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P.2.140 Does coronary artery disease severity play an important role in post-MI depression, in the PTCA era?
P2 Affective disorders and antidepressants
$452
serotonin norepinephrine reuptake inhibitors (SNRIs). This class, which includes venlafaxine, milnacipran, and duloxetine has a different mechanism of action compared to the older class of specific serotonin reuptake inhibitors (SSRIs). In this symposium, we will examine the differences between the SNRIs and SSRIs. We will also discuss similarities and differences between the SNRIs and the older class of tricyclic antidepressants (TCAs). Antidepressants are an important part of psychiatric practice, and by keeping up with current developments, we can make sure our patients are getting the most complete care available.
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Subsyndromal symptoms in euthymic bipolar patients and effects on course & treatment
E. Kesgin*, E. Erten, E. Kurt, N. Ko~al, A. Hariri, O. Ar,)soy, E.T. Oral. Bak~rkdy State Hospital for Psychiatty and Neurology,
Psychiatty, Mood Disorders Unit, Istanbul, Turkey Introduction: Recent studies have shown that a significant number of patients with bipolar disorder experienced subsyndromal symptoms during almost 50% of their course of disease and these subsyndromal depressive and hypomanic symptoms were seen 3 times more common than the symptoms that reached syndromal level. Research results indicate that as the severity of subsyndromal symptoms increase, degree of functional impairment increases consequently. Persistent subsyndromal symptoms are now regarded as a predictor of relapse. Therefore, to understand how these subsyndromal symptoms are probed and managed is important. This study aimed to evaluate the impact of subsyndromal symptoms on the course, treatment, prognosis and cost of bipolar disorder. Method: In this study, treatment files of 216 patients who were admitted to the Rapit Tahsin Mood Disorders Outpatient Clinic of Bal@rk6y State Hospital for Psychiatry & Neurology in Istanbul (RTDDM) between February 1st and September 1st, 2003 with a diagnosis of Bipolar Disorder (DSM-IV-TR) were both retrospectively and prospectively evaluated. Patient records starting from a year before the admission till a year after that were examined in terms of the effects of specialized outpatient clinic follow up on the course of the disease and treatment. Previous data were reached from the general psychiatric outpatient clinic records and RTDDM records were used after the patients had been started to be followed by this specialized unit. Results revealed that 52.6% of the patients had subsyndromal symptoms in the euthymic period. Subsyndromal depressive symptoms were more common and those who had subsyndromal symptoms experienced more mood episodes profoundly depressive in nature. Patients with subsyndromal symptoms needed treatment with more than one mood stabilizer than the ones without subsyndromal symptoms and direct cost of these patients were 12.2% higher than the others. Conclusion: Half of the bipolar patients had subsyndromal symptoms in euthymic period. Patients with subsyndromal symptoms had a more deteriorating illness course and their direct treatment costs were also higher.
References [1] Judd, L.L., Akiskal, H.S., Maser, J.D., et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry. 1998; 55(8): 694. [2] MacQueen, G.M., Marriott, M., Begin, H., Robb, J., Joffe, R.T., Young, L.T. Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Bipolar Disord. 2003; 5(5): 349 55.
[3] Martin, B., Philip, W., John, M., Gelenberg, J. et al. Subsyndromal symptoms of bipolar disorder. Arch Gen Psychiatt2¢. 1992; 49:371 376.
~ D o e s coronary artery disease severity play an important role in post-MI depression, in the PTCA era? M. Abreu 1 *, A. Matos-Pires 1, F. Sim6es-Couto 1, F. Arriaga 2.
