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Gupta R, Mirza T, Majeed MH, Seemüller F, Moeller HJ. Survival of Melancholia: a Retrospective Study of Patients with Depressive Disorders. East Asian Arch Psychiatry 2020; 30:39-43. [PMID: 32611825 DOI: 10.12809/eaap1884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The DSM-IV and the DSM-5 eliminated the importance of the syndromal identity of melancholic depression in favour of a dimensional model within the domain of major depressive disorders. Melancholic depression was excluded from DSM as a distinct disorder owing to the impact of ageing, genetics, and course of illness. We challenge these assertions using retrospective data collected from patients with depression. METHOD Electronic medical records of 1073 patients with depressive-spectrum disorders in 12 centres across Germany spanning from January 2010 to June 2013 were retrospectively reviewed. The diagnosis of melancholia was made using the Hamilton Depression Rating Scale 21 items (HAMD-21). Patients were followed up every 2 weeks and yearly until discharge from inpatient units. The final dataset consisted of 1014 patients; each had received a minimum of two complete observations. RESULTS At baseline, patients with melancholic depression had higher HAMD-21 score than did patients with non-melancholic depression (32.6 vs 23.13, p < 0.001). At the final visit, patients with melancholic depression responded to treatment more often than did patients with non-melancholic depression (81.3% vs 69.04%, p = 0.0156), whereas the two groups were comparable in terms of remission status (50.55 vs 48.68%, p = 0.1943). The relapse rate was higher in patients with melancholic depression than in patients with non-melancholic depression after 1 year (60% vs 45.01%, p = 0.0599), 2 years (77.78% vs 60.36%, p = 0.0233), and 4 years (80% vs 64.45%, p = 0.0452). CONCLUSION Melancholic depression has an identifiable constellation of symptoms and it is not just a severe form of major depression. Melancholic depression is not the result of age-related or pathoplastic changes. We advocate including melancholia as its own illness entity in the next edition of the DSM.
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Affiliation(s)
- R Gupta
- Headspace Youth Early Psychosis Program, Darwin, NT, Australia
| | - T Mirza
- Headspace Youth Early Psychosis Program, Darwin, NT, Australia
| | - M H Majeed
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - F Seemüller
- Kbo Lech-Mangfall Clinic, Garmisch-Partenkirchen, Germany
| | - H-J Moeller
- Department of Psychiatry, Ludwig Maximilian University, Germany
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Schennach R, Riedel M, Obermeier M, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt L, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke M, Rüther E, Klingberg S, Gastpar M, Möller HJ. What are depressive symptoms in acutely ill patients with schizophrenia spectrum disorder? Eur Psychiatry 2020; 30:43-50. [DOI: 10.1016/j.eurpsy.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022] Open
Abstract
AbstractBackground:Aim was to examine depressive symptoms in acutely ill schizophrenia patients on a single symptom basis and to evaluate their relationship with positive, negative and general psychopathological symptoms.Methods:Two hundred and seventy-eight patients suffering from a schizophrenia spectrum disorder were analysed within a naturalistic study by the German Research Network on Schizophrenia. Using the Calgary Depression Scale for Schizophrenia (CDSS) depressive symptoms were examined and the Positive and Negative Syndrome Scale (PANSS) was applied to assess positive, negative and general symptoms. Correlation and factor analyses were calculated to detect the underlying structure and relationship of the patient’s symptoms.Results:The most prevalent depressive symptoms identified were depressed mood (80%), observed depression (62%) and hopelessness (54%). Thirty-nine percent of the patients suffered from depressive symptoms when applying the recommended cut-off of a CDSS total score of > 6 points at admission. Negligible correlations were found between depressive and positive symptoms as well as most PANSS negative and global symptoms despite items on depression, guilt and social withdrawal. The factor analysis revealed that the factor loading with the PANSS negative items accounted for most of the data variance followed by a factor with positive symptoms and three depression-associated factors.Limitations:The naturalistic study design does not allow a sufficient control of study results for the effect of different pharmacological treatments possibly influencing the appearance of depressive symptoms.Conclusion:Results suggest that depressive symptoms measured with the CDSS are a discrete symptom domain with only partial overlap with positive or negative symptoms.
