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Olivé V, Navinés R, Macías L, López JA, Ariz J, Quesada S, Barroso S, Filella X, Langohr K, Martin-Santos R. Psychosocial and biological predictors of resident physician burnout. Gen Hosp Psychiatry 2022; 78:68-71. [PMID: 35901627 DOI: 10.1016/j.genhosppsych.2022.07.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome. OBJECTIVES To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors. METHODOLOGY We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis. RESULTS We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019-1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778-0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees. CONCLUSION Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels.
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Affiliation(s)
- V Olivé
- Department of Medicine, Psychiatry Functional Unit, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.; Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - R Navinés
- Department of Psychiatry and Psychology, Hospital Clinic, UB, Institut d' Investigació, Biomèdica August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain.
| | - L Macías
- Department of Biochemistry and Molecular Genetics, Center of Biomedic Diagnosis (CDB), Hospital Clinic, UB, IDIBAPS, Barcelona, Spain.
| | - J A López
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - J Ariz
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - S Quesada
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - S Barroso
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - X Filella
- Department of Biochemistry and Molecular Genetics, Center of Biomedic Diagnosis (CDB), Hospital Clinic, UB, IDIBAPS, Barcelona, Spain.
| | - K Langohr
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya/Barcelonatech (UPC), Barcelona, Spain.
| | - R Martin-Santos
- Department of Medicine, Psychiatry Functional Unit, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.; Department of Psychiatry and Psychology, Hospital Clinic, UB, Institut d' Investigació, Biomèdica August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain.
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Imaz M, Torra M, Martin M, Aliart I, Martin-Santos R, Vieta E, Garcia-Esteve L. Point-of-care test for rapid assessment of blood lithium levels in women with bipolar disorder during perinatal period. Eur Psychiatry 2022. [PMCID: PMC9565989 DOI: 10.1192/j.eurpsy.2022.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Determination of lithium levels in serum has become a standard of care due to its narrow therapeutic rang, thus an immediate test for determination of blood lithium may contribute to minimize toxicit, to avoid relapse and to ensure treatment adherence. This is particularly relevant during pregnancy and early postpartum because pharmaokinetic changes in renal physiology. Objectives The aim of this study is verify Medimate point-of-care method performance and systematically compare it with the routine laboratory measurement of lithium. Methods This cross-sectional method comparison study was conductec in the Unit of Perinatal Mental Health in the Hospital Clinic of Barcelona. Pearson and Bland-Altman analyses were performed to assess the accuracy, precision and correlation between the capillary electrophoresis technology (Medimate MiniLab) and the ion selective electrode (ISE) potentiometry method (AVL 9180). Results Twenty-five women with bipolar disorder in treatment with lithium during perinatal period were enrolled, corresponding to 75 blood specimens for analyses. Correlation (r), mean difference (bias), and 95% limit of agreement (LOA) of the point-of-care method [r=0.917; bias 0.0021 (95% LOA; 0.440, 0.619) mEq/L], showed that difference between ISE method and capillary electrophoresis technology was not statistically significant. Conclusions Considering the practicality, the microchip capillary electrophoresis technology provides a simple and highly affordable way of measuring lithium levels in a single drop of blood outside the clinical laboratory. The Medimate point-of-care system (POC) appears well adapted for the rapid and specific detection of lithium as an alternative to the current ISE procedure. Disclosure No significant relationships.
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Navinés R, Oriolo G, Mora M, Cavero M, Gómez-Gil E, Martin-Santos R. Less basal thyrotropin levels predict antidepressant response in patients with major depression. Eur Psychiatry 2022. [PMCID: PMC9565975 DOI: 10.1192/j.eurpsy.2022.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction The close association among thyroid metabolism, mood disorders and behavior has long been known. The role of basal thyroid axis in antidepressant treatment response is less known. Objectives The aim of the present study was to study the association of basal serum thyrotropin (TSH) levels, with antidepressant treatment response in major depressive disorder. Methods Thirty-one depressed adult outpatients were included. Major depressive episode was diagnosed through the MINI (DSM-IV-TR) interview. Clinical symptomatology and blood samples were assessed at baseline, and at 4-
and 8-weeks of either escitalopram or sertraline. Treatment response was defined by an improvement ≥50% in MADRS scores at 4-, and 8-weeks. Basal TSH levels were included in a linear regression model as predictor of treatment response. Results Twenty-seven patients finished 8-weeks of treatment. Response to treatment was of 74% at 4-weeks, and 63% at 8-weeks of antidepressant treatment. Basal median TSH levels were between normal ranges (M+SD=1.85+1,02 mlU/L). Basal TSH levels not correlated with basal MADRS scores, but with higher MADRS scores at week-4 (r=0,415, p=0,031) and at week-8 (r=0,392, p=0,043). Moreover, less baseline TSH levels trend to be a significant good predictor for treatment response at 4-weeks (R2=.116, p=.083); and a good predictor at 8-weeks treatment (R2=.147, p=.049). Conclusions Baseline TSH levels even within the normal range may play a role in predicting antidepressant response. Disclosure No significant relationships.
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Martin-Santos R, Bartrés C, Nacar L, Navinés R, Cavero M, Lens S, Rodriguez-Tajes S, Pariante J, Horrillo I, Muñoz-Moreno E, Bargallo N, Capuron L, Meana J, Forns X, Mariño Z. Significant early and long-term improvement of neuropsychiatry symptomatology in HCV-infected patients after viral eradication with DAA. Eur Psychiatry 2022. [PMCID: PMC9564256 DOI: 10.1192/j.eurpsy.2022.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Chronic Hepatitis C infection is considered a systemic disease with extrahepatic manifestations, mainly neuropsychiatric symptoms,
which is associated with a chronic low-grade inflammatory state. Hepatitis C virus (HCV) eradication is currently achieved in >98% of cases with oral direct-acting antivirals (DAA).
