Environmental Factors and Admission Rates in Patients with Major Psychiatric Disorders

The aim of this study was to identify environmental factors that might correlate with the admission rate of patients with major psychiatric disorders. During the years 1988-90, 393 consecutive admissions (119 unipolar depressed patients, 211 schizophrenic patients, and 63 bipolar depressed patients) were monitored. Correlations were calculated between the mean daily admission rate for each month and monthly photoperiod, rate of change in photoperiod, mean temperature, mean relative humidity, and mean barometric pressure. It was found that the admission rate of bipolar depressed patients negatively correlated with monthly photoperiod, which means that during winter the admission rate of these patients increased.     

Depression in elderly medical inpatients: a meta-analysis of outcomes

OBJECTIVE: To determine the prognosis of elderly medical inpatients with depression. DATA SOURCES: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Eight reports (involving 265 patients with depression) met the following 5 inclusion criteria: original research, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affective state reported as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. DATA EXTRACTION: Information about the patient population, the proportion of cases detected and treated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. DATA SYNTHESIS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 3 months or less indicated that 18% of patients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors associated with worse outcomes included more severe depression, more serious physical illness and symptoms of depression before admission. CONCLUSIONS: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low and the mortality rate high.     

A Network Approach to Bipolar Symptomatology in Patients with Different Course Types

Objective

The longitudinal mood course is highly variable among patients with bipolar disorder(BD). One of the strongest predictors of the future disease course is the past disease course, implying that the vulnerability for developing a specific pattern of symptoms is rather consistent over time. We therefore investigated whether BD patients with different longitudinal course types have symptom correlation networks with typical characteristics. To this end we used network analysis, a rather novel approach in the field of psychiatry.

Method

Based on two-year monthly life charts, 125 patients with complete 2 year data were categorized into three groups: i.e., a minimally impaired (n = 47), a predominantly depressed (n = 42) and a cycling course (n = 36). Associations between symptoms were defined as the groupwise Spearman’s rank correlation coefficient between each pair of items of the Young Mania Rating Scale (YMRS) and the Quick Inventory of Depressive Symptomatology (QIDS). Weighted symptom networks and centrality measures were compared among the three groups.

Results

The weighted networks significantly differed among the three groups, with manic and depressed symptoms being most strongly interconnected in the cycling group. The symptoms with top centrality that were most interconnected also differed among the course group; central symptoms in the stable group were elevated mood and increased speech, in the depressed group loss of self-esteem and psychomotor slowness, and in the cycling group concentration loss and suicidality.

Conclusion

Symptom networks based on the timepoints with most severe symptoms of bipolar patients with different longitudinal course types are significantly different. The clinical interpretation of this finding and its implications are discussed.     

Hypothalamic-Pituitary Function in Depressive Illness: Insensitivity to Hypoglycaemia

The insulin tolerance test was performed in 16 severely depressed patients on admission to hospital and after treatment with electric convulsion therapy. The mean plasma cortisol response to hypoglycaemia was significantly impaired before treatment, particularly in the patients who also showed resistance to dexamethasone suppression. The results are consistent with hypothalamic-pituitary insensitivity to hypoglycaemia in these subjects.     

Effects of Age,Sex, Index Admission,and Predominant Polarity on the Seasonality of Acute Admissions For Bipolar Disorder: A Population-Based Study

