Dissertations / Theses on the topic 'Mood disorder; Depression and aging'

Bariatric surgery is a life-altering procedure that leads to substantial weight loss for most patients with obesity. Psychiatric conditions that may interfere with eating behavior and other behavioral prescriptions after surgery are common. Disordered eating is an established risk factor for inferior weight loss but the effects of negative mood and impulsivity are largely unknown. This thesis aims to investigate the prevalence of and associations between these potential risk factors and eating behavior in bariatric surgery patients. Study I assessed the prevalence of adult Attention Deficits/Hyperactivity Disorder (ADHD) symptoms in bariatric surgery patients. Symptoms of adult ADHD were elevated compared to the normal population and associated with symptoms of disordered eating, anxiety, and depression. Study II investigated whether treatment with Behavioral Activation (BA) could ameliorate binge eating and other symptoms of disordered eating in patients with obesity and Binge Eating Disorder. The results showed that BA was effective in increasing activity levels and improving mood but not in ameliorating binge eating in these patients. Study III was a prospective study on disordered eating, symptoms of depression and anxiety, symptoms of adult ADHD, and alcohol risk consumption before surgery and at follow-up after 12 months. After controlling for age, no variable measured before surgery could predict weight loss after surgery. Disordered eating after surgery was associated with inferior weight loss in men and a subgroup of older female participants. The present thesis concludes that symptoms of adult ADHD are common among bariatric surgery patients and associated with disordered eating. There is no indication that symptoms of adult ADHD are associated with short-term inferior weight loss after surgery. However, adult ADHD may be a risk factor for postsurgical alcohol abuse. The treatment study showed no direct association among activity, mood, and binge eating. BA, while effective in improving mood, was found not to be an effective treatment for BED, at least in the short group format investigated.

Thesis (Ph. D.)--Ohio State University, 2005.
Title from first page of PDF file. Document formatted into pages; contains xii, 117 p.; also includes graphics (some col.) Includes bibliographical references (p. 74-81). Available online via OhioLINK's ETD Center

The current work assesses the relationship between reinforcement sensitivity theory (RST) and Personality Traits for the DSM-5 (PID-5), to explore the degree to which they are associated with mood disorder symptoms. Participants (N = 138) from a large public university in the South were administered a semi-structured interview to assess for current mood disorder and anxiety symptoms. They were also administered self-report inventories, including the Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) scales and the Personality Inventory for DSM-5 (PID-5). Results indicate that both the BIS/BAS scales and the PID-5 scales were strongly associated with current mood symptoms. However, the maladaptive personality traits demonstrated significantly greater associations with symptoms compared to the BIS/BAS scales. Results also indicated support for using a 2-factor model of BIS as opposed to a single factor model. Personality models (such as the five factor model) are strongly associated with mood symptoms. Results from this study add to the literature by demonstrating credibility of an alternative five-factor model of personality focused on maladaptive traits. Knowledge of individual maladaptive personality profiles can be easily obtained and used to influence case conceptualizations and create treatment plans in clinical settings.

While mood disorders rank within the top ten disabilities worldwide, there has been limited research done on cognitive schemas and the role they play in the development of mood disorders in South Africa. Cognitive conceptualisations of depression typically emphasize the schema-based automatic processing of information. Beck (1967, 1976 & 1987) suggested that schematically driven automatic thinking is a key element in depressive disorders. Research in the field of depression has identified cognitive schemas as a factor which increases an individual’s diathesis to depression. The primary aim of this research is to explore and describe maladaptive cognitive schemas, hopelessness and levels of depression amongst individuals diagnosed with Unipolar Mood Disorder. A further aim of the research has been to explore the relationship between maladaptive cognitive schemas and hopelessness as a diathesis to depression. In order to achieve the objectives, data was collected from a sample of 50 inpatients diagnosed with Unipolar Mood Disorder. The following measures were used: Young’s Schema Questionnaire, Beck's Depression Inventory – 2nd edition and Beck’s Hopelessness Scale. The research is quantitative in nature and takes the form of an exploratory-descriptive study. Data has been analysed by means of descriptive statistics in order to identify the mean, ranges and standard deviation of the measures used. Cross-tabulations have been used to further explore the relationship between the variables mentioned above. It was found that a statistically significant correlation exists between the BDI, BHS and YSQ. Maladaptive cognitive schemas were found to have a strong positive correlation 4 to depression, whereas hopelessness was found to have a less significant role in Unipolar Mood Disorder. The most significant schemas found in relation to hopelessness, were the Social Isolation, Unrelenting Standards and Pessimism schemas. With regards to depression, the most significant schemas were found to be Mistrust, Practical Incompetence, Vulnerability, Subjugation, Self-Sacrifice, Emotional Inhibition, Unrelenting Standards, Entitlement, Insufficient Self-Control, Admiration, Pessimism and Self-Punitiveness. All the above mentioned variables proved to have a statistically significant relationship. The findings of this research study are for the most part consistent with the literature on depression, hopelessness and cognitive vulnerabilities, and all of the above mentioned concepts have been found to be related.

The purpose of this study proposal is to examine the potential relationship between linguistic creativity and mood disorders, specifically depression and bipolar disorder. Participants will be approximately 67 adults who have either bipolar disorder, major depressive disorder, or serve as a healthy control group. Participants will complete prompts in order to measure linguistic creativity and then fill out several questionnaires relating to depressed mood, mania, general creativity, and rumination levels. It is predicted that bipolar disorder will have higher levels of certain types of linguistic creativity, such as lexical and semantic creativity, whereas depression will have more syntactic creativity. Furthermore, it is anticipated that higher rumination levels in the depressed group will be associated with higher levels of linguistic creativity, as opposed to participants in the depressed group with lower levels of rumination. Lastly, it is predicted that the type of writing prompt will influence the amount of creativity exhibited by each participant group. The proposed study has implications for therapeutic benefits, the emergence of a new area of research in two separate fields, and a new way of analyzing shifts in speech patterns of those with mood disorders.

Background Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. Method Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. Results Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses. Conclusions CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Background Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. Method Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. Results Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses. Conclusions CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

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Objetivo Geral • Comparar o desempenho cognitivo e o funcionamento global entre adultos jovens com e sem o diagnóstico de Transtorno Bipolar, bem como correlacionar estas medidas nos sujeitos com Transtorno Bipolar. 2.2 Objetivos Específicos • Comparar o funcionamento global de adultos jovens com e sem diagnóstico de TB; • Comparar o desempenho cognitivo de adultos jovens com e sem diagnóstico de TB; • Correlacionar o desempenho cognitivo e o funcionamento em uma amostra populacional de adultos jovens; • Correlacionar o desempenho cognitivo e o funcionamento nos adultos jovens com Transtorno Bipolar; • Correlacionar a severidade dos sintomas maníacos e depressivos com o desempenho cognitivo e o funcionamento dos jovens com TB.

Fetma och psykisk ohälsa är två utbredda folkhälsoproblem som förutom att orsaka stor samsjuklighet, även ger stora ekonomiska förluster för samhällena. Den här systematiska litteraturstudien gjordes i syftet att undersöka eventuell förekomst av sambandet mellan fetma och psykisk ohälsa. I denna studie avses psykisk ohälsa som ångest, låg sinnesstämning och depression. Pub Med och Lib Hub användes för datainsamling. Vid urval av artiklarna var en av de huvudsakliga etiska principerna att artiklarna måste blivit granskade. Efter urval analyserades och jämfördes den insamlade data. Det resultat som framkom var inte helt entydigt, det står klart att samband finns men de är av olika karaktär. Ett starkare samband har hittats hos kvinnor, lågutbildade och personer med fetma (BMI på >35), det finns även skillnader inom olika etniciteter. Vidare forskning föreslås vara av mer världsomfattande och långsiktig karaktär, med entydig mätmetod, för att göra resultatet mer generaliserbart och användbart vid interventioner i en rad av kontexter.
Obesity and mental illness are two global public health problems which causes not only comorbidity but also huge economic losses for societies. This systematic review was carried out with the purpose to investigate the occurrence of the association between obesity and mental illness. In this study mental illness includes anxiety, low mood and depression. Databases that were used were Lib Hub and PubMed. Ethical criteria were met and the used articles had been peer reviewed. Collected data were then analyzed and compared. The results showed that there is an association between obesity and mental illness, although there are some differences. A stronger association is found in women, in the lower educated, in people with more severe obesity and for some ethnic groups. Further research proposed to be more global and made with the same measurement techniques, to make sure that the results are generalizable and usable in different contexts.

O presente estudo avaliou um grupo de pacientes com transtorno do humor bipolar (THB), episódio depressivo, através de uma bateria de testes neuropsicológicos – Dígitos da Escala Wechsler de Inteligência para Adultos, 3ª edição (WAIS-III) e Wisconsin Card Sorting Test (WCST) –, escala de funcionalidade – Functioning Assessment Short Test (FAST) – e escala de sintomas depressivos – Montgomery-Asberg Depression Rating Scale (MADRS) – e o comparou com um grupo de controles saudáveis. Obtiveram-se como resultados déficits cognitivos significativos no grupo dos pacientes com THB, no que se refere à memória imediata e de trabalho e funções executivas, quando comparados aos controles saudáveis. Também se encontrou uma correlação entre funcionalidade, sintomatologia depressiva e déficits na memória de trabalho e funcionamento executivo. Estes achados levantam a hipótese de que as dificuldades cognitivas e sintomas depressivos interferem significativamente no funcionamento laboral, afetivo e social dos pacientes com THB.
The present study evaluated a group of patients with Bipolar Disorder (BD), major depressive episode, through a battery of neuropsychological tests - Digits of the Wechsler Intelligence Scale for Adults, 3rd edition (WAIS-III) and Wisconsin Card Sorting Test (WCST) - scale functionality - Functioning Assessment Short Test (FAST) - and scale of depressive symptoms - Montgomery-Asberg Depression Rating scale (MADRS) - and compared with a group of healthy controls. Results were obtained as significant cognitive deficits in the patients with BD, with regard to the immediate and working memory and executive functions compared to healthy controls. We also found a correlation between functionality, depressive symptoms and deficits in working memory and executive functioning. These findings raise the hypothesis that the cognitive and depressive symptoms significantly interfere with work functioning, affective and social development of BD patients.

