Augmenting/reducing of the evoked potential has been shown to be related to sensation seeking (SS) and specific clinical disorders. Buchsbaum demonstrated that patients with bipolar affective disorders (BAD) tend to be augmenters, as is the case with sensation seekers, and patients with unipolar affective disorders (UPD) tend to be reducers. In addition, he reported that prophylactic medication reduced the tendency to augment in bipolar patients. However, evidence for these relations is restricted to a few studies. This study explores whether Buchsbaum’s initial findings can be found in a naturalistic clinical setting. Acoustic evoked potentials were recorded for six levels of intensity (59, 71, 79, 88, 92, 96 dB SPL) from 24 healthy adults, 21 unipolar depressed patients, and 21 patients with BAD. Participants also completed personality questionnaires, especially the Sensation Seeking Scales Form V. Results revealed a positive correlation between SS and augmenting/reducing in healthy controls, thereby replicating earlier findings. Bipolar depressed patients showed larger P1/N1 slopes than healthy controls, when medication was statistically controlled. Unipolar depressed patients showed smaller P2 slopes, but only when medication was not controlled. Implications of these results for further research on augmenting/reducing and affective disorders and their relationship to SS are discussed. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Die klinische Erfahrung zeigt, dass sich depressive Episoden sehr schnell innerhalb weniger Stunden bis Tage oder sehr langsam innerhalb mehrerer Wochen bis Monate entwickeln können. Hauptziel dieser Arbeit war es, die zeitliche Entwicklung depressiver Episoden bei Patienten mit einer unipolaren oder bipolaren affektiven Störung zu untersuchen. Mithilfe des dafür entwickelten und im Rahmen dieser Studie weiter modifizierten strukturierten Patienteninterview ODI (Onset of Depression Inventory) wurde die Geschwindigkeit des Depressionsbeginns bei 223 konsekutiven Patienten erfasst, von denen 129 in die Auswertung eingeschlossen werden konnten. Es zeigte sich, dass sich depressive Episoden bei Patienten mit bipolarer affektiver Störung signifikant schneller manifestieren als bei Patienten mit unipolarer affektiver Störung. Somit kann die Geschwindigkeit des Depressionsbeginns, gemessen mit dem ODI, als Differenzierungsmerkmal zwischen unipolarer und bipolarer affektiver Störung gewertet werden und im klinischen Alltag helfen, zwischen den beiden Störungsbildern zu unterscheiden.

Abstract In addition to the visual information, external light causes non-image-forming (NIF) effects that modulate brain function and induce psychophysiological effects. The light signal is traditionally assumed to only be mediated via the eyes. Recent studies have suggested the existence of putatively light sensitive structures in the rodent and human brain and penetration of light into the skull and brain tissue has been observed. The brain activation observed during transcranial bright light (TBL) exposure indicates a direct light responsivity of brain tissue. The aim of this thesis was to explore the psychophysiological responses related to TBL. The studies comprising this thesis were conducted in healthy subjects and patients suffering from seasonal affective disorder. TBL exposure was administered via the ear canals in all study settings using light-emitting diodes (LEDs). The comparisons in studies I, II, and III were conducted against the inactivated sham device. Study IV explored the effect of TBL dose. Neither melatonin nor cortisol secretions were altered when acutely exposed to nocturnal TBL. Circadian profiles in TBL setting were in parallel to control conditions for both