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Sharma A, Neely J, Camilleri N, James A, Grunze H, Le Couteur A. Incidence, characteristics and course of narrow phenotype paediatric bipolar I disorder in the British Isles. Acta Psychiatr Scand 2016; 134:522-532. [PMID: 27744649 DOI: 10.1111/acps.12657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate the surveillance incidence of first-time diagnosis of narrow phenotype bipolar I disorder (NPBDI) in young people under 16 years by consultants in child and adolescent psychiatry (CCAP) in the British Isles and describe symptoms, comorbidity, associated factors, management strategies and clinical outcomes at 1-year follow-up. METHOD Active prospective surveillance epidemiology was utilised to ask 730 CCAP to report cases of NPBDI using the child and adolescent psychiatry surveillance system. RESULTS Of the 151 cases of NPBDI reported, 33 (age range 10-15.11 years) met the DSM-IV analytical case definition with 60% having had previously undiagnosed mood episodes. The minimum 12-month incidence of NPBDI in the British Isles was 0.59/100 000 (95% CI 0.41-0.84). Irritability was reported in 72% cases and comorbid conditions in 51.5% cases with 48.5% cases requiring admission to hospital. Relapses occurred in 56.67% cases during the 1-year follow-up. CONCLUSIONS These rates suggest that the first-time diagnosis of NPBDI in young people <16 years of age by CCAP in the British Isles is infrequent; however, the rates of relapse and admission to hospital warrant close monitoring.
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Affiliation(s)
- A Sharma
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Neely
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - N Camilleri
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Tees, Esk and Wear Valley NHS Foundation Trust, Darlington, UK
| | - A James
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - H Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - A Le Couteur
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA. Age at Onset of Bipolar Disorder Related to Parental and Grandparental Illness Burden. J Clin Psychiatry 2016; 77:e1309-e1315. [PMID: 27631141 DOI: 10.4088/jcp.15m09811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 11/16/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The age at onset of bipolar disorder varies greatly in different countries and continents. The association between load of family history of psychiatric illness and age at onset has not been adequately explored. METHODS 979 outpatients with bipolar disorder (from 4 sites in the United States and 3 in the Netherlands and Germany) gave informed consent and completed a questionnaire about their demographics, age at onset of illness, and family history of unipolar and bipolar disorder, alcohol and substance abuse comorbidity, suicide attempts, and "other" illnesses in their parents, 4 grandparents, and any offspring. We examined how the parental and grandparental burden of these illnesses related to the age at onset of the patients' bipolar disorder. RESULTS The burden of family psychiatric history was strongly related to an earlier age at onset of illness in both US and European patients (F₃,₉₀₆ = 35.42, P < .0001). However, compared to the Europeans, patients in the United States had both more family history of most difficulties and notably earlier age at onset. Earlier age at onset was associated with a greater illness burden in the patient's offspring (t₅₆₈ = 4.1, P < .0001). CONCLUSIONS More parental and grandparental psychiatric illness was associated with an earlier age at onset of bipolar disorder, which is earlier in the United States compared with Europe and is strongly related to a poor long-term prognosis. This apparent polygenic contribution to early onset deserves further study and therapeutic attempts at ameliorating the transgenerational impact.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, 5415 West Cedar Ln, Ste 201B, Bethesda, MD 20814.
