SS.10-01

Neurasthenia and atypical depression

J. Angst, F. Benazzi, V. Ajdacic-Gross, D. Eich-Höchli, W. Rösssler, A. Gamma. Psychiatrische Universitsätskl, Zürich, Switzerland

Introduction: In the Zurich Cohort Study of a community sample we found a spectrum of fatigue syndromes with the following cumulative prevalence rates up to age 41: ICD-10. 3- months neurasthenia (6%), 2-weeks neurasthenia (9,7%) and recurrent brief neurasthenia (12.1%). Half of all ICD-10. neurasthenia cases were associated with major depressive or bipolar-II disorder. Comorbidity of ICD-10. neurasthenia with functional-somatic syndromes (stomach, intestines, circulation, back, headache) was increased. Atypical depression (AD) was specified by DSM-IV criteria (five symptoms) and by Zurich criteria as a triadic atypical depression (TAD), taking only three symptoms into account: overeating and oversleeping and excessive physical fatigue. The latter two symptoms form a considerable conceptual overlap between AD and neurasthenia, creating a significant association (Odds ratio=3.1) by definition. AD was associated with migraine, gastric, intestinal, cardiac and circulatory syndromes Triadic atypical major depression showed a prevalence rate of 6.8% and atypical subthreshold depression another 4%. This form of major AD is much more prevalent among women (15.1%) than men (3.2%) explaining the gender difference of depression.

SS-10-02

Diabetes and comorbid depression

C. Kuehner, F. Lederbogen, M. Epidemiology, CIMH Genetic Mannheim, Germany Deuschle.

Objective: To review the literature on the association between diabetes and depression, and to determine depression prevalence rates in a sample of patients with diabetes. A second goal is to identify demographic and clinical characteristics associated with depression in these patients.

Methods: As a part of the “Augsburg Diabetes Family Study”, 455 patients treated for type II diabetes were recruited from health care clinics and through physician referrals. These patients went through comprehensive laboratory tests at the study centre in Augsburg. The CES-D (Hautzinger & Bailer, 1993) was used to screen for depressive symptoms. Patients scoring >=16 participated in a SCID (Wittchen et al., 1997) interview by telephone for the assessment of depressive disorders according to DSM-IV.

Results: Identified prevalence rates of elevated depressive symptoms (CES-D >=16, 32.3%) and a current diagnosis of depression (SCID, 14.9%) match closely to those found in the literature. Compared with men, women were twice as likely to display elevated scores and to fulfil DSM-IV criteria for a depressive disorder (MDD, Dysthymia). Multiple logistic and linear regressions identified female gender, living without a partner, and multiple disease-related complications as independent factors associated with both depressed symptoms and diagnosis, while laboratory data (e.g., HbAlc levels, Cholesterol) were not connected with depression.

Conclusion: This study confirmed the high prevalence of depression in patients suffering from diabetes. Demographic and illness-related factors were similarly associated with depressive symptoms and with a DSM-IV diagnosis of depression. The literature suggests bi-directional influences in explaining this comorbidity.

SS-10-03

Depression in neurological diseases: Emphasis on Parkinsons disease

F. Morkeberg Nilsson, M. Brandt-Christensen. University Hospital of Copenha, Copenhagen, Denmark

Objective: To investigate the temporal relationships between a range of neurological diseases and affective disorders.

Methods: Data derived from linkage of the Danish Psychiatric Central Register and the Danish National Hospital Register. Seven cohorts with neurological index diagnoses and two control group diagnoses were followed for up to 21 years. The rate of discharge diagnosis of depression on readmission was estimated with the use of competing risks in survival analysis. The rates were compared with the rates for readmission with a diagnosis of depression for patients with osteoarthritis, and patients with diabetes.

Results: We found an increased incidence of affective disorders in dementia, Parkinson's disease, epilepsy, stroke, and intracerebral haemorrhage compared with control groups. The association was found to be the strongest for dementia and Parkinson's disease when compared with the incidence in the control groups. In Parkinson's disease an increased probability of developing a diagnosis of depression was found for both women and men throughout their lifetime when this was compared with the control groups. No effect of age at onset of Parkinson' s disease was found.

Conclusion: In neurological diseases there seems to be an increased incidence of affective disorders. The elevated incidence was found especially high for dementia and Parkinson's disease (neurodegenerative diseases). The findings support the hypothesis that depression in patients with Parkinson's disease may be a consequence of some kind of brain dysfunction.

SS-10-04

Comorbidity of mood disorders and migraine

M. Preisig. CHUV DUPA, Prilly, Switzerland

Objective: Clinical and epidemiological studies have consistently revealed lifetime associations between mood disorders and migraine. However, the evidence regarding the nature of these associations remains unclear. Consequently, the goals of the present study were to 1) determine the association between migraine and unipolar as well as bipolar mood disorders; 2) assess the patterns of familial aggregation of migraine and mood disorders.

Methods: The present paper was based on data from a family study of 131 bipolar-I probands (18% with migraine), 156 unipolar depressive probands (24% with migraine), 95 normal controls (12% with migraine) as well as their adult first-degree relatives (n=1404). Diagnoses were made according to a best-estimate procedure based on a semi-structured interview (DIGS), a migraine interview, medical records and family history information.

Results: The major findings were that 1) migraine was more strongly associated with unipolar depression than bipolar disorder (OR = 2.0 vs. 1.6) in the relatives; 2) there was evidence of strong familial aggregation of bipolar-I disorder (OR = 5.8), whereas unipolar depression (OR= 1.5) and migraine (OR = 2.5) showed a lower degree of familial aggregation; 3) there was no evidence of cross-aggregation between mood disorders and migraine.

Conclusion: Our data confirm familial aggregation of bipolar-I disorder, unipolar depression and migraine. The finding of an increased risk of migraine with aura among relatives of probands with unipolar depression alone could indicate partially shared etiological factors underlying unipolar depression and subtypes of migraine.

SS-10-05

Somatic health and illness and depressive symptomatology: Data from a population health survey

M. Kovacs, M. Kopp. Semmelweis University, Budapest, Hungary

Objective: To investigate the rate and associations of selfreported physical health and illnesses and depressive symptomatology, and also their impact on everyday psychosocial functioning and quality of life.

Methods: Data were obtained from the Hungarostudy 2002, a national representative health survey of the adult (18+) Hungarian population (Kopp et al., 2002, N=12668). Depressive symptomatology was measured by the shortened version of the Beck Depression Inventory (BDI). Participants signed their main illness caused the highest problems in the previous 12 months. General quality of life was measured by the WHO Well-being Index, and the Illness Intrusiveness Scale showed the extent of impairment in psychosocial functioning caused by the main illness.

Results: BDI scores were negatively correlated with the WHO Well-being, the self-assessed general health state, and positively with the Illness Intrusiveness scores. 69.6% of those with BDI above 19 reported decreased or missing well-being, this rate was 20.8% in those with BDI below 19 (OR: 8.7, 95%CI: 7.8-9.8). Depression was the main cause of daily limitations in 1.7% of the whole sample (2.3% in women and 0.8% in men). However this rate was much lower than the rate of those who signed musculosceletal (18.0%), or cardiovascular diseases (13.4%), regarding the extent of impairment, those with depression had the highest Illness Intrusiveness mean scores in both sexes, in all age groups.

Conclusion: Although depression was only the seventh most frequent cause of daily limitation, it caused the highest negative impact of everyday functioning, preceding all the other major illness groups, and significant decrease in the general well-being.