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Objetivos: Investigar a relação entre Religiosidade/Espiritualidade (R/E) e o estado de humor, qualidade de vida, ocorrência de internações hospitalares e tentativas graves de suicídio entre pacientes bipolares. Métodos: Em um estudo transversal com pacientes bipolares em tratamento ambulatorial (n=168) foram avaliados sintomas de Mania (YMRS) e Depressão (MADRS), Religiosidade (Duke Religious índex), Coping Religioso-Espiritual (Brief RCOPE) e Qualidade de Vida (WHOQOL-BREF). Dados sociodemográficos, número tentativas de suicídio e internações foram obtidos através da entrevista com o indivíduo e análise do prontuário médico. Foram realizadas regressões logísticas e lineares das associações entre os indicadores de R/E e as variáveis clinicas, controlando para variáveis sociodemográficas. Resultados: Referiram alguma filiação religiosa 148 (88,1%) indivíduos. Religiosidade Intrínseca e mais estratégias de Coping Religioso-Espiritual (CRE) positivo associaram-se a menos sintomas depressivos, respectivamente (OR) 0.19, (Cl) 0.06 — 0.57, (p) 0.003 e (OR) 0.25, (Cl) 0.09 — 0.71, (p) 0.01. Qualidade de vida associou-se a Religiosidade Organizacional (B) 0.188, (p) 0.019, Religiosidade Intrínseca (B) 0.306, (p) <0,001 e CRE positivo (B) 0.264, (p) 0.001. CRE negativo associou-se a pior qualidade de vida (B) — 0.253, (p) 0.001. Conclusões: Religiosidade intrínseca e CRE positivo associaram-se a menor ocorrência de depressão e melhor qualidade de vida de forma significativa. Estudos longitudinais serão úteis na investigação de relações causais.
Aims: To investigate the relationship between Religiousness/Spirituality (R/S) and mood, quality of life, hospitalizations and severe suicide attempts among bipolar patients. Methods: In a transversal study among bipolar patients under ambulatory care (n=168), symptoms of Mania (YMRS) and Depression (MADRS), Religiousness (Duke Religious Index), Religious Coping (Brief RCOPE) and Quality of Life (WHOQOL-BREF) were assessed. Socio-demographic data, number of suicide attempts and hospitalizations were obtained through an interview with the individual and analysis of medical records. Logistical and linear regressions of the association between the Religious indicators and clinical variables were carried out, controlling for socio-demographic variables. Results: 148 individuals mentioned some kind of religious affiliation (88.1%). Intrinsic Religiousness (IR) and Positive Religious Coping (RC) strategies associated to less depressive symptoms [respectively odds ratio (OR) = 0.19, 95% confidence interval (Cl) = 0.06 - 0.57, p=0.003 and OR= 0.25; Cl = 0.09 - 0.71, p=0.01]. Quality of life inversely associated with negative RC ([3= - 0.253, p=0.001) and directly associated with Organizational Religiousness (13= 0.188, p=0.019), Intrinsic Religiousness (13= 0.306, =p <0,001) and positive RC (13- 0.264, p= 0.001). Conclusions: Intrinsic Religiousness and positive RC are strongly associated with less depressive symptoms and better quality of life. Negative RC associated to worse quality of life. Religiousness is a relevant aspect which must be taken into consideration by physicians when assessing and guiding

Introdução: Comparados com pacientes bipolares com episódios maníacos/hipomaníacos e depressivos, os que apresentam estados mistos tendem a curso mais grave da doença, início mais precoce, ocorrência mais frequente de sintomas psicóticos, maior risco de suicídio, altas taxas de comorbidade e tempo maior para remissão. Portanto, medidas objetivas de avaliação desses estados são necessárias. Objetivo:Avaliar a concordância entre três pares formados por uma de três escalas de mania (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) ou Clinician-Administered Rating Scale for Mania (CARS-M)) e uma de depressão (21-item Hamilton Depression) na avaliação da resposta a estabilizadores do humor em pacientes mistos. Método:Sessenta e oito (n=68) consecutivos pacientes ambulatoriais bipolares Tipo I e II com sintomatologia mista pelo DSM-IV-TR e pelos critérios de Cincinatti foram incluídos nesse estudo aberto de 8 semanas entre 2010 e 2014 foram randomizados para receberem em monoterapia, ácido valproico, carbamazepina ou carbonato de lítio. Resultados: O padrão de resposta (diminuição de, pelo menos, 50% em uma das escalas de mania e na de depressão) foi muito semelhante: 21-HAM-D + YMRS = 22,1%, 21-HAM-D + BRMS = 20,6% e 21-HAM-D + CARS-M = 23,5%; p < 0,368). Os resultados referentes à concordância de resposta revelam valores de kappa bastante altos: 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0,87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0,78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0,91 (p < 0,001). Conclusões:O presente estudo sugere que qualquer uma das três escalas de mania utilizadas (YMRS, BRMS, CARS-M) pode ser associada à 21-HAM-D na avaliação da resposta em bipolares mistos.
Background: Compared with patients with bipolar disorder who exhibit pure manic/hypomanic or depressive episodes, the presence of mixed mood states is associated with a more severe course of illness, younger age of onset, more frequent ocurrence of psychotic symptoms, major risk of suicide, higher rates of comorbidities and longer time to achieve remission. Therefore, objective avaliation of these states are necessary. Objective: To evaluate the concorccance amog three pairs of three scales (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) or Clinician-Administered Rating Scale for Mania (CARS-M)) and a depression scale (21-item Hamilton Depression) in the assessment of response to humor stabizator drugs in mix bipolar patients. Methods: Sixty eight (n=68) consecutive bipolar type I and II outpatients with mixed sitomatology accordint to DSM-IV-TR and Cincinatti Criteria were included in these 8 weeks open-trial, from 2010 through 2014, to, randomly, receive monotherapy valporic acid, carbamazepine or lithium carbonate. Results: The response answer (decrease of, at least 50 %, in one of the mania and depression scales) were very similar: 21-HAM-D + YMRS = 22.1%, 21-HAM-D + BRMS = 20.6% e 21-HAM-D + CARS-M = 23.5%; p < 0,368). The kappa values were : 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0.87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0.78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0.91 (p < 0,001). Conclusions: The present study suggests that any of the three mania scales used (YMRS, BRMS, CARS-M) may be associated to 21-HAM-D in the assessment of the response o bipolar patients.

Depression is the most common type of emotional disorder among the world's population. It is characterized by negative sentiments, the feeling of guilt, low self-esteem, a loss of interest, a high-level process of reflection, and in general by a decrease of the individual's psychic functions. The new non-invasive neuroimaging techniques have increased the ability of studying possible variations in patients' brain activity. In concrete, functional magnetic resonance imaging (fMRI) has become the most important method to study human brain functions in the past two decades, being non-invasive and with no risk for human health. Biswal and others in 1995, and later Lowe and his colleagues in 1998, showed the existence of continous spontaneous activity in the brain's activity at rest. These fluctuations have also been verified in other species like macaques (Vicent JL et l, 2007). Studying the brain's activity at rest (rs-fMRI) by means of neuroimaging techniques has become a powerful tool for the investigation of diseases, since it has demonstrated a better signal to noise ratio concerning task-based approaches on one hand, and since certain patients could have difficulties to perform cognitive, language or motor tasks on the other hand. However, it seems that because of certain inconsistencies found among studies, rs-fMRI techniques would not reach a practical clinical use of a personalised monitoring, prognosis or pre-diagnosis in individuals with depression. In this respect, even if Grecius MD exposed in 2008 the benefits of rs-fMRI techniques, he also commented that the signal to noise ratio remains to be improved to be used in a clinical routine. Grecius suggested to lenghthen the time of the temporal series at rest, and to improve analysis procedures. The aim of this thesis is to elucidate if the existence of certain factors or components in the functional signal at rest could be used at the clinical health level. In order to achieve this, we use rs-fMRI data on two sets of samples. In the first set of samples, composed by 27 patients with major depression (MDD) and 27 individuals as controls, we design descriptors that describe both static and dynamic aspects of the resting-state signal for the construction of prediction models. Conversely, with the second type of samples (48 twins), we analyse the relation between possible genetic and environmental factors which could explain certain depressive components in the activity in resting condition. On the one hand, the results show that depression could simultaneously affect different brain networks located in the prefrontal-limbic area, in the DMN, and between the frontoparietal lobes. Besides, it seems that the alterations in these networks could be explained by both static and dynamic aspects existing in the rest signal. Finally, we achieve the creation of models that would partially explain certain clinical phenomenons present in depressive patients by means of global descriptors in these networks. These network descriptors could be used for personalised monitoring in patients with major depression. On the other hand, using the twin sample, we achieve the construction of a risk model from the amygdalar activity which evaluates the risk or predisposition of an individual from analytical components in the activity at rest. The cerebellum of this sample was also analysed, and the environment was found to be possibly modifying the activity in these regions
La depresión es el tipo de trastorno emocional más común en la población mundial. Se caracteriza por sentimientos de culpa o negativos, baja autoestima, pérdida de interés, alto nivel de reflexión y en general una disminución de las funciones psíquicas del individuo. Las nuevas técnicas de neuroimagen no invasivas han incrementado la habilidad para estudiar posibles variaciones de la actividad cerebral en pacientes. En concreto, las imágenes por resonancia funcional magnética (fRMI) se han convertido en las dos últimas décadas el método más importante, no-invasivo sin riesgo para la salud humana, para el estudio de las funciones cerebrales humanas. Biswal y otros en 1995, y posteriormente Lowe y compañía en 1998, demostraron la existencia de actividad espontanea continua en la actividad cerebral en estado de reposo. Estas fluctuaciones también han sido confirmadas en otras especies como en macacos (Vincent JL y compañía, 2007). El estudio mediante técnicas de neuroimagen sobre la actividad cerebral en reposo (rs-fMRI) se ha convertido en una potente herramienta para el estudio de enfermedades, puesto que, por un lado, se ha demostrado tener una mejor relación señal-ruido respecto a enfoques basados en tareas, y por otro lado, ciertos pacientes podrían tener dificultades para realizar algún tipo de tareas cognitivas, de lenguaje o motoras. Sin embargo, parece ser que debido a ciertas inconsistencias encontradas entre estudios, las técnicas de rs-fMRI no estarían llegando a un uso clínico-práctico para el seguimiento, pronóstico o pre-diagnostico personalizado en individuos con depresión. En línea a esto, aunque Grecius MD en 2008 expuso los beneficios de la técnica rs-fMRI también comentó que para poder ser utilizada en la rutina clínica aún se debería mejorar la relación señal-ruido. Propuso alargar los tiempos de las series temporales en estado de reposo y mejorar los procedimientos de análisis. En esta tesis se trabaja para dilucidar si existen ciertos factores o componentes en la señal funcional en estado de reposo que pudieran ser utilizados para su uso en la salud clínica. Por ello, utilizamos datos de rs-fMRI sobre dos conjunto de muestras. En el primer conjunto, 27 pacientes con depresión mayor (MDD) y 27 individuos como control, diseñamos descriptores que describan aspectos estáticos y dinámicos de la señal de reposo para la construcción de modelos de prónostico. En cambio, con el segundo tipo de muestras, 48 gemelos, analizamos la relación de posibles factores genéticos y de entorno que pudieran explicar ciertos componentes depresivos en la actividad en estado de reposo. Por un lado, los resultados muestran que la depresión pudiera estar afectando diferentes redes cerebrales al mismo tiempo localizadas en la parte prefrontal-limbica, en la red DMN, y entre los lóbulos frontoparietales. Además, parece ser que las alteraciones sobre estas redes pudieran ser explicadas tanto por aspectos estáticos y dinámicos existentes en la señal de reposo. Finalmente, conseguimos crear modelos que explicarían parcialmente ciertos fenómenos clínicos presentes en los pacientes depresivos, mediante descriptores globales de estas redes. Estos descriptores de red pudieran ser utilizados para el seguimiento personalizado en pacientes con depresión mayor. Por otro, utilizando la muestra de gemelos, conseguimos construir un modelo de riesgo a partir de la actividad amigdalar que evalúa el riesgo o propensión de un individuo a partir de componentes analíticas en la actividad de reposo. También sobre esta muestra, se analizó el cerebelo encontrando que el entorno pudiera estar modificando la actividad en estas regiones