hormones. Intermittent TBL exposure led to alleviation of jet lag symptoms. Overall post-travel jet lag symptoms as well as subjective feelings of fatigue, inertia, and forgetfulness were reduced. The time to execute the motor response i.e. motor time with a visual warning signal was improved by the TBL treatment. TBL alleviated both depressive and anxiety symptoms related to seasonal affective disorder (SAD). A dose-response relationship regarding the intensity of dose administered via the ear canals was not found. Altogether, TBL seems to affect human brain function by alleviating symptoms of jet lag and SAD and improving psychomotor performance. The acute effect is suggested to be mediated via structures unrelated to acute melatonin secretion i.e. the retinohypotalamic tract (RHT). These results support the light sensitivity of the human brain although the mechanism of action is not yet established. / Tiivistelmä Visuaalisen informaation lisäksi valo aiheuttaa käytöksellisiä ja fysiologisia vaikutuksia, jotka eivät liity kuvan muodostamiseen. Yleisesti vaikutuksen ajatellaan välittyvän aivoihin ainoastaan silmien kautta. Viimeaikaiset tutkimukset ovat havainneet jyrsijöiden ja ihmisten aivoissa mahdollisesti valolle vasteellisia rakenteita. Valon on osoitettu lisäksi läpäisevän kallon ja saavuttavan aivokudoksen. Aivojen aktivoituminen kallon läpi annettavan valoaltistuksen aikana viittaa myös suoraan aivojen valovasteellisuuteen. Tämän väitöskirjan tavoitteena oli tarkastella vaikuttaako kallon läpi annettava valo ihmisen psykofysiologiaan. Tähän väitöskirjaan sisällytetyt tutkimukset tehtiin terveillä vapaaehtoisilla tutkittavilla ja kaamosmasennuspotilailla. Ledin avulla tuotettu valo annettiin kaikissa tutkimusasetelmissa korvakäytävien kautta. Tutkimukset I, II ja III tehtiin lumekontrolliasetelmassa. Tutkimuksessa IV tarkasteltiin valon annosvastetta. Akuutin yöaikaisen valoaltistuksen ei havaittu muuttavan melatoniinin tai kortisolin eritystä. Molempien hormonien vuorokausieritysprofiilit olivat kontrolliasetelman kaltaiset. Jaksottaisen valoaltistuksen havaittiin lievittävän aikaerorasituksen kokonaisoireita ja vähentävän väsymystä, inertiaa ja hajamielisyyttä. Motorisen nopeuden havaittiin paranevan kolmen viikon valohoitojakson aikana. Lisäksi neljän viikon valohoitojakso lievitti kaamosmasennukseen liittyviä masennus- ja ahdistusoireita. Vaikutuksessa ei havaittu eroa eri valoannoksen saaneiden ryhmien välillä. Kallon läpi annettava kirkasvalo näyttäisi vaikuttavan ihmisen aivotoimintaan lievittämällä aikaerorasituksen ja kaamosmasennuksen oireita sekä parantamalla psykomotorista suorituskykyä. Vaikutus ei ole yhteydessä akuuttiin melatoniinin erityksen estämiseen. Tämän tutkimuksen tulokset tukevat ajatusta aivojen valovasteellisuudesta. Kallon kautta annettavan valon vaikutusmekanismia ei kuitenkaan tiedetä vielä.

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Jana Rambousková Supervisor: Prof. MUDr. Radomír Hrdina, CSc. Title of diploma thesis: Pharmacotherapy of mood disorder This diploma thesis deals with the characterization of mood disorders concentrating especially on depression disorders. It presents the classification of mood disorders according to classification MKN-10. The diploma thesis presents patophysiology of depression disorders, their causes, symptoms and progress. It analyses the choice of pharmacotherapy in depression disorders and bipolar affective disorder. It describes individual groups of antidepressants and drugs used for treatement of bipolar affective disorder. It analyses their mechanism of action, indications, contraindications and adverse effects. At the end of diploma thesis states the other use of antidepressants in non- psychiatric indications.

