Antidepressants and recurrence of depression in the postpartum period.

To examine postpartum recurrence rates of depression comparing women receiving antidepressant treatment to women not being treated with psychotropic medication. This was a prospective study of 130 women with major depressive disorder (MDD) who attended a tertiary care perinatal clinic during and after pregnancy. Depression recurrence was defined as a score of 13 or more on the Edinburgh Postnatal Depression Scale (EPDS) or a score of greater than 13 on the Hamilton Depression Rating Scale (HDRS). Over half of women (56.9%) were not receiving medication during pregnancy to treat their mood disorder, with the rate of medication use increasing over the 1-year postpartum period. When comparing women being treated with antidepressant medication (monotherapy or combination therapy) to women receiving no psychotropic medication, no significant differences in recurrence rates were observed during the postpartum period. However, we did observe that the occurrence of depression in our sample fluctuated between rates comparable to general population estimates to rates that were at times more than twofold higher, regardless of treatment with antidepressant medication. The findings of this study align with research which suggests that the postpartum period is a particularly vulnerable time for recurrence of depression. Moreover, our results suggest that this remains the case regardless of antidepressant treatment.

The value of middle phalangeal hair as an anthropometric marker: A review of the literature.

Middle phalangeal hair (MPH) is a trait frequently examined in anthropological studies throughout the 20th century. MPH is found on the back of the middle segment of the fingers, excluding the thumb. Typically, researchers examined the presence and absence of hair in various populations, and described it in terms of age, ancestry, and sex. Recently MPH has been examined as a potential anthropometric indicator of: androgen levels, androgen-related side effects in women, gene homozygosity, and disease resistance. Given the potential value of this marker, the present paper provides a comprehensive overview of MPH and its associated characteristics (i.e., ethnicity, sex, age, and hormonal variations) and presents new data on the reliability of MPH assessment. Findings suggest that ethnicity, sex, and age need to be controlled in any studies examining MPH and its relationship with other variables. Two measures of MPH (i.e., presence/absence of MPH and actual hair count) are both acceptable to use in MPH assessment; and the use of a hand lens to examine MPH provides high reliability when MPH is assessed by expert raters. However, researchers should avoid participant self-assessment. Future avenues for research are suggested (e.g., measurement issues and studies on hormonal correlates in women). MPH could be useful in research or for clinical purposes as a possible non-invasive indicator of hormone levels or hormonal sensitivity, or of predisposition toward androgen-related or gene-homozygosity-related health issues or behaviors.

Preliminary assessment of intrahemispheric QEEG measures in bipolar mood disorders.

OBJECTIVE: This study assessed the quantitative electroenchephalographic (QEEG) absolute power and coherence differences between a group of patients with bipolar I mood disorder (BMD I) and a group of patients with schizophrenia. We also examined the correlation between QEEG measures and family history of BMD. METHOD: Using the National Institutes of Mental Health (NIMH) Global Rating Scale, we rated 18 adult inpatients with a DSM-III-R diagnosis of BMD I for the severity of the current episode. We also collected data on the family history of the illness. This group was then matched for age, sex, and handedness with an equal number of inpatients with a DSM-III-R diagnosis of schizophrenia. QEEG absolute power and coherence was calculated for the alpha bandwidth (8.0 to 12.0 Hz), assessed at 18 pairs of electrodes in both hemispheres during resting, eyes-closed condition in all the patients. RESULTS: The patients with schizophrenia showed significantly higher coherence (P = 0.047) at 6 pairs of electrodes on the right side. The group with BMD showed significantly higher power (P = 0.042) at 2 pairs of electrodes on the right side. Correlational analysis showed that QEEG measures were significantly correlated (P = 0.01) with positive family history of BMD. CONCLUSION: These findings suggest that the patients with BMD are more disorganized in the right anterior hemisphere and that there is a significant positive correlation between the QEEG measures and the presence of family history of BMD. Further studies in a larger sample are required to confirm these preliminary findings.

Effects of oral contraceptives on daily self-ratings of positive and negative affect.

OBJECTIVES: The relationship between affect and duration of oral contraceptive (OC) use was investigated. METHOD: Ninety-six women (17 first-time OC users, 34 long-time users, and 45 never-users) completed the Positive and Negative Affect Schedule (PANAS) and the Menstrual Distress Questionnaire (MDQ) daily for 35 days. This study was the first to examine positive affect variability; and personal family psychiatric history; and to compare early-, late-, and never-users of OCs. RESULTS: Triphasic users experienced greater variability in positive affect across the cycle, likely due to the variable hormone levels. Withdrawal of a constant level of hormones (monophasics) during early use was associated with greater variability in positive affect than withdrawal of changing hormonal levels (triphasics). Furthermore, personal and family psychiatric history may mediate an effect of OCs on negative affect variability. CONCLUSIONS: OCs and, therefore, hormones can alter day-to-day affect variability. Four variables are associated with this effect: duration of use, OC type, personal psychiatric history, and family psychiatric history.

