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Treatment of bipolar depression: an update.

J Affect Disord. 2008 Jul;109(1-2):21-34

Authors: Fountoulakis KN, Grunze H, Panagiotidis P, Kaprinis G

This article attempts to summarize the current status of our knowledge and practice in the acute treatment and prophylaxis of bipolar depression. For prophylactic treatment, our knowledge about lithium firmly supports its usefulness against bipolar depression and its specific effectiveness for suicidal prevention. Valproic acid and carbamazepine could be effective, too, while lamotrigine which seems to be preferably effective against depression but not mania. The FDA has approved the olanzapine-fluoxetine combination and quetiapine monotherapy for the treatment of acute bipolar depression. The usefulness of antidepressants in bipolar depression is controversial both for acute and prophylactic treatment; guidelines suggest their cautious use and always in combination with an antimanic and mood stabilizer agent, because in some patients they may induce switching to mania or hypomania, mixed episodes and rapid cycling. Data on psychosocial intervention are restricted to the maintenance phase. Electroconvulsive therapy and transcranial magnetic stimulation are additional options for refractory patients. Bipolar depression seems to be a more difficult condition to treat than mania. Most patients need complex combination treatment although the published evidence on this type of treatment is limited.

PMID: 18037498 [PubMed - indexed for MEDLINE]

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A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment.

J Psychiatr Res. 2008 Jul;42(9):717-26

Authors: Bornovalova MA, Gratz KL, Daughters SB, Nick B, Delany-Brumsey A, Lynch TR, Kosson D, Lejuez CW

The concept of emotion dysregulation has been integrated into theory and treatment for borderline personality disorder (BPD), despite limited empirical support. Expanding upon existing research on the relationship between emotion dysregulation and BPD, the present study utilized a multimodal approach to the assessment of emotion dysregulation (including two behavioral measures of the willingness to tolerate emotional distress, and a self-report measure of emotion dysregulation broadly defined) to examine the relationship between emotion dysregulation and BPD among inner-city substance users in residential treatment (n=76, with 25 meeting criteria for BPD). Results provide laboratory-based evidence for heightened emotion dysregulation in BPD, extending extant research on BPD to underserved clinical populations. Specifically, the presence of a BPD diagnosis among a sample of inner-city inpatient substance users was associated with both higher scores on the self-report measure of emotion dysregulation and less willingness to tolerate emotional distress on the behavioral measures of emotion dysregulation. Moreover, both self-report and behavioral measures of emotion dysregulation accounted for unique variance in BPD status, suggesting the importance of utilizing comprehensive assessments of emotion dysregulation within studies of BPD. Findings suggest the need to further explore the role of emotion dysregulation in the development and maintenance of BPD among inner-city substance users in residential treatment.

PMID: 17868698 [PubMed - indexed for MEDLINE]

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Association of platelet-derived soluble glycoprotein VI in plasma with Alzheimer’s disease.

J Psychiatr Res. 2008 Jul;42(9):746-51

Authors: Laske C, Leyhe T, Stransky E, Eschweiler GW, Bueltmann A, Langer H, Stellos K, Gawaz M

Accumulating evidence from epidemiological, clinical and experimental studies suggests that vascular risk factors and angiopathic mechanisms are involved in the pathogenesis of Alzheimer’s disease (AD). Platelets could be the missing link between AD and the vasculature. Soluble glycoprotein VI (sGPVI) and beta-thromboglobulin (beta-TG) plasma and cerebrospinal fluid (CSF) levels as markers of platelet activity were measured in 30 AD patients and 20 age-matched healthy elderly controls by ELISA. The severity of dementia was assessed by mini-mental state examination (MMSE). We found in AD patients significantly decreased sGPVI plasma levels (0.55+/-0.18ng/ml) as compared to healthy controls (0.75+/-0.43ng/ml; p=0.033). In AD patients, sGPVI levels were positively correlated with beta-TG plasma levels (r=0.244, p=0.05) and with cognitive status as measured by MMSE score (r=0.271; p=0.048). In unconcentrated CSF samples, levels of beta-TG and sGPVI were below the detection limit of the assays in AD patients and healthy controls. Our results suggest an association of sGPVI with the pathogenesis of AD. These findings encourage future research into whether sGPVI plasma levels may reflect or even mediate neuroprotective mechanisms in AD.

