RESUMO
This study explores the predictive value of various clinical, neuropsychological, functional, and emotion regulation processes for recovery in Bipolar Disorder. Clinical and demographic information was collected for 27 euthymic or residually depressed BD participants. Seventy one percent of the sample reported some degree of impairment in psychosocial functioning. Both residual depression and problems with emotion regulation were identified as significant predictors of poor psychosocial functioning. In addition, to residual depression, the results of the current study introduce a variable of emotion dysregulation to account for poor psychosocial functioning among BD populations. Improving emotion regulation strategies, in particular, concentration and task accomplishment during negative emotional states could have important consequences for improving overall psychosocial functioning among this population, helping to reduce both the economic burden and high costs to personal wellbeing associated with BD.
Este estudio explora el valor predictivo de los diversos procesos de regulación clínicos, neuropsicológicos, funcionales y emocionales para la recuperación en el Trastorno Bipolar. La información clínica y demográfica se recogió de 27 participantes de TB eutímicos o residualmente deprimidos. Setenta y uno por ciento de la muestra reportó algún grado de deterioro en el funcionamiento psicosocial. Tanto la depresión residual y problemas con la regulación de las emociones fueron identificados como predictores significativos de mal funcionamiento psicosocial. Además de la depresión residual, los resultados del presente estudio introducen una variable de disregulación emocional para dar cuenta del pobre funcionamiento psicosocial en las poblaciones de TB. La mejora de las estrategias de regulación emocional, en particular, la concentración y la realización de tareas durante los estados emocionales negativos podrían tener consecuencias importantes para mejorar el funcionamiento psicosocial global en esta población ayudando a reducir tanto la carga económica y los altos costos para el bienestar personal asociado con TB.
Assuntos
Transtorno Bipolar , Depressão , Impacto PsicossocialRESUMO
The relationships between serotonin and fear and anxiety disorders have been much studied yet many important questions remain, despite selective serotonin reuptake inhibitors having been the primary treatments for these disorders for some time. In order to explore this issue we performed a pooled analysis of six of our studies in remitted patients with a fear/anxiety disorder who were exposed to syndrome-specific aversive stimulation under acute tryptophan depletion. We based our analysis on the hypothesis that the inconsistencies observed in the studies could be predicted by Deakin and Graeff's theory about the dual role of serotonin in responses to threats, whereby serotonin is critical to prevent fear (panic) but not anxiety. In accordance with this view, our results give support to a dissociation of the disorders traditionally grouped under fear and anxiety-related disorders in terms of different roles of serotonin in modulation of responses to aversive stimulation. Implications for future studies and psychiatric nosology are discussed.
Assuntos
Transtornos de Ansiedade/metabolismo , Transtornos de Ansiedade/fisiopatologia , Ansiedade/metabolismo , Ansiedade/fisiopatologia , Medo/fisiologia , Serotonina/metabolismo , Adulto , Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/tratamento farmacológico , Feminino , Humanos , Masculino , Pânico/efeitos dos fármacos , Pânico/fisiologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Triptofano/metabolismoRESUMO
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for posttraumatic stress disorder (PTSD). Serotonergic (5HT) attenuation of stress sensitivity is postulated from SSRIs' effects in other anxiety disorders, and we studied this in PTSD. METHODS: Ten patients with PTSD fully recovered on SSRIs (Clinical Global Impression Scale-I 1 and 2) were enrolled in the study. Patients were tested on two occasions 1 week apart; in each session, they received a drink containing large neutral amino acids (LNAAs) either with (sham tryptophan depletion [STD], control) or without (acute tryptophan depletion [ATD]) tryptophan. At 5.5 hours after the drink, subjects were exposed to a trauma-related exposure challenge. Self-reports of PTSD (visual analogue scales [VAS] and the Davidson Trauma Scale [DTS]), anxiety (Spielberger State Inventory [STAI] Form Y-1), and mood (Profile of Mood States [POMS]) were obtained. Heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure were also measured. RESULTS: The trauma-related exposure challenge induced anxiety on both days, with more marked responses on the ATD day according to VAS, DTS, POMS, and DBP (p < .05). A trend of significance (.1 > p > .05) was observed for STAI Form Y-1, HR, and SBP. CONCLUSIONS: These data demonstrate that ATD accentuates responses to trauma-related stimuli in SSRI-recovered PTSD. They also suggest that SSRI-induced increases in serotonin function restrain PTSD symptoms, especially under provocation, supporting a role for serotonin in mediating stress resilience.