Showing papers in "Acta Psychiatrica Scandinavica in 2000"

Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning.

Abstract: Morosini P-L, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social funtioning. Acta Psychiatr Scand 2000: 101:323–329. © Munksgaard 2000. Objective: Development of a scale to assess patients' social functioning, the Personal and Social Performance scale (PSP). Method: PSP has been developed through focus groups and reliability studies on the basis of the social functioning component of the DSM-TV Social and Occupational Functioning Assessment Scale (SOFAS). The last reliability study was carried out by 39 workers with different professional roles on a sample of 61 psychiatric patients admitted to the rehabilitation unit. Each patient was rated independently on the scale by the two workers who knew them best. Results: The PSP is a 100–point single-item rating scale, subdivided into 10 equal intervals. The ratings are based mainly on the assessment of patient's functioning in four main areas: 1) socially useful activities; 2) personal and social relationships; 3) self-care; and 4) disturbing and aggressive behaviours. Operational criteria to rate the levels of disabilities have been defined for the above-mentioned areas. Excellent inter-rater reliability was also obtained in less educated workers. Conclusion: Compared to SOFAS, PSP has better face validity and psychometric properties. It was found to be an acceptable, quick and valid measure of patients' personal and social functioning.

Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity.

Abstract: Objective: Lifetime and 12-month prevalence of traumatic events and DSM-IV post-traumatic stress disorder as well as risk factors and comorbidity patterns were investigated in a representative community sample (n=3021, aged 14–24 years). Method: Traumatic events and PTSD were assessed with the Munich Composite International Diagnostic Interview (CIDI). Results: Although 26% of male subjects and 17.7% of female subjects reported at least one traumatic event, only a few qualified for a full PTSD diagnosis (1% of males and 2.2% of females). Traumatic events and PTSD were strongly associated with all other mental disorders examined. PTSD occurred as both a primary and a secondary disorder. Conclusion: The prevalence of PTSD in this young German sample is considerably lower than reported in previous studies. However, the conditional probability for PTSD after experiencing traumas, risk factors and comorbidity patterns are quite similar. Traumatic events and full PTSD may increase the risk for other disorders, and vice versa.

Sex differences in schizophrenia, a review of the literature

Abstract: Objective: To comprehensively and critically review the literature on gender differences in schizophrenia. Method: An initial search of MEDLINE abstracts (1966–1999) was conducted using the terms sex or gender and schizophrenia, followed by systematic search of all relevant articles. Results: Males have consistently an earlier onset, poorer premorbid functioning and different premorbid behavioral predictors. Males show more negative symptoms and cognitive deficits, with greater structural brain and neurophysiological abnormalities. Females display more affective symptoms, auditory hallucinations and persecutory delusions with more rapid and greater responsivity to antipsychotics in the pre-menopausal period but increased side effects. Course of illness is more favorable in females in the short- and middle-term, with less smoking and substance abuse. Families of males are more critical, and expressed emotion has a greater negative impact on males. There are no clear sex differences in family history, obstetric complications, minor physical anomalies and neurological soft signs. Conclusion: This review supports the presence of significant differences between schizophrenic males and females arising from the interplay of sex hormones, neurodevelopmental and psychosocial sex differences.

Autism and Asperger syndrome: coexistence with other clinical disorders

Abstract: Objective: To provide a clinically useful analysis of the extent to which autism and Asperger syndrome coexist with other disorders. Method: Selective review of the literature detailing data pertaining to symptoms and disorders sometimes encountered in connection with autism or Asperger syndrome. Results: A large number of medical conditions, psychiatric disorders and behavioural and motor dyscontrol symptoms are associated with autism and Asperger syndrome. Conclusion: Comorbidity is to be expected in autism spectrum disorders — directly or indirectly. Comorbid conditions may be markers for underlying pathophysiology and suggest a more varied treatment approach. There is a great need for in-depth research into this area, meaning that the exclusion criteria of current diagnostic manuals, i.e. those that rule out a diagnosis of autism in some disorders, and a diagnosis of certain other disorders in autism may have to be revised.