PMID: 17854831 [PubMed - indexed for MEDLINE]

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Brugada syndrome as a potential cardiac risk factor during electroconvulsive therapy (ECT).

World J Biol Psychiatry. 2008;9(2):150-3

Authors: Luckhaus C, Hennersdorf M, Bell M, Agelink MW, Zielasek J, Cordes J

A case of asystole (> 5 s) during electroconvulsive therapy (ECT) is reported in a patient who was subsequently diagnosed to have Brugada syndrome (BS). This hereditary sodium-channelopathy is characterized by typical, though intermittent, ECG abnormalities and carries a high risk of ventricular arrythmia and sudden cardiac death. The general occurence of BS is rare; however, it is more prevalent in men and in southeast Asian populations. As in the reported case, BS carriers may lack a telltale medical history and can present with normal ECG recordings. In these cases, BS can only be unmasked by repeated ECG recordings over time or by specialist cardiological examinations. To our knowledge, BS, which was first characterized in 1992, has not yet been in the focus of cardiac complications during ECT. However, as the presented case illustrates, this syndrome should be considered as a rare but potentially severe cardiac risk factor in the context of ECT.

PMID: 17853265 [PubMed - indexed for MEDLINE]

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Outcomes in major depressive disorder: the evolving concept of remission and its implications for treatment.

World J Biol Psychiatry. 2008;9(2):102-14

Authors: Möller HJ

It is increasingly recognised that major depressive disorder can be a chronic condition with many patients experiencing recurrent episodes. Remission from a depressive episode implies the absence or near absence of depressive symptoms. However, for many patients the periods between depressive episodes are not symptom free. Residual symptoms are predictors of relapse or recurrence, and may be associated with residual psychosocial impairment. In clinical studies, remission is commonly defined using a cut-off score on a rating scale for depressive symptoms, such as a score of < or = 7 on the 17-item Hamilton scale. However, there is debate about which scales and cut-offs are optimal and full-length rating scales are not widely used in clinical practice. In spite of such issues, it seems clear that a therapy should aim at the most complete remission possible. Unfortunately, recent studies have highlighted that in clinical practice usually only a low rate of remission is achieved. Although long-term treatment with antidepressants can reduce the risk of relapse or recurrence only a minority of patients in clinical practice achieve this as treatment is often prematurely stopped due to long-term side effects such as sleep disturbance, sexual dysfunctioning and weight gain. Therefore, it represents an unmet need to come up with antidepressant drugs of greater efficacy and improved tolerability as such treatments could lead to more complete remission in more patients.

PMID: 18428079 [PubMed - indexed for MEDLINE]

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Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: a naturalistic study in 2694 patients.

Drug Alcohol Depend. 2008 Jun 1;95(3):245-57

Authors: Wittchen HU, Apelt SM, Soyka M, Gastpar M, Backmund M, Gölz J, Kraus MR, Tretter F, Schäfer M, Siegert J, Scherbaum N, Rehm J, Bühringer G

BACKGROUND: In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs). OBJECTIVES: To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings. METHODS: 12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N=2694 maintenance patients, recruited from a nationally representative sample of N=223 substitution physicians. RESULTS: The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became “abstinent” during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates. CONCLUSION: The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.

PMID: 18337025 [PubMed - indexed for MEDLINE]

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The therapeutic alliance in medical-based interventions impacts outcome in treating alcohol dependence.

Drug Alcohol Depend. 2008 Jun 1;95(3):230-6

Authors: Dundon WD, Pettinati HM, Lynch KG, Xie H, Varillo KM, Makadon C, Oslin DW

