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ABSTRACT: BACKGROUND: Partial response and non-response to treatments are common problems in major depression. The identification of biological markers of clinical response may be of special interest for some adjunctive treatments, such as repetitive transcranial magnetic stimulation (rTMS), as it may ultimately improve their cost-effectiveness. OBJECTIVE: To identify pre-treatment functional imaging correlates of clinical response to rTMS in major depression. METHODS: We evaluated 21 depressed patients. They were randomized to receive 15 sessions of active or sham rTMS on the left dorsolateral prefrontal cortex. Functional magnetic resonance imaging (fMRI) was used to assess pre-treatment regional brain activity evoked by a word generation task. These regional activations were correlated (voxel-wise) with the Hamilton Rating Scale for Depression (HAM-D) reduction between baseline and end of treatment. A group of 13 healthy controls was also assessed using the same fMRI protocol to obtain reference imaging measurements. RESULTS: At the end of treatment, the percentage of patients with a HAM-D reduction greater than 50% was larger in the active than in the sham rTMS group (70% vs. 27.3%). In the active rTMS group, larger HAM-D reductions were significantly correlated with smaller deactivations during pre-treatment fMRI assessment in the anterior cingulate, the left medial orbitofrontal and the right middle frontal cortices, in addition to larger activations in the left ventral-caudal putamen. CONCLUSIONS: These results suggest that brain activity in regions arguably relevant for major depression may predict clinical response to rTMS. This approach may help in identifying the most suitable candidates to undergo rTMS treatment.
Brain Stimulation 02/2012; · 3.76 Impact Factor
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ABSTRACT: Several studies have reported clinical and biological differences between early- and late-onset(EO and LO) depression, which suggest different underlying aetiological processes. The aim of the present study is to examine whether there are differences between EO and LO depressed patients with melancholy, controlling for current age, with regard to clinical variables, vascular risk factors and family history of affective disorders or suicide.
One hundred and twenty-one melancholic patients were divided into three groups: patients with current age and onset earlier than 60 (N = 60), patients aged 60 or over and with onset at 60 or later(N = 30) and patients aged 60 or over and with onset before the age of 60 (N = 31). Systematic clinical data were collected with the structured interview ’The Schedule for Affective Disorders and Schizophrenia’. Symptom ratings at admission and at discharge were assessed by means of the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Widlöcher Depression Retardation Scale. Family history of affective disorders or suicide was obtained using the Family History Research Diagnostic Criteria. Vascular risk factors were also recorded.
The only symptoms that differed across the groups were feelings of anger and irritability, which scored lower in the LO older group. No other significant differences were found in the variables studied.
According to this study, LO depression with melancholia should not be considered as a distinct entity. Further studies on EO and LO-depression should consider this diagnostic subtype, among others, as a key variable.
International Journal of Geriatric Psychiatry 06/2011; 26(6):615-21. · 2.42 Impact Factor
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ABSTRACT: Environmental stressors are considered to play an important role in the triggering of mental disorders such as obsessive-compulsive disorder (OCD). Although there is extensive literature on traumatic life events, little is known about the role of nontraumatic but nonetheless stressful life events (SLEs) in OCD. The aim of this study was to establish whether OCD preceded by an SLE presents a different clinical pattern compared to non-SLE-preceded OCD.
We interviewed 412 OCD patients to assess both SLEs at onset of OCD and other clinical variables, including OCD symptom dimensions. Logistic regression was then applied to explore the relationship between clinical variables and OCD preceded by an SLE.
The SLE-preceded OCD group showed a later onset of the disorder (OR = 1.04, P = .015), a history of complicated birth (OR = 5.54, P<.001), less family history of OCD (OR = 0.42, P = .014), and the presence of contamination/cleaning symptoms (OR = 1.99, P = .01).
Patients with OCD onset close to an SLE and those without an SLE close to OCD onset show a distinct clinical pattern.
