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Pinto JV, Crippa JAS, Ceresér KM, Vianna-Sulzbach MF, Silveira Júnior ÉDM, Santana da Rosa G, Testa da Silva MG, Hizo GH, Simão Medeiros L, Santana de Oliveira CE, Bristot G, Campos AC, Guimarães FS, Hallak JEC, Zuardi AW, Yatham LN, Kapczinski F, Kauer-Sant’Anna M. Cannabidiol as an Adjunctive Treatment for Acute Bipolar Depression: A Pilot Study: Le cannabidiol comme traitement d'appoint de la dépression bipolaire aiguë : une étude pilote. Can J Psychiatry 2024; 69:242-251. [PMID: 37920963 PMCID: PMC10924581 DOI: 10.1177/07067437231209650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The treatment of bipolar depression remains challenging due to the limited effective and safe therapeutic options available; thus, developing newer treatments that are effective and well tolerable is an urgent unmet need. The objective of the present trial was to test 150 to 300 mg/day of cannabidiol as an adjunctive treatment for bipolar depression. METHOD A randomized, double-blind, placebo-controlled pilot study to assess the efficacy of adjunctive cannabidiol in bipolar depression was used. Efficacy parameters were changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 8. Secondary outcomes included response and remission rates, changes in anxiety and psychotic symptoms, and changes in functioning. Patients continued double-blind treatment until week 12 to monitor for adverse effects, laboratory analysis, and manic symptoms. Study registry: NCT03310593. RESULTS A total of 35 participants were included. MADRS scores significantly decreased from baseline to the endpoint (placebo, -14.56; cannabidiol, -15.38), but there was no significant difference between the groups. Similarly, there were no other significant effects on the secondary outcomes. However, an exploratory analysis showed a significant effect of cannabidiol 300 mg/day in reducing MADRS scores from week 2 to week 8 (placebo, -6.64; cannabidiol, -13.72). There were no significant differences in the development of manic symptoms or any other adverse effects. CONCLUSION Cannabidiol did not show significantly higher adverse effects than placebo. Despite the negative finding on the primary outcome, an exploratory analysis suggested that cannabidiol should be further studied in bipolar depression in higher doses of at least 300 mg/day and under research designs that could better control for high placebo response.
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Affiliation(s)
- Jairo Vinícius Pinto
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Psychiatry and Behavioural Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - José Alexandre S. Crippa
- Department of Neuroscience and Behavioural Sciences, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology in Translational Medicine (INCT–TM), CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
| | - Keila Maria Ceresér
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Psychiatry and Behavioural Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Miréia Fortes Vianna-Sulzbach
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Psychiatry and Behavioural Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Érico de Moura Silveira Júnior
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Psychiatry and Behavioural Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Santana da Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Gabriel Henrique Hizo
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leonardo Simão Medeiros
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Giovana Bristot
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alline Cristina Campos
- National Institute for Science and Technology in Translational Medicine (INCT–TM), CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
- Department of Pharmacology, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Francisco Silveira Guimarães
- National Institute for Science and Technology in Translational Medicine (INCT–TM), CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
- Department of Pharmacology, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jaime E. C. Hallak
- Department of Neuroscience and Behavioural Sciences, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology in Translational Medicine (INCT–TM), CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
| | - Antonio W. Zuardi
- Department of Neuroscience and Behavioural Sciences, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology in Translational Medicine (INCT–TM), CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Flávio Kapczinski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Psychiatry and Behavioural Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- National Institute for Science and Technology in Translational Medicine (INCT–TM), CNPq/FAPESP/CAPES, Ribeirão Preto, Brazil
- Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, ON, Canada
| | - Márcia Kauer-Sant’Anna
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Programme in Psychiatry and Behavioural Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduate Programme in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Cristiano VB, Vieira Szortyka MF, Lobato MI, Ceresér KM, Belmonte-de-Abreu P. Postural changes in different stages of schizophrenia is associated with inflammation and pain: a cross-sectional observational study. Int J Psychiatry Clin Pract 2017; 21:104-111. [PMID: 27868463 DOI: 10.1080/13651501.2016.1249892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the relationship between posture and inflammatory response markers (C-reactive protein [CRP] and von Willebrand factor [vWF]) in schizophrenics. METHODS Forty patients with stable schizophrenia were divided into early-stage (<10 years since first episode, n = 15) and late-stage (≥10 years since first episode, n = 25) groups. Both groups were compared to controls (n = 26). All participants underwent postural assessment by biophotogrammetry. Cases alone underwent blood collection. The significance level was set at 5%, and analyses were carried out in SPSS 18.0. RESULTS In the early-stage group, 15 postural angles were significantly different from their reference ranges, whereas in the late-stage group, only seven angles were significantly different. In comparison with the control group, only six angles were significantly different. There was no difference in inflammation markers between the early- and late-stage groups. However, CRP levels were higher in cases with greater disease severity, and vWF was associated with forward head posture. Pain correlated with five postural angles, and late-stage patients reported more pain than early-stage cases. CONCLUSIONS CRP was associated with disease severity, while vWF and pain were associated with forward head posture, hyperlordosis and scoliosis, suggesting an association between vascular inflammation and pain, with an influence on posture.
