Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders.

Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.

Does Post-Traumatic Spectrum Comorbidity Influence Symptom Severity in Bipolar Disorders? A Cross-Sectional Study in a Real-World Setting.

BACKGROUND: The present cross-sectional study investigates the relationship between post-traumatic spectrum comorbidity and the severity of symptoms in subjects diagnosed with Bipolar Disorders (BD). SUBJECTS AND METHODS: In- and outpatients diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were consecutively recruited. Sociodemographic and clinical data were collected. Psychopathology was evaluated by means of the Hamilton Rating Scale for Depression (HAM-D), the Young Mania Rating Scale (YMRS), and the Positive and Negative Syndrome Scale (PANSS). Sociodemographic, clinical and psychopathological characteristics of BD subjects with and without sub-threshold PTSD were compared by means of bivariate analyses (p<0.05). RESULTS: BD subjects with post-traumatic spectrum comorbidity (n=24.49%) presented a significantly higher number of hospitalizations when compared to those who did not present the co-occurrence of the two conditions (2.67±2.3 versus 1.65±2.32, p=0.039). As for treatment features, subjects with subthreshold PTSD were more frequently prescribed benzodiazepines at the moment of evaluation or in the past (n=18, 100% versus n=22.55%, p=0.032). When assessing differences in terms of psychopathological characteristics, subjects with subthreshold PTSD showed higher HAM-D total score (16.22±9.06 versus 10.22±7.23, p=0.032) and higher PANSS negative symptom scale score (16.06±6.92 versus 11.41±4.68, p=0.017). CONCLUSIONS: Findings from the present study suggest that subthreshold PTSD may underpin higher symptom severity and worse outcomes when occurring as a comorbid condition in BD.

Eating Disorders: the Role of Childhood Trauma and the Emotion Dysregulation.

BACKGROUND: The present retrospective case-control study is aimed at evaluating the presence of childhood traumatic factors and the difficulty in regulating emotions, within a sample of patients with eating disorders compared to the group of healthy controls. SUBJECTS AND METHODS: We included 65 people assessed for eating disorders, 40 patients and 25 healthy controls, who were given two tests: the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to investigate the presence of traumatic events and the Difficulties in Emotion Regulation Scale (DERS) to assess the emotional regulation. RESULTS: People with eating disorders showed higher average scores, and therefore greater severity than the control group, in all the domains explored, both considering traumatic experiences and emotional dysregulation. The domain emotional neglect showed the closest correlation with eating disorders (average scoring 15.9 vs 9.9 of healthy controls), followed by emotional abuse (12.2 vs 7.8), physical neglect (8.2 vs 6.6), physical abuse (8.3 vs 6.6) and sexual abuse (7.2 vs 5.6). In the same way, the emotional dysregulation was greater among people with eating disorder than healty controls, concerning every items explored by DERS, as clarity (average scoring 14.8 vs 11.4), awareness (17.1 vs 11.7), goals (16.3 vs 12.9), strategy (22.0 vs 14.7), non acceptance (17.4 vs 12.1) and impulse (16.5 vs 11.4). CONCLUSIONS: Childhood traumatic experiences and emotional dysregulation result significantly higher in people with eating disorders than healthy controls.