Depression and Anxiety 02/2011; 28(5):367-76. · 4.18 Impact Factor
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Marina López-Solà,
Jesus Pujol,
Rosa Hernández-Ribas,
Ben J Harrison,
Oren Contreras-Rodríguez,
Carles Soriano-Mas,
Joan Deus,
Héctor Ortiz,
José M Menchón, Julio Vallejo,
Narcís Cardoner
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ABSTRACT: Major depressive disorder (MDD) is characterized by a constellation of affective, cognitive, and somatic symptoms associated with functional abnormalities in relevant brain systems. Painful stimuli are primarily stressful and can trigger consistent responses in brain regions highly overlapping with the regions altered in MDD patients. Duloxetine has proven to be effective in treating both core emotional symptoms and somatic complaints in depression. This study aimed to assess the effects of duloxetine treatment on brain response to painful stimulation in MDD patients. A total of 13 patients and a reference group of 20 healthy subjects were assessed on three occasions (baseline, treatment week 1, and week 8) with functional magnetic resonance imaging (fMRI) during local application of painful heat stimulation. Treatment with duloxetine was associated with a significant reduction in brain responses to painful stimulation in MDD patients in regions generally showing abnormally enhanced activation at baseline. Clinical improvement was associated with pain-related activation reductions in the pregenual anterior cingulate cortex, right prefrontal cortex, and pons. Pontine changes were specifically related to clinical remission. Increased baseline activations in the right prefrontal cortex and reduced deactivations in the subgenual anterior cingulate cortex predicted treatment responders at week 8. This is the first fMRI study addressed to assess the effect of duloxetine in MDD. As a novel approach, the application of painful stimulation as a basic neural stressor proved to be effective in mapping brain response changes associated with antidepressant treatment and brain correlates of symptom improvement in regions of special relevance to MDD pathophysiology.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 10/2010; 35(11):2305-17. · 6.99 Impact Factor
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Virginia Soria,
Erika Martínez-Amorós,
Geòrgia Escaramís,
Joaquín Valero,
Rosario Pérez-Egea,
Cecilia García,
Alfonso Gutiérrez-Zotes,
Dolors Puigdemont,
Mònica Bayés,
José M Crespo,
Lourdes Martorell,
Elisabet Vilella,
Antonio Labad, Julio Vallejo,
Víctor Pérez,
José M Menchón,
Xavier Estivill,
Mònica Gratacòs,
Mikel Urretavizcaya
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ABSTRACT: Disruptions in circadian rhythms have been described in mood disorders (MD), but the involvement of genetic variation in genes pertaining to the molecular circadian machinery in the susceptibility to MD has not been conclusively determined. We examined 209 single-nucleotide polymorphisms (SNPs) covering 19 circadian genes (ADCYAP1, ARNTL, ARNTL2, BHLHB2, BHLHB3, CLOCK, CRY1, CRY2, CSNK1E, DBP, NPAS2, NR1D1, PER1, PER2, PER3, RORA, TIMELESS, VIP, and VIPR2) in a sample of 534 MD patients (335 with unipolar major mood depression (MDD) and 199 with bipolar disorder (BD)) and 440 community-based screened controls. Nominally, statistically significant associations were found in 15 circadian genes. The gene-wide test, corrected for the number of SNPs analyzed in each gene, identified significant associations in CRY1 (rs2287161), NPAS2 (rs11123857), and VIPR2 (rs885861) genes with the combined MD sample. In the MDD subsample, the same SNPs in CRY1 and NPAS2 of the combined sample remained associated, whereas in the BD subsample CLOCK (rs10462028) and VIP (rs17083008) were specifically associated. The association with an SNP located 3' near CRY1 gene in MDD remained statistically significant after permutation correction at experiment level (p=0.007). Significant additive effects were found between the SNPs that were statistically significant at the gene-wide level. We also found evidence of associations between two-marker haplotypes in CRY1 and NPAS2 genes and MD. Our data support the contribution of the circadian system to the genetic susceptibility to MD and suggest that different circadian genes may have specific effects on MD polarity.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 05/2010; 35(6):1279-89. · 6.99 Impact Factor
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ABSTRACT: The lateral surface of the right frontal lobe has a relevant role in modulating behavioral responses to aversive stimuli and may significantly influence pain experience. Imaging studies suggest that this modulatory role is multifaceted, but no studies have assessed the regional specialization of this cortex on the basis of its response dynamics during pain processing. We aimed to investigate functional specialization within the right lateral frontal cortex using a dynamic fMRI approach. Brain responses to a mechanical painful stimulus and a preceding anticipatory cue (auditory tone) were assessed in 25 healthy subjects. Functional data were decomposed into 15 sequential activation maps covering the full anticipation-painful stimulation cycle using a finite impulse response (FIR) analysis approach. Movie sequences showing the temporal evolution of brain activation illustrate the findings. A region involving premotor-prefrontal cortices was activated soon after the anticipatory cue and showed a significant correlation with both anterior cingulate cortex activation and subjective pain ratings. The frontal operculum also showed a significant anticipatory response, but the most robust activation followed painful stimulation onset and was strongly correlated with insula activation. The anterior prefrontal cortex showed full activation during late painful stimulation and was negatively correlated with pain unpleasantness. In conclusion, different elements within the right lateral frontal cortex showed distinct activation dynamics in response to painful stimulation, which would suggest relevant regional specialization during pain processing. These findings are congruent with the broad functional role of the right frontal cortex and its influence on crucial aspects of human behavior.