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Affiliation(s)
- Viviane Batista Cristiano
- a PhD Students of the Psychiatry Program of the Federal University of Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | | | - Maria Inês Lobato
- b Department of Psychiatry of the Hospital de Clinicas de Porto Alegre (HCPA) , Porto Alegre , Brazil
| | - Keila Maria Ceresér
- b Department of Psychiatry of the Hospital de Clinicas de Porto Alegre (HCPA) , Porto Alegre , Brazil.,c Professor of the Program of Post Graduation in Psychiatry at the Federal University of Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | - Paulo Belmonte-de-Abreu
- b Department of Psychiatry of the Hospital de Clinicas de Porto Alegre (HCPA) , Porto Alegre , Brazil.,c Professor of the Program of Post Graduation in Psychiatry at the Federal University of Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
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Szortyka MFV, Cristiano VB, Ceresér KM, Francesconi LP, Lobato MI, Gama C, Belmonte-de-Abreu P. Physical Functional Capacity and C-Reactive Protein in Schizophrenia. Front Psychiatry 2016; 7:131. [PMID: 27547191 PMCID: PMC4974248 DOI: 10.3389/fpsyt.2016.00131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/12/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Schizophrenia is a severe, debilitating mental disorder that affects both the physical health and the functional capacity of patients, causing great impairment throughout the life course. Although physical and cognitive impairments may represent different expressions of a single systemic inflammatory process, little is known about the relationship between motor function and schizophrenia. OBJECTIVE To evaluate physical functional capacity in patients with schizophrenia and ascertain whether it correlates with markers of inflammation, disease severity, and pharmacotherapy. METHODS Cross-sectional study using a convenience sampling strategy. Forty patients with stable schizophrenia, undergoing treatment, were recruited from the Outpatient Program of Hospital de Clínicas de Porto Alegre, University Hospital linked to Public Health System. Physical functional capacity was assessed by the 6-min walk test (6MWT), and inflammatory markers were measured by C-reactive protein (CRP) and Von Willebrand factor. RESULTS Mean functional capacity and clinical variables differed among patients and Brazilian population regarding heart rate (p = 0.004), diastolic (p = 0.001) and systolic (p < 0.001) blood pressure, respiratory rate (p < 0.001), CRP (p = 0.015), Borg Scale of Perceived Exertion scores (BSPE) (p < 0.001), and 6MWT both in men (p < 0.001) and women (p = 0.024). Additionally, 6MWT and dyspnea in BSPE were positively associated with CRP (r = -0.369, p = 0.019) and (r = -0.376, p = 0.017) and (r = 0.354, p = 0.025 and r = 0.535, p < 0.001, respectively). CONCLUSION The present study detected significant association between measures of functional impairment and markers of inflammation, especially elevated CRP in a group of stable outpatients with DSM-IV and ICD10 diagnosis of schizophrenia. Possible explanations for the associations could be linked to continued use of antipsychotics, although underlying neuroinflammatory mechanisms directly related to illness (schizophrenia) could not be ruled out. The findings of this study expand evidences of neuroinflammation to systemic inflammation in schizophrenia linking it to alterations of physical functional capacity and point to the need of additional studies exploring general inflammation and novel therapeutic interventions.
