Dissertations / Theses on the topic 'Unipolar depressive disorder'

Background. This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents. Methods. Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14–17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI). Results. The overall cumulative lifetime incidence of any depressive condition was 20·0% (major depressive disorder (MDD), 12·2%; dysthymia, 3·5%; subthreshold MDD, 6·3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8–23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD. Conclusions. DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.

Background. This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents. Methods. Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14–17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI). Results. The overall cumulative lifetime incidence of any depressive condition was 20·0% (major depressive disorder (MDD), 12·2%; dysthymia, 3·5%; subthreshold MDD, 6·3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8–23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD. Conclusions. DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.

Numerosos estudios sugieren que la función dopaminérgica está alterada al menos en un subgrupo de pacientes deprimidos, especialmente en los pacientes bipolares. Los test neuroendocrinos son una de las técnicas utilizadas para explorar la función dopaminérgica en psiquiatría y el agonista dopaminérgico más estudiado es la apomorfina (un agonista dopaminérgico D1/D2). La mayoría de los estudios realizados con el Test a la Apomorfina que evalúan la respuesta de prolactina y de hormona de crecimiento en pacientes deprimidos unipolares y bipolares han mostrado resultados divergentes. El objetivo de este estudio es valorar con el Test a la Apomorfina si la función dopaminérgica en la depresión unipolar y bipolar está alterada. Para ello, me basaré en tres estudios que desarrollo. En el primer estudio se exploró una muestra reducida de sujetos, en la que se incluyeron una selección homogénea de pacientes bipolares tipo II. El objetivo de este estudio fue examinar la sensibilidad de los receptores dopaminérgicos en 19 pacientes ingresados con depresión mayor: 10 deprimidos bipolares tipo II, 9 deprimidos unipolares, comparados con 15 controles sanos. En estos pacientes, se evaluó la respuesta hormonal al agonista dopaminérgico apomorfina (APO, 0,75 mg SC) con el objetivo de obtener un indicador de la neurotransmisión dopaminérgica a nivel post-sináptico. También se examinó en los mismos sujetos la respuesta de prolactina al Test con TRH a las 8 AM y 11PM (TRH 200μg IV), y la respuesta de cortisol al Test de supresión de Dexametasona (DST, 1 mg oral). Los pacientes deprimidos bipolares mostraron un porcentaje de frenación a la prolactina (PFP) significativamente más bajo que los sujetos sanos (p = 0,0003) y los pacientes deprimidos unipolares (p = 0,04). El segundo estudio tuvo por objetivo principal confirmar los resultados obtenidos mediante el Test con Apomorfina encontrados en el estudio anterior, en una población más extensa e incluyendo a pacientes bipolares tipo I y II. La población estudiada está compuesta por 54 pacientes bipolares deprimidos (mayoritariamente tipo I), 80 pacientes deprimidos unipolares y 36 sujetos sanos hospitalizados. Los pacientes bipolares mostraron una menor supresión de Prolactina inducida por apomorfina que los pacientes unipolares y los sujetos sanos (ambas comparaciones: p< 0,00001). Los resultados del Test con TRH del primer estudio y los resultados del Test con DST de los dos estudios descartaron que los resultados del Test con apomorfina no se debían a una alteración de las células lactótrofas inducida por la TRH, o a una hiperactividad del eje corticotropo. El tercer estudio se realizó con una subpoblación del segundo estudio en la que se obtuvieron análisis seriados de prolactina. La población estudiada estuvo compuesta por 68 pacientes deprimidos unipolares, 39 pacientes deprimidos bipolares, comparados con 24 controles sanos. Los pacientes deprimidos bipolares mostraron una frenación de Prolactina (PFP) al Test a la Apomorfina significativamente menor que los pacientes deprimidos unipolares (p < 0.005) y los sujetos sanos (p < 0.001). Los ritmos circadianos de PRL fueron comparables entre los pacientes bipolares y unipolares, y no se encontraron diferencias estadísticamente significativas entre los mesores circadianos y ampitudes entre los dos grupos de pacientes. Además, la respuesta de prolactina a la apomormina no se correlacionó con los valores circadianos de prolactina. En conclusión, los resultados de nuestros tres estudios muestran que los pacientes deprimidos bipolares tienen una alteración funcional de los receptores dopaminérgicos D2 post-sinápticos a nivel hipofisario, evaluada mediante la respuesta de prolactina al Test con Apomorfina. Dicha alteración no se encuentra en los pacientes deprimidos unipolares de manera que, si se confirmasen los datos en posteriores estudios, el Test de la Apomorfina podría tener un valor significativo como biomarcador de depresión bipolar.