The European Journal of Psychiatry

Do depressive symptoms correlate with oxidative stress in a sample of healthy college students?

Background and Objectives: Major depression and sub-threshold depressive symptoms are associated with health crisis. Oxidative stress may be a mechanism for major depression. In the present study, we examined the relationship between the degree of depressive symptoms and oxidative status using a reliable and inexpensive method that evaluates endogenous hydroperoxides. Methods: We conducted a cross-sectional study in 54 non-smoking college students and measured serum reactive oxygen metabolites (ROMs) and the biological antioxidant potential (BAP) as an index of oxidative status. Depressive symptoms were assessed by the Beck Depression Inventory (BDI). Results: The concentrations of ROMs did not differ between the lower BDI group (BDI < 14) and the higher BDI group (BDI > 14) (282.7 - 59.84 U.CARR vs 307.7 - 67.51 U.CARR, z = -1.19, P = 0.239). We did find a significant relationship between ROM concentration values and higher BDI scores (rho = 0.30, P = 0.042). BAP levels in the hig-her BDI group were not significantly greater than those in the lower BDI group (z = -0.108, P = 0.287). There was no significant correlation between BAP and depressive symptoms (rho = 0.22, P = 0.140). Moreover, we conducted a multiple regression analysis to control for gender difference and difference in sleep perception of the previous night between the two BDI groups. However, depressive symptoms were not significantly predicted by ROM concentrations (beta = 0.28, P = 0.076). Conclusions: While results of the present study demonstrated a slight correlation between depressive symptoms and oxidative stress, this linkage could not be confirmed after controlling for significant confounding factors. This result should be verified in a larger sample.

Insight, psychosis and aggressive behaviour in mania

Background and Objectives: Aggressiveness is a common component of manic symptoms. The aim of this study was to determine the clinical characteristics associated with aggressive behaviour in bipolar patients with acute manic episodes. Methods: A study was carried out with 173 patients who met the DSM-IV criteria for manic or mixed bipolar disorder. Clinical and demographic variables were evaluated using the Positive and Negative Symptoms Scale (PANSS), the Young Mania Rating Scale (YMRS), the Brief Psychiatric Rating Scale (BPRS), and the Hamilton Depression Rating Scale (HDRS). Significance and independence of relevant variables were tested with regression models. Results: Forty percent of patients displayed aggressive behaviour. Involuntary nature of admission, positive psychotic symptoms and lack of insight were predictors of aggressive behaviour in manic patients. Conclusions: Aggressive behaviour during acute manic episodes appears to be related with the severity of the psychopathology, and particularly positive psychotic symptoms, involuntary admissions and lack of insight.

Insight in first episode psychosis: Conceptual and clinical considerations

Background and Objectives: Poor insight or impaired awareness of illness is a very common feature in psychosis. The purpose of this study is to review critically the conceptual approximations from different perspectives to insight in psychosis and address its relations to other clinical and psychopathological variables. Methods: We reviewed the principal factors that have been proposed to contribute to deficient insight in first episode psychosis patients from different conceptual frameworks, defence mechanisms or coping styles, structural or volumetric brain associations, cognitive deficits, and severity of clinical symptoms. Results: This review of literature suggests that insight is a complex mental faculty heavily influenced by additional factors, such as social and cultural aspects, among others. Results also show the correlates of insight in first episode psychosis and treatment adherence in the course of the illness, although it is not stable over time. In fact, adequate level of insight is a necessary, but not sufficient condition for an adequate adherence. Conclusions: Insight is a complex and multidimensional mental faculty that is a key factor in the prognosis of the illness. The link between both is probably mediated by the interaction of additional variables such as DUP, affective symptoms, sociodemographics, and drug abuse. Due to the complex relationships among insight, cognition and psychopathology in psychosis, these three factors could be considered as semi-independent phenomena. Finally, the neuroscience perspective about insight in psychosis is an especially productive research line that has contributed to a better understanding of the complex picture.

