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Volume 16 - Issue 9 - September 2011

Contents

Original Research

  • Symptom Dimensional Approach and BDNF in Unmedicated Obsessive-Compulsive Patients: An Exploratory Study

  • Igor Marcanti dos Santos, Leandro Ciulla, Daniela Braga, Keila Maria Ceresér, Clarissa Severino Gama, Flávio Kapczinski, Ygor Arzeno Ferrão
  • Published online by Cambridge University Press:
    01 September 2011, pp. 179-189
  • Introduction

    The dimensional approach of the obsessive-compulsive symptoms may help to find more homogeneous groups of patients. The brain derived neurotrophic factor (BDNF) may help to identify neurobiological differences between obsessive-compulsive symptom dimensions.

    Methods

    We compared serum BDNF (pg/μg) levels of 25 unmedicated patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for obsessivecompulsive disorder (OCD) and 25 controls, using the Dimensional Yale‐Brown Obsessive‐Compulsive Scale, the Yale‐Brown Obsessive‐Compulsive Scale and the Beck's Anxiety and Depression Inventories.

    Results

    There were no sociodemographic differences between the groups. The standard error of mean serum BDNF levels were reduced in unmedicated OCD patients (0.47+0.038) when compared to healthy controls (0.75+0.060) (P<.001). The patients with the presence of sex/religion obsessive-compulsive symptoms (OCS) dimension (P=.002), with chronic course of OCS (P=.022) and the presence of lifetime major depression (P=.016) and social anxiety (P=.030) presented higher levels of BDNF than OCD patients without those features. The severity of aggression (P=.039) and sex/religion (P<.001) OCS dimension presented direct (moderate and strong, respectively) correlation with serum BDNF levels in this sample. Serum BDNF levels were decreased in OCD patients when compared to healthy controls.

    Discussion/Conclusion

    Sexual and religious content of symptoms and aggression and sex/religion dimensions severity should be better explored, since these specific OCS dimensions could be based on neurocircuits diverse from those of the other OCS dimensions.

Review Article

  • Clinical and Pharmacologic Perspectives on the Treatment of Major Depressive Disorder

  • James W. Jefferson
  • Published online by Cambridge University Press:
    01 September 2011, pp. 191-203

  • Major depressive disorder (MDD) is commonly encountered in clinical practice but is often underdiagnosed and undertreated, in part because many patients present only with vague somatic complaints instead of typical depressed symptomatology. Once diagnosed, patients with MDD can be treated with pharmacologic and/or nonpharmacologic therapies, but it is difficult to predict how or whether an individual will respond. Studies have shown that the majority of depressed patients fail to remit with initial therapy and, even if remission is achieved, many patients will relapse. While the management of patients with MDD presents challenges, data indicate that the achievement and maintenance of remission can be improved by frequent follow-ups with a clinician who can provide individualized education/support and appropriate referral to other healthcare specialists. Novel pharmacotherapies that are formulated for oncedaily dosing with improved safety profiles can improve adherence to treatment and reduce the morbidity and mortality associated with MDD.

Original Research

  • Hostility, Impulsivity, and Behavior Inhibition Among Women with PMDD

  • Ju-Yu Yen, Cheng-Chung Chen, Shun-Jen Chang, Chih-Hung Ko, Cheng-Sheng Chen, Cheng-Fang Yen
  • Published online by Cambridge University Press:
    01 September 2011, pp. 205-213
  • Introduction

    This study aimed to compare hostility, impulsivity, and behavior inhibition between women with and without premenstrual dysphoric disorder (PMDD) during both luteal and follicular phases and to examine whether these variables contribute to irritability and daily functional impairment of PMDD.

    Methods

    PMDD was screened via the Premenstrual Symptoms Screening Tool. A diagnosis of PMDD was confirmed by psychiatric interviewing without 2-month prospective confirmation. Sixty women in the PMDD group and 60 women in the control group completed the Chinese Version of the Buss-Durkee Hostility Inventory-Short Form, Dickman's Impulsivity Inventory, and the Behavior Inhibition System Scale during the luteal and follicular phases.

    Results

    We found that the PMDD group had significantly higher levels of hostility, dysfunctional impulsivity, and behavioral inhibition than the control group in both luteal and follicular phases. The PMDD group also had more premenstrual aggravation on total hostility, hostility affect, and suppressive hostility than the control group. Higher hostility, dysfunctional impulsivity, and behavior inhibition were associated with more severe irritability and functional impairment of PMDD.

    Discussion

    Hostility, impulsivity, and behavior inhibition might contribute to irritability and functional impairment in women with PMDD.

    Conclusion

    Assessment and interventions based on these factors should be provided for women with PMDD, especially in the luteal phase.