The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.

Abstract: Objective: To describe baseline diagnostic co-occurrence in the Collaborative Longitudinal Personality Disorders Study. Method: Six hundred and sixty-eight patients were reliably assessed with diagnostic interviews for DSM-IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive-Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD). Results: Mean number of Axis I lifetime diagnoses was 3.4; STPD and BPD groups had more diagnoses than AVPD, OCPD, and MDD groups. Significant Axis I co-occurrences emerged for Social Phobia/AVPD, PTSD/BPD and Substance Use/BPD. Mean number of co-occurring PDs was 1.4; STPD had more than BPD group which had more than AVPD and OCPD groups. Significant PD co-occurrence emerged for: STPD/ Paranoid and Schizoid PDs, BPD with Antisocial and Dependent PDs, and lower frequency for OCPD/Antisocial PD. Conclusion: Diagnostic co-occurrences generally followed base rates, while significant departures resemble those of controlled literature.

Why do people with anxiety disorders become depressed? A prospective‐longitudinal community study

Abstract: Objective: To examine the temporal relationships of anxiety and depressive disorders, their risk factors and to explore why people with anxiety develop depression. Method: Data from an original 4-5-year prospective-longitudinal community study (N = 3021) of adolescents and young adults with DSM-IV anxiety and depressive disorders identified with the Composite International Diagnostic Interview are used to examine risk factors, as well as course and outcome. Results: (i) Anxiety disorders, except for panic disorder, are almost always primary conditions. (ii) Over the follow-up period, rates of comorbid anxiety-depression increased substantially and resulted in increased impairment and disabilities. (iii) Predictors for first onset of 'pure' depressive and 'pure' anxiety disorders revealed recognizable differences. (iv) Baseline clinical characteristics of anxiety disorders were significantly associated with an increased risk to develop major depression over the follow-up period. Conclusion: Findings suggest that most anxiety disorders are primary disorders that substantially increase the risk for secondary depression.

PET measurements of brain glucose metabolism and blood flow in major depressive disorder: a critical review.

Abstract: Objective: To show that PET investigations of brain function in patients with major depression can contribute with valuable pathophysiological knowledge about brain function of these states. Methods: PET studies of cerebral blood flow or glucose metabolism in patients with unipolar or bipolar depression were reviewed. Results: The studies have great discrepancies related to sample size, subject selection, imaging protocol and image analysis. In spite of this shortcoming, there is evidence that patients with major depression have reduced blood flow and metabolism in the prefrontal cortex, particularly when they exhibit psychomotor retardation. Abnormalities are also found in the anterior cingulate gyrus and the basal ganglia. A few studies point to the possibility that response to antidepressant treatment can be predicted from PET scans. Conclusion: This evidence is consistent with the hypothesis that depressive symptoms are caused by dysfunction of regions of the limbic system and the frontal lobes in close connection with the basal ganglia.

Atypical antipsychotics and weight gain--a systematic review.

Abstract: Objective: To review systematically data relating to weight changes with atypical antipsychotics. Method: We conducted a Medline search on October 29 1999 and covered the period 1980–99. All recovered papers were examined for further relevant reports. In addition, we wrote to pharmaceutical manufacturers and 10 practising clinicians to ask them to provide other relevant reports known to them. Results: Eighty reports mentioning change in body weight were retrieved. Data relating to weight changes were of variable quality. Weight changes were indicated by a variety of measures. The majority of reports related to short-term changes. Conclusion: All atypical drugs, with the exception of ziprasidone, have been associated with weight increases. Clozapine seems to have the highest risk of weight gain, followed by olanzapine and quetiapine. There is probably a lower risk with risperidone, sertindole and zotepine and a still lower risk with amisulpride. Ziprasidone appears not to be associated with weight gain. In the absence of more compelling data, these rankings must be considered approximate and preliminary. Longer, more robust trials are needed.

