Dear colleagues,
I am excited to present to you our fifth issue of 2014 featuring up-to-date research on epidemiological and treatment characteristics of bipolar disorder, the association between physical and physiological variables with psychiatrically relevant aspects, as well as effects and geographic distribution of electroconvulsive therapy.
Introducing the first topic, Grunze and Azorin reviewed the treatment of bipolar mixed states using efficacy data of licensed and non-licensed physical or pharmacological treatments. The authors found that the strongest evidence in treating co-occurring manic and depressive symptoms was for monotherapy with aripiprazole, asenapine, extended release carbamazepine, valproate, olanzapine and ziprasidone. As adjunctive treatment, the strongest evidence of efficacy was found for olanzapine plus lithium or valproate, recommended add-on treatments were lithium or valproate plus quetiapine. The authors concluded that there is a lack of studies addressing the efficacy of medications in mixed affective symptoms and that available guidelines do not fully reflect current evidence.
Bellivier and colleagues focused on analysing differences in reported age at onset of bipolar I affective disorder in clinical samples drawn from Europe and the US. The authors found that the proportion of patients belonging to the early-onset subgroup was higher in the US sample and mean age at onset in the early-onset subgroup was lower for the US sample. On the other hand, the intermediate- and late-onset subgroups were reported to have similar characteristics in the two samples.
Heralding our second topic, Lucas and co-workers evaluated the association between coffee and caffeine consumption and suicide risk in cohorts of US men and women drawn from three large-scale health studies between the years 1988 and 2008. The authors assessed consumption of caffeine, coffee and decaffeinated coffee every 4 years using validated food-frequency questionnaires, whereas deaths from suicide were determined by physician review of death certificates. The results support an association between caffeine consumption and lower risk of suicide.
Demirakca and colleagues investigated healthy individuals across a broad age range for the relationship between habitual physical activity and brain morphology by using whole brain voxel based morphometry for gray and white matter volumes and densities. A positive association between self-reported physical activity and gray matter volume bilaterally in the anterior hippocampal and parahippocampal gyrus, independent of age and gender, was detected. Furthermore, age as well as leisure and locomotion activities were linked to enhanced white matter volumes in the posterior cingulate gyrus and precuneus, suggesting a positive interaction especially in seniors.
Szwed and co-workers set out to address the short-term effect of “no-touch” coronary artery bypass grafting (“no touch” OPCABG), an advantageous operating procedure designed to minimize risk for postoperative cognitive dysfunction, on patients’ attention and executive functions. The authors found that, 1 week after surgery, patients who underwent “no touch” OPCABG showed better postoperative performance in neuropsychological tests compared to patients treated with “traditional” OPCABG.
A clinical trial by Garfield and colleagues assessed whether functional genetic polymorphisms of serotonin transporter and receptors involved in bone metabolism predict changes in bone metabolism during serotonin reuptake inhibitors (SRIs). For this purpose, serum markers were essayed before and after treatment with SRI venlafaxine for major depression, and patients were genotyped for putative high- versus low-expressing polymorphisms in the serotonin transporter (5HTTLPR) and 1B receptor (HTR1B) genes. Bone formation indeed was found to be reduced with administration of venlafaxine in participants with the high-expressing 5HTTLPR genotype and those with low- expressing HTR1B genotype.
Our third topic is introduced by Brunoni and colleagues, who evaluated whether electroconvulsive therapy (ECT) induces neurotrophic effects, indexed by the measurement of peripheral brain-derived neurotrophic factor (BDNF) levels. The authors performed a systematic review and meta-analysis of 11 studies that enrolled patients with unipolar, bipolar and psychotic depression and varied regarding electrode placement and previous use of pharmacotherapy. The authors’ findings revealed that BDNF increased after ECT, and meta-regression results did not show any association of the outcome with any clinical and demographic variable, including depression improvement, suggesting ECT induced neurotrophic effects regardless of clinical response in depression.
Finally, Lookene and co-workers explored ECT practice in the three Baltic countries in the year 2010 and revealed significant differences in the geographic use and availability of this therapeutic method. Throughout Estonia, ECT was administered to 362 patients. In Lithuania, ECT is provided by four services and was received by approximately 120 patients, whereas it is provided by only two centres in Latvia, where it was administered to nine patients.
Yours sincerely,
Siegfried Kasper, MD
Chief Editor