Objectives
To study potential clinical neuropsychiatric changes (mood, cognition, sleep, gastrointestinal, sickness, and motion) in HCV-infected patients after HCV eradication with DAA.
Methods
Design: Cohort study. Subjects: 37 HCV-infected patients, aged<55 years old, with non-advanced liver disease receiving DAA; free of current mental disorder. 24 healthy controls were included at baseline. Assessment: -Baseline (BL) (socio-demographic and clinical variables, MINI-DSM-IV, and Neurotoxicity Scale (NRS), (mood, cognitive, sleep, gastrointestinal, sickness and motor dimensions). Follow-up: End-of-treatment, 12weeks-after and 48weeks-after DAA: NRS. Analysis: Descriptive and bivariate non-parametrical analysis.
Results
NRS total score and dimensions where different between cases and controls (.000) at baseline. NRS total score (.000) and mood (.000), cognition (.000), sleep (.002), gastrointestinal (.017), and sickness (.003), except motor dimension score (.130) showed significant longitudinal improvement.
Conclusions
HCV-infected patients with mild liver disease presented significantly worse scores for neurotoxicity symptomatology in all dimensions compared to healthy individuals. After HCV eradication with DAA, both at short and long follow-up a significant improvement of the NRS total score and each of the dimensions (except motor) were observed. However, they did not reach the values of healthy individuals, suggesting a not complete neuropsychiatric restoration in the period studied. Grant: ICIII-FIS:PI17/02297.(One way to make Europe) (RMS) and Gilead Fellowship-GLD17/00273 (ZM); and the support of SGR17/1798 (RMS)
Disclosure
No significant relationships.
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Cavero M, Planas T, Goikolea J, Lens S, Bartrés C, Colomer L, García C, Valentí M, Ruiz V, Rivas Y, Benabarre A, Catalan R, Masana G, Colom J, Forns X, Martin-Santos R, Mariño Z. Screnning of viral hepatitis in mental disorder patients: Psiqui-Clinic Programme. Eur Psychiatry 2022. [PMCID: PMC9567413 DOI: 10.1192/j.eurpsy.2022.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The WHO would increase diagnosis and treatment of viral hepatitis in the world by 2030, based on the high efficacy of direct-acting-antivirals against HCV, extended vaccination programs in HBC, and epidemiological data. Diagnostic of HCV/HBV infection has been simplified by point-of-care (POC) devices (cheap/easy-to-use/interprete/qick-results), detecting anti-HCV-antibodies or HBV-antigen in capillary blood at the patients´site. The current seroprevalence of viral hepatitis B/C in general population in Spain is 0.5%/1% and would be higher (3-17%) in people with severe-mental-disorder due to risk factors and traditionally less access to health care. Objectives To design a screening protocol for HCV eradication and HBV-detection, and risk factors among severe-mental-disorder patients in a CommunityMentalHealthCenter. To guarantee equal access to viral hepatitis screening and therapy among this population. Methods Outpatients visited along one-year who accepts participate. Using POC-device for qualitative detection of anti-HCV-antibodies (Quickview-of-Lumiquick-Diagnostics®)/HBsAG (Abbott-Rapid-Diagnostics®). Socio-demographic data; mental disorder(ICD-10); HCV/HBV risk-factors; Neurotoxicity-scale (mood/cognition/sleep/gastrointestinal/sickness/motor); SF-12; Patient-satisfaction. Subjects with positive HCV/HBV POC-test will have a on-site venopuncture to assess hemograme/liver tests, and HCV-RNA (Cobas-TaqMan-RocheDiagnostics)/HBsAg-ELISA (Atellica-Siemens). In positive HCV-RNA (active infection) the psychiatric-team will inform the hepatology-team for non-invasive liver fibrosis assessment and DAA prescription. The patient will receive 8-12-weeks on-site treatment, and assessed (Neurotoxicity/SF-12).HCV cure will be confirmed by HCV-RNA in blood. Chronic-cases will be managed at Hepatology-Unit. Results We will present the results of the implementation of the programme and their ability to detect viral-hepatitis-positive cases among patients with severe-mental-disorders and to treat them effectively. Conclusions Our results may support the generalisation of the programme in among CMHC’s. Disclosure No significant relationships.
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Imaz M, Garcia-Esteve L, Torra M, Soy D, Langohr K, Martin-Santos R. Lithium placental passage at delivery: an observational study. Eur Psychiatry 2022. [PMCID: PMC9566328 DOI: 10.1192/j.eurpsy.2022.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Lithium is used as a first-line treatment for bipolar disorder during perinatal period. Dosing of lithium can be challenging as a result of pharmacokinetic changes in renal physiology. Frequent monitoring of lithium blood levels during pregnancy is recommended in order remain within the therapeutic window (0.5 to 1.2 mEq/L). Lower neonatal lithium blood level (<0.64 mEq/L) at time of delivery reduces the risk of lithium side effects in the neonate. Objectives The aim of the present study was to quantify the rate of lithium placental passage in real word. Methods We included a total of 68 mother-infant pairs for which a lithium measurement was performed intrapartum. Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer. The limit of quantification (LoQ) was 0.20 mEq/L and detection limit was 0.10 mEq/L. Pearson analyse was performer to assess the correlation between mother and umbilical cord lithium serum concentrations. Results The mean of umbilical cord serum concentration at delivery was 0.57 mEq/L (SD=0.26, range 0,20-1,42). The mean infant-mother lithium ratio at delivery for the 68 pairs was 1.12 (SD=0.24) across a wide range of maternal concentrations (range 0.14-1,40 mEq/L). There was a strong positive correlation between maternal and umbilical cord lithium blood levels (Peearson correlation coefficient 0.948, p<0.001). Conclusions Lithium demostrates complete placental passage. This finding is consistent with the results of others studies (Newport 2005; Molenaar 2021). Disclosure No significant relationships.
