Ecological momentary assessment of mood disorders and mood dysregulation.

In this review, we discuss ecological momentary assessment (EMA) studies on mood disorders and mood dysregulation, illustrating 6 major benefits of the EMA approach to clinical assessment: (a) Real-time assessments increase accuracy and minimize retrospective bias; (b) repeated assessments can reveal dynamic processes; (c) multimodal assessments can integrate psychological, physiological, and behavioral data; (d) setting- or context-specific relationships of symptoms or behaviors can be identified; (e) interactive feedback can be provided in real time; and (f) assessments in real-life situations enhance generalizability. In the context of mood disorders and mood dysregulation, we demonstrate that EMA can address specific research questions better than laboratory or questionnaire studies. However, before clinicians and researchers can fully realize these benefits, sets of standardized e-diary questionnaires and time sampling protocols must be developed that are reliable, valid, and sensitive to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile mood disorders and office psychopharmacology

Mood disorders afflict pediatric patients, cause significant impairment, and interfere with normal development. Increasingly, pediatricians are called on to assess and collaborate with mental health practitioners in medicating children and adolescents with mood disorders. Approaching the juvenile with a primary emphasis on clarifying the diagnoses, determining environmental antecedents and sequelae, and investigating suicide risk enables the pediatrician to institute appropriate treatment. Despite limited data from controlled studies, psychotherapy often is used for mild to moderate depression. Pharmacotherapy is indicated in cases unresponsive to psychotherapy and in severe or suicidal cases. First-line pharmacotherapy for depressed adolescents is usually an SRI followed by the atypical or TCA antidepressants. Bipolar disorder typically requires an aggressive medication regimen, including anticonvulsants, lithium, or a combination, as well as environmental modifications. With severe, difficult, or refractory cases, mental health consultation is recommended to clarify diagnoses and to provide psychotherapy and medication input.     

Assessing unipolar mood disorders in women

OBJECTIVES: Iso-osmotic bowel preparation (Klean Prep) improves the accuracy of iliac duplex examination and reduces the time of each examination. Full-dose Klean Prep entails 4 l of fluid. We studied the effect of 2 l of Klean Prep (half-dose) and Picolax on image quality. DESIGN: Prospective study comparing clarity of duplex examination after three different bowel preparation regimes with that after 12 h starvation. MATERIALS AND METHODS: Thirty patients underwent iliac duplex examination after 12 h starvation. Scans were scored subjectively for grey scale and colour image quality, and Doppler signal-to-noise ratio. Patients were allocated blindly to: (a) full-dose Klean Prep, (b) half-dose Klean Prep, or (c) Picolax. After out-patient preparation, the scan was repeated and scored by the same observer, blinded to the preparation. RESULTS: Both full- and half-dose Klean Prep produced significant improvements in image quality for all three modalities; Picolax produced minimal change. There was minimal advantage of full-dose over half-dose Klean Prep. Patients preferred half-dose Klean Prep to full-dose. CONCLUSION: Klean Prep significantly improves the image obtained by iliac duplex examination; Picolax does not. Half-dose Klean Prep is an acceptable preparation to patients.     

Postpartum mood disorders: clinical perspectives

Mood disorders are common in women. A prepregnancy personal history of mood disorder (bipolar or major depression), premenstrual syndrome, or (possibly) postpartum blues places a woman at high risk for a postpartum exacerbation of symptoms. Untreated or unrecognized postpartum mood disorders can lead to serious psychologic and social consequences, in some cases even leading to suicide or infanticide. Women at risk for postpartum mood disorders need to be referred for psychiatric consultation before pregnancy and parturition. Informed, professional collaboration offers the best opportunities for prevention, as well as the earliest recognition and treatment of emergent symptoms.     

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.     

