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Miola A, Trevisan N, Salvucci M, Minerva M, Valeggia S, Manara R, Sambataro F. Network dysfunction of sadness facial expression processing and morphometry in euthymic bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:525-536. [PMID: 37498325 PMCID: PMC10995000 DOI: 10.1007/s00406-023-01649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/07/2023] [Indexed: 07/28/2023]
Abstract
Facial emotion recognition (FER), including sadness, is altered in bipolar disorder (BD). However, the relationship between this impairment and the brain structure in BD is relatively unexplored. Furthermore, its association with clinical variables and with the subtypes of BD remains to be clarified. Twenty euthymic patients with BD type I (BD-I), 28 BD type II (BD-II), and 45 healthy controls completed a FER test and a 3D-T1-weighted magnetic resonance imaging. Gray matter volume (GMV) of the cortico-limbic regions implicated in emotional processing was estimated and their relationship with FER performance was investigated using network analysis. Patients with BD-I had worse total and sadness-related FER performance relative to the other groups. Total FER performance was significantly negatively associated with illness duration and positively associated with global functioning in patients with BD-I. Sadness-related FER performance was also significantly negatively associated with the number of previous manic episodes. Network analysis showed a reduced association of the GMV of the frontal-insular-occipital areas in patients with BD-I, with a greater edge strength between sadness-related FER performance and amygdala GMV relative to controls. Our results suggest that FER performance, particularly for facial sadness, may be distinctively impaired in patients with BD-I. The pattern of reduced interrelationship in the frontal-insular-occipital regions and a stronger positive relationship between facial sadness recognition and the amygdala GMV in BD may reflect altered cortical modulation of limbic structures that ultimately predisposes to emotional dysregulation. Future longitudinal studies investigating the effect of mood state on FER performance in BD are warranted.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy
| | - Nicolò Trevisan
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy
| | - Margherita Salvucci
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy
| | - Matteo Minerva
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy
| | - Silvia Valeggia
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy
| | - Renzo Manara
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
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Brancati GE, Nunes A, Scott K, O'Donovan C, Cervantes P, Grof P, Alda M. Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment. Int J Bipolar Disord 2023; 11:25. [PMID: 37452256 PMCID: PMC10349025 DOI: 10.1186/s40345-023-00304-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The distinction between bipolar I and bipolar II disorder and its treatment implications have been a matter of ongoing debate. The aim of this study was to examine differences between patients with bipolar I and II disorders with particular emphasis on the early phases of the disorders. METHODS 808 subjects diagnosed with bipolar I (N = 587) or bipolar II disorder (N = 221) according to DSM-IV criteria were recruited between April 1994 and March 2022 from tertiary-level mood disorder clinics. Sociodemographic and clinical variables concerning psychiatric and medical comorbidities, family history, illness course, suicidal behavior, and response to treatment were compared between the bipolar disorder types. RESULTS Bipolar II disorder patients were more frequently women, older, married or widowed. Bipolar II disorder was associated with later "bipolar" presentation, higher age at first (hypo)mania and treatment, less frequent referral after a single episode, and more episodes before lithium treatment. A higher proportion of first-degree relatives of bipolar II patients were affected by major depression and anxiety disorders. The course of bipolar II disorder was typically characterized by depressive onset, early depressive episodes, multiple depressive recurrences, and depressive predominant polarity; less often by (hypo)mania or (hypo)mania-depression cycles at onset or during the early course. The lifetime clinical course was more frequently rated as chronic fluctuating than episodic. More patients with bipolar II disorder had a history of rapid cycling and/or high number of episodes. Mood stabilizers and antipsychotics were prescribed less frequently during the early course of bipolar II disorder, while antidepressants were more common. We found no differences in global functioning, lifetime suicide attempts, family history of suicide, age at onset of mood disorders and depressive episodes, and lithium response. CONCLUSIONS Differences between bipolar I and II disorders are not limited to the severity of (hypo)manic syndromes but include patterns of clinical course and family history. Caution in the use of potentially mood-destabilizing agents is warranted during the early course of bipolar II disorder.
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Affiliation(s)
- Giulio Emilio Brancati
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Abraham Nunes
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Katie Scott
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada
| | - Claire O'Donovan
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada
| | - Pablo Cervantes
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building (room 3088), Halifax, NS, B3H 2E2, Canada.
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Hernandorena CV, Baldessarini RJ, Tondo L, Vázquez GH. Status of Type II vs. Type I Bipolar Disorder: Systematic Review with Meta-Analyses. Harv Rev Psychiatry 2023; 31:173-182. [PMID: 37437249 DOI: 10.1097/hrp.0000000000000371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Analyze and compare the different bipolar disorder (BD) types.• Identify markers that distinguish BD types and explain how the DSM-IV defines the disorder. ABSTRACT Since the status of type II bipolar disorder (BD2) as a separate and distinct form of bipolar disorder (BD) remains controversial, we reviewed studies that directly compare BD2 to type I bipolar disorder (BD1). Systematic literature searching yielded 36 reports with head-to-head comparisons involving 52,631 BD1 and 37,363 BD2 patients (total N = 89,994) observed for 14.6 years, regarding 21 factors (with 12 reports/factor). BD2 subjects had significantly more additional psychiatric diagnoses, depressions/year, rapid cycling, family psychiatric history, female sex, and antidepressant treatment, but less treatment with lithium or antipsychotics, fewer hospitalizations or psychotic features, and lower unemployment rates than BD1 subjects. However, the diagnostic groups did not differ significantly in education, onset age, marital status, [hypo]manias/year, risk of suicide attempts, substance use disorders, medical comorbidities, or access to psychotherapy. Heterogeneity in reported comparisons of BD2 and BD1 limits the firmness of some observations, but study findings indicate that the BD types differ substantially by several descriptive and clinical measures and that BD2 remains diagnostically stable over many years. We conclude that BD2 requires better clinical recognition and significantly more research aimed at optimizing its treatment.
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Affiliation(s)
- Carolina V Hernandorena
- From Braulio A. Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina (Dr. Hernandorena); Department of Psychiatry, Queen's University (Drs. Hernandorena and Vázquez); Harvard Medical School, Boston, MA (Drs. Baldessarini and Tondo); McLean Hospital, Belmont, MA (Drs. Baldessarini, Tondo, and Vázquez); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Dr. Tondo)
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Zhang ZF, Huang J, Zhu XQ, Yu X, Yang HC, Xu XF, Fang YR, Tan QR, Li HC, Wang G, Zhang L. Clinicodemographic correlates of psychotic features in bipolar disorder - a multicenter study in China. BMC Psychiatry 2023; 23:365. [PMID: 37226150 DOI: 10.1186/s12888-023-04761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Psychotic symptoms are prevalent in patients with bipolar disorder (BD). However, nearly all previous studies on differences in sociodemographic and clinical factors between patients with (BD P +) and without (BD P-) psychotic symptoms were conducted in Western populations, and limited information is known in China. METHOD A total of 555 patients with BD from seven centers across China were recruited. A standardized procedure was used to collect patients' sociodemographic and clinical characteristics. The patients were divided into BD P + or BD P- groups based on the presence of lifetime psychotic symptoms. Mann-Whitney U test or chi-square test was used to analyze differences in sociodemographic and clinical factors between patients with BD P + and BD P-. Multiple logistic regression analysis was conducted to explore factors that were independently correlated with psychotic symptoms in BD. All the above analyses were re-conducted after the patients were divided into BD I and BD II group according to their types of diagnosis. RESULTS A total of 35 patients refused to participate, and the remaining 520 patients were included in the analyses. Compared with patients with BD P-, those with BD P + were more likely to be diagnosed with BD I and mania/hypomania/mixed polarity in the first mood episode. Moreover, they were more likely to be misdiagnosed as schizophrenia than major depressive disorder, were hospitalized more often, used antidepressants less frequently, and used more antipsychotics and mood stabilizers. Multivariate analyses revealed that diagnosis of BD I, more frequent misdiagnosis as schizophrenia and other mental disorders, less frequent misdiagnosis as major depressive disorder, more frequent lifetime suicidal behavior, more frequent hospitalizations, less frequent use of antidepressants, more frequent use of antipsychotics and mood stabilizers were independently correlated with psychotic symptoms in BD. After dividing the patients into BD I and BD II groups, we observed notable differences in sociodemographic and clinical factors, as well as clinicodemographic correlates of psychotic features between the two groups. CONCLUSIONS Differences in clinical factors between patients with BD P + and BD P- showed cross-cultural consistency, but results on the clinicodemographic correlates of psychotic features were not. Notable differences between patients with BD I and BD II were found. Future work exploring the psychotic features of BD needs to take types of diagnosis and cultural differences into consideration. TRIAL REGISTRATION This study was first registered on the website of the ClinicalTrials.gov ( https://clinicaltrials.gov/ ) on 18/01/2013. Its registration number is NCT01770704.
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Affiliation(s)
- Zhi-Fang Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Juan Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xue-Quan Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xin Yu
- Peking University Institute of Mental Health (the sixth Hospital) & National Clinical Research Center for Mental Disorders & the key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hai-Chen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Guangdong Province, Shenzhen, China
| | - Xiu-Feng Xu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, China
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hui-Chun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069, Beijing, China.