Although less than half of all patients with mental disorders seek mental health treatment per se, approximately 80% of all people will visit their primary care physician (PCPs) within a year (Strosahl, 1998). However, it is not well understood how to best handle patients presenting with mental health issues in primary care practices. The purpose of this project was to implement an intervention involving a screening measure for anxiety and mood disorders in a primary care setting to increase the volume of anxiety and mood disorder screening, to increase the accuracy of disorder detection, and to also enhance PCPs patterns of referral to mental health professionals (MHPs). Though starting with a quantitative design, difficulties encountered throughout the project eventually led to a largely qualitative analysis, which did yield useful information. A pilot project demonstrated anxiety and mood disorders were commonly noted in patients’ medical charts (46%), but also found referrals were rarely made for mental health services (7%), despite colocation of a licensed psychologist and licensed clinical social worker within the practice. This indicated that services available to provide comprehensive integrated total health care may not be have been used to their full potential. In the main project, 59 participants from a family medicine clinic and 20 PCPs from that clinic participated. The My Mood Monitor (M3) was administered to the patients and became part of their Electronic Medical Records (EMR). The M3 screens for anxiety, depression, and bipolar disorders within primary care settings. In 2 separate noon conferences, PCPs were trained on diagnostic criteria for anxiety disorders and mood disorders, interpretation of M3 results, and the internal Mental Health Professional referral process. The project was hampered by a full-scale switch from paper-based medical records to an EMR and accompanying lack of user experience with EMR functions, lack of efficient transfer of M3 results into the EMR, and an unforeseen switch of psychologists mid-way through the study. However, results were obtained that showed relatively low levels of PCP review of M3 results, potentially high rates of anxiety disorders and mood disorders within the setting, relatively high levels of PCP knowledge of diagnostic criteria for anxiety and mood disorders, and that patients may not prefer a ‘warm handoff’ model of mental health referral. These findings are couched within a number of important caveats, but future directions for research were clearly implied.

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A doença de Crohn (DC) é uma doença Inflamatória intestinal crônica até o presente momento incurável. Embora fatores psicológicos tenham sido inicialmente considerados participantes da etiologia da DC, esta hipótese foi descartada. Apesar de existirem evidências crescentes de que sintomas depressivos e ansiosos são muito frequentes em pacientes com DC, poucos dados a cerca da oscilação destes sintomas psicológicos durante o curso clínico da doença, particularmente em suas fases de remissão e recidiva estão disponíveis. Os objetivos deste estudo foram avaliar em pacientes portadores de DC a possível ocorrência de oscilação do humor (sintomas depressivos e/ou ansiosos), bem como os possíveis fatores associados à mesma. Neste estudo prospectivo longitudinal 50 pacientes (30 mulheres e 20 homens, com média de idade de 40,6 anos e variação de 18 a 65 anos) com diagnóstico estabelecido de DC foram avaliados durante o período de agosto de 2009 a dezembro de 2010. As principais características sócio demográficas e clínicas relacionados à DC foram registradas. Adotou-se a classificação de Viena para determinação do fenótipo da DC e, para a atividade clinica, o índice de atividade da DC. Os sintomas depressivos e ansiosos foram avaliados por instrumentos de auto avaliação do estado psicológico, o Inventário de Depressão de Beck (IBD) e a Sub-escala de Ansiedade da Escala Hospitalar de Ansiedade e Depressão (HADS-A). Os instrumentos foram aplicados na inclusão no estudo e, a seguir, em intervalos de quatro meses, durante 12 meses subsequentes. A maioria dos pacientes apresentava o fenótipo inflamatório da doença (86%), 18(36%) já haviam se submetido a algum procedimento cirúrgico para tratamento de complicações da DC, sendo que 41(82%) pacientes estavam em remissão clínica na inclusão. Quatorze (28%) pacientes apresentaram humor depressivo de base e 28 (56%) sintomas de ansiedade. Oscilação do humor ocorreu em 29 pacientes (58%); destes 14 (28%) evoluíram com sintomas depressivos e/ou ansiosos a partir do humor normal de base, enquanto 15 (30%) apresentaram normalização do humor depressivo e/ ou ansioso de base. Dos 29 (58%) pacientes com oscilação do humor, 19 (38%) não apresentaram mudança na atividade clínica da doença (p=0,015), enquanto 10 (20%) tiveram alteração na atividade da DC, sendo que 5 (10%) apresentaram reativação da doença previamente em remissão e 5 (10%) remissão da doença que inicialmente encontrava-se em atividade. Os pacientes do sexo feminino e aqueles que não se apresentavam história de cirurgia prévia devido a complicações da DC exibiram significantemente maior oscilação do humor (p=0,04 para ambos). Observou-se uma tendência dos participantes que consumiam álcool a apresentarem maior oscilação do humor (p=0,06), embora o número de pacientes com ingestão alcoólica (n=3) foi pequeno para a análise estatística robusta. Neste estudo verificou-se elevada incidência (58%) de oscilação do humor em pacientes com DC. Não houve correlação entre a oscilação do humor com a mudança de atividade clínica da doença (p=0,15). Conclui-se que os pacientes do sexo feminino e aqueles que não se submeteram a cirurgia prévia devido a complicações da DC apresentaram significantemente maior oscilação do humor. Avaliação psicológica periódica pode ser útil para detecção e possível abordagem da oscilação do humor em pacientes com DC.
Introduction: Crohn Disease (CD) is a chronic inflammatory bowel disease not curable until now. Although psychological issues have been initially considered participants in the etiology of CD this hypothesis was is currently discharged. There are rising evidence that depressive symptoms and anxiety are very frequently in these patients, but little data about humor oscillation and it influence in clinical course of the disease is available. Objective: Estimate the incidence of mood disorders in patients with CD and the possible issues associated with them. Methodology: This prospective longitudinal study evaluate 50 patients (60% female gender; mean age 40.6 yrs) with CD assisted by our institution in a 16 months period time. The clinic activity of the disease was measured by the Crohn’s Activity Index and the mood disorders by Beck Depression Inventory and Hospital Anxiety Scale. The instruments used to assess psychological status were applied in the inclusion and then each four months. Results: The major phenotype of CD found was the inflammatory (86%), 36% had a past history of surgery due to CD complications, 82% had no active disease in the admission period. Humor oscillation (HO) was observed in 58% of patients; 28% had depressive and or anxiety symptoms and 30% had normalization of their baseline depressive or anxiety humor. In 38% of the patients with HO there was no change in disease activity 9p:0.015), while 20% had some degree of variation in clinical activity. Female gender and the absence of previous surgery related to CD were associated with HO (p:0.04). Conclusion: Female gender and the absence of previous surgery due to CD’s complications were associated with HO. Periodically Female gender and previous surgery related to CD’s complication are associated with HO. Periodically psychological evaluation can be worthy for detection and management of HO patients with CD.