Minor physical anomalies in schizophrenia and mood disorders

The purpose of the present study was to examine the effect of a two day and a five day administration of 22-oxa-calcitriol (OCT) on calcium metabolism in rats with advanced chronic renal failure and severe secondary hyperparathyroidism. A first series of 27 uremic rats received either placebo, OCT or calcitriol (0.3 microgram i.p./rat) 48 and 24 hours before sacrifice. A second series of 18 uremic rats received either placebo, OCT (0.3 microgram i.p./rat) or calcitriol (0.05 microgram i.p./rat) for five days. We found that after 48 hours (series 1) both calcitriol and OCT increased blood ionized calcium (Ca2+) as compared to vehicle (1.23 +/- 0.04 and 1.10 +/- 0.02 mM, P < 0.01 and P < 0.05, respectively vs. control, 1.02 +/- 0.03 mM). Duodenal Ca transport (S/M) using the everted gut sac technique was not stimulated by OCT, even though it increased from 2.8 +/- 0.4 to 7.0 +/- 0.6 (P < 0.01) with calcitriol. In contrast, duodenal calbindin-D9k mRNA expression and protein content increased to a similar extent with OCT and calcitriol. Calcitriol was more potent in reducing plasma iPTH1-34 levels than OCT: 344 +/- 75 pg/ml (calcitriol) versus 632 +/- 46 pg/ml (OCT) compared with 897 +/- 74 pg/ml (control), P < 0.01. In the second series of rats, the injection of OCT (0.3 microgram i.p./rat) over five days was less effective than the lower dose of calcitriol (0.05 microgram i.p./rat) in reducing circulating iPTH: 110 +/- 26 (calcitriol) and 281 +/- 64 (OCT) versus 624 +/- 135 pg/ml (control), P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alcohol cue reactivity and mood induction in male and female alcoholics

The purpose of this study was twofold: to investigate gender differences in alcohol cue reactivity, and to study the effect of individualized mood induction on cue reactivity. Male (n = 38) and female (n = 19) alcoholics were exposed to an alcoholic beverage before and after mood induction to assess their reactivity to the beverage cues. The mood induction was based on a situation the subject had identified as being high risk for relapse. Subjects showed urge and salivary reactivity in response to alcohol beverage cues prior to mood induction, and the induction of mood enhanced urge reactivity in both men and women. Analyses with alcohol urge reactors (subjects that demonstrate an increased urge to drink alcohol in response to an alcoholic beverage cue) suggested that women show more urge reactivity in response to negative moods than do men. No gender differences were seen in reactivity to beverage cues alone. These results identify an important gender difference in the effect of negative moods on cue reactivity and suggest that negative mood situations may place women at a higher risk for relapse than men.     

Analysis of depressive symptomatology in mood disorders

BACKGROUND: At this time little information is available about the relationship between glaucomatous visual field defects and impaired blood flow in the optic nerve head. The purpose of this study was to examine blood flow of the juxtapapillary retina and the rim area of the optic nerve head in primary open-angle glaucoma with a borderline visual defect. METHODS: Juxtapapillary retinal and neuroretinal rim area blood flow was measured by scanning laser Doppler flowmetry (SLDF). The visual field was evaluated by static perimetry (Octopus-G1). The optic nerve head was assessed on 15 degrees color stereo photographs. We examined 116 eyes of 91 patients with POAG with controlled IOP and 66 eyes of 44 healthy individuals. The POAG group was divided into eyes with a mean defect lower than 2 dB (POAG group I) and in eyes with a mean defect equal to or greater than 2 dB (POAG group II). The mean age of POAG group I and POAG group II was 55 +/- 11 years and 57 +/- 10 years, respectively. The mean age of the control group was 45 +/- 15 years. The eyes of POAG group I had an average C/D ratio of 0.71 +/- 0.18 with an average mean defect of the visual field of 0.97 +/- 0.68 dB; the eyes of POAG group II had an average C/D ratio of 0.80 +/- 0.17 with an average mean defect of the visual field of 8.2 +/- 6.0 dB. The intraocular pressure on the day of measurement in POAG group I was 18.2 +/- 3.7 mmHg, in POAG group II 17.6 +/- 4.0 mmHg, and in the control group 15.1 +/- 2.5 mmHg. For statistical analysis, age-matched groups of 32 normal eyes of 32 subjects (mean age 52 +/- 10 years) were compared to 18 glaucomatous eyes of 18 patients (POAG group I, mean age 55 +/- 11 years) and 59 glaucomatous eyes of 59 patients (POAG group II, mean age 55 +/- 10 years). RESULTS: In the eyes of POAG group I and POAG group II, both juxtapapillary retinal blood flow and neuroretinal rim area blood flow were significantly decreased compared to an age-matched control group: neuroretinal rim area "flow" POAG group I -65%, POAG group II -66%; juxtapapillary retina "flow" POAG group I -52%, POAG group II -44%. All eyes of the POAG group I (MD < 2 dB) and 56 of 61 eyes of the POAG group II (MD > = 2 dB) showed a retinal perfusion lower than the 90% percentile of normal blood flow. We found no correlation between reduction of juxtapapillary or papillary blood flow and mean defect in POAG eyes. CONCLUSION: Glaucomatous eyes with no defects or borderline visual field defects as well as glaucomatous eyes in an advanced disease stage show significantly decreased optic nerve head and juxtapapillary retinal capillary blood flow.     