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Khoubaeva D, Dimick M, Timmins VH, Fiksenbaum LM, Mitchell RHB, Schaffer A, Sinyor M, Goldstein BI. Clinical correlates of suicidality and self-injurious behaviour among Canadian adolescents with bipolar disorder. Eur Child Adolesc Psychiatry 2023; 32:41-51. [PMID: 34028609 DOI: 10.1007/s00787-021-01803-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
There is high risk of suicidality in bipolar disorder (BD), particularly in early onset cases. The literature regarding correlates and putative predictors of suicide attempts (SA), non-suicidal self-injury (NSSI) and suicidal ideation (SI) among youth with BD remains sparse. Participants included 197 adolescents with BD, divided into 4 groups: SA (with or without NSSI), NSSI (with or without SI), SI only, and comparison group (CG; no SA/NSSI/SI). Diagnoses, treatment, and suicidality measures were determined via semi-structured interviews, conducted between 2009 and 2017. Univariate analyses were followed by multinomial regression. Overall, 73.6% of participants had history of SA, NSSI, and/or SI. In comparison to CG, SA and NSSI were each associated with BD-II/-NOS (odds ratio [OR] = 15.99, p = 0.002; OR = 16.76, p = 0.003), female sex (OR = 6.89, p = 0.006; OR = 3.76, p = 0.02), and emotion dysregulation (OR = 1.10, p < 0.001; OR = 1.07, p = 0.004). NSSI and SI were each associated with most severe lifetime depression (OR = 1.10, p = 0.01; OR = 1.10, p = 0.01). SA and SI were associated with psychiatric hospitalization (OR = 19.45, p = 0.001; OR = 6.09, p = 0.03). SA was associated with poorer global functioning at most severe episode (OR = 0.88, p = 0.008). NSSI was associated with not living with both natural parents (OR = 0.22, p = 0.009). Study limitations include cross-sectional and retrospective design, stringent cut-offs for SA and NSSI, and recruitment from a tertiary clinical setting. Three quarters of adolescents with BD have had suicidality and/or self-injury. SA and NSSI were most similar to one another, and most different from CG, supporting the broader construct of self-harm. Future research should address the gap in knowledge regarding how sex differences and neurobiology are associated with the observed clinical differences.
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Affiliation(s)
- Diana Khoubaeva
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Mikaela Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Vanessa H Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | | | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Söderholm JJ, Socada JL, Rosenström T, Ekelund J, Isometsä E. Bipolar disorder predicted shorter and borderline personality disorder symptoms longer time to remission - A prospective cohort study of major depressive patients. J Affect Disord 2022; 316:161-168. [PMID: 35985516 DOI: 10.1016/j.jad.2022.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major depressive episodes (MDEs) of major depressive (MDD) or bipolar disorders (BD) are frequently complicated by features of borderline personality disorder (BPD). Mixed features are a hallmark of BD and affective lability of BPD, and both may markedly influence illness course. However, direct comparisons of outcome of depression in MDD, BD, and BPD are scarce. METHODS In a cohort study based on stratified sampling, we diagnosed psychiatric MDE patients with SCID-I/P and SCID-II interviews and examined mixed symptoms using the Mix-MDE scale and borderline symptoms using the Borderline Personality Disorder Severity Index. During a six-month prospective follow-up, the MDE patients with MDD (n = 39), BD (n = 33), or BPD (n = 23) completed biweekly online assessments. Using life chart methodology, we divided the follow-up period into qualitatively different mood state periods. We investigated durations of mood episodes, times to first full symptomatic remission, and their predictors. RESULTS Remission rates were similar in MDD, MDE/BD, and MDE/BPD patients. MDE/BD patients experienced more numerous and shorter distinct mood state periods during follow-up than the others. MDE/BD was associated with shorter (HR = 2.44, 95 % CI = 1.27-4.67) and dimensionally assessed BPD severity with longer time to first remission (HR = 0.95, 95 % CI = 0.91-1.00). LIMITATIONS Moderate sample size and follow-up duration. CONCLUSIONS Course of illness over six months differs between the three depressive groups. Bipolar depressive patients have the most alternating course and the shortest time to first period of remission. Dimensionally assessed severity of BPD may predict longer time to remission from depression.
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Affiliation(s)
- John J Söderholm
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital Brain Center, Helsinki, Finland
| | - J Lumikukka Socada
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital Brain Center, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jesper Ekelund
- Helsinki University Hospital Brain Center, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital Brain Center, Helsinki, Finland.
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Luciano M, Sampogna G, Del Vecchio V, Giallonardo V, Di Cerbo A, Palummo C, Malangone C, Lampis D, Veltro F, Bardicchia F, Ciampini G, Orlandi E, Moroni A, Biondi S, Piselli M, Menculini G, Nicolò G, Pompili E, Carrà G, Fiorillo A. Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study. Bipolar Disord 2022; 24:647-657. [PMID: 35114727 PMCID: PMC9790519 DOI: 10.1111/bdi.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aims to explore the long-term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post-intervention in terms of improvement of: (1) patients' symptoms and global functioning and (2) relatives' objective and subjective burden and coping strategies. METHODS This is a multicentre, real-world, controlled, outpatient trial. Recruited patients and key-relatives were consecutively allocated to the experimental intervention or treatment as usual. Patients were assessed at baseline, and after one and five years. RESULTS One hundred and thirty-seventh number families have been recruited; 70 have been allocated to the experimental intervention, and 67 have been allocated to the control group. We observed an increasing positive effect of the PFI on patients' clinical status, global functioning and objective and subjective burden after one year. We also found a reduction in the levels of relatives' objective and subjective burden and a significant improvement in the levels of perceived professional support and of coping strategies. The efficacy of PFI on patients' clinical status was maintained at five years from the end of the intervention, in terms of relapses, hospitalizations and suicide attempts. CONCLUSIONS The study showed that the provision of PFI in real-world settings is associated with a significant improvement of patients' and relatives' mental health and psychosocial functioning in the long term. We found that the clinical efficacy of the intervention, in terms of reduction of patients' relapses, hospitalization and suicide attempts, persists after 5 years. It is advisable that PFI is provided to patients with BD I in routine practice.
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Affiliation(s)
- Mario Luciano
- Department of PsychiatryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Gaia Sampogna
- Department of PsychiatryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Valeria Del Vecchio
- Department of PsychiatryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | | | - Arcangelo Di Cerbo
- Department of PsychiatryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Carmela Palummo
- Department of PsychiatryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | | | | | - Franco Veltro
- Mental Health Department of CampobassoCampobassoItaly
| | | | | | | | | | | | | | | | | | | | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMonzaItaly
| | - Andrea Fiorillo
- Department of PsychiatryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
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Arvilommi P, Pallaskorpi S, Linnaranta O, Suominen K, Leppämäki S, Valtonen H, Isometsä E. Long-term work disability due to type I and II bipolar disorder: findings of a six-year prospective study. Int J Bipolar Disord 2022; 10:19. [PMID: 35811322 PMCID: PMC9271449 DOI: 10.1186/s40345-022-00264-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/10/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, the prevalence and predictors of long-term work disability among patients with type I and II BD have scarcely been studied. We investigated the clinical predictors of long-term work disability among patients with BD. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (n = 191) of adult psychiatric in- and out-patients with DSM-IV type I and II BD in three Finnish cities. Within JoBS we examined the prevalence and predictors of disability pension being granted during a six-year follow-up of the 152 patients in the labor force at baseline and collected information on granted pensions from national registers. We determined the predictors of disability pension using logistic regression models. Results Over the 6 years, 44% of the patients belonging to the labor force at baseline were granted a disability pension. Older age; type I BD; comorbidity with generalized anxiety disorder, post-traumatic stress disorder or avoidant personality disorder; and duration of time with depressive or mixed symptoms predicted disability pensions. Including disability pensions granted before baseline increased their total prevalence to 55.5%. The observed predictors were similar. Conclusion This regionally representative long-term prospective study found that about half of patients with type I or II bipolar disorder suffer from persistent work disability that leads to disability pension. In addition to the severity of the clinical course and type I bipolar disorder, the longitudinal accumulation of time depressed, psychiatric comorbidity, and older age predicted pensioning. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00264-6.
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Affiliation(s)
- Petri Arvilommi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Pallaskorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Kirsi Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Valtonen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Kieseppä T, Mäntylä R, Luoma K, Rikandi E, Jylhä P, Isometsä E. White Matter Hyperintensities after Five-Year Follow-Up and a Cross-Sectional FA Decrease in Bipolar I and Major Depressive Patients. Neuropsychobiology 2022; 81:39-50. [PMID: 34130283 DOI: 10.1159/000516234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION An increase in brain white matter hyperintensities (WMHs) and a decrease in white matter fractional anisotrophy (FA) have been detected in bipolar I (BPI), II (BPII), and major depressive disorder (MDD) patients. Their relationship, and differences in diagnostic groups are obscure. Longitudinal studies are rare. OBJECTIVE After 5-year follow-up, we evaluated WMHs in BPI, BPII, and MDD patients as compared with controls, and studied the effects of clinical variables. We also explored the associations of clinical variables with cross-sectional whole brain FA. METHODS Eight BPI, 8 BPII, 6 MDD patients, and 19 controls participated in magnetic resonance imaging at baseline and follow-up. Diffusion weighted imaging was included at follow-up. WMHs were rated by the Coffey scale, and a tract-based spatial statistics method was used for diffusion data. The general linear model, ANOVA, Fisher's exact, Wilcoxon sign, and Kruskal-Wallis tests were used for statistical analyses. RESULTS Periventricular WMHs were increased in BPI patients (p = 0.047) and associated with the duration of disorder and lifetime occurrence of substance use disorder (p = 0.018). FA decrease was found in the corpus callosum of BPI patients (p < 0.01). MDD patients showed FA decrease in the right cerebellar middle peduncle (RCMP) (p < 0.01). In BPI patients, the duration of disorder associated with FA increase in RCMP (p < 0.05). No FA decrease was detected in patients with WMHs as compared with those without. CONCLUSIONS Preceding illness burden associated modestly with WMHs, and FA increase in RCMP in BPI patients. MDD patients had FA decrease in RCMP. No association with FA decrease and WMHs was found.
