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 Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Publishing Process Manager Anja Filipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team 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