Acta Psychiatrica Scandinavica

Cover image for Vol. 129 Issue 5

Edited By: Povl Munk-Jørgensen

Impact Factor: 4.857

ISI Journal Citation Reports © Ranking: 2012: 12/121 (Psychiatry (Social Science)); 18/135 (Psychiatry)

Online ISSN: 1600-0447

Article of the Month


A profile approach to impulsivity in bipolar disorder: the key role of strong emotions
L. Muhtadie, S. L. Johnson, C. S. Carver, I. H. Gotlib, T. A. Ketter

Impulsivity is a hallmark symptom of bipolar disorder (BD), and previous research has highlighted its association with illness onset and severity. In the February issue of Acta Psychiatrica Scandinavica, Muhtadie and colleagues present a study designed to test which domains of impulsivity are most informative of clinical severity in BD. The investigators adeptly integrate their findings into the impulsivity and BD literature and also suggest potential targets for therapeutic intervention, including the development of effective emotion regulation and impulse control strategies.

Max Martinson, Amber Cardoos, Rosemary Walker, James Doorley, Angela Pisoni, Kelley Durham Depression Clinical & Research Program (DCRP) Massachusetts General Hospital, Harvard Medical School, Boston (MA), USA


DSM-5 criteria for depression with mixed features: a farewell to mixed depression
A. Koukopoulos n, G. Sani

Throughout its history, the DSM has struggled to categorize mixed forms of mood disorders. With its fifth edition, the DSMproposes a new way to diagnose depression with mixed features. Koukopoulos and Sani’s critique of the DSM-5’s proposed criteria for depression with mixed features in the January issue of Acta Psychiatrica Scandinavica argues that the symptoms that the DSM-5 specifies are neither scientifically nor clinically comprehensive.Koukopoulos and Sanipropose a different set of symptoms which they argue are more clinically adept.

Max Martinson, Amber Cardoos, Rosemary Walker, James Doorley, Angela Pisoni, Kelley Durham Depression Clinical & Research Program (DCRP) Massachusetts General Hospital, Harvard Medical School, Boston (MA), USA


Lithium's role in neural plasticity and its implications for mood disorders
Gray JD, McEwan BS.

Stressful life events are temporally and possibly causatively related to the precipitation of affective disorders. From animal models we know that stress can cause numerous structural and functional changes in regions like the hippocampus and amygdala which are associated with mood disorders in humans. The clinical overview by Gray and McEwen in the November issue of Acta Psychiatrica Scandinavica proposes that onset of mood disorders represents a maladaptive state in which the brain is unable to adequately respond after stress and stress-induced changes in certain regions may become “locked in” when neuroplasticity is lost. Lithium, the Grand old Lady in the treatment of bipolar disorder, has pronounced effects on various aspects of cellular morphology and signalling and can block many of the deleterious effects induced by stress. In this issue Gray and McEwen give a comprehensive and elegant review of how Lithium facilitates the regain of plasticity after stress and thus helps to “unlock” the brain from the disease state.

Ida Hageman
Copenhagen, Denmark


Anatomical substrates of cognitive and clinical dimensions in first episode schizophrenia
S. Rigucci, C. Rossi-Espagnet, S. Ferracuti, A. De Carolis, V. Corigliano, F. Carducci, I. Mancinelli, F. Cicone, R. Tatarelli, A. Bozzao, P. Girardi and A. Comparelli.

Development of neuroimaging has shown promise for clinical implications in individualized medicine. In the October issue of Acta Psychiatrica Scandinavica, Rigucci et al. go beyond the descriptive diagnosis to show that the negative and cognitive symptoms of early schizophrenia relate to the integrity of several white matter pathways. Chronic cognitive and negative symptoms are strong predictors of outcome, and therefore biomarkers that can guide early individualized interventions are welcome. In the long term, such biomarkers may contribute to etiopathogenetic understanding that holds promise for development of new preventive and curative interventions.

The promise of neuroanatomical markers in psychosis
P. Dazzan.

Paola Dazzan highlights the importance of the rationale and results of the study above by Rigucci et al in an accompanying editorial comment. She points out methodological strengths of the study, including combination of structural and diffusion tensor MRI. She concludes that the findings advance our understanding of the relation between previously known schizophrenia-related brain changes and cardinal clinical symptoms of the disorder. Such evidence supports research lines aiming to restore the disturbed connectivity in schizophrenia.


Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis
Bourne C, Aydemir Ö, Balanzá-Martínez V, Bora E, Brissos S, Cavanagh JTO et al.

Less cognitive impairment in euthymic bipolar disorder than previously thought An article by Bourne and colleagues in the September issue of Acta Psychiatrica Scandinavica suggests that the cognitive impairment in bipolar disorder might be lower than previous meta-analyses have suggested. The authors reached this conclusion by combining individual data from 31 studies into a large dataset (N= 2876) with patients and controls. This dataset allowed the researchers to control for a greater range of confounding factors (age, sex, number of affective episodes, medication) than previous meta-analyses. The results showed that even though bipolar patients were cognitively impaired compared to controls in the domains attention/working memory, verbal memory, speed, and executive function, the effect sizes were considerably lower than previous studies have suggested. The number of manic episodes and treatment with antipsychotic drugs were associated with impairment, whereas the number of depressive episodes and other treatment (lithium, anticonvulsants, and antidepressants) were not. The cognitive deficits that remained, however, could not be explained solely by side effects of drug therapy or residual mood symptoms.