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Cavero M, Mariño Z, Navines R, Pariente J, Moreno EM, Bartres C, Nacar L, Lens S, Rodriguez-Tajes S, Cañizares S, Bargallo N, Forns X, Martin-Santos R. Early changes in brain structure, functional connectivity and neuropsychiatric symptoms after HCV infection cure with direct-acting antivirals. Eur Psychiatry 2021. [PMCID: PMC9528459 DOI: 10.1192/j.eurpsy.2021.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) infection is known to be associated with neuropsychiatric manifestations as part of the disease. Previous neuroimaging studies showed brain connectivity dysfunction among HCV-infected patients Objectives To assess, by MR in resting state, the potential structural and connectivity changes before (BL) and after HCV eradication (FU12) with direct-acting antivirals (DAA), along with clinical parameters. Methods
Twenty-one HCV-patients, aged≤55 years, without psychiatric history, nor advanced liver disease, and eligible for DAA, and 25 healthy controls were included. Evaluations were performed at BL and FU12. Brain volume and local gyrification index (LGI) were assessed in MR-T1, and functional connectivity by seed-based analysis (left insula). Depression (MADRS/PHQ9) and neurotoxicity symptomatology (NRS) were assessed. We compared patients between BL/FU12, and controls by means of paired/independent T-test analysis. Results Substained virologycal response was obtained in all patients (100%). Depressive and neurotoxicity symptomatology improved after cure (p<0.01). HCV-patients showed a reduced volume in a right latero-occipital area compared to controls (CWP<0.005) in both BL and FU12. This difference was smaller between FU12 and controls. LGI was higher in FU12-HCV compared to BL-HCV. fMRI connectivity showed a high association between insula and occipital/parietal territories in patients than controls, being higher among BL-HCV and controls. Differences were limited to occipital areas among FU12-HCV and controls. Conclusions Neuropsychiatric symptomatology improved after cure. Left insula is altered among HCV-patients in structured and connectivity (mainly occipital areas). After cure differences with controls were reduced, suggesting a partial restoration of brain connectivity.
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Imaz M, Torra M, Soy D, Langorh K, Garcia-Esteve L, Martin-Santos R. Infant exposure to lithium through breast milk. Eur Psychiatry 2021. [PMCID: PMC9471553 DOI: 10.1192/j.eurpsy.2021.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Women who take lithium during pregnancy and continue after delivery may opt to breastfeed, formula feed, or mix these options. Objectives To evaluate the neonatal lithium plasma concentrations and nursing infant outcomes based on these three feeding trajectories. Methods We followed 24 women with bipolar disorder on lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ). Results The mean ratio of lithium concentration in the umbilical cord to maternal serum being 1.12 (0.17). We used the Turnbull estimator for interval-censored data to estimate the probability that the LoQ was reached as a function of time. The median times to LoQ was 6–8, 7–8, and 53–60 days for formula, mixed, and breastfeeding, respectively. Generalised log-rank testing indicated that the median times to LoQ differed by feeding trajectory (p = 0.037). Multivariate analysis confirmed that the differences remained after adjusting for serum lithium concentrations at birth (formula, p = 0.015; mixed, p = 0.012). We did not found any acute observable growth or developmental delays in any of the neonates/infants. Conclusions Lithium did not accumulate in the infant under either exclusive or mixed-breastfeeding. Lithium concentrations declined in all trayectories. The time needed to reach the LoQ was much longer for those breastfeeding exclusively. Lithium transfer via breastmilk is much less than via the placenta. We did not found any acute observable growth or developmental delays in any infant during follow-up. Disclosure No significant relationships.
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Imaz M, Torra M, Soy D, Langorh K, Garcia-Esteve L, Martin-Santos R. Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study. Eur Psychiatry 2021. [PMCID: PMC9471310 DOI: 10.1192/j.eurpsy.2021.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Lithium is an effective mood stabilizer and is widely used as a first-line treatment for bipolar disorder in the perinatal period. Several guidelines have provided clinical advice on dosing strategy (dose reduction versus stop lithium) in the peripartum period to minimize the risk of neonatal complications. An association has been observed between high neonatal lithium concentrations (> 0.64 mEq/L) and lower 1-min Apgar scores, longer hospital stays, and central nervous system and neuromuscular complications.ObjectivesTo quantify the rate of lithium placental passage at delivery. To assess any association between plasma concentration of lithium at delivery and neonatal outcome.Methods
In this retrospective observational cohort study, we included women treated with llithium at least in late pregnancy. Maternal (MB) and umbilical cord (UC) lithium blood level measurement were collected at delivery. Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer. The limit of quantification (LoQ) was 0.20 mEq/L and detection limit was 0.10 mEq/L. From the medical records, we extracted information on neonatal outcomes (preterm birth, birth weight, Apgar scores, pH-values, and admision to NICU) and complications categoriced by organ system: respiratory, circulatory, hematological, gastro-intestinal, metabolic, neurological, and immune system (infections).ResultsUmbilical cord and maternal lithium blood levels were strongly correlated: mean (SD) range UC/MR ratio 1.15 (0.24). Umbilical cord lithium levels ranged between 0.20 to 1.42 mEq/L. We observed no associations between umbilical cord lithium blood levels at delivery and neonatal outcomes.ConclusionsIn our study, newborns tolerated well a wide range of lithemias, between 0.20 and 1.42 mEq/L.
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Gelabert E, Gutierrez-Zotes A, Navines R, Labad J, Puyané M, Donadon MF, Guillamat R, Mayoral F, Jover M, Canellas F, Gratacós M, Guitart M, Gornemann I, Roca M, Costas J, Ivorra JL, Subirà S, de Diego Y, Osorio FL, Garcia-Esteve L, Sanjuan J, Vilella E, Martin-Santos R. The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study. Arch Womens Ment Health 2020; 23:585-593. [PMID: 31802248 DOI: 10.1007/s00737-019-01007-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
Abstract
Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.