- Bipolar Collaborative Network, Bethesda, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, California, USA
| | - Ralph Kupka
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, Ohio, USA
- Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, Michigan, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, Maryland, USA
| | - Heinz Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Lindner Center of HOPE, Mason, Ohio, USA
| | | | - Willem A Nolen
- University Medical Center, University of Groningen, the Netherlands
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Miller S, Suppes T, Mintz J, Hellemann G, Frye MA, McElroy SL, Nolen WA, Kupka R, Leverich GS, Grunze H, Altshuler LL, Keck PE, Post RM. Mixed Depression in Bipolar Disorder: Prevalence Rate and Clinical Correlates During Naturalistic Follow-Up in the Stanley Bipolar Network. Am J Psychiatry 2016; 173:1015-1023. [PMID: 27079133 DOI: 10.1176/appi.ajp.2016.15091119] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE DSM-5 introduced the "with mixed features" specifier for major depressive episodes. The authors assessed the prevalence and phenomenology of mixed depression among bipolar disorder patients and qualitatively compared a range of diagnostic thresholds for mixed depression. METHOD In a naturalistic study, 907 adult outpatients with bipolar disorder participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,310 visits from 1995 to 2002. The Inventory of Depressive Symptomatology-Clinician-Rated Version (IDS-C) and the Young Mania Rating Scale (YMRS) were administered at each visit. RESULTS Mixed depression, defined as an IDS-C score ≥15 and a YMRS score >2 and <12 at the same visit, was observed in 2,139 visits (14.9% of total visits, and 43.5% of visits with depression) by 584 patients (64.4% of all patients). Women were significantly more likely than men to experience subthreshold hypomania during visits with depression (40.7% compared with 34.4%). Patients with one or more mixed depression visits had more symptomatic visits and fewer euthymic visits compared with those with no mixed depression visits. DSM-5-based definitions of mixed depression (ranging from narrower definitions requiring ≥3 nonoverlapping YMRS items concurrent with an IDS-C score ≥15, to broader definitions requiring ≥2 nonoverlapping YMRS items) yielded lower mixed depression prevalence rates (6.3% and 10.8% of visits, respectively) but were found to have similar relationships to gender and longitudinal symptom severity. CONCLUSIONS Among outpatients with bipolar disorder, concurrent hypomanic symptoms observed during visits with depression were common, particularly in women. The DSM-5 diagnostic criteria for depression with mixed features may yield inadequate sensitivity to detect patients with mixed depression.
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Affiliation(s)
- Shefali Miller
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Trisha Suppes
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Jim Mintz
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Gerhard Hellemann
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Mark A Frye
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Susan L McElroy
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Willem A Nolen
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Ralph Kupka
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Gabriele S Leverich
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Heinz Grunze
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Lori L Altshuler
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Paul E Keck
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Robert M Post
- From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA. Age of onset of bipolar disorder: Combined effect of childhood adversity and familial loading of psychiatric disorders. J Psychiatr Res 2016; 81:63-70. [PMID: 27392070 DOI: 10.1016/j.jpsychires.2016.06.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 04/18/2016] [Accepted: 06/10/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Family history and adversity in childhood are two replicated risk factors for early onset bipolar disorder. However, their combined impact has not been adequately studied. METHODS Based on questionnaire data from 968 outpatients with bipolar disorder who gave informed consent, the relationship and interaction of: 1) parental and grandparental total burden of psychiatric illness; and 2) the degree of adversity the patient experienced in childhood on their age of onset of bipolar disorder was examined with multiple regression and illustrated with a heat map. RESULTS The familial loading and child adversity vulnerability factors were significantly related to age of onset of bipolar and their combined effect was even larger. A heat map showed that at the extremes (none of each factor vs high amounts of both) the average age of onset differed by almost 20 years (mean = 25.8 vs 5.9 years of age). LIMITATIONS The data were not based on interviews of family members and came from unverified answers on a patient questionnaire. CONCLUSIONS Family loading for psychiatric illness and adversity in childhood combine to have a very large influence on age of onset of bipolar disorder. These variables should be considered in assessment of risk for illness onset in different populations, the need for early intervention, and in the design of studies of primary and secondary prevention.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington D.C., USA.