NeuroImage 04/2010; 50(3):1177-87. · 5.89 Impact Factor
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Virginia Soria,
Egrave]|rika Mart|[iacute]|nez-Amor|[oacute]|s,
Ge|[ograve]|rgia Escaram|[iacute]|s,
Joaqu|[iacute]|n Valero,
Rosario P|[eacute]|rez-Egea,
Cecilia Garc|[iacute]|a,
Alfonso Guti|[eacute]|rrez-Zotes,
Dolors Puigdemont,
M|[ograve]|nica Bay|[eacute]|s,
Jos|[eacute]| M Crespo,
Lourdes Martorell,
Elisabet Vilella,
Antonio Labad, Julio Vallejo,
V|[iacute]|ctor P|[eacute]|rez,
Jos|[eacute]| M Mench|[oacute]|n,
Xavier Estivill,
M|[ograve]|nica Gratac|[ograve]|s,
Mikel Urretavizcaya
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ABSTRACT: Disruptions in circadian rhythms have been described in mood disorders (MD), but the involvement of genetic variation in genes pertaining to the molecular circadian machinery in the susceptibility to MD has not been conclusively determined. We examined 209 single-nucleotide polymorphisms (SNPs) covering 19 circadian genes (ADCYAP1, ARNTL, ARNTL2, BHLHB2, BHLHB3, CLOCK, CRY1, CRY2, CSNK1E, DBP, NPAS2, NR1D1, PER1, PER2, PER3, RORA, TIMELESS, VIP, and VIPR2) in a sample of 534 MD patients (335 with unipolar major mood depression (MDD) and 199 with bipolar disorder (BD)) and 440 community-based screened controls. Nominally, statistically significant associations were found in 15 circadian genes. The gene-wide test, corrected for the number of SNPs analyzed in each gene, identified significant associations in CRY1 (rs2287161), NPAS2 (rs11123857), and VIPR2 (rs885861) genes with the combined MD sample. In the MDD subsample, the same SNPs in CRY1 and NPAS2 of the combined sample remained associated, whereas in the BD subsample CLOCK (rs10462028) and VIP (rs17083008) were specifically associated. The association with an SNP located 3′ near CRY1 gene in MDD remained statistically significant after permutation correction at experiment level (p=0.007). Significant additive effects were found between the SNPs that were statistically significant at the gene-wide level. We also found evidence of associations between two-marker haplotypes in CRY1 and NPAS2 genes and MD. Our data support the contribution of the circadian system to the genetic susceptibility to MD and suggest that different circadian genes may have specific effects on MD polarity.Keywords: clock genes; mood disorders; circadian rhythms; association; polymorphism; haplotype
Neuropsychopharmacology 01/2010; 35(6):1279-1289. · 7.99 Impact Factor
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ABSTRACT: Ninety female outpatients with obsessive-compulsive disorder (OCD) completed a semistructured interview to assess the relationship between different OCD symptom dimensions and the onset of OCD at menarche or during the perinatal period. Patients with hoarding symptoms had an earlier age at menarche than non-hoarders (12.1 +/- 1.3 vs 13.0 +/- 1.5 years, p = 0.019) and were more likely to report OCD onset at menarche (OR = 4.1, p = 0.034). Patients with symptoms of the contamination/cleaning dimension were more likely to report the onset of their disorder during pregnancy or postpartum (OR = 9.3, p = 0.048).