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Affiliation(s)
- Tuula Kieseppä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Institute for Health and Welfare, Public Health and Welfare, Mental Health, Helsinki, Finland
| | - Riitta Mäntylä
- Department of Radiology, HUS Medical Imaging Center, Hyvinkää Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katariina Luoma
- Department of Radiology, HUS Medical Imaging Center, Meilahti Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eva Rikandi
- Finnish Institute for Health and Welfare, Public Health and Welfare, Mental Health, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Pekka Jylhä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Institute for Health and Welfare, Public Health and Welfare, Mental Health, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Institute for Health and Welfare, Public Health and Welfare, Mental Health, Helsinki, Finland
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11
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Zeighami R, Raeisolhagh A, Ranjbaran M. Effect of Home Nursing Care on the Severity of Symptoms in Patients With Bipolar I Disorder: A Randomized Clinical Trial. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320969122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bipolar I disorder is a common, chronic, and recurrent disease in which improper and inadequate follow-up of patients after discharge leads to increased hospitalization. This study aimed at investigating the effect of home nursing care on the severity of symptoms of bipolar I disorder. This clinical trial was performed on 90 patients admitted to 22 Bahman Qazvin Hospital in 2019. The available sampling was done using random allocation of six blocks in experimental and control groups. In the experimental group, after leaving the hospital, the intervention was performed for 3 months in the form of two telephone calls and one face-to-face meeting per month. Data were collected using a demographic questionnaire, the Yang scale questionnaire, and entered into the SPSS-24 software. Statistical tests such as Mann-Whitney u test, Fisher, independent T-test, paired T-test, chi-square, and ANCOVA were used at the significance level of p < .05. The severity of the disease before the intervention in the experimental and control groups were (93/9 ± 25/32) and (04/11 ± 86/28), respectively, showing no statistically significant difference ( p = .146). However, after the intervention, the mean severity of the disease in the experimental and control groups were (17/5 ± 38/13) and (79/12 ± 21/33), respectively, showing a statistically significant difference ( p < .05). According to the results, the home nursing care for patients leads to a reduction in the severity of symptoms and a reduction in the rate of re-hospitalization of patients.
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Affiliation(s)
| | | | - Mehdi Ranjbaran
- School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
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12
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Clinical and genetic differences between bipolar disorder type 1 and 2 in multiplex families. Transl Psychiatry 2021; 11:31. [PMID: 33431802 PMCID: PMC7801527 DOI: 10.1038/s41398-020-01146-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023] Open
Abstract
The two major subtypes of bipolar disorder (BD), BD-I and BD-II, are distinguished based on the presence of manic or hypomanic episodes. Historically, BD-II was perceived as a less severe form of BD-I. Recent research has challenged this concept of a severity continuum. Studies in large samples of unrelated patients have described clinical and genetic differences between the subtypes. Besides an increased schizophrenia polygenic risk load in BD-I, these studies also observed an increased depression risk load in BD-II patients. The present study assessed whether such clinical and genetic differences are also found in BD patients from multiplex families, which exhibit reduced genetic and environmental heterogeneity. Comparing 252 BD-I and 75 BD-II patients from the Andalusian Bipolar Family (ABiF) study, the clinical course, symptoms during depressive and manic episodes, and psychiatric comorbidities were analyzed. Furthermore, polygenic risk scores (PRS) for BD, schizophrenia, and depression were assessed. BD-I patients not only suffered from more severe symptoms during manic episodes but also more frequently showed incapacity during depressive episodes. A higher BD PRS was significantly associated with suicidal ideation. Moreover, BD-I cases exhibited lower depression PRS. In line with a severity continuum from BD-II to BD-I, our results link BD-I to a more pronounced clinical presentation in both mania and depression and indicate that the polygenic risk load of BD predisposes to more severe disorder characteristics. Nevertheless, our results suggest that the genetic risk burden for depression also shapes disorder presentation and increases the likelihood of BD-II subtype development.
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13
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Luciano M, Steardo L, Sampogna G, Caivano V, Ciampi C, Del Vecchio V, Di Cerbo A, Giallonardo V, Zinno F, De Fazio P, Fiorillo A. Affective Temperaments and Illness Severity in Patients with Bipolar Disorder. MEDICINA-LITHUANIA 2021; 57:medicina57010054. [PMID: 33435391 PMCID: PMC7826695 DOI: 10.3390/medicina57010054] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
Abstract
Background and objectives: Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and the highest suicide rate. Although affective temperaments can impact on BD long-term outcome, their role remains poorly investigated. The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to assess the relation between affective temperaments and severity of clinical picture in a sample of patients with BD. Materials and Methods: A total of 199 patients have been recruited in the outpatients units of two university sites. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments. Results: Predominant cyclothymic and irritable temperaments are associated to higher number of relapses, poorer quality of life, higher rates of aggressive behaviors, and suicide attempts. Conversely, the predominant hyperthymic disposition was a protective factor for several outcome measures, including relapse rate, severity of anxiety, depressive and manic symptoms, suicidality, and earlier age at onset. One limitation of the present study is that the recruitment took place in two university sites; therefore, our findings cannot be fully generalized to the whole community of BD patients. Other limitations are the lack of a control group and the cross-sectional design of the study. Conclusions: The early identification of affective temperaments can help clinicians to identify those BD patients who are more likely to show a poor long-term outcome. An early screening of affective temperaments can be useful to develop targeted integrated pharmacological and psychosocial interventions.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
- Correspondence: ; Tel.: +39-0815666516 or +39-3490730150
| | - Luca Steardo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, 88100 Catanzaro, Italy;
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Vito Caivano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Carmen Ciampi
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Arcangelo Di Cerbo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Francesca Zinno
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, 88100 Catanzaro, Italy;
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80132 Naples, Italy; (L.S.J.); (G.S.); (V.C.); (C.C.); (V.D.V.); (A.D.C.); (V.G.); (F.Z.); (A.F.)
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14
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Karanti A, Kardell M, Joas E, Runeson B, Pålsson E, Landén M. Characteristics of bipolar I and II disorder: A study of 8766 individuals. Bipolar Disord 2020; 22:392-400. [PMID: 31724302 DOI: 10.1111/bdi.12867] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Large-scale studies on phenotypic differences between bipolar disorder type I (BDI) and type II (BDII) are scarce. METHODS Individuals with BDI (N = 4806) and BDII (N = 3960) were compared with respect to clinical features, illness course, comorbid conditions, suicidality, and socioeconomic factors using data from the Swedish national quality assurance register for bipolar disorders (BipoläR). RESULTS BDII had higher rate of depressive episodes and more frequent suicide attempts than BDI. Furthermore, the BDII group were younger at first sign of mental illness and showed higher prevalence of psychiatric comorbidity but were more likely to have completed higher education and to be self-sustaining than the BDI group. BDII more frequently received psychotherapy, antidepressants, and lamotrigine. BDI patients had higher rate of hospitalizations and elated episodes, higher BMI, and higher rate of endocrine, nutritional, and metabolic diseases. BDI were more likely to receive mood stabilizers, antipsychotic drugs, electroconvulsive therapy, and psychoeducation. CONCLUSIONS These results demonstrate clear differences between BDI and II and counter the notion that BDII is a milder form of BDI, but rather a more complex condition with regard to clinical course and comorbidity.
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Affiliation(s)
- Alina Karanti
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Joas
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Remission and recurrence in bipolar disorder: The data from health outcomes and patient evaluations in bipolar disorder (HOPE-BD) study. J Affect Disord 2020; 268:150-157. [PMID: 32174473 DOI: 10.1016/j.jad.2020.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The HOPE-BD was a naturalistic study established to follow individuals in Canada seeking treatment for bipolar disorder (BD). The study aimed to examine the course of BD and describe how clinical and sociodemographic factors are associated with outcomes. METHODS Individuals with BD had their clinical data recorded at enrolment and were naturalistically treated. Participant were followed for up to four years, and visits occurred at least once every three months. We investigated the longitudinal outcomes with logistic, Cox, and quantile regressions. RESULTS Among the 354 participants, 57.3% had BD type I. Depression as first episode, younger ages at onset and older ages of the first professional help predicted longer delays in correct diagnosis. Among the symptomatic patients at baseline, the median time to remission was 10.9 months. Comorbid alcohol use disorder and the severity of baseline depressive symptoms predicted longer times to remission. Among the euthymic participants, the median time to recurrence was 14.5 months. History of anxiety disorder and younger ages at onset predicted shorter times to recurrence. Baseline depression scores predicted recurrence in euthymic patients. LIMITATIONS We did not investigate the predictors of each polarity. Our findings may not apply to individuals followed in non-specialised outpatient services. CONCLUSION Our study reinforces the necessity of early diagnosis and interventions, as well as the importance of treating depressive symptoms and comorbidities.