Predictors of outcome in the early course of first-episode psychosis

Background and Objectives: The identification of characteristics that predict clinical and functional outcomes in patients with schizophrenia and related psychotic disorders is essential for enhancing our understanding of the pathophysiology and the treatment of the disorder. The present study employed a retrospective design to examine the predictive validity of demographic, clinical, and psychosocial characteristics of first-episode patients on diagnosis, presence of residual psychotic symptoms, and number of psychotic episodes three to five years later. Methods: Information on baseline predictor variables and outcome was obtained from the clinical records of 44 patients who had their first psychotic episode between 1999 and 2003 and whose available follow-up period was at least 3 years long (mean = 5.7 years, SD = 1.3 years). Results: Male gender, single marital status, and poor premorbid adjustment were significantly associated with residual symptoms at follow-up. Poor insight at onset was significantly associated with subsequent relapses. Diagnosis of schizophrenia (as opposed to other psychotic disorders) at the follow-up assessment showed no significant association with any of the baseline predictors. Conclusions: Consistent with previous findings, the constellation of male gender, single status, poor premorbid adjustment and poor insight appeared to predict especially poor outcome. Residual symptoms appear to be an especially useful index of clinical and functional status for examining the course and outcome of first-episode psychosis.

The early Kraepelin´s dichotomy of schizophrenia and affective disorder - Evidence of separate diseases?^a

Background and Objectives: Testing Kraepelin´s dichotomy model, we studied the separability of schizophrenia and affective disorders by their symptoms and course. Methods: To this end symptoms and illness course were assessed retrospectively in individually matched untreated probands with schizophrenia and depression (n=130 each) from first admission back to illness onset in comparison with 130 "healthy" controls. In a second study these same variables were studied prospectively in 107 patients with schizophrenia over a homogenised follow-up of 134 months (11.2 years). The actual mean length of the follow-up period was 12.3 years. Results: The symptom most frequently marking the onset of both schizophrenia and depression was depressive mood. Both disorders exhibited the same prodromal core syndrome. It was not until the emergence of positive symptoms that the disorders became separable by the international classification systems. Depression remained the most frequent syndrome over the course of schizophrenia. Conclusions: Obviously, depression does not represent comorbidity, but an integral part of psychosis. A dimensional disease model based on (successively emerging) hierarchical symptom patterns of the human brain with increasing brain dysfunction in the course of schizophrenia and several neuro-degenerative disorders, not unknown to the later Kraepelin, is offered as an explanation.

The predictive value of psychological assessment of candidates for gastric bypass: A medical chart review

Background and Objectives: Guidelines for bariatric surgery demand a psychological evaluation of applicants. The aim of this study was to evaluate if the presence of "psychological risk factors" predicts postoperative weight loss after gastric bypass. Methods: Medical records of obese women who underwent bariatric surgery between 2000 and 2004 were reviewed. Psychological assessment consisted of a one-hour semi-structured interview, summarized in a written report. Anthropometric assessment at baseline and 6,12,18 and 24 months after surgery included body weight, height and body mass index. Results: The mean BMI of included patients (N = 92) was 46.2 + 6,3 kg/m² (range 38.4 - 69.7). Based on the psychological assessment, 27% (N = 25) of the patients were classified as having "psychological risk factors" and 28% (N = 26) were diagnosed with a psychiatric diagnosis, most often major depression. Two years after gastric bypass, 16% of patients with "psychological risk factors" achieved an excellent result (%EWL > 75) versus 39% of those without (p < 0.05). About 1 out of 4 patients was in postoperative psychiatric treatment, but only half of them were identified as having "psychological risk factors" at baseline. Weight loss of patients initiating a psychiatric treatment only after surgery was less than of patients who continued psychiatric treatment already initiated before surgery (55.7 + 14.8 versus 66.5 + 14.2 %EWL). Conclusions: A single semi-structured psychological interview may identify patients who are at risk for diminished postoperative weight loss; however, psychological assessment did not identify those patients who were in need of a psychiatric postoperative treatment.