]Faculty of Medicine of Lisbon, Psychiatty, Lisbon, Portugal; 2Faculty of Medicine of Portugal, Psychiatty, Portugal Objectives: To evaluate the contribution of cardiac disease severity on the development of depressive symptoms post-myocardial infarction (MI) in a population submitted to percutaneous transluminal coronary angioplasty (PTCA). Does cardiac disease severity predict, somehow, depressive psycopathology in this group of patients? Methods: 20 consecutive inpatients at a Coronary Intensive Care Unit, who met established criteria for MI and submitted to PTCA, were prospectively evaluated during the first week and in a month. Psychiatric diagnosis was established by using DSM-IV criteria. A comprehensive evaluation (has been) undertaken and patients were separated in two groups according to: 1. MI location (anterior wall vs inferior wall) 2. Left ventricular ejection fraction (LVEF) ( > 4 0 % vs <40%) measured by angiographic ventriculography 3. Severity and extent of coronary disease (one vs multivessels disease) observed in coronary arteriography and 4. History of previous MI. The total scores of Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were compared in the two groups. Fisher test or ANOVA were used for statistical analysis. Results: Regarding the first subgroup MI location on the first evaluation we found higher scores of BDI (p < 0.01) in anterior MI (n 10). At second evaluation, most patients with anterior MI were associated to major depression diagnosis (p < 0.02) and a higher scores in BDI (p < 0.01), HAM-D (p < 0.01) and HAM-A (p < 0.05). In the subgroup of LVEF, we found no significative association on both evaluations, either in depression diagnosis or rating scales. Concerning the third subgroup one vessel (n 9) vs multivessels (n 11) disease we found no significative results on the first evaluation. One month later, the multivessels disease group was associated to major depression diagnosis (p < 0.02). The last subgroup previous MI had the same results as LVEF subgroup. Conclusions: Although the existing controversy, it seems that cardiac disease severity parameters influence the development of depressive symptoms in post-MI patients. Similar conclusions were helded by some past studies. Nevertheless, this is the first study using only PTCA patients. These patients may have different characteristics from those of previous studies, namely PTCA improves morbidity and mortality and reduces the stress associated with MI. Our study shows that in PTCA era, cardiologic parameters do have an impact on the development of post-MI depressive symptoms, making important their identification.
References [1] Frasure-Smith, N., et al, 2003: Depression and other psychological risks following myocardial infarction. Arch Gen Psychiatry 60 (6), 627 636. [2] Luutonen, S., et al, 2002. Inadequate treatment of depression after myocardial infarction. Acta Psyciatr Scand 106 (6), 434M39.
$452
serotonin norepinephrine reuptake inhibitors (SNRIs). This class, which includes venlafaxine, milnacipran, and duloxetine has a different mechanism of action compared to the older class of specific serotonin reuptake inhibitors (SSRIs). In this symposium, we will examine the differences between the SNRIs and SSRIs. We will also discuss similarities and differences between the SNRIs and the older class of tricyclic antidepressants (TCAs). Antidepressants are an important part of psychiatric practice, and by keeping up with current developments, we can make sure our patients are getting the most complete care available.
•
Subsyndromal symptoms in euthymic bipolar patients and effects on course & treatment
E. Kesgin*, E. Erten, E. Kurt, N. Ko~al, A. Hariri, O. Ar,)soy, E.T. Oral. Bak~rkdy State Hospital for Psychiatty and Neurology,
Psychiatty, Mood Disorders Unit, Istanbul, Turkey Introduction: Recent studies have shown that a significant number of patients with bipolar disorder experienced subsyndromal symptoms during almost 50% of their course of disease and these subsyndromal depressive and hypomanic symptoms were seen 3 times more common than the symptoms that reached syndromal level. Research results indicate that as the severity of subsyndromal symptoms increase, degree of functional impairment increases consequently. Persistent subsyndromal symptoms are now regarded as a predictor of relapse. Therefore, to understand how these subsyndromal symptoms are probed and managed is important. This study aimed to evaluate the impact of subsyndromal symptoms on the course, treatment, prognosis and cost of bipolar disorder. Method: In this study, treatment files of 216 patients who were admitted to the Rapit Tahsin Mood Disorders Outpatient Clinic of Bal@rk6y State Hospital for Psychiatry & Neurology in Istanbul (RTDDM) between February 1st and September 1st, 2003 with a diagnosis of Bipolar Disorder (DSM-IV-TR) were both retrospectively and prospectively evaluated. Patient records starting from a year before the admission till a year after that were examined in terms of the effects of specialized outpatient clinic follow up on the course of the disease and treatment. Previous data were reached from the general psychiatric outpatient clinic records and RTDDM records were used after the patients had been started to be followed by this specialized unit. Results revealed that 52.6% of the patients had subsyndromal symptoms in the euthymic period. Subsyndromal depressive symptoms were more common and those who had subsyndromal symptoms experienced more mood episodes profoundly depressive in nature. Patients with subsyndromal symptoms needed treatment with more than one mood stabilizer than the ones without subsyndromal symptoms and direct cost of these patients were 12.2% higher than the others. Conclusion: Half of the bipolar patients had subsyndromal symptoms in euthymic period. Patients with subsyndromal symptoms had a more deteriorating illness course and their direct treatment costs were also higher.
