Affective disorders : Multivariate investigations of clinical and biological variables
Author: Wahlund, Björn
Date: 1998-01-07
Location: Psykiatriska klinikens föreläsningssal vid S:t Görans sjukhus
Time: 9.00
Abstract
AFFECTIVE DISORDERS
MULTIVARIATE INVESTIGATIONS OF CLINICAL AND BIOLOGICAL VARIABLES
Björn Wahlund, MD, Dissertation, Karolinska Institute, Department of
ClinicalNeuroscience, Section of Psychiatry, St. Göran's Hospital, S-112
81 Stockholm,Sweden
This thesis is a methodological and clinical investigation of patients
with affectivedisorders. The goal of the study was to determine the
extent to which biologicaland clinical measures may cluster clinical
subpopulations. Analytical and statisticalprocedures were applied for
this purpose.
Abnormalities in the Hypothalamic-Pituitary-Adrenal (HPA) axis have been
foundin about 50 % of the depressed patients in the acute phase using the
dexamethasonesuppression test (DST). To further test HPA-axis
disturbances in depression, therelease of adrenal corticotropin (ACTH)
after administration of corticotropin- releasinghormone (CRH) was studied
in 24 depressed patients, in relation to the DST. AfterCRH-stimulation
significantly lower cortisol and ACTH levels were found for
DST-non-suppresserscompared to DST-suppessers.
In a sample of 28 depressed patients, over a 15-year observation period,
differentstatistical and clinical clusters were identified. Examination
of 45 variables, testedusing Principle Component Analysis (PCA), revealed
that the three biological variables;platelet monoamine oxidase activity
(MAO), peak nocturnal serum melatonin and maximumpost dexamethasone
cortisol, and the two clinically psychomotor symptoms; Reducedspeech and
Slowness of movements, contributed most to the clustering of individuals.
The patients were clinically distributed with high scores of agitation in
theextreme of one direction and with high scores of retardation in the
opposite direction.By using the combined clinical and biological
variables a diagnostic subcategorywith latent bipolar disorder was
identified. Two clusters of unipolar patients, onewith low melatonin and
low psychomotor retardation scores, and one with high melatoninand high
psychomotor retardation scores were found. The identification of the
individualswith latent bipolar disorder may have potential therapeutic
value since bipolar patientsshould be taken care of by a specialist in
psychiatry, should avoid tricyclic antidepressanttherapy, and may be
candidates for lithium treatment.
The confounding effect of including latent bipolar patients in
investigationson depression is inherent in all studies where presumably
unipolar patients are selectedduring the first couple of depressive
episodes. In the present study the clusteringof more homogenous subgroups
of unipolar patients have been possible, because thebipolar patients have
been identified and statistically analysed as a separate
subpopulation.Replication studies are called for to refute, or verify,
the reported findings ofthe three subgroups of patients with affective
disorders, in particular a populationwith latent bipolar illness.
Key words: Affective disorders, psychiatric symptoms, classification,
unipolardepression, bipolar disorder, cortisol, melatonin, monoamine
oxidase, principle componentanalysis.
ISBN 91-628-2725-1
Björn Wahlund, Stockholm 1997
Issue date: 1997-12-17
Publication year: 1998
ISBN: 91-628-2725-1
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