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16
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Joas E, Bäckman K, Karanti A, Sparding T, Colom F, Pålsson E, Landén M. Psychoeducation for bipolar disorder and risk of recurrence and hospitalization - a within-individual analysis using registry data. Psychol Med 2020; 50:1043-1049. [PMID: 31057138 PMCID: PMC7191782 DOI: 10.1017/s0033291719001053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/06/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The efficacy of psychoeducation for bipolar disorder has been demonstrated in clinical trials, but it is not known if the results translate into effectiveness in routine clinical practice. The aim was to determine the effectiveness of psychoeducation for bipolar disorder in a routine clinical setting. METHOD We identified 2819 patients with at least three registrations in the Swedish Quality Assurance Register for Bipolar Disorder. Among those, 402 had not been exposed to psychoeducation at the first visit, but received psychoeducation during any of the following registrations. Using within-individual analyses, the risk of recurrence after having received psychoeducation was compared with the risk prior to psychoeducation. RESULTS In adjusted within-individuals comparisons, periods after psychoeducation was associated with decreased risks of any recurrence [odds ratio (OR) 0.57, 95% CI 0.42-0.78], (hypo-)manic or mixed episodes (OR 0.54, 95% CI 0.39-0.76), depressive episodes (OR 0.63, 95% CI 0.47-0.86), and inpatient care (OR 0.54, 95% CI 0.33-0.86) relative to periods prior to psychoeducation. There was no association with rates of involuntary sectioning or suicide attempts. CONCLUSIONS The results suggest that psychoeducation for bipolar disorder reduces the risk of mood episodes and inpatient care also when implemented in routine clinical practice.
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Affiliation(s)
- Erik Joas
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kristoffer Bäckman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alina Karanti
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Timea Sparding
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Francesc Colom
- Mental Health Group, IMIM-Hospital del Mar-CIBERSAM, Barcelona-Catalonia, Spain
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Tuineag M, Therman S, Lindgren M, Rouanet M, Nahon S, Bertrand L, Saury S, Renaud S, Beaulieu S, Linnaranta O. Dissociative symptoms as measured by the Cambridge Depersonalization Scale in patients with a bipolar disorder. J Affect Disord 2020; 263:187-192. [PMID: 31818776 DOI: 10.1016/j.jad.2019.11.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/25/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Cambridge Depersonalization Scale (CDS) characterizes the quality, frequency, and duration of dissociative symptoms. While the psychometric properties of the CDS have been evaluated in primary dissociative disorder, this has been insufficiently addressed among other psychiatric patient groups such as patients with a bipolar disorder (BD). METHODS Outpatients with variable mood (n = 73) responded to a survey that assessed dissociative symptoms and other characteristics. We used factor analysis and McDonald's omega to evaluate psychometric properties of the CDS, and correlations with other characteristics. RESULTS Previously suggested multifactorial models of the CDS were not supported, but the single-dimensional model fit both dichotomized (p = 0.31, CFI = 0.99, RMSEA = 0.02, ECV 70%) and trichotomized CDS responses (p = 0.06, CFI = 0.96, RMSEA = 0.04, ECV 47%). The CDS showed high internal consistency (ω = 0.96). CDS factor scores correlated with symptom severity on the Quick Inventory for Depressive Symptoms (QIDS-SR-16) (ρ = 0.59), the Social Phobia Inventory (ρ = 0.52), the American Association of Psychiatry Severity measure for Panic Disorders (ρ = 0.46), the Childhood Trauma Questionnaire (ρ = 0.44), and the Trauma Screening Questionnaire (ρ = 0.53). Two abbreviated versions of the CDS, retaining the best 14 or 7 items were proposed. LIMITATIONS The sample size remained moderate. CONCLUSIONS The CDS is a psychometrically sound, unidimensional measure with clinical impact to detect and characterize dissociative symptoms in BD patients. Establishing the reliability and validity of the abbreviated scales for screening necessitates further study.
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Affiliation(s)
- Maria Tuineag
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Mood disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Sebastian Therman
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Maija Lindgren
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Manon Rouanet
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sara Nahon
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Lia Bertrand
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sybille Saury
- Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Suzanne Renaud
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
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18
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Cotrena C, Branco LD, Shansis FM, Fonseca RP. Predictors of quality of life in bipolar disorder: A path analytical study. Psychiatry Res 2020; 285:112846. [PMID: 32066003 DOI: 10.1016/j.psychres.2020.112846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/18/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Quality of life (QoL) is an important outcome in psychiatric illnesses like bipolar disorder (BD). However, little is known about the variables that affect it, and therefore contribute to prognosis and treatment outcomes in these populations. This study aimed to explore QoL in BD and investigate its relationship with modifiable (cognitive reserve, cognitive ability, mood symptoms) and non-modifiable factors (diagnosis, previous suicide attempts, substance misuse, age). The WHOQOL-bref was administered to 121 control participants and 109 patients with BD, who also underwent clinical and neuropsychological assessments. Factor analysis was used to identify latent constructs underlying WHOQOL-bref domains, and structural equation models were used to examine predictors of each latent construct. Two latent constructs were identified in the WHOQOL-bref, and labeled 'Personal' and 'Social' QoL. Both were directly predicted by depression symptoms and a diagnosis of BD, and indirectly predicted by (hypo)manic symptoms. Cognitive reserve was a stronger predictor of social QoL than a diagnosis of BD. Our findings suggest that the management of depression symptoms and fostering of cognitive reserve may improve QoL in BD. A diagnosis of BD and/or substance use disorders were risk factors for poor QoL, and may signal the need for preventive interventions to promote well-being.
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Affiliation(s)
- Charles Cotrena
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, building 11, rm 940, Porto Alegre 90619-900, RS, Brazil.
| | - Laura Damiani Branco
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, building 11, rm 940, Porto Alegre 90619-900, RS, Brazil.
| | - Flávio Milman Shansis
- Medical Sciences Pos Graduate Program, University of Vale do Taquari (Univates), Lajeado, RS, Brazil
| | - Rochele Paz Fonseca
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, building 11, rm 940, Porto Alegre 90619-900, RS, Brazil
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19
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van den Ameele S, van Nuijs AL, Lai FY, Schuermans J, Verkerk R, van Diermen L, Coppens V, Fransen E, de Boer P, Timmers M, Sabbe B, Morrens M. A mood state-specific interaction between kynurenine metabolism and inflammation is present in bipolar disorder. Bipolar Disord 2020; 22:59-69. [PMID: 31398273 DOI: 10.1111/bdi.12814] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Cytokines are thought to contribute to the pathogenesis of psychiatric symptoms by kynurenine pathway activation. Kynurenine metabolites affect neurotransmission and can cause neurotoxicity. We measured inflammatory markers in patients with bipolar disorder (BD) and studied their relation to kynurenine metabolites and mood. METHODS Patients with BD suffering from an acute mood episode were assigned to the depressive (n = 35) or (hypo)manic (n = 32) subgroup. Plasma levels of inflammatory markers [cytokines, C-reactive protein] and kynurenine metabolites [tryptophan (TRP), kynurenine (KYN), 3-hydroxykynurenine (3-HK), quinolinic acid (QA), kynurenic acid (KYNA)] were measured on 6 time points during 8 months follow-up. Biological marker levels in patients were compared to controls (n = 35) and correlated to scores on mood scales. Spearman correlations and linear mixed models were used for statistical analysis. RESULTS Twenty patients of the manic subgroup, 29 of the depressive subgroup, and 30 controls completed the study. The manic subgroup had a rapid remission of mood symptoms, but in the depressive subgroup subsyndromal symptoms persisted. No differences in inflammation were found between groups. A strong correlation between tumor necrosis factor-α and KYN, KYN/TRP, 3-HK and QA (ρ > 0.60) was specific for the manic group, but only at baseline (during mania). The depressive subgroup had a lower neuroprotective ratio (KYNA/3-HK, P = .0004) and a strong association between interferon-y and kynurenine pathway activation (P < .0001). KYNA was low in both patient groups versus controls throughout the whole follow-up (P = .0008). CONCLUSIONS Mania and chronic depressive symptoms in BD are accompanied by a strong interaction between inflammation and a potentially neurotoxic kynurenine metabolism.
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Affiliation(s)
- Seline van den Ameele
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel - VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, CHU Brugmann, Brussels, Belgium
| | - Alexander Ln van Nuijs
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Foon Yin Lai
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium.,Department of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden
| | - Jeroen Schuermans
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel - VZW Emmaüs, Duffel, Belgium
| | - Robert Verkerk
- Laboratory of Medical Biochemistry, University of Antwerp, Antwerp, Belgium
| | - Linda van Diermen
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel - VZW Emmaüs, Duffel, Belgium
| | - Violette Coppens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel - VZW Emmaüs, Duffel, Belgium
| | - Erik Fransen
- StatUa Centre for Statistics, University of Antwerp, Antwerp, Belgium
| | - Peter de Boer
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Maarten Timmers
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel - VZW Emmaüs, Duffel, Belgium
| | - Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel - VZW Emmaüs, Duffel, Belgium
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20
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Aaltonen KI, Rosenström T, Jylhä P, Holma I, Holma M, Pallaskorpi S, Riihimäki K, Suominen K, Vuorilehto M, Isometsä ET. Do Suicide Attempts of Mood Disorder Patients Directly Increase the Risk for a Reattempt? Front Psychiatry 2020; 11:547791. [PMID: 33324247 PMCID: PMC7725715 DOI: 10.3389/fpsyt.2020.547791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/09/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Preceding suicide attempts strongly predict future suicidal acts. However, whether attempting suicide per se increases the risk remains undetermined. We longitudinally investigated among patients with mood disorders whether after a suicide attempt future attempts occur during milder depressive states, indicating a possible lowered threshold for acting. Methods: We used 5-year follow-up data from 581 patients of the Jorvi Bipolar Study, Vantaa Depression Study, and Vantaa Primary Care Depression Study cohorts. Lifetime suicide attempts were investigated at baseline and during the follow-up. At follow-up interviews, life-chart data on the course of the mood disorder were generated and suicide attempts timed. By using individual-level data and multilevel modeling, we investigated at each incident attempt the association between the lifetime ordinal number of the attempt and the major depressive episode (MDE) status (full MDE, partial remission, or remission). Results: A total of 197 suicide attempts occurred among 90 patients, most during MDEs. When the dependencies between observations and individual liabilities were modeled, no association was found between the number of past suicide attempts at the time of each attempt and partial remissions. No association between adjusted inter-suicide attempt times and the number of past attempts emerged during follow-up. No indication for direct risk-increasing effects was found. Conclusion: Among mood disorder patients, repeated suicide attempts do not tend to occur during milder depressive states than in the preceding attempts. Previous suicide attempts may indicate underlying diathesis, future risk being principally set by the course of the disorder itself.