Archives of Women s Mental Health 09/2009; 13(1):75-81. · 2.06 Impact Factor
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ABSTRACT: This study sought to examine the effectiveness of group and individual cognitive-behavioral treatment (CBT) and to compare the results with those of a wait-list control group among a sample of patients with obsessive-compulsive disorder (OCD). Fifty-seven individuals diagnosed with OCD were evaluated pre- and posttreatment with the Yale-Brown Obsessive Compulsive Scale and the Hamilton Rating Scales for Anxiety and Depression. Both group and individual CBT obtained statistically significant reductions in anxiety and depressive symptoms. Patients in individual treatment achieved a statistically significant reduction in OCD symptoms compared with those in group treatment, but their dropout rate was twice as high. Patients with symmetry and order rituals presented less improvement in anxiety symptoms than those with other rituals. Associated general symptoms were lower in patients receiving either mode of CBT compared with wait-list participants. The authors found that individual treatment is more effective in reducing obsessive-compulsive symptoms than group treatment.
Psychotherapy Research 10/2008; 18(5):604-14. · 1.75 Impact Factor
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P Alonso,
M Gratacòs,
J M Menchón,
C Segalàs,
J R González,
J Labad,
M Bayés,
E Real,
R de Cid,
A Pertusa,
G Escaramís, J Vallejo,
X Estivill
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ABSTRACT: Recent work suggests that neurotrophic factors may contribute to the genetic susceptibility to obsessive-compulsive disorder (OCD). Among other clinical dimensions, the presence of hoarding obsessions and compulsions has been shown to be correlated with a number of clinical and neuroimaging findings, as well as with a different pattern of genetic inheritance. We used a linkage disequilibrium (LD)-mapping approach to investigate whether neurotrophic tyrosine kinase receptor type 3 (NTRK3), the high-affinity receptor of neurotrophin 3 (NT-3), plays a role in increasing susceptibility to hoarding in OCD. We performed an association study of 52 tag single nucleotide polymorphisms (tagSNPs) covering the whole NTRK3 gene in a sample comprising 120 OCD patients and 342 controls. Single nucleotide polymorphism association and haplotype analysis were performed. Thirty-six of our patients (30%) exhibited significant hoarding obsessions and compulsions. A significant association of two SNPs in the 3' downstream region of NTRK3 gene and obsessive-compulsive hoarding was identified: rs1017412 [odds ratio (OR) = 2.16; P = 0.001] and rs7176429 (OR = 2.78; P = 0.0001), although only the latter remained significant after Bonferroni correction. Although the haplotype analysis did not show significant results, a more extended block of LD in the OCD hoarders with respect to the control group was observed, suggesting a lower haplotype diversity in these individuals. Our findings suggest that NTRK3 may contribute to the genetic susceptibility to hoarding in OCD and may constitute an interesting gene to focus on in studies of the genetic basis of obsessive-compulsive hoarding.
Genes Brain and Behavior 07/2008; 7(7):778-85. · 3.48 Impact Factor
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Pino Alonso,
Mónica Gratacòs,
José M Menchón,
Jerónimo Saiz-Ruiz,
Cinto Segalàs,
Enrique Baca-García,
Javier Labad,
José Fernández-Piqueras,
Eva Real,
Concepción Vaquero,
Mercedes Pérez,
Helen Dolengevich,
Juan R González,
Mónica Bayés,
Rafael de Cid, Julio Vallejo,
Xavier Estivill
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ABSTRACT: Family, twin and molecular studies provide increasing evidence for the importance of genetic factors in obsessive-compulsive disorder (OCD). Recent work suggests that brain-derived neurotrophic factor (BDNF) may be involved in OCD pathophysiology. We used a linkage disequilibrium (LD)-mapping approach to investigate the role that BDNF and its specific receptor neurotrophic tyrosine kinase receptor type 2 (NTRK2) may play in increasing susceptibility to OCD.
Eight tag single nucleotide polymorphisms (tagSNPs) covering the BDNF gene region and 46 tagSNPs in the NTRK2 region were genotyped in 215 OCD patients and 342 control subjects. Single nucleotide polymorphism association and haplotype analysis were performed. The possible relationship between genetic factors and clinical characteristics including age of OCD onset, tic disorders, clinical dimensions, and family history of OCD were investigated.
Haplotype analysis revealed a significant association between OCD and a five-marker protective haplotype located toward the 5' of the BDNF gene (odds ratio [OR] = .80; 95% confidence interval [CI] = .69-.92; permutation p value = .006) containing the functional valine (Val)66-to-methionine (Met) variant. A significant association between a NTRK2 intronic SNP (rs2378672) and OCD was identified (p < .0001) in female patients under an additive model. A protective haplotype located in intron 19 of NTRK2 was also associated with OCD (OR = .76; 95% CI = .66-.87; permutation p value = .001).