Bipolar disorder seasonality has been documented previously, though information on the effect of demographic and clinical variables on seasonal patterns is scant. This study examined effects of age, sex, index admission, and predominant polarity on bipolar disorder seasonality in a nationwide population. An inpatient cohort admitted to hospital exclusively for mental illness was derived from the Taiwan National Health Insurance Research Database for 2002–2007. The authors identified 9619 inpatients with bipolar disorder, who had generated 15 078 acute admission records. An empirical mode decomposition method was used to identify seasonal oscillations in bipolar admission data, and regression and cross-correlation analyses were used to quantify the degree and timing of bipolar admission seasonality. Results for seasonality timing found that manic or mixed episodes peak in spring or summer, and depressive episodes peak in winter. Analysis for degree of seasonality revealed that (1) the polarity of patients' index admission predicted the seasonality of relapse admissions; (2) seasonality was significant in female admissions for depressive episodes and in male admissions for manic episodes; (3) young adults displayed a higher degree of seasonality for acute admissions than middle-aged adults; and (4) patients with predominantly depressive admissions displayed a higher degree of seasonality than patients with predominantly manic admissions. Demographic and clinical variables were found to affect the seasonality of acute admissions for bipolar disorders. These findings highlight the need for research on identification and management of seasonal features in bipolar patients. (Author correspondence: ccyang@physionet.org)     

Reproductive biology of Pseudocorynopoma doriai (Pisces: Characidae) in the High Basin of the Samborombón River, province of Buenos Aires, Argentina

The reproductive period of the Glandulocaudine Pseudocorynopoma doriai was determined by the analysis of 240 females, 90 males and 138 immature individuals collected monthly in the Manantiales and the El Portugués rivers. The reproductive period is seasonal, occurring from late winter to mid‐summer, with another reproductive peak of smaller magnitude in early autumn. The mean monthly GSI in males has a significant correlation with rainfall. Other analyzed environmental variables, including temperature, photoperiod, pH and conductivity, did not show a correlation with the mean monthly GSI in females and males. First maturity in females was reached within the 42–43 mm standard length class. Like other Glandulocaudines from southern Brazil, males initiate sexual maturation before females, which implies an adaptive advantage in that this would enable females to spawn under optimal environmental conditions. The mean absolute fecundity was 1286.42 oocytes (SD = 496.9083); the mean relative fecundity was 0.5070 (SD = 0.1333) oocytes by milligram body weight.     

Differences in hypothyroidism between lithium-free and -treated patients with bipolar disorders

The majority of the previous studies of thyroid abnormalities in bipolar patients was conducted in populations containing various proportions of lithium-treated subjects. In the present study, we sought to determine whether there exist differences in hypothyroid profile between lithium-free and -treated bipolar patients. Bipolar patients never treated with lithium and carbamazepine (n=78) and those currently in lithium therapy (n=53) were included in this study. Serum concentrations of total thyroxine (T(4)), total triiodothyronine (T(3)), and thyroid-stimulating hormone (TSH) were compared between lithium-free and -treated patients. The rate of hypothyroidism in lithium-free patients was significantly lower than those treated with lithium (6.3%-10.8% vs. 28.0%-32.1%). Significant changes in the three thyroid indices indicative of hypothyroidism were consistently associated with longer illness duration in lithium-free manic patients, but with greater severity of mania and more mood episodes in their lithium-treated counterparts. In lithium-free depressed patients, more episodes were associated with lower T(4) levels; whereas in their lithium-treated counterparts, longer illness duration was associated with higher TSH levels and females with lower T(3) levels. These results suggest that bipolar patients with and without lithium exposure differ in prevalence and association of hypothyroidism and may have different response to thyroid hormone therapy.     

The Effect of a Smoking Ban on Hospitalization Rates for Cardiovascular and Respiratory Conditions in Prince Edward Island,Canada

Background

This is the first study to have examined the effect of smoking bans on hospitalizations in the Atlantic Canadian socio-economic, cultural and climatic context. On June 1, 2003 Prince Edward Island (PEI) enacted a province-wide smoking ban in public places and workplaces. Changes in hospital admission rates for cardiovascular (acute myocardial infarction, angina, and stroke) and respiratory (chronic obstructive pulmonary disease and asthma) conditions were examined before and after the smoking ban.

Methods

Crude annual and monthly admission rates for the above conditions were calculated from April 1, 1995 to December 31, 2008 in all PEI acute care hospitals. Autoregressive Integrated Moving Average time series models were used to test for changes in mean and trend of monthly admission rates for study conditions, control conditions and a control province after the comprehensive smoking ban. Age- and sex-based analyses were completed.