The aims of the studies were to assess body image perceptions, the role of stress and other possible associated psychopathologies within a non-clinical sample. The prevalence of body image concern is increasing and is widely considered as secondary to evolving socio-cultural trends. Negative self-perceptions about body image can be manifest as measurable indicators of physiological stress, or even psychopathology. This thesis describes two quantitative studies into the role and relevance of various causative factors in the development of negative body image in cohorts of volunteers drawn from the general population of the University of Bradford in West Yorkshire, UK. In Study One, subjects (n=360) completed a self-directed questionnaire that psychometrically measured satisfaction/dissatisfaction with personal appearance, queried which external sources influenced those opinions, and correlated these with demographic information. In particular, we sought to examine how a subject¿s opinion about their personal appearance varied with age, gender, ethnicity, mental health, relationship status, sexual orientation and Body Mass Index (BMI). Subjective views regarding personal appearance were determined by answers given to specific body image questions that revealed a subject¿s day-to-day appearance concerns, all preoccupations, and the extent to which these concerns resulted in distress, all social impairment. Overall, the results demonstrated that BMI values were positively correlated with personal appearance concerns. High BMI values correlated with greater dissatisfaction with personal appearance. Self ratings of appearance values were negatively correlated with BMI scores. Subjects who gave themselves high appearance ratings were relatively unaffected by media influence with regard to their image, compared to subjects rating themselves less attractive. These latter subjects also showed higher peer pressure scores in terms of both the amount of time they compared themselves to peers, and the degree to which peer comparisons affected their self-appearance ratings. Based on responses to the body image questions specifically, the entire cohort of subjects were categorised into principal clusters: those largely unaffected by any body image concerns; and those profoundly distressed by their self assessed body image. Perhaps the most interesting aspect of these findings is that the scores for this latter (n=17) group of subjects on the body image questions revealed a degree of personal distress this is almost identical to the scores expected from those people diagnosed with body dysmorphic disorder (BDD). Collectively, these results suggest that high BMI values in subjects negatively impact on self-appearance ratings, render subjects more prone to media messages that portray body image ideals, and elicit frequent comparisons with peers to validate self-image concerns. Furthermore, severely affected subjects with high BMI scores may show similar psychopathology to that of BDD sufferers. In Study Two, a small cohort of subjects (n=60) were given questionnaires and were interviewed to further investigate self-appearance ratings and mood/depressive traits. The body image questions used in Study One to assess image concerns and the magnitude of distress were repeated in Study Two. Mood and depressive state were measured using the validated Beck¿s Depression Inventory (BDI). In parallel, subjects completed the Derriford Appearance Scale 59 (DAS 59), which is a valid psychometric indication of an individual's perception of their appearance as ¿normal¿ or ¿disfigured¿, and used as a tool by plastic surgeons to inform decisions regarding the necessity for surgery to correct an individual's appearance. Physiological markers were recorded before and after exposure of subjects to a physical and a psychological stressor: these were saliva concentrations of cortisol and sIgA (an immune marker), blood glucose and blood pressure. The results of Study Two revealed no changes in scores for any of the physiological measures following stressors. BDI scores for most subjects fell within normal ranges, although females scored higher than males, but not at a pathological level. Those subjects with a history of mental illness or those who reported feeling a high degree of stress on a daily basis, or those who expressed greater self-appearance concerns, all had significantly elevated BDI values. Perhaps the most intriguing finding from Study Two, as in Study One, was that subjects again tended to fall within specific categories for body image concerns: those unaffected or minimally affected by body image concerns, and those (n=6) greatly and deleteriously affected by body image concerns. This subsection of subjects also scored very high on the DAS 59 for disfigurement. On the basis of these findings it would seem that body image concerns may be severe enough for some individuals for them to perceive themselves as actually being disfigured, or that the DAS 59 (a widely used assessment tool in plastic surgery), may not be entirely appropriate for assessment of an individual's need for surgery because it cannot distinguish between those genuinely disfigured and those merely expressing severe body image concerns.

Abstract Maternal depressed mood during pregnancy is common, but studies on the offspring of antenatally depressed mothers, with a long follow-up, are scarce. The aim was to study whether the adult offspring of antenatally depressed mothers are at an elevated risk of psychoses, depression, bipolar disorder, antisocial and borderline personality disorder, and schizotypal and affective traits. Parental severe mental disorder was considered as both a genetic and environmental risk factor for mental disorders. The data are based on the unselected, prospective, population-based Northern Finland 1966 Birth Cohort of 12,058 live-born children. The data were collected beginning from pregnancy and ending mid-adulthood. The mothers were asked about their mood during pregnancy at the antenatal clinic at 24–28 gestational weeks. Of the mothers, 13.9% rated themselves as depressed (11.8%) or very depressed (2.1%) during pregnancy. Parents’ severe, hospital-treated mental disorders, and the cohort members’ mental disorders were identified mainly by using the Finnish Care Register for Health Care. In this study, the adult offspring of antenatally depressed mothers had an increased risk of depression, and the male offspring for antisocial personality disorder, compared to cohort members without antenatally depressed mothers. The offspring with both maternal antenatal depressed mood and parental severe mental disorder had a markedly elevated risk of schizophrenia and depression, compared to cohort members without one or both of the risk factors. This is the first study where the offspring of antenatally depressed mothers were followed till mid-adulthood, also taking into account parental severe mental disorders. Based on the findings, the prevention of and early intervention in antenatal depression, especially in families with severe mental illness, might present an opportunity to reduce the risk of mental disorders in the offspring
Tiivistelmä Äitien raskausajan masennus on yleistä, mutta pitkiä seurantatutkimuksia raskausaikana masentuneiden äitien lapsista on vähän. Tutkimuksen tavoitteena oli selvittää, onko raskausaikana masentuneiden äitien aikuisilla jälkeläisillä kohonnut riski sairastua skitsofreniaan, masennukseen, kaksisuuntaiseen mielialahäiriöön, epäsosiaaliseen tai epävakaaseen persoonallisuushäiriöön, ja ilmeneekö heillä enemmän skitsotyyppisiä tai affektiivisia piirteitä. Vanhempien vakavien mielenterveydenhäiriöiden katsottiin olevan sekä mahdollisia geneettisiä että ympäristöön liittyviä riskitekijöitä jälkeläisten mielenterveyshäiriöille. Tutkimus perustuu yleisväestöön pohjautuvaan, prospektiiviseen Pohjois-Suomen vuoden 1966 syntymäkohorttiin, johon kuuluu 12 058 elävänä syntynyttä lasta. Kohortin jäseniä on seurattu sikiöajalta keski-ikään, aina 49 ikävuoteen saakka. Äitien raskaudenaikaista mielialaa tiedusteltiin raskausviikoilla 24–28 neuvolassa. 13,9 % äideistä raportoi mielialansa masentuneeksi (11,8 %) tai hyvin masentuneeksi (2.1%) raskausaikana. Vanhempien vakavat mielenterveydenhäiriöt ja kohortin jäsenten mielenterveyshäiriöt selvitettiin pääosin hoitoilmoitusrekisteritiedoista. Tutkimuksessa raskaudenaikana masentuneiden äitien lapsilla havaittiin kohonnut depressioriski sekä kohonnut epäsosiaalisen persoonallisuushäiriön riski miehillä, verrattuna kohortin jäseniin, joiden äitien mieliala ei ollut masentunut raskausaikana. Kohortin jäsenillä, joiden äideillä oli raskausajan masennusta ja toisella vanhemmista vakava mielenterveyshäiriö, oli kohonnut riski sairastua skitsofreniaan ja depressioon, verrattuna heihin, joilla oli vain yksi tai ei kumpaakaan näistä riskitekijöistä. Tämä on ensimmäinen tutkimus, jossa raskausaikana masentuneiden äitien lapsia on seurattu keski-ikään saakka, huomioiden myös vanhempien vakavat mielenterveydenhäiriöt. Tutkimuksen tulosten perusteella äidin raskausajan masennusoireiden varhaisen tunnistamisen ja hoidon voitaisiin ajatella vähentävien jälkeläisten mielenterveysongelmien riskiä, etenkin perheissä, joissa on vakavia mielenterveysongelmia

The aims of the studies were to assess body image perceptions, the role of stress and other possible associated psychopathologies within a non-clinical sample. The prevalence of body image concern is increasing and is widely considered as secondary to evolving socio-cultural trends. Negative self-perceptions about body image can be manifest as measurable indicators of physiological stress, or even psychopathology. This thesis describes two quantitative studies into the role and relevance of various causative factors in the development of negative body image in cohorts of volunteers drawn from the general population of the University of Bradford in West Yorkshire, UK. In Study One, subjects (n=360) completed a self-directed questionnaire that psychometrically measured satisfaction/dissatisfaction with personal appearance, queried which external sources influenced those opinions, and correlated these with demographic information. In particular, we sought to examine how a subject's opinion about their personal appearance varied with age, gender, ethnicity, mental health, relationship status, sexual orientation and Body Mass Index (BMI). Subjective views regarding personal appearance were determined by answers given to specific body image questions that revealed a subject's day-to-day appearance concerns, all preoccupations, and the extent to which these concerns resulted in distress, all social impairment. Overall, the results demonstrated that BMI values were positively correlated with personal appearance concerns. High BMI values correlated with greater dissatisfaction with personal appearance. Self ratings of appearance values were negatively correlated with BMI scores. Subjects who gave themselves high appearance ratings were relatively unaffected by media influence with regard to their image, compared to subjects rating themselves less attractive. These latter subjects also showed higher peer pressure scores in terms of both the amount of time they compared themselves to peers, and the degree to which peer comparisons affected their self-appearance ratings. Based on responses to the body image questions specifically, the entire cohort of subjects were categorised into principal clusters: those largely unaffected by any body image concerns; and those profoundly distressed by their self assessed body image. Perhaps the most interesting aspect of these findings is that the scores for this latter (n=17) group of subjects on the body image questions revealed a degree of personal distress this is almost identical to the scores expected from those people diagnosed with body dysmorphic disorder (BDD). Collectively, these results suggest that high BMI values in subjects negatively impact on self-appearance ratings, render subjects more prone to media messages that portray body image ideals, and elicit frequent comparisons with peers to validate self-image concerns. Furthermore, severely affected subjects with high BMI scores may show similar psychopathology to that of BDD sufferers. In Study Two, a small cohort of subjects (n=60) were given questionnaires and were interviewed to further investigate self-appearance ratings and mood/depressive traits. The body image questions used in Study One to assess image concerns and the magnitude of distress were repeated in Study Two. Mood and depressive state were measured using the validated Beck's Depression Inventory (BDI). In parallel, subjects completed the Derriford Appearance Scale 59 (DAS 59), which is a valid psychometric indication of an individual's perception of their appearance as 'normal' or 'disfigured', and used as a tool by plastic surgeons to inform decisions regarding the necessity for surgery to correct an individual's appearance. Physiological markers were recorded before and after exposure of subjects to a physical and a psychological stressor: these were saliva concentrations of cortisol and sIgA (an immune marker), blood glucose and blood pressure. The results of Study Two revealed no changes in scores for any of the physiological measures following stressors. BDI scores for most subjects fell within normal ranges, although females scored higher than males, but not at a pathological level. Those subjects with a history of mental illness or those who reported feeling a high degree of stress on a daily basis, or those who expressed greater self-appearance concerns, all had significantly elevated BDI values. Perhaps the most intriguing finding from Study Two, as in Study One, was that subjects again tended to fall within specific categories for body image concerns: those unaffected or minimally affected by body image concerns, and those (n=6) greatly and deleteriously affected by body image concerns. This subsection of subjects also scored very high on the DAS 59 for disfigurement. On the basis of these findings it would seem that body image concerns may be severe enough for some individuals for them to perceive themselves as actually being disfigured, or that the DAS 59 (a widely used assessment tool in plastic surgery), may not be entirely appropriate for assessment of an individual's need for surgery because it cannot distinguish between those genuinely disfigured and those merely expressing severe body image concerns.