<br>Numerous studies suggest that the dopaminergic function is impaired at least in a subgroup of depressed patients, especially in bipolar patients. Neuroendocrine tests are one technique used to explore dopaminergic function in psychiatry and the most studied dopamine agonist is apomorphine (a dopamine agonist D1 / D2). Most of studies involving Apomorphine Test to evaluate the response to prolactin and growth hormone in unipolar and bipolar depressed patients have shown conflicting results. The objective of this study is to assess with the Apomorphine Test if dopaminergic function is altered in unipolar and bipolar depression. To that end I will be based on the development of three studies. In the first study a reduced sample of subjects in a homogeneous selection of type II bipolar patients was included. The purpose of this study was to assess the sensitivity of dopamine receptors in 19 patients admitted with major depression: 10 depressed bipolar type II, 9 unipolar depressed, compared with 15 healthy controls. We evaluated the multihormonal responses to the dopamine agonist Apomorphine (APO, 0.75 mg SC) in order to obtain an index of dopaminergic neurotransmission at the post synaptic level. In addition we assess in the same subjects, prolactin (PRL) response to 8AM and 11PM protirelin challenges (TRH, 200μg IV) and cortisol response to Dexamethasone suppression Test (DST,1 mg orally). Bipolar depressed patients showed a percentage of frenación to prolactin (PFP) significantly lower than healthy subjects (p = 0.0003) and unipolar depressed patients (p = 0.04). The main objective of the second study was to confirm the results obtained with Apomorphine Test found in the previous study, in a more extensive population and including mainly bipolar patients type I. The study population consists of 54 depressed bipolar patients, 80 depressed unipolar patients and 36 healthy subjects. Bipolar patients showed lower prolactin suppression to Apomorphine Test than unipolar patients and healthy subjects (both comparisons: p <0.00001). The results of TRH Test from the first study and the results of DST Test from the two studies ruled out that the results obtained with Apomorphine Test were not due to an alteration of lactotroph cells induced by TRH, or an overactivity of the corticotroph axis. The third study was conducted with a subpopulation of the second study in which a serial analysis of prolactin were added. The study population was 68 unipolar depressed patients, 39 bipolar depressed patients, compared with 24 healthy controls. Bipolar patients showed lower prolactin suppression to the Apomorphine Test than unipolar patients (p< 0.005) and healthy subjects (p<0.001). Nyctohemeral profiles of PRL were strictly comparable between unipolar and bipolar patients, and no statistically significant difference in PRL circadian mesor and amplitude could be demonstrated between patients and control subjects. Furthermore, APO-induced PRL suppression was not correlated with circadian PRL values. In conclusion, the results of the three studies showed that bipolar depressed patients have a altered post synaptic receptor sensitivity D2 in the tuberoinfundibular dopamine level, as assessed by the prolactin response to Apomorphine Test. This alteration is not in unipolar depressed patients so that , if the data were confirmed in subsequent studies, the test Apomorphine may have significant value as a biomarker of bipolar depression.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-11-14T11:31:31Z No. of bitstreams: 1 André Machado Patella.pdf: 498161 bytes, checksum: 47369bcd9256152f21588aa54e902f91 (MD5)<br>Made available in DSpace on 2018-11-14T11:31:32Z (GMT). No. of bitstreams: 1 André Machado Patella.pdf: 498161 bytes, checksum: 47369bcd9256152f21588aa54e902f91 (MD5) Previous issue date: 2018-10-18<br>Bipolar disorder is one of the most incapacitating diseases in the world. The first manifestations of this disease are usually depressive states that can be frequently mistaken by unipolar depression. An incorrect diagnosis at this point can turn into a problem as it delays the specific treatment for bipolar disease, or even worse, an inappropriate treatment can aggravate the clinical presentation. Currently differential diagnosis between bipolar disorder and unipolar depression holds on the presence of a maniac or hippomaniac episode. This study aims to evaluate social demographics and clinical aspects of young adults with age between 18-29 years, living in the city of Pelotas, Rio Grande do Sul, Brazil, searching for factors that can differentiate both affective diseases.<br>O transtorno afetivo bipolar é uma das doenças mais incapacitantes do mundo. As primeiras manifestações dessa doença geralmente são quadros depressivos que podem ser facilmente confundido com um transtorno depressivo unipolar. Um erro no diagnóstico pode acarretar em atraso no tratamento específico e até mesmo em um tratamento incorreto que pode levar a um agravamento do quadro clínico. Atualmente o diagnóstico diferencial entre transtorno afetivo bipolar e transtorno depressivo é feito apenas pela existência de um episódio maníaco ou hipomaníaco nos pacientes bipolares. O presente estudo busca avaliar aspectos sócios demográficos e clínicos de pacientes adultos jovens com idade entre 18-29 anos, residentes no município de Pelotas, Rio Grande do Sul, Brasil, a fim de identificar fatores que possam diferenciar ambos os quadros afetivos.

