Somatic comorbidity, metabolic syndrome, cardiovascular risk, and CRP in patients with recurrent depressive disorders.

AIM: To investigate the association between depression, metabolic syndrome (MBS), somatic, particularly cardiovascular comorbidity, and low-grade chronic inflammation assessed using C-reactive protein (CRP). METHODS: This cross-sectional study included 76 patients with recurrent depressive disorder (RDD) and 72 non-depressed medical staff controls from the Department of Psychiatry, University Hospital Center Zagreb between January 2011 and June 2012. RESULTS: Seventy-five percent of patients had somatic comorbidity. The most common comorbid conditions were cardiovascular disorders (46.1%), locomotor system diseases (35.5%), carcinoma (15.8%), thyroid diseases (9.2%), and diabetes (9.2%). MTB was more common in RDD patients (31.6%) than in controls (23.6%), but the difference was not significant. Elevated CRP was found to be significantly more frequent in patients with recurrent depressive disorders (RDD) (35.5%; χ(2) test, P=0.001, Cramer V=0.29) than in controls (12.5%) and was associated with lowered high-density lipoprotein and overweight/obesity. CONCLUSION: We found some intriguing links between stress, depression, metabolic syndrome, and low grade inflammation, which may be relevant for the prevalence of somatic comorbidity in patients with RDD, but further studies are needed to confirm our results.

The role of personality traits in posttraumatic stress disorder (PTSD).

BACKGROUND: A number of studies have shown that although exposure to potentially traumatic events is common, development of PTSD is relatively rare, which is one of the reasons PTSD still remains a controversial psychiatric entity. The aim of this article was to provide an overview of the research on the role of personality traits in the vulnerability, resilience, posttraumatic growth and expressions associated with PTSD. Personality based approach represents a dimensional aspect of the transdisciplinary integrative model of PTSD. METHODS: We conducted a systematic search on PubMed, PsycINFO, and Academic Search Complete from 1980 (the year PTSD was first included in the DSM) and 2012 (the year the literature search was performed). Manual examination of secondary sources such as the reference sections of selected articles and book chapters were also conducted. RESULTS: Most of the reviewed studies dealing with personality traits as vulnerability and protective factors for PTSD examined the relationship between basic personality dimensions and severity of symptoms of PTSD. These studies have applied three types of methodological designs: cross-sectional, post-trauma and pre-trauma longitudinal studies, with latter being the least common option. CONCLUSION: Finding that appears relatively consistent is that PTSD is positively related to negative emotionality, neuroticism, harm avoidance, novelty-seeking and self-transcendence, as well as to trait hostility/anger and trait anxiety. On the other hand, PTSD symptoms are negatively associated with extraversion, conscientiousness, self-directedness, the combination of high positive and low negative emotionality, as well as with hardiness and optimism, while posttraumatic growth shows inverse relation to most of these traits. Furthermore, a number of studies have confirmed the existence of three distinct personality-based subtypes of PTSD: internalizing, externalizing and low pathology PTSD. These findings may help in further uncovering etiological mechanisms and in building new strategies for prevention, identification and reduction of health risks among this trauma population, as well as facilitating potential posttraumatic growth. However, focusing on just a single dimensional perspective will unable us to generate comprehensive knowledge of the etiology, course and treatment of PTSD.

Metabolic syndrome and serum homocysteine in patients with bipolar disorder and schizophrenia treated with second generation antipsychotics.

There is accumulating evidence for an increased prevalence of metabolic syndrome (MetS) in bipolar patients, which is comparable to the prevalence of MetS in patients with schizophrenia. Hyperhomocysteinaemia has emerged as an independent and graded risk factor for the development of cardiovascular disease (CVD), which is, at the same time, the primary clinical outcome of MetS. The aim of this study was to ascertain if the presence of MetS was associated with hyperhomocysteinaemia in patients with bipolar disorder (N=36) and schizophrenia (N=46) treated with second-generation antipsychotics (SGA). MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria and the cut-off point for hyperhomocysteinaemia was set up at 15 µmoll(-1). Results of the study indicated that the presence of the MetS is statistically significantly associated with the elevated serum homocysteine in all participants. As hyperhomocysteinaemia has emerged as an independent risk factor for psychiatric disorder and CVD, it could be useful to include fasting homocysteine serum determination in the diagnostic panels of psychiatric patients to obtain a better assessment of their metabolic risk profile.

Depressive disorders and comorbidity: somatic illness vs. side effect.

BACKGROUND: The rate of comorbid depression and medical illness varies from 10 to 40%. Patients with depressive disorder compared to general population more often have cardiovascular and cerebrovascular disorders, diabetes, irritable bowel syndrome, and some types of tumor. Side effects of mental health medications may appear in a form that is very similar to clinical presentation of somatic illness. Side effects that appear during treatment of depressive disorder, e. g. cardiovascular, gastrointestinal, movement disorders, etc., may provoke certain diagnostic issues regarding origin of such symptoms (somatic illness vs. side effect). The aim of this article is to review literature regarding comorbidity of depressive disorder and somatic illness and to point at possible diagnostic problems in differentiating comorbid somatic illness and side effects of antidepressants. CONTENT ANALYSIS OF LITERATURE: Literature research included structured searches of Medline and other publications on the subject of comorbidity of depressive disorder and somatic disorders and possible diagnostic problems in differentiating comorbid somatic illnesses from side effects of antidepressants. CONCLUSION: Comorbidity between depressive disorder and various somatic disorders appears often. Investigations suggest that depressive disorder is underdiagnosed in such cases. Side effects of antidepressants are sometimes very hard to differentiate from symptoms of somatic illness, which may lead to diagnostic issues. Bearing in mind frequent comorbidity between of depressive and somatic disorders, early recognition of such comorbidity is important, as well as the selection of antidepressant. It is important to recognize depressive disorder in patients with somatic illnesses, as well as somatic illness in patients primarily treated because of depressive disorder.