Thesis (MBA (Business Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Experimental research in psychology and economics indicates that depression causes heightened risk aversion. Previous research has documented robust links between seasonal variation in length of day, seasonal depression (known as seasonal affective disorder, or SAD), risk aversion and stock market returns. One such study provides international evidence that stock market returns vary seasonally with the length of the day, a result called the SAD effect. Stock returns are shown to be significantly related to the amount of daylight throughout the autumn and winter. Another study examines the SAD effect in the context of an equilibrium asset pricing model to determine whether the seasonality can be explained using a conditional version of the capital asset pricing model (CAPM) that allows the price of risk to vary over time. Given the above as the base departure point, this report analyses the SAD effect in the context of the South African capital market, where, firstly, the variation in length of day during the year is not so severe compared with other countries like Sweden and the UK and, secondly, a more recent dataset includes the effects of integrated markets and globalisation, that possibly resulted in a shift of seasonal behaviour in the market. It quantifies the SAD effect in general, across industry sectors, over time periods and confirms that a conditional CAPM holds in explaining the seasonality due to SAD. The results differ substantially from those of prior studies. The expected signs of the SAD and Aut coefficients are reversed. Closer analysis shows that seasonality in stock returns has undergone a shift compared to seasonality in an older dataset. A prior finding that effects, such as the SAD, are better explained using excess returns than using raw total returns of the market, is reinforced. The analysis of SAD over time sheds some light on the unexpected outcome of the SAD and Aut coefficients by providing evidence that the validity of regression models deteriorated over time and, more conclusively, that in two consecutive periods, the SAD and Aut coefficients decreased in absolute value. It also found that the coefficients are linearly related to excess returns during the latter period only. The conditional CAPM provides evidence that the effect of SAD is captured in the time variation in the price of risk. The factor of reducing the remainder of SAD in error terms is, however, remarkably smaller. The implication is that market risk already accounts for the SAD effect, but only to a degree, and that the remaining contribution of the SAD effect contained in varying the price of risk is substantially less significant. This finding coupled with the contradictory results in the signs of SAD and Aut coefficients renders evidence of SAD in the South African market rather inconclusive. / AFRIKAANSE OPSOMMING: Navorsing in die gebied waar sielkunde en ekonomie oorvleuel, toon dat depressie ‘n verlaagde risiko-aptyt meebring. Meer spesifiek, vorige navorsing dokumenteer dat robuuste skakels tussen seisoenale lengtes van dae, seisoenale depressie (beter bekend as winter depressie), risiko-aptyt en opbrengste op die andelebeurs bestaan. Een van hierdie studies, wat uitgevooer was op ’n aantal hoof internasionale markte, bevind dat opbrengste op die aandelebeurse wel seisoenaal varieer in ooreenstemming met die lengtes van dae. In dié studie word daar getoon dat opbrengste noemenswaardig ooreenstem met die hoeveelheid sonlig gedurende herfs en winter. ’n Ander studie bestudeer weer seisoenale depressie in konteks met ’n ekwilibrium kapitaal-bate prysmodel om vas te stel of seisoenaliteit verklaar kan word deur ’n kondisionele weergawe van hierdie model waar die prys van risiko varieer oor tyd. Met bogenoemde as vertrekpunt, analiseer die verslag wat volg winterdepressie in die Suid-Afrikaanse aandelemark waar, eerstens, die variasie in lengtes van dae gedurende die jaar minder is as vir ander lande soos Swede en Engeland, en tweedens, waar ’n meer onlangse datastel die effekte van geintegreerde markte en globalisasie insluit. Die verslag kwantifiseer seisoenale depressie in die algemeen op die effektebeurs, pas dan regressie-modelle toe op verskeie industrie-sektore en oor verskillende periodes. Ten einde, word bevestig dat ’n kondisionele kapitaal-bate prysmodel seisoenaliteit as gevolg van winterdepressie kan verklaar. Vergeleke met vorige studies, word daar teenstrydighede in die resultate opgemerk ten opsigte van die verwagte tekens van die koeffisiënte. Met nadere ondersoek word bevind dat die seisoenaliteit in opbrengste ’n verskuiwing ondergaan het vergeleke met ’n ouer datastel. ’n Vorige bevinding dat faktore, tipies soos seisoenale depressie, beter verklaar kan word deur alpha opbrengste (risiko vrye obrengste afgetrek) as rou opbrengste, word bevestig. Die analise oor tyd verklaar gedeeltelik die onverwagte koeëfisiënte. Daar word waargeneem dat die geldigheid van regressie modelle oor twee opeenvolgende tydperke verswak het. Verder word daar ook bevind dat die absolute waardes van die koeëfisiënte verklein het en dat koeëfisiënte ’n liniêre verwantskap met opbrengste toon, slegs in die latere tydperk. Die toepassing van ‘n kondisionele kapitaal-bate prysmodel bevestig dat seisoenale depressie teenwoordig is in die prys van risiko. Daar word verder bevestig dat mark risiko gedeeltelik seisoenale depressie verklaar en dat die oorblywende teenwoordigheid daarvan in die prys van risiko heelwat minder statistiese geldigheid het. Gegewe dit, tesame met die teenstrydigheid in die tekens van die koeëfisiënte, word enige duidelike konklusies ten opsigte van seisoenale depressie se teenwoordigheid in die Suid-Afrikaanse mark verhoed.