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Affiliation(s)
- E Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - A Gutierrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Labad
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - M Puyané
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M F Donadon
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - R Guillamat
- Departamento de Psiquiatria, Departamento de Salud Mental, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - F Mayoral
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Jover
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - F Canellas
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - M Gratacós
- Centro de Regulación Genómica (CRG) y UPF, Barcelona, Spain
| | - M Guitart
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - I Gornemann
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - J Costas
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servizo Galego de Saúde (SERGAS), Complexo Hospitalario Universitario de Santiago (CHUS), Galicia, Spain
| | - J L Ivorra
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - S Subirà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Y de Diego
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - F L Osorio
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - L Garcia-Esteve
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Sanjuan
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain.
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil.
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Oriolo G, Egmond E, Mariño Z, Cavero M, Navines R, Zamarrenho L, Solà R, Pujol J, Bargallo N, Forns X, Martin-Santos R. Systematic review with meta-analysis: neuroimaging in hepatitis C chronic infection. Aliment Pharmacol Ther 2018. [PMID: 29536563 DOI: 10.1111/apt.14594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C is considered a systemic disease because of extra-hepatic manifestations. Neuroimaging has been employed in hepatitis C virus-infected patients to find in vivo evidence of central nervous system alterations. AIMS Systematic review and meta-analysis of neuroimaging research in chronic hepatitis C treatment naive patients, or patients previously treated without sustained viral response, to study structural and functional brain impact of hepatitis C. METHODS Using PRISMA guidelines a database search was conducted from inception up until 1 May 2017 for peer-reviewed studies on structural or functional neuroimaging assessment of chronic hepatitis C patients without cirrhosis or encephalopathy, with control group. Meta-analyses were performed when possible. RESULTS The final sample comprised 25 studies (magnetic resonance spectroscopy [N = 12], perfusion weighted imaging [N = 1], positron emission tomography [N = 3], single-photon emission computed tomography [N = 4], functional connectivity in resting state [N = 1], diffusion tensor imaging [N = 2] and structural magnetic resonance imaging [N = 2]). The whole sample was of 509 chronic hepatitis C patients, with an average age of 41.5 years old and mild liver disease. A meta-analysis of magnetic resonance spectroscopy studies showed increased levels of choline/creatine ratio (mean difference [MD] 0.12, 95% confidence interval [CI] 0.06-0.18), creatine (MD 0.85, 95% CI 0.42-1.27) and glutamate plus glutamine (MD 1.67, 95% CI 0.39-2.96) in basal ganglia and increased levels of choline/creatine ratio in centrum semiovale white matter (MD 0.13, 95% CI 0.07-0.19) in chronic hepatitis C patients compared with healthy controls. Photon emission tomography studies meta-analyses did not find significant differences in PK11195 binding potential in cortical and subcortical regions of chronic hepatitis C patients compared with controls. Correlations were observed between various neuroimaging alterations and neurocognitive impairment, fatigue and depressive symptoms in some studies. CONCLUSIONS Patients with chronic hepatitis C exhibit cerebral metabolite alterations and structural or functional neuroimaging abnormalities, which sustain the hypothesis of hepatitis C virus involvement in brain disturbances.
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Affiliation(s)
- G Oriolo
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - E Egmond
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Department of Health and Clinical Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Z Mariño
- Liver Unit, Hospital Clinic, IDIBAPS, Centro Investigación Biomédica en Red de Enfermedades hepáticas y digestivas, (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - M Cavero
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - L Zamarrenho
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - R Solà
- Liver Unit, Parc de Salut Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, CIBERSAM, Barcelona, Spain
| | - N Bargallo
- Center of Diagnostic Image (CDIC), Hospital Clinic, Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - X Forns
- Liver Unit, Hospital Clinic, IDIBAPS, Centro Investigación Biomédica en Red de Enfermedades hepáticas y digestivas, (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
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Egmond E, Oriolo G, Cavero M, Langohr K, Solà R, Navines R, Martin-Santos R. Substance abuse and quality of life in chronic hepatitis C patients receiving antiviral treatment. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionChronic hepatitis C virus (HCV) is one of world's most important chronic infections. HCV can be treated using interferon-alpha (IFNα) and ribavirin (RBV). HCV, IFNα and RBV are known to impair mental and physical life quality. Many HCV-infected individuals have life-prevalence of substance use disorder (SUD).ObjectivesTo study life quality (SF-36) in HCV patients with SUD history during antiviral treatment.MethodsSF-36 questionnaire was assessed in 384 HCV patients at baseline, and at 4, 12, 24, and 48 weeks of treatment. ANCOVA models were used to study the association of SF-36 scores and potential risk factors at baseline. Risk factors from baseline scores over time were studied through linear mixed models, adjusting for baseline scores.ResultsAt baseline, SUD men had worse mental (P = 0.03) and physical health (P = 0.022), and younger patients had worse social functioning (P = 0.011), and mental (P = 0.001) but better physical health (P < 0.001). Figs. 1 and 2 show the results of mental and physical life quality during treatment from baseline.ConclusionsThis study emphasizes the decrease in life quality in HCV patients with SUD before and during antiviral treatment.GrantInstituto de Carlos III-FIS: PSICOCIT-PI110/01827,EU “One way to make Europe”, Ministerio de Economia y Competitividad (MTM2012-38067-C02-01), and support of SGR/2014/1135.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Bhattacharyya S, Iyegbe C, Atakan Z, Martin-Santos R, Crippa JA, Xu X, Williams S, Brammer M, Rubia K, Prata D, Collier DA, McGuire PK. Protein kinase B (AKT1) genotype mediates sensitivity to cannabis-induced impairments in psychomotor control. Psychol Med 2014; 44:3315-3328. [PMID: 25065544 DOI: 10.1017/s0033291714000920] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND What determines inter-individual variability to impairments in behavioural control that may underlie road-traffic accidents, and impulsive and violent behaviours occurring under the influence of cannabis, the most widely used illicit drug worldwide? METHOD Employing a double-blind, repeated-measures design, we investigated the genetic and neural basis of variable sensitivity to cannabis-induced behavioural dyscontrol in healthy occasional cannabis users. Acute oral challenge with placebo or Δ9-tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, was combined with functional magnetic resonance imaging, while participants performed a response inhibition task that involved inhibiting a pre-potent motor response. They were genotyped for rs1130233 single nucleotide polymorphisms (SNPs) of the protein kinase B (AKT1) gene. RESULTS Errors of inhibition were significantly (p = 0.008) increased following administration of THC in carriers of the A allele, but not in G allele homozygotes of the AKT1 rs1130233 SNP. The A allele carriers also displayed attenuation of left inferior frontal response with THC evident in the sample as a whole, while there was a modest enhancement of inferior frontal activation in the G homozygotes. There was a direct relationship (r = -0.327, p = 0.045) between the behavioural effect of THC and its physiological effect in the inferior frontal gyrus, where AKT1 genotype modulated the effect of THC. CONCLUSIONS These results require independent replication and show that differing vulnerability to acute psychomotor impairments induced by cannabis depends on variation in a gene that influences dopamine function, and is mediated through modulation of the effect of cannabis on the inferior frontal cortex, that is rich in dopaminergic innervation and critical for psychomotor control.
