Comorbidity of depression and anxiety leads to a poor prognosis following angina pectoris patients: a prospective study

Background Depression and anxiety are two common mood problems among patients with cardiovascular disease (CVD) and are associated with poor cardiac prognoses. The comorbidity of depression and anxiety is considered to be a more severe psychological status than non-comorbid mood disorders. However, little is known about the relationship between depression or anxiety and noncardiac readmission. We conducted a prospective study on the prognostic impact of depression, anxiety, and the comorbidity of the two among angina pectoris (AP) patients. Method In this prospective study, 443 patients with AP were included in the analysis. Follow-up assessments were performed 1 year, and 2 years after patient discharges. Clinical outcomes of interest included noncardiac readmission, major adverse cardiovascular events (MACEs), and composite events. Depression and anxiety symptom scores derived from the patient health questionnaire-9 (PHQ-9) and generalised anxiety disorder-7 (GAD-7) questionnaire were used to assess mood symptoms at baseline. Participants with symptom scores of ≥10 on both the depression and anxiety questionnaires formed the clinical comorbidity subgroup. We used multivariable Cox proportional hazards models to evaluate the impact of individual mood symptom and comorbidity on clinical outcomes. Results Among all the AP patients, 172 (38. 9%) were determined to have depression symptoms, 127 (28.7%) patients had anxiety symptoms and 71 (16.0%) patients suffered from their comorbidity. After controlling covariates, we found that patients who endured clinical depression (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.06–5.33, p = 0.035) and anxiety ([HR] 2.85, 95% [CI] 1.10–7.45, p = 0.032) had a high risk of noncardiac readmission. Compared to participants with no mood symptoms, those with clinical comorbidity of depression and anxiety presented a greater risk of noncardiac readmission ([HR] 2.91, 95% [CI] 1.03–8.18, p = 0.043) MACEs ([HR] 2.38, 95% [CI] 1.11–5.10, p = 0.025) and composite event ([HR] 2.52, 95% [CI] 1.35–4.69, p = 0.004). Conclusion Depression and anxiety were found to have predictive value for noncardiac readmission among patients with AP. Furthermore, prognoses were found to be worse for patients with comorbidity of depression and anxiety than those with single mood symptom. Additional attention needs to be focused on the initial identification and long-term monitoring of mood symptom comorbidity.

S103. ASSESSING MOOD SYMPTOMS IN PSYCHOSIS: EXAMINING DIFFERENCES IN MOOD SYMPTOM PRESENTATION AMONGST RACIAL AND ETHNIC MINORITIES WITH PSYCHOSIS

Background Previous studies have shown that African Americans are more likely than Caucasians to receive a diagnosis of schizophrenia. Once diagnosed, African Americans are slower to seek treatment, more likely to underutilize mental health services, tend to display lower rates of medication adherence, and respond more slowly to psychosocial interventions. This disparity in diagnoses is due to multiple factors. One notable issue is the under-diagnosis of mood symptoms in African Americans with psychosis. Specifically, studies have shown that African Americans are more likely than Caucasians to receive a non-affective psychosis diagnosis, even though the rates of current mood episodes between the Caucasians and African Americans are similar. This is seen more with regards to depressive symptoms than those of mania. These disparities in diagnosis may contribute to decreased treatment efficacy, erosion of trust in treatment providers, and increased attrition in African Americans. Therefore, this issue is one deserving of further understanding. In the current study we sought to explore differences in mood diagnoses in a sample of help-seeking individuals with comorbid psychosis spectrum and mood symptoms. Methods A sample of 537 individuals were selected from an outpatient clinic serving lower income individuals with Medicaid. Investigators reviewed records from previous providers and compared them with gold-standard semi-structured assessments. A researcher who received training in cultural humility and differences in mood symptom presentation across racial and ethnic minorities was blinded to demographics and reviewed each client’s records and determined if individuals presented with significant mood symptoms that would criteria for a major mood diagnosis (MDE, Bipolar Disorder, Schizoaffective Disorder, Persistent Depressive Disorder, and Disruptive Mood Dysregulation Disorder). Of the 537 records reviewed 167 individuals endorsed mood symptoms during the structured assessment and to at least 1 outside provider. The sample of clients was then analyzed to determine whether mood symptoms were under-diagnosed (i.e. symptoms appear to warrant a mood diagnosis that was not given by the previous provider). Results The sample of 167 individuals with mood symptoms was sufficiently diverse; 25% were Caucasian, 45% were African American, 20% Other, 1% Asian or Pacific Islander. We performed a Chi Square Test of Independence to ascertain whether or not Race had an impact on the likelihood that participants would have under diagnosed mood symptoms. The relationship between variables was statistically significant, χ2 (1) = 3.964, p < .05. Of the 53 individuals who were under diagnosed 61% were African American compared to 13% that were Caucasian. Discussion The results of this study indicate a differential rate of diagnosing mood symptoms in African Americans with psychosis compared to Caucasians. These discrepancies may indicate a need for understanding cultural differences in symptoms presentation (e.g. apathy vs. sadness, greater somaticization in minorities, etc.). This study indicates a need for further investigation to better understand factors impacting differences in diagnosis of mood symptoms in African Americans.