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.

Hintergrund: Die Befundlage zum Zusammenhang von Persönlichkeitsstörungen (PS) und dem Behandlungserfolg bei Depressionen ist heterogen. Methode: 168 Patienten mit unipolarer Depression wurden vor und nach einer stationären Depressionsbehandlung sowie ein Jahr später untersucht. Die Depressivität wurde mit der HAMD und dem BDI, die psychische Gesamtbelastung mit dem BSI und die gesundheitsbezogene Lebensqualität mit dem SF-12 erfasst. Ergebnisse: Sowohl Patienten mit als auch ohne PS zeigten während des Klinikaufenthaltes eine signifikante Symptomreduktion. Im post-stationären Jahr wiesen Patienten mit PS im Gegensatz zu Patienten ohne PS eine leichte Symptomzunahme auf. Auch Patienten mit zwanghafter, selbstunsicherer und/oder dependenter bzw. Cluster B PS profitierten von der Behandlung. Ein Jahr nach dem Klinikaufenthalt wiesen Patienten mit Cluster B PS eine moderate Symptomzunahme auf. Patienten mit selbstunsicherer/dependenter PS zeigten im Katamneseintervall keine Symptomzunahme, wiesen jedoch aufgrund ihrer höheren Symptombelastung nach dem Klinikaufenthalt zum Katamnesezeitpunkt eine stärkere Symptomatik auf als Patienten ohne PS. Patienten mit zwanghafter PS zeigten einen mit Patienten ohne PS weitgehend vergleichbaren Behandlungserfolg. Der Zusammenhang einer dimensionalen Beurteilung der diagnostischen Konstrukte des DSM-IV mit dem Behandlungserfolg war inkonsistent. Diskussion: Patienten mit PS profitierten kurzfristig in gleichem Maße von der Depressionsbehandlung wie Patienten ohne PS. Sie wiesen jedoch einen ungünstigeren längerfristigen Krankheitsverlauf auf. Vor allem Patienten mit Cluster B PS konnten ihren Behandlungserfolg nicht aufrechterhalten. Für diese Patienten sollten spezifische Maßnahmen zur Rückfallprophylaxe und eine störungsspezifische Psychotherapie in Betracht gezogen werden. Die Ausprägungsgrade von Persönlichkeitsfaktoren des DSM-IV hatten keine stärkere Vorhersagekraft für den Behandlungserfolg als die kategorialen PS-Diagnosen.<br>Background: Empirical findings regarding the relationship of personality disorders (PD) and outcome of treatment for depression are inconclusive. Method: 168 inpatients with unipolar depression were assessed at admission, discharge and one-year follow-up using HRSD and BDI to assess depression severity, BSI to measure symptom distress and SF-12 to assess subjective health. Results: Patients without PD as well as with at least one PD showed a significant intake-to-discharge symptom reduction. In contrary to patients without PD, patients with PD showed a slight increase in symptom severity at one-year follow-up. Furthermore, patients with ‘pure’ obsessive-compulsive, avoidant/dependent or Cluster B PD benefited from the inpatient treatment of depression. One year after discharge, patients with ‘pure’ Cluster B PD could not sustain their treatment outcome. Patients with ‘pure’ avoidant and/or dependent PD did not show an increase in symptom severity in the follow-up year. Nevertheless, they scored higher in HRSD and BSI at follow-up, compared to patients without PD, due to their higher symptom level at discharge. Patients with ‘pure’ obsessive-compulsive PD showed a short- and longer-term treatment outcome that was largely comparable to that of patients without PD. Moreover, the findings regarding the relationship of treatment outcome with a dimensional representation of DSM-IV PDs were inconsistent. Discussion: Patients with PD benefited from an inpatient treatment for depression as much as patients without PD. Nevertheless, in the first year follow-up patients with PD, especially with Cluster B PD, could not sustain their treatment outcome. Therefore, measures to prevent relapses and disorder-specific psychotherapy for these patients should be taken into account. Moreover, our results indicate that a dimensional model of personality pathology that is closely connected to the categorical assessment of PDs does not improve prediction of treatment outcome.