These findings support a role for the BDNF/NTRK2 signaling pathway in genetic susceptibility to OCD.
Biological psychiatry 04/2008; 63(6):619-28. · 8.93 Impact Factor
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ABSTRACT: Memory deficits have been reported in several neuropsychological studies of obsessive-compulsive disorder (OCD). Dysfunction in nonverbal memory has been consistently reported, whereas findings on verbal memory are more heterogeneous. The authors studied 50 patients with OCD who were matched for sex, age, educational level, and hand dominance with 50 healthy controls (HC). Cognitive performance in both groups was assessed on verbal and nonverbal memory tasks, and several clinical variables were also assessed in the patient group. Patients with OCD showed a pattern of cognitive dysfunction with alterations in areas of nonverbal memory (recall and recognition), and verbal memory (learning and recall). Older age at onset of OCD was associated with poorer performance on verbal memory tasks. Low scores on some verbal memory tasks were associated with severity of OCD, and nonverbal memory was influenced by depressive symptoms. The study suggests the existence of dysfunction in the execution of verbal and nonverbal memory tasks in OCD; the influence of clinical variables depends on the specific neuropsychological function.
Neuropsychology 04/2008; 22(2):262-72. · 3.82 Impact Factor
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ABSTRACT: Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric phenotypes influenced by both genetic and environmental factors. We investigated the genetic contribution of four single nucleotide polymorphisms (SNPs) within the serotonin receptor 5HT2C and two sequence variants within the serotonin transporter SLC6A4 to different ED-related psychopathological symptoms in a total sample of 82 ED patients. All patients were diagnosed according to DSM-IV criteria and underwent diagnostic and psychopathological assessments by means of structured clinical interviews and rating scales. We detected significant evidence of association between the -995A/-759T/-697C/Cys23 haplotype of the 5HT2C gene and different anxious and depressive subscales of the SCL90-R instrument, that included Somatization (p = 0.029), Obsessive-Compulsiveness (p = 0.021), Depression (p = 0.032), Anxiety (p = 0.004), Hostility (p = 0.028), Phobic Anxiety (p = 0.029) and Paranoid Ideation (p = 0.008), in BN patients. We also observed a strong association between the 5HTTLPR polymorphism of the SLC6A4 gene and Anxiety in the same group of BN patients (p = 0.004). However, no epistatic effects between the 5HT2C and SLC6A4 genes on the different anxious and depressive subscales were observed. Our preliminary data suggest that the serotoninergic system contributes to the different psychopathological symptoms that may be partially responsible for the phenotypical variability within the bulimic phenotype.
Journal of Psychiatric Research 02/2008; 42(1):50-7. · 4.66 Impact Factor
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ABSTRACT: Research on the relationship between personality factors and obsessive-compulsive disorder (OCD) has proved difficult to interpret due to conceptual problems including a lack of consensus on the model of personality employed as a framework as well as a failure to consider the clinical heterogeneity of the disorder. The aim of this study was to examine the dimensional personality profile associated with OCD and to determine whether any relationship exists between personality factors and clinical variables in a sample of 60 OCD outpatients who were administered Cloninger's Temperament and Character Inventory (TCI). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS) and the Y-BOCS symptom checklist were used to assess the severity of obsessive-compulsive and depressive symptoms and the presence of the main OCD symptom dimensions. OCD patients showed significantly higher scores in harm avoidance and lower scores in novelty-seeking, self-directedness and cooperativeness than healthy subjects. These results remained unchanged when only pure OCD patients without comorbid psychiatric conditions were considered. Comorbid depressive symptoms and hoarding obsessions and compulsions were significantly associated with high harm avoidance scores. These results support the existence of a dimensional personality profile associated with OCD and characterized by high harm avoidance and low novelty-seeking, self-directedness and cooperativeness scores, but also emphasize the importance of considering the influence of comorbid clinical conditions or symptom subtypes in addressing the role of personality factors in OCD.
