Journal of affective disorders
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Bilateral electroconvulsive therapy (BLECT) is useful in affective disorders and schizophrenia. Studies on electrical dose during BLECT are sparse. The Royal College of Psychiatrists recommends the use of electrical dose at 50-100% above seizure threshold. We studied the impact of change of BLECT practice from using threshold-level to 1.5 times threshold-level electrical dose in patients with depression, mania and schizophrenia. ⋯ Patients with schizophrenia and depression treated with BLECT at 1.5 times threshold-level electrical stimulus require similar number of ECT sessions as with threshold-level. However, patients with mania show clinical improvement with significantly fewer ECT sessions if treated at suprathreshold stimulus.
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It has been suggested that antidepressants may have neuroprotective abilities but it has newer been investigated lately whether treatment with antidepressants reduces the risk of dementia. ⋯ Continued long-term antidepressant treatment was associated with a reduced rate of dementia, however, not to the same level as the rate for the general population.
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Depression in older adults is associated with neuropsychological dysfunction, fronto-subcortical brain changes and sleep disturbance. Research suggests that adequate sleep is critical for many aspects of cognition including processing speed, verbal skills and memory. However, the association between sleep disturbance and neuropsychological functioning in depression has not been well evaluated. The current study therefore aimed to investigate these relationships. ⋯ This is the first known study to indicate that late insomnia in older people with major depression may be independently and aetiologically linked to neuropsychological performance, particularly verbal fluency and memory. It may also indicate underlying structural and neurochemical changes. Sleep and circadian disturbance may serve as a biomarker for ongoing cognitive decline and may be a potentially modifiable risk factor.
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Delayed onset of efficacy of antidepressants and a high proportion of depressed patients being poor or non-responders to antidepressants are well known clinical challenges. Therefore, it seems to be necessary to identify predictors for response and - even more important - for remission. It has been suggested that reduction of depressive symptoms at an early stage of antidepressant treatment may predict treatment outcome. Our objective was to test, if this hypothesis derived from randomized controlled studies (RCTs) in outpatients, would be confirmed in a large naturalistic study in a cohort of inpatients with major depression. Patients were treated with various antidepressants and co-medication according to the protocol based on evidence-based clinical guidelines. ⋯ The results support earlier findings that early improvement in the first two weeks may predict with high sensitivity later response and remission, even in hospitalized patients suffering from a more severe degree of depression. Since we used a naturalistic study design, the data may be considered as a replication of previous results drawn from RCTs in a naturalistic environment. We found a global antidepressant effect which was consistent across treatment subgroups regarding sensitivity values. However, we are aware of the inability of effectiveness studies to draw causal treatment relationships from the uncontrolled approach. Nevertheless, the replication of previous results might indicate that a drug switch during treatment in case of lack of early improvement could be accelerated.
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Comparative Study
The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations.
Earlier studies have suggested a relationship between bipolar disorder (BP) and eating disorders (ED), more specifically, bulimia nervosa (BN) and bipolar II disorder (BP-II). In the present report we extend this relationship to broader definitions of bipolarity. ⋯ In line with previous reports we describe an association between bulimia nervosa and bipolar disorder. Furthermore we report a relationship between lifetime bulimia and anorexia and cyclothymic and related affective temperaments.