O objetivo deste estudo foi verificar a elaboração e a recontagem de histórias de crianças com o diagnóstico de depressão maior unipolar (DSM-IV, 1997), bem como a influência da terapia medicamentosa com fluoxetina em um estudo duplo-cego longitudinal controlado com placebo. Fizeram parte do estudo trinta sujeitos com idades entre 10 e 14 anos e diagnosticados com depressão, randomizados para o uso de fluoxetina ou placebo. Ambos os grupos foram avaliados quanto à elaboração livre de textos orais e escritos e à recontagem de textos (fábulas de Êsopo ou La Fontaine) na etapa 0 (sem o uso de medicação) e na etapa 3 (três meses após a introdução de medicação ou placebo). Os textos foram analisados de acordo com o modelo de Kintsch e Van Dijk (1978), baseado no número de macro e microestruturas produzidas e/ou recordadas e nos componentes relativos à superestrutura textual. A este modelo foi acrescida a análise do conteúdo proposicional (positivo, negativo ou neutro), com o intuito de observar o fenômeno da “memória condizente com o humor”. Não foram observadas diferenças significativas com relação a esses critérios entre os grupos ou períodos analisados, nem quanto à produção e/ou recontagem de textos orais ou escritos, mesmo com a melhora da sintomatologia clínica observada por meio da escala CDRS (Poznanski & Mokros, 1996).<br>The aim of this study was to evaluate the textual production and recontagem of children with unipolar major depression (DSM-IV, 1997), and the influence of drug therapy with fluoxetine in a longitudinal, double-blinded, placebo-controlled study. Thirty subjects with depression, aged between 10 and 14 years, were selected and randomized for the use of fluoxetine or placebo. Both groups were analyzed regarding to spontaneous oral and written production and to the recontagem of the texts (Esopo’s or La Fontaine’s fables) in the period zero (without medication) and period 3 (three months after starting placebo or fluoxetine). The texts were analyzed according to Kintsch and Van Dijk’s model (1978), taking in account the number of macro and microstructures elaborated and/or recalled and the textual superstructure. We added to this model the proposition-content analysis (positive, negative or neutral), in order to observe the “mood-congruent memory” phenomenon. Regarding these criteria, no differences were found amongst the groups or periods analyzed, neither amongst the oral and written elaborated or recontados texts, even after the improvement of clinical symptoms evaluated by CDRS scale (Poznanski and Mokros, 1996).

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2016-08-01T12:24:32Z No. of bitstreams: 1 amanda reyesvolume final - 23-07-15.pdf: 348695 bytes, checksum: 2ee5f76444cb295f170acae0bec93565 (MD5)<br>Made available in DSpace on 2016-08-01T12:24:32Z (GMT). No. of bitstreams: 1 amanda reyesvolume final - 23-07-15.pdf: 348695 bytes, checksum: 2ee5f76444cb295f170acae0bec93565 (MD5) Previous issue date: 2014-11-25<br>.<br>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.

Die klinische Erfahrung zeigt, dass sich depressive Episoden sehr schnell innerhalb weniger Stunden bis Tage oder sehr langsam innerhalb mehrerer Wochen bis Monate entwickeln können. Hauptziel dieser Arbeit war es, die zeitliche Entwicklung depressiver Episoden bei Patienten mit einer unipolaren oder bipolaren affektiven Störung zu untersuchen. Mithilfe des dafür entwickelten und im Rahmen dieser Studie weiter modifizierten strukturierten Patienteninterview ODI (Onset of Depression Inventory) wurde die Geschwindigkeit des Depressionsbeginns bei 223 konsekutiven Patienten erfasst, von denen 129 in die Auswertung eingeschlossen werden konnten. Es zeigte sich, dass sich depressive Episoden bei Patienten mit bipolarer affektiver Störung signifikant schneller manifestieren als bei Patienten mit unipolarer affektiver Störung. Somit kann die Geschwindigkeit des Depressionsbeginns, gemessen mit dem ODI, als Differenzierungsmerkmal zwischen unipolarer und bipolarer affektiver Störung gewertet werden und im klinischen Alltag helfen, zwischen den beiden Störungsbildern zu unterscheiden.