Suicide prevention — a medical breakthrough?

Abstract: OBJECTIVE: The author hypothesized, based on research until 1991, that a five-fold increase in the use of antidepressants might reduce Swedish suicide rates by 25%. A subsequent 3.5-fold increase in the use of antidepressants provided a 'natural experimental situation' for prospectively testing this hypothesis. METHOD: Swedish statistics on suicide, use of antidepressants, unemployment and alcohol consumption were obtained for 1978-96. Time-series of the latter variables were compared with suicide rates. Demographic subgroups regarding age, gender and county were analysed. Suicide rates were also compared with the use of antidepressants in Denmark, Norway and Finland. RESULTS: Suicide rates decreased in accordance with the a priori hypothesis. Alcohol consumption and unemployment rates did not correlate well with suicide rates. CONCLUSION: This naturalistic study is not conclusive. The increased use of antidepressants appears, however, to be one of the contributing factors to the decrease in the suicide rate. It is of great scientific and clinical importance that this be evaluated by further studies. Language: en

An overview of epidemiological studies on seasonal affective disorder.

Abstract: Objective: To review and systematize all epidemiological studies of seasonal affective disorder (SAD). Method: The relevant papers were identified by searches in Medline, Excerpta Medica, PsychLIT and other databases. The primary reports were reviewed for additional citations. The studies were classified into retrospective and prospective population surveys, surveys of patient populations and studies of seasonal variations in psychiatric illnesses other than mood disorders. Results: The prevalence estimates of SAD across 20 retrospective studies varied from 0% to 9.7%. All prospective population studies, except one, find seasonal variations in mood, depressive symptoms usually peaking in winter. SAD was more prevalent at higher northern latitudes, but the prevalence varied across ethnic groups. SAD has also been identified in children and adolescents. Seasonal exacerbations and remissions are not limited to mood disorders, it has also been found in bulimia nervosa, anxiety disorders and other psychiatric illnesses. Conclusions: The actuality of seasonal variation in mood has been documented thoroughly by both retrospective and prospective studies. In the general population, depressive symptoms peak in winter, and the most extreme form of this disposition, SAD, appears to be a relatively common disorder.

Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation.

Abstract: Objective: To investigate change in personality disorder (PD) traits between early adolescence and early adulthood among individuals in the community. Method: PD traits were assessed in 1983 (mean age=14), 1985–86 (mean age=16) and 1992 (mean age=22) in a representative community sample of 816 youths. Results: Overall, PD traits declined 28% during both adolescence and early adulthood. PD traits were moderately stable during the first 2-year interval, and were as stable as they have been reported to be among adults over similar intervals. PD trait stability declined slightly as the inter-assessment interval increased. Adolescents with PDs tended to have elevated PD traits during early adulthood. Conclusion: PD traits tend to decline steadily in prevalence during adolescence and early adulthood. However, adolescents with PDs often have elevated PD traits as young adults, and the stability of PD traits appears to be similar during adolescence and early adulthood.

Swedish universities Scales of Personality (SSP) : construction, internal consistency and normative data

Abstract: Swedish universities Scles of personality (SSP): construction, internal consistency and normative data

The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale.

Abstract: Objective: Reports suggesting that quality of life in schizophrenia is more highly related to negative rather than positive symptoms are largely based on use of the Quality of Life Scale which was devised to assess deficit symptoms and does not include an assessment of subjective general wellbeing In the current paper we examined symptoms, level of community functioning as well as living circumstances as correlates of Quality of Life Scale scores and scores on the General Well-Being Scale Method: One hundred and twenty-eight patients completed the General Well-Being Scale and were rated on the Quality of Life Scale as well as scales assessing positive and negative symptoms Results: While negative symptoms, level of functioning and positive symptoms all were related to the scores on the Quality of Life Scale, General Well-Being Scale scores were primarily related to positive symptoms, particularly reality distortion Conclusion: The results highlight the importance of recognizing the complex nature of the concept of quality of life They demonstrate that varying indices of quality of life are likely to have different predictors

Predicting medication adherence in severe mental disorders.