Alcohol dependence syndrome: Measurement and validation.

Developed a 29-item Alcohol Dependence Scale with substantial internal consistency reliability from the measurement and validation of the alcohol dependence syndrome in 225 volunteers with alcohol problems (15–66 yrs). Scale scores conformed closely to a normal distribution, which supports a quantitative interpretation of the syndrome. Higher levels of alcohol dependence were associated with social consequences from drinking as well as with greater quantities of alcohol consumed. As alcohol dependence increased, Ss were less likely to show up for their first treatment appointment. The degree of alcohol dependence was directly related to psychopathology (thinking disorder, hypochondriasis, persecutory ideas, anxiety, depression) and also to physical symptoms of the nervous, cardiovascular, and digestive systems. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

GABA and mood disorders: a brief review and hypothesis

Considerable evidence implicates the neurotransmitter gamma-aminobutyric acid (GABA) in the biochemical pathophysiology of mood disorders. Animal models of depression show regional brain GABA deficits and GABA agonists have antidepressant activity in these models. Somatic treatments for depression and mania upregulate the GABAB receptor, similar to the effect of GABA agonists. Clinical data indicate that decreased GABA function accompanies depressed or manic mood states. GABA agonists are effective antidepressant and antimanic agents. Low GABA levels are found in brain, cerebrospinal fluid and plasma of patients with depression and in plasma of patients with mania. Plasma GABA levels, which reflect brain GABA, are not normalized with treatment and clinical remission in depression, suggesting low GABA is not a marker for mood state. Some somatic treatments, including valproic acid and electroconvulsive shock, reduced plasma GABA and response to these correlates with higher levels of baseline plasma GABA. From these data, a GABA hypothesis for mood disorders is formulated. Low GABA function is proposed to be an inherited biological marker of vulnerability for development of mood disorders. Environmental factors, including stress and excessive alcohol use, may increase GABA, causing symptoms of depression or mania. Treatment, or the passage of time, then returns GABA to its presymptomatic baseline as the symptoms remit. This hypothesis, applicable to a subset of mood disordered persons, is testable.     

Recent developments in the pharmacotherapy of mood disorders

This article reviews recent developments in the pharmacotherapy of mood disorders. Pharmacotherapy is the best studied and most widely validated approach for acute phase treatment and prevention of relapse-recurrence for patients with major depression, dysthymia, and bipolar affective disorder. Antidepressants are also the mainstay of inpatient treatment and, when considered together with electroconvulsive therapy, represent the first line of treatment for the most severe and incapacitating forms of depression. Similarly, pharmacotherapy with mood stabilizers is the first line of treatment for bipolar depression and mania. Despite such efficacy, problems associated with pharmacotherapy include acceptability, tolerability, adherence, incomplete remission, and high rates of recurrence after drug discontinuation. Moreover, a small subset of patients do not respond to multiple medication trials.     

