Clinical Correlates of Alcohol Use Disorder in Depressed Patients with Unipolar and Bipolar Disorder

OBJECTIVE: Alcohol use disorder (AUD) is one of the most frequent comorbid conditions in mood disorders. We aimed to examine the relationships between clinical phenotypes of acutely depressed subjects and co-occurring AUD.METHODS: Clinical assessment including diagnosis of mood disorder and co-occurring AUD, the severity of depressive or manic symptoms, and affective temperaments were conducted in 137 subjects suffering from a major depressive episode. According to the presence of AUD, clinical variables were compared between the two groups. Using binary logistic regression models, the effects of mood symptoms and affective temperaments on the risk of AUD were determined.RESULTS: Severity of manic symptoms, suicidal ideation, and childhood trauma were higher in the AUD group than in the non-AUD group. Scores for irritable and hyperthymic temperament were higher and the score for anxious temperament was lower in the AUD group. In regression models adjusting confounders, anxious temperament was an independent protector against AUD. On the other hand, the diagnosis of bipolar disorder and the irritable manic symptom dimension increased the risk of AUD.CONCLUSION: Anxious temperament decreased the AUD risk, whereas irritable manic symptoms increased the risk during depression. AUD in mood disorders may be an expression of manic psychopathology.

The Border between Bipolar Disorder and Personality Disorders / 신경정신의학

The concept of bipolar spectrum disorder (BSD) has developed to include affective temperaments such as cyclothymia and hyperthymia. This has greatly helped clinicians to differentiate depressed patients, who would potentially benefit from mood stabilizing treatment, from those with unipolar depression. Cyclothymia, however, has significant similarities with personality disorders, especially with borderline personality disorder (BPD). All the diagnostic items for BPD are frequently found in patients with BSD as well, which presents diagnostic challenges. There are no clear guidelines on how to differentiate BSD from BPD. Featuring borderline pathology for clinical purposes, it may be useful to rely on psychodynamic approaches to identify primitive defense mechanisms of splitting and projective identification suggesting borderline personality organization. Based on new findings on common features between BSD and BPD, some authors have proposed a renewal of the classification system of mental disorders. The dichotomy of bipolar and unipolar depression has gestated a new concept of BSD. Currently, the BSD concept forced us to formulate the border of BSD and personality disorders.

Validação da versão em português brasileiro da ferramenta de triagem de sintomas pré-menstruais e associação entre sintomas disfóricos pré-menstruais, temperamentos afetivos e qualidade de vida em uma amostra de mulheres brasileiras

O Transtorno Disfórico Pré-Menstrual (TDPM) afeta aproximadamente três a oito por cento das mulheres em idade fértil. Tal quadro é caracterizado por uma miríade demanifestações psicológicas (tristeza, irritabilidade, choro fácil, etc.) e físicas (dores nas articulações, inchaço, sensibilidade mamária etc.). O TDPM gera enorme sofrimento amulheres que apresentam esse quadro, acarretando disfunção no trabalho, nas relações interpessoais e prejuízo na qualidade de vida. A sintomatologia é cíclica e surge na fase lúteado ciclo menstrual, desaparecendo após o início da menstruação. Temperamentos afetivos são considerados manifestações subclínicas e precursores dos transtornos afetivos. Neste trabalho,buscou-se validar a Ferramenta de Triagem de Sintomas Pré-Menstruais (PSST), bem comoverificar se diferentes temperamentos afetivos e dimensões emocionais estariam associados a um rastreio positivo para TDPM em uma amostra de mulheres brasileiras e como a gravidaded estes sintomas poderia impactar de modo independente a qualidade de vida nesta amostra.Trata-se de um estudo quantitativo e transversal realizado em instituições universitárias do Estado do Ceará [Universidade Federal do Ceará – UFC, Centro Universitário Christus –Unichristus e Universidade de Fortaleza – UNIFOR, bem como no Hospital Universitário Walter Cantídio (HUWC), com estudantes universitárias, docentes e profissionais da saúde, totalizando uma amostra de 801 mulheres...

percent of women of childbearing age. This situation is characterized by a myriad ofpsychological (sadness, irritability, tearfulness, etc.) and physical (joint pain, bloating, breasttenderness, etc.) manifestations. PMDD generates significant distress to women leading topsychosocial dysfunction and impaired quality of life. The symptoms are cyclical and appearin the luteal phase of the menstrual cycle, disappearing after the onset of menstruation.Affective Temperaments are considered subclinical manifestations and intermediatephenotypes of affective disorders. In this work, we sought to validate the PremenstrualSymptoms Screening Tool (PSST). In addition, we aimed to verify if different affectivetemperaments and emotional dimensions could be associated with a positive screening forPMDD in a sample of Brazilian women and how the severity of premenstrual symptomscould independently impact the quality of life of this sample. This is a quantitative and crosssectionalstudy in universities of Ceará [Federal University of Ceará - UFC, University CentreChristus - Unichristus and University of Fortaleza – UNIFOR, as well as at the UniversityHospital Walter Cantídio (HUWC)], with university students, teachers and healt hprofessionals...