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Affiliation(s)
- Kari I Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Pekka Jylhä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Irina Holma
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Mikael Holma
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Sanna Pallaskorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Riihimäki
- Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Suominen
- Department of Mental Health and Substance Abuse Services, Department of Health and Social Services, Helsinki, Finland
| | - Maria Vuorilehto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
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21
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Ragazan DC, Eberhard J, Ösby U, Berge J. Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005-2014: A register-based study. J Affect Disord 2019; 256:183-191. [PMID: 31177046 DOI: 10.1016/j.jad.2019.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 05/27/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. METHODS Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005-2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic features, mixed, and other. Psychotropic therapies preceding the corresponding admissions were attained from the Prescribed Drug Register. Mixed-effects zero-truncated negative binomial regressions were employed to model the length of stay per admission. RESULTS Analysis included 39,653 admissions by 16,271 inpatients (60.0% women). Overall, when compared to men, women spent 7.5% (95% CI: 4.2-11.0%, p < 0.001) extra days hospitalized per admission. However, upon adjusting for candidate confounders, including the bipolar subtype, and selected comorbidities and psychotropics, the association weakened wherein women then spent 3.7% (95% CI: 0.1-6.9%, p = 0.028) extra days hospitalized per admission. LIMITATIONS The integrity of register data can be variable and the adherence to outpatient dispensed psychotropics could not be validated. CONCLUSION Although the influence of gender on the bipolar disorder inpatient length of stay is evident, other factors attenuate and better explain this crude observation.
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Affiliation(s)
- Dragos C Ragazan
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden.
| | - Jonas Eberhard
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden
| | - Urban Ösby
- Karolinska Institutet, Dept. of Clinical Neuroscience, Stockholm, Sweden
| | - Jonas Berge
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden
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22
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Uher R, Pallaskorpi S, Suominen K, Mantere O, Pavlova B, Isometsä E. Clinical course predicts long-term outcomes in bipolar disorder. Psychol Med 2019; 49:1109-1117. [PMID: 29950190 DOI: 10.1017/s0033291718001678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The long-term outcomes of bipolar disorder range from lasting remission to chronic course or frequent recurrences requiring admissions. The distinction between bipolar I and II disorders has limited utility in outcome prediction. It is unclear to what extent the clinical course of bipolar disorder predicts long-term outcomes. METHODS A representative sample of 191 individuals diagnosed with bipolar I or II disorder was recruited and followed for up to 5 years using a life-chart method. We previously described the clinical course over the first 18 months with dimensional course characteristics and latent classes. Now we test if these course characteristics predict long-term outcomes, including time ill (time with any mood symptoms) and hospital admissions over a second non-overlapping follow-up period in 111 individuals with available data from both 18 months and 5 years follow-ups. RESULTS Dimensional course characteristics from the first 18 months prospectively predicted outcomes over the following 3.5 years. The proportion of time depressed, the severity of depressive symptoms and the proportion of time manic predicted more time ill. The proportion of time manic, the severity of manic symptoms and depression-to-mania switching predicted a greater likelihood of hospital admissions. All predictions remained significant after controlling for age, sex and bipolar I v. II disorder. CONCLUSIONS Differential associations with long-term outcomes suggest that course characteristics may facilitate care planning with greater predictive validity than established types of bipolar disorders. A clinical course dominated by depressive symptoms predicts a greater proportion of time ill. A clinical course characterized by manic episodes predicts hospital admissions.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry,Dalhousie University,Halifax,Nova Scotia,Canada
| | - Sanna Pallaskorpi
- Mental Health Unit,National Institute of Health and Welfare,Helsinki,Finland
| | - Kirsi Suominen
- Helsinki City Department of Social Services and Healthcare,Mental Health and Substance Abuse Services,Helsinki,Finland
| | - Outi Mantere
- Department of Psychiatry,McGill University,Montréal, QC,Canada
| | - Barbara Pavlova
- Department of Psychiatry,Dalhousie University,Halifax,Nova Scotia,Canada
| | - Erkki Isometsä
- Department of Psychiatry,University of Helsinki and Helsinki University Central Hospital,Helsinki,Finland
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23
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Pallaskorpi S, Suominen K, Rosenström T, Mantere O, Arvilommi P, Valtonen H, Leppämäki S, García-Estela A, Grande I, Colom F, Vieta E, Isometsä E. Predominant polarity in bipolar I and II disorders: A five-year follow-up study. J Affect Disord 2019; 246:806-813. [PMID: 30634112 DOI: 10.1016/j.jad.2018.12.093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/20/2018] [Accepted: 12/24/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BD) differ in their relative predominance of types of episodes, yielding predominant polarity, which has important treatment implications. However, few prospective studies of predominant polarity exist. METHODS In the Jorvi Bipolar Study (JoBS), a regionally representative cohort of 191 BD I and BD II in- and outpatients was followed for five years using life-chart methodology. Differences between depressive (DP), manic (MP), and no predominant polarity (NP) groups were examined regarding time ill, incidence of suicide attempts, and comorbidity. RESULTS At baseline, 16% of patients had MP, 36% DP, and 48% NP. During the follow-up the MP group spent significantly more time euthymic, less time in major depressive episodes, and more time in manic states than the DP and NP groups. The MP group had significantly lower incidence of suicide attempts than the DP and NP group, lower prevalence of comorbid anxiety disorders but more psychotic symptoms lifetime and more often (hypo)manic first phase of the illness than the DP group. Classification of predominant polarity was influenced by the timeframe used. LIMITATIONS The retrospective counting of former phases is vulnerable to recall bias. Assignment of dominant polarity may necessitate a sufficient number of illness phases. CONCLUSIONS Predominant polarity has predictive value in predicting group differences in course of illness, but individual patients' classification may change over time. Patients with manic polarity may represent a more distinct subgroup than the two others regarding illness course, suicide attempts, and psychiatric comorbidity.
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Affiliation(s)
- Sanna Pallaskorpi
- Helsinki University Central Hospital, Department of Psychiatry, Helsinki, Finland; National Institute of Health and Welfare, Mental Health Unit, Helsinki, Finland; University of Helsinki, Department of Psychiatry, Helsinki, Finland
| | - Kirsi Suominen
- Helsinki City Department of Social Services and Healthcare, Psychiatric and Substance Abuse Services, Helsinki, Finland
| | - Tom Rosenström
- University of Helsinki, Department of Psychology and Logopedics, Helsinki, Finland; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Outi Mantere
- McGill University, Department of Psychiatry, Quebec, Canada; Douglas Mental Health University Institute, Bipolar Disorders Clinic, Quebec, Canada
| | - Petri Arvilommi
- National Institute of Health and Welfare, Mental Health Unit, Helsinki, Finland; University of Helsinki, Department of Psychiatry, Helsinki, Finland
| | - Hanna Valtonen
- Helsinki City Department of Social Services and Healthcare, Psychiatric and Substance Abuse Services, Helsinki, Finland
| | - Sami Leppämäki
- Helsinki University Central Hospital, Department of Psychiatry, Helsinki, Finland
| | - Aitana García-Estela
- Hospital del Mar-IMIM, Mental Health Research Group, CIBERSAM, Barcelona, Catalonia, Spain
| | - Iria Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Francesc Colom
- Hospital del Mar-IMIM, Mental Health Research Group, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Erkki Isometsä
- Helsinki University Central Hospital, Department of Psychiatry, Helsinki, Finland; National Institute of Health and Welfare, Mental Health Unit, Helsinki, Finland; University of Helsinki, Department of Psychiatry, Helsinki, Finland.