Comorbidity of opiate dependence and mental disorders

In a 5-year-follow-up study of 350 opiate addicts in contact with a drug help system in Hamburg, 272 clients (78%) were interviewed a second time after 1 year. The objective of the study was to examine the correlation between mental disorders and drug consumption and its relationship to clients' general life situation. In the majority of the opiate addicts, a pattern of polydrug consumption was observed, but the amount of drugs consumed was clearly lower after 1 year. In the initial survey, a mental disorder according to ICD-10 could be diagnosed for 55% of the sample. Among groups formed by the severity and course of mental disorders or their symptoms, a significant correlation was observed, particularly at the time of follow-up, between the extent of drug consumption and the course of the mental disorder. Other areas, like physical health or social problems/conflicts, were also related to comorbidity (i.e., heavy drug consumption and/or mental disorder). These interrelationships should be taken into account in treatment, care and guidance to increase the prospects for successful treatment.     

Temperament, personality, and the mood and anxiety disorders.

Reviews the literature on temperament, personality, and mood and anxiety disorders. The review is organized primarily around L. A. Clark and D. Watson's (1991) tripartite model for these disorders, but other influential approaches are also examined. Negative affectivity (or neuroticism) appears to be a vulnerability factor for the development of anxiety and depression, indicates poor prognosis, and is itself affected by the experience of disorder. Positive affectivity (or extraversion) is related more specifically to depression, may be a risk factor for its development, suggests poor prognosis, and also may be affected by the experience of disorder. Other personality dimensions (e.g., anxiety sensitivity, attributional style, sociotropy or dependency, autonomy or self-criticism, and constraint) may constitute specific vulnerability factors for particular disorders. It is suggested that more longitudinal and measurement-based research that jointly examines anxiety and depression is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gabapentin treatment of mood disorders: a preliminary study

OBJECTIVE: To determine if gabapentin is effective either as adjunctive treatment or as monotherapy for major affective disorders in a naturalistic setting. METHOD: All charts of patients meeting DSM-IV criteria for bipolar disorder or unipolar major depressive disorder treated with gabapentin in a private psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impressions scale for Improvement (CGI-I). RESULTS: Gabapentin was moderately to markedly effective in 30% (15/50) of patients, with statistically nonsignificant differences between patients with bipolar disorder type I, bipolar disorder type II and NOS, and unipolar major depressive disorder. 70% reported side effects, mainly sedation, with 16% of the total sample discontinuing treatment due to adverse events. CONCLUSION: Gabapentin appears to be somewhat effective as add-on treatment in a subgroup of patients with mood disorders in a naturalistic setting. Prospective, controlled studies are required to clarify these pilot data.     

GABA function in mood disorders: an update and critical review

Over the past twenty years, several lines of evidence from preclinical and clinical studies has accumulated suggesting that a GABA deficit may be involved in mood disorders, particularly in depression, and that increasing GABAergic neurotransmission may exert an antidepressant effect and perhaps a mood stabilizing effect. Given that GABA has an inhibitory effect on biogenic amine neurotransmitters such as norepinephrine and serotonin and this inhibition may be involved in local circuits and interneurons, it has been suggested that the hypothesis of a GABA deficit in mood disorders does not compete with but complements the well-established hypotheses of alterations in noradrenergic and serotonergic function in mood disorders. In this paper, we systematically reviewed the results from preclinical and clinical studies of GABA function in the pathophysiology of mood disorders and in the mechanism of action of mood stabilizers, antidepressants and electroconvulsive therapy. We also discussed the unifying theory of the neurochemistry of mood disorders, which integrates the GABA hypothesis into the biogenic amine hypotheses, and indicated future directions for research.