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Seemüller F, Riedel M, Obermeier M, Schennach-Wolff R, Spellmann I, Meyer S, Bauer M, Adli M, Kronmüller K, Ising M, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Möller HJ. The validity of self-rated psychotic symptoms in depressed inpatients. Eur Psychiatry 2020; 27:547-52. [DOI: 10.1016/j.eurpsy.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 12/22/2022] Open
Abstract
AbstractBackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P<0.001) and with the BDI total score (0.64, P<0.001). Moderate correlations were found for the MADRS (0.34, P<0.001), HAMD (0.37, P<0.001) and AMDP depression score (0.33, P<0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P<0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P<0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.
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Wolff-Menzler C, Gyßer S, Große C, Häfner S, Seemüller F, Godemann F, Wiegand H, Löhr M. Aufnahme- und Entlassentscheidungen in der Psychiatrie. Nervenarzt 2015; 87:753-9. [DOI: 10.1007/s00115-015-4385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Godemann F, Wolff-Menzler C, Löhr M, Nitschke R, Salize H, Seemüller F, Laengle G, Wolff J, Hauth I. Berechnung der Personalbemessung bei einer Umsetzung von 100 % Psych-PV. Nervenarzt 2015; 86:845-51. [DOI: 10.1007/s00115-015-4354-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Godemann F, Löhr M, Wiegand H, Wolff-Menzler C, Nitschke R, Seemüller F. Das neue Entgeltsystem in der Psychiatrie – gehören ältere Patienten zu den Verlierern? Eine Analyse auf der Grundlage der VIPP-Datenbank. Fortschr Neurol Psychiatr 2014; 82:634-9. [DOI: 10.1055/s-0034-1385266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Godemann
- Klinik für Psychiatrie und Psychotherapie, St. Joseph-Krankenhaus Berlin-Weißensee, Berlin
| | - M. Löhr
- Psychiatrie, Fachhochschule für Diakonie, Bielefeld
| | - H. Wiegand
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph-Krankenhaus, Berlin
| | - C. Wolff-Menzler
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen
| | - R. Nitschke
- Medizincontrolling, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - F. Seemüller
- Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen
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Berger M, Musil R, Seemüller F. [Long-term treatment of bipolar disorder]. Fortschr Neurol Psychiatr 2014; 82:346-360. [PMID: 24901318 DOI: 10.1055/s-0034-1366575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M Berger
- Klinik für Psychiatrie und Psychotherapie, Clienia Schlössli, Oetwil am See, Schweiz
| | - R Musil
- Klinik für Psychiatrie und Psychotherapie der Ludwig-Maximilians-Universität, München
| | - F Seemüller
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen
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Schennach R, Riesbeck M, Mayr A, Seemüller F, Maier W, Klingberg S, Heuser I, Klosterkötter J, Gastpar M, Schmitt A, Sauer H, Schneider F, Jäger M, Wölwer W, Gaebel W, Möller HJ, Riedel M. Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients? Acta Psychiatr Scand 2013; 127:474-81. [PMID: 22957829 DOI: 10.1111/acps.12006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the predictive validity of early response in first-episode schizophrenia within a 1-year follow-up trial and to compare the resulting cutoff to the currently proposed early response definition (20% improvement by week 2). METHOD Receiver operator characteristic (ROC) analyses were used to identify the predictive validity of the psychopathological improvement of treatment from week 1 to week 8, regarding the maintenance of response until week 52 as well as to define the most reasonable cutoff in 132 first-episode patients. The Youden Index (maximum of sensitivity and specificity) was used to compare the newly developed and the commonly used early response definition. RESULTS Starting with week 6, a reasonable validity to predict the maintenance of response was found (area under the curve = 0.721) with the best fitting cutoff being a 51.6% PANSS total score improvement. Using this cutoff 74 patients (56%) were correctly identified to become responder and maintain response during follow-up (sensitivity: 0.747). The Youden Index was higher applying the newly developed early response cutoff featuring higher specificity compared to the commonly used early response definition. CONCLUSION Regarding long-term treatment, it seems more appropriate to base predictions of the patient's maintenance of response not before 6 weeks of treatment.