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Ralph Kupka
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MI, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Heinz Grunze
- Paracelsus Medical University, Salzburg, Austria
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA
| | | | - Willem A Nolen
- University Medical Center, University of Groningen, Groningen, The Netherlands
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Post RM, Kupka R, Keck PE, McElroy SL, Altshuler LL, Frye MA, Rowe M, Grunze H, Suppes T, Leverich GS, Nolen WA. Further Evidence of a Cohort Effect in Bipolar Disorder: More Early Onsets and Family History of Psychiatric Illness in More Recent Epochs. J Clin Psychiatry 2016; 77:1043-9. [PMID: 27379705 DOI: 10.4088/jcp.15m10121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Given that a cohort effect is rarely mentioned as one of the possible contributors to the increased incidence of childhood-onset bipolar disorder in the United States, we reexamined evidence for the phenomenon within our outpatient Bipolar Collaborative Network. METHODS 968 outpatients (mean age, 41 years) with DSM bipolar disorder from 1995 to 2002 from 4 sites in the United States and 3 in the Netherlands and Germany (abbreviated as Europe) gave informed consent and provided detailed demographic, illness, and family history information on a patient questionnaire. Family history of bipolar disorder, depression, suicide attempt, alcohol abuse, substance abuse, and "other" illness was collected for each parent and the 4 grandparents. Age at onset and family history of illness burden were then assessed as a function of the age of the patient at network entry. RESULTS Data for patients aged 35 years or older (n = 613) were included in the first analysis. Compared to older patients, those who were younger when they entered the network had an earlier age at onset of their bipolar disorder (r = 0.33, P < .001). Similarly, the youngest patients at entry (representing the most recent cohorts) had parents and grandparents with more psychiatric illness than patients born in earlier cohorts (n = 968). CONCLUSIONS These preliminary data, taken with the substantial literature, suggest a cohort effect for earlier age at onset of bipolar disorder and greater burden of psychiatric disorders in 2 generations of direct progenitors of our patients. The resulting likely increase in severity of bipolar illness in future generations based on this earlier age at onset and increased familial loading, particularly in the United States, deserves focused clinical and public health attention and attempts at amelioration.
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Affiliation(s)
- Robert M Post
- 5415 W Cedar Ln, Ste 201-B, Bethesda, MD 20814.
- Bipolar Collaborative Network, Bethesda, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC
| | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Ohio, USA
- Lindner Center of HOPE, Mason, Ohio, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, Ohio, USA
- Biological Psychiatry Program, University of Cincinnati Medical College, Ohio, USA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, California, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, Maryland, USA
| | - Heinz Grunze
- Newcastle University, Institute of Neuroscience & Campus of Aging and Vitality, Wolfson Research Centre, Newcastle upon Tyne, United Kingdom
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Willem A Nolen
- University of Groningen, University Medical Center Groningen, the Netherlands
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Post RM, Leverich GS, Kupka R, Keck PE, McElroy SL, Altshuler LL, Frye MA, Rowe M, Grunze H, Suppes T, Nolen WA. Clinical correlates of sustained response to individual drugs used in naturalistic treatment of patients with bipolar disorder. Compr Psychiatry 2016; 66:146-56. [PMID: 26995248 DOI: 10.1016/j.comppsych.2016.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To report use and treatment success rates of medications for bipolar disorder as a function of patients' clinical characteristics. METHOD Outpatients with bipolar illness diagnosed by SCID were rated by research assistants on the NIMH-LCM and those who had an good response for at least 6months (much or very much improved on the CGI-BP) were considered responders (treatment "success"). Clinical characteristics associated with treatment response in the literature were examined for how often a drug was in a successful regimen when a given characteristic was either present or absent. RESULTS Lithium was less successful in those with histories of rapid cycling, substance abuse, or (surprisingly) a positive parental history of mood disorders. Valproate was less successful in those with ≥20 prior episodes. Lamotrigine (LTG) was less successful in those with a parental history of mood disorders or in BP-I compared to BP-II disorder. Antidepressants (ADs) had low success rates, especially in those with a history of anxiety disorders. Benzodiazepines had low success rates in those with child abuse, substance use, or ≥20 episodes. Atypical antipsychotics were less successful in the presence of rapid cycling, ≥20 prior episodes, or a greater number of poor prognosis factors. CONCLUSION Success rates reflect medications used in combination with an average of two other drugs during naturalistic treatment and thus should be considered exploratory. However, the low long-term success rates of drugs (even when used in combination with others) that occurred in the presence of many very common clinical characteristics of bipolar illness speak to the need for the development of alternative treatment strategies.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA.
| | | | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MI, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Heinz Grunze
- Institute of Neuroscience, Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | - Willem A Nolen
- University Medical Center, University of Groningen, Groningen, the Netherlands
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA. More illness in offspring of bipolar patients from the U.S. compared to Europe. J Affect Disord 2016; 191:180-6. [PMID: 26655863 DOI: 10.1016/j.jad.2015.11.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/22/2015] [Accepted: 11/22/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Evidence suggests that patients with bipolar disorder from the United States have an earlier age of onset and a more difficult course of illness than those from Germany and the Netherlands. These characteristics were related to a greater family burden of psychiatric illness and the experience of more psychosocial adversity in childhood. We hypothesized that this greater illness burden would extend to the offspring of the US patients. METHODS 968 outpatients (average age 41) with bipolar illness gave informed consent for participation in a treatment outcome network and filled out a detailed questionnaire about their illness and family history of illness, including whether their offspring had a diagnosis of depression, bipolar disorder, alcohol or substance abuse, suicide attempt or "other" illness. Of those with children, 356 were from the US and 132 were from Europe. RESULTS Compared to the Europeans, offspring of patients from the US had significantly (p<0.001) more depression, bipolar disorder, drug abuse, and "other" illnesses. The number of illnesses in the offspring was related to the bipolar parent being from the US, having had childhood adversity, more than 20 prior episodes, and more parental psychiatric illness. CONCLUSIONS While the findings are limited by their basis on self report, the distribution of the percentages in the US offspring are similar to those of Axelson et al. (2015) who used direct interviews. The higher burden of illness in the offspring and their in direct progenitors from the US compared to Europe warrant new attempts at better treatment and prevention.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington D.C., USA.
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA; Julia S. Gouw Professor in Mood Disorders Research, Director, UCLA Mood Disorders Research Program, USA
| | - Ralph Kupka
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MI, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Heinz Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA
| | | | - Willem A Nolen
- University Medical Center, University of Groningen, Groningen, The Netherlands
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McAllister-Williams RH, Anderson IM, Finkelmeyer A, Gallagher P, Grunze HCR, Haddad PM, Hughes T, Lloyd AJ, Mamasoula C, McColl E, Pearce S, Siddiqi N, Sinha BNP, Steen N, Wainwright J, Winter FH, Ferrier IN, Watson S. Antidepressant augmentation with metyrapone for treatment-resistant depression (the ADD study): a double-blind, randomised, placebo-controlled trial. Lancet Psychiatry 2016; 3:117-27. [PMID: 26727041 DOI: 10.1016/s2215-0366(15)00436-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many patients with major depressive disorder have treatment-resistant depression, defined as no adequate response to two consecutive courses of antidepressants. Some evidence suggests that antiglucocorticoid augmentation of antidepressants might be efficacious in patients with major depressive disorder. We aimed to test the proof of concept of metyrapone for the augmentation of serotonergic antidepressants in the clinically relevant population of patients with treatment-resistant depression. METHODS This double-blind, randomised, placebo-controlled trial recruited patients from seven UK National Health Service (NHS) Mental Health Trusts from three areas (northeast England, northwest England, and the Leeds and Bradford area). Eligible patients were aged 18-65 years with treatment-resistant depression (Hamilton Depression Rating Scale 17-item score of ≥18 and a Massachusetts General Hospital Treatment-Resistant Depression staging score of 2-10) and taking a single-agent or combination antidepressant treatment that included a serotonergic drug. Patients were randomly assigned (1:1) through a centralised web-based system to metyrapone (500 mg twice daily) or placebo, in addition to their existing antidepressant regimen, for 21 days. Permuted block randomisation was done with a block size of two or four, stratified by centre and primary or secondary care setting. The primary outcome was improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) score 5 weeks after randomisation, analysed in the modified intention-to-treat population of all randomly assigned patients that completed the MADRS assessment at week 5. The study has an International Standard Randomised Controlled Trial Number (ISRCTN45338259) and is registered with the EU Clinical Trial register, number 2009-015165-31. FINDINGS Between Feb 8, 2011, and Dec 10, 2012, 165 patients were recruited and randomly assigned (83 to metyrapone and 82 to placebo), with 143 (87%) completing the primary outcome assessment (69 [83%] in the metyrapone and 74 [90%] in the placebo group). At 5 weeks, MADRS score did not significantly differ between groups (21·7 points [95% CI 19·2-24·4] in the metyrapone group vs 22·6 points [20·1-24·8] in the placebo group; adjusted mean difference of -0·51 points [95% CI -3·48 to 2·46]; p=0·74). 