Abstract: Objective: This study explored the utility of the health belief model (HBM) in explaining medication adherence in subjects with severe and disabling mental disorders. Method: Six well-established measuring instruments, with confirmed reliability and validity, were used to assess each component of the HBM and medication adherence in 39 hospital-treated subjects with affective disorders (n=27) or schizophrenia (n=12). Results: Highly adherent and partially adherent subjects differed significantly in their perception of illness severity, their beliefs about themselves and their control over the disorder, and their concerns about further hospitalization. Two components of the HBM (perceived severity of illness and perceived benefits of treatment) explained 43% of the variance in adherence behaviour. Conclusion: Although the study has a number of methodological limitations, the results suggest that clinical assessment of components of the HBM may improve the detection of patients at risk of medication non-adherence.

Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors

Abstract: Peretti S, Judge R, Hindmarch I. Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors. Acta Psychiatr Scand 2000: 101: 17–25. © Munksgaard 2000. Objective: An important consideration in the choice of an antidepressant is its safety and tolerability. Method: We present a review of literature, clinical trials and meta-analyses regarding the safety and tolerability of the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs) in depressed patients. Results: The SSRIs have a very favourable side-effect profile compared to the TCAs and are associated with fewer treatment discontinuations. Unlike the TCAs, they do not cause anticholinergic, hypotensive or sedating reactions, and are not associated with impaired cognitive function. Their most common side-effects (nausea, vomiting, nervousness, insomnia, headache and sexual dysfunction) are usually mild and typically disappear as treatment continues. The SSRTs also exhibit lower toxicity and lower lethality when taken in an overdose situation. Although the safety profiles of the principal SSRTs appear to be comparable, there is some data showing important differences in the severity and frequency of specific adverse events. Conclusion: The SSRTs have a more favourable safety profile than the TCAs in both acute and long-term treatment of major depression.

Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors.

Abstract: Zohar J, Westenberg HGM. Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand 2000: 101: 39–49. © Munksgaard 2000. Objective: Anxiety disorders are the most common mental health disorders. While the older tricylic antidepressants (TCAs) are efficacious in the treatment of many anxiety disorders, recent studies with fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have emphasized the role of serotonin in the aetiology of these conditions. Method: We reviewed the efficacy, safety and tolerability of TCAs and SSRIs in the treatment of the most common anxiety disorders, specifically, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder. Results: Both the TCA and SSRI antidepressants are effective in treating a wide variety of anxiety disorders. SSRIs, due to their greater safety and tolerability, should be the preferred choices in treating anxiety disorders in those instances where TCAs and SSRIs are considered equally effective. In the cases of OCD and social phobia, SSRIs are almost always preferable given that the TCAs do not appear effective in these disorders. Conclusion: Further research is needed on the naturalistic long-term use of the TCAs and SSRIs in the treatment of anxiety disorders.

Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy.

Abstract: Objective: To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience. Method: A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest. Results: PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4–0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4–0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5–0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3–7.5]). Conclusion: Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.

Gender aspects in schizophrenia: bridging the border between social and biological psychiatry.

Abstract: Objective: This paper tries to show that gender differences in mental diseases are a valuable paradigm for research into the interplay between biological and psychosocial factors — not only regarding pathogenetic mechanisms, but also concerning therapeutic approaches. Method: Based on relevant literature, this topic is highlighted using schizophrenia as an example. Results: Schizophrenic disorders show a later age of onset in women and a slightly better course, especially in young women. As to pathogenesis, there is some evidence that the age difference might be due at least partly to the female sex hormone oestradiol being a protective factor. Differences in course might also have to do with this biological factor, but at the same time with the psychosocial advantages of a higher age of onset and other psychosocial factors. Concerning therapy, these gender differences have important implications for pharmacotherapy, but also psychotherapy and social measures. Conclusion: A gender-sensitive approach in psychiatry improves our understanding of mental illness and our therapeutic strategies and at the same time illustrates that comprehensive psychiatry cannot be practised in artificially separated ‘drawers’ called ‘biological psychiatry’, on one hand, and ‘social psychiatry’ on the other.

Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects.

Abstract: Objective: To assess the baseline characteristics predicting poor medication adherence following a first admission for psychosis, and the impact of poor medication adherence on outcome. Method: First-admitted subjects with psychosis (n=65) were assessed at 6-month intervals over a 2-year follow-up. Medication adherence was assessed using multiple sources of information. Results: Baseline lower occupational status, alcohol misuse and the intensity of delusional symptoms and suspiciousness predicted poor medication adherence during the 2-year follow-up. Over this period, subjects with poor medication adherence presented more frequently with an episodic course of illness and were more frequently readmitted, especially with regard to involuntary readmission. Conclusion: In naturalistic conditions one out of two subjects with psychosis interrupts his/her treatment in the months following his/her first discharge from hospital. Therapeutic programmes aimed at improving medication adherence should be implemented early in the course of psychosis to reduce the deleterious consequences of poor medication adherence on clinical outcome.

The 12‐month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

Abstract: Objective: This study reports the 12-month prevalence of major depressive episode and its risk factors in a representative nationwide sample. Method: A random sample of non-institutionalized Finnish individuals aged 15–75 years (N=5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Results: The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age-adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males. Conclusion: The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex-specific risk factor associations warrant further investigation into sex differences in depression.

Schizophrenia and violence.

Abstract: OBJECTIVE: The relationship between schizophrenia and violence is studied from a psychiatric and a public health perspective. METHOD: All epidemiological studies which have been published since 1990 are reviewed. RESULTS: Despite differences in the methodological approaches chosen the studies reviewed concur in supporting the assumption that there is a moderate but significant association between schizophrenia (or more generally psychotic disorders) and violence. However, compared with the magnitude of risk associated with substance abuse and personality disorders, that associated with schizophrenia or other major mental disorders is small. In addition, the elevated risk to behave violently appears to be limited to particular symptom constellations. The evidence available so far suggests that the proportion of violent crimes committed by people suffering from a severe mental disorder is small. There is no unambiguous evidence of an increase of violent acts committed by severely mentally ill people in general and people suffering from schizophrenia in particular during recent years. Strangers appear to be at an even lower risk of being violently attacked by someone suffering from severe mental disorder than by someone who is mentally healthy. CONCLUSION: While the assessment of relative risk is of great interest for psychiatric researchers who are trying to identify factors which may increase or decrease the risk of violent behaviour among the mentally ill, which in turn may provide some clues as to how to intervene best in order to reduce the risk, the attributable risk is of special interest for the public since it informs about the risk of becoming victim of a violent act committed by someone who is suffering from a mental disorder. Language: en

Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates

Abstract: Objective: To investigate the association between mental illness and cancer incidence, mortality and case fatality. Method: A population-based record linkage study was undertaken based on 172 932 patients of mental health services in Western Australia. Records of mental health service contacts were linked with cancer registrations and death records. Results: While there was little difference in overall cancer incidence rates between psychiatric patients and the general community (RR in males 1.05, 95% CI 1.02–1.09, RR in females 1.02, 0.98–1.05), cancer mortality was 39% higher in males (95% CI: 32–46%) and 24% higher in females (17–32%). Conclusion: People with mental illness in Western Australia do not show an increased incidence rate of cancer, but do have higher cancer mortality. This was attributed to a higher cancer case fatality rate among people with mental illness.