Made available in DSpace on 2016-03-22T17:26:31Z (GMT). No. of bitstreams: 1 Giovanna Del Grande da Silva.pdf: 628517 bytes, checksum: 06b68a3889aadb6b7efa26d51ccf7dee (MD5) Previous issue date: 2011-02-28<br>Background: Caregiver burden has been associated both with the caregiver s need for support and information, and the caregiver s mental disorders. However, there are not quantitative studies in Brazil regarding caregiver burden in a community sample. Methods: This is a cross-sectional study, nested in a population-based crosssectional study with youngsters, conducted in the city of Pelotas, Brazil. The caregivers (n=187) responded to the Burden Interview (BI), to the M.I.N.I. and to the CAGE, and they also answered questions regarding socioeconomic variables. Results: Caregiver burden was associated to the following variables: young person s low schooling, being the caregiver of young people with Depression Disorder and Bipolar Disorder, and caregiver s Axis I disorders. Also, there is an indication that alcohol abuse/dependence and caregiver burden are related. Limitations: Since there is no data previous to the young people diagnosis (Bipolar and Depressive Disorder), it is not possible to conclude neither that the burden is a contributing factor for the caregiver s Axis I Disorders (and the alcohol abuse) nor if these factors have lead to the caregiver burden. Conclusions: Caregivers are affected by the young people s disorder even before the diagnosis. Such impact may lead to serious impairments provoked by the burden and its correlate factors. These findings should contribute to further studies and to the creation of intervention strategies targeting the informal caregiver Keywords: Burden, Caregiver, Depression, Bipolar Disorder<br>O Transtorno de Humor Bipolar (THB) é um transtorno crônico e recorrente e causa um grande prejuízo na vida do indivíduo. Sua característica básica é a oscilação de humor entre episódios de euforia (mania/hipomania) e depressão, podendo estes apresentar-se distintos ou mistos. Da mesma forma, outros sintomas podem estar associados e causar um impacto ainda maior, como irritabilidade, agressividade, auto-estima inflada, comportamentos inadequados e/ou de risco, tais como: compras exageradas, uso/abuso de substâncias, dirigir em alta velocidade, comportamento hipersexualizado; entre outros. A alta prevalência de suicídios e/ou tentativas ao longo da vida também é um fator de extrema importância no THB, sendo este associado à sobrecarga do cuidador em alguns estudos. A estimativa com relação ao desenvolvimento do transtorno bipolar por volta dos 20 anos de idade é de que o indivíduo perderá cerca de nove anos em sua expectativa média de vida, 12 anos de saúde normal e 14 anos de trabalho (Scott, 1995) o que demonstra o profundo impacto do transtorno sobre a qualidade de vida do indivíduo e seus familiares. A presente investigação tem como foco principal os cuidadores informais (não profissionais) de jovens com Transtorno Bipolar, caracterizando-se o cuidador como a pessoa que passa a maior parte do tempo com o jovem e, portanto está mais exposta às características do transtorno. Outros fatores como a sobrecarga financeira também serão avaliados. Os cuidadores serão os pais ou companheiro(a) do jovem e, portanto é pertinente investigar o impacto do transtorno no âmbito familiar. O presente trabalho contempla também a identificação da sobrecarga em cuidadores de indivíduos com Depressão Unipolar. A motivação para tal objetivo consiste nos resultados de alguns estudos que indicam que o Transtorno Bipolar muitas vezes é diagnosticado erroneamente como Transtorno Depressivo, o que pode levar a atrasos e prejuízos no tratamento correto. Além disso, a Depressão Unipolar é um transtorno recorrente que 9 comprovadamente exerce um grande impacto sobre o indivíduo e a família, principalmente devido ao aspecto agudo do episódio. O Transtorno Bipolar, em contrapartida, tem um aspecto crônico e ocasiona prejuízos interpessoais e ocupacionais mesmo nos períodos de eutimia. Por conseguinte, tanto os cuidadores de indivíduos com Transtorno Depressivo como os de indivíduos com Transtorno Bipolar estão expostos a sobrecarga e podem apresentar prejuízos em decorrência desta. Vários estudos realizados sobre Transtorno Bipolar e família, têm como foco o nível de sobrecarga dos familiares cuidadores, alguns destes em comparação com familiares de indivíduos com transtorno depressivo maior (TDM). Porém, no Brasil este é um aspecto muito pouco explorado. Desta forma, este estudo visa identificar os níveis de sobrecarga nos cuidadores de jovens com Transtorno do Humor Bipolar e nos cuidadores de jovens com Transtorno Depressivo Maior para, assim, fornecer subsídios para futuros estudos e embasar estratégias de intervenção para essa população

