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Volume 16 - Issue 6 - June 2011

Contents

Original Research

  • Ethnicity and Age at Onset in Bipolar Spectrum Disorders

  • Naima Javaid, James L. Kennedy, Vincenzo De Luca
  • Published online by Cambridge University Press:
    01 June 2011, pp. 127-134
  • Introduction

    To determine the influence of ethnicity on the age at onset (AAO) and further understand the significance of AAO as a clinical marker of bipolar and schizoaffective disorders.

    Methods

    Admixture analysis was used to identify sub-groups characterized by differences in AAO. Differences in clinical features were analyzed for these sub-groups using multivariate logistic regression. Comparisons were made with previous studies using the 2-Sample Kolmogorov-Smirnov Test.

    Results

    Admixture analysis yielded a combination of 2 normal theoretical distributions with means (SD) of 16.9 (3.6) for the early-onset sub-group and 24.4 (9.2) years for the late-onset sub-group. The sub-groups were divided by a cut-off of 22 years. There were significant differences between the early and late onset bipolar patient populations regarding substance abuse comorbidity (P=.044) and psychotic features (P=.015). Ethnicity did not have a significant influence on the AAO.

    Discussion

    The associations between early-onset and higher incidence of psychosis and substance abuse in our sample are consistent with other studies exploring the AAO in bipolar disorder.

    Conclusion

    Our findings support the notion of AAO as a clinical marker for the underlying heterogeneity of bipolar spectrum disorders. In particular, we found a strong overlap of early AAO with clinical features associated with greater severity and poor outcome.

Review Article

  • Marked Response to VNS in a Post-Cingulotomy Patient: Implications for the Mechanism of Action of VNS in TRD

  • Charles R. Conway, Mehret D. Gebretsadik, Richard D. Bucholz
  • Published online by Cambridge University Press:
    01 June 2011, pp. 135-141

  • Treatment-resistant major depression (TRMD, major depressive disorder that fails to respond to numerous therapies) is a relatively common and clinically challenging disorder. In many cases, the most severely affected TRMD patients have received surgical intervention (subcaudate tractotomy, limbic leucotomy, anterior capsulotomy, and anterior cingulotomy). New treatments, including vagus nerve stimulation (VNS) and deep brain stimulation, have emerged to treat individuals with TRMD. We describe the case of a woman, 53 years of age, with a long and sustained history of TRMD (33 years), which was unresponsive to numerous treatments (multiple pharmacotherapies, psychotherapy, electroconvulsive therapy [ECT]). Additionally, her TRMD failed to respond to a bilateral anterior cingulotomy. She underwent placement of a cervical vagus nerve stimulator and a brief course of ECT (3 unilateral treatments). Her depression improved markedly, and it has remained in sustained remission for 3.5 years. This case suggests a potential synergistic effect of VNS and ECT, as well as provides possible clues to the neural circuitry of VNS in TRMD.