Psychiatry Research 02/2008; 157(1-3):159-68. · 2.52 Impact Factor
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ABSTRACT: The high comorbidity of obsessive-compulsive disorder (OCD) with major depressive disorder (MDD) suggests common neurobiological substrates. We assessed the contribution of lifetime MDD to brain structural alterations in OCD using magnetic resonance imaging. OCD patients with (n=33) or without (n=39) lifetime MDD, and 72 control subjects were assessed. Comparative region of interest (ROI) analyses assessed the contribution of lifetime MDD to gray matter volume alterations in OCD patients. Interregional correlations of gray matter volume were also examined and voxelwise analyses were performed to identify alterations in other brain regions. OCD patients with lifetime MDD showed a larger reduction of medial orbitofrontal cortex (mOFC) gray matter volume. Both OCD groups showed distinct correlations of mOFC gray matter volume with other relevant brain regions. For patients with MDD, this involved the medial frontal gyrus, and right insula and amygdala regions, whereas for those OCD patients without MDD, the rostral anterior cingulate cortex was involved. Our findings support existing evidence suggesting a non-specific involvement of mOFC alterations in a range of neuropsychiatric disorders. Nevertheless, volume reduction in this region, together with an abnormal pattern of interregional correlations with other emotion-relevant brain areas, may contribute to explain the diathesis for MDD comorbidity in OCD.
NeuroImage 12/2007; 38(3):413-21. · 5.89 Impact Factor
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ABSTRACT: The aim of the present study was to determine whether anorexia nervosa (AN), bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) share clinical and psychopathological traits. The sample consisted of 90 female patients (30 OCD; 30 AN; 30 BN), who had been consecutively referred to the Department of Psychiatry, University Hospital of Bellvitge, Barcelona. All subjects met DSM-IV criteria for those pathologies. The assessment consisted of the Maudsley Obsessive-Compulsive Inventory (MOCI), Questionnaire of obsessive traits and personality by Vallejo, Eating Attitudes Test-40 (EAT-40), Eating Disorder Inventory (EDI), and Beck Depression Inventory (BDI). ANCOVA tests (adjusted for age and body mass index) and multiple linear regression models based on obsessive-compulsiveness, obsessive personality traits and perfectionism, as independent variables, were applied to determine the best predictors of eating disorder severity. On ancova several significant differences were found between obsessive-compulsive and eating-disordered patients (MOCI, P < 0.001; EAT, P < 0.001; EDI, P < 0.001), whereas some obsessive personality traits were not eating disorder specific. A total of 16.7% OCD patients presented a comorbid eating disorder, whereas 3.3% eating disorders patients had an OCD diagnosis. In the eating disorder group, the presence of OC symptomatology was positively associated (r = 0.57, P < 0.001) with the severity of the eating disorder. The results were maintained after adjusting for comorbidity. Although some obsessive-compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different.
Psychiatry and Clinical Neurosciences 08/2007; 61(4):385-91. · 2.13 Impact Factor
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ABSTRACT: The dexamethasone suppression test (DST) is the main hormonal disturbance in psychotic depression compared to non-psychotic depression. However, although there have been many studies of individual hormonal axes in depression, few multi-axial studies have been reported. This study aims to examine hormonal differences between these groups of patients through three functional hormonal tests: DST, thyroid stimulating hormone response to thyroid releasing hormone (TSH-TRF) and growth hormone response to growth hormone releasing factor (GH-GRF).
Forty inpatients meeting DSM-III-R criteria for major depressive episode with melancholia (21 non-psychotic and 19 psychotic) were studied. Dexamethasone suppression test, TSH-TRF and GH-GRF tests were undertaken for all patients.
In the whole melancholic sample, 80.0% showed disturbances in at least one hormonal axis, 40.0% in two axes and 5.0% in all three axes. Basal and post-dexamethasone cortisol levels were significantly higher in psychotic than in non-psychotic patients. An association between post-dexamethasone cortisol and blunted GH-GRF response was demonstrated in those with psychotic depression. In the whole sample, GH blunting was found in 62.5% of patients, DST non-suppression in 37.5% and TSH blunting in 25.0% (no differences were found between psychotic and non-psychotic patients).
Sample was restricted to melancholia and unknown factors may influence hormonal responses to stress.
Hormonal disturbances in depression are more evident when studying several axes, being the HPA and the GH axes the most prominents. Psychotic depression showed more HPA disturbance than non-psychotic depression. Influence of the HPA on the GH axis is discussed.