Results

The mean rate of acute myocardial infarctions was reduced by 5.92 cases per 100,000 person-months (P = 0.04) immediately after the smoking ban. The trend of monthly angina admissions in men was reduced by −0.44 cases per 100,000 person-months (P = 0.01) in the 67 months after the smoking ban. All other cardiovascular and respiratory admission changes were non-significant.

Conclusions

A comprehensive smoking ban in PEI reduced the overall mean number of acute myocardial infarction admissions and the trend of angina hospital admissions.     

The Association between Meteorological Parameters and Aneurysmal Subarachnoid Hemorrhage: A Nationwide Analysis

Prior research has suggested that regional weather patterns impact the risk of rupture of cerebral aneurysms, but the findings in the literature have been inconsistent. Furthermore, no nationwide analysis to date has examined the association between meteorological factors and the post-procedural outcomes of patients after the treatment for ruptured cerebral aneurysms. The purpose of this study was to use a nationwide sample to analyze the association between specific meteorological parameters—temperature, precipitation, sunlight, and humidity—and hospital admission rate for and outcome after aneurysmal subarachnoid hemorrhage. Patients were identified using the Nationwide Inpatient Sample (2001–2010): Those with an ICD-9 diagnosis code for subarachnoid hemorrhage and a procedural code for aneurysm repair were included. Climate data were obtained from the State of the Climate Report 2010 released by the National Climatic Data Center. Multivariate regression models were constructed to analyze the association between average state monthly temperature, precipitation, and percent possible sunlight, as well as relative morning humidity and both monthly hospital admission rate, adjusted for annual state population in millions, and in-hospital mortality. 16,970 admissions were included from 723 hospitals across 41 states. Decreased daily sunlight and lower relative humidity were associated with an increased rate of admission for ruptured cerebral aneurysms (p<0.001), but had no association with differential inpatient mortality. No significant changes in these observed associations were seen when multivariate analyses were constructed. This is the first nationwide study to suggest that decreased sunlight and lower relative humidity are associated with admission for ruptured cerebral aneurysms. While it has been postulated that external atmospheric factors may cause hormonal and homeostatic changes that impact the risk of rupture of cerebral aneurysms, additional research is needed to confirm and further understand these relationships.     

3H]-ketanserin binding sites in different psychiatric disorders

The results of the present study showed the presence of a high-affinity and saturable binding of [3H]-ketanserin to frontal and parietal brain membranes obtained postmortem from bipolar, depressed, schizophrenic patients and normal controls. The human brain samples (60 frontal cortex and 51 parietal cortex), were donated by the Stanley Foundation Brain Collection. The overall data showed that normal controls, depressed and schizophrenic patients had a higher density in the frontal than in the parietal cortex, while bipolar patients did not show any difference. When the data were analysed according to the two hemispheres, some additional, intriguing observations were made: it emerged that [3H]-ketanserin binding sites did not show any difference in the two frontal cortices, while they were less represented in the right parietal cortex of normal and bipolar patients and more dense in schizophrenic patients. In conclusion, our study has demonstrated the presence of heterogenous alterations of [3H]-ketanserin binding sites in healthy controls and different psychiatric disorders that may be of help in a further elucidation of the specific role that 5-HT(2A) receptors may play in these disorders.     

Visual cognitive dysfunction in depression: an event-related potential study

The P3(00) event-related potentials (ERPs) elicited by visual stimuli in two visual tasks were assessed in depressed patients (12 patients with major depression and 11 patients with bipolar disorder) and compared with those of 20 age-matched normal controls. At remission, the ERPs from 18 of the depressed patients were again recorded. The visual oddball (VO) paradigm presented both target and standard visual stimuli and the simple visual (SV) paradigm presented a target but no standard visual stimulus. Subjects performed the VO task significantly less accurately than the SV task, as reflected by the behavioral measures (reaction-time and task accuracy). Depressed patients of the bipolar group showed longer P3 peak latency for the VO task and no change in P3 amplitude. No significant differences were found in any other ERP component between the groups. During remission, slowing RTs and reduced P3 peak latencies were observed for both major depression and bipolar disorder groups. Thus, the P3 ERP may be an index of the contribution of the slowed central processing to psychomotor retardation in clinically homogenous samples of depressive patients performing an appropriately demanding task.     