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Affiliation(s)
- S Bhattacharyya
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - C Iyegbe
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - Z Atakan
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - R Martin-Santos
- Pharmacology Research Unit, IMIM-Hospital del Mar and Psychiatric Department,ICN,Hospital Clinico, Barcelona,Spain
| | - J A Crippa
- Department of Neurology, Psychiatry and Medical Psychology, Faculty of Medicine of Ribeirão Preto,University of São Paulo,Brazil
| | - X Xu
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - S Williams
- Department of Neuroimaging, Centre for Neuroimaging Sciences,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - M Brammer
- Department of Neuroimaging, Centre for Neuroimaging Sciences,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - K Rubia
- Department of Child and Adolescent Psychiatry,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - D Prata
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - D A Collier
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - P K McGuire
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
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Roca A, Imaz ML, Torres A, Plaza A, Subirà S, Valdés M, Martin-Santos R, Garcia-Esteve L. Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder. J Affect Disord 2013; 150:807-13. [PMID: 23566335 DOI: 10.1016/j.jad.2013.02.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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] [Received: 08/01/2012] [Revised: 02/26/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify the factors associated with discontinuation of selective serotonin reuptake inhibitors (SSRIs) in pregnant women and to determine the rates of SSRI reintroduction during pregnancy. METHOD A prospective study was conducted in the Perinatal Psychiatry Service of the Hospital Clínic in Barcelona. The total sample comprised 132 consecutive pregnant women with depressive or anxiety disorder (DSM-IV criteria), seen between January 2005 and December 2008 and who were receiving SSRIs at the time of conception. Clinical, psychometric and socio-demographic variables were collected at the first visit. All women were assessed during treatment with the Edinburgh Perinatal Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Dose and type of antidepressant were recorded at each visit during pregnancy. RESULTS Seventy women (53%) discontinued SSRI treatment upon confirmation of pregnancy. Socio-demographic, obstetric and psychiatric variables did not differ significantly between women who maintained and women who discontinued treatment. Only unplanned pregnancy was associated with a greater risk of discontinuation (OR=2.7, 95% CI=1.34-5.52). Women who discontinued treatment also had higher EPDS and STAI scores in the first visit and prenatal visit (34-36 weeks) (p<.05). Of the 70 women who discontinued treatment, 57.1% (N=40) reintroduced treatment, almost half of these in the first trimester of pregnancy. CONCLUSIONS Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs upon confirmation of pregnancy in women with depressive or anxiety disorder. More than half the pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.
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Affiliation(s)
- A Roca
- Perinatal Psychiatry Service, Department of Psychiatry, Hospital Clínic Universitari, Barcelona, Spain.
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Martin-Santos R, Crippa JA, Batalla A, Bhattacharyya S, Atakan Z, Borgwardt S, Allen P, Seal M, Langohr K, Farré M, Zuardi AW, McGuire PK. Acute effects of a single, oral dose of d9-tetrahydrocannabinol (THC) and cannabidiol (CBD) administration in healthy volunteers. Curr Pharm Des 2013; 18:4966-79. [PMID: 22716148 DOI: 10.2174/138161212802884780] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/10/2012] [Indexed: 11/22/2022]
Abstract
RATIONALE Animal and humans studies suggest that the two main constituents of cannabis sativa, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have quite different acute effects. However, to date the two compounds have largely been studied separately. OBJECTIVE To evaluate and compare the acute pharmacological effects of both THC and CBD in the same human volunteers. METHODS A randomised, double-blind, cross-over, placebo controlled trial was conducted in 16 healthy male subjects. Oral THC 10 mg or CBD 600 mg or placebo was administered in three consecutive sessions, at one-month interval. Physiological measures and symptom ratings were assessed before, and at 1, 2 and 3 hours post drug administration. The area under the curve (AUC) between baseline and 3 hours, and the maximum absolute change from baseline at 2 hours were analysed by one-way repeated measures analysis of variance, with drug condition (THC or CBD or placebo) as the factor. RESULTS Relative to both placebo and CBD, administration of THC was associated with anxiety, dysphoria, positive psychotic symptoms, physical and mental sedation, subjective intoxication (AUC and effect at 2 hours: p < 0.01), an increase in heart rate (p < 0.05). There were no differences between CBD and placebo on any symptomatic, physiological variable. CONCLUSIONS In healthy volunteers, THC has marked acute behavioural and physiological effects, whereas CBD has proven to be safe and well tolerated.
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Affiliation(s)
- R Martin-Santos
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, UK.