Journal of Affective Disorders 07/2007; 100(1-3):65-73. · 3.52 Impact Factor
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ABSTRACT: Structural neuroimaging studies have reported a variety of brain alterations between groups of obsessive-compulsive disorder (OCD) patients and healthy controls. However, the large heterogeneity in discrete anatomical measures that exists among patients prevents a clear discrimination of single patients from healthy subjects. This reduces the potential clinical applicability of structural neuroimaging studies. In the present study we assessed the feasibility of identifying OCD patients on the basis of whole-brain anatomical alterations. Whole-brain magnetic resonance images were collected from two consecutive samples of OCD outpatients (n=72 and n=30), and control subjects (n=72 and n=30). We computed the whole-brain (voxel-wise) pattern of structural difference between OCD patients and control subjects at the group level. A single expression value of this difference pattern was calculated for each subject, expressing their degree of 'OCD-like' anatomical alteration. Accuracy of patient classification based on these expression values was assessed using two validation approaches. Firstly, using a cross-validation method, we obtained a high classification accuracy (average of the sensitivity and specificity indices) of 93.1%. In a second assessment, which classified new groups of OCD patients and control subjects, overall accuracy was lower at 76.6%. Individual expression values for OCD patients were significantly correlated with overall symptom severity as measured by the Y-BOCS scale. Our results suggest that OCD patients can be identified on the basis of whole-brain structural alterations, although the accuracy of our approach may be limited by the inherent variability of psychiatric populations. Nevertheless, the anatomical characterization of individual patients may ultimately provide the psychiatrist with relevant biological information.
NeuroImage 05/2007; 35(3):1028-37. · 5.89 Impact Factor
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ABSTRACT: The aim of our study was to assess the role of gender in OCD symptom dimensions with a multivariate analysis while controlling for history of tic disorders and age at onset of OCD. One hundred and eighty-six consecutive outpatients with a DSM-IV diagnosis of OCD were interviewed. Yale-Brown Obsessive-Compulsive Scale (YBOC-S), YBOC-S Symptom Checklist, and Hamilton Depression and Anxiety Scales were administered to all patients. Lifetime history of tic disorders was assessed with the tic inventory section of the Yale Global Tic Severity Scale. Age at onset of OCD was assessed by direct interview. Statistical analysis was carried out through logistic regression to calculate adjusted female:male odds ratios (OR) for each dimension. A relationship was found between gender and two main OCD dimensions: contamination/cleaning (higher in females; female:male OR=2.02, P=0.03) and sexual/religious (lower in females; female:male OR=0.41, P=0.03). We did not find gender differences in the aggressive/checking, symmetry/ordering, or hoarding dimensions. We also found a greater history of tic disorders in those patients with symptoms from the symmetry/ordering, dimension (P<0.01). Both symmetry/ordering and sexual/religious dimensions were associated with an earlier age at onset of OCD (P<0.05). Gender is a variable that plays a role in the expression of OCD, particularly the contamination/cleaning and sexual/religious dimensions. Our results underscore the need to examine the relationship between OCD dimensions and clinical variables such as gender, tics, age at onset and severity of the disorder to improve the identification of OCD subtypes.
Depression and Anxiety 04/2007; 25(10):832-8. · 4.18 Impact Factor
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ABSTRACT: Poor insight has been reported in 15% to 36% of patients with obsessive-compulsive disorder (OCD), but little is known about its clinical correlations. This study examines insight among patients with OCD using a standardized instrument, the Brown Assessment of Beliefs Scale, and analyzes its relationship with clinical factors. Insight was assessed in 132 patients with OCD, before and after pharmacologic treatment, using the Brown Assessment of Beliefs Scale. Differences between patients with good and poor insight on sociodemographic variables, OCD severity, comorbidity, and treatment response were studied. Stability of insight after pharmacologic treatment was also examined. Thirty-nine patients (29.5%) exhibited poor insight. They showed more depressive symptoms (P = .001) and personality disorders (P = .001), especially the schizotypal form, than did good insight subjects, but there were no significant differences in treatment response. Insight significantly improves after treatment (P < .001). Our results suggest that insight in OCD varies widely and constitutes a dynamic phenomenon that can improve after treatment and is influenced by clinical conditions such as affective status or personality.
Comprehensive Psychiatry 03/2007; 49(3):305-12. · 2.26 Impact Factor