Castelli risk indexes 1 and 2 are higher in major depression but other characteristics of the metabolic syndrome are not specific to mood disorders

Aims

This study examined whether Castelli risk indexes 1 (total/high-density lipoprotein (HDL) cholesterol) and 2 (low density lipoprotein (LDL)/HDL cholesterol) and other shared metabolic disorders might underpin the pathophysiology of the metabolic syndrome, major depression or bipolar disorder.

Main methods

This cross-sectional study examined 92 major depressed, 49 bipolar depressed and 201 normal controls in whom the Castelli risk indexes 1 and 2 and key characteristics of the metabolic syndrome, i.e. waist/hip circumference, body mass index (BMI), systolic/diastolic blood pressure, total cholesterol, low-density lipoprotein (LDL) and HDL cholesterol, triglycerides, insulin, glucose, hemoglobin A1c (HbA1c) and homocysteine were assessed.

Key findings

Castelli risk indexes 1 and 2 were significantly higher in major depressed patients than in bipolar disorder patients and controls. There were no significant differences in waist or hip circumference, total and LDL cholesterol, triglycerides, plasma glucose, insulin, homocysteine and HbA1c between depression and bipolar patients and controls. Bipolar patients had a significantly higher BMI than major depressed patients and normal controls.

Significance

Major depression is accompanied by increased Castelli risk indexes 1 and 2, which may be risk factors for cardiovascular disease. Other key characteristics of the metabolic syndrome, either metabolic biomarkers or central obesity, are not necessarily specific to major depression or bipolar disorder.     

Alterations in Growth, Photosynthesis, and Respiration in a Starchless Mutant of Arabidopsis thaliana (L.) Deficient in Chloroplast Phosphoglucomutase Activity

A mutant of Arabidopsis thaliana (L.) Heynh. which lacks leaf starch was isolated by screening for plants which did not stain with iodine. The starchless phenotype, confirmed by quantitative enzymic analysis, is caused by a single recessive nuclear mutation which results in a deficiency of the chloroplast isozyme of phosphoglucomutase. When grown in a 12-h photoperiod, leaves of the wild-type accumulated substantial amounts of starch but lower levels of soluble sugars. Under these conditions, the mutant accumulated relatively high levels of soluble sugars. Rates of growth and net photosynthesis of the mutant and wild-type were indistinguishable when the plants were grown in constant illumination. However, in a short photoperiod, the growth of the mutant was severely impaired, the rate of photosynthesis was depressed relative to the wild-type, and the rate of dark respiration, which was high following the onset of darkness, exhibited an uncharacteristic decay throughout the dark period. The altered control of respiration by the mutant, which may be related to the relatively high levels of soluble carbohydrate that accumulate in the leaf and stem tissue, is believed to be partially responsible for the low growth rate of the mutant in short days. The depressed photosynthetic capacity of the mutant may also reflect a metabolic adaptation to the accumulation of high levels of soluble carbohydrate which mimics the effects of alterations in source/sink ratio. The activities of sucrose phosphate synthase and acid invertase are significantly higher in the mutant than in the wild-type whereas ADP-glucose pyrophosphorylase activity is lower. This suggests that the activities of these enzymes may be modulated in response to metabolite concentrations or flux through the pathways.     

The Combined Dexamethasone/CRH Test (DEX/CRH Test) and Prediction of Acute Treatment Response in Major Depression

Background

In this study the predictive value of the combined dexamethasone/CRH test (DEX/CRH test) for acute antidepressant response was investigated.