JULY 2013

Resilience in mental health: linking psychological and neurobiological perspectives
Rutten BPF, Hammels C, Geschwind N, Menne-Lothmann C, Pishva E, Schruers K, van den Hove D, Kenis G, van Os J, Wichers M.

Understanding mental health does not only require research on the factors and mechanisms that determine vulnerability to illness, but also the factors and mechanisms that stimulate individuals to remain healthy and to recover from adversity, or ‘resilience’. The review by Rutten et al. in the July issue of Acta Psychiatrica Scandinavica demonstrates that research on resilience can crucially advance mental health care. Resilience is not simply the positive end of a continuum of risk, but is determined by separate biological and psychological factors that promote wellbeing and recovery. Neurobiological research points to the neurocircuitries mediating the stress response and reward experience. Psychologically, secure attachment, experiencing positive emotions, and having a purpose in life are crucial. Understanding these factors will help develop strategies aimed at swift recovery after exposure to severe adversity. Read more...

Lydia Krabbendam - Cognition Field Editor
Amsterdam, the Netherlands

JUNE 2013

Schizophrenia patients with and without Post-traumatic Stress Disorder (PTSD) have different mood symptom levels but same cognitive functioning DE Peleikis, M Varga, K Sundet, S Lorentzen, I Agartz, OA Andreassen

Schizophrenia is related to multiple psychiatric co-morbidities that may be difficult to differentiate from symptoms and consequences of schizophrenia. In the June issue of Acta Psychiatrica Scandinavica, Peleikis and co-workers tested the hypotheses that the patients with schizophrenia and psychological traumatization have more severe psychopathology than the patients with schizophrenia without psychological traumatization. The two patient groups, well matched for potential confounding covariates, did not differ in any test of comprehensive neuropsychological pattern, but the patients with psychological trauma had more severe depression. These findings add to the understanding of co-morbidity. We should recognize the psychological trauma history of the patients with schizophrenia and offer treatment for trauma-related suffering. Read more.

MAY 2013

Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data).
Grande, J. M. Goikolea, C. de Dios, A. Gonz_lez-Pinto, J. M. Montes, J. Saiz-Ruiz, E. Prieto, E. Vieta, for the PREBIS group.

The current evidence suggests that patients with bipolar disorder (BD) present a relevant functional impairment across all phases of the disorder including during interepisode intervals. Several variables have been reported to negatively influence functioning such as male gender, older age, living without a partner, number of previous episodes, number of previous hospitalizations, length of admission, rapid cycling, psychotic symptoms and substance use disorder. Moreover, occupational adjustment is one functional domain with a major impact on personal and societal costs. In the May issue of Acta Psychiatrica Scandinavica, Grande and colleagues present a relevant study that help to better understand the underlying causes of occupational disability in BD patients. The results emphasize the importance of early diagnosis and treatment of BD, the clinical relevance of comorbidity with personality disorders, the impact of social support, and the need to closely monitor patients who are occupationally disabled, given their high tendency to recurrence. Read more...

Vasco Videira Dias - Bipolar Disorder Field Editor
Lisbon, Portugal

APRIL 2013

A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression
C Dack, J Ross, c Papadopoulos, D Stewart, L Bowers

Clinicians daily face the task of estimating the risk for aggressive behavior by psychiatric patients. Although ensuring the safety of patients and staff is a top priority of in-patient psychiatric wards, aggressive behavior is quite common in this setting. In fact, about one third of in-patients and 40-80% of staff of in-patient psychiatric wards report having suffered aggressive behavior. Unfortunately, the evidence about risk factors associated with inpatient aggression is very limited.

In the Acta Psychiatrica Scandinavica April issue Dack and colleagues present data from the first meta-analysis of aggression by psychiatric in-patients. They found that several clinical and socio-demographic factors are associated with in-patient aggression. However, given the small magnitude of these associations, the authors conclude that more attention should be paid to other dynamic factors such as the patient’s current state and context to prevent in-patient aggression.


Antidepressant use in pregnancy: a critical review focused on risks and controversies.
N. Byatt, KM. Deligiannidis, MP.Freeman

There has been a long-standing debate about the use of antidepressants in pregnancy due to the lack of and conflicting data and the ethical restrictions of randomized controlled trials in pregnant women. In the Acta Psychiatrica Scandinavica February issue, Byatt and colleagues try to make order in such a complicated topic. The authors put the light on not only the review of the literature on risks of exposure to antidepressants during pregnancy but also on the risks of untreated depression and anxiety. Unfortunately, the findings are inconsistent and controversial. Moreover, the authors strongly suggest that the treatment is tailored to each patient. Read more...

In an accompanying Invited Comment, Einarson discusses the conclusions by Byatt and colleagues.

The importance of critical evaluation of the literature regarding safety of antidepressant use in pregnancy
A. Einarson

Maria Paola Rapagnani - Trainee Advisory Board
Verona, Italy


Are immediate- and extended-release drugs interchangeable?
D. Cohen, AJM. Loonen

The January issue of Acta Psychiatrica Scandinavica brings a discussion paper by Dan Cohen and Anton J.M. Loonen in which they discuss whether immediate- and extended-release drugs are interchangeable and whether branded drugs can be substituted by generic drugs. The paper is commented by Stephen M. Stahl, David Taylor and Wolfgang Fleischhacker in three different editorial comments.

The tyranny of the majority and the interchangeability of drugs
S.M. Stahl

Just ask the patient
D.M. Taylor

Are original, branded psychotropics and generic medications interchangeable?
W. Fleischhacker