Does body fat protect against negative moods in women?

An examination of the relationship between body mass index (BMI) and negative mood revealed an inverse relationship between BMI and negative mood symptoms (i.e., depression and negative affect scale scores) in women who were not taking oral contraceptives. The strength of the negative correlations between BMI and negative affect was uniformly higher on days of the menstrual cycle when estrogen levels are expected to be highest. Two interpretations are suggested. Given the positive relationship between estrogen levels and body fat, estrogen may have an effect on both body fat storage and negative affect. The cyclical release of estrogen may also have activational effects on negative affect. These findings have implications for common beliefs about the relationship between body size and emotional well-being, and provide converging evidence for the role of hormones in the regulation of mood.

Treatment of bipolar depression: a survey of Canadian psychiatrists.

OBJECTIVE: This study was conducted to examine how Canadian psychiatrists manage bipolar depression. METHOD: A questionnaire specific to the treatment of bipolar depression was mailed to 1639 active members of the Canadian Psychiatric Association. RESULTS: Seven hundred and sixty-six completed questionnaires were returned (46.7%). Most psychiatrists indicated that a combination of psychotherapy and somatic therapy was their preferred approach. For bipolar disorder, depressed, lithium carbonate and selective serotonin reuptake inhibitors (SSRIs) were the preferred treatment strategies. For substitution, tricyclic antidepressants (TCAs) were the favoured choice. Lithium carbonate was the preferred choice for augmentation and, addition. CONCLUSION: These findings indicate that a combination of psychotherapy and somatic therapy is the preferred treatment approach for bipolar depression. Lithium carbonate and SSRIs are the favoured somatic therapies.

Psychiatric patients' attitudes about medication and factors affecting noncompliance.

OBJECTIVE: Attitudes about medication and factors affecting medication compliance were investigated in a sample of 148 psychiatric patients. METHODS: Structured interviews assessed attitudes about medication, history of compliance, and other relevant clinical and psychosocial variables. RESULTS: Eighty-seven subjects expressed positive attitudes about medication in general. Forty believed that their illness was biologically or chemically based. A large proportion attributed their illness to situational factors, including stress (36 subjects) and family problems (18 subjects). Fifty-one subjects said that they required medications to get better. Approximately half of the subjects previously either changed their medication regimen or discontinued their medication. Opposition to the idea of taking medication, belief that the medication did not work, and physical side effects were the most frequent reasons for stopping. Previous patient-initiated changes in the medication regimen, education level, and inpatient or outpatient status were the only variables associated with noncompliance. CONCLUSIONS: The findings suggest that several relevant clinical, demographic, and attitudinal variables may not be associated with medication compliance.

The phenomenon of rapid cycling in bipolar mood disorders: a review.

OBJECTIVE: To review the various pharmacological and nonpharmacological factors associated with the induction of rapid cycling in bipolar mood disorder, and to introduce the idea that parturition may also have a role. Factors known to contribute to bipolar mood disorder rapid cycling include antidepressant agents, female gender and middle age. Currently, there is evidence that hypothyroidism may also play a role. METHOD: A critical review of the literature was undertaken. CONCLUSION: Caution should be exercised in the use of antidepressants in patients with bipolar mood disorders.

A comparison of comorbid patterns in treatment-resistant unipolar and bipolar depression.

OBJECTIVE: To examine the occurrence of concomitant psychiatric disorders in patients with treatment-resistant unipolar and bipolar depression. METHOD: Forty-nine patients participated as subjects. Twenty-four (49%) had unipolar depression and 25 (51%) had bipolar depression using DSM-III-R criteria. Structured clinical interviews were conducted with all patients. Chart reviews and interviews with family members were also carried out. Information relating to both current and lifetime diagnoses was obtained. RESULTS: Of the entire sample, 75.5% were found to have at least one other Axis I diagnosis and 46.9% had at least two additional Axis I diagnoses. The unipolar group had significantly more current comorbid diagnoses. When type of diagnoses was examined, unipolar patients had significantly more anxiety diagnoses at the time of the index episode, and over their entire lifetime. Bipolar patients had significantly more lifetime substance abuse diagnoses. CONCLUSIONS: Axis I comorbidity appears to be differentially associated with treatment resistance in unipolar and bipolar depression.

Cognitive deterioration from long-term abuse of dextromethorphan: a case report.

Dextromethorphan (DM), the dextrorotatory isomer of 3-hydroxy-N-methylmorphinan, is the main ingredient in a number of widely available, over-the-counter antitussives. Initial studies (Bornstein 1968) showed that it possessed no respiratory suppressant effects and no addiction liability. Subsequently, however, several articles reporting abuse of this drug have appeared in the literature. The drug is known to cause a variety of acute toxic effects, ranging from nausea, restlessness, insomnia, ataxia, slurred speech and nystagmus to mood changes, perceptual alterations, inattention, disorientation and aggressive behavior (Rammer et al 1988; Katona and Watson 1986; Isbell and Fraser 1953; Devlin et al 1985; McCarthy 1971; Dodds and Revai 1967; Degkwitz 1964; Hildebrand et al 1989). There have also been two reported fatalities from DM overdoses (Fleming 1986). However, there are no reports describing the effects of chronic abuse. This report describes a case of cognitive deterioration resulting from prolonged use of DM.

