A prospective study of psychiatric comorbidity of DSM-IV bipolar I and II disorders

A prospective study of psychiatric comorbidity of DSM-IV bipolar I and II disorders

Abstract/Journal of Affective Disorders 122 (2010) S32–S41 the QoL.BD explains additional variance over and above commonly used generic measures of Q...

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Abstract/Journal of Affective Disorders 122 (2010) S32–S41

the QoL.BD explains additional variance over and above commonly used generic measures of QoL. Discussion: Complete Phase I field testing suggests that the QoL.BD meets the urgent need for a disorder-specific measure of quality of life in BD. The latent structure of the instrument awaits confirmation in an independent sample, and further research will investigate its sensitivity to putative moderators of QoL in this complex condition. Keywords: Quality of Life; Mixed-method; Psychometric doi:10.1016/j.jad.2010.02.014

[O2.6] Longer-term outcome in treatment-resistant depression: Prediction of remission, recovery and episode persistence A. Fekadu1,2, L.J. Rane1,2, S.C. Wooderson1,2, K. Markopoulou1,2, L. Poon2, A.J. Cleare*,1,3 1

King's College London, UK South London and Maudsley NHS Foundation Trust, UK 3 The NIHR Biomedical Research Centre at South London and Maudsley NHS Trust & Institute of Psychiatry (King's College London), UK 2

Background: Systematic studies on the outcome of treatmentresistant depression (TRD) are scarce. Aims: To describe the longer-term outcome and predictors of TRD. Method: 118 participants with confirmed TRD (77 cases with unipolar, 27 with bipolar and 14 with secondary TRD) were followed up for a mean (SD) duration of 39 (20) months. Longitudinal outcomes were operationalised (sustained recovery, remission, subsyndromal depression, depressive episode, and (for bipolar patients) subsyndromal mania and manic/mixed episode) for every month of follow-up using the Longitudinal Interval Follow-up Evaluation (LIFE) chart. The association of potential risk factors with these outcomes was assessed, primarily for unipolar TRD. Results: Most participants had achieved either sustained recovery (48.3%) or remission (11.9%), while a substantial minority suffered persistent subsyndromal depression (19.5%) or persistent depressive episode (20.3%). For unipolar TRD, achieving remission or recovery was predicted by strong social support (OR; 95% CI = 1.90; 1.12, 3.22), particularly having multiple confidants (OR; 95% CI = 3.79; 1.06, 13.47) and supportive neighbours (OR; 95% CI = 4.05; 1.30, 12.65). Social support also predicted recovery in bipolar TRD. The main independent predictor for persistence of depressive episode was baseline symptom severity. Conclusions: 1) A large proportion of cases with TRD continue to experience a significant level of persistent symptomatology; thus, more effort is required to improve the longer-term prospect of patients with TRD; 2) The study reconfirms the important role of social support in TRD and suggests that supportive intervention should be part of the management of TRD; 3) Outcome predictors in TRD are similar to that of major depression in general. This supports the view that TRD forms part of the spectrum of general depressive disorder rather than representing a unique condition.

Keywords: Treatment Resistant Depression; Long term course; Life chart doi:10.1016/j.jad.2010.02.015

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[O2.7] A prospective study of psychiatric comorbidity of DSM-IV bipolar I and II disorders O. Mantere1,2, E. Isometsä*,1,2, M. Ketokivi3, O. Kiviruusu1, K. Suominen1,2, H.M. Valtonen1,2, et al. 1

National Institute of Health and Welfare, Finland Helsinki University Central Hospital, Finland Helsinki University of Technology, Finland

2 3

Objective: To test two hypotheses in bipolar disorder (BD): 1) comorbid disorders are independent of BD course, and 2) comorbid disorders in BD are determined by mood. Methods: In the Jorvi Bipolar Study (JoBS), 191 secondary-care out- and inpatients with DSM-IV BD I or II were evaluated with SCID-I/P plus symptom scales at intake, and at 6 and 18 months. Three evaluations of comorbidity were available for 144 (65 BD I, 79 BD II; 76.6% of 188 living patients). Structural equation modeling (SEM) was used to examine correlations between mood symptoms and comorbidity, and a latent change model (LCM) to examine intraindividual changes across time in depressive and anxiety symptoms. Current mood was modeled in terms of current illness phase, Beck Depression Scale (BDI), Young Mania Rating Scale, and Hamilton Depression Rating Scale; comorbidity in terms of categorical DSM-IV anxiety disorder diagnosis, Beck Anxiety Inventory (BAI) score, and DSM-IV-based dimensional scales of substance use and eating disorders. Results: In the SEM, depression and anxiety exhibited strong cross-sectional and autoregressive correlation; high levels of depression were associated with high concurrent anxiety, both tending to persist over time. Substance use disorders covaried with manic symptoms (r = 0.16 to 0.20, p < 0.05), and eating disorders with depressive symptoms (r = 0.15 to 0.32, p < 0.05). In the LCM, longitudinal intraindividual improvements in BDI were associated with similar BAI improvement (r = 0.42, p < 0.001). Conclusions: Depressive and anxiety symptoms covary strongly cross-sectionally and longitudinally in BD. Substance use disorders are moderately associated with manic symptoms, and eating disorders with depressive mood. Keywords: Bipolar disorder; Comorbidity; Prospective; Structural equation modeling doi:10.1016/j.jad.2010.02.016

[O2.8] Depression incidence rates and predictors of major and minor depression in patients with chronic heart failure N. Lossnitzer*,1, W. Herzog1, G. Gelbrich2, S. Störk3, B. Wild1 1

University of Heidelberg, Germany University of Leipzig, Germany 3 University of Würzburg, Germany 2

Introduction: Depression is common in patients with chronic heart failure (CHF) and associated with personal suffering and adverse cardiovascular outcomes. Cross-sectional correlates of depression are well-known. We investigated for the first time predictors of incident major and minor depressive disorders in a large cohort of CHF patients.