Introduction : Issus des données animales, les modèles neurotrophiniques du mécanisme d’action des médicaments antidépresseurs pourraient permettre d’identifier chez l’Homme des biomarqueurs prédictifs de la réponse et de la rémission sous antidépresseurs. Nous évaluons l’intérêt clinique, chez les patients souffrant de trouble dépressif caractérisé unipolaire, de 11 biomarqueurs : polymorphismes nucléotidiques simples (SNP) du Brain Derived Neurotrophic Factor (BDNF) et de son récepteur, le Récepteur Tyrosine-Kinase B (TRKB), taux plasmatiques de BDNF et volume hippocampique sur la réponse/rémission sous antidépresseurs. Méthode : Les données originales de ce travail sont issues de la cohorte METADAP. Il s’agit d’une cohorte, prospective, multicentrique incluant 624 patients présentant un épisode dépressif caractérisé dans le cadre d’un trouble dépressif caractérisé unipolaire et nécessitant l’introduction d’un traitement antidépresseur. Le traitement antidépresseur est prescrit de façon naturaliste (tous antidépresseurs commercialisés en France). Les patients sont évalués 1, 3 et 6 mois après l’introduction du traitement antidépresseur. Les biomarqueurs étudiés sont les polymorphismes Val66Met du BDNF et 8 SNP du TRKB et les dosages de BDNF plasmatiques. Une étude ancillaire est menée à partir de 63 patients ayant bénéficié d’Imagerie par Résonnance Magnétique cérébrale réalisée en pratique courante à l’inclusion de cette cohorte afin d’évaluer les volumes hippocampiques. Résultats : 1) Une revue de la littérature met en évidence une association entre la réponse aux antidépresseurs et 12 SNP du BDNF/TRKB sur 242 étudiés, ainsi qu’une association entre allèle Met du polymorphisme Val66Met du BDNF et meilleure réponse sous antidépresseurs chez les patients asiatiques. 2) Nos données ne mettent pas en évidence d’impact de 8 SNP du TRKB sur la réponse/rémission après traitement antidépresseur, mais un effet différentiel du Val66Met du BDNF selon la classe de traitement antidépresseur. 3) L’étude des dosages de BDNF plasmatiques n’est pas concluante. 4) Concernant les volumes hippocampiques, notre méta-analyse montre que des volumes hippocampiques moindres prédisent une moindre réponse/rémission après traitement antidépresseur. 5) Concernant les liens entre les biomarqueurs étudiés, nous ne mettons pas en évidence d’association. Conclusion : Sur les 11 biomarqueurs étudiés, seuls 2 pourraient présenter une utilité en pratique clinique. Si nos travaux étaient répliqués, le polymorphisme Val66Met du BDNF et le volume hippocampique pourraient conduire à orienter le choix des antidépresseurs dans le traitement des épisodes dépressifs caractérisés. Malgré une littérature cohérente chez l’Animal, nous n’avons pas mis en évidence, dans l’échantillon étudié, de lien entre les biomarqueurs génétiques étudiés et les volumes hippocampiques. Nous poursuivons ce travail d’évaluation des biomarqueurs neurotrophiniques et neurogéniques avec des méthodes d’évaluations nouvelles : séquençage nouvelle génération pour la génétique et imagerie multimodale (acquisition répétée d’IRM structurelle, fonctionnelle et de diffusion) de l’hippocampe. Nous évaluerons également de nouveaux biomarqueurs<br>Introduction: developed with Animal preclinical approachs, neurtrophinic and neurogenic models of antidepressant mechanism of action lead to identify biomarkers in Human which could be predict antidepressant response and remission in depressed patients. We assess the clinical benefit of 11 biomarkers in depressed patients: Brain Derived Neurotrophic Factor (BDNF) and its receptor Tyrosine Receptor -Kinase B (TRKB), Plasma BDNF and Hippocampal volumes to predict antidepressant response/remission. Methods: The original research data of this work are from METADAP cohort. It is a prospective, multicentric cohort including 624 patients with a diagnosis of major depressive disorder and a current major depressive episode at the start of the index antidepressant treatment. Antidepressant treatment is prescribed in naturalistic conditions (all commercialized antidepressant in France). Patient are assessed 1, 3 and 6 months after the start of antidepressant treatment. Studied biomarkers are BDNF Val66Met polymorphism, 8 TRKB SNP and plasma BDNF. Ancillary study are done with 63 patients which benefit in clinical practice of Magnetic Resonnance (MRI) at the inclusion of the cohort. Results: 1) A review of literature reports associations between antidepressant efficacy and 12 BDNF/TRKB SNP on 242 studied SNP and an association with Met allele of Val66Met BDNF polymorphism and a best antidepressant efficacy in Asian patients. 2) Our original data show no impact of 8 TRKB SNP on antidepressant response remission but a differential effect of Val66Met BDNF polymorphism depending on antidepressant treatment class. 3) Plasma BDNF study is not conclusive. 4) Concerning hippocampal volumes, our meta-analysis show that smaller hippocampal volumes predict lower response/remission rate after antidepressant treatment. 5) No association is found between studied biomarkers. Conclusion: 2 of the 11 studied biomarkers could be useful in clinical practice. After replication of our results, Val66Met polymorphism could lead to personalized antidepressant prescription in major depressive disorder. Although the animal prelinical littérature appar strong, we dont report association between genetic biomarker and hippocampal volume in ours ample. We will assess neurotrophinic and neurogenic biomarkers with new methods: next generation sequencing for genetic, multimodal imaging (repeated structural, functional and diffusion MRI) of hippocampus. We also will assess new biomarkers

博士<br>國立中正大學<br>資訊管理系醫療資訊管理研究所<br>105<br>Unipolar major depressive disorder (MDD) and bipolar disorder are two major mood disorders. The two disorders have different treatment strategies and prognoses. However, bipolar disorder may begin with depression and could be diagnosed as MDD at the initial stage which may contribute to treatment failure. Previous studies indicated that a significant proportion of patients who were diagnosed with MDD will over time develop bipolar disorder. This kind of hidden bipolar disorder may contribute to the treatment resistance observed in MDD patients. In this population-based study, our aim is to investigate the rate and risk factors for a diagnostic change from unipolar MDD to bipolar disorder during a 10-year follow up using Taiwan National Health Insurance Research Database (NHIRD). Association rule mining (ARM) was used to discover the associations of bipolar conversion and clinical characteristics before enrollment. Furthermore, a risk stratification model was also developed for MDD to bipolar conversion by using the classification and regression trees (CART) method. There are 2820 MDD patients enrolled in our study, among whom 60.1% were women. During follow-up period, 536 patients was diagnosed with bipolar disorder (19.0%). The results of ARM showed that variables including mean psychiatric outpatient visits of February, March, April, May, August, September, October, and November, age between 20 and 39 years, mean annual hospitalizations, and mean annual use of benzodiazepine, composed association rules discovered in our work. Furthermore, the CART method identified 6 variables (total psychiatric outpatient visits, mean outpatient visits of March, mean psychiatric outpatient visits of fall, February, and August, and mean annual use of benzodiazepines) as significant predictors of risk of bipolar conversion. Using these variables, we could group patients into low, intermediate, or high risk for bipolar conversion. The risk stratification model can be easily applied in clinical practice and help to identify patients with bipolar disorder early and to arrange appropriate treatment for these patients.