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BACKGROUND: Postpartum depression (PPD) is the most common psychiatric complication observed in women after birth. Some women have a particular sensitivity to hormonal changes, starting in early menarche, which increases their vulnerability to psychological stressing agents that are triggered by environment and physiological factors during life. Decreased serum brain-derived neurotrophic factor (BDNF) levels have been associated to different neuropsychiatric conditions and BDN has been considered as a candidate marker for such disfunctions. The goal of this study was to compare the levels of BDNF between mothers with PPD and control mothers as well as to seek for associations between BDNF levels and the severity of PPD. METHODS: This is a case-control study including 36 mothers with PPD and 36 control mothers. PPD was defined according to the Beck Depression Inventory (BDI). Serum BDNF was assayed with the sandwich ELISA method. RESULTS: Serum levels of BDNF were significantly lower in women with PPD than in control mothers (p = 0.026). No significant correlation between BDI score and serum BDNF levels was observed (r= 0.16, p = 0.09). CONCLUSIONS: Our study suggests that low BDNF levels are associated with PPD, although not with PPD severity. This result point out to the potential usage of BDNF in the screening of PPD, which could promote early treatment and, therefore, reduce the burden to the PPD women and to the health system
O BDNF (brain-derived neurotrophic factor) é um fator neurotrófico que parece estar envolvido na fisiopatologia de muitos transtornos psiquiátricos, incluindo depressão 1. O pós-parto é um período de risco psiquiátrico aumentado no ciclo de vida da mulher. A depressão pós-parto pode se manifestar com intensidade variável, tornando-se um fator que dificulta o estabelecimento de um vínculo afetivo seguro entre mãe e filho, podendo interferir nas futuras relações interpessoais estabelecidas pela criança. Fatores neurotróficos, ou neurotrofinas são famílias de proteínas, nas quais são capazes de promover o desenvolvimento, modulação e sobrevivência dos neurônios no sistema nervoso central (SNC) e periférico. Estes fatores são secretados pelos tecidos e vão atuar de diversas maneiras tais como na modulação sináptica, na apoptose, na diferenciação celular, dentre outras. O BDNF é crítico no desenvolvimento e modulação do SNC 2. As diversas funções das neurotrofinas são mediadas via duas classes de receptores: o Trk (cinase do receptor tropomiosina), da família dos RTKs (receptor da tirosina cinase), e o p75NTR (receptor da neurotrofina p75). Os subtipos dos receptores Trk ligam-se a neurotrofinas maduras com diferentes especificidades. O TrkB preferencialmente liga-se ao BDNF e ao NT4 (neurotrofina-4). O p75NTR liga-se a todas neurotrofinas maduras com baixa afinidade. O p75NTR também pode interagir com outros receptores, incluindo os receptores Trks 3. Para a mulher, o ciclo gravídico-puerperal é considerado período de risco para o psiquismo devido à intensidade da experiência vivida 4. A prevalência deste transtorno pode variar de acordo com os critérios utilizados para o diagnóstico, como o período de início dos sintomas e o método utilizado para a avaliação. Uma meta-análise estimou uma prevalência de 10 13% de depressão pós-parto (DPP) em mulheres 5. Recentemente, Moraes et al. (2006) e Pinheiro et al. (2006) encontraram prevalência de DPP de 19,1% em mulheres na cidade de Pelotas/RS 6,7. A partir da primeira semana após o parto 80% das mulheres apresentam um estado de tristeza materna (baby blues), podendo vir a ser confundido com a depressão. O quadro é benigno e regride por si só por volta do primeiro mês. Os sintomas mais freqüentes são: irritabilidade, mudanças bruscas de humor, indisposição, tristeza, insegurança, baixa auto-estima, sensação de incapacidade de cuidar do bebê, entre outros 8. Recentemente, o envolvimento do BDNF, tem sido foco de interesse na pesquisa relacionada com a regulação dos transtornos de humor e depressão. Interessantemente, diversos estudos caso-controle têm encontrado níveis séricos de BDNF diminuídos em pacientes deprimidos. Nos casos em que a depressão é induzida por alterações nos níveis de BDNF, os sintomas desaparecem após o final do tratamento ou com o uso de antidepressivos 1,9,10. A descoberta de novos marcadores pode não só auxiliar no diagnóstico, monitoramento, como também na escolha do tratamento a ser seguido, bem como no desenvolvimento de novos fármacos para o tratamento da depressão. Existem fortes evidências do envolvimento do BDNF na fisiopatologia da depressão, como esses achados envolveram exclusivamente amostras clínicas oriundas de sistema terciário, o fato de utilizarmos uma amostra comunitária aumenta a representatividade dos achados, e é relevante ao entendimento da neurobiologia e conseqüentemente abre caminho à pesquisa de novas abordagens no tratamento da DPP. Sendo assim o presente estudo pretende utilizar medidas mais sofisticadas para o diagnóstico e intervenção no tratamento da DPP, relacionando essa patologia com a concentração sérica de BDNF

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Mood disorders are characterized by affective manifestations considered unsuitable in terms of intensity, frequency and duration. According to the previous description, this study intends to investigate the prevalence of physical activity among patients who have bipolar disorder or depression compared to population controls. This transversal study selected 211 young people of a population-based study which surveyed 1,560 youths aged 18 to 24 years. The instruments used were a Questionnaire of Habitual Physical Activity and the Semi-Structured Clinical Interview (SCID) for the DSM-IV, conducted by psychologists in the research laboratory of the University Hospital San Francisco de Paula. The data were analyzed by descriptive statistics, chi-square and Poisson s regression with the use of the software STATA 9.0. The study was approved by the Ethics Search the Catholic University of Pelotas, obtaining the following scores mean physical activity: 12.74 ± 8.43 in control population; 8.75 ± 8.07 in Depression; and 11.95 ± 7.31 in Bipolar. Factors associated with higher prevalence of physical inactivity/ sedentariness in the studied sample was being female (p = 0.010) and have a clinical diagnosis of depression (p <0.001). We can conclude that sedentariness is more likely to occur to young people with depression than to those with bipolar disorder or those in the control group
Os transtornos de humor caracterizam-se por manifestações afetivas consideradas inadequadas em termos de intensidade, freqüência e duração. De acordo com a descrição anterior, o presente estudo tem como objetivo investigar a prevalência da prática de atividade física entre portadores de transtorno bipolar ou depressão comparados a controles populacionais. Este estudo transversal selecionou 211 jovens de um estudo de base populacional que entrevistou 1560 jovens de 18 a 24 anos. Os instrumentos utilizados foram um Questionário de Atividade Física Habitual e a Entrevista Clínica Semi-Estruturada (SCID) para o DSM-IV, realizada por psicólogas no laboratório de pesquisa do Hospital Universitário São Francisco de Paula. Os dados foram analisados por meio de estatística descritiva, teste do qui-quadrado e regressão de Poisson no programa STATA 9.0. O estudo foi aprovado pelo comitê de Ética em Pesquisa da Universidade Católica de Pelotas. Obtiveram-se os seguintes escores médios de atividade física: 12,74±8,43 no controle populacional; 8,75±8,07 na Depressão e 11,95±7,31 no Transtorno Bipolar. Os fatores associados à maior prevalência de inatividade física/sedentarismo na amostra estudada, foi ser do sexo feminino (p=0,010) e ter o diagnóstico clínico de depressão (p<0,001). Conclui-se que os jovens com depressão estão mais propensos a ocorrência de sedentarismo do que os jovens com transtorno bipolar ou aqueles do grupo controle

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Contexto: Apesar do grande número de estudos encontrados na literatura sobre as relações entre religiosidade/espiritualidade e depressão, outros transtornos mentais e doenças físicas, há uma carência de pesquisas acerca do impacto da religiosidade/espiritualidade em pacientes bipolares, notadamente de estudos longitudinais. Objetivos: Investigar as possíveis relações entre diversas dimensões de religiosidade/espiritualidade sobre sintomas de depressão, mania e qualidade de vida em um estudo longitudinal de 24 meses. Métodos: Estudo observacional longitudinal de dois anos acrescido de aspectos qualitativos, com 168 pacientes bipolares ambulatoriais, avaliando dados sócio demográficos, sintomas de mania (Young Mania Rating Scale), depressão (Montgomery–Asberg Depression Rating Scale), religiosidade (Duke Religious Index), coping religioso (Brief RCOPE) e qualidade de vida (World Health Organization Quality of Life–Brief Version). Análises de regressão linear da associação entre indicadores religiosos e variáveis clínicas foram controladas por variáveis sociodemográficas. Resultados: Entre os 158 pacientes reavaliados após dois anos, Coping Religioso Positivo em T1 predisse melhor qualidade de vida em todos os seus quatro domínios: físico (β 10,2; 95%CI; 4,2–16,1), mental (β 13,4; 95%CI; 7,1–19,7), social (β 10,5; 95%CI, 3,6–17,33) e ambiental (β 11,1; 95%CI; 6,2–16,1) em T2, dois anos depois. Coping Religioso Negativo em T1 predisse pior saúde mental (β -28,1; 95%CI; -52,06– -4,2) e ambiental (β -20,4; 95%CI; -39,3– -1,6) em qualidade de vida. Religiosidade Intrínseca em T1 predisse melhor qualidade de vida ambiental (β 9,56; 95%CI; 2,76–16,36) em T2. Coping Religioso Negativo em T1 predisse sintomas maníacos (β 4.1) em T2. Na investigação qualitativa, 88,2% dos sujeitos relataram que sua fé ajudou a lidar com sua doença e o apoio de sua comunidade religiosa em relação ao tratamento foi apontado por 35,3%. Não houve relato de oposição de líderes religiosos ao tratamento. Limitações: Este é um estudo observacional, inferências causais devem ser feitas com cautela. Conclusão: religiosidade/espiritualidade pode influenciar a qualidade de vida de pacientes com transtorno bipolar, mesmo quando em eutimia. Usar religiosidade/espiritualidade (especialmente coping religioso positivo e negativo) em intervenções psicossociais podem contribuir para melhorar a qualidade de vida de pacientes com transtorno bipolar.
Background: Although several studies have examined the relationship between religiosity/spirituality and depression, there is little research examining the effect of religious involvement on the course of bipolar disorder. This study investigated the effects of religious activity and coping behaviors on the course of depression, mania and quality of life in patients with bipolar disorder. Methods: Two-year longitudinal study of 168 outpatients with bipolar disorder. Linear regression was used to examine associations between religious predictors and outcome variables (manic symptoms, depression, and quality of life), controlling for sociodemographic variables. Results: Among the 158 patients reassessed after two years, positive religious coping at T1 (baseline) predicted better quality of life across all four domains: physical (β 10.2, 95%CI, 4.2 - 16.1), mental (β 13.4; 95%CI; 7.1–19.7), social (β 10.5; 95%CI; 3.6–17.33) and environmental (β 11.1; 95%CI; 6.2–16.1) at T2 (2-years later). Negative religious coping at T1 predicted worse mental (β -28.1; 95%CI; -52.06– -4.2) and environmental (β -20.4; 95%CI; -39.3– -1.6) quality of life. Intrinsic religiosity at T1 predicted better environmental quality of life (β 9.56; 95%CI; 2.76–16.36) at T2. Negative religious coping at T1 predicted manic symptoms (β 4.1) at T2. In the qualitative research, 88.2% of the subjects reported that their faith helped to cope with their illness and the support of their religious community regarding the treatment was pointed out by 35.3%, there was no report of opposition of religious leaders to the treatment. Limitations: This is an observational study, causal inferences must be made cautiously. Conclusions: religiosity/spirituality may influence the quality of life of patients with bipolar disorder over time, even among euthymic patients. Targeting religiosity/spirituality (especially positive and negative religious coping) in psychosocial interventions may enhance the quality of recovery in patients with bipolar disorder.

