To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Altered white matter brain connectivity has been linked to depression. The aim of this study was to investigate the association of markers of white matter connectivity with prevalence, incidence and course of depressive symptoms.
Markers of white matter connectivity (node degree, clustering coefficient, local efficiency, characteristic path length, and global efficiency) were assessed at baseline by 3 T MRI in the population-based Maastricht Study (n = 4866; mean ± standard deviation age 59.6 ± 8.5 years, 49.0% women; 17 406 person-years of follow-up). Depressive symptoms (9-item Patient Health Questionnaire; PHQ-9) were assessed at baseline and annually over seven years of follow-up. Major depressive disorder (MDD) was assessed with the Mini-International Neuropsychiatric Interview at baseline only. We used negative binominal, logistic and Cox regression analyses, and adjusted for demographic, cardiovascular, and lifestyle risk factors.
A lower global average node degree at baseline was associated with the prevalence and persistence of clinically relevant depressive symptoms [PHQ-9 ⩾ 10; OR (95% confidence interval) per standard deviation = 1.21 (1.05–1.39) and OR = 1.21 (1.02–1.44), respectively], after full adjustment. On the contrary, no associations were found of global average node degree with the MDD at baseline [OR 1.12 (0.94–1.32) nor incidence or remission of clinically relevant depressive symptoms [HR = 1.05 (0.95–1.17) and OR 1.08 (0.83–1.41), respectively]. Other connectivity measures of white matter organization were not associated with depression.
Our findings suggest that fewer white matter connections may contribute to prevalent depressive symptoms and its persistence but not to incident depression. Future studies are needed to replicate our findings.
Neuroimaging findings have reported aberrant functional connectivity in brain regions involved reward system in individuals with anorexia nervosa (AN) altering hedonic processing over food. Likewise, endocannabinoids such as Anandamide (AEA) and 2-Arachidonoylglycerol (2-AG) have been involved in rewarding aspects of food intake.
To identify nucleus accumbens (NAcc) functional connectivity with whole-brain comparing between individuals with AN and controls. Furthermore, in a sub-study, to explore the interaction between NAcc functional connectivity and peripheral AEA and 2-AG levels.
A total of 60 adult women (18 to 56 years of age) took part in the present study. Twenty-six individuals belonged to the AN group (BMI<18) and 34 to the HC group (BMI=18-24.99). All participants underwent functional magnetic resonance in resting-state, and blood samples were obtained in fasting.
Negative functional connectivity was observed in the AN group compared with the control group between the NAcc and the cerebellum (pFWE<.001), between the NAcc and the insula (pFWE<.001), between the NAcc and the supramarginal gyrus (pFWE=.019), and between the NAcc and the postcentral gyrus (pFWE=.010). Analyses exploring the association between NAcc functional connectivity and peripheral endocannabinoids levels displayed altered NAcc-cerebellum functional connectivity was negatively associated with peripheral 2-AG levels in the AN group (r= -.553; p=.011).
Understanding the interaction between the reward system and peripheral endocannabinoids in patients with AN could contribute to better elucidate the pathophysiology of this disorder. Future studies will need to further investigate the clinical and therapeutic implications of these findings in patients with AN.
Disasters may have major impacts to mental health and to the utilization of mental health services (MHS). Moreover, these effects may be worsened by the preclusion of access to basic services following the event. The aim of this study is to evaluate the utilization of public MHS by the population that suffered water supply interruption following the Mariana Dam Failure in Brazil, 2015.
We conducted an Interrupted Time Series analyzing secondary health data from the municipalities that faced water supply interruption, comparing it to data from the other municipalities of Minas Gerais state.
We found a higher immediate (RR: 1.78; 95% CI: 1.25–2.53) and gradual (RR: 1.05; 95% CI: 1.03–1.06) change in the rate of mental health visits (MHV) in the affected population following the event, whereas there was an immediate fall (RR: 0.41; 95% CI: 0.29–0.59) followed by a higher gradual increase (RR: 1.04; 95% CI: 1.02–1.06) in the rate of hospital admissions (HA) in the affected population.
The results suggest that there was an increase in the utilization of public MHS by the population that suffered water supply interruption following the disaster.