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24
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Warwick H, Tai S, Mansell W. Living the life you want following a diagnosis of bipolar disorder: A grounded theory approach. Clin Psychol Psychother 2019; 26:362-377. [DOI: 10.1002/cpp.2358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Helen Warwick
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science CentreThe University of Manchester Manchester UK
| | - Sara Tai
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science CentreThe University of Manchester Manchester UK
| | - Warren Mansell
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science CentreThe University of Manchester Manchester UK
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25
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Botturi A, Oldani L, Bottinelli F. Catatonia and Cotard’s Syndrome. CLINICAL CASES IN PSYCHIATRY: INTEGRATING TRANSLATIONAL NEUROSCIENCE APPROACHES 2019:189-208. [DOI: 10.1007/978-3-319-91557-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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26
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Murru A, Pacchiarotti I, Verdolini N, Reinares M, Torrent C, Geoffroy PA, Bellivier F, Llorca PM, Vieta E, Samalin L. Modifiable and non-modifiable factors associated with functional impairment during the inter-episodic periods of bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2018; 268:749-755. [PMID: 28534186 DOI: 10.1007/s00406-017-0811-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/17/2017] [Indexed: 12/13/2022]
Abstract
The chronic, long-term evolution of bipolar disorder (BD) requires a careful clinical characterization with prognostic implications in terms of symptom and functional control. The OPTHYMUM multicenter study was conducted in France with the objective of evaluating residual symptoms on overall functioning of BD patients during inter-episodic period. The aims of the present study were to identify the potentially modifiable (e.g., treatable) and non-modifiable variables associated with functional impairment during the inter-episodic periods of BD. Sample was divided into two groups according to level of functioning (adequate vs. impaired), based on the FAST scale total score. FAST cut-off for functional impairment is a score >11. The two subgroups were compared as per sociodemographic and clinical variables with standard univariate analyses, and a logistic regression model was created. The model as a whole contained independent non-modifiable factors (age, gender, BD type, illness duration) and modifiable factors (illness severity, predominant polarity, depressive and manic residual symptoms, comorbidities). The final model was statistically significant (χ 2 = 53.89, df = 5, p < 0.001). Modifiable factors most strongly associated with functional impairment were manic predominant polarity (OR = 1.79, CI 95% 1.09-2.96, p = 0.022), residual depressive symptoms (OR = 1.30, CI 95% 1.18-1.43, p < 0.001) and illness severity (OR = 1.24, CI 95% 1.01-1.52, p = 0.037), whilst non-modifiable factor was illness duration (OR = 1.03, CI 95% 1.01-1.05, p = 0.017). Despite intrinsic and non-modifiable illness characteristics, a clinical-wise choice of treatment may help to improve control of manic relapses. Potential improvement of residual depressive symptoms may alleviate the functional burden associated with bipolar disorder.
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Affiliation(s)
- Andrea Murru
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maria Reinares
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Carla Torrent
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Pierre-Alexis Geoffroy
- Inserm U1144, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis-Lariboisiére-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Frank Bellivier
- Inserm U1144, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis-Lariboisiére-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France. .,CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France.
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27
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Sanchez-Moreno J, Bonnin CM, González-Pinto A, Amann BL, Solé B, Balanzá-Martinez V, Arango C, Jiménez E, Tabarés-Seisdedos R, Garcia-Portilla MP, Ibáñez A, Crespo JM, Ayuso-Mateos JL, Martinez-Aran A, Torrent C, Vieta E. Factors associated with poor functional outcome in bipolar disorder: sociodemographic, clinical, and neurocognitive variables. Acta Psychiatr Scand 2018; 138:145-154. [PMID: 29726004 DOI: 10.1111/acps.12894] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar disorder(BD) presenting moderate-severe levels of functional impairment. METHODS Two-hundred and thirty-nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run. RESULTS The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM-D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance. CONCLUSIONS Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.
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Affiliation(s)
- J Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - C M Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - A González-Pinto
- Álava University Hospital, CIBERSAM, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - B L Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Department of Psychiatry, Parc de Salut Mar, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - B Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - V Balanzá-Martinez
- Department of Medicine, CIBERSAM, INCLIVA, University of Valencia, Valencia, Spain.,Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - C Arango
- Child and Adolescent Psychiatry Department, Hospital Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - E Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - R Tabarés-Seisdedos
- Department of Medicine, CIBERSAM, INCLIVA, University of Valencia, Valencia, Spain
| | - M P Garcia-Portilla
- Department of Psychiatry, School of Medicine, CIBERSAM Instituto de Neurociencias del Principado de Asturias, INEUROPA, Servicio de Salud del Principado de Asturias (SESPA), University of Oviedo, Oviedo, Spain
| | - A Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERSAM, Universidad de Alcalá, Madrid, Spain
| | - J M Crespo
- Department of Psychiatry, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, University Hospital of Bellvitge, Barcelona, Spain
| | - J L Ayuso-Mateos
- Department of Psychiatry, IIS-IP, CIBERSAM, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - C Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - E Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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28
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Caldieraro MA, Dufour S, Sylvia LG, Gao K, Ketter TA, Bobo WV, Walsh S, Janos J, Tohen M, Reilly-Harrington NA, McElroy SL, Shelton RC, Bowden CL, Deckersbach T, Nierenberg AA. Treatment outcomes of acute bipolar depressive episode with psychosis. Depress Anxiety 2018; 35:402-410. [PMID: 29329498 DOI: 10.1002/da.22716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/18/2017] [Accepted: 11/13/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The impact of psychosis on the treatment of bipolar depression is remarkably understudied. The primary aim of this study was to compare treatment outcomes of bipolar depressed individuals with and without psychosis. The secondary aim was to compare the effect of lithium and quetiapine, each with adjunctive personalized treatments (APTs), in the psychotic subgroup. METHODS We assessed participants with DSM-IV bipolar depression included in a comparative effectiveness study of lithium and quetiapine with APTs (the Bipolar CHOICE study). Severity was assessed by the Bipolar Inventory of Symptoms Scale (BISS) and by the Clinical Global Impression Scale-Severity-Bipolar Version (CGI-S-BP). Mixed models were used to assess the course of symptom change, and Cox regression survival analysis was used to assess the time to remission. RESULTS Psychotic features were present in 10.6% (n = 32) of the depressed participants (n = 303). Those with psychotic features had higher scores on the BISS before (75.2 ± 17.6 vs. 54.9 ± 16.3; P < .001) and after (37.2 ± 19.7 vs. 26.3 ± 18.0; P = .003) 6-month treatment. The CGI-S-BP yielded similar results. Participants with and without psychosis had similar course of symptom improvement and similar time to remission. There was no significant difference in the treatment outcomes of lithium (n = 11) and quetiapine (n = 21) among the psychotic subgroup. CONCLUSION Bipolar depressive episodes with psychotic features are more severe, and compared to nonpsychotic depressions, present a similar course of improvement. Given the small number of participants presenting psychosis, the lack of statistically significant difference between lithium- and quetiapine-based treatment of psychotic bipolar depressive episodes needs replication in a larger sample.
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Affiliation(s)
- Marco Antonio Caldieraro
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Steven Dufour
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Keming Gao
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Terence A Ketter
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Samantha Walsh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica Janos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Noreen A Reilly-Harrington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA.,Deparment of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Li K, Tao J, Li Y, Chen M, Wu X, Liao Y, Lin X, Gan Z. Patterns of persistence with pharmacological treatment among patients with current depressive episode and their impact on long-term outcome: a naturalistic study with 5-year follow-up. Patient Prefer Adherence 2018; 12:681-693. [PMID: 29765205 PMCID: PMC5939908 DOI: 10.2147/ppa.s160767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of the study was to describe and compare the patterns of medication persistence among patients with unipolar depression (UD) or bipolar depression in a 5-year follow-up, and explore their impact on long-term outcome. PATIENTS AND METHODS A total of 333 eligible patients with current major depressive episode were observed and followed up from the first index prescription for 5 years. Lack of persistence or treatment interruption was defined as a gap of at least 2 consecutive months without taking any medication. Time to lack of persistence in the first (TLP1) and the second (TLP2) episode of treatment, number of visits before the first treatment interruption (NV) and number of treatment interruptions (NTI) were measured. RESULTS During the 5-year follow-up, nearly 50% of patients experienced at least two times of treatment interruption. Pattern of medication persistence did not significantly differ between UD and bipolar disorder (BD) patients. TLP1 was positively associated with TLP2. Shorter TLP1 predicted a higher possibility of subsequent visits because of recurrence or relapse and more NTI meant a lower likelihood of achieving full remission in the fifth year for both UD and BD patients. For UD patients, shorter TLP1 or less NV predicted a lower chance of achieving remission, while for BD patients, shorter TLP1 meant an earlier subsequent visit and more NTI predicted a lower possibility of achieving remission. CONCLUSION Pattern of medication persistence was similar but its impact on the long-term outcome was quite different between UD and BD.
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Affiliation(s)
- Kanglai Li
- Department of Very Important Patient, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jiong Tao
- Department of Psychiatry, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yuemei Li
- Department of Obstetrics, Wuzhou Gongren Hospital, Wuzhou, People’s Republic of China
| | - Minhua Chen
- Department of Psychiatry, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiuhua Wu
- Department of Psychiatry, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yingtao Liao
- Department of Psychiatry, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaolan Lin
- Department of Infectious Diseases, the 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Correspondence: Xiaolan Lin, Department of Infectious Diseases, the 3rd Affiliated Hospital of Sun Yat-Sen University, No 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong, People’s Republic of China, Tel +86 20 8525 3333, Fax +86 20 8525 3336, Email
| | - Zhaoyu Gan
- Department of Psychiatry, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Zhaoyu Gan, Department of Psychiatry, the 3rd Affiliated Hospital of Sun Yat-Sen University, No 600, Tianhe Road, Tianhe District, Guangzhou, Guangdong 510630, People’s Republic of China, Tel +86 20 8525 3423, Fax +86 20 8525 2479, Email
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Serafini G, Geoffroy PA, Aguglia A, Adavastro G, Canepa G, Pompili M, Amore M. Irritable temperament and lifetime psychotic symptoms as predictors of anxiety symptoms in bipolar disorder. Nord J Psychiatry 2018; 72:63-71. [PMID: 29022840 DOI: 10.1080/08039488.2017.1385851] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Affective temperaments, hopelessness, alexithymia, and anxiety/agitation symptoms may play a significant role in the psychopathological characteristics of bipolar disorder (BD). Here, we aimed to investigate the eventual association between the mentioned explanatory variables and anxiety/agitation symptoms in BD. MATERIALS AND METHODS We recruited at the Section of Psychiatry, Department of Neuroscience, University of Genoa (Italy), 92 BD inpatients having a mean age of 52 (±13.8) years. Participants were assessed using specific psychometric instruments. Anxiety/agitation symptoms have been evaluated using the 11-item of the Beck Depression Inventory II (BDI-II). RESULTS Overall, 53.8% of participants presented with anxiety/agitation symptoms and 46.2% without. The two groups significantly differed about socio-economic status, lifetime psychotic symptoms, and residual depressive symptoms between episodes. Anxiety/agitation symptoms significantly correlated with irritable affective temperament (r = 0.407; p = .01), hopelessness (r = 0.541; p ≤ .001), difficulty identifying feelings (r = 0.440; p ≤ .001), difficulty describing feelings (r = 0.437; p ≤ .001), and externally oriented-thinking (r = 0.393; p ≤ .001). After multivariate analyses, irritable affective temperament (OR = 2.457, p ≤ .01) and less lifetime psychotic symptoms (OR = 0.007, p ≤ .05) remained the only significant variables associated with anxiety/agitation symptoms. CONCLUSIONS The generalization of the main findings is limited by the small sample size and cross-sectional study design. Nevertheless, our results suggest that the careful assessment of affective temperaments and psychotic symptoms may help to early identify BD patients suffering from anxiety/agitation symptoms and may allow to perform targeted interventions in the clinical practice.