INTRODUÇÃO: O Transtorno Bipolar (TB) é um transtorno psiquiátrico crônico e debilitante e sua etiologia e patologia ainda não são completamente conhecidos, apesar de um componente genético importante ser evidenciado em estudos de família, adoção e gêmeos. Recentemente, o TB tem sido relacionado a um processo de envelhecimento acelerado, com alguns estudos mostrando telômeros encurtados nesta população. O objetivo do presente estudo foi investigar a associação entre o comprimento telomérico, um dos parâmetros do processo de envelhecimento celular, com a ausência ou presença de TB em famílias com muitos membros afetados, além de associar a sintomatologia clínica e outras variáveis a esse parâmetro. Procurou-se também avaliar as influências genéticas e ambientais sobre o comprimento telomérico nessas famílias, estimando-se a herdabilidade desta característica. MÉTODOS: O comprimento telomérico (T) foi mensurado em uma amostra de 143 indivíduos de 22 famílias (60 deles com TB), em relação a um gene de cópia única (S) - beta-globina, através do método de PCR (Polymerase Chain Reaction) em tempo real quantitativo, no qual forneceu uma proporção do número de cópias de T por S (razão T/S). Considerando a estrutura familiar na análise estatística foi ajustado para cada análise o modelo misto poligênico. RESULTADOS: O efeito do TB no comprimento dos telômeros foi pequeno, não tendo sido observada uma associação estatisticamente significante entre TB e comprimento telomérico quando comparado com familiares saudáveis (p > 0,05). No entanto, observou-se associação do comprimento telomérico à covariável ideação suicida (p = 0,02) e à interação entre ideação suicida e curso da doença (p = 0,02). Associação do comprimento telomérico com idade materna e TB também foi observada (p < 0,05). Por fim, estimou-se em 68% a herdabilidade do comprimento telomérico nas 22 famílias do estudo. CONCLUSÕES: A teoria do envelhecimento acelerado em TB, vista pela óptica do comprimento dos telômeros, não pôde ser confirmada no presente estudo, pois não foi encontrada diferença no comprimento telomérico entre indivíduos saudáveis e com TB nas famílias. Por outro lado, covariáveis que indicam gravidade da doença, como a ideação suicida e a interação entre ideação suicida e curso da doença foram associadas ao comprimento telomérico (p < 0,05), ou seja, um encurtamento telomérico foi correlacionado à gravidade clínica do TB. Associação do comprimento telomérico com idade materna e TB (p < 0,05) sugeriu que a idade materna avançada não só pode ser um marcador de longevidade, como também o fenótipo TB pareceu reforçar essa condição. Por fim, a alta herdabilidade estimada do comprimento telomérico (0,68) revelou uma importante variabilidade genética desse fenótipo entre as famílias do estudo. Em súmula, este é o primeiro estudo que relatou uma associação entre ideação suicida, curso da doença, idade materna e comprimento telomérico em famílias com vários membros afetados pelo TB. Outras investigações independentes são necessárias para confirmar esses resultados preliminares
BACKGROUND: Bipolar Disorder (BD) is a debilitating and chronic mental illness. It is etiology and pathology are not completely known yet, despite the evidence of an important genetic component from family, twin and adoption studies. Recently, BD has been related to a process of accelerated aging, with some studies showing shortened leukocyte telomeres in this population. The purpose of the present study was to investigate the association between leucocyte telomere length (LTL) in BD patients compared with healthy relatives of 22 families with several affected members by this illness, besides associating clinical symptomatology and other covariates with this parameter. It was also examined the genetic and environmental influences on telomere length trait in these BD families, using a variance component approach, by estimating the heritability of this trait as well as covariate effects. METHODS: Telomere length (T) was estimated in a sample of 143 individuals, including 60 BD patients from 22 families, which was measured in relation to the single copy gene (S) - beta-globin gene, using a singleplex real time PCR (Polymerase Chain Reaction), providing a ratio of number of copies of T by S (T/S ratio). Taking in consideration the family structure, the statistical analysis was adjusted for the polygenic mixed model. RESULTS: The effect of BD illness in telomere length was small and we found no association between BD group and LTL (p > 0.05). However, LTL was associated with the variable suicidal ideation (p = 0.02) and interaction between suicidal ideation and course of disorder (p = 0.02). Association of LTL and maternal age and BD was also observed (p < 0.05). In addition, an important genetic component for telomere length was also observed (heritability = 0.68) in these families. CONCLUSIONS: The hypothesis of accelerated aging in BD, investigating the telomere length as one of its components, was not confirmed in our study. We found no difference between LTL and BD in our family group. However, using covariates that indicate severity of disease, both suicidal ideation and interaction between suicidal ideation and course of disorder were statistically significant with LTL, showing that shorter LTL was associated with worse clinical course (p < 0.05) and suicidal ideation (p < 0.05) in BD patients. Association of LTL with maternal age and BD (p < 0.05) suggests that advanced maternal age may not only be a marker of longevity, but also the BD phenotype may reinforce this condition. A high heritability for telomere length (0.68) also suggests an important genetic variability of this trait presented among those families. To our knowledge, this is the first study that found association between suicidal ideation, course of disorder, maternal age and LTL in families with several members affected by BD. Further investigations, including replication studies in other BD families, are needed to confirm these new findings

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O objetivo deste trabalho foi analisar os processos compreendidos na formação social dos transtornos do humor, com base no acúmulo teórico-prático de dois campos do conhecimento, a Saúde Coletiva e a Psicologia Histórico-Cultural, ambos fundamentados no materialismo histórico-dialético. De acordo com a Organização Mundial de Saúde, os transtornos do humor, com destaque para a depressão, estão entre as principais causas de incapacitação no mundo hoje. Não à toa a saúde mental vem ganhando cada vez mais destaque tanto nos estudos científicos como na demanda por políticas públicas que atendam às necessidades das pessoas em sofrimento psíquico. Entretanto, a produção de conhecimento e de práticas está hegemonizada por concepções biológicas, pautadas na lógica produtivista do capital. Esta pesquisa se soma aos esforços de análise do sofrimento psíquico expressos como depressão e bipolaridade em suas determinações mais profundas, tendo em vista que o processo saúde-doença consiste de uma expressão particular do processo geral da vida social. Para isso, foi realizada uma investigação teórica conjugada com pesquisa de campo, com observação participante, grupos focais e entrevistas com quinze pessoas diagnosticadas com depressão e bipolaridade, vinculadas a um serviço da rede pública de saúde. Com isso, buscou-se entender, por meio da dialética singular-particular-universal, a determinação social na constituição da depressão e da bipolaridade nas histórias de vida. A análise teve como ponto de partida a caracterização psiquiátrica da depressão e da bipolaridade, seguida de uma argumentação em favor da adoção do termo sofrimento psíquico. Fundada nos aportes da teoria da determinação social do processo saúde-doença, seguiu-se avaliando como os transtornos do humor sobressaíram no perfil epidemiológico como resultado dos modos de vida na atual fase de acumulação capitalista. Para entender as alterações na dinâmica da personalidade envolvidas na depressão e na bipolaridade, retomou-se as contribuições da Psicologia Histórico-Cultural sobre o desenvolvimento humano, a formação da personalidade e suas respectivas alterações patológicas. Por fim, com a articulação das trajetórias singulares de vida em um nível maior de generalização, sustentamos a tese segundo a qual a gênese da depressão e da bipolaridade está radicada nos processos críticos da vida social, como expressão das crescentes exigências psíquicas e resistência às constrições pelo capital, e se desenrola na forma de alterações na personalidade centradas na esfera afetivo-volitiva da atividade.
The aim of this paper was to analyze the processes comprised in the social formation of mood disorders, based on the theoretical and practical accumulation of two fields of knowledge, Collective Health and Historic-Cultural Psychology, both grounded in historical-dialectical materialism. According to the World Health Organization, mood disorders, especially depression, are today among the leading causes of disability worldwide. Not for nothing, mental health has been gaining increasing prominence both in scientific studies and in the claim for public policies suited for people in psychic suffering. However, biological conceptions, based on the productivist logic of capital, are hegemonic in the production of knowledge and practices. This research joins the efforts of analyzing psychic suffering expressed as depression and bipolar disorder in its deeper determinations, given that the health-illness process consists of a particular expression of the general process of social life. For this purpose, a theoretical investigation was conducted in conjunction with a field research, with participant observation, focus groups and interviews with fifteen people diagnosed with depression and bipolar disorder who benefited from a service from the public health system. Thus, we sought to understand, through the singular-particular-universal dialectic, the social determination in the constitution of depression and bipolar disorder in life stories. The analysis had its starting point in the psychiatric characterization of depression and bipolar disorder, followed by an argumentation in favor of adopting the term psychic suffering. Based on the contributions of the theory of social determination of the health-illness process, we continued by evaluating how mood disorders stood out in the epidemiological profile as a result of the lifestyles of the current phase of capitalist accumulation. To understand the changes in personality dynamics that are involved in depression and bipolar disorder, we retrieved the contributions of Historic-Cultural Psychology about human development, personality formation and its respective pathological alterations. Lastly, by articulating the singular trajectories of life in a greater level of generalization, we supported the thesis that the genesis of depression and bipolar disorder is rooted within critical processes of social life, as an expression of increasing psychic demands and resistance to the restrains of capital, unfolding in the form of personality changes centered on the affective-volitional sphere of activity.

