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Previous findings suggested that electrodermal hyporeactivity has a high sensitivity (up to 97%) and high raw specificity (up to 98%) for suicide.
To evaluate prevalence, sensitivity and specificity of electrodermal hyporeactivity for suicide and suicide attempt, with and without death intent and with violent method or not, in adult patients with a primary diagnosis of depression.
At each study site at least 100 patients with a primary diagnosis of depression, also in remission, will be recruited. Depressive symptomatology will be evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts will be registered and the death intent of the worst attempt will be rated according to the first eight items of the Beck Suicide Intent Scale. The risk of suicide will be assessed according to rules and traditions at the centre. The EDOR Test (ElectroDermal Orienting Reactivity) will be performed. Two fingers are put on gold electrodes. Through headphones a moderately strong tone is presented now and then during the test. Sensors located within the electrodes are able to register the electrodermal response to those tones, measuring the skin conductance (i.e. electrodermal activity from sweat gland activity). Each patient will be followed up for one year for actions of intentional self-harm that require medical care and for suicide. The death intent will also be rated.
It is expected that the EDOR test detects a previously unknown neuropsychological dysfunction that is independent of the depressive state and can predict suicidality with a high sensitivity and specificity.
The scales for the assessment of depressive symptoms, translated and validated in Italian, lacks in the recognition of the psychopathological nuances of the disorder. The Bipolar Depression Rating Scale (BDRS) is a tool specifically built to reflect the characteristics of bipolar depression.
- aged 18–65 years
- diagnosis of BD (DSM-IV-TR) (125 patients) or
- diagnosis of MDD (DSM-IV-TR) (30 patients)
- manifestation of depressive symptoms
- no further psychiatric comorbidity on axis I and axis II (including abuse/addiction)
The analysis of the BDRS scores, according to the Kolmogorov-Smimov method shows a normal distribution; the α Cronbach's coefficient shows that the the scale, in its Italian version, has considerable validity and reliability (r = 0.82). The factor analysis was verified using the Varimax rotational method: after several tests, we found 2 subscales, one linked to mixed/depressive symptoms and a second related to (hypo)manic symptoms.
The BDRS is a valid scale for the measurement of depression in patients with Bipolar Disorder, with a notable internal consistency (Cronbach α 0.82), a significant consistency between items/total (Cronbach α from 0.80 to 0.82) and positive correlation with other scales (MADRS r 0.67, p < 0.001; HAM-D r 0.81, p < 0.001; YMRS r 0.46 p < 0.0001), including the Young Mania Rating Scale (better than the original validation sample Berk et al., 2007).
The study gathered information in order to draw useful conclusions to describe bipolar patients and their clinical management. The data collection was conducted as part of RENDiBi epidemiological study.
The statistical analysis of the collected data will be essential to understand the possible changes in drug treatment, through the help offered by a parameter, Polarity Index (PI), the numerical expression of the efficacy profile of a drug, very useful especially in the long-term management.
Administration of a first detection card (demographic data, medical history) and five scales (CGI-BP, Mood Insight Scale, YMRS, HDRS) and a structured interview (MINI). The parameters analyzed were: polarity prevalence, ratios efficiency (IE) (values indicating the effectiveness of treatment compared to manic components and/or depressive), treatment and PI.
The degree of correlation between PI and IETot is positive and statistically significant. The correlation between PI and IEm is statistically significant; the correlation is however not significant between PI and IEd; treatment with antipsychotics alone has increased PI, while the one with mood stabilizers has lesser; treatment with antipsychotics has increased PI in patients with predominantly polarity than those with manic depressive prevailing polarity.
There is a correlation between PI and effectiveness on manic symptoms and it is statistically significant (as already evident in the literature). The PI is numerically higher in the treatment of the subject with manic polarity, in agreement with previous studies that associate to the more effective drugs used for the management of manic recurrences a higher PI.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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