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Affiliation(s)
- Gianluca Serafini
- a Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genoa , Genoa , Italy
| | - Pierre A Geoffroy
- b Sorbonne Paris Cité, UMR-S 1144 , Université Paris Diderot , Paris , France.,c Pôle de Psychiatrie et de Médecine Addictologique , AP-HP, GH Saint-Louis - Lariboisière - F. Widal , Paris , France
| | - Andrea Aguglia
- a Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genoa , Genoa , Italy
| | - Giulia Adavastro
- a Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genoa , Genoa , Italy
| | - Giovanna Canepa
- a Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genoa , Genoa , Italy
| | - Maurizio Pompili
- d Department of Neuroscience , Suicide Prevention Center, Sant'Andrea Hospital, University of Rome , Rome , Italy
| | - Mario Amore
- a Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genoa , Genoa , Italy
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Tundo A, Musetti L, Benedetti A, Massimetti E, Pergentini I, Cambiali E, Dell'Osso L. Predictors of recurrence during long-term treatment of bipolar I and II disorders. A 4 year prospective naturalistic study. J Affect Disord 2018; 225:123-128. [PMID: 28826088 DOI: 10.1016/j.jad.2017.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/22/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the large number of treatments available for bipolar disorder (BD), more than one half of patients have a recurrence within 2 years, and over 90% experience at least one additional affective episode during their lifetime. METHODS The aim of this study was to test the impact of a number of demographic and clinical features on the risk to recurrence in a real- word representative sample of 266 outpatients with BD-I or II treated in a naturalistic setting during a 4-years-follow-up period. RESULTS We found that the number of episodes per year after study entry, compared to the number of episodes per year before study entry,significantly decreased and that about one third of patients had no recurrences during the observation period. The length of follow-up and the number of previous episodes, mainly depressive, predicted the risk of recurrence, while female gender, higher age at intake, and a higher frequency of past mixed episodes predicted a higher frequency of recurrences. LIMITATIONS The study had some limitations to consider: i.e. the risk of poor reliability of information on the previous course of illness or the naturalistic treatment during the follow-up. CONCLUSIONS Our study suggests that (a) an evidence-based long-term treatment, with regular follow-up visits could improve the course of disease and prognosis; (b) clinicians should carefully consider the presence of a high number of mixed episodes, to provide more targeted treatment strategies; (c) an appropriate use of antidepressants in selected patients did not worsen the course of illness.
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Affiliation(s)
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Irene Pergentini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Erika Cambiali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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van den Ameele S, Coppens V, Schuermans J, De Boer P, Timmers M, Fransen E, Sabbe B, Morrens M. Neurotrophic and inflammatory markers in bipolar disorder: A prospective study. Psychoneuroendocrinology 2017; 84:143-150. [PMID: 28711724 DOI: 10.1016/j.psyneuen.2017.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/26/2017] [Accepted: 07/04/2017] [Indexed: 01/09/2023]
Abstract
Altered neurotrophic signaling is thought to impair neuroplasticity in bipolar disorder (BD). Brain-derived neurotrophic factor (BDNF) is proposed as a neurotrophic marker in BD. However, the current evidence for its use in monitoring disease activity and illness progression is conflicting and an exploration of additional neurotrophic markers is needed. This prospective case-control study investigated mood-specific changes in potential neurotrophic markers and their association to inflammatory activity. Patients with BD were included during an acute mood episode, either depressive (n=35) or (hypo)manic (n=32). Fifty-nine patients (88%) and 29 healthy controls (97%) completed the study. Peripheral blood levels of BDNF, vascular endothelial growth factor A (VEGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and tumor necrosis factor alpha (TNF-α) were measured at baseline and after 2 months. Biomarker levels in patients were compared to controls and correlated to HDRS-17 and YMRS total scores and the PANSS positive subscale scores. Linear mixed model analysis revealed no significant differences in neurotrophic markers between patients and controls. We found significantly increased TNF-α levels in patients and a subsequent normalization during euthymia. None of the biomarkers strongly correlated to mood symptom severity. Despite standardized methodological practices, BDNF and VEGF levels had a wide distribution range. We need a better understanding of methodological aspects influencing the analysis of neurotrophic factors to improve future research on markers for mood state monitoring and illness progression in BD.
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Affiliation(s)
- Seline van den Ameele
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.
| | - Violette Coppens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Jeroen Schuermans
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Peter De Boer
- Experimental Medicine Neuroscience, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Maarten Timmers
- Janssen Research and Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Belgium
| | - Erik Fransen
- StatUa - Center for Statistics, University of Antwerp, Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
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Social and academic premorbid adjustment domains predict different functional outcomes among youth with first episode mania. J Affect Disord 2017; 219:133-140. [PMID: 28550765 DOI: 10.1016/j.jad.2017.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/21/2017] [Accepted: 05/19/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Premorbid characteristics may help predict the highly variable functional and illness outcomes of young people with early stage Bipolar Disorder (BD). We sought to examine the relationships between premorbid adjustment and short to medium-term outcomes after a first treated episode of mania. METHODS We examined the baseline and 18-month follow-up characteristics of 117 participants with first episode of mania, treated at two tertiary early intervention services in Melbourne, Australia. The baseline demographic, family history, diagnoses, comorbidity and clinical features were determined using unstructured questionnaires and structured diagnostic interviews. Premorbid adjustment was determined using the Premorbid Adjustment Scale (PAS), the components of which were identified using a principal component analysis. Eighteen-month follow-up outcome measures included the Clinical Global Impressions scale, Social and Occupational Functioning Assessment Scale and the Heinrichs' Quality of Life Scale (QLS). Correlations and linear regressions were utilised to examine the relationships between component scores and outcomes, while controlling for baseline and follow-up confounders. RESULTS The social adjustment component of the PAS correlated with the interpersonal relations (rs = -0.46, p<0.001) domain of QLS while the academic adjustment component of the PAS correlated with the vocational functioning domain of QLS (rs =-0.39, p = 0.004). Premorbid adjustment did not predict illness severity or objective functioning. LIMITATIONS Lack of information on cognition, personality factors and prodromal symptoms limited the assessment of their impact on outcomes. CONCLUSIONS Impairments in domains of premorbid adjustment may be early markers of persistent difficulties in social and vocational functioning and may benefit from targeted interventions.
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Italian Bipolar II vs I patients have better individual functioning, in spite of overall similar illness severity. CNS Spectr 2017; 22:325-332. [PMID: 26905615 DOI: 10.1017/s1092852915000887] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
UNLABELLED Introduction Bipolar disorders (BDs) comprise different variants of chronic, comorbid, and disabling conditions, with relevant suicide and suicide attempt rates. The hypothesis that BD types I (BDI) and II (BDII) represent more and less severe forms of illness, respectively, has been increasingly questioned over recent years, justifying additional investigation to better characterize related sociodemographic and clinical profiles. METHODS A sample of 217 outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-described BD (141 BDI, 76 BDII), without a current syndromal mood episode, was recruited, and sociodemographic and clinical characteristics of BDI and II patients were compared. RESULTS BDII patients had significantly more favorable sociodemographics, in relation to occupational stability, cohabitation, and marital status. However, BDII compared with BDI patients had significantly longer duration of untreated illness, more frequent lifetime anxiety disorders comorbidity, longer most recent episode duration, higher rate of depressive first/most recent episode, and more current antidepressant use. In contrast, BDI compared with BDII patients had significantly more severe illness in terms of earlier age at onset; higher rate of elevated first/most recent episode, lifetime hospitalizations, and involuntary commitments; lower Global Assessment of Functioning score; and more current antipsychotic use. BDI and II patients had similar duration of illness, psychiatric family history, lifetime number of suicide attempts, current subthreshold symptoms, history of stressful life events, and overall psychiatric/medical comorbidity. CONCLUSION BDII compared with BDI patients had more favorable sociodemographic features, but a mixture of specific unfavorable illness characteristics, confirming that BDII is not just a milder form of BD and requires further investigation in the field.
