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Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and high suicide rate. Although affective temperaments are considered possible mediators of outcome, their role on the course and outcome of BD remains poorly studied.
The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to verify which affective temperaments are associated with a more severe clinical picture in a sample of patients with BD.
All patients with BD referring to the outpatient units of two Italian university sites have been recruited. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments.
199 patients were recruited. 54.8% of patients had a diagnosis of bipolar I disorder. 56.8% of the sample reported at least one episode of aggressive behaviours and 30.2% of suicidal attempt. Predominant cyclothymic and irritable temperaments predicted more frequent relapses, a poorer quality of life (p<;0.05), more aggressive behaviours and suicide attempts (p<;0.01). The predominant hyperthymic disposition was a protective factor for several outcome measures, including relapses and suicidality (p<;0.01), and was correlated with a less severity of psychiatric symptoms and later age at onset (p<;0.05).
Early identification of affective temperaments in BD patients can help clinicians to identify those who could show a worse prognosis. A screening of affective temperaments can be useful to develop early targeted integrated pharmacological and psychosocial interventions.
Vitamin D modulates the biosynthesis of neurotransmitters and neurotrophic factors, thus influencing mood and its alterations. Decreased blood levels of Vitamin D are involved in many psychiatric disorders, in particular, affective disorders. As regards bipolar disorder (BD), an association between vitamin D deficiency and severity of illness has been found.
In this observational study, we assessed calcium homeostasis imbalance in a sample of patients with BD; in particular, we explored whether serum levels of PTH, Vitamin D and calcium influence the clinical presentation of BD and its symptom severity.
All patients were administered with validated assessment instruments to assess psychopathology, affective temperaments and global functioning. Vitamin D and PTH levels were assessed in all patients. An-ad hoc schedule was administered for socio-demographic and clinical characteristics.
The total sample consisted of 199 patients (females: 51%; mean age: 47.1 ± 13.2 years). Levels of serum PTH were directly correlated with the total number of hospitalizations (p< 0.01), and of depressive (p< 0.0001), manic (p< 0.001) and hypomanic episodes (p< 0.01). Serum levels of Vitamin D were positively associated with age at first psychiatric contact and were inversely correlated with the total number of depressive episodes (p< 0.05) and cyclothymic temperament (p< 0.05).
Increased levels of PTH and Vit D correlate with a worse clinical outcome of patients with BD. Our results highlight the importance to routinely assess PTH, Vit D and calcium levels in BD patients. Moreover, vitamin D may represent a valid add-on treatment for these patients.
Childhood trauma exposure is associated with the risk of eating disorders (EDs) in adulthood. The biological basis of this link may involve a persistent dysregulation of the endogenous stress response system, in particular the hypothalamic-pituitary-adrenal (HPA) axis, as a consequence of early life maltreatment.
Adult patients with EDs and history of childhood trauma may have a dysregulation of the HPA axis that could be different from EDs patients without childhood trauma exposure.
In order to assess the effects of childhood trauma experiences on HPA-axis activity in EDs, we compared the salivary cortisol response to the Trier Social Stress Test (TSST) of adult patients with EDs according to their history of childhood trauma.
Twenty-seven EDs patients and 13 healthy women participated in the study. Salivary cortisol responses during exposure to the TSST was measured. Participants also completed the childhood trauma questionnaire (CTQ) and eating-related psychopathological rating scales.
According to CTQ, 15 individuals with EDs reported childhood maltreatment whereas 12 EDs patients and all the healthy women did not experience childhood maltreatment. Compared with the control group, non-maltreated EDs patient group exhibited a slightly enhanced cortisol response to TSST, whereas the group of non-maltreated EDs patients showed a normal cortisol response. Moreover, EDs patients with childhood maltreatment exhibited statistically significant blunting of cortisol compared to non-maltreated ones.
The present findings support the evidence that, in patients with EDs, there is a dysregulation of HPA-axis activity and that childhood trauma exposure may contribute to this dysregulation.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Although the available evidence strongly supports an association between depression and coronary heart disease (CHD), the possible biological link between these two conditions still remains to be clarified. The hypothalamus-pituitary-adrenal (HPA) axis is the main endogenous system mediating the stress response and changes in cortisol secretion have been associated with depressed mood in patients with CHD. Therefore, the study of the correlation between cortisol levels and depressed mood in acute coronary syndrome (ACS) patients could help to clarify the nature of the relationship between ACS and the risk to develop a depressive syndrome.
We aimed to explore the relationships between HPA axis activity and depressed mood in ACS patients.
The purpose of this study was to determine whether the cortisol awakening response (CAR) is associated and/or predict depressive symptoms in patients with an ACS.
Patients admitted to an ACS ward were asked to fill in the Beck Depression Inventory (BDI) and to collect saliva samples in the morning to measure their CAR. All the procedures were carried out within 1 week after an ACS. Patients were asked again to fill in the BDI six months after their ACS.
A lower CAR was associated with higher BDI scores after 6 months from an ACS.
Our preliminary results suggest that hypoactivity of the HPA axis in the first week of an ACS may predict more severe depressive symptoms after 6 months from the ACS.
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