The prevalence of personality disorder among UK primary care attenders

Abstract: Objective: To determine the prevalence rate of personality disorder among a consecutive sample of UK primary care attenders. Associations between a diagnosis of personality disorder, sociodemographic background and common mental disorder were examined. Method: Three hundred and three consecutive primary care attenders were examined for the presence of ICD-10 and DSM-4 personality disorders using an informant-based interview. Results: Personality disorder was diagnosed in 24% (95% CI: 19–29) of the sample. Personality-disordered subjects were more likely to have psychiatric morbidity as indicated by GHQ-12, to report previous psychological morbidity, to be single and to attend the surgery on an emergency basis. ‘Cluster B’ personality disorders were particularly associated with psychiatric morbidity. Conclusion: There is a high prevalence rate of personality disorders among primary care attenders. These disorders are associated with the presence of common mental disorder and unplanned surgery attendance. Personality disorders may represent a significant source of burden in primary care.

Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments.

Abstract: Objective: To present prevalence findings of DSM-IV somatoform symptoms, syndromes and disorders in a representative sample of adolescents and young adults. Method: Data come from the Early Developmental Stages of Psychopathology (EDSP) study, in which a total of 3021 respondents aged 14-24 years were assessed by the Munich-Composite International Diagnostic Interview. Results: Although specific DSM-TV somatoform disorders were relatively rare with a lifetime rate of 2.7%, a considerably higher proportion of respondents met criteria for clinically significant somatoform syndromes as defined by the Somatic Symptom Index SSI4, 6 (lifetime: 1.7%), as well as the undifferentiated somatoform/dissociative syndrome USDS (lifetime: 9.1%), resulting in an overall prevalence rate of 12.6%. Somatoform conditions are often comorbid with other mental disorders and were found to be associated with remarkable impairments and disabilities. Conclusion: Somatoform disorders and syndromes in young adults are frequent, impairing and often associated with the development of other mental disorders.

Schizophrenia and quality of life

Abstract: Objective: The purpose of this paper is to examine critically results of quality-of-life research in schizophrenic patients living in the community Method: Based on the relevant literature results of specific studies are discussed in the light of the methodological problems of assessing quality of life in these people Results: Subjectively assessed quality of life was found to be higher in the less educated and in female patients, and when a sense of control is experienced If negative or extrapyramidal symptoms are experienced and stigmatization is perceived, subjective quality of life is reported as being poorer These results are discussed in view of the additional needs and fewer resources of this population, their stigma-dilemma and their occasional difficulties in adequately assessing quality of life Conclusion: It is argued that subjective and quantitative measures of quality of life in schizophrenic patients should be supplemented by external assessment and qualitative methods

Sex differences in late‐life depression

Abstract: Sonnenberg CM, Beekman ATF, Deeg DJH, van Tilburg W. Sex differences in late-life depression. Acta Psychiatr Scand 2000: 101: 286–292. © Munksgaard 2000. Objective: The primary aim of this study was to assess sex differences in depression in later life. Method: In a random, age and sex-stratified community sample of 3056 older Dutch people (55–85 years) the prevalence, symptom-reporting and risk factors associated with depression in later life were studied. Depression was measured with the Center for Epidemiologic Studies Depression scale (CES-D). Bivariate, multivariate and factor analyses were used. Results: Prevalence of depression in women was almost twice as high as in men. Controlling for age and competing risk factors reduced the relative risk for females with more than half. Symptom-patterns in men and women were very much alike. Sex differences in associations with risk factors were small, but exposure to these risk factors was considerably higher in females. Conclusion: Very little evidence for a typical ‘female depression’ was found. Female preponderance in depression was related to a greater exposure to risk factors.

Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission.