This study examined the relationship of the therapeutic alliance and treatment outcomes for alcohol-dependent patients receiving naltrexone or placebo and one of three different types of clinical interventions, including two medical-based (non-specialty) treatments. This is a secondary analysis of a 24-week randomized, placebo-controlled, clinical trial of 100mg/day of naltrexone or placebo for patients with DSM-IV alcohol dependence. Patients were also randomized to one of three interventions: (1) medication clinic only, (2) medication clinic plus BRENDA (an intervention promoting pharmacotherapy), or (3) medication clinic plus cognitive behavioral therapy (CBT). Early in treatment, patients and clinicians completed the working alliance inventory (WAI). Regression analyses were conducted to determine the predictive validity of the WAI on percent days abstinent and percent of sessions attended over the clinical trial. In the medication clinic only condition, the clinicians’ WAI total score was marginally correlated to percent of visits attended (p=.057) but not percent days abstinent. In the medication clinic plus BRENDA condition, clinicians’ WAI total score was positively correlated with percent days abstinent (p=.013) but not percent visits attended. No significant relationships were found between the WAI scores and either outcome measure in the CBT condition or for any of the patient rated assessments. To our knowledge, this is the first published report providing some support for the importance of the therapeutic alliance in medical interventions for alcohol dependence but only in the context of the clinicians’ ratings. The absence of other effects underscores the need for further research.

PMID: 18329827 [PubMed - indexed for MEDLINE]

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Cognitive deficits in marijuana users: Effects on motivational enhancement therapy plus cognitive behavioral therapy treatment outcome.

Drug Alcohol Depend. 2008 Jun 1;95(3):279-83

Authors: Aharonovich E, Brooks AC, Nunes EV, Hasin DS

Clinical variables that affect treatment outcome for marijuana-dependent individuals are not yet well understood, including the effects of cognitive functioning. To address this, level of cognitive functioning and treatment outcome were investigated. Twenty marijuana-dependent outpatients were administered a neuropsychological battery at treatment entry. All patients received 12 weekly individual sessions of combined motivational enhancement therapy and cognitive behavioral therapy. The Wilcoxon Exact Test was used to compare cognitive functioning test scores between completers and dropouts, and the Fisher Exact Test was used to compare proportion of negative urines between those with higher and lower scores on the cognitive tests. Marijuana abstinence was unrelated to cognitive functioning. However, dropouts scored significantly lower than completers on measures of abstract reasoning and processing accuracy, providing initial evidence that cognitive functioning plays a role in treatment retention of adult marijuana-dependent patients. If supported by further studies, the findings may help inform the development of interventions tailored for cognitively impaired marijuana-dependent patients.

PMID: 18329188 [PubMed - indexed for MEDLINE]

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Internet-administered cognitive behavior therapy for health problems: a systematic review.

J Behav Med. 2008 Apr;31(2):169-77

Authors: Cuijpers P, van Straten A, Andersson G

Cognitive-behavioral interventions are the most extensively researched form of psychological treatment and are increasingly offered through the Internet. Internet-based interventions may save therapist time, reduce waiting-lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments. We conducted a systematic review of twelve randomized controlled or comparative trials. Studies were identified through systematic searches in major bibliographical databases. Three studies focused on patients suffering from pain, three on headache, and six on other health problems. The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache. The other interventions also showed some effects, although effects differed across target conditions. Internet-delivered cognitive-behavioral interventions are a promising addition and complement to existing treatments. The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems.

PMID: 18165893 [PubMed - indexed for MEDLINE]

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William Gregory (1803-58): Professor of Chemistry at the University of Edinburgh and enthusiast for phrenology and mesmerism.

J Med Biogr. 2008 Aug;16(3):128-33

Authors: Kaufman MH

William Gregory was descended from a long line of academics. Although he graduated in medicine, he had earlier determined on a career in Chemistry but more particularly to succeed Professor Thomas Charles Hope in the Edinburgh Chair in that discipline. At various times during the 1830s and 1840s he studied Chemistry at Giessen in Germany under Professor Justus Liebig and was closely associated with him over the succeeding years, translating and editing in all seven of his books. Gregory taught initially in London, at the Edinburgh Extra-mural School, in Dublin, at the Andersonian University, Glasgow and as Mediciner and Professor of Chemistry in Aberdeen. In 1844 he was appointed to the Chair of Chemistry in Edinburgh and remained in this post until his death in 1858. Shortly after he graduated he joined the Edinburgh Phrenological Society (he was initially its Secretary and later President) and took a particularly active role in the meetings of this Society and in the Aberdeen Phrenological Society. He was also interested in the phenomena of Mesmerism and Mesmero-Phrenology, despite the agitation and scorn of many of his academic colleagues both in Aberdeen and in Edinburgh.

PMID: 18653829 [PubMed - indexed for MEDLINE]

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