Metabolic syndrome and depression in war veterans with post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD), depression and metabolic syndromes are growing public health problems in post-war countries. Understanding the co-morbidity among PTSD, depression and metabolic syndrome has an important clinical and theoretical issue. OBJECTIVE: To examine the relationship between combat-related PTSD, co-morbid depression and metabolic syndrome as well as between severity of depression and metabolic syndrome. METHOD: Metabolic syndrome and co-morbid depression were investigated in 100 male war veterans with combat PTSD and in 79 males who needed medical attention in dispensary of family medicine. RESULTS: Metabolic syndrome according NCEP: ATP III was found in 25 % of war veterans with PTSD. Metabolic syndrome was identified more frequently in PTSD patients with co-morbid depression (47.8 %) compared to those without depression (9.1%). PTSD with moderate and severe co-morbid depression was associated with higher rates of metabolic syndrome (78.6% and 90.9% respectively) in comparison with mild depression (26.2%). CONCLUSIONS: PTSD is frequently comorbid with depression, and when the two disorders co-occur, the risk for metabolic syndrome is increased. Treatment of war veterans with PTSD should address co-morbid depression and metabolic syndrome as well as the clinical features of PTSD.

Some treatment dilemmas in rapidly developing dementia: a case report.

The treatment of rapidly deteriorating dementia is always very challenging. This case report describes a 78-year-old male patient with rapidly developing dementia treated successfully with orally disintegrating olanzapine, memantine, donepezil, omega-3 and vitamin-B complex. The prevailing fatalism and treatment nihilism regarding treatment of dementia should give way to more hope and optimism. Several important treatment dillemas in rapidly developing dementia are discussed.

Metabolic syndrome and combat post-traumatic stress disorder intensity: preliminary findings.

BACKGROUND: Post-traumatic stress disorder (PTSD) has been associated with co-morbidity of many major mental and somatic disorders as well as with premature mortality. OBJECTIVE: The objective of this study was to examine the relationship between combat-related PTSD, metabolic syndrome and its components as well as between PTSD severity and metabolic syndrome. METHODS: Metabolic syndrome and its components were investigated in 100 male war veterans with combat PTSD and in 79 males who needed medical attention in a family medicine dispensary. RESULTS: Metabolic syndrome according to the modified NCEP: ATP III criteria was found in 35% of our PTSD patients. Metabolic syndrome and intensity of PTSD were significantly related. Metabolic syndrome was identified in 66.7% of the war veterans with high intensity of PTSD in comparison to 23.3% of the veterans with low intensity PTSD. CONCLUSIONS: Prevalence of metabolic syndrome and its components is elevated in war veterans with PTSD. PTSD is a multi-systemic disorder and treatment of war veterans with PTSD should address co-morbid somatic disorders including metabolic syndrome in addition to the clinical features of PTSD.

Mental disorders and metabolic syndrome: a fatamorgana or warning reality?

BACKGROUND: There has been a growing interest in the effect that comorbid mental and somatic disorders may have on each other. Metabolic syndrome is an important risk factor for the development of diabetes mellitus, cardiovascular disease and premature mortality. OBJECTIVES: To examine the association between various mental disorders (schizophrenia, schizoaffective disorder, bipolar disorder, depression, post-traumatic stress disorder and other mental disorders) and metabolic syndrome and discuss the possible pathophysiologic mechanisms that may link specific mental disorders and metabolic syndrome. METHOD: A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to identify studies included (1) English language, (2) published studies with original data in peer-reviewed journals. RESULTS: Clinical investigation of the metabolic syndrome in patients with mental disorders, except schizophrenia, has been surprisingly scarce. Metabolic syndrome was reported in 19-63% of schizophrenic patients, in 42.4% of patients with schizo-affective disorder, in 24.6-50% of bipolar patients, in 12-36% of the patients with recurrent depression and in 31.9-35% of patients with combat posttraumatic stress disorder. CONCLUSION: Metabolic syndrome can contribute to significant morbidity and premature mortality and should be accounted for in the treatment of mental disorders. No definite or reliable insight into the pathophysiological link between metabolic syndrome and mental disorders is available.

Metabolic syndrome, somatic and psychiatric comorbidity in war veterans with post-traumatic stress disorder: Preliminary findings.

BACKGROUND: There has been a growing interest in the effect that co-morbid mental and somatic disorders may have on each other. Post-traumatic stress disorders (PTSD) have been associated with comorbidity of many major somatic and mental disorders as well as with premature mortality. OBJECTIVE: The objective of this study was to examine the relationship between combat-related PTSD, metabolic syndrome and comorbid psychiatric and somatic diagnoses. METHOD: Metabolic syndrome and its components as well as comorbid somatic and mental disorders were analysed in 47 male war veterans with combat PTSD. RESULTS: Only 4.25% of our patients were without any comorbid somatic and mental disorders, metabolic syndrome or any of its components. Other psychiatric or medical condition was diagnosed in 76.6 % of the PTSD patients. Metabolic syndrome according NCEP: ATP III was found in 31.9% of our PTSD patients. CONCLUSIONS: PTSD is multisystemic mental and somatic disorder. The treatment of war veterans with PTSD should address comorbid other mental and somatic disorders including metabolic syndrome as well as the clinical features of PTSD.