Despite previous research demonstrating the benefits of including growth factors and antioxidants to maturation medium to support embryo production, to date the effect of epidermal growth factor (EGF) and melatonin (Mel) on oocyte competency has not been studied. This study supplemented in vitro maturation (IVM) medium with EGF (10 ng/ml) and Mel (50 ng/ml) alone, or in combination, and evaluated cumulus cell (CC) gene expression and the development and quality of parthenogenetic blastocysts. No differences in CC gene expression levels indicative of developmental potential were found among the treatment groups. Antioxidant gene CuZnSOD was significantly (P < 0.05) decreased in CCs from the Mel group. Moreover, blastocyst rates on day 7 were significantly increased in EGF or Mel (P < 0.05), but not EGF+Mel. Significant decrease (P < 0.05) in GPX1, CuZnSOD, SLC2A1 and HSPA1A (P = 0.07) mRNA levels was observed in blastocysts from the Mel group. OCT4 gene expression was significantly increased (P < 0.05) in EGF+Mel and confirmed using immunofluorescence. Our results indicate that, despite the lack of changes of competence-related genes in CCs, IVM medium supplemented with Mel improved the culture environment sufficiently, resulting in improved blastocysts. Moreover, EGF and Mel combined during maturation increased OCT4 gene and protein expression in blastocysts, indicating its potential for stem cells.
The purpose of this study was to evaluate the quality of Marandu grass (Brachiaria brizantha) haylage according to different dry matter (DM) contents in storage. The design adopted was completely randomized with four treatments and five replications. The treatments were DM contents of the plant at the moment of storage (in natura, 30–40, 40–50 and 50–60% DM). The analyses to assess the quality of the haylage were performed after 90 days of storage. The chemical composition, microbiological population, gas quantification, pH, N-NH3, volatile fatty acids, soluble carbohydrates (CHO) and the aerobic stability were evaluated. The means were compared through the Tukey's test and linear regression. The treatment with 50–60% DM presented the highest DM and CHO contents which were 563.8 and 42.0 g/kg, respectively. There was a higher presence of oxygen in the haylage of in natura material, which was 4.8%. There was no difference between treatments for the population of lactic acid bacteria; however, the treatment with 50–60% DM had the highest concentration of enterobacteria. The haylage with 30–40% DM and 50–60% DM presented high concentrations of acetic acid. There was no break in aerobic stability for any treatment within 120 h after opening the bales. There was a smaller amount of N-NH3 in treatments with 40–50% DM and 50–60% DM. The Marandu grass with a DM content of 50–60% for haylage making demonstrated better quality characterization of conserved forage.
Tourism can be a powerful tool for wildlife conservation if well controlled and responsibly managed. Apex predators constitute particularly attractive subjects for tourism, but simultaneously they may generate conflict with local communities. Harpy Eagles Harpia harpyja are the largest eagle species and are highly sought-after by ecotourists. The last stronghold of the Harpy Eagle is the Amazon Forest, which is being deforested for cattle ranching. We tested methods for developing Harpy Eagle ecotourism as a potential tool to harmonize these issues. Using camera traps, we collected data on timing of Harpy Eagle visits to their nests, as well as on probabilities of viewing an eagle. Harpy Eagles can only be seen predictably during the first 12 of the 30–36 month nest cycle. In nests with nestlings (up to 5–7 months), adults are visible on a daily basis, and this period lasts 16.6% of the nesting cycle, demanding a minimum of 13, 17, and 26 nests to have at least one nest with a nestling on 90%, 95% and 99% of the days. After this 5–7 month window, we found that two and 4.16 days spent at nests afforded high probabilities of sighting a fledgling or adult eagle, respectively. Harpy Eagles were mainly active at the beginning and the end of the day. Activity core lasted 6.5 decimal hours for adults, peaking at 10h00, and 7.45 decimal hours for fledged eagles, peaking at 15h00. Our results demonstrate that Harpy Eagles fit several criteria for a viable wildlife attraction: predictable in activity and location, viewable, and diurnal, even though at the same time they are considered a rarity. In a broader perspective, Harpy Eagle tourism shows every indication of being a significant tool for more robust rainforest conservation.
The critical timing of weed removal (CTWR) is the point in crop development when weed control must be initiated to prevent crop yield loss due to weed competition. A field study was conducted in 2018 and 2020 near Scottsbluff, NE, to determine how the use of preemergence herbicides affects the CTWR in dry bean. The experiment was arranged as a split plot, with herbicide treatment and weed removal timing as main and sub-plot factors, respectively. Herbicide treatments consisted of no-preemergence application, or pendimethalin (1,070 g ai ha–1) + dimethenamid-P (790 g ai ha–1) applied preemergence. Sub-plot treatments included season-long weed-free, weed removal at: V1, V3, V6, R2, and R5 dry bean growth stages, and a season-long weedy control. A four-parameter logistic model was used to estimate the impact of time of weed removal, for all response variables including dry bean yield, dry bean plants m–1 row, number of pods per plant, number of seeds per pod, and seed weight. The CTWR based on 5% yield reduction was estimated to range from the V1 growth stage [(16 d after emergence (DAE)] to the R1 growth stage (39 DAE) in the no-preemergence herbicide treatment. In the preemergence-applied treatment, the CTWR began at the R2 growth stage (47 DAE). Number of dry bean plants m–1 row was reduced in the no-preemergence treatment when weed removal was delayed beyond the R2 growth stage in the 2020 field season. The use of preemergence herbicides prevented a reduction in the number of pods per plant in 2020, and the number of seeds per pod in 2018 and 2020. In 2018, the number of pods per plant was reduced by 73% when no preemergence herbicide was applied, compared to 26% in the preemergence-applied treatment. The use of preemergence-applied soil-active herbicides in dry bean delayed the CTWR and preserved yield potential.