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Affiliation(s)
- R Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich Department of Psychiatry and Psychotherapy, University of Göttingen, Germany.
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Seemüller F, Berger M, Musil R, Severus E, Dittmann S, Born C, Schaub A, Dargel S, Grunze H. [The challenge of treating bipolar outpatients]. Fortschr Neurol Psychiatr 2013; 81 Suppl 1:S35-9. [PMID: 23681716 DOI: 10.1055/s-0033-1335275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The course of bipolar illness comprises a wide range, which may vary between one single episode once every five years and a severe ultra rapid cycling course with mood changes within days. Even with optimal pharmacological treatment the functional outcome in bipolar patients is still poor. Underlying pathomechanisms are not fully understood yet. This article addresses three possible illness specific-aspects: cognitive defects, high relapse frequency and poor adherence. Causes as well as therapeutic interventions for these therapeutic pitfalls are summarised.
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Affiliation(s)
- F Seemüller
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München, Germany
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Seemüller F, Lewitzka U, Bauer M, Meyer S, Musil R, Schennach R, Riedel M, Doucette S, Möller HJ. The Relationship of Akathisia with Treatment Emergent Suicidality among Patients with First-Episode Schizophrenia Treated with Haloperidol or Risperidone. Pharmacopsychiatry 2012; 45:292-6. [DOI: 10.1055/s-0032-1309004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F. Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - U. Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M. Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - S. Meyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - R. Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - R. Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - M. Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - S. Doucette
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - H.-J. Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Schennach R, Meyer S, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Insight in schizophrenia-course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur Psychiatry 2012; 27:625-33. [PMID: 22542652 DOI: 10.1016/j.eurpsy.2012.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 12/23/2011] [Accepted: 01/04/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To analyse insight of illness during the course of inpatient treatment, and to identify influencing factors and predictors of insight. METHODS Insight into illness was examined in 399 patients using the item G12 of the Positive and Negative Syndrome Scale ("lack of insight and judgement"). Ratings of the PANSS, HAMD, UKU, GAF, SOFAS, SWN-K and Kemp's compliance scale were performed and examined regarding their potential association with insight. The item G12 was kept as an ordinal variable to compare insight between subgroups of patients. RESULTS Almost 70% of patients had deficits in their insight into illness at admission. A significant improvement of impairments of insight during the treatment (p<0.0001) was observed. At admission more severe positive and negative symptoms, worse functioning and worse adherence were significantly associated with poorer insight. Less depressive symptoms (p=0.0004), less suicidality (p=0.0218), suffering from multiple illness-episodes (p<0.0001) and worse adherence (p=0.0012) at admission were identified to be significant predictors of poor insight at discharge. CONCLUSION The revealed predictors might function as treatment targets in order to improve insight and with it outcome of schizophrenia.
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Affiliation(s)
- R Schennach
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstraße 7, 80336 Munich, Germany.
