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The effect of olanzapine monotherapy on subjective sleep estimates in acute mania
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Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
for shared variance among the five personality domains, indicated that Neuroticism (χ 2 = 4.06, p = .04) and Conscientiousness (χ2 = 8.98, p = .003) were significantly and uniquely associated with response. The twoway interactions between Neuroticism × Extraversion (χ2 = 4.49, p = .03) and Extraversion × Conscientiousness (χ2 = 5.91, p = .01) were also associated with response. These were mostly replicated across the treatment completer and intent-to-treat samples. Conclusions: Dimensional personality traits predict of response for individuals with MDD. Keywords: Major depression, Treatment outcome, Personality, Prognosis doi:10.1016/j.jad.2007.12.075
[P1.43] Predictors of patient non-adherence to continuation and maintenance antidepressant use in recurrent depression M.C. ten Doesschatea, C.L.H Bocktingb, A.H. Schene*,a a
University of Amsterdam, The Netherlands University of Groningen, The Netherlands
b
Introduction: In chronic diseases adherence to medication is a problem. In recurrent depression adequate adherence to antidepressants (AD) is needed to achieve optimal benefit from treatment, i.e. to prevent recurrence. Little is known about adherence to AD and its predictors after the acute phase in depression. Finding predictors for non-adherence to AD in the continuation and maintenance phase might help to identify high risk patients and to develop tailored interventions for this particular group. Methods: We studied 131 patients with recurrent depression (DSM-IV) remitted on AD participating in a trial comparing preventive cognitive therapy vs. treatment as usual (1,2). The intervention was not aimed at improving adherence to AD. First, we prospectively assessed (non-) adherence every three months over 2 years with the Medication Adherence Questionnaire (3). Secondly, we quantified the association of non-adherence with future recurrence. Finally, we examined patient-, illness- and treatment related factors as potential predictors of nonadherence to continuation and maintenance AD use. Results: Non-adherence during 2 year follow-up ranged from 39.7% to 52.7%. Based on these prevalences over two years 20.9% was always non-adherent, 48.4% was
intermittently non-adherent and 30.8% was always adherent. Non-adherence predicted time to recurrence. The prediction model for non-adherence over two years included lower education level, more personality disorder symptomatology and more previous episodes (R2 = 18%). Discussion: Non-adherence to continuation and maintenance AD treatment (the longest phase of treatment) in recurrent depression is frequent (like in other chronic diseases) and a potential risk for recurrence. Nonadherence seems difficult to predict. Clinical implications of these findings and suggestions for future research will be addressed. References Bockting, C.L., Schene, A.H., Spinhoven, P., et al. (2005) Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. J. Consult. Clin. Psychol., 73, 647–657. Bockting, C.L., ten Doesschate, M.C., Spijker, J., et al. (in press) Continuation and maintenance use of antidepressants in recurrent depression. Psychother. Psychosom. Morisky, D.E., Green, L.W., and Levine, D.M. (1986) Concurrent and predictive validity of a selfreported measure of medication adherence. Med. Care, 24, 67–74. Keywords: Recurrent depression, Non-adherence, Antidepressants, Prediction doi:10.1016/j.jad.2007.12.076
[P1.44] The effect of olanzapine monotherapy on subjective sleep estimates in acute mania B.H. Yoon*,a, W.M. Bahkb, S.Y. Leec , J.G. Leed, D.I. Jone, K.J. Minf a
Naju National Hospital, Republic of Korea Catholic University of Korea, Republic of Korea c Wonkwang University, Republic of Korea d Dong-Seo Hospital, Republic of Korea e Hallym University, Republic of Korea f Chung-Ang University, Republic of Korea b
Objective: The aim of this study was to investigate the effect of 6-week olanzapine monotherapy on subjective estimates of sleep and hangover in patients with acute bipolar disorder. Method: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
treatment with olanzapine. Clinical improvement was evaluated using Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar version (CGIBP). Extrapyramidal side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The overall subjectively reported adverse events were gathered during the study period. Modified version of Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of night-time sleep and hangover, which included the factors covering four areas: i) getting to sleep (GTS), ii) quality of sleep (QOS), iii) awakening from sleep (AFS), and iv) behavior following wakefulness (BFW) or hangover during the next day. All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with olanzapine. Results: A total of 76 (male = 38, female = 38) patients were included. Fifty-four (71.1%) patients completed the study. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. While mean changes of GTS, QOS and AFS from baseline were significantly improved at days 7, 14, 21 and 42, those of BFW or hangover were not significantly differed between baseline and post-treatment assessments. Conclusion: Data showed that olanzapine monotherapy had favourable effect on acute manic symptoms and well tolerable. The components affecting nighttime sleep improved after olanzapine treatment, but those related with hangover during the next day was not influenced. This result suggests that olanzapine may improve the self-perceived quality of sleep without any impairment following sleep in acute manic patients. Keywords: Olanzapine, Subjective sleep, Acute mania doi:10.1016/j.jad.2007.12.077
