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CLINICAL, RESEARCH AND
TREATMENT APPROACHES
TO AFFECTIVE DISORDERS
Edited by Mario Francisco Juruena
Clinical, Research and Treatment Approaches to Affective Disorders
Edited by Mario Francisco Juruena
Published by InTech
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First published February, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org
Clinical, Research and Treatment Approaches to Affective Disorders,
Edited by Mario Francisco Juruena
p. cm.
ISBN 978-953-51-0177-2
Contents
Preface IX
Part 1 Clinical 1
Chapter 1 Biological Prediction of Suicidal Behavior
in Patients with Major Depressive Disorder 3
Yong-Ku Kim
Chapter 2 Self-Reported Symptoms Related
to Depression and Suicidal Risk 19
Kouichi Yoshimasu, Shigeki Takemura,
Jin Fukumoto and Kazuhisa Miyashita
Chapter 3 Chronobiological Aspects of Mood Disorders 35
Rosa Levandovski, Ana Harb, Fabiana Bernardi
and Maria Paz Loayza Hidalgo
Chapter 4 Mood Disorders in Individuals with
Genetic Syndromes and Intellectual Disability 49
Maria Cristina Triguero Veloz Teixeira,
Maria Luiza Guedes de Mesquita, Marcos Vinícius de Araújo,
Laís Pereira Khoury and Luiz Renato Rodrigues Carreiro
Chapter 5 Mood Disorders and Cardiovascular Disease 73
Jennifer L. Gordon, Kim L. Lavoie, André Arsenault,
Blaine Ditto and Simon L. Bacon
Part 2 Childhood and Adolescence 103
Chapter 6 Mood Disorders in Childhood and
Adolescence and Their Outcome in Adulthood 105
Ulf Engqvist
Chapter 7 Different Types of
Childhood Adverse Experiences and Mood Disorders 143
Alessandra Alciati
VI Contents
Part 3 Neurobiology 165
Chapter 8 Bipolar Disorder: Diagnosis,
Neuroanatomical and Biochemical Background 167
Kristina R. Semeniken and Bertalan Dudás
Chapter 9 Neurotransmission in Mood Disorders 191
Zdeněk Fišar, Jana Hroudová and Jiří Raboch
Chapter 10 Depression Viewed as a GABA/Glutamate
Imbalance in the Central Nervous System 235
Joanna M. Wierońska, Agnieszka Pałucha-Poniewiera,
Gabriel Nowak and
Andrzej Pilc
Chapter 11 The Role of Blue Native/
SDS PAGE in Depression Research 267
Chunliang Xie, Ping Chen and Songping Liang
Part 4 Treatment 281
Chapter 12 Mood Disorders in the Puerperium and the
Role of the Midwife: Study on Improvement
of Midwives’ Knowledge About Post-Natal
Depression After an Educational Intervention 283
Ana Polona Mivšek and Teja Zakšek
Chapter 13 Psychoeducation for Bipolar Mood Disorder 323
Mohammad Reza Fayyazi Bordbar and Farhad Faridhosseini
Chapter 14 Recent Therapies in Depression 345
Sangita Saini, Anil Shandil and S. K. Singh
Chapter 15 Deep Brain Stimulation for
Treatment-Resistant Depression:
A State-of-the-Art Review 357
Lucas Crociati Meguins
Preface
A fundamental problem in diagnosis is the fact that elaborate classification systems
that exist today are solely based on subjective descriptions of symptoms. Such detailed
phenomenology includes the description of multiple clinical subtypes; however, there
is no biological feature that distinguishes one subtype from another. Moreover, it is
recognized that a variety of disorders can exhibit similar clinical symptoms and that
one disorder can manifest with distinct patterns in different people.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the
International Classification of Disease (ICD), the manuals that specify these diagnoses
and the criteria for making them, are currently undergoing revision. These processes
are involving a huge numbers of researchers from around the world; it is thus an
appropriate time to question if neuroscience is prepared for the DSM-V and the ICD-
11, and if they in turn are set for neuroscience. The presence of merely a few number
of well-validated biomarkers and the early stage in which our understanding of
neurobiology and genetics finds itself have obstructed the integration of neuroscience
into psychiatric diagnosis to date. If we integrate a neurobiological approach that
describes reliable neurobiological findings based on psychopathological syndrome, it
will be more solid contrasted to a non-etiological system of classification. A future
diagnostic criteria system in which aetiology and pathophysiology are essential in
diagnostic decision-making would bring psychiatry closer to other specialties of
medicine.