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12
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Schennach-Wolff R, Obermeier M, Seemüller F, Jäger M, Messer T, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Evaluating depressive symptoms and their impact on outcome in schizophrenia applying the Calgary Depression Scale. Acta Psychiatr Scand 2011; 123:228-38. [PMID: 21029053 DOI: 10.1111/j.1600-0447.2010.01608.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine depressive symptoms, their course during treatment, and influence on outcome. METHOD Weekly Calgary Depression Scale for Schizophrenia ratings were performed in 249 inpatients with schizophrenia. Early response was defined as a 20% reduction in the total score of the Positive and Negative Syndrome Scale for Schizophrenia from admission to week 2, response as a 50% reduction in the total score of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) from admission to discharge and remission according to the consensus criteria. RESULTS Thirty six per cent of the patients were depressed at admission, with 23% of them still being depressed at discharge. Depressed patients scored significantly higher on the PANSS negative and general psychopathology subscore, featured more impairments in subjective well-being (P < 0.0001) and functioning (P < 0.0001). They suffered from more suicidality (P = 0.0021), and had greater insight into their illness (P = 0.0105). No significant differences were found regarding early response, response, and remission. CONCLUSION Patients with depressive symptoms should be monitored closely, given the burden of negative symptoms, their impairments in well-being and functioning and the threat of suicidality.
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Affiliation(s)
- R Schennach-Wolff
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
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Henkel V, Seemüller F, Obermeier M, Adli M, Bauer M, Kronmüller K, Holsboer F, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Mayr A, Riedel M, Möller HJ. Relationship between baseline severity of depression and antidepressant treatment outcome. Pharmacopsychiatry 2010; 44:27-32. [PMID: 20981642 DOI: 10.1055/s-0030-1267177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Assessment of depression severity is of key importance, since several clinical guidelines recommend choice of treatment dependent on the depression severity grade. Using different tools to assess baseline severity may result in different outcomes. METHODS This paper describes the results of a multicentre, naturalistic study investigating the relationship between depression symptom severity (using 4 different measures of symptom severity) and clinical outcome among patients hospitalised for depression (N=1 014). Moreover, the impact of differences between methods of measuring depression severity has been investigated. Statistical analyses (univariate measurements, logistic regression models) were conducted to detect coherences and differences between the various methods of severity categorisation. RESULTS Results revealed different associations between outcome and classification methods. Response or remission rates varied if baseline severity was assessed by different instruments. Moreover, the number of responders increased with higher baseline severity grades of depression, whereas the number of remitters decreased. Additional analyses dependent on outcome criteria using continuous instead of categorical data revealed similar results. DISCUSSION Baseline severity may be only one of many other important clinical variables that mediate clinical outcome, but it is surely an important one deserving further research and consideration.
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Affiliation(s)
- V Henkel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Schennach-Wolff R, Möller HJ, Jäger M, Seemüller F, Obermeier M, Messer T, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Riedel M. A critical analysis and discussion of the appropriateness of the schizophrenia consensus remission criteria in clinical pharmaceutical trials. Pharmacopsychiatry 2010; 43:245-51. [PMID: 20927697 DOI: 10.1055/s-0030-1262788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this paper is to apply the proposed consensus remission criteria to an acutely ill inpatient sample at admission and evaluate their adaptability in this patient population and pharmaceutical trials. METHODS The Remission in Schizophrenia Working Group's consensus criteria were applied to 272 acutely ill schizophrenia patients. Patients were examined using the PANSS, HAMD, UKU and SWN-K total scales at admission as well as the GAF, SOFAS and the Strauss-Carpenter Prognostic Scale. Sociodemographic and clinical baseline variables were assessed using a standardized documentation system. RESULTS 33 patients (12%) fulfilled the symptom severity component of the proposed remission criteria already at baseline. Almost no significant differences were found when comparing patients with achieved and failed symptom severity component that would explain the hospitalization of the patients with achieved criteria despite their apparently mild psychopathological symptoms. The only explainable difference was that patients with an achieved symptom severity component had received significantly more antipsychotics and had suffered from significantly more life events before admission. CONCLUSION The present results raise the question whether the symptom severity threshold is adequate to identify patients in remission when applied in clinical trials.
