RESUMEN
BACKGROUND: Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression and Anxiety (NESDA) regarding prevalence, temporal sequence, course and longitudinal patterns; sociodemographic, vulnerability and neurobiological indicators; and functional, somatic and mental health indicators of comorbidity. METHODS: Narrative synthesis of earlier NESDA based papers on comorbidity (n=76). RESULTS: Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder. Higher severity and chronicity characterized a poorer comorbidity course. Over time, transitions between depressive and anxiety disorders were common. Consistent comorbidity risk indicators in subjects with depressive and anxiety disorders were childhood trauma, neuroticism and early age of onset. Psychological vulnerabilities, such as trait avoidance tendencies, were more pronounced in comorbid than in single disorders. In general, there were few differences in biological markers and neuroimaging findings between persons with comorbid versus single disorders. Most functional, somatic, and other mental health indicators, ranging from disability to cardiovascular and psychiatric multimorbidity, were highest in comorbid disorders. LIMITATIONS: The observational design of NESDA limits causal inference. Attrition was higher in comorbid relative to single disorders. CONCLUSIONS: As compared to single disorders, persons with comorbid depressive and anxiety disorders were characterized by more psychosocial risk determinants, more somatic and other psychiatric morbidities, more functional impairments, and poorer outcome. These results justify specific attention for comorbidity of depressive and anxiety disorders, particularly in treatment settings.
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Trastorno Depresivo , Trastornos de Ansiedad/epidemiología , Niño , Comorbilidad , Trastorno Depresivo/epidemiología , Humanos , Países Bajos/epidemiología , PrevalenciaRESUMEN
BACKGROUND: No instrumnt exists that can predict the incidence of bipolar disorders (BD). The Bipolarity index (BI), originally developed to improve diagnostic confidence for a lifetime diagnosis of BD, may predict incident BD. AIM: To assess the predictive performance of the BI for incident BD in persons with a lifetime depression. METHODS: The BI score was composed from different questionnaires and interviews in nâ¯=â¯1857 subjects without BD and with a lifetime unipolar depressive disorder from the Netherlands Study of Depression and Anxiety, a longitudinal cohortstudy. The incidence of DSM-IV defined BD I or II as a criterion diagnosis was established with the Composite International Diagnostic Interview after 2, 4, 6 and 9 years of follow-up. Cox regression analyses calculated whether the BI predicts incident BD during 9-years of follow-up. The area Under the Curve (AUC) was determined. At the optimal cut-off score, sensitivity, specificity, positive, and negative predictive values (PPV and NPV) were calculated. RESULTS: Over the course of 9 years, bipolar conversion occurred in nâ¯=â¯46 subjects (2.5%). Each point increase in BI score significantly predicted incident BD (HR[95%CI]= 1.047[1.018-1.076], pâ¯=â¯0.001). The AUC was 0.61 (95%CI: 0.54-0.68). At the optimal cut-off of 30, sensitivity was 67%, specificity 52%, PPV 3% and NPV 98%. LIMITATIONS: Not all items of the BI were fully covered; mean age of the sample of 42. CONCLUSION: The BI score predicts bipolar conversion over 9 years in those with a lifetime depression. However, given the modest performance metrics, the BI cannot guide clinical decision making yet.
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Trastorno Bipolar/diagnóstico , Trastorno Depresivo/psicología , Entrevista Psicológica/normas , Encuestas y Cuestionarios/normas , Adulto , Área Bajo la Curva , Trastorno Bipolar/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Evidence suggests that alcohol use and smoking are negatively associated with mood in bipolar disorders (BD). It is unknown if this relationship is moderated by the number of previous mood episodes. Therefore, this paper aims to examine whether the number of previous mood episodes moderates the relationship between alcohol use and smoking, and mood. METHOD: This study assessed the outcomes of 108 outpatients with BD I and II in a prospective observational cohort study. For 1 year, subjects daily registered mood symptoms and substance use with the prospective Life Chart Method. The relationship between the average daily consumption of alcohol and tobacco units in the whole year and mood were examined by multiple linear regression analyses. Number of previous mood episodes, grouped into its quartiles, was added as effect moderator. Outcome was the number of depressive, hypomanic and manic days in that year. RESULTS: The number of depressive days in a year increased by 4% (adjusted ß per unit tobacco = 1.040; 95% CI 1.003-1.079; p = 0.033) per unit increase in average daily tobacco consumption in that same year. Interaction analyses showed that in those subjects with less than 7 previous mood episodes, the number of manic and hypomanic days increased by 100.3% per unit increase in alcohol consumption (adjusted ß per unit alcohol = 2.003; 95% CI 1.225-3.274; p = 0.006). In those with 7 to 13 previous mood episodes, the number of manic and hypomanic days decreased by 28.7% per unit increase in alcohol consumption (adjusted ß per unit alcohol = 0.713; 95% CI 0.539-0.944; p = 0.019); and in subjects with 14 to 44 previous mood episodes, the number of manic and hypomanic days decreased by 7.2% per unit increase in tobacco consumption (adjusted ß per unit tobacco = 0.928; 95% CI 0.871-0.989; p = 0.021). CONCLUSIONS: The number of previous mood episodes moderates the relationship between alcohol use and smoking and mood; and smoking is adversely associated with the number of depressive days.
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Afecto , Consumo de Bebidas Alcohólicas/epidemiología , Trastorno Bipolar/epidemiología , Fumar/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/psicología , Trastorno Bipolar/psicología , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pacientes Ambulatorios/estadística & datos numéricos , Estudios Prospectivos , Fumar/psicología , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
In this study, we examined the metabolic activity of nucleus basalis of Meynert (NBM) neurons in individuals clinically diagnosed with no cognitive impairment (NCI, n = 8), mild cognitive impairment (MCI, n = 9), and subjects with moderate Alzheimer disease (AD, n = 7). We used Golgi apparatus (GA) size as a measure of neuronal metabolic activity. Subjects with MCI showed increased NBM metabolic activity; they had significantly more neurons with larger GA size as compared with NCI and AD subjects. In contrast, more NBM neurons with extremely small GA sizes, indicating reduced metabolic activity, were seen in AD. When these cases were classified according to their AD pathology (Braak I-II, III-IV, or V-VI), Braak III-IV subjects showed significantly increased GA sizes, comparable with the increase in clinically diagnosed MCI, whereas in Braak V-VI, GA sizes were dramatically reduced. Of all MCI and NCI subjects with similar Braak III-IV pathology, the MCI subjects again had significantly larger GA sizes. The larger NBM neuronal GA size seen in MCI suggests increased metabolic activity, associated with both the clinical progression from NCI to MCI, and with the early stages of AD pathology.