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Bhattacharyya S, Atakan Z, Martin-Santos R, Crippa JA, Kambeitz J, Prata D, Williams S, Brammer M, Collier DA, McGuire PK. Preliminary report of biological basis of sensitivity to the effects of cannabis on psychosis: AKT1 and DAT1 genotype modulates the effects of δ-9-tetrahydrocannabinol on midbrain and striatal function. Mol Psychiatry 2012; 17:1152-5. [PMID: 22290123 DOI: 10.1038/mp.2011.187] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Roca A, Garcia-Esteve L, Imaz ML, Torres A, Hernández S, Botet F, Gelabert E, Subirà S, Plaza A, Valdés M, Martin-Santos R. Obstetrical and neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors: the relevance of dose. J Affect Disord 2011; 135:208-15. [PMID: 21890210 DOI: 10.1016/j.jad.2011.07.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 05/17/2011] [Revised: 07/24/2011] [Accepted: 07/24/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on obstetrical and neonatal outcomes. METHOD A case-control study was conducted to compare perinatal outcomes among pregnant women with affective disorder (DSM-IV criteria) and who received SSRIs during pregnancy with those of women without an active psychiatric disorder during pregnancy who were non-exposed to antidepressants during pregnancy. Each case was matched to two controls for maternal age (± 2 years) and parity. RESULTS A total of 252 women were enrolled in the study, 84 exposed and 168 non-exposed. Demographic and clinical characteristics did not differ significantly between the groups. The rates of prelabor rupture of membranes, induction of labor and cesarean delivery were slightly higher but not statistically significant in the exposed group. The mean gestational age at birth was 38.8 (± 1.86) weeks for the exposed group and 39.4 (± 1.52) weeks for the non-exposed group (p=.005). Rates for preterm birth were higher in the exposed group (OR=3.44, 95% CI=1.30-9.11). After stratification for dose, it was found that exposure to a high-dose was associated with lower gestational age (p=.009) and higher rates of prematurity (OR=5.07, 95% CI=1.34-19.23). The differences remained significant after controlling for maternal status and the length of exposure. CONCLUSION Women treated with SSRIs during pregnancy, mainly at high-dose, had an increased risk of preterm birth compared to healthy women of similar age and parity who were not exposed to SSRI during pregnancy.
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Affiliation(s)
- A Roca
- Perinatal Psychiatry Program, Institut Clinic of Neuroscience (ICN), Hospital Clínic, Barcelona, Spain.
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Binelli C, Ortiz A, Gelabert E, Crippa J, Subirà S, Martin-Santos R. Early negative life events during childhood and social anxietyin adulthood. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)71851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BackgroundAlthough there is considerable evidence on the impact of negative life events during childhood on the etiology of psychiatric disorders, little is known about the specific influence on the social anxiety disorder. The objective of the study was to examine this association.MethodIn a cross-sectional survey in 571 university students we analysed the association between loss of someone close, emotional abuse, physical abuse, family violence and sexual abuse with social anxiety assessed by the Liebowitz Social Anxiety Scale.ResultsTwenty percent of the sample had social anxiety and 50,6% had an early negative life events in childhood. After controlling for family psychiatric history and gender only family violence was associated with an increased risk of social anxiety (OR = 4.63; 95%CI = 1.13–18.9).ConclusionsThis study found childhood family violence associated with social phobia in university students.
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Fusar-Poli P, Bhattacharyya S, Allen P, Crippa J, Borgwardt S, Martin-Santos R, Seal M, O’Carroll C, Atakan Z, Zuardi A, McGuire P. Effect of image analysis software on neurofunctional activation during processing of emotional human faces. J Clin Neurosci 2010; 17:311-4. [DOI: 10.1016/j.jocn.2009.06.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 06/19/2009] [Accepted: 06/25/2009] [Indexed: 11/27/2022]
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Torres A, Garcia-Esteve L, Navarro P, Tarragona M, Imaz M, Gutiérrez F, Santos C, Ascaso C, Martin-Santos R, Subirà S. P02-397 - Personality profile or postraumatic stress disorder? personality characteristics in women victim of chronic intimate partner violence. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71399-7] [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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Bhattacharyya S, Fusar-Poli P, Borgwardt S, Martin-Santos R, Carroll C, Seal M, Crippa J, Atakan Z, Mcguire P. Opposite Neural Effects of the Main Psychoactive Ingredients of Cannabis- Neural Basis for Potential Therapeutic Effects of Cannabidiol. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70924-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There is considerable interest in the therapeutic potential of Cannabidiol (CBD), the second most abundant component of Cannabis. While delta-9-THC, the main psychoactive ingredient of cannabis, impairs memory and induces anxiety and psychotic symptoms acutely and increases the risk of psychotic disorders in regular cannabis users, CBD does not impair memory, may have anxiolytic and possibly antipsychotic effects. Hence, we compared directly the acute neural effects of these two active ingredients of cannabis, by combining pharmacological challenge with fMRI. Using a double-blind, repeated measures design and oral challenge with 10mg of delta-9-THC, 600mg of CBD or placebo in 15 healthy volunteers, we examined whether delta-9-THC and CBD have opposing effects on the neural substrates of verbal memory and fear processing and whether they also have opposing effects on the neural substrates of anxiety and psychotic symptoms induced by delta-9-THC. Delta-9-THC induced anxiety and psychotic symptoms acutely while there was a trend for a reduction in anxiety but no change in psychotic symptoms with CBD. During the memory task, delta-9-THC attenuated and CBD increased activation in the striatum bilaterally. Effect of delta-9-THC on striatal activation was inversely correlated with the psychotic symptoms induced by it concomitantly. During the processing of fearful faces, delta-9-THC increased and CBD attenuated activation in the amygdala and these effects correlated with their anxiogenic and anxiolytic effects respectively. These opposing effects of CBD on the key neural substrates for psychotic symptoms and anxiety induced by delta-9-THC may suggest its possible therapeutic role in countering these conditions.