The relationship between stress and affective disorders is a strong example of a field of
study that can be more fully understood from an integrative perspective. The potential
of an integrative approach to contribute to improvements in human health and well
being are more important than historical biases that have been associated with an
integrative science approach. Approximately 60% of cases of depressive episodes are
preceded by exposure to stressors, especially psychosocial stressors. Among the
factors associated with depression in adulthood are exposure to childhood stressors
such as the death of a parent or substitute, maternal deprivation, paternal
abandonment, parental separation, and divorce. Psychological stress may change the
internal homeostatic state of an individual. During acute stress, adaptive physiological
responses occur, including increased adrenocortical hormone secretion, primarily
cortisol. Whenever an acute interruption of this balance occurs, illness may result.
X Preface
Particularly interesting are psychological stress (i.e., stress in the mind) and the
interactions with the nervous, endocrine, and immune systems. For example
childhood maltreatment is a major social problem. It is a complex global phenomenon
that does not respect boundaries of class, race, religion, age, or educational level and
can occur both publicly and privately, resulting in serious physical injury or even
death. Moreover, its psychological consequences can acutely affect a child’s mental
health well into adulthood.
This approach says very clearly and without a doubt that the causes, development and
outcomes of affective disorders are determined by the relationship of psychological,
social and cultural factors with biochemistry and physiology. Biochemistry and
physiology are not disconnected and different from the rest of our experiences and life
events. This system is based on current studies that reported that the brain and its
cognitive processes show a fantastic synchronization. Consequently, accepting the
brain–body–mind complex is possible only when the three systems – nervous,
endocrine and immune – have receptors on critical cells that can receive information
(through messenger molecules) from each of the other systems. The fourth system, the
mind (our thoughts, our feelings, our beliefs and our hopes), is part of the functioning
of the brain integrating the paradigm. The interaction of the mind, an explicit
functioning of the brain, with other body systems is critical for the maintenance of
homeostasis and well being.
It is now broadly accepted that psychological stress may change the internal
homeostatical state of an individual. During acute stress, adaptive physiological
responses occur, which include hyperactivity of the hypothalamic–pituitary–adrenal
(HPA) axis. Whenever there is an acute interruption of this balance, illness may result.
The social and physical environments have an enormous impact on our physiology
and behaviour, and they influence the process of adaptation or ‘allostasis’. It is correct
to state that at the same time that our experiences change our brain and thoughts,
namely, changing our mind, we are changing our neurobiology. Of special interest are
the psychological stress (stress in the mind) and the interactions of the nervous,
endocrine and immune systems. Increased adrenocortical secretion of hormones,
primarily cortisol in major depression, is one of the most consistent findings in
psychiatry. A significant percentage of patients with major depression have been
shown to exhibit increased concentrations of cortisol (the endogenous glucocorticoid
in humans) in the plasma, urine, saliva and cerebrospinal fluid (CSF); an exaggerated
cortisol response to adrenocorticotropic hormone (ACTH); and an enlargement of both
the pituitary and adrenal glands. The maintenance of the internal homeostatic state of
an individual is proposed to be based on the ability of circulating glucocorticoids to
exert negative feedback on the secretion of hypothalamic-pituitary-adrenal (HPA)
hormones through binding to mineralocorticoid receptors (MRs) and glucocorticoid
receptors (GRs), limiting the vulnerability to diseases related to psychological stress in
genetically predisposed individuals. The HPA axis response to stress can be thought of
as a mirror of the organism’s response to stress: acute responses are generally
adaptive, but excessive or prolonged responses can lead to deleterious effects.