A literatura aponta que traumas emocionais precoces (TEP) podem ser um fator de risco para o desenvolvimento do transtorno afetivo bipolar (TAB). Estudos também indicam associações entre TAB, prejuízos no reconhecimento de expressões faciais de emoções (REFE) e no funcionamento psicossocial, envolvendo traços de personalidade e habilidades sociais, os quais podem estar presentes inclusive em indivíduos em risco para o transtorno, como os parentes de primeiro grau. O objetivo deste estudo foi avaliar as associações entre TEP, características psicossociais e REFE em sujeitos portadores (eutímicos) e em condição de risco para o TAB em comparação com um grupo de indivíduos saudáveis da comunidade. Foi avaliada uma amostra total de 109 sujeitos adultos de ambos os sexos, sendo 40 do grupo com TAB (GB), 30 do grupo em risco (GR) e 39 do grupo controle (GC). A avaliação do diagnóstico foi feita por meio da Entrevista Clínica Estruturada para o DSM-IV e do estado de humor atual pelo Questionário Sobre a Saúde do Paciente-9 e pela Escala de Avaliação de Mania (EAM). Para a avaliação dos desfechos foram utilizados instrumentos de auto relato (Inventário de Auto-avaliação de Traumas Precoces - Versão Reduzida, Inventário de Cinco Fatores NEO Revisad-versão reduzida, Inventário de Habilidades Sociais), e uma tarefa dinâmica de REFE. Os dados foram analisados por testes estatísticos paramétricos (teste do QuiQuadrado, teste para a comparação de duas proporções, ANOVA e ANCOVA) e pela análise de componentes principais (analise multivariada). Os resultados apontaram que o GB apresentou mais vivências de TEP, características psicossociais desadaptativas e maiores prejuízos no REFE em comparação ao GR e GC. Os sujeitos do grupo GR apresentaram um perfil com traços de prejuízo quando comparados ao GC, mas em menor nível que o GB, expressos sobretudo por presença de altos índices de neuroticismo na personalidade e de falhas no processo do REFE. Por outro lado, apresentaram fatores protetores como traços de abertura e bom nível de habilidades sociais. De maneira geral, os achados corroboram a literatura prévia reforçando a presença de possíveis marcadores genéticos para o TAB, subjacentes ao seu desenvolvimento, e apontam indicadores de resiliência que podem favorecer condutas de prevenção e intervenção precoce. / The literature shows that early emotional traumas (EETs) can be a risk factor for development of affective bipolar disorder (ABD). Studies have also reported associations between ABD and impairment in both recognition of emotional facial expressions (REFE) and psychosocial functioning, involving personality traits and social skills, and which may be present in at-risk individuals, such as first-degree relatives. The objective of this study was to assess the associations between EET, psychosocial characteristics and REFE in subjects who are euthymic (i.e. ABD carrier) and those who are at risk of ABD in comparison with healthy individuals in the community. In total, 109 male and female adults were divided into groups as follows: 40 subjects with ABD (GB), 30 subjects at risk (GR) and 39 healthy subjects as controls (GC). Diagnostic evaluation was carried out by means of a structured clinical interview for DSM-IV disorders and the current state of mood by using the patient health questionnaire-9 and mania assessment scale (MAS). For assessment of outcomes, self-report instruments (i.e. early trauma inventory self-report - short version, revised NEO five-factor inventory - short version, and social skills inventory) and a dynamic task of recognition of emotional facial expressions were used. The resulting data were analysed by using parametric statistical tests (i.e. chi-square test, two-proportion comparison test, ANOVA and ANCOVA) and analysis of the main components (i.e. multivariate analysis). The results showed that subjects of GB group had experienced more EETs, maladaptive psychosocial characteristics and more impaired REFE compared to those of GR and GC groups. The subjects of GR group had a worse psychological profile compared to that of GC group, but better than that of GB as subjects with ABD exhibited high levels of neurotic personality traits and poor REFE. On the other hand, they presented protective factors such as openness and good social skills. Overall, the findings corroborate the literature by reinforcing the presence of possible genetic markers for ABD secondary to its development and by suggesting indicators of resilience, which can favour preventive measures and early intervention.