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Affiliation(s)
- R Schennach-Wolff
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
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15
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Schennach-Wolff R, Jäger M, Seemüller F, Obermeier M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Outcome of suicidal patients with schizophrenia: results from a naturalistic study. Acta Psychiatr Scand 2010; 121:359-70. [PMID: 19878135 DOI: 10.1111/j.1600-0447.2009.01484.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Purpose was to assess suicidality before and at the time of admission in patients with schizophrenia and compare outcome differences. METHOD Biweekly PANSS (Positive and Negative Syndrome Scale), HAMD (Hamilton Depression Rating Scale) and UKU (Udvalg for Klinske Undersogelser Side Effect Rating Scale) ratings were evaluated in 339 in-patients with schizophrenic spectrum disorders. Response was defined as an initial 20% PANSS total score reduction at discharge, remission was defined according to the proposed consensus criteria by the Remission in Schizophrenia Working Group. RESULTS Suicidal patients (22%) scored significantly higher on the PANSS negative subscore, PANSS insight item and HAMD total score at admission and at discharge. They developed significantly more side effects. No differences were found concerning response and remission between the two patient subgroups. CONCLUSION Despite receiving significantly more antidepressants the suicidal patients suffered from significantly more depressive symptoms up to discharge, yet without differing regarding response and remission.
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Affiliation(s)
- R Schennach-Wolff
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
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Jäger M, Riedel M, Obermeier M, Schennach-Wolff R, Seemüller F, Messer T, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Kühn KU, Lemke MR, Rüther E, Klingberg S, Gastpar M, Bottlender R, Möller HJ. Time course of antipsychotic treatment response in schizophrenia: results from a naturalistic study in 280 patients. Schizophr Res 2010; 118:183-8. [PMID: 20181461 DOI: 10.1016/j.schres.2010.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the course of positive and negative symptoms during inpatient treatment and examine remission and response rates under routine clinical care conditions. METHODS Two hundred and eighty inpatients with schizophrenia (DSM-IV criteria) were assessed with the Positive and Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the symptom-severity component of the consensus criteria (Remission in Schizophrenia Working Group) as a rating of three or less in the relevant PANSS items at discharge, and response as a reduction of at least 20% in the PANSS total score from admission to discharge. RESULTS The mean duration of inpatient treatment was 54.8 days. Of the total sample, 78.5% achieved the criteria for response and 44.6% those for remission. Mean PANSS total scores decreased from 72.4 at admission to 52.5 at discharge (p<0.001). A reduction in PANSS total scores was found from visit to visit, up to week 8. The most pronounced decline was observed within the first two weeks of treatment. CONCLUSION Response rates were comparable to those found in efficacy studies, and remission rates were slightly higher. This may be explained by differences in the selection and the treatment of patients. Nevertheless, the findings might indicate that a complex naturalistic treatment approach is beneficial in terms of effectiveness.
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Affiliation(s)
- M Jäger
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstr 7, D-80336 Munich, Germany
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Riedel M, Schennach-Wolff R, Musil R, Dehning S, Cerovecki A, Opgen-Rhein M, Matz J, Seemüller F, Obermeier M, Engel RR, Müller N, Möller HJ, Spellmann I. Neurocognition and its influencing factors in the treatment of schizophrenia-effects of aripiprazole, olanzapine, quetiapine and risperidone. Hum Psychopharmacol 2010; 25:116-25. [PMID: 20196179 DOI: 10.1002/hup.1101] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To examine influencing variables of neurocognition in patients with schizophrenia and to predict cognition during antipsychotic treatment. METHODS Data were obtained from patients with an acute episode of schizophrenia participating in two double-blind and one open label trial comparing the effects of different atypical antipsychotics on cognition. In total, 129 patients were enrolled in this analysis. Cognitive function was assessed at admission, week 4 and 8. Efficacy and tolerability were assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and the Simpson Angus Sale (SAS). Patients were treated with aripirazole, olanzapine, quetiapine and risperidone. Regression analysis including mixed effect models was performed. RESULTS A significant improvement in all cognitive domains was observed from baseline to week 8. Regarding the antipsychotic treatment applied quetiapine seemed to achieve the most favourable cognitive improvement. Negative and depressive symptoms, the patient's age and the concomitant and antipsychotic treatment applied were observed to significantly influence and predict neurocognition. CONCLUSION The results may indicate that schizophrenia is a static disorder with trait and state dependent cognitive components especially in the memory domains. The influence of negative and depressive symptoms should be considered in daily clinical routine.