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Borgwardt S, Allen P, Bhattacharyya S, Fusar-Poli P, Crippa J, Seal M, Fraccaro V, Atakan Z, Martin-Santos R, O'Carroll C, Rubia K, McGuire P. Neurofunctional Effects of Cannabis on Response Inhibition. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background:This study examined the effect of Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on brain activation during a motor inhibition task.Methods:Functional magnetic resonance imaging and behavioural measures were recorded while 15 healthy volunteers performed a Go/No-Go task following administration of either THC or CBD or placebo in a double-blind, pseudo-randomized, placebo-controlled repeated measures within-subject design.Results:Relative to placebo, THC attenuated activation in the right inferior frontal and the anterior cingulate gyrus. In contrast, CBD deactivated the left temporal cortex and insula. These effects were not related to changes in anxiety, intoxication, sedation, and psychotic symptoms.Conclusions:These data suggest that THC attenuates the engagement of brain regions that mediate response inhibition. CBD modulated function in regions not usually implicated in response inhibition.
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Bhattacharyya S, Crippa JA, Martin-Santos R, Winton-Brown T, Fusar-Poli P. Imaging the neural effects of cannabinoids: current status and future opportunities for psychopharmacology. Curr Pharm Des 2009; 15:2603-14. [PMID: 19689331 DOI: 10.2174/138161209788957465] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although recreational and medicinal use of cannabis has been known for many centuries, it is only in recent decades that it has again attracted considerable systematic attention because of its adverse psychological and potential beneficial effects. This has also been prompted by better understanding of the molecular targets of cannabinoids in the living organism. While cannabis has attracted the attention of mental health professionals because of accumulating evidence linking regular frequent use of cannabis to psychotic disorders like schizophrenia, neuroscientists and pharmacologists have focused their attention on the potential beneficial effects of cannabinoids in neuropsychiatric diseases. However, evidence regarding the neurobiological basis of these adverse psychological or potential beneficial effects has been mainly derived from pre-clinical research. Developments in neuroimaging modalities now offer the unique opportunity to examine in vivo how the different cannabinoids may act on the human brain to mediate their effects. In this review, we focus on research investigating the effects of cannabinoids in the human brain using neuroimaging techniques and explore how this adds to the current understanding about the pathophysiological correlates of psychotic disorders and points towards newer therapeutic candidates for psychotic and anxiety disorders. Further, we also discuss how combining neuroimaging and pharmacological challenge with cannabinoids may open up newer avenues for target identification and validation in psychopharmacology.
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Affiliation(s)
- S Bhattacharyya
- Section of Neuroimaging, Box PO67, Division of Psychological Medicine & Psychiatry, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
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Sanjuan J, Martin-Santos R, Garcia-Esteve L, Carot JM, Guillamat R, Gutierrez-Zotes A, Gornemann I, Canellas F, Baca-Garcia E, Jover M, Navines R, Valles V, Vilella E, de Diego Y, Castro JA, Ivorra JL, Gelabert E, Guitart M, Labad A, Mayoral F, Roca M, Gratacos M, Costas J, van Os J, de Frutos R. Mood changes after delivery: role of the serotonin transporter gene. Br J Psychiatry 2008; 193:383-8. [PMID: 18978318 DOI: 10.1192/bjp.bp.107.045427] [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: 12/18/2022]
Abstract
BACKGROUND Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period. AIMS To study the role of 5-HTT polymorphic variations in mood changes after delivery. METHOD One thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2-3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression. RESULTS One hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose-response fashion at 8 weeks post-partum, but not at 32 weeks. CONCLUSIONS High-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.
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Affiliation(s)
- J Sanjuan
- Hospital Clínico, UV, CIBER Enfermedades Mentales,Valencia, Spain.
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Bhattacharyya S, Fusar-Poli P, Borgwardt S, Allen P, Martin-Santos R, O'Carroll C, Seal M, Atakan Z, McGuire P. Delta-9-tetrahydrocannabinol modulates parahippocampal and ventral striatal activity during processing of verbal memory. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.1028] [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: 11/26/2022] Open
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Imaz M, Garcia-Esteve L, Gelabert E, Navarro P, Plaza A, Torrens M, Navines R, Martin-Santos R. Substance use during pregnancy and perinatal outcomes. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.1308] [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: 11/24/2022] Open
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28
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Plaza A, Garcia-Esteve L, Navarro P, Ascaso C, Piñeiro M, Martin-Santos R, Gelabert E. The presence of childhood sexual abuse a risk for antithyroid antibodies posivity in the postpartum depression. A preliminary study. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.669] [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: 11/15/2022] Open
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Garcia-Esteve L, Navarro P, Torres A, Tarragona M, Plaza A, Farras U, Salanova C, Gutierrez F, Martin-Santos R. Block escape in intimate partner violence scale: Development and preliminar analysis of its psychometric properties. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.1286] [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: 10/22/2022] Open
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McGuire P, Crippa J, Martin-Santos R, O'Carroll C, Bhattacharyya S, Borgwardt S, Fusar-Poli P, Atakan Z. Effects of cannabis on memory and response inhibition. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.083] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Gelabert E, Navarro P, Plaza A, Imaz M, Subira S, Garcia-Esteve L, Martin-Santos R. Early screening of risk factors of postpartum depression at the obstetric ward. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.794] [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: 11/17/2022] Open
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Garcia-Esteve L, Botet F, Perez J, Soler C, Figueras J, Navarro P, Martin-Santos R, Gelabert E, Imaz M. Antidepressant treatment during pregnancy: Pros and cons. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.171] [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: 12/01/2022] Open