<p>This study investigated a consecutive cohort of 88 youngsters with onset of a psychotic disorder at age 15.7 (sd 1.5) years and followed-up 10.6 (sd 3.6) years after first admission at the age of 26.5 (sd 3.7) years. A subsample of 15 subjects were assessed with the Five Minute Speech Sample for measuring Expressed Emotion and subsequent recording of relapses during a two year period.</p><p>A diagnostic split between schizophrenia spectrum psychosis and affective psychotic disorder was usually stable over time. The main diagnostic shift was an influx to schizophrenia spectrum disorder of subjects with a better premorbid function and less insidious onset as compared to those with a stable schizophrenia diagnosis.</p><p>Early onset schizophrenia spectrum disorder usually had a poor functional outcome. Most subjects needed support in the form of a disability pension. Early onset affective psychotic disorder usually had a good functional outcome. Most subjects worked and enjoyed regular friendships. The functional level before onset of illness was the best predictor of future functional level in psychotic disorders. A family history of non-affective psychosis predicted a worse function in schizophrenia. Frequent episodes and low intelligence predicted a worse function in affective disorders.</p><p>Four men (4.5% of the sample) committed suicide. The risk of suicide was increased about 30 times. Almost a third of subjects attempted suicide. Females made more attempts. Suicide attempts were related to more depressive symptoms but less negative symptoms at first episode, to readmissions and to dependence on nicotine. </p><p>Subjects with schizophrenia spectrum psychoses were less satisfied with life than those with affective psychotic disorder. Subjective satisfaction in schizophrenia was strongly associated to depressive mood while in affective disorders it was associated to degree of employment.</p><p>Adolescents with psychosis in families rated high or borderline high in Expressed Emotion either during first episode or after discharge had an increased risk of relapse.</p>

This study investigated a consecutive cohort of 88 youngsters with onset of a psychotic disorder at age 15.7 (sd 1.5) years and followed-up 10.6 (sd 3.6) years after first admission at the age of 26.5 (sd 3.7) years. A subsample of 15 subjects were assessed with the Five Minute Speech Sample for measuring Expressed Emotion and subsequent recording of relapses during a two year period. A diagnostic split between schizophrenia spectrum psychosis and affective psychotic disorder was usually stable over time. The main diagnostic shift was an influx to schizophrenia spectrum disorder of subjects with a better premorbid function and less insidious onset as compared to those with a stable schizophrenia diagnosis. Early onset schizophrenia spectrum disorder usually had a poor functional outcome. Most subjects needed support in the form of a disability pension. Early onset affective psychotic disorder usually had a good functional outcome. Most subjects worked and enjoyed regular friendships. The functional level before onset of illness was the best predictor of future functional level in psychotic disorders. A family history of non-affective psychosis predicted a worse function in schizophrenia. Frequent episodes and low intelligence predicted a worse function in affective disorders. Four men (4.5% of the sample) committed suicide. The risk of suicide was increased about 30 times. Almost a third of subjects attempted suicide. Females made more attempts. Suicide attempts were related to more depressive symptoms but less negative symptoms at first episode, to readmissions and to dependence on nicotine. Subjects with schizophrenia spectrum psychoses were less satisfied with life than those with affective psychotic disorder. Subjective satisfaction in schizophrenia was strongly associated to depressive mood while in affective disorders it was associated to degree of employment. Adolescents with psychosis in families rated high or borderline high in Expressed Emotion either during first episode or after discharge had an increased risk of relapse.