Invasive species are leading to ecosystem changes and socioeconomic deterioration around the globe. In 2018, unknown soft corals were noticed forming a massive ‘blue carpet’ on a shallow reef environment at Todos os Santos Bay, South-west Atlantic. In this study we identified the species, quantified their distribution and abundance as a first step for baseline invasion monitoring, and discussed origin, vector and impacts on native competitors. Coral samples were identified based on morphology and a multilocus DNA barcode, and benthic structure was characterized using digital photoquadrats. Our results revealed two new harmful non-native octocorals in this tropical rocky reef, the ‘blue polyps’ genus Sarcothelia (Xeniidae), native to Hawaii but likely an undescribed cryptic species, and Briareum hamrum (Briareidae), native to the Indian Ocean. Sarcothelia sp. was the dominant taxon in the rocky reef (mean cover 23.66% ± 21.46), exhibiting high coverage as well in the sandy and patch reef habitats (15.83% ± 15.81), however, only three colonies of B. hamrum were found, all outside the sampling area. These octocorals were in physical contact with native benthic organisms, mainly with the most abundant group, but apparently avoid turf algae in sandy and patch reef habitats. We suggest that irresponsible marine aquarium releases likely introduced these species to Brazilian reefs. After identifying the aquarium trade as the main vector of octocoral introductions, we reinforce the importance of inspecting marine species importation and the urgent need to implement a government plan to mitigate invasive species' impacts on the natural reefs of Brazil.
Depressed patients with early traumatic experiences may represent a clinically distinct subtype with worse clinical outcome. Since early traumatic experiences alter the development of systems that regulate the stress response, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behaviour.
To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behaviour in patients with major depressive disorder (MDD).
The sample included 190 patients [mean age (SD)=53.71 (10.37); females: 66.3%], with current MDD. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity. We developed mediation models by bootstrap sampling methods.
81 (42.6%) patients had previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b=0.007, 95% CI=0.001, 0.015), after controlling for sex, HDRS-Total, and LTE-Total.
Impulsivity could mediate the influence of childhood trauma on suicidal behaviour. This will help understand the role of risk factors in suicidal behaviour and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.
Anandamide (AEA) and 2-Arachidonoylglycerol (2-AG) play a pivotal role in food intake and reward aspects of feeding. Aberrant functioning in the endocannabinoid system has been observed in patients with eating disorders (EDs). This dysfunction may influence the incentive processes stimulating behaviors towards food acquisition or the hedonic evaluation of ingested food.
The aims of this study are to compare fasting peripheral levels of AEA and 2-AG in ED patients, obese subjects (OB) and healthy controls (HCs), and to explore their association with clinical and anthropometric variables.
The sample included a total of 63 adult women. Peripheral blood samples were collected to investigate fasting levels of AEA and 2-AG in 31 ED patients: 22 Anorexia Nervosa (AN) and 9 Binge Eating Disorder (BED), compared to 21 OB and 11 HCs. Several clinical and anthropometric variables were also assessed.
Comparing groups, significant differences in AEA levels were found (p=0.001). Specifically, individuals with AN exhibited lower AEA than OB (p<0.001) and BED (p=0.007), while OB showed higher AEA than HCs (p=0.015). 2-AG was positively correlated with hostility dimension in EDs and negatively associated with impulsive traits in OB. AEA showed a direct association with body dissatisfaction in AN, contrary to OB. Finally, in AN, AEA negatively correlated with the body mass index, while 2-AG was positively associated with the fat mass.
These results suggest an interaction between biological and clinical factors defining a vulnerability pathway that could help fitting personalized therapeutic approaches in each condition.
Post-traumatic stress disorder (PTSD) is often a chronic condition, despite the existence of evidence-based treatment options. Psychotherapy is the designated first line treatment for PTSD, although high rates of psychiatric and medical comorbidity are observed among patients who have undergone treatment. The psychoactive properties of psychedelics may be of particular interest within a substance-assisted psychotherapy approach, offering new treatment opportunities for this debilitating disorder.