Depression is a common mood disorder. Although major ethical challenges make it nearly impossible to invasively and directly measure serotonin (5-hydroxytryptamine, 5-HT) levels in human brains, neuroimaging technologies have shown macroscopic structural and functional abnormalities in the prefrontal cortex (PFC) of depressed patients. The monoamine hypothesis of depression is based on the neurotransmitter imbalance, such as deceased serotonin brain levels are implicated in the cause of depression. Research has focused on the control mechanisms involved in the dorsal raphé nucleus (DRN) which is the serotonergic control center located in the midbrain. We hypothesized that activation 5-HT 2A receptor in PFC would increase serotonin levels by an AMPA-dependent mechanism in both DRN and PFC. Enhancement of the 5-HT in DRN may inhibit 5-HT level in PFC by 5-HT 1A receptor. This becomes the full feedback loop system. While 5-HT levels in the PFC have been well studied, pathway that modulate this DRN pool through upstream cascade interactions leading to a downstream feedback loop have been difficult to elucidate. Developing a mechanism-based pharmacokinetics (PK) and pharmacodynamics (PD) model to quantitatively describe the effect of 5-HT 2A receptors regulation to serotonin in the DRN and PFC would help us to better understand the complex brain. 5-HT 2A receptor agonist and AMPA receptor agonist and antagonist were used to activate or block the related receptor. Male Wistar rats underwent neurosurgery for implantation of microdialysis (MD) probes. Three to five rats were randomly assigned to experimental arms. Using the MD method, the drug combination was examined to explore the drug effect on time course of 5-HT release in DRN and PFC. Based on the experiment results, a mechanism-based PD model was developed. Phoenix WinNonlin ® and Berkeley Madonna™ were used for model estimation, external validation with secondary data set, and simulation. The result supports the possibility of a 5-HT 2A /AMPA feedback control circuit that originates in the PFC and modulates DRN and PFC 5-HT levels through feedback coupling of 5-HT. The time-course profiles of 5-HT in both DRN and PFC was well modeled and model parameters were estimated with good precision (CV% ranged from 1.37% to 35.03%). The mechanism model was developed to characterize and better understand the neurotransmitter mechanisms, providing estimations of various parameters of the disease related receptor system.

The World Health Organization has made global mental health a priority since making it the center of world health day 2001, yet much of the current literature on mental health examines the subject within the context of the U.S. and Western Europe. This research takes a more global approach, shifting the focus to the issue of depression in Ukraine. Specifically this thesis analyzes data to examine the hypotheses that: 1) a statistically significant relationship exists between gender and depression prevalence in Ukraine; 2) women over the age of 50 in Ukraine have a significantly higher chance of suffering from depression than other age groups, unlike trends described in the literature; and 3) there are socio-economic and social factors present in Ukraine, which impact depression prevalence among women. A mixed-methodology, which utilizes analysis of quantitative data from the World Mental Health survey initiative, completed in Ukraine in 2004, and qualitative interview data, was employed to explore these hypotheses. Strong relationships are found between gender and depression and between depression and aging, particularly past the age of 50. Some socio-demographics of significance include low level of education, very inadequate financial resources and being on a pension. The conclusions that result from this analysis, describe an interesting case for assessment of global mental health issues. While the results are perhaps not generalizable far beyond Ukraine the conclusions drawn have interesting implications for how we study global mental health and the characteristics which make a person more or less vulnerable to mental illness.
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Stigma is one of the key barriers to mental health services and there has been growing efforts to develop anti-stigma programs. However, little research has been done on quantifying experiences of stigma and their psychosocial impacts in the perspectives of those that suffer from mental illnesses. It is essential to develop an instrument that quantifies the extent and impact of stigma. Therefore, we conducted a study to field-test The Inventory of Stigmatizing Experiences and measure the difference in perceived stigma and its psychosocial impacts on Korean and Canadian patients with Depression and Bipolar disorders. A cross-sectional comparison study was conducted. Data collection took place at tertiary care hospitals located in Kingston, Ontario, Canada and Seoul, South Korea. In total, 214 Canadian and 51 Korean individuals with depression and bipolar disorder participated. Canadian participants reported significantly higher experience with stigma (p << 0.05) and its impact (p << 0.05) compared to Korean participants. Moreover, patients with bipolar disorder had significantly higher scores on both stigma experience and impact compared to patients with depression (p << 0.05). However, the diagnosis status was not a significant factor in the linear regression analyses, whereas nationality remained as a strong predictor of stigma. Age of symptom onset was also a strong predictor for both stigma experience and stigma impact. Marital status was also a significant factor for stigma impact. Both subscales of the inventory (the stigma experiences scale and the stigma impact scale) were highly reliable, with reliability coefficients of 0.81 and 0.93, respectively. In conclusion, there seems to be higher level of stigma and impact in the Canadian population compared to the Korean population. In addition, bipolar disorder patients may experience more stigma and higher impact compared to patients with depression. These differences in stigma experience and its impact in different populations (by nationality and diagnosis) suggest the need to develop more tailored anti-stigma programs. The Inventory of Stigmatizing Experiences is a highly reliable instrument.
Thesis (Master, Neuroscience Studies) -- Queen's University, 2012-08-17 12:23:14.762

Studies suggest that sleep disturbance may be an important etiological factor in the development of comorbid anxiety and depressive disorders, whereby anxiety leads to sleep difficulties, which in turn increase the vulnerability for depression. The primary aim of this study was to determine whether the sequential comorbidity patterns observed at the disorder level (i.e., where anxiety disorders most often precede insomnia, and insomnia most often precedes depression) were also present in daily fluctuations of symptoms. The secondary aim was to explore possible moderators of any observed temporal associations. Participants were 15 patients with generalized anxiety disorder (GAD; mean age = 28.9 years, SD = 9.8) and 15 good sleeper controls (mean age = 27.1 years, SD = 8.3) who were comparable in female:male ratio (73% female vs. 67% female). For 14 days, participants wore an actigraph to objectively assess sleep quality (sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency) and completed daily symptom ratings multiple times each day using their smartphones to assess symptoms of anxiety, depressed mood, and subjective sleep quality. Study aims were assessed using multilevel modeling, with daily symptoms nested within individuals. Many of the analyses were lagged such that the time-varying predictor variable preceded the time-varying outcome variable temporally. Consistent with hypotheses, results demonstrated that anxious mood was predictive of later subjective and objective sleep disturbance in individuals with GAD, and this effect was strongest among individuals with higher levels of neuroticism, negative affect, and dysfunctional beliefs about sleep. Anxious mood was not associated with later subsequent sleep disturbance in healthy controls. In the GAD group, subjective and objective sleep disturbance predicted later depressed mood; this effect was moderated by temperament and dysfunctional beliefs about sleep. For the control group, the effect of subjective sleep disturbance on later depressed mood was moderated by neuroticism and the effect of objective sleep disturbance was moderated by dysfunctional beliefs about sleep, suggesting that sleep disturbance may increase vulnerability for depressed mood even in healthy individuals. These results suggest that explicitly targeting sleep disturbance during the treatment of GAD may attenuate the experience of depressive symptoms.

Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model.
Psychology
D. Litt. et Phil. (Psychology)