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Affiliation(s)
- Michele Fonseca Vieira Szortyka
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Rio Grande do Sul , Brazil
| | - Viviane Batista Cristiano
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Rio Grande do Sul , Brazil
| | - Keila Maria Ceresér
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Rio Grande do Sul , Brazil
| | - Lenise Petter Francesconi
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Rio Grande do Sul , Brazil
| | - Maria Inês Lobato
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Department of Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Schizophrenia Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Clarissa Gama
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Department of Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Schizophrenia Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo Belmonte-de-Abreu
- Post-Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Department of Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Schizophrenia Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Chiarani F, Fries GR, Stertz L, Ceresér KM, Wyse ATS, Kapczinski FP, Kunz M. Expression of matrix metalloproteinases in patients with bipolar disorder. Braz J Psychiatry 2013; 35:375-9. [PMID: 24402212 DOI: 10.1590/1516-4446-2012-1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/16/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE High cardiovascular mortality rates have been reported in patients with bipolar disorder (BD). Studies indicate that matrix metalloproteinases (MMPs) are implicated in cardiovascular diseases. We evaluated the expression pattern of MMP-2 and MMP-9 in blood from patients with BD during acute mania and after euthymia, in comparison with healthy controls. METHODS Twenty patients and 20 controls were recruited and matched for sex and age. MMP messenger RNA (mRNA) levels were measured using real-time quantitative polymerase chain reaction (PCR). Body mass index (BMI) was calculated for all subjects. RESULTS There were no significant differences in MMP-2 and MMP-9 mRNA expression between patients and controls. mRNA levels were not significantly different during mania and euthymia. However, MMP-2 mRNA levels were negatively associated with BMI in BD patients and positively associated with BMI in controls. There was no difference in the pattern of MMP-9 expression between patients and controls. CONCLUSIONS Our results suggest a different pattern of association between MMP-2 and BMI in BD patients as compared with controls. Despite some study limitations, we believe that the role of MMPs in BD should be further investigated to elucidate its relationship with cardiovascular risk.
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Affiliation(s)
- Fábria Chiarani
- Molecular Psychiatry Unit and National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto AlegreRS, Brazil
| | - Gabriel Rodrigo Fries
- Molecular Psychiatry Unit and National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto AlegreRS, Brazil
| | - Laura Stertz
- Molecular Psychiatry Unit and National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto AlegreRS, Brazil
| | - Keila Maria Ceresér
- Molecular Psychiatry Unit and National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto AlegreRS, Brazil
| | - Angela T S Wyse
- Graduate Program in Biological Sciences, Biochemistry, UFRGS, Porto AlegreRS, Brazil
| | - Flávio Pereira Kapczinski
- Molecular Psychiatry Unit and National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto AlegreRS, Brazil
| | - Maurício Kunz
- Molecular Psychiatry Unit and National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto AlegreRS, Brazil
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Chiarani F, Tramontina JF, Ceresér KM, Kunz M, Paim L, Vargas CR, Sitta A, Machado SP, Wyse ATDS, Kapczinski FP. Homocysteine and other markers of cardiovascular risk during a manic episode in patients with bipolar disorder. Rev Bras Psiquiatr 2013; 35:157-60. [DOI: 10.1590/1516-4446-2012-0797] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/14/2012] [Indexed: 11/22/2022]
Affiliation(s)
- Fábria Chiarani
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; UFRGS, Brazil
| | | | | | - Maurício Kunz
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; UFRGS, Brazil
| | - Leonardo Paim
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | | | | | - Flávio Pereira Kapczinski
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; UFRGS, Brazil; UFRGS, Brazil; UFRGS, Brazil
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Thomé ES, Dargél AA, Migliavacca FM, Potter WA, Jappur DMC, Kapczinski F, Ceresér KM. Stigma experiences in bipolar patients: the impact upon functioning. J Psychiatr Ment Health Nurs 2012; 19:665-71. [PMID: 22093281 DOI: 10.1111/j.1365-2850.2011.01849.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
The aim of this study was to investigate the impact of self-rated stigma and functioning in patients with bipolar disorder in South Brazil. This is a cross-sectional study. Sixty participants with bipolar disorder were recruited from an outpatient Bipolar Disorder Program. Experiences with and impact of perceived stigma were evaluated using the Inventory of Stigmatizing Experiences. Functional impairment was assessed with the Functioning Assessment Short Test (FAST). Higher scores of self-perceived stigma were correlated with higher FAST scores, indicating more disability. After linear correlation analysis, current depressive symptoms, age at onset of treatment, age at diagnosis and functioning were correlated with self-perceived stigma. The study demonstrated a correlation between stigma and poor functioning in bipolar disorder. Perceived stigma is really important to individuals with bipolar disorder, both to how they experience their illness and to its results on functioning. Potential consequences of such results for mental health care professionals are discussed. Differential clinical features, sociocultural factors and the sample size limit the generalization of the present findings.