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Affiliation(s)
- M Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
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Schennach-Wolff R, Seemüller F, Mayr A, Maier W, Buchkremer G, Heuser I, Klosterkötter J, Gastpar M, Häfner H, Sauer H, Schneider F, Gaebel W, Moeller HJ, Riedel M. S35-01 - Clinical influencing factors of acute treatment outcome in first-episode schizophrenia patients. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Schennach-Wolff R, Mayr A, Seemüller F, Jäger M, Moeller HJ, Riedel M. PW01-192 - Development of a valid early improvement threshold to predict response and remission in FES. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Severus E, Fast K, Tomova N, Berger M, Obermeier M, Seemüller F, Dittmann S, Bernhard B, Möller HJ, Riedel M. S20-01 - Parathyroid hormone and cognitive deficits in lithium-treated bipolar patients. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Riedel M, Spellmann I, Schennach-Wolff R, Musil R, Dehning S, Cerovecki A, Opgen-Rhein M, Matz J, Seemüller F, Obermeier M, Severus E, Engel RR, Müller N, Möller HJ. Effect of aripiprazole on cognition in the treatment of patients with schizophrenia. Pharmacopsychiatry 2009; 43:50-7. [PMID: 20336597 DOI: 10.1055/s-0029-1239539] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the cognitive effects of aripiprazole in inpatients with schizophrenia. METHODS This was an investigator-initiated, open label eight-week trial evaluating 56 inpatients with the DSM-IV diagnosis of schizophrenia. Efficacy was assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and tolerability was assessed each week using the Udvalg for Klinske Undersogelser side effect rating scale (UKU). Cognitive function was assessed at baseline, week 4 and week 8. RESULTS Aripiprazole showed significant improvement in PANSS total score and all subscores between baseline and endpoint visit. The substance was very well tolerated. Patients improved significantly in verbal memory, reaction time and reaction quality/attention from baseline to week eight. Furthermore, mean z-values of individual cognitive domains summarized in a global cognitive index improved significantly from baseline to week eight. DISCUSSION Our results suggest that aripiprazole provides a valuable treatment option for patients with schizophrenia.
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Affiliation(s)
- M Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Born C, Seitz NN, Grunze H, Vieta E, Dittmann S, Seemüller F, Amann B. Preliminary results of a fine-grain analysis of mood swings and treatment modalities of bipolar I and II patients using the daily prospective life-chart-methodology. Acta Psychiatr Scand 2009; 120:474-80. [PMID: 19485960 DOI: 10.1111/j.1600-0447.2009.01412.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aimed to increase the knowledge about the detailed course differences between different forms of bipolar disorder. METHOD Using the prospective life-chart-clinician version, we compared the fine-grain analysis of mood swings and treatment modalities of 18 bipolar II with 31 bipolar I patients. RESULTS During an observational period of a mean of 26 months we observed an increase of euthymic days, and a decrease of (sub)depressive and (hypo)manic days. Days in a (sub)depressed state were more frequent than days of (hypo)mania as well as days of subdepression or hypomania in comparison to days of full-blown depression or mania. Bipolar II patients showed an increase in hypomanic days receiving more frequently antidepressants. Bipolar I patients, with a decrease of manic days, were significantly taking more often mood stabilizers. CONCLUSION Treatment in a specialized bipolar clinic improves the overall outcome, but bipolar II disorder seems to be still treated sub-optimally with a possible iatrogenic increase of hypomanic days.
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Affiliation(s)
- C Born
- Department of Psychiatry, Ludwig-Maximilian- University, Munich, Germany.