Methodology/Principal Findings

In 114 depressed inpatients suffering from unipolar or bipolar depression (sample 1) the DEX/CRH test was performed at admission and shortly before discharge. During their stay in the hospital patients received different antidepressant treatment regimens. At admission, the rate of nonsuppression (basal cortisol levels >75.3 nmol/l) was 24.6% and was not related to the later therapeutic response. Moreover, 45 out of 114 (39.5%) patients showed an enhancement of HPA axis function at discharge in spite of clinical improvement. In a second sample, 40 depressed patients were treated either with reboxetine or mirtazapine for 5 weeks. The DEX/CRH test was performed before, after 1 week, and after 5 weeks of pharmacotherapy. Attenuation of HPA axis activity after 1 week was associated with a more pronounced alleviation of depressive symptoms after 5-week mirtazapine treatment, whereas downregulation of HPA system activity after 5 weeks was related to clinical response to reboxetine. However, early improvement of HPA axis dysregulation was not necessarily followed by a beneficial treatment outcome.

Conclusions/Significance

Taken together, performance of a single DEX/CRH test does not predict the therapeutic response. The best predictor for response seems to be an early attenuation of HPA axis activity within 1 or 2 weeks. However, early improvement of HPA system dysfunction is not a sufficient condition for a favourable response. Since a substantial part of depressive patients display a persistence of HPA axis hyperactivity at discharge, downregulation of HPA system function is not a necessary condition for acute clinical improvement either. Our data underline the importance of HPA axis dysregulation for treatment outcome in major depression, although restoration of HPA system dysfunction seems to be neither a necessary nor a sufficient determinant for acute treatment response.     

Mood and disruptive behavior disorders and symptoms in the offspring of patients with bipolar I disorder

The study aimed to ascertain the prevalence of mood and disruptive behavior disorders and symptoms in 35 children of 29 adult outpatients with a DSM-IV diagnosis of bipolar I disorder, compared with 33 children of 29 healthy adults, matched with patients on age, socioeconomic status and education. The offspring of bipolar patients had a 9.48 fold higher risk of receiving a psychiatric diagnosis. While only two children of patients with bipolar disorder were diagnosed with a mood disorder, 30.9% displayed mild depressed mood, compared with 8.8% of the controls, a statistically significant difference. The bipolar offspring also scored significantly higher on the hyperactivity and conduct problems subscales as well as the ADHD index of the Conners’ Teacher Rating Scale. The disruptive behavior and mood symptoms observed in early life in the offspring of bipolar patients may indicate the need for early psychosocial intervention.     

The clinical history and costs associated with delayed diagnosis of bipolar disorder

The purpose of this reported study was to determine healthcare utilization and costs associated with delayed diagnosis of bipolar disorder. With use of automated data from a large integrated health system in the Midwest, all patients with newly diagnosed bipolar disorder recorded in any inpatient or outpatient encounter from January 1, 2000 to August 31, 2002 were identified. The date of initial diagnosis was the index date. For each patient in the bipolar cohort, 5 comparison patients were randomly selected from the general population of health system members and matched with the bipolar patients by sex, race, and age (-/+ 5 years). Data on healthcare utilization (inpatient, outpatient, emergency department, pharmacy) were collected with a focus on mental health, from January 1, 1990, through 1 year after the index date. The cohort is 62% female and 64% White. Median time between initial mental health diagnosis and bipolar diagnosis was 21 months, with 33% of subjects receiving a bipolar diagnosis within 6 months of their initial mental health diagnosis; however, for 31% of the remaining bipolar subjects, the time of their initial mental health presentation to bipolar diagnosis was 4 years or more. The number and duration of treatment with antidepressants increased as time to bipolar diagnosis increased. Patients with bipolar disorder had at least twice the number of interactions with the healthcare system before the index date than the non-bipolar comparison group. Mean monthly costs before and after bipolar diagnosis were not strikingly different for patients with bipolar disorder, but costs after bipolar diagnosis increased with increasing time to bipolar diagnosis. Bipolar disorder is a costly illness for which the impact on the healthcare system may vary depending on how quickly it is diagnosed. Delays in diagnosis appear related to additional costs after diagnosis.     