12 serious adverse events were reported in four (5%) of 83 patients in the metyrapone group and six (7%) of 82 patients in the placebo group, none of which were related to study treatment. 134 adverse events occurred in 58 (70%) patients in the metyrapone group compared with 95 events in 45 (55%) patients in the placebo group, of which 11 (8%) events in the metyrapone group and four (4%) in the placebo group were judged by principle investigators at the time of occurrence to be probably related to the study drug. INTERPRETATION Metyrapone augmentation of antidepressants is not efficacious in a broadly representative population of patients with treatment-resistant depression within the NHS and therefore is not an option for patients with treatment-resistant depression in routine clinical practice at this time. Further research is needed to clarify if such augmentation might benefit subpopulations with demonstrable hypothalamic-pituitary-adrenal axis abnormalities. FUNDING Efficacy and Mechanism Evaluation (EME) programme, a UK Medical Research Council and National Institute for Health Research partnership.
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Affiliation(s)
- R Hamish McAllister-Williams
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Manchester University, Manchester, UK
| | - Andreas Finkelmeyer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Heinz C R Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, Manchester University, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Tom Hughes
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Adrian J Lloyd
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Elaine McColl
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Pearce
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Najma Siddiqi
- Bradford District Care NHS Foundation Trust, Bradford, UK; Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Baxi N P Sinha
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Nick Steen
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - June Wainwright
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona H Winter
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Mohammed Z, Grunze H. Acute pharmacological treatment strategies for bipolar depression. Neuropsychiatry (London) 2016. [DOI: 10.4172/neuropsychiatry.1000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Garriga M, Pacchiarotti I, Kasper S, Zeller SL, Allen MH, Vázquez G, Baldaçara L, San L, McAllister-Williams RH, Fountoulakis KN, Courtet P, Naber D, Chan EW, Fagiolini A, Möller HJ, Grunze H, Llorca PM, Jaffe RL, Yatham LN, Hidalgo-Mazzei D, Passamar M, Messer T, Bernardo M, Vieta E. Assessment and management of agitation in psychiatry: Expert consensus. World J Biol Psychiatry 2016; 17:86-128. [PMID: 26912127 DOI: 10.3109/15622975.2015.1132007] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions. METHODS An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items. RESULTS Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic. CONCLUSIONS Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.
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Affiliation(s)
- Marina Garriga
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
- b Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Isabella Pacchiarotti
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Siegfried Kasper
- c Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | | | - Michael H Allen
- e University of Colorado Depression Center , Denver , CO 80045 , USA
| | - Gustavo Vázquez
- f Research Center for Neuroscience and Neuropsychology, Department of Neuroscience , University of Palermo , Buenos Aires , Argentina
| | | | - Luis San
- h CIBERSAM, Parc Sanitari Sant Joan De Déu , Barcelona , Catalonia , Spain
| | - R Hamish McAllister-Williams
- i Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Konstantinos N Fountoulakis
- j 3rd Department of Psychiatry, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Philippe Courtet
- k Department of Emergency Psychiatry and Post Acute Care , Hôpital Lapeyronie , CHU Montpellier , France
| | - Dieter Naber
- l Department for Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Esther W Chan
- m Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine , the University of Hong Kong , Hong Kong , China
| | - Andrea Fagiolini
- n School of Medicine, Department of Molecular Medicine , University of Siena , Siena , Italy
| | - Hans Jürgen Möller
- o Department of Psychiatry and Psychotherapy , Ludwig Maximilian University , Munich , Germany
| | - Heinz Grunze