Review current evidence, therapeutic context, and possible mechanisms of action of different types of psychedelics in the treatment of PTSD.
Literature review using Medline database.
3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with treatment-refractory PTSD. Based on a small number of studies, ketamine administration appears to result in temporary symptom relief and may, in combination with psychotherapy, lead to lasting reductions in PTSD symptoms. Although these have not yet been investigated in controlled studies, it is known that psilocybin and LSD induce psychoactive effects that could as well contribute to the psychotherapeutic treatment of PTSD.
The use of psychedelic compounds within a substance-assisted psychotherapy framework offers a novel method for pharmacotherapy-psychotherapy integration, although there is still much to learn from both a clinical and neurobiological perspective. It is necessary to generate more data regarding the safety and efficacy of psychedelics, in addition to research on cost-effectiveness, its use in mental health care infrastructure and also regarding the training of specialized therapists.
Using newly harmonised individual-level data on health and socio-economic environments in Latin American cities (from the Salud Urbana en América Latina (SALURBAL) study), we assessed the association between obesity and education levels and explored potential effect modification of this association by city-level socio-economic development.
This cross-sectional study used survey data collected between 2002 and 2017. Absolute and relative educational inequalities in obesity (BMI ≥ 30 kg/m2, derived from measured weight and height) were calculated first. Then, a two-level mixed-effects logistic regression was run to test for effect modification of the education–obesity association by city-level socio-economic development. All analyses were stratified by sex.
One hundred seventy-six Latin American cities within eight countries (Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico and Peru).
53 186 adults aged >18 years old.
Among women, 25 % were living with obesity and obesity was negatively associated with educational level (higher education–lower obesity) and this pattern was consistent across city-level socio-economic development. Among men, 18 % were living with obesity and there was a positive association between education and obesity (higher education–higher obesity) for men living in cities with lower levels of development, whereas for those living in cities with higher levels of development, the pattern was inverted and university education was protective of obesity.
Among women, education was protective of obesity regardless, whereas among men, it was only protective in cities with higher levels of development. These divergent results suggest the need for sex- and city-specific interventions to reduce obesity prevalence and inequalities.
Individuals with depression often experience widespread and persistent cognitive deficits, which might be due to brain atrophy and cerebral small vessel disease (CSVD). We therefore studied the associations between depression, markers of brain atrophy and CSVD, and cognitive functioning.
We used cross-sectional data from the population-based Maastricht study (n = 4734; mean age 59.1 ± 8.6 years, 50.2% women), which focuses on type 2 diabetes. A current episode of major depressive disorder (MDD, n = 151) was assessed by the Mini-International Neuropsychiatric Interview. Volumes of cerebral spinal fluid, white matter, gray matter and white matter hyperintensities, presence of lacunar infarcts and cerebral microbleeds, and total CSVD burden were assessed by 3 T magnetic resonance imaging. Multiple linear and logistic regression analyses tested the associations between MDD, brain markers and cognitive functioning in memory, information processing speed, and executive functioning & attention, and presence of cognitive impairment. Structural equation modeling was used to test mediation.
In fully adjusted models, MDD was associated with lower scores in information processing speed [mean difference = −0.18(−0.28;−0.08)], executive functioning & attention [mean difference = −0.13(−0.25;−0.02)], and with higher odds of cognitive impairment [odds ratio (OR) = 1.60(1.06;2.40)]. MDD was associated with CSVD in participants without type 2 diabetes [OR = 1.65(1.06;2.56)], but CSVD or other markers of brain atrophy or CSVD did not mediate the association with cognitive functioning.
MDD is associated with more impaired information processing speed and executive functioning & attention, and overall cognitive impairment. Furthermore, MDD was associated with CSVD in participants without type 2 diabetes, but this association did not explain an impaired cognitive profile.
