A magnetic resonance imaging study of hippocampal, amygdala and subgenual prefrontal cortex volumes in major depression subtypes: melancholic versus psychotic depression.

BACKGROUND: Volumetric studies examining brain structure in depression subtypes are limited and inconclusive. The aim of the current study was to compare the volumes of brain regions previously implicated in depression among patients with melancholic major depressive disorder (MDD), patients with psychotic MDD and normal controls. METHODS: Twenty two patients with melancholic MDD, 17 with psychotic MDD and 18 normal controls were included in the study. Hippocampal (HV), amygdala (AV), anterior (ASCV) and posterior (PSCV) subgenual cortex volumes were measured on magnetic resonance volumetric images. RESULTS: There were no volumetric differences between patients with melancholic and psychotic subgroups. We identified larger AVs and smaller left ASCVs in both patient groups compared to controls with medium to large effect sizes. Regression analysis revealed that AVs were predicted by the presence of depression, late depression-onset, insomnia and left hippocampal tail volume in patients, but not in controls. There were no differences in HVs, right ASCVs and PSCVs across the 3 groups. LIMITATIONS: Small sample size, a possible inclusion of paracingulate gyrus in ASCV and PSCV tracings, significant differences in education level and medication status are discussed as limitations. CONCLUSIONS: Diagnostically delineated melancholic and psychotic MDD patients do not differ in medial temporal and cingulate volumes. However, significant volumetric differences were detected between both patient-groups and controls.

Late onset suicide: distinction between "young-old" vs. "old-old" suicide victims. How different populations are they?

Elderly suicide rates are the highest of any age group. Greece is among the countries with the highest proportion of elderly people in the European Union (EU). Elderly suicide victims seem to possess different characteristics. Aim of our study was to elucidate the different characteristics of elderly suicide victims. Data was collected from a two-year psychological autopsy study, conducted at the Athens' Department of Forensic Medicine, the largest in Greece. Elderly suicide victims represented 35% of total suicides. The majority (69.5%) were males. Only 12.4% had previous psychiatric hospitalization but more than half (65.2%) had psychiatric history (81% of them had history of depression). As expected, there was a high incidence of physical illness (81.6%). The majority (82%) of the elderly suicide victims made a suicide attempt for the first time and it was unfortunately successful. When the elderly suicide victims were divided in two categories ("young-old" and "old-old") the differences between the two groups were: elderly over 75 years had more physical problems and more frequently positive psychiatric history without ever been hospitalized for psychiatric problems. Late life suicides seem to encapsulate population groups with different characteristics. Their differences can be a useful guide aiming to formulate specific suicide prevention strategies. This is of great importance, given the very high frequency of completed suicides in this age group.

Pituitary volume in psychosis.

BACKGROUND: Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown. AIMS: To examine pituitary volume variation in people at different stages of psychotic disorder. METHOD: Pituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls. RESULTS: Compared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics. CONCLUSIONS: The first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.