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Caldieraro MA, Sylvia LG, Dufour S, Walsh S, Janos J, Rabideau DJ, Kamali M, McInnis MG, Bobo WV, Friedman ES, Gao K, Tohen M, Reilly-Harrington NA, Ketter TA, Calabrese JR, McElroy SL, Thase ME, Shelton RC, Bowden CL, Kocsis JH, Deckersbach T, Nierenberg AA. Clinical correlates of acute bipolar depressive episode with psychosis. J Affect Disord 2017; 217:29-33. [PMID: 28365478 DOI: 10.1016/j.jad.2017.03.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/24/2017] [Accepted: 03/05/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Psychotic bipolar depressive episodes remain remarkably understudied despite being common and having a significant impact on bipolar disorder. The aim of this study is to identify the characteristics of depressed bipolar patients with current psychosis compared to those without psychosis. METHODS We used baseline data of a comparative effectiveness study of lithium and quetiapine for bipolar disorder (the Bipolar CHOICE study) to compare demographic, clinical, and functioning variables between those with and without psychotic symptoms. Of the 482 participants, 303 (62.9%) were eligible for the present study by meeting DSM-IV criteria for an acute bipolar depressive episode. Univariate analyses were conducted first, and then included in a model controlling for symptom severity. RESULTS The sample was composed mostly of women (60.7%) and the mean age was 39.5±12.1 years. Psychosis was present in 10.6% (n=32) of the depressed patients. Psychotic patients had less education, lower income, and were more frequently single and unemployed. Psychosis was also associated with a more severe depressive episode, higher suicidality, more comorbid conditions and worse functioning. Most group differences disappeared when controlling for depression severity. LIMITATIONS Only outpatients were included and the presence of psychosis in previous episodes was not assessed. CONCLUSION Psychosis during bipolar depressive episodes is present even in an outpatient sample. Psychotic, depressed patients have worse illness outcomes, but future research is necessary to confirm if these outcomes are only associated with the severity of the disorder or if some of them are independent of it.
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Affiliation(s)
- Marco Antonio Caldieraro
- Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Steven Dufour
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Samantha Walsh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica Janos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dustin J Rabideau
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Keming Gao
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Noreen A Reilly-Harrington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Terence A Ketter
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA USA
| | - Joseph R Calabrese
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College, Ithaca, NY, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Carta MG, Atzeni M, D’Oca S, Perra A, D’Aloja E, Brasesco MV, Moro MF, Minerba L, Sancassiani F, Moro D, Mausel G, Bhugra D. Depression in Sardinian immigrants in Argentina and residents in Sardinia at the time of the Argentinian default (2001) and the Great Recession in Italy (2015). BMC Psychiatry 2017; 17:59. [PMID: 28178943 PMCID: PMC5299775 DOI: 10.1186/s12888-017-1226-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 02/01/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study is to measure in two samples of Sardinian immigrants in Buenos Aires and representatives of the population in Sardinia the prevalence of depressive symptoms at the time of an economic crisis in Sardinia and to compare these results with those collected at the time of a similar crisis in Argentina more than 10 years before. METHODS Observational study. The associations of Sardinian immigrants in Buenos Aires provided the lists of families of Sardinian origin. A random sample of one fifth of registered families was selected. The sample of a study carried out in Sardinia was used as the control. The results were compared with those of the previous study performed in 2001-2002. The Patient Health Questionnaire (PHQ9) was used for the screening of depression. RESULTS The Sardinian immigrants show a lower rate of scoring positively on PHQ9 (i.e. less risk of being depressed) and reach statistical significance after standardization (8.7% vs. 13.1%, P = 0.046). Young women (≤40) are at higher risk. On the contrary, the risk of depression was higher in Sardinian immigrants in Argentina during the 2001-2002 crises. CONCLUSION The study indicates a risk for depressive episodes linked to the fallout of the economic crisis (in Argentina in 2001-2002, in Sardinia in 2015) and specifically more in females than in males. Due to the associated socio-demographic risk factors, these results could be interpreted as due to an increase in non-bipolar depression.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| | - Michela Atzeni
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Silvia D’Oca
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Alessandra Perra
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Ernesto D’Aloja
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Maria Francesca Moro
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Daniela Moro
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Gustavo Mausel
- grid.441630.4Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Dinesh Bhugra
- 0000 0001 2322 6764grid.13097.3cKing’s College, London, UK
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Pallaskorpi S, Suominen K, Ketokivi M, Valtonen H, Arvilommi P, Mantere O, Leppämäki S, Isometsä E. Incidence and predictors of suicide attempts in bipolar I and II disorders: A 5-year follow-up study. Bipolar Disord 2017; 19:13-22. [PMID: 28176421 DOI: 10.1111/bdi.12464] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/29/2016] [Accepted: 12/16/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Few long-term studies on bipolar disorder (BD) have investigated the incidence and risk factors of suicide attempts (SAs) specifically related to illness phases. We examined the incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and bipolar II (BD-II) patients, and risk factors specifically for SAs during major depressive episodes (MDEs). METHODS In the Jorvi Bipolar Study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to 5 years. The incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models. RESULTS During the 5 years of follow-up, 90 SAs per 718 patient-years occurred. The incidence was highest, over 120-fold higher than in euthymia, during mixed states (765/1000 person-years; 95% confidence interval [CI] 461-1269 person-years), and also very high in MDEs, almost 60-fold higher than in euthymia (354/1000 person-years; 95% CI 277-451 person-years). For risk of SAs during MDEs, the duration of MDEs, severity of depression, and cluster C personality disorders were significant predictors. CONCLUSIONS We confirmed in this long-term study that the highest incidences of SAs occur in mixed and major depressive illness phases. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question "when" rather than "who" may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.
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Affiliation(s)
- Sanna Pallaskorpi
- Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland.,Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Kirsi Suominen
- Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Mikko Ketokivi
- Operations and Technology Department, IE Business School - IE University, Madrid, Spain
| | - Hanna Valtonen
- Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Petri Arvilommi
- Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland.,Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Outi Mantere
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Sami Leppämäki
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.,Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Gkintoni E, Pallis EG, Bitsios P, Giakoumaki SG. Neurocognitive performance, psychopathology and social functioning in individuals at high risk for schizophrenia or psychotic bipolar disorder. J Affect Disord 2017; 208:512-520. [PMID: 27810272 DOI: 10.1016/j.jad.2016.10.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although cognitive deficits are consistent endophenotypes of schizophrenia and bipolar disorder, findings in psychotic bipolar disorder (BDP) are inconsistent. In this study we compared adult unaffected first-degree relatives of schizophrenia and BDP patients on cognition, psychopathology, social functioning and quality of life. METHODS Sixty-six unaffected first-degree relatives of schizophrenia patients (SUnR), 36 unaffected first-degree relatives of BDP patients (BDPUnR) and 102 controls participated in the study. Between-group differences were examined and Discriminant Function Analysis (DFA) predicted group membership. RESULTS Visual memory, control inhibition, working memory, cognitive flexibility and abstract reasoning were linearly impaired in the relatives' groups. Poorer verbal fluency and processing speed were evident only in the SUnR group. The SUnR group had higher depressive and somatization symptoms while the BDPUnR group had higher anxiety and lower social functioning compared with the controls. Individuals with superior cognition were more likely to be classified as controls; those with higher social functioning, prolonged processing speed and lower anxiety were more likely to be classified as SUnR. LIMITATIONS The relatives' sample is quite heterogeneous; the effects of genetic or environmental risk-factors were not examined. CONCLUSIONS Cognitive functions mediated by a fronto-parietal network, show linear impairments in unaffected relatives of BDP and schizophrenia patients; processing speed and verbal fluency impairments were evident only in schizophrenia relatives. Self-perceived symptomatology and social functioning also differ between schizophrenia and BDP relatives. The continuum seen in patients in several indices was also seen in the cognitive impairments in unaffected relatives of schizophrenia and BDP patients.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece
| | - Eleftherios G Pallis
- Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Panos Bitsios
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stella G Giakoumaki
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece.
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Aaltonen K, Näätänen P, Heikkinen M, Koivisto M, Baryshnikov I, Karpov B, Oksanen J, Melartin T, Suominen K, Joffe G, Paunio T, Isometsä E. Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders. J Affect Disord 2016; 193:318-30. [PMID: 26774520 DOI: 10.1016/j.jad.2015.12.033] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. METHODS The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. RESULTS Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. LIMITATIONS Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. CONCLUSIONS Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.
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Affiliation(s)
- Kari Aaltonen
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti Heikkinen
- Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maaria Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilya Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Boris Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Oksanen
- Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tarja Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Suominen
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Paunio
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Jylhä P, Rosenström T, Mantere O, Suominen K, Melartin T, Vuorilehto M, Holma M, Riihimäki K, Oquendo MA, Keltikangas-Järvinen L, Isometsä ET. Personality disorders and suicide attempts in unipolar and bipolar mood disorders. J Affect Disord 2016; 190:632-639. [PMID: 26590510 DOI: 10.1016/j.jad.2015.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/07/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. METHODS Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. RESULTS Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. LIMITATIONS Findings generalizable only to patients with mood disorders. CONCLUSIONS Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
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Affiliation(s)
- Pekka Jylhä
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Tom Rosenström
- IBS, Unit of Personality, Work and Health Psychology,University of Helsinki, Helsinki, Finland
| | - Outi Mantere
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Kirsi Suominen
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; City of Helsinki, Social Services and Healthcare, Department of Mental Health and Substance Abuse, Helsinki, Finland
| | - Tarja Melartin
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Maria Vuorilehto
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Mikael Holma
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Riihimäki
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; Healthcare and Social Services, City of Järvenpää, Järvenpää, Finland
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Erkki T Isometsä
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
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