Mucositis is an inflammation of the gastrointestinal mucosa resulting from high doses of radio/chemotherapy treatment and may lead to interruption of antineoplasic therapy. Soluble fibres, like pectin, increase SCFA production, which play a role in gut homoeostasis and inflammation suppression. Due to the properties of pectin, the aim of the present study was to evaluate the effect of a high-fibre (HF) diet on chemotherapy-induced mucositis in a murine model. C57/BL6 mice received control (AIN93M), HF, low/zero fibre (LF) diets for 10 d prior to mucositis challenging with irinotecan (75 mg/kg), or they were treated with acetate added to drinking water 5 d prior to and during the mucositis induction. Mice that received the HF diet showed decreased immune cells influx and improved histopathological parameters in the intestine, compared with mice that received the normal diet. Furthermore, the HF diet decreased intestinal permeability induced in the mucositis model when compared with the control group. This effect was not observed for acetate alone, which did not improve gut permeability. For instance, mice that received the LF diet had worsened gut permeability, compared with mice that received the normal diet and mucositis. The effects of the HF and LF diets were shown to modulate the intestinal microbiota, in which the LF diet increased the levels of Enterobacteriaceae, a group associated with gut inflammation, whereas the HF diet decreased this group and increased Lactobacillus and Bifidobacterium (SCFA producers) levels. In conclusion, the results demonstrated the importance of dietary fibre intake in the modulation of gut microbiota composition and homoeostasis maintenance during mucositis in this model.
The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression – how age affects clinical presentation in first-episode psychosis – has not been thoroughly investigated.
Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12–40 years, 1–12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development.
Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood.
These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain–behavior relationships vary as a function of development.
The objective of this study consisted in developing a theory about the psychotherapeutic process in Psychoanalytic Psychotherapy and to verify the relevance of the common and specific factors. the participants were three psychoanalytical psychotherapists. Semi-structured interviews and 15 session's notes given by one of the therapists (one psychotherapeutic process of a 24 year old psychotic patient) were used and analysed according to the Grounded Theory method. A process called constant modification was found in the core of psychoanalytic psychotherapy, through which changes occur in the psychic functioning and in the relational style of the patient. This process functions at an intrapsychic and extrapsychic level. A model based on the concept of Enzymatic Catalysis was developed, in order to integrate and relate common factors (therapeutic bond), specific factors (therapeutic interventions), patient characteristics, therapist characteristics, external factors and therapeutic results to the central process. It was concluded that both common and specific factors contribute to the therapeutic process in a mutual dynamic.
This study was performed to identify the predictive factors of functional capacity assessed by the Spanish University of California Performance Skills Assessment (Sp-UPSA) and real-world functioning assessed by the Spanish Personal and Social Performance scale (PSP) in outpatients with schizophrenia.
Naturalistic, 6-month follow-up, multicentre, validation study. Here, we report data on 139 patients with schizophrenia at their baseline visit. Assessment: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), Sp-UPSA and PSP. Statistics: Pearson's correlation coefficient (r) was used to determine the relationships between variables, and multivariable stepwise linear regression analyses to identify predictive variables of Sp-UPSA and PSP total scores.
Functional capacity: scores on the PSP and PANSS-GP entered first and second at P < 0.0001 and accounted for 21% of variance (R2 = 0.208, model df = 2, F = 15.724, P < 0.0001). Real-world functioning: scores on the CGI-S (B = −5.406), PANSS-N (B = −0.657) and Sp-UPSA (B = 0.230) entered first, second and third, and accounted for 51% of variance (model df = 3, F = 37.741, P < 0.0001).
In patients with schizophrenia, functional capacity and real-world functioning are two related but different constructs. Each one predicts the other along with other factors; general psychopathology for functional capacity, and severity of the illness and negative symptoms for real-world functioning. These findings have important clinical implications: (1) both types of functioning should be assessed in patients with schizophrenia and (2) strategies for improving them should be different.
Bipolar disorder (BD) commonly co-occurs with anxiety disorders (AD) and this comorbidity has been associated to worse clinical outcomes in BD patients. However frequency and clinical outcomes data might be biased once some of them had been originated from acutely ill bipolar patients as well as those in remission.
To assess AD in bipolar sample in order to know if this frequency vary according illness phase and identify possible clinical outcomes related to this comorbidity.
A population of 355 outpatients with bipolar I disorder were evaluated using structured instruments (SCID). The sample was split into four groups considering the illness phase and the presence of AD: euthymic without AD (euthymic/non- AD); euthymic with AD (euthimic/AD); non-euthymic without AD (non-euthymic/non-AD) and non-euthymic with AD (noneuthymic/ AD) groups. Clinical and socio-demographics differences between the groups were compared through bivariate analysis.
There was a progressive and significantly increasing in some worst clinical outcomes frequency, such as rapid cycling, suicide attempts, substance and alcohol use disorders, history of antidepressant use and decreased scores in all domains of QoL, from control group (euthymic /non-AD) through out intermediate group (non-euthymic/non-AD) until the group most affected (non-euthymic/AD). Both euthymic/non-AD and euthimic/AD groups did not differ.
We identified a group of severe bipolar patients that have worse clinical outcomes, and among them, the anxiety comorbidity. But, contrary to what has been stated, AD appears to be related with poor bipolar prognosis only when other severity clinical factors are presents.