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Affiliation(s)
- E S Thomé
- Hospital das Clínicas de Porto Alegre and Post-Graduate Medical Sciences Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Kunz M, Ceresér KM, Goi PD, Fries GR, Teixeira AL, Fernandes BS, Belmonte-de-Abreu PS, Kauer-Sant'Anna M, Kapczinski F, Gama CS. Serum levels of IL-6, IL-10 and TNF-α in patients with bipolar disorder and schizophrenia: differences in pro- and anti-inflammatory balance. ACTA ACUST UNITED AC 2012; 33:268-74. [PMID: 21971780 DOI: 10.1590/s1516-44462011000300010] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 07/22/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Previous reports suggest that cytokines act as potential mediators of the interaction between the immune and neuroendocrine systems, and that a proinflammatory state may be associated with bipolar disorder and schizophrenia. The aim is to compare cytokine levels in both disorders. METHOD Twenty euthymic bipolar disorder patients, 53 chronic stabilized schizophrenia patients and 80 healthy controls were recruited. Subjects were all non-smokers and non-obese. Cytokines TNF-α, IL-6, and IL-10 were examined by sandwich ELISA. RESULTS IL-6 levels were increased in schizophrenia patients when compared to controls (p < 0.0001) and euthymic bipolar disorder patients (p < 0.0001). IL-6 levels were no different in controls compared to euthymic bipolar disorder patients (p = 0.357). IL-10 was lower in controls compared to schizophrenia patients (p = 0.001) or to bipolar disorder patients (p = 0.004). There was no significant difference in TNF-α serum levels among the groups (p = 0.284). Gender-based classification did not significantly alter these findings, and no correlation was found between the antipsychotic dose administered and cytokine levels in patients with schizophrenia. DISCUSSION These findings evidence a chronic immune activation in schizophrenia. Bipolar disorder seems to present an episode-related inflammatory syndrome. Increased anti-inflammatory factor IL-10 in bipolar disorder and schizophrenia suggests different patterns of inflammatory balance between these two disorders. Results further support the need to investigate cytokines as possible biomarkers of disease activity or treatment response.
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Affiliation(s)
- Mauricio Kunz
- Bipolar Disorder Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Sória LDS, Gubert CDM, Ceresér KM, Gama CS, Kapczinski F. Increased serum levels of C3 and C4 in patients with schizophrenia compared to eutymic patients with bipolar disorder and healthy. Revista Brasileira de Psiquiatria 2012. [DOI: 10.1590/s1516-44462012000100022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Santos Sória LD, Moura Gubert CD, Ceresér KM, Gama CS, Kapczinski F. Increased serum levels of C3 and C4 in patients with schizophrenia compared to eutymic patients with bipolar disorder and healthy. Braz J Psychiatry 2012; 34:119-120. [PMID: 22392401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Kunz M, Ceresér KM, Goi PD, Fries GR, Teixeira AL, Fernandes BS, Belmonte-de-Abreu PS, Kauer-Sant'Anna M, Kapczinski F, Gama CS. Serum levels of IL-6, IL-10 and TNF-α in patients with bipolar disorder and schizophrenia: differences in pro- and anti-inflammatory balance. Rev Bras Psiquiatr 2011. [DOI: 10.1590/s1516-44462011005000009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fernandes BS, Gama CS, Ceresér KM, Yatham LN, Fries GR, Colpo G, de Lucena D, Kunz M, Gomes FA, Kapczinski F. Brain-derived neurotrophic factor as a state-marker of mood episodes in bipolar disorders: a systematic review and meta-regression analysis. J Psychiatr Res 2011; 45:995-1004. [PMID: 21550050 DOI: 10.1016/j.jpsychires.2011.03.002] [Citation(s) in RCA: 273] [Impact Index Per Article: 21.0] [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] [Received: 12/27/2010] [Revised: 02/20/2011] [Accepted: 03/03/2011] [Indexed: 11/24/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) plays a central role in synaptic plasticity and neurogenesis. Bipolar disorder (BD) is among the most disabling of all psychiatric disorders and is associated with poor outcomes. Some studies suggest that BDNF levels decrease during mood states and remain normal during euthymia, but other studies have contradicted this paradigm. Therefore, the aim of this study was to perform a meta-analysis of all studies that measured peripheral BDNF levels in adults with BD. We conducted a systematic review using electronic databases. Inclusion criteria were studies