware of parental diagnosis. Anonymous diagnoses were derived based on Research Diagnostic Criteria. It was found that the offspring of bipolar Ss exhibited significantly higher rates of affective disorder in general and cyclothymia in particular than the offspring of the nonaffective controls, a finding concordant with the proposed hypothesis. The offspring groups did not differ on rates of nonaffective disorders. Results support a continuum model of bipolar disorder in which cyclothymia is viewed as a mild form of full syndromal bipolar illness. (84 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abnormal behavioral responses to fenfluramine in patients with affective and personality disorders. Correlation with increased serotonergic responsivity

Serotonergic responsivity was assessed in 20 psychiatric patients by the prolactin response to a fenfluramine challenge test. During the fenfluramine challenge 6 of 20 patients (30%) spontaneously reported psychopathologic reactions that included: increased anxiety/agitation, psychotic symptoms, illusions, mood elevation, and anergia. The time of peak behavioral symptoms (2.5 +/- 0.8 hrs) corresponded closely to the time of peak increase in prolactin levels (3.0 +/- 1.1 hr). Abnormal behavioral responders had statistically significant greater increases in prolactin 1 to 4 hr after fenfluramine when compared to normal responders. Patients who developed an abnormal psychopathologic response to fenfluramine were characterized by higher levels of anxiety and agitation at the time of admission to the hospital but otherwise were not distinguishable on the basis of severity of other psychiatric symptoms. This study suggests that increased serotonergic transmission may trigger anxiety, psychosis, and mood elevation in specific vulnerable individuals, whereas other patients with similar psychiatric illnesses are not affected.     

PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders.

Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-, 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhanced calcium response to serotonin in platelets from patients with affective disorders

The additional use of the palmaris longus tendon is presented with the composite radial forearm-palmaris longus free flap, as useful for improving the final cosmetic appearance. This flap has the additional advantage of avoiding gravitational descent, which is a common problem encountered with many free flaps in head and reconstructions. A clinical case is also presented as an example of this approach.