Background Affective disorders are poorly defined and studied in sub-Saharan Africa despite their substantial public health impact. Objectives Overall objective: To describe the epidemiology of selected affective disorders in rural Ethiopia. Specific objectives 1. To describe the validity and utility of the concept of minor depressive disorder (mD). 2. To describe the manifestation, prevalence and the short-term clinical and functional course and outcome of bipolar disorder. Subjects and methods Population: Zay community residents (age ≥16), and residents of Butajira (ages 15-49), in Southern Ethiopia. Study design: Population-based cross-sectional and longitudinal studies Case identification: For the identification of cases with bipolar disorder, a two stage process was employed. An initial screen used key informants and interview with the Composite International Diagnostic Interview (CIDI) to identify cases with probable bipolar disorder. A second confirmatory diagnostic assessment stage employed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). For the identification of cases with mD, data from the CIDI was used. Follow-up: 312 cases with bipolar disorder from Butajira were followed up for a mean of 2.5 years (ranging 1-4 years) through monthly clinical assessments and annual symptom and functional ratings. Results The CIDI was administered to 1714 adults among the Zay and to 68, 378 adults among the Butajira residents. The prevalence of mD among the Zay and Butajira was 20.5% and 2.2% respectively. Up to 80% of cases with mD had used services for their symptoms, while a third to a half of cases had thought about self harm. Up to a sixth of cases had attempted suicide. Age, marital status, education and somatic symptoms were independently associated with mD. The prevalence of bipolar disorder among the Zay was 1.8%. During a 2.5-year follow-up of 312 cases with bipolar disorder from Butajira, 65.9% relapsed (47.8% manic, 44.3% depressive and 7.7% mixed episodes) while 31.1% experienced persistent illness. Female gender predicted depressive relapse whereas male gender predicted manic relapse. Only being on psychotropic medication predicted remission (OR=3.42; 95% CI=1.82, 6.45). Disability was much worse among bipolar patients than in the general population and was predicted by symptom se3verity. Conclusions This is the largest study on mD and bipolar disorder in Africa. mD appears to have potential clinical utility in this setting given its association with service use and risk. The identified risk factors for mD also suggest potential aetiological continuity with major depression. The relatively high prevalence of bipolar disorder among the Zay may be related to genetic predisposition perhaps mediated through a founder effect, but other factors need exploring. In relation to the outcome of bipolar disorder, this study indicates that, contrary to previous assumptions, the course of bipolar disorder is characterised by both manic and depressive relapses in a relatively proportionate fashion. Bipolar disorder also leads to significant levels of disability. This is the only prospective outcome study of bipolar disorder in Africa where cases were monitored systematically at short assessment intervals. Therefore, findings are likely to be more robust than previous reports.

Oral Health Status and Treatment Needs of the Institutionalized Chronic Psychiatric Patients in two Ontario Psychiatric Care Centres Neyaz Farrahi-Avval Master of Science Graduate Department of Dentistry University of Toronto 2008 Abstract Purpose: To examine the oral health status of psychiatric in-patients at two long-term psychiatric health centres, with one operating a full-time dental care facility. Methods: Data were gathered from clinical examinations, a structured interview and hospital records from 120 participants. Periodontal (CPI) and dental (DMFT) indices, subjectively reported oral health status, and oral health behaviour were subsequently analyzed. Results: Referrals for dental problems were made for 62.9% of participants. Bivariate analyses revealed positive correlations between DMFT scores, age and length of stay. Multiple regression analyses demonstrated correlations between DMFT scores and infrequent dental visits, frequent snacking and age. Patients at the psychiatric hospital without a full-time dental care facility were more likely to have had higher DMFT scores, and infrequent dental visits. Conclusions: Psychiatric patients have poor oral health and significant oral health treatment needs. This study underlines the need for on-site dental care facilities at long-term psychiatric care centres.