Development and validation of a scale for rating mood states of psychiatric inpatients.

OBJECTIVE: The authors assessed reliability and validity of a scale developed for use with inpatients on a mood disorders unit. The scale is used to rate a patient's mood along a quantitative continuum from -5, depressive stupor, through 0, euthymic, to 5, full mania. The scale lists behaviors that constitute criteria for each rating point. Mixed states and idiosyncratic behavior can also be assessed. METHODS: Assessment of the scale's reliability and validity was based on data for 53 psychiatric inpatients. The scale's reliability was assessed by comparing nurses' ratings. Validity was assessed by comparing nurses' ratings with patients' self-ratings using previously validated self-report instruments as well as a patient self-report version of the scale. RESULTS: Interrater reliability for the instrument was high (r = .84). Estimates of validity obtained using patient self-report measures ranged from .54 to .85. CONCLUSIONS: The psychometric properties of the scale are comparable to and in some cases are superior to those reported for instruments that include more items and that take longer to complete.

Factor analysis of open-field behavior in the rat (Rattus norvegicus): application of the three-way PARAFAC model to a longitudinal data set.

We examined the multivariate nature of open-field behavior in adult male rats (n = 26) by subjecting a longitudinal data set, obtained during 4 open-field test sessions (4 min in duration and spaced 48 h apart), to a three-way PARAFAC analysis. Unlike conventional two-way factor analytical models, the PARAFAC procedure allows for the direct factor analysis of 3-dimensional arrays, which then provided a unique factor solution to the longitudinal data set. The PARAFAC analysis extracted 2 factors: i) emotional reactivity and ii) exploratory behavior. These two factors changed in temporal prominence, with animals showing greater emotional reactivity on the first test session, and greater levels of exploration on the third and fourth test sessions. These results are in general agreement with previous findings which used more conventional factor analytic approaches. These findings indicate that multivariate procedures, such as the PARAFAC analysis, can be helpful in the quantitative characterization of behavioral phenomena in a more 'realistic' manner.

Treatment of rapid cycling bipolar disorder with combination therapy of valproate and lithium.

Over the past two decades there has been a great deal of interest in the use of anticonvulsants to treat a variety of primary psychiatric disorders. Valproate, one such anticonvulsant, has been found to be effective in the treatment of acute mania, mixed states and rapid cycling disorders. This paper presents the results of an open study with combination therapy of valproate and lithium in a series of nine patients (mean age = 50 years). These patients had previously been treated with various psychotropic agents, including a combination of carbamazepine and lithium. All but one patient showed marked or moderate improvement in their condition. Of particular interest was the observation that in three patients there was evidence of augmentation between valproate and lithium during the depressed phase of their illness. There was significant improvement in their depression within 24 to 48 hours of the addition of lithium to valproate. The combination therapy was very well-tolerated. It is concluded that valproate and lithium combination therapy provides a safe and effective alternative for the treatment of rapid cycling variant of bipolar illness.

Clinical construct validity of the Holden Psychological Screening Inventory (HPSI).

With a sample of 64 adult psychiatric patients, we examined the construct validity of the Holden Psychological Screening Inventory (HPSI) for a clinical population. Factor analysis supported the three-dimensional nature of the HPSI and the appropriateness of the instrument's scoring key. Reliability information confirmed the internal consistency of the inventory's scales. Clinical staff ratings were used as criteria, and analyses indicated that HPSI scales demonstrated convergent validity. Overall, findings extend previous nonclinical research on the HPSI and suggest that the instrument possesses construct validity for clinical applications.

Some behavioral factors related to the effects of cold-restraint stress in rats: a factor analytic-multiple regression approach.

Recently, some individual differences in rats have been shown to be related to stress-induced physiological responses. As yet there has been no attempt to incorporate measurement techniques from the psychometric field to this line of research. The present study was conducted to examine the utility of applying such methods to animal research. Physiological responses to cold-restraint stress in 26 male rats were investigated using a factor analytic-multiple regression procedure. Nineteen behavioral and physiological measures obtained during open-field testing, motor activity monitoring, and passive avoidance learning were subjected to a principle components factor analysis. Five factors were extracted which reflected exploratory behavior, general activity level, metabolic rate, behavioral reactivity, and autonomic reactivity. The obtained factor scores were used to predict physiological responses to four hours of supine cold-restraint using a step-wise multiple regression procedure. General activity level was the best predictor of adrenal weight and temperature loss. Autonomic reactivity was the best predictor of ulcer incidence and severity. Applications of these statistical procedures are discussed.