[P1.45] Prediction of recurrence and the influence of consecutive episodes on vulnerability: A 2-year prospective study in recurrent depression C.L.H. Bocktinga, Ph. Spinhovenb, M.W.J. Koeterc, L.F. Woutersc, A.H. Schene*,c a
University of Groningen, The Netherlands Leiden University, The Netherlands c University of Amsterdam, The Netherlands b
Introduction: Depression is often a recurrent disease. Identifying risk factors for recurrence is essential. We
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aimed to identify factors predictive of recurrence and to examine whether previous depressive episodes, a wellknown predictor of recurrence, influence vulnerability for subsequent depressive episodes in a sample of remitted patients with recurrent depression. Methods: Recurrence was examined prospectively over 24 months in 172 euthymic patients with recurrent depression (DSM-IV). Baseline illness related characteristics, coping, and stress (life events and daily hassles) were examined as predictors of subsequent recurrence over 2 years. Results: Risk factors for recurrence were a higher number of previous episodes, more residual depressive symptoms and psychopathology, and more daily hassles. Factors with both an increasing and decreasing pathogenic effect with increasing episode number were detected. Discussion: We found some support for dynamic vulnerability models that propose a change of vulnerability with consecutive episodes. These results suggest that some factors that predict recurrence in patients with two previous episodes are not the same for patients with 5 episodes, or even 10 episodes. Researchers should not only differentiate between first onset and subsequent depression, but also consider both the increasing and decreasing pathogenic influence of lifetime history of depressive disorder. Preventive psychological interventions, should be considered in patients with multiple recurrences, focussing on residual symptomatology and specific coping styles. References Bockting, C.L.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Schene, A.H. and the DELTA study group: Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability: a 2-year prospective study. Journal of Clinical Psychiatry 2006;67:747–755. Bockting, C.L.H., Schene, A.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Huyser, J., and Kamphuis, J.H.: Preventing relapse/recurrence in recurrent depression using cognitive therapy. Journal of Consulting and Clinical Psychology 2005;73: 647–657. Bockting, C.L.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Visser, I., Schene, A.H. and the DELTA study group: Differential predictors of response to preventive cognitive therapy in recurrent depression: a 2-year prospective study. Psychotherapy and Psychosomatics 2006; 75:229–236. Keywords: Major depressive disorder recurrent, Relapse/recurrence, Prediction, Risk factors doi:10.1016/j.jad.2007.12.078
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
for shared variance among the five personality domains, indicated that Neuroticism (χ 2 = 4.06, p = .04) and Conscientiousness (χ2 = 8.98, p = .003) were significantly and uniquely associated with response. The twoway interactions between Neuroticism × Extraversion (χ2 = 4.49, p = .03) and Extraversion × Conscientiousness (χ2 = 5.91, p = .01) were also associated with response. These were mostly replicated across the treatment completer and intent-to-treat samples. Conclusions: Dimensional personality traits predict of response for individuals with MDD. Keywords: Major depression, Treatment outcome, Personality, Prognosis doi:10.1016/j.jad.2007.12.075
[P1.43] Predictors of patient non-adherence to continuation and maintenance antidepressant use in recurrent depression M.C. ten Doesschatea, C.L.H Bocktingb, A.H. Schene*,a a
University of Amsterdam, The Netherlands University of Groningen, The Netherlands
b
Introduction: In chronic diseases adherence to medication is a problem. In recurrent depression adequate adherence to antidepressants (AD) is needed to achieve optimal benefit from treatment, i.e. to prevent recurrence. Little is known about adherence to AD and its predictors after the acute phase in depression. Finding predictors for non-adherence to AD in the continuation and maintenance phase might help to identify high risk patients and to develop tailored interventions for this particular group. Methods: We studied 131 patients with recurrent depression (DSM-IV) remitted on AD participating in a trial comparing preventive cognitive therapy vs. treatment as usual (1,2). The intervention was not aimed at improving adherence to AD. First, we prospectively assessed (non-) adherence every three months over 2 years with the Medication Adherence Questionnaire (3). Secondly, we quantified the association of non-adherence with future recurrence. Finally, we examined patient-, illness- and treatment related factors as potential predictors of nonadherence to continuation and maintenance AD use. Results: Non-adherence during 2 year follow-up ranged from 39.7% to 52.7%. Based on these prevalences over two years 20.9% was always non-adherent, 48.4% was