that measured BDNF in plasma or serum in vivo in adult patients with BD. The resulting studies were compiled to measure the effect sizes (ESs) of the differences in BDNF levels between BD patients in different mood states and controls. Thirteen studies were included with a total of 1113 subjects. The BDNF levels were decreased in both mania and depression when compared to controls (ES -0.81, 95% CI -1.11 to -0.52, p < 0.0001 and ES -0.97, 95% CI -1.79 to -0.51, p = 0.02, respectively). The BDNF levels were not different in euthymia when compared to controls (ES -0.20, 95% CI -0.61 to 0.21, p = 0.33). Meta-regression analyses in euthymia showed that age (p < 0.0001) and length of illness (p = 0.04) influenced the variation in ES. There was also an increase in BDNF levels following the treatment for acute mania (ES -0.63, 95% CI -1.11 to -0.15, p = 0.01). In conclusion, BDNF levels are consistently reduced during manic and depressive episodes and recover after treatment for acute mania. In euthymia, BDNF decreases with age and length of illness. These data suggest that peripheral BDNF could be used as a biomarker of mood states and disease progression for BD.
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Francesconi LP, Ceresér KM, Mascarenhas R, Stertz L, Gama CS, Belmonte-de-Abreu P. Increased annexin-V and decreased TNF-α serum levels in chronic-medicated patients with schizophrenia. Neurosci Lett 2011; 502:143-6. [PMID: 21741441 DOI: 10.1016/j.neulet.2011.06.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/06/2011] [Accepted: 06/17/2011] [Indexed: 12/22/2022]
Abstract
Schizophrenia (SZ) is a chronic severe mental disorder. Increased inflammatory processes have been shown in acute and chronic SZ. Apoptotic processes may alter the neuronal network and are involved in the pathogenesis of several neurodegenerative diseases, such as SZ. Annexin-V seems to have a role on inhibition of pro-inflammatory activities during apoptosis. Tumor necrosis factor (TNF-alpha) is a cytokine involved in systemic inflammation and is a member of a group of cytokines which stimulate acute phase reactions. A chronic immune activation in SZ has been shown. The aim of this study was to compare annexin-V and TNF-alpha serum levels in chronic medicated patients with SZ and healthy controls. Thirty-eight outpatients from the HCPA Schizophrenia Program and 38 healthy controls were enrolled to this study protocol. Annexin-V and TNF-alpha serum levels were measured with ELISA. Serum annexin-V levels were significantly higher in patients with SZ than in controls (p<0.001) and TNF-alpha significantly lower (p<0.001). The present result of increased annexin-V and decreased serum levels of TNF-alpha compared to controls may be a result of the stabilization phase of psychosis and a reduction in metabolic brain aggression. In this complex picture, increased levels of annexin-V and decreased levels of TNF-alpha in our sample would be explained by illness stability and chronic treatment. Our findings support the hypothesis of a state dependant process of inflammation in SZ. Further prospective studies to clarify the findings described in this paper are needed.
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Affiliation(s)
- L P Francesconi
- Programa de Pós-Graduacão em Medicina, Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Cacilhas AA, Magalhães PVDS, Ceresér KM, Walz JC, Weyne F, Rosa AR, Vieta E, Kapczinski F. Bipolar disorder and age-related functional impairment. Rev Bras Psiquiatr 2009; 31:354-7. [DOI: 10.1590/s1516-44462009000400012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Although bipolar disorder is a major contributor to functional impairment worldwide, an independent impact of bipolar disorder and ageing on functioning has yet to be demonstrated. The objective of the present study was to evaluate the effect of bipolar disorder on age-related functional status using matched controls as a standard. METHOD: One-hundred patients with bipolar disorder and matched controls were evaluated for disability. Age-related effects controlled for confounders were cross-sectionally evaluated. RESULTS: Patients were significantly more impaired than controls. Regression showed effects for aging in both groups. The effect, size, however, was significantly stronger in patients. CONCLUSION: Bipolar disorder was an important effect modifier of the age impact on functioning. While a longitudinal design is needed to effectively demonstrate this different impact, this study further depicts bipolar disorder as a chronic and progressively impairing illness.
