Resilience concepts in psychiatry demonstrated with bipolar disorder.

BACKGROUND: The term resilience describes stress-response patterns of subjects across scientific disciplines. In ecology, advances have been made to clearly distinguish resilience definitions based on underlying mechanistic assumptions. Engineering resilience (rebound) is used for describing the ability of subjects to recover from adverse conditions (disturbances), and is the rate of recovery. In contrast, the ecological resilience definition considers a systemic change: when complex systems (including humans) respond to disturbances by reorganizing into a new regime (stable state) where structural and functional aspects have fundamentally changed relative to the prior regime. In this context, resilience is an emergent property of complex systems. We argue that both resilience definitions and uses are appropriate in psychology and psychiatry, but although the differences are subtle, the implications and uses are profoundly different. METHODS: We borrow from the field of ecology to discuss resilience concepts in the mental health sciences. RESULTS: In psychology and psychiatry, the prevailing view of resilience is adaptation to, coping with, and recovery (engineering resilience) from adverse social and environmental conditions. Ecological resilience may be useful for describing vulnerability, onset, and the irreversibility patterns of mental disorders. We discuss this in the context of bipolar disorder. CONCLUSION: Rebound, adaptation, and coping are processes that are subsumed within the broader systemic organization of humans, from which ecological resilience emanates. Discerning resilience concepts in psychology and psychiatry has potential for a mechanistically appropriate contextualization of mental disorders at large. This might contribute to a refinement of theory and contextualize clinical practice within the broader systemic functioning of mental illnesses.

Pulse Intravenous Clomipramine as an alternative antidepressant treatment to ECT. A pilot study

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Background and Objectives: The aim of the study was to examine the antidepressant effect of a single pulse dose of intravenous clomipramine (200 mg i.v.) followed by oral administration as an alternative method to electroconvulsive therapy. Methods: Twenty-one inpatients (8 male, 13 female) with major depression were included. Depression severity was measured by Montgomery Asberg Rating Scale (MADRS) and Clinical Global Impression severity scale (CGI-S) before the pulse dose and 1 week after. The day after the pulse dose, the patient was medicated with 75 mg of oral clomipramine and from day two with 150 mg clomipramine daily. Results: The MADRS score dropped with 39% ± 22% and the CGI score with 28% ± 19% in one week. The improvement of the MADRS score after one week was 13.1(C.I.9.5-17.0). CGI-ratings dropped from a mean of 5.5 (SD 1.2) to 3.9 (SD 1.1), an improvement of 28% ± 19%.(C.I. 1.0-2.1). Both improvements were significant (p<000.1).Conclusions: Single pulse dose clomipramine administration ameliorates depressive symptoms, and may be an alternative to ECT (AU)

Three circadian clock genes Per2, Arntl, and Npas2 contribute to winter depression.

BACKGROUND: Multiple lines of evidence suggest that the circadian clock contributes to the pathogenesis of winter depression or seasonal affective disorder (SAD). We hypothesized that sequence variations in three genes, including Per2, Arntl, and Npas2, which form a functional unit at the core of the circadian clock, predispose to winter depression. METHODS: In silico analysis of the biological effects of allelic differences suggested the target single-nucleotide polymorphisms (SNPs) to be analyzed in a sample of 189 patients and 189 matched controls. The most relevant SNP in each gene was identified for the interaction analysis and included in the multivariate assessment of the combined effects of all three SNPs on the disease risk. RESULTS: SAD was associated with variations in each of the three genes in gene-wise logistic regression analysis. In combination analysis of variations of Per2, Arntl, and Npas2, we found additive effects and identified a genetic risk profile for the disorder. Carriers of the risk genotype combination had the odds ratio of 4.43 of developing SAD as compared with the remaining genotypes, and of 10.67 as compared with the most protective genotype combination. CONCLUSION: Variations in the three circadian clock genes Per2, Arntl, and Npas2 are associated with the disease, supporting the hypothesis that the circadian clock mechanisms contribute to winter depression.

A psychiatric and social matched case series comparison of victims of criminal homicide and homicide perpetrators in Sweden.

The aim of the present study was to compare the psychosocial profiles of criminal homicide victims with those of a matched sample of perpetrators. The hypothesis was that chance determines whether someone becomes a victim or a perpetrator. In a retrospective examination of forensic psychiatric records as well as hospital records, the following variables were studied: nationality, education, substance abuse and psychiatric diagnoses. A comparative study was performed of 88 perpetrators and 83 victims in Sweden during a time period of 17 years (1978-1994). All subjects had been treated as psychiatric inpatients before the homicide. The results support the hypothesis that perpetrators and victims of homicide are similar with regard to psychiatric morbidity and social functioning. The majority were born in Sweden, and the educational level was low in both groups. Substance abuse was common in both groups: 96.7% of male and 65.3% of female victims compared with 76.6% of male and 75% of female perpetrators. Many in both of the groups had criminal records. The only major difference between the groups was recorded for psychotic disorder diagnoses, with a higher rate among perpetrators as well as a lower rate of substance abuse in this group.