Effects of short photoperiod on the ability of golden hamster pituitaries to secrete prolactin and gonadotropins in vitro

Transfer of male golden (Syrian) hamsters from a 14L:10D (light:dark) to a 5L:19D photoperiod induced significant changes in pituitary function tested in vitro. Within 27 days after transfer to a 5L:19D photoperiod, basal prolactin (Prl) release was significantly depressed and response to dopamine (DA) was significantly enhanced as compared to Prl release by pituitaries from 14L: 10D hamsters. Follicle-stimulating hormone (FSH) release tended to be depressed after 9 or 27 days of 5L:19D exposure, but the effect was not significant. After 77 days of 5L:19D exposure, Prl release was further suppressed, while FSH release surpassed that seen in 14L:10D pituitaries. In vitro FSH response to luteinizing hormone releasing hormone (LHRH) was also enhanced at this time. After 15 weeks of exposure to a short photoperiod, FSH secretion was still elevated above control levels, but Prl release and Prl response to DA were no longer different from that of 14L: 10D controls. Secretion of luteinizing hormone (LH) in vitro, either basal or LHRH stimulated, was not affected by photoperiod at any time tested. From these results, we conclude that short photoperiod exposure does not reduce the pituitary's ability to secrete LH or FSH, although secretion of Prl is severely attenuated.     

Water temperature behaviour in the River Danube during the twentieth century

Monthly mean water temperatures in the River Danube at Linz, Austria during the period 1901–1990 have been investigated in relation to equivalent information on air temperature and river discharge. Statistical analysis revealed a significant increase in monthly mean water temperatures of 0.8 °C and showed strongest rises in mean values for autumn and early winter months. No statistically significant trends were evident for air temperature or river discharge, and rising water temperatures are likely to reflect increasing human modification of the river system. A strong overall correlation between monthly mean water and air temperatures at Linz was made up of a series of more scattered and less steep water/air temperature relationships for individual months, while the influence of snowmelt runoff depressed average water temperatures in the spring and early summer period by 1.5 °C. Multiple regression relationships developed for individual months from data on air temperature, river discharge and time trend during the study period were able to predict monthly mean water temperatures in 1991 and 1992 with a root mean square error of 0.5 °C. These regression equations, when combined with scenarios of future changes in air temperature and river flow as a consequence of global warming, suggest that only modest rises in monthly mean water temperature will be experienced in the River Danube by the end of the present century, but that increases of > 1 °C for all months, and > 2 °C for the autumn period of low flows, can be anticipated by the year 2030.     

Transfer of sodium ions across the erythrocyte membrane in manic — Depressive illness: Treatment with lithium carbonate

The efflux of ²²Na from erythrocytes was measured $\text{in vitro}$ under experimental conditions such that rate constants due to efflux either by active transport, passive diffusion, or exchange diffusion could be calculated. No significant differences were found in the rate constants for ²²Na efflux between seven male bipolar depressed patients and eight male control subjects, who had no personal or family history of psychiatric illness. Treatment of patients with lithium carbonate either for less than one week or for 4–5 weeks produced no changes in the rate constants describing the efflux of ²²Na from red cells. Also, addition of 1mM LiCl $\text{in vitro}$ did not alter the active transport of ²²Na from erythrocytes. These data provide no evidence for either an abnormality in ²²Na transfer across the red cell membrane of bipolar depressives or an effect of the lithium ion upon such transfer.     

Effect of Temperature on Hospital Admissions for Myocardial Infarction in a Subarctic Area

In a study of the effect of mean daily temperature on the admission and fatality rates of 771 patients with myocardial infarction the admission rate was found to be significantly higher on cold (temperature below 0°C.) than on warm (temperature above 0°C.) days. The fatality rate was almost equal in cold and warm weather. Thus the seasonal fluctuation in the admission rate of patients with myocardial infarction is probably due to a direct effect of environmental temperature.