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Affiliation(s)
| | | | | | | | | | - Adriane Ribeiro Rosa
- Universidade Federal do Rio Grande do Sul, Brazil; University of Barcelona, Spain
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14
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de Oliveira GS, Ceresér KM, Fernandes BS, Kauer-Sant'Anna M, Fries GR, Stertz L, Aguiar B, Pfaffenseller B, Kapczinski F. Decreased brain-derived neurotrophic factor in medicated and drug-free bipolar patients. J Psychiatr Res 2009; 43:1171-4. [PMID: 19473667 DOI: 10.1016/j.jpsychires.2009.04.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [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: 02/20/2009] [Revised: 04/08/2009] [Accepted: 04/09/2009] [Indexed: 11/24/2022]
Abstract
Bipolar disorder (BD) has been associated with abnormalities in neuroplasticity and previous studies suggest an important role for BDNF in the pathophysiology of BD. The confounding effect of the use of medication in these studies has been considered a limitation. Thus, studies with both drug-free and medicated patients are necessary to assess the role of medication in serum BDNF levels. Twenty-two manic and depressed drug-free and 22 medicated BD type I patients were matched to 22 controls according to sex and age in a cross-sectional study. BDNF serum levels were assessed using sandwich-ELISA. Serum BDNF levels in drug-free (0.23+/-0.09), and medicated (0.29+/-0.19) BD patients were decreased when compared to controls (0.40+/-0.12) - drug-free/medicated vs. control p<0.001. The BDNF levels did not differ between medicated and drug-free BD patients. When analyzing patients according to mood states, serum BDNF levels were lower in BD patients during both manic (0.28+/-0.11) and depressive episodes (0.22+/-0.17), as compared with healthy controls (0.40+/-0.12) - manic/depressed patients vs. controls p<0.001. Results suggest that the association of lower serum BDNF and BD mood episodes is kept even in medicated patients, which strengthens the notion that BDNF serum levels may be considered a biomarker of mood episodes in BD.
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Cacilhas AA, Magalhães PVDS, Ceresér KM, Walz JC, Weyne F, Rosa AR, Vieta E, Kapczinski F. Validity of a short functioning test (FAST) in Brazilian outpatients with bipolar disorder. Value Health 2009; 12:624-627. [PMID: 19900260 DOI: 10.1111/j.1524-4733.2008.00481.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES As the use of functioning outcomes is increasingly being advocated in multinational clinical trials and comparative studies, making available instruments with known validity and reliability in several languages is required. Here we present data on the Portuguese validation of the Functioning Assessment Short Test (FAST), which was explicitly designed to gauge functioning dimensions empirically linked to bipolar disorder. METHODS One hundred patients with bipolar disorder and matched controls were assessed with the FAST, which was evaluated regarding discriminant, content and construct validity, concurrent validity with functioning instruments, internal consistency and test-retest reliability. RESULTS The FAST displayed a five-factor structure very similar to its conceptualization, successfully discriminated patient and control groups, and correlated highly with other functioning measures; it also showed excellent test-retest reliability and internal consistency. CONCLUSIONS The FAST is a measure with sufficient validity and reliability, with potential for the use in international clinical trials and comparative studies.