intermittently non-adherent and 30.8% was always adherent. Non-adherence predicted time to recurrence. The prediction model for non-adherence over two years included lower education level, more personality disorder symptomatology and more previous episodes (R2 = 18%). Discussion: Non-adherence to continuation and maintenance AD treatment (the longest phase of treatment) in recurrent depression is frequent (like in other chronic diseases) and a potential risk for recurrence. Nonadherence seems difficult to predict. Clinical implications of these findings and suggestions for future research will be addressed. References Bockting, C.L., Schene, A.H., Spinhoven, P., et al. (2005) Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. J. Consult. Clin. Psychol., 73, 647–657. Bockting, C.L., ten Doesschate, M.C., Spijker, J., et al. (in press) Continuation and maintenance use of antidepressants in recurrent depression. Psychother. Psychosom. Morisky, D.E., Green, L.W., and Levine, D.M. (1986) Concurrent and predictive validity of a selfreported measure of medication adherence. Med. Care, 24, 67–74. Keywords: Recurrent depression, Non-adherence, Antidepressants, Prediction doi:10.1016/j.jad.2007.12.076
[P1.44] The effect of olanzapine monotherapy on subjective sleep estimates in acute mania B.H. Yoon*,a, W.M. Bahkb, S.Y. Leec , J.G. Leed, D.I. Jone, K.J. Minf a
Naju National Hospital, Republic of Korea Catholic University of Korea, Republic of Korea c Wonkwang University, Republic of Korea d Dong-Seo Hospital, Republic of Korea e Hallym University, Republic of Korea f Chung-Ang University, Republic of Korea b
Objective: The aim of this study was to investigate the effect of 6-week olanzapine monotherapy on subjective estimates of sleep and hangover in patients with acute bipolar disorder. Method: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
treatment with olanzapine. Clinical improvement was evaluated using Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar version (CGIBP). Extrapyramidal side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The overall subjectively reported adverse events were gathered during the study period. Modified version of Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of night-time sleep and hangover, which included the factors covering four areas: i) getting to sleep (GTS), ii) quality of sleep (QOS), iii) awakening from sleep (AFS), and iv) behavior following wakefulness (BFW) or hangover during the next day. All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with olanzapine. Results: A total of 76 (male = 38, female = 38) patients were included. Fifty-four (71.1%) patients completed the study. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. While mean changes of GTS, QOS and AFS from baseline were significantly improved at days 7, 14, 21 and 42, those of BFW or hangover were not significantly differed between baseline and post-treatment assessments. Conclusion: Data showed that olanzapine monotherapy had favourable effect on acute manic symptoms and well tolerable. The components affecting nighttime sleep improved after olanzapine treatment, but those related with hangover during the next day was not influenced. This result suggests that olanzapine may improve the self-perceived quality of sleep without any impairment following sleep in acute manic patients. Keywords: Olanzapine, Subjective sleep, Acute mania doi:10.1016/j.jad.2007.12.077
[P1.45] Prediction of recurrence and the influence of consecutive episodes on vulnerability: A 2-year prospective study in recurrent depression C.L.H. Bocktinga, Ph. Spinhovenb, M.W.J. Koeterc, L.F. Woutersc, A.H. Schene*,c a
University of Groningen, The Netherlands Leiden University, The Netherlands c University of Amsterdam, The Netherlands b
Introduction: Depression is often a recurrent disease. Identifying risk factors for recurrence is essential. We
S89
aimed to identify factors predictive of recurrence and to examine whether previous depressive episodes, a wellknown predictor of recurrence, influence vulnerability for subsequent depressive episodes in a sample of remitted patients with recurrent depression. Methods: Recurrence was examined prospectively over 24 months in 172 euthymic patients with recurrent depression (DSM-IV). Baseline illness related characteristics, coping, and stress (life events and daily hassles) were examined as predictors of subsequent recurrence over 2 years. Results: Risk factors for recurrence were a higher number of previous episodes, more residual depressive symptoms and psychopathology, and more daily hassles. Factors with both an increasing and decreasing pathogenic effect with increasing episode number were detected. Discussion: We found some support for dynamic vulnerability models that propose a change of vulnerability with consecutive episodes. These results suggest that some factors that predict recurrence in patients with two previous episodes are not the same for patients with 5 episodes, or even 10 episodes. Researchers should not only differentiate between first onset and subsequent depression, but also consider both the increasing and decreasing pathogenic influence of lifetime history of depressive disorder. Preventive psychological interventions, should be considered in patients with multiple recurrences, focussing on residual symptomatology and specific coping styles. References Bockting, C.L.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Schene, A.H. and the DELTA study group: Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability: a 2-year prospective study. Journal of Clinical Psychiatry 2006;67:747–755. Bockting, C.L.H., Schene, A.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Huyser, J., and Kamphuis, J.H.: Preventing relapse/recurrence in recurrent depression using cognitive therapy. Journal of Consulting and Clinical Psychology 2005;73: 647–657. Bockting, C.L.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Visser, I., Schene, A.H. and the DELTA study group: Differential predictors of response to preventive cognitive therapy in recurrent depression: a 2-year prospective study. Psychotherapy and Psychosomatics 2006; 75:229–236. Keywords: Major depressive disorder recurrent, Relapse/recurrence, Prediction, Risk factors doi:10.1016/j.jad.2007.12.078