67 Effects of Long-term Valbenazine on Psychiatric Status in Patients with Tardive Dyskinesia and a Primary Mood Disorder

ObjectiveValbenazine is approved for tardive dyskinesia (TD) in adults based on clinical trials that included patients with mood disorders (e.g., bipolar disorder, major depressive disorder). In two long-termphase 3 trials, KINECT 3 (NCT02274558) and KINECT 4 (NCT02405091), sustained TD improvements were found in participants who received once-daily treatment with valbenazine (40 or 80mg). Data from these studies were analyzed post hoc to evaluate changes in psychiatric status of patients with a primary mood disorder.MethodsData were pooled from participants with mood disorders in KINECT 3 (6-week double-blind, placebo-controlled period; 42-week double-blind extension period; 4-week drug-free washout) and KINECT 4 (48week open-label treatment; 4-week drug-free washout). At screening, patients must have had a Brief Psychiatric Rating Scale total score <50. Mood changes were evaluated after long-term treatment (Week 48) and washout (Week 52) using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS). For each scale, mean changes from baseline in the total score and individual item scores were analyzed descriptively.ResultsOf the 95 participants with a primary mood disorder (40mg , n=32; 80mg , n=63), 59 (62.1%) were diagnosed with bipolar disorder, 32 (33.7%) with major depressive disorder, and 4 (4.2%) with another mood disorder. A majority of all mood participants received concomitant antidepressants (84.2%) and/or antipsychotics (76.8%) during treatment; other common concomitant medications included antiepileptics (47.4%), anxiolytics (38.9%), and anticholinergics (22.1%). Mean YMRS and MADRS total scores in all mood participants indicated mood symptom stability at baseline (YMRS, 2.7; MADRS, 5.9). This stability was maintained during the studies, as indicated by minimal changes from baseline in mean total scores (YMRS: Week 48, 1.0; Week 52, –1.0; MADRS: Week 48, 0.3; Week52,0.9). Changes in individual items on both scales were also small (<±0.3), indicating no clinically significant changes or worsening in specific mood symptoms or domains.ConclusionsMood symptom stability was maintained in patients with TD and a primary mood disorder who received up to 48 weeks of treatment with once-daily valbenazine in addition to their psychiatric medication(s).Funding Acknowledgements: Neurocrine Biosciences, Inc.

White blood cell count correlates with mood symptom severity and specific mood symptoms in bipolar disorder

Objective: Immune alterations may play a role in bipolar disorder etiology; however, the relationship between overall immune system functioning and mood symptom severity is unknown. Methods: The two comparative effectiveness trials, the Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder Study (Bipolar CHOICE) and the Lithium Treatment Moderate-Dose Use Study (LiTMUS), were similar trials among patients with bipolar disorder. At study entry, white blood cell count and bipolar mood symptom severity (via Montgomery-Aasberg Depression Rating Scale and Bipolar Inventory of Symptoms Scale) were assessed. We performed analysis of variance and linear regression analyses to investigate relationships between deviations from median white blood cell and multinomial regression analysis between higher and lower white blood cell levels. All analyses were adjusted for age, gender, body mass index, smoking, diabetes, hypertension and hyperlipidemia. Results: Among 482 Bipolar CHOICE participants, for each 1.0 × 109/L white blood cell deviation, the overall Bipolar Inventory of Symptoms Scale severity increased significantly among men (coefficient = 2.13; 95% confidence interval = [0.46, −3.79]; p = 0.013), but not among women (coefficient = 0.87; 95% confidence interval = [−0.87, −2.61]; p = 0.33). Interaction analyses showed a trend toward greater Bipolar Inventory of Symptoms Scale symptom severity among men (coefficient = 1.51; 95% confidence interval = [−0.81, −3.82]; p = 0.2). Among 283 LiTMUS participants, higher deviation from the median white blood cell showed a trend toward higher Montgomery-Aasberg Depression Rating Scale scores among men (coefficient = 1.33; 95% confidence interval = [−0.22, −2.89]; p = 0.09), but not among women (coefficient = 0.34; 95% confidence interval = [−0.64, −1.32]; p = 0.50). When combining LiTMUS and Bipolar CHOICE, Montgomery-Aasberg Depression Rating Scale scores increased significantly among men (coefficient = 1.09; 95% confidence interval = [0.31, −1.87]; p = 0.006) for each 1.0 × 109/L white blood cell deviation, whereas we found a weak association among women (coefficient = 0.55; 95% confidence interval = [−0.20, −1.29]; p = 0.14). Lower and higher white blood cell levels correlated with greater symptom severity and specific symptoms, varying according to gender. Conclusion: Deviations in an overall immune system marker, even within the normal white blood cell range, correlated with mood symptom severity in bipolar disorder, mostly among males. Studies are warranted investigating whether white blood cell count may predict response to mood-stabilizing treatment.