Abstract: Krabbendam L, Honig A, Wiersma J, Vuurman EFPM, Hofman PAM, Derix MMA, Nolen WA, Jolles J. Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission. Acta Psychiatr Scand 2000: 101: 274–280. © Munksgaard 2000. Objective: To compare cognitive functioning in relation to white matter lesions in bipolar disorder in remission and schizophrenia. Method: Cognitive performance and the occurrence of white matter lesions on MRI images of the brain were assessed in 22 patients with bipolar disorder in remission, 22 patients with schizophrenia and 22 healthy volunteers. Results: Performance of tests of memory, speed and cognitive flexibility was significantly impaired in both patient groups. The frequency of white matter lesions did not differ significantly between the three groups. No differences in cognitive performance were found between patients with white matter lesions and patients without such lesions. Conclusion: White matter lesions apparently do not underlie cognitive deficits that are found in patients with bipolar disorder in remission and in patients with schizophrenia.

Do anxiety and depression have a common pathophysiological mechanism

Abstract: Objective: To review, examine and propose a common mechanism for anxiety and depression based on modifications observed in neurotransmitter systems (mainly noradrenergic and serotonergic) and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. Method: The relevant papers were identified by searches in Medline, Excerpta Medica, PsychLIT and other databases. The primary reports were reviewed and classified into animal and human data concerning: modifications of the monoamine receptors in anxiety and depression, pathophysiology of endocrine factors in anxiety and depression, patho-physiology of the hypothalamic–pituitary–adrenal (HPA) axis and the pathophysiology of the HPA dysregulation in anxiety and in depression. In addition, a proposed model of a neuroendocrine continuum for anxiety and depression, in which anxiety occurs first during the life course and major depressive episodes occur later, was examined. Results: Based on the available literature, increased concentrations of corticotropin-releasing factor (CRF) in the cerebrospinal fluid has been reported in both anxiety and depression. However, release of other peptides or hormones of the HPA axis is regulated differently in the two disorders. Anxiety is characterized by hypocortisolemia, supersuppression after dexamethasone and increased numbers of glucocorticoid receptors, whereas depression is characterized by hypercortisolemia, non-suppression after dexamethasone and decreased numbers of gluco-corticoid receptors. A ‘neuroendocrine continuum’ model is proposed to explain these differences. A general desensitization of CRF receptors at pituitary, limbic (amygdala) and cortical as well as hippocampal levels could be secondary to the loss of hippocampal inhibition resulting from hippocampal damage linked to repeated stressing events. Conclusion: The proposed hypothesis remains to be tested by examination of either the changes in receptors and neurotransmission or the mech-anisms underlying the dysregulation of endocrine factors.

Effect of number of episodes on wellbeing and functioning of patients with bipolar disorder

Abstract: Objective: To examine the relationship between number of episodes and inter-episode functioning in bipolar disorder. Method: Sixty-four euthymic subjects with bipolar affective disorder completed the Medical Outcomes Questionnaire Short Form and the Global Assessment of Functioning Scale. Goodness-of-fit models were used to define the relation between episode number and level of function. Results: Non-linear logarithmic and power relations best described the association between number of episodes and outcome. Number of past depressions was a stronger determinant of outcome than past manias. Conclusion: Strategies to minimize the number of episodes experienced by patients with bipolar illness must be pursued aggressively if function is to be maintained, with particular attention given to minimizing episodes of depression.

Compliance with antipsychotic treatment.

Abstract: Objective: Despite the demonstrated efficacy of antipsychotics the relapse rate among patients with schizophrenia remains high. One major reason for this is non-compliance. In this article we review different factors influencing compliance and discuss possibilities to enhance compliance among schizophrenic patients. Method: This review is based on a systematic literature search in Medline. Results: We summarize the four main factors (patient-, environment-, physician- and treatment-related) that influence compliance and discuss possible measures to enhance compliance. Next to many other variables discussed in more detail, it is crucial to ensure a positive doctor–patient relationship and to provide sufficient information about the benefit/risk ratio of the medication as well as about the illness itself to build up and sustain compliance. Significant others should be included into the therapeutic alliance whenever possible. Conclusion: Despite many published reports on compliance, it remains to be a problem of eminent clinical relevance. Clinicians must not underestimate it in order to optimize the treatment of patients with schizophrenia.