[...]... found the opposite (Biegon and Fieldust 1992) Increased TH and α2- 6 Clinical, Research and Treatment Approaches to Affective Disorders adrenergic receptor densities could be indicative of noradrenergic depletion compensatory to increased NA release Increased NA release may be explained by the relationship between the noradrenergic system and stress response, as severe anxiety and agitation are associated... pleased to edit this book where the authors achieve a balance among diagnostic, research, clinical and new treatment approaches to Affective Disorders Mario Francisco Juruena, MD, MSc, MPhil, PhD Stress and Affective Disorders Programme (SAD Programme) Department of Neurosciences and Behaviour Faculty of Medicine Ribeirao Preto, University of Sao Paulo Brazil XI Part 1 Clinical 1 Biological Prediction... addressed when combinations of risk factors for suicide are used to estimate the suicide risk of individuals For instance, several researchers have examined combinations of two biological risk factors for suicide simultaneously Specifically, researchers have studied the coupling of CSF 5-HIAA and DST 10 Clinical, Research and Treatment Approaches to Affective Disorders non-suppression (Jokinen et al... associations between somatic symptoms and suicidal risk 24 Clinical, Research and Treatment Approaches to Affective Disorders 2.3.1 Assessments of depression and suicidal risk Assessments of depression and suicidal risk were conducted in the same manner as for community dwellers using M.I.N.I as described above Furthermore, assessments of posttraumatic stress disorders (PTSD) by M.I.N.I were included for... in learning and memory and in monoamine metabolism 18 Clinical, Research and Treatment Approaches to Affective Disorders in the rat brain British Journal of Pharmacology, Vol.115, No.5, pp 852-858, ISSN 0007-1188 Yerevanian, B.I., Feusner, J.D., Koek, R.J., Mintz, J (2004) The dexamethasone suppression test as a predictor of suicidal behavior in unipolar depression Journal of Affective Disorders, Vol.83,... Depression, cytokines, and glial function Metabolism: Clinical and Experimental, Vol.54, No.5 Suppl 1, pp 33-38, ISSN 0026-0495 Montague, P.R., Gancayco, C.D., Winn, M.J., Marchase, R.B., Friedlander, M.J (1994) Role of NO production in NMDA receptor-mediated neurotransmitter release in cerebral cortex Science, Vol.263, No.5149, pp 973-977, ISSN 0036-8075 16 Clinical, Research and Treatment Approaches to Affective. .. system seems to be hypofunctional in major depression (Kapur and Mann 1992) 3 Neurotrophic factors 3.1 Brain derived neurotrophic factor (BDNF) Neurotrophic factors including BDNF, nerve growth factor (NGF) and neurotrophin (NT)- 3, 4/5, play an important physiological role in the maintenance and growth of neurons and synaptic plasticity in the adult brain (Lewin and Barde 1996) and are known to be involved... are considered to have this tendency more strongly than the general population (Royle, Keenan, & Farrell, 2009) In such populations, some particular self-reported somatic symptoms may serve as an alternative for detecting depressive disorders or suicidal signs Furthermore, if such people have a prejudice against mental 20 Clinical, Research and Treatment Approaches to Affective Disorders disorders, rather... symptom by yes/no answers to the corresponding questions At the same time, they were asked to note the three symptoms that were causing them the most distress, and how long they had been suffering from these symptoms, since information regarding chief complaints is important in clinical setting The three most distressing symptoms were checked with the original health 22 Clinical, Research and Treatment Approaches. .. according to each calculating algorithm due to the missing values of the relevant factors to be adjusted for In addition, the gender differences in psychiatric symptoms related to suicidal ideation were assessed in patients with major depressive disorders by logistic regression analysis using the stepwise method In this analysis, the candidates’ psychiatric symptoms considered to be related to suicidal . CLINICAL, RESEARCH AND
TREATMENT APPROACHES
TO AFFECTIVE DISORDERS
Edited by Mario Francisco Juruena
Clinical, Research and Treatment. from orders@intechweb.org
Clinical, Research and Treatment Approaches to Affective Disorders,
Edited by Mario Francisco Juruena
p. cm.
ISBN 978-953-51-0177-2
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