References [1] Judd, L.L., Akiskal, H.S., Maser, J.D., et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry. 1998; 55(8): 694. [2] MacQueen, G.M., Marriott, M., Begin, H., Robb, J., Joffe, R.T., Young, L.T. Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Bipolar Disord. 2003; 5(5): 349 55.
[3] Martin, B., Philip, W., John, M., Gelenberg, J. et al. Subsyndromal symptoms of bipolar disorder. Arch Gen Psychiatt2¢. 1992; 49:371 376.
~ D o e s coronary artery disease severity play an important role in post-MI depression, in the PTCA era? M. Abreu 1 *, A. Matos-Pires 1, F. Sim6es-Couto 1, F. Arriaga 2.
]Faculty of Medicine of Lisbon, Psychiatty, Lisbon, Portugal; 2Faculty of Medicine of Portugal, Psychiatty, Portugal Objectives: To evaluate the contribution of cardiac disease severity on the development of depressive symptoms post-myocardial infarction (MI) in a population submitted to percutaneous transluminal coronary angioplasty (PTCA). Does cardiac disease severity predict, somehow, depressive psycopathology in this group of patients? Methods: 20 consecutive inpatients at a Coronary Intensive Care Unit, who met established criteria for MI and submitted to PTCA, were prospectively evaluated during the first week and in a month. Psychiatric diagnosis was established by using DSM-IV criteria. A comprehensive evaluation (has been) undertaken and patients were separated in two groups according to: 1. MI location (anterior wall vs inferior wall) 2. Left ventricular ejection fraction (LVEF) ( > 4 0 % vs <40%) measured by angiographic ventriculography 3. Severity and extent of coronary disease (one vs multivessels disease) observed in coronary arteriography and 4. History of previous MI. The total scores of Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were compared in the two groups. Fisher test or ANOVA were used for statistical analysis. Results: Regarding the first subgroup MI location on the first evaluation we found higher scores of BDI (p < 0.01) in anterior MI (n 10). At second evaluation, most patients with anterior MI were associated to major depression diagnosis (p < 0.02) and a higher scores in BDI (p < 0.01), HAM-D (p < 0.01) and HAM-A (p < 0.05). In the subgroup of LVEF, we found no significative association on both evaluations, either in depression diagnosis or rating scales. Concerning the third subgroup one vessel (n 9) vs multivessels (n 11) disease we found no significative results on the first evaluation. One month later, the multivessels disease group was associated to major depression diagnosis (p < 0.02). The last subgroup previous MI had the same results as LVEF subgroup. Conclusions: Although the existing controversy, it seems that cardiac disease severity parameters influence the development of depressive symptoms in post-MI patients. Similar conclusions were helded by some past studies. Nevertheless, this is the first study using only PTCA patients. These patients may have different characteristics from those of previous studies, namely PTCA improves morbidity and mortality and reduces the stress associated with MI. Our study shows that in PTCA era, cardiologic parameters do have an impact on the development of post-MI depressive symptoms, making important their identification.
References [1] Frasure-Smith, N., et al, 2003: Depression and other psychological risks following myocardial infarction. Arch Gen Psychiatry 60 (6), 627 636. [2] Luutonen, S., et al, 2002. Inadequate treatment of depression after myocardial infarction. Acta Psyciatr Scand 106 (6), 434M39.