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Schennach-Wolff R, Zill P, Jäger M, Seemüller F, Obermeier M, Bondy B, Möller HJ, Riedel M. Outcome of suicidal patients with schizophrenia and the possible genetic association: results from a naturalistic study. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Born C, Dittmann S, Biedermann C, Seemüller F, Amann B, Grunze H, Schärer LO. Validity of the National Institutes of Mental Health Life Chart self version (NIHM-sLCM). Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schennach-Wolff R, Jäger M, Mayr A, Seemüller F, Möller HJ, Riedel M. Depressive symptoms and their influence and predictive validity on treatment outcome in patients with first-episode schizophrenia. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Obermeier M, Mayr A, Schennach-Wolff R, Seemüller F, Möller HJ, Riedel M. How to handle the PANSS in statistical analyses. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Born C, Bernhard B, Dittmann S, Seemüller F, Grunze H. Lamotrigine in bipolar disorder: results of a mirror-image evaluation using the NIMH Lifechart-Methodology. J Affect Disord 2009; 115:241-5. [PMID: 18775569 DOI: 10.1016/j.jad.2008.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Revised: 07/18/2008] [Accepted: 07/19/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lamotrigine (LTG) is characterized by prophylactic efficacy against bipolar depression (BPD). We evaluated retro- and prospectively the naturalistic treatment outcome with LTG analysing lifecharts of patients from the bipolar outpatient clinic. METHODS Lifechart-data of 20 patients routinely treated with LTG for the first time were evaluated, comparing number and duration of manic, depressive and mixed episodes prior to LTG and after initiation of treatment (mirror-image evaluation). The mean prospective evaluation period based on the lifechart was 18.1 months. Also we compared the number and severity of "switches" from depression in mania. Additionally, CGI-BP, YMRS, IDS-C and GAF scores at the monthly visits were compared for time after LTG initiation. RESULTS We found no significant differences in the absolute number of manic, depressive and mixed episodes, respectively, before and after initiation of LTG. The number of "switches" did not differ significantly. A significant difference in duration of time patients suffered from a depressive state before and after initiation of LTG was observed in favour of LTG treatment (p=.006). A similar finding was observed for the time spent in mixed episodes (p<.001). No significant difference was observed for scores of mood scales at the monthly visits (CGI-BP, YMRS, IDS-C, GAF). LIMITATIONS Generalizability of these results is limited due to the uncontrolled design and the issues in comparing prospective and retrospective data. CONCLUSION These data underline not only the antidepressant profile of LTG, but also the usefulness of the Lifechart-Methodology (LCM) in the evaluation of treatment outcome under routine conditions.
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Affiliation(s)
- C Born
- Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstr. 7, D-80336, Munich, Germany.
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Severus WE, Kleindienst N, Seemüller F, Frangou S, Möller HJ, Greil W. What is the optimal serum lithium level in the long-term treatment of bipolar disorder--a review? Bipolar Disord 2008; 10:231-7. [PMID: 18271901 DOI: 10.1111/j.1399-5618.2007.00475.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is substantial uncertainty about the most efficacious serum lithium level for the long-term treatment of bipolar disorder (BD). This review focuses on the available evidence taking into consideration the effects of previous lithium history, changes in lithium level and polarity of relapse or recurrence. METHODS We conducted a MEDLINE search, using the MeSH Terms 'bipolar disorder' and 'lithium' together with 'randomized controlled trial' or 'controlled clinical trial' covering the time span from 1966 to March 2006. We only included studies reporting on the long-term treatment of mood disorders where patients with BD were examined as a separate group and were assigned to precisely specified target ranges of lithium level. RESULTS The minimum efficacious serum lithium level in the long-term treatment of bipolar disorder was 0.4 mmol/L with optimal response achieved at serum levels between 0.6-0.75 mmol/L. Lithium levels >0.75 mmol/L may not confer additional protection against overall morbidity but may further improve control of inter-episode manic symptoms. Abrupt reduction of serum levels of more than 0.2 mmol/L was associated with increased risk of relapse. CONCLUSIONS In the long-term treatment of bipolar disorder clinicians should initially aim for serum lithium levels of 0.6-0.75 mmol/L, while higher levels may benefit patients with predominantly manic symptoms.