Introduction: Cardiovascular disease (CVD) and mood disorders (MD) are two of the world’s leading health problems. Both conditions are chronic, debilitating, and extremely prevalent among the general population, often occurring together in the same individual. Epidemiological evidence has been growing suggesting that there is a two-way relationship between them. In fact, a significant proportion of people with no prior record of MD develop depression after a cardiovascular event. As well, physically healthy individuals who are diagnosed with depression are at increased risk of developing CVD compared to the general population. This link is particularly evident between depression and heart failure (HF). The HF population with depression is particularly known to have an increased risk of hospitalizations, emergency visits and re-admissions with higher mortality rates and worse health-related outcomes. The burden of these diseases is overwhelming when they occur individually and even greater when they occur in comorbidity, yet there is still no consensus or any particular guidelines for the best method to treat patients with comorbid MD and CVD. This may be partially due to the fact that MD remains poorly understood. To better clarify the pathophysiology behind this spectrum of disorders we should not be confined to certain conceptual boundaries. First, although there are clear clinical distinctions between depression and Bipolar Disorder (BD), experts still debate the possibility of some degree of continuum between these diseases. Second, the biological mechanisms behind MD are not yet fully understood; namely what separates them and what mechanisms they have in common. This is also true if we aim to identify common biological changes between CVD and MD, particularly between HF and depression. HF is one of the most common causes of hospitalization, mortality, and economic burden worldwide. It is crucial to develop new and improved models of care for this condition. A new program design at Health Sciences North (HSN) called the Heart Failure Disease Management Program (HFDMP) utilizes various outpatient strategies that aim to avoid emergency department (ED) visits, to decrease HF hospitalizations, to improve outcomes, and to decrease mortality and health care costs. The success of this outpatient program model needs to be evaluated. Furthermore, since the association of depression with HF seems to be extremely relevant the prevalence and impact of depression in an original program like the HFDMP needs to be clarified. The general aims of this work were: 1. To investigate pathophysiological mechanisms in mood disorders; 2. To investigate common pathophysiological mechanisms between mood disorders and cardiovascular disease, particularly depression and heart failure; 3. To further investigate the relationship between depression and heart failure from a clinical perspective. The following specific aims were established to address the general goals of this work: 1 To investigate pathophysiological changes in mood disorders, namely the role of mechanisms known to be relevant to the pathophysiology of cardiovascular disease. 1.1 To investigate oxidative stress changes across the life span of patients with MD, Specifically, to analyse the levels of oxidative damage in plasma from 185 subjects, consisting of 110 euthymic older BD patients (BD-I and BD-II with 35 years of evolution of disease) compared to 75 healthy controls; 1.2 To investigate oxidative changes in different mood episodes and mood polarities (depression, hypomania and euthymia) and their relationship with hippocampus changes in patients with MD; specifically, to analyse peripheral levels of oxidative stress markers and decreased hippocampal subvolume dentate gyrus–cornu ammonis (CA4) in correlation to depressive, hypomanic and euthymic episodes in 62 subjects consisting of 29 patients with BD-II and 33 healthy controls. 2 To investigate common pathophysiological mechanisms between mood disorders and cardiovascular disease, particularly between depression and heart failure: 2.1 To review the role of inflammation as a pathophysiological mechanism shared between depression and CVD; specifically, to discuss the evidence of the benefit ofanti-inflammatory drugs in both conditions in support of the hypothesis of a shared pathophysiology between these diseases through inflammation. 2.2 To investigate further common biological pathways between MD and CVD, in HF patients with depression; specifically, to investigate whether NT-proBNP mediated reduced ejection fraction (EF) and depressive symptoms in 124 subjects with HF and depression compared to HF patients without depression. 3 To evaluate an original outpatient program for heart failure management and the relationship of depression with patients as well as the program’s outcomes: 3.1 To investigate the safety and effectiveness of the program HFDMP in managing HF in an outpatient setting; specifically, to investigate the ability of the program to reduce emergency department visits, to decrease HF admissions and readmissions, to improve HF outcome, and to decrease mortality in 138 patients enrolled and followed in the program over a period of 12 months; 3.2 To investigate the relationship between depression, quality of life (QoL) and HF outcomes in the HFDMP; specifically, to investigate the prevalence of depression in the HFDMP and the impact of depression in the QoL and clinical symptoms and outcomes of 124 patients enrolled and followed in the program over a period of 12-months. Results and discussion: The pathophysiological mechanisms responsible for MD are complex and multifaceted. The multiple studies conducted in this work and its respective findings support the idea of that complexity. The hypothesis of a central role for oxidative stress in MD is supported and highlighted by the findings (*1.1) of increased levels of an early component of the peroxidation chain, the lipid hydroperoxide (LPH), in euthymic patients with BD-I and BD-II into late life. This suggests a persistent effect of reactive species of oxygen throughout a BD patient’s life. Further proof for this hypothesis can be gleaned from the findings (*1.2) of increased peripheral levels of two lipid peroxidation markers, the 4-hydroxy-2-nonenal (4-HNE) and LPH, which is significantly correlated with depressive episodes and with decreased dentate gyrus–CA4 volume. It was shown that a larger number of depressive episodes predict a greater volume loss in patient’s hippocampus. Furthermore, it was shown that 4-HNE is negatively associated with left and right dentate gyrus–CA4 volumes. Altogether, these results are consistent in proving the by oxidative stress in the pathophysiology of MD. Furthermore, they suggest that depressive episodes and elevated oxidative stress might contribute to hippocampal volume loss in these patients. In addition, these findings provide further support for the hypothesis that peripheral lipid peroxidation markers may reflect brain alterations and may one day represent a biomarker for these disorders. Oxidative stress is a mechanism well established in CVD and in our findings it appears to also play a central role in MD pathophysiology. Therefore, oxidative stress is an extremely likely biological interface between mood and heart problems. Oxidative stress and inflammation are closely related pathophysiological mechanisms. One can be easily induced by the other, therefore both processes are simultaneously found in many pathological conditions. Similar to oxidative stress, inflammation also seems to be implicated in the pathophysiology of both depression and CVD. Inflammation also seems to have a central role in MD and to be a central candidate mediating the link between depression and CVD, as suggested by the results of our review (*2.1). Taking this hypothesis further, we have found original and seemingly important biological pathways shared between depression and HF, highlighted by the findings in our study (*2.2) that suggest that NT-proBNP is a potential mediator between reduced EF and depression in patients with HF. This indicates that NT-proBNP may be a potential biomarker for HF patients with reduced EF and depression who are at higher risk in terms of disease prognosis and mortality. In this work we have also investigated the original approach established at HSN for HF management named HFDMP. This program was shown (*3.1) to be a safe and effective way to manage HF and avoid ED visits and decrease HF hospitalizations and mortality, all while improving clinical symptoms and decreasing health care expenditures. Finally, we have shown that depression is extremely prevalent in this program’s HF population (*3.2) and is associated with worse QoL levels in patients and worse outcomes in the program. On the other hand, this program was shown to be highly effective in improving patients’ QoL over time, both physically and emotionally. Altogether, these studies provide further evidence of the strong association between HF and depression, from molecular to clinical perspectives. Conclusion: Altogether this work leads to several conclusions. Firstly, oxidative stress and inflammation appear to have a central role in the pathophysiology of MD. Oxidative stress and a decreased volume in hippocampus seem to be directly implicated in the pathophysiology of depressive episodes in MD. Furthermore, oxidative stress and inflammation are central candidates for proving a shared pathophysiology between MD and CVD. Clinical and biological pathways were found between HF and depression in patients enrolled in the HFDMP. This original program for HF management – demonstrated also in this work to be an efficient and safe way to manage HF in an outpatient setting – was shown to have a population where depression is extremely prevalent and where depression influences HF patients’ QoL and outcomes. Finally, in this work we have found an important indicator for the existence of a shared pathophysiology between depression and HF: depressive symptoms and reduced ejection fraction in HF seem to be mediated by NT-proBNP, a gold-standard indicator of the clinical status, diagnosis and severity of HF. We have found that this biological marker, extremely well established in HF, reacts differently with the existence of depressive symptoms in HF patients. This finding provides a strong hint at the common pathways between these diseases. Altogether, this work contributed to clarifications on the pathophysiology of MD as well as the biological connections between MD and CVD. Furthermore, this work has shown important indicators of common pathways between depression and HF, two highly impactful comorbid diseases. It is expected that these findings may in the future contribute to the development of better therapeutic approaches and biomarkers that will help in the diagnosis of disease progression and the evaluation of treatment response in patients with this comorbidity.

L’adhésion au traitement réfère à la mesure selon laquelle un patient respecte la posologie et la fréquence des prises médicamenteuses telles que prescrites par le médecin pour la durée recommandée. En dépit de nombreux traitements efficaces, la problématique de la non-adhésion demeure omniprésente en médecine, notamment dans les populations psychiatriques. Les patients aux prises avec un trouble de l’humeur ou un TDAH peuvent présenter des déficits cognitifs. Un projet de recherche mené auprès de 52 patients est présenté. Les résultats montrent une association entre les difficultés cognitives telles que perçues par les patients et l’adhésion. Des sous-domaines cognitifs comme la capacité d’inhibition, la flexibilité, la mémoire de travail, la planification et l’organisation de même que la capacité d’initier une action sont particulièrement impliqués. La capacité d’initier une tâche est corrélée avec l’adhésion et tend à la prédire. L’utilisation en clinique de méthodes d’évaluation simples et rapides de la cognition et de l’adhésion permettrait d’identifier ces difficultés. Des interventions visant à améliorer l’adhésion pourraient ainsi être offertes de façon plus ciblée. L’adaptation des interventions au profil de chaque individu est une avenue à explorer davantage pour tenter d’améliorer l’efficacité limitée de celles-ci jusqu’à maintenant.
Adherence refers to the extent to which a patient respects the dosage and frequency of medication taken as prescribed for the recommended time. Despite the availability of many effective treatments, the problem of non-adherence is ubiquitous in medicine and in the psychiatric population. Patients with mood disorder or ADHD often have cognitive deficits. A research project conducted with 52 patients is presented. Results show that cognitive difficulties as perceived by patients reduce adherence. Areas such as inhibition, shift, working memory, planning and organization and the ability to initiate an action are particularly important. Ability to initiate tasks shows a trend to predict poorer adherence and correlates with adherence. Quick and simple tools permitting the assessment of cognition and adherence in clinical practice could help identify these problems. Targeted adherence enhancing interventions could then be offered to patients with such difficulties. Choosing interventions adapted to the individual on the basis of the specific profile of adherence influencing factors is an avenue which requires further exploration.

This study investigates the connection between different pathophysiological processes in mitochondria and psychopathological symptoms in patients with bipolar disorder. Changes in activity of selected components of the respiratory chain and overall respiratory rate of mitochondria were analyzed in patients with bipolar disorder when compared to healthy controls. Diagnostic scales and questionnaires, high-resolution respirometry, radiochemical and spectroscopic methods were used. 37 patients with a diagnosis of bipolar disorder (F31) and 21 healthy volunteers were involved in the study. Statistical analysis included the methods of parametric and nonparametric analysis, factor analysis, one-way analysis of variance and linear regression analysis. Obtained results revealed that cellular energetics plays a great role in the pathophysiology of bipolar disorder. There was a mild difference between different mitochondrial enzymes activity in patients within manic phases and depressive phases of the disease. Changes in mitochondrial respiration in patients with BD as compared to healthy controls were also shown. Mitochondrial respiration indexes for patients with BD in remission as compared to healthy controls were altered in accordance with the previous phase of the disease. Association between the...

Population-based administrative data (2009-2012) from several sources were used to compare the health status and access to health services between a cohort of children in care with developmental disabilities (DD) (n=1,212) and a matched comparison group of children in care without DD (n=2,424). The two study groups were compared on a number of measures, including total respiratory morbidity, prevalence of diabetes, mood and anxiety disorders, continuity of care, injury-related hospitalizations, hospital-based dental care, and total number of ambulatory physician visits. Children in care with DD were significantly more likely to have a history of mood and anxiety disorders, respiratory illnesses, diabetes, hospital-based dental care, and injury-related hospitalizations compared to the matched comparison group. Children in care with DD also had significantly higher number of physician visits than children in the matched comparison group. No significant difference between the two study groups was found for continuity of care.
October 2015