Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate.

OBJECTIVES: Patients with bipolar disorder have been reported to have neurocognitive deficits; however, it is not known whether the cognitive dysfunctions are state-dependent or a stable trait. Lithium and valproate, 2 of the most widely used mood stabilizers in the treatment of bipolar disorder, have also been associated with cognitive impairment. However, the degree and pattern of neurocognitive impairment in euthymic bipolar patients on either monotherapy with lithium or valproate have not been compared before in depth. METHODS: We compared 17 euthymic outpatients with bipolar disorder (BD) on lithium monotherapy to 11 euthymic outpatients with BD on valproate monotherapy and 29 comparison subjects using tests measuring immediate verbal memory and executive functions in addition to 3 subtests of the Wechsler Adult Intelligence Scale Revised. The groups were similar in terms of level of education, duration and severity of illness, and gender distribution. Patients on lithium monotherapy were older than patients on valproate and healthy controls. Mood symptoms as assessed by standardized scales were mild to non-existent in both patient groups. RESULTS: Immediate verbal memory was impaired in both patient groups compared to controls, where the main effect of age was not significant. No significant differences could be found on the other cognitive measures. CONCLUSIONS: Both lithium and valproate may be associated with immediate verbal memory impairment, sparing other cognitive functions. Presence of a similar verbal memory deficit in the lithium and valproate groups suggests that this deficit might be intrinsic to BD or that the 2 medications influence immediate verbal memory similarly. Larger samples of remitted bipolar patients on monotherapy should be studied for more precise conclusions.

Psychological status of patients with chronic urticaria.

Although chronic urticaria is the most common cutaneous disorder seen in our outpatient allergy clinics, to our knowledge, no study of psychiatric morbidity in allergy departments has been carried out in our country. For the present study, we used the Minnesota Multiphasic Personality Inventory (MMPI) to evaluate the personality traits and psychological status of patients with chronic idiopathic urticaria (CIU). Fifty-nine outpatients with CIU and 59 healthy control subjects were enrolled in the study. Patients were included if no specific cause for their urticaria could be identified by detailed history and appropriate investigations. Psychiatric evaluation for all patients and controls was conducted at the Department of Psychiatry by using MMPI. Analysis of the MMPI profile showed that the scores for hypochondriasis, depression, hysteria, psychopathic deviance, paranoia, psychasthenia, schizophrenia, and social introversion were higher in patients with CIU compared to the control group (P < 0.05). The mean score of hysteria was significantly higher in women. There were no significant correlations between the scores of MMPI and duration of the disease. These data indicate that our patients with CIU seem to have more depressive, hysteric, touchy and suspicious personality traits with hypochondriac tendencies and in more conflict with their social environment. Attitudes such as perfectionism, need for approval, external control and need to be loved were also characteristics of the patient group. We believe that psychological status should be considered for effective management of patients with CIU.

Psychological status of patients with seasonal and perennial allergic rhinitis.

There has been a tendency among some clinicians to underestimate the psychological problems of patients with rhinitis. This study assesses the psychological status of allergic rhinitis patients and the influence of type, duration, and severity of rhinitis on the psychiatric evaluation. Forty-one patients with seasonal and perennial allergic rhinitis and 36 healthy control subjects were enrolled in the study. All patients and control subjects were studied through psychological interviews and several psychological tests such as Symptom Checklist-90 (SCL-90), Courtauld Emotional Control Scale, the McMaster Family Assessment Device, and the Satisfaction with Life Scale. Statistically significant differences between patients and controls were observed in all subscales of the SCL-90, particularly in somatization, depression, and general symptom index subscales. Differences between groups were not significant for the other psychological tests. Additionally, differences between seasonal and perennial allergic rhinitis patients were not significant in all questionnaires. Total symptom scores of rhinitis were positively correlated with general symptom index, somatization, interpersonal relationship difficulties subgroups of the SCL-90, whereas negatively correlated with the scores of satisfaction with the life scale. Patients with allergic rhinitis--regardless of type of rhinitis--may develop a group of psychological complaints related to symptom severity. Since the recognition of specific psychiatric disorders can have therapeutic importance, further studies focusing on the associations of these disorders and allergic rhinitis should be conducted.