- p Paracelsus Medical University , Salzburg , Austria
| | - Pierre Michel Llorca
- q Service De Psychiatrie B , CHU De Clermont-Ferrand , Clermont-Ferrand , France
| | | | - Lakshmi N Yatham
- s Mood Disorders Centre, Department of Psychiatry , University of British Columbia , Vancouver , British Columbia , Canada
| | - Diego Hidalgo-Mazzei
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Marc Passamar
- t Centre Hospitalier Pierre-Jamet, SAUS , Albi , France
| | - Thomas Messer
- u Danuvius Klinik GmbH, Pfaffenhofen an Der Ilm , Germany
| | - Miquel Bernardo
- b Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Eduard Vieta
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
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Post RM, Leverich GS, Kupka R, Keck PE, McElroy SL, Altshuler LL, Frye MA, Rowe M, Grunze H, Suppes T, Nolen WA. Increases in multiple psychiatric disorders in parents and grandparents of patients with bipolar disorder from the USA compared with The Netherlands and Germany. Psychiatr Genet 2015; 25:194-200. [PMID: 26146875 DOI: 10.1097/ypg.0000000000000093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We previously found that compared with Europe more parents of the USA patients were positive for a mood disorder, and that this was associated with early onset bipolar disorder. Here we examine family history of psychiatric illness in more detail across several generations. METHODS A total of 968 outpatients (average age 41) with bipolar disorder from four sites in the USA and three in the Netherlands and Germany (abbreviated as Europe) gave informed consent and provided detailed demographic and family history information on a patient questionnaire. Family history of psychiatric illness (bipolar disorder, unipolar depression, suicide attempt, alcohol abuse, substance abuse, and other illness) was collected for each parent, four grandparents, siblings, and children. RESULTS Parents of the probands with bipolar disorder from the USA compared with Europe had a significantly higher incidence of both unipolar and bipolar mood disorders, as well as each of the other psychiatric conditions listed above. With a few exceptions, this burden of psychiatric disorders was also significantly greater in the grandparents, siblings, and children of the USA versus European patients. CONCLUSION The increased complexity of psychiatric illness and its occurrence over several generations in the families of patients with bipolar disorder from the USA versus Europe could be contributing to the higher incidence of childhood onsets and greater virulence of illness in the USA compared with Europe. These data are convergent with others suggesting increased both genetic and environmental risk in the USA, but require replication in epidemiologically-derived populations with data based on interviews of the family members.
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Affiliation(s)
- Robert M Post
- aBipolar Collaborative Network, Bethesda, Maryland bDepartment of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia cDepartment of Psychiatry and Behavioral Neuroscience dDepartment of Psychiatry and Behavioral Neuroscience, Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati eLindner Center of HOPE, Mason, Ohio fDepartment of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California gDepartment of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles hDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine iV.A. Palo Alto HealthCare System, Palo Alto, California jDepartment of Psychiatry, Mayo Clinic, Rochester, Michigan, USA kDepartment of Psychiatry, VU University Medical Center, Amsterdam lDepartment of Psychiatry, University Medical Center, University of Groningen, Groningen, The Netherlands mDepartment of Psychiatry and Psychotherapy, Christian Doppler Klink, Paracelsus Medical University Salzburg, Austria
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Abstract
BACKGROUND Bipolar II disorder (BP II) is a chronic, frequently co-morbid, and complex disorder with similar rates of attempted suicide to BP I. However, case identification for BP II studies that is based on clinician diagnosis alone is prone to error. This paper reports on differences between clinical and research diagnoses and then describes the clinical characteristics of a carefully defined BP II cohort. METHODS A cohort of rigorously defined BP II cases were recruited from a range of primary and secondary health services in the North of England to participate in a programme of cross-sectional and prospective studies. Case identification, and rapid cycling, comorbidities and functioning were examined. RESULTS Of 355 probable clinical cases of BP II disorder, 176 (∼50%) met rigorous diagnostic criteria. The sample mean age was ∼44 years, with a mean duration of mood disorder of ∼18 years. Two thirds of the cohort were female (n=116), but only 40% were in paid employment. Current and past year functioning was more impaired in females and those with rapid cycling. LIMITATIONS This paper describes only the preliminary assessments of the cohort, so it was not possible