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Martin-Santos R, Gelabert E, Plaza A, Navarro P, Navines R, Ascaso C, Garcia C, Gratacos M, Estivill X, Garcia Esteve L. Antidepressant treatment response of postpartum depression: Clinical and genetic factors. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.172] [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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34
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Domschke K, Kuhlenbäumer G, Schirmacher A, Lorenzi C, Armengol L, DiBella D, Gratacos M, Garritsen HS, Nöthen MM, Franke P, Sand P, Fritze J, Perez G, Maier W, Sibrowski W, Estivill X, Bellodi L, Ringelstein EB, Arolt V, Martin-Santos R, Catalano M, Stögbauer F, Deckert J. Human nuclear transcription factor gene CREM: genomic organization, mutation screening, and association analysis in panic disorder. Am J Med Genet B Neuropsychiatr Genet 2003; 117B:70-8. [PMID: 12555239 DOI: 10.1002/ajmg.b.10018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/10/2022]
Abstract
Panic disorder is an anxiety disorder with an estimated heritability of 48%. Variation in the gene of the nuclear transcription factor "cAMP-responsive element modulator" (CREM) might contribute to its pathogenesis. CREM knock-out mice exhibit significantly less anxiety behavior than wild-type mice and the alternative CREM gene product "inducible cAMP early repressor" (ICER) plays a pivotal role in the hypothalamo-pituitary-adrenal (HPA) axis, which is disturbed in panic disorder. We characterized the genomic organization of the human CREM gene and performed a systematic mutation screening by means of single stranded conformational analysis (SSCA) in a sample of 40 German patients with panic disorder (DSM-III-R). Four novel single nucleotide polymorphisms in CREM promoters P 1 and P 4, one trinucleotide (ATT)-repeat polymorphism in CREM promoter P 2-generating the ICER isoform-and a rare amino acid substitution in CREM exon glut 2 were identified. Association analysis in an extended sample of German patients (n = 88) revealed a significant excess of the shorter CREM P 2 promoter eight-repeat trinucleotide allele and of genotypes containing the eight-repeat trinucleotide allele in panic disorder (P = 0.02), in particular in panic disorder without agoraphobia (P = 0.001). A replication study in independent Italian (n = 76) and Spanish (n = 62) samples, however, failed to confirm this observation. This suggests that the CREM P 2 promoter trinucleotide polymorphism is not a major susceptibility factor in the pathogenesis of panic disorder. Functional analysis of the observed CREM P 2 promoter polymorphism as well as studies in independent panic disorder samples are necessary.
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Affiliation(s)
- K Domschke
- Department of Psychiatry, University of Münster, Münster, Germany
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Gilaberte I, Montejo AL, de la Gandara J, Perez-Sola V, Bernardo M, Massana J, Martin-Santos R, Santiso A, Noguera R, Casais L, Perez-Camo V, Arias M, Judge R. Fluoxetine in the prevention of depressive recurrences: a double-blind study. J Clin Psychopharmacol 2001; 21:417-24. [PMID: 11476126 DOI: 10.1097/00004714-200108000-00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 11/26/2022]
Abstract
Optimal outcomes from depression treatment are long-term recovery and, in the case of recurrent depression, prevention of new episodes. However, few data are available concerning the long-term efficacy of antidepressants in prophylactic treatment to prevent recurrences of depression. The efficacy and safety of fluoxetine 20 mg/day was evaluated in reducing the number of depressive episodes and in extending the time free of symptoms in patients with recurrent unipolar major depression. Patients with recurrent unipolar major depression according to DSM-III-R criteria and who responded to 32 weeks of open-label fluoxetine were randomly assigned to receive fluoxetine 20 mg/day (N = 70) or placebo (N = 70) for 48 weeks of double-blind maintenance treatment. Outcome measures were the percentage of recurrences and time to recurrence. Safety assessments included treatment-emergent adverse events, reasons for discontinuation, vital signs, and laboratory measures. Fluoxetine was associated with a statistically significantly smaller percentage of patients who had a recurrence compared with placebo (20% vs. 40%; chi2 analysis, p = 0.010). The symptom-free period was significantly longer for patients treated with fluoxetine versus placebo (295 vs. 192 days; Kaplan-Meier estimates, log-rank test, p = 0.002). Treatments were well tolerated during maintenance treatment. The only statistically significant difference in adverse events between treatment groups was anxiety, which was more frequent in the placebo group (fluoxetine, 12.9% vs. placebo, 30%; chi2 analysis, p = 0.013). Two placebo-treated patients and no fluoxetine-treated patients were withdrawn because of adverse events. In conclusion, fluoxetine at 20 mg/day was effective and well tolerated for the prophylactic treatment of recurrent unipolar major depression.
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Affiliation(s)
- I Gilaberte
- Lilly Research Centre, Windlesham, Surrey, United Kingdom.
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Berrios GE, Bulbena A, Bakshi N, Dening TR, Jenaway A, Markar H, Martin-Santos R, Mitchell SL. Feelings of guilt in major depression. Conceptual and psychometric aspects. Br J Psychiatry 1992; 160:781-7. [PMID: 1617361 DOI: 10.1192/bjp.160.6.781] [Citation(s) in RCA: 28] [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: 12/27/2022]
Abstract
A new scale for the evaluation of feelings of guilt is described. Two types of guilt feeling were of potential interest: 'delusional' guilt or shame (experienced in relation to one's actions), and 'affective' guilt (a more general feeling of unworthiness). Reliability and validity analyses for the first (15-item) version of the scale were performed in three separate and contrasting clinical samples. The second and final (seven-item) version was tested in another sample of major depressives and in normal controls. The HRSD was used as a measure of severity throughout. The BDI and Widlöcher psychomotor retardation scale were also used as external criteria for the seven-item scale. Exploratory factor analysis of this sample yielded two factors--'cognitive/attitudinal' and 'mood/feeling'--of which only the first correlated with scores for psychomotor retardation. It is suggested that these two factors represent two forms of guilt, but that only the former is related to a putative dopaminergic disorder. Guilt scores and measures of severity were not correlated. It is suggested that feelings of guilt should be considered as a behavioural marker for a subtype of depression.
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Affiliation(s)
- G E Berrios
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital
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