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Affiliation(s)
- W E Severus
- Department of Psychiatry, University of Munich, Munich, Germany.
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Severus E, Kleindienst N, Seemüller F, Frangou S, Möller HJ, Greil W. What is the optimal serum lithium level in the long-term treatment of bipolar disorder? A review. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-1002803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seemüller F, Riedel M, Mayr A, Mundt C, Holsboer F, Marneros A, Laux G, Bender W, Adli M, Heuser I, Zeiler J, Gaebel W, Jäger M, Möller HJ, Henkel V. Do data from a large prospective naturalistic study (N=1014, MDD) support the new FDA recommendation concerning antidepressants suicidality risk? Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Born C, Seitz NN, Grunze H, Dittmann S, Seemüller F, Amann B. Are we treating bipolar II disorder insufficient? Preliminary results of a sample of bipolar patients using the prospective NIMH Lifechart-Methodology. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dittmann S, Seemüller F, Schwarz MJ, Kleindienst N, Stampfer R, Zach J, Born C, Bernhard B, Fast K, Grunze H, Engel RR, Severus E. Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results. Bipolar Disord 2007; 9:63-70. [PMID: 17391351 DOI: 10.1111/j.1399-5618.2007.00412.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Elevated homocysteine (Hcy) levels have been demonstrated to have a negative impact on cognitive functioning in healthy elderly people. Further studies suggest that they are an independent risk factor for dementia, in particular for Alzheimer's disease. Bipolar disorder is also associated with cognitive impairment. However, the pathophysiological mechanisms of these deficits have not been elucidated yet. This study examines the role of Hcy on cognition and its impact on psychosocial functioning in euthymic bipolar patients. METHODS A total of 55 euthymic bipolar patients and 17 healthy controls were enrolled in the study. Neuropsychological assessments consisted of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Trail Making Test (TMT), the Weschler Adult Intelligence Scale, 3(rd) edition (WAIS-III) subtest Letter-Number Sequencing Test (LNST) and the HAWIE-R (German version of the WAIS-R) subtest Information. Psychosocial functioning was assessed using the Social Adjustment Scale (SAS). To obtain plasma levels of Hcy, blood samples were collected in EDTA tubes, immediately put on ice, centrifuged within 15 min and stored at -80 degrees C. Total Hcy concentration was measured using high-performance liquid chromatography. RESULTS In the neuropsychological tests, patients differed significantly from healthy controls on the TMT B and the RBANS composite indices Language, Attention and Total Score. No differences were found on the HAWIE-R subtest Information, the TMT A, LNST or the RBANS composite indices Immediate Memory, Visuospatial/Constructional Abilities and Delayed Memory. Mean Hcy levels were 9.8 +/- 3.2 microm/L in the patient group and 7.8 +/- 2.1 microm/L in the control group, respectively (p = 0.012). In the patient group Hcy levels significantly correlated with gender, diagnosis and RBANS index scores for Immediate Memory, Language, Attention and Total Score. Linear regression analyses revealed a significant and independent association of Hcy levels with Immediate Memory and TMT B scores in the patient group. Homocysteine levels did not correlate with any measure in the control group. Spearman's correlations indicated that psychosocial functioning in bipolar patients is not associated with clinical variables apart from time in remission. However, it correlated significantly with working memory measures (LNST). No relationship could be determined between psychosocial functioning and Hcy plasma levels. CONCLUSIONS Elevated Hcy levels seem to be associated with cognitive impairment in euthymic bipolar patients, but not with psychosocial functioning. More studies are needed to clarify the role of Hcy in cognition in bipolar disorder.
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Affiliation(s)
- S Dittmann
- Department of Psychiatry, Ludwigs-Maximilians-University, Munich, Germany.
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Diebold J, Amann G, Seemüller F, Mayr D. Diagnostic and molecular genetic pathology of serous borderline tumours of the ovary. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.cdip.2004.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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