碩士<br>國立中正大學<br>資訊管理學系暨研究所<br>102<br>Over the last few decades, unipolar depression has been the second leading cause of disability. Clinical features of unipolar depression and bipolar disorder, do not readily differentiate the two illness trajectories in the early course of illness. Although a lot of research work has been done in this filed to seek for reliable measurement, there is no clear direction to distinguish bipolar disorder from unipolar depression. Antidepressants are drugs used for the treatment of unipolar depression. Because the mood swings are less obvious from depression to manic episodes, many bipolar disorder patients are often wrongly treated with antidepressants alone. Treating these patients with antidepressants alone can actually increase the manic episodes and worsen the disorder. Our purpose of this study is to explore the comorbidity symptoms of unipolar depression (UD) patients who are developing into bipolar disorder. The method to carry out this study is using data mining with WEKA decision trees、artificial neural network and logistic regression. The data consisted of 5830 patients with a history of depression from the National Health Insurance Research Database in Taiwan during 2003 to 2010. The results show that 73 of 5830 patients who are diagnosed with depression actually suffering from bipolar disorder (BD). We extract 30 random sample sets from 5757 UD patients. Each set includes 4 percent of 5757 UD patients and is merged with 73 BD patients. We use 30 sets to run the WEKA classifier and the results show that decision tree is significantly superior to artificial neural network and logistic regression. We get the average accuracy rate of decision tree is 73.4%. We can accurately predict patients who have comorbidity symptoms, such as personality disorders, drug addiction, adjustment disorder, alcohol dependence syndrome, anxiety disorder and neurotic disorders, could have a greater chance of developing into bipolar disorder. Therefore, the experimental result of this study proves that the comorbidity symptoms described above were beneficial to explore the potential patients who suffering from bipolar disorder. This study also demonstrated that unhealthy patient behaviors were also increased the risk of developing bipolar disorder.

As Perturbações Unipolar e Bipolar- Impactos nos Sistema Familiar, constitui o tema da presente dissertação de mestrado em Serviço Social. Esta investigação visa analisar os impactos das perturbações unipolar e bipolar ao nível do sistema familiar e compreender a importância da intervenção do Serviço Social neste contexto, mais concretamente no trabalho com as famílias. Tendo em conta o cariz desta investigação, optámos pela abordagem qualitativa. Trata-se de um estudo descritivo simples e mediante os procedimentos técnicos baseia-se num estudo fenomenológico, orientado por uma lógica indutiva a partir de entrevistas semi-diretivas aos familiares das pessoas com perturbação unipolar e bipolar acompanhadas na ADEB. Os dados foram posteriormente tratados através da análise de conteúdo. No que refere aos resultados, concluímos que as perturbações unipolar e bipolar têm impactos no sistema familiar ao nível da coesão interna, integração externa, necessidades e nos aspetos positivos relacionados com a convivência. Verificámos que este pode-se constituir um campo de intervenção do Serviço Social tendo em conta o referencial teórico e os testemunhos dos entrevistados. Em termos das políticas públicas e sociais de apoio às famílias de pessoas com doença mental, estas são percecionadas como disfuncionais, pelos familiares.<br>Depression and Bipolar Disorder- Impacts on Family System, is the subject of this Master´s Thesis in Social Work. This research aims to analyze the impacts of depression and Bipolar disorders in the family system and understand the importance of Social Work intervention in this context, specifically in working with families. In light of the nature of this investigation, we opted for a qualitative methodology. This is a simple descriptive study and through the technical procedures is based on a phenomenological study, guided by an inductive logic based on semi-directive interviews with the family of people with depression and bipolar disorder accompanied in ADEB. The data was subsequently processed through content analysis. In terms of results, we concluded that depression and bipolar disorders have impacts on the family system of internal cohesion, external integration, needs and in the positive aspects related to coexistence. We have found that this can be a field of Social Work intervention taking into account the theoretical framework and the testimonies of the respondents. In terms of public and social policies to support families of people with mental illness, these are perceived as dysfunctional by the family.

Die klinische Erfahrung zeigt, dass sich depressive Episoden sehr schnell innerhalb weniger Stunden bis Tage oder sehr langsam innerhalb mehrerer Wochen bis Monate entwickeln können. Hauptziel dieser Arbeit war es, die zeitliche Entwicklung depressiver Episoden bei Patienten mit einer unipolaren oder bipolaren affektiven Störung zu untersuchen. Mithilfe des dafür entwickelten und im Rahmen dieser Studie weiter modifizierten strukturierten Patienteninterview ODI (Onset of Depression Inventory) wurde die Geschwindigkeit des Depressionsbeginns bei 223 konsekutiven Patienten erfasst, von denen 129 in die Auswertung eingeschlossen werden konnten. Es zeigte sich, dass sich depressive Episoden bei Patienten mit bipolarer affektiver Störung signifikant schneller manifestieren als bei Patienten mit unipolarer affektiver Störung. Somit kann die Geschwindigkeit des Depressionsbeginns, gemessen mit dem ODI, als Differenzierungsmerkmal zwischen unipolarer und bipolarer affektiver Störung gewertet werden und im klinischen Alltag helfen, zwischen den beiden Störungsbildern zu unterscheiden.