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Cardoso BM, Kauer Sant'Anna M, Dias VV, Andreazza AC, Ceresér KM, Kapczinski F. The impact of co-morbid alcohol use disorder in bipolar patients. Alcohol 2008; 42:451-7. [PMID: 18760714 DOI: 10.1016/j.alcohol.2008.05.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 05/26/2008] [Accepted: 05/28/2008] [Indexed: 10/21/2022]
Abstract
Alcohol use is highly prevalent in patients with bipolar disorder (BD) and is associated with significant mortality and morbidity. The detrimental effects of each condition are compounded by the presence of the other. The objective of this study was to examine the impact of alcohol abuse and of alcohol dependence in BD in a Brazilian sample, as indicated by clinical severity, functional impairment, and quality of life (QOL). A cross-sectional survey of 186 bipolar outpatients were interviewed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. The primary outcome measures were functioning, as indicated by the Global Assessment of Functioning Scale scores and QOL, as indicated by the World Health Organization Quality of Life Instrument. Secondary outcomes were clinical severity features. Alcohol abuse and dependence were associated with male gender, lower education, earlier age of onset, psychosis within first episode, depressive symptoms, and worse functioning. In addition, the presence of alcohol abuse or dependence was associated with remarkably high rates of suicide attempt. Our findings suggest that the co-occurrence of alcohol abuse/dependence with BD increases the risk for suicide attempt, which may reflect in part the greater severity of symptoms and impaired functioning. This subgroup of bipolar patients requires a treatment tailored to address both conditions.
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Guimarães LR, Jacka FN, Gama CS, Berk M, Leitão-Azevedo CL, Belmonte de Abreu MG, Lobato MI, Andreazza AC, Ceresér KM, Kapczinski F, Belmonte-de-Abreu P. Serum levels of brain-derived neurotrophic factor in schizophrenia on a hypocaloric diet. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1595-8. [PMID: 18582525 DOI: 10.1016/j.pnpbp.2008.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [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] [Received: 05/15/2008] [Revised: 06/02/2008] [Accepted: 06/06/2008] [Indexed: 01/13/2023]
Abstract
Dietary factors influence BDNF in animal studies, but there is no comparable data in clinical populations. We examined the effect of a dietary intervention on BDNF serum levels in 67 DSM-IV schizophrenic outpatients (51 males and 16 females). Two groups were assessed in a cross-sectional study: one on a hypocaloric diet (HD) and the other not on a hypocaloric diet. Weight, height and BMI data were collected concurrently with 5-ml blood sampling of each subject. BDNF levels were measured with a sandwich-ELISA. The blood sample was obtained a minimum of one month after the exposure to dietary intervention. Serum BDNF levels were significantly higher in patients on the HD (p=0.023). Additional research examining the interaction among patterns of nutritional food behavior and underlying physiopathology may result in insights upon which evidence-based decisions regarding dietary interventions can be made in people identified with major psychiatric disorders, such as schizophrenia.
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Affiliation(s)
- Lísia Rejane Guimarães
- Psychiatry Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Schizophrenia Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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18
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Andreazza AC, Cassini C, Rosa AR, Leite MC, de Almeida LMV, Nardin P, Cunha ABN, Ceresér KM, Santin A, Gottfried C, Salvador M, Kapczinski F, Gonçalves CA. Serum S100B and antioxidant enzymes in bipolar patients. J Psychiatr Res 2007; 41:523-9. [PMID: 16956621 DOI: 10.1016/j.jpsychires.2006.07.013] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.9] [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] [Received: 04/13/2006] [Revised: 07/14/2006] [Accepted: 07/25/2006] [Indexed: 12/22/2022]
Abstract
Bipolar disorder (BD) is a chronic, severe, and highly disabling psychiatric disorder; peripheral markers have been used to assess biochemical alterations associated with BD and/or possibly involved in its pathophysiology. Beyond neuronal commitment, many groups have proposed the involvement of glial activity in psychiatric disorders. Other biochemical markers, particularly associated with oxidative stress, have been studied in BD. In the present study, we evaluated glial involvement and oxidative stress in patients with BD. Glial activity was assessed by measuring serum S100B content; oxidative stress was assessed using serum thiobarbituric acid reactive substances (TBARS) and activities of antioxidant enzymes in BD patients during different episodes of disease. We found a significant increment of serum S100B during episodes of mania and depression, but not in euthymic patients. Superoxide dismutase (SOD) activity, as well the SOD/glutathione peroxidase plus catalase ratio, was also increased in manic and depressed patients. On the other hand, TBARS levels were increased in BD patients regardless of the phase of the disorder. These findings suggest a potential oxidative damage in BD patients. This peripheral oxidative imbalance indicates that systemic changes are taking place during the active phases of the illness. Such changes appear to relate to astrocyte function, as indicated by serum S100B elevation.
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Affiliation(s)
- Ana Cristina Andreazza
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2600-Anexo, 90035-003 Porto Alegre, RS, Brazil
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Gazalle FK, Hallal PC, Tramontina J, Rosa AR, Andreazza AC, Zanatto V, Santin A, Kapczinski F, Ceresér KM. Polypharmacy and suicide attempts in bipolar disorder. Rev Bras Psiquiatr 2007. [DOI: 10.1590/s1516-44462007000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gazalle FK, Hallal PC, Tramontina J, Rosa AR, Andreazza AC, Zanatto V, Santin A, Kapczinski F, Ceresér KM. Polypharmacy and suicide attempts in bipolar disorder. Braz J Psychiatry 2007; 29:35-8. [PMID: 17435926] [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] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 08/21/2006] [Indexed: 05/14/2023]
Abstract
OBJECTIVE The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.
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Affiliation(s)
- Fernando Kratz Gazalle
- Post-graduate Psychiatry Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Gazalle FK, Hallal PC, Tramontina J, Rosa AR, Andreazza AC, Zanatto V, Santin A, Kapczinski F, Ceresér KM. Polypharmacy and suicide attempts in bipolar disorder. Rev Bras Psiquiatr 2006. [DOI: 10.1590/s1516-44462006005000021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD: One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS: Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS: Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.
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Affiliation(s)
- Fernando Kratz Gazalle
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | | | - Juliana Tramontina
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Adriane Ribeiro Rosa
- Universidade Federal do Rio Grande do Sul, Brazil; Clinical Institute of Neuroscience, Espanha
| | | | | | - Aida Santin
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Flávio Kapczinski
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
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Gazalle FK, Andreazza AC, Hallal PC, Kauer-Sant'anna M, Ceresér KM, Soares JC, Santin A, Kapczinski F. Bipolar depression: the importance of being on remission. Rev Bras Psiquiatr 2006; 28:93-6. [PMID: 16810390 DOI: 10.1590/s1516-44462006000200004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The aim of the present study is to compare quality of life among currently depressed, subsyndromal and remitted patients with bipolar disorder (BD) and to assess whether the level of depression correlates with the scores of quality of life in BD patients. METHOD: Sixty bipolar outpatients diagnosed using the Structured Clinical Interview for DSM-IV who met criteria for diagnosis of BD type I, II or not otherwise specified (BD-NOS), and who were not currently on a manic or mixed episode were included. The main variables of interest were quality of life (QOL) assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF) and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS). RESULTS: A linear trend test showed a dose response association between patients' current mood state and all domains of quality of life. Higher quality of life scores were found among remitted patients, followed by subsyndromal patients; depressed patients presented lower scores of quality of life, except for the social domain. The four domains of the WHOQOL scale correlated negatively with the HDRS. CONCLUSIONS: Our findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with QOL in BD patients.
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Gazalle FK, Andreazza AC, Ceresér KM, Hallal PC, Santin A, Kapczinski F. Clinical impact of late diagnose of bipolar disorder. J Affect Disord 2005; 86:313-6. [PMID: 15935253 DOI: 10.1016/j.jad.2005.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 11/29/2004] [Accepted: 01/12/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study assessed the impact of number of years undiagnosed (NYU) on current morbidity in patients with bipolar disorder. LIMITATIONS The sample size used was rather small, which may make difficult the generalization of our findings to larger datasets. The data about age of onset and age when patients received their diagnosis may present a certain degree of recall error. METHOD Sixty-five bipolar outpatients diagnosed using the Structured Clinical Interview for DSM were included. The main outcome measurements were quality of life (QOL) assessed using the 26-item World Health Organization QOL instrument (WHOQOL-Bref) and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS). RESULTS Age of onset and years of disorder were not correlated with the outcomes assessed. The NYU were associated with higher scores of HDRS (P<0.01), lower scores of QOL within the physical (p<0.01) and psychological (p<0.05) domains of QOL. CONCLUSION Our findings suggest that the NYU may be an important predictor of the current clinical status of bipolar patients.
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Affiliation(s)
- Fernando Kratz Gazalle
- Psychiatry Research Unit, Post-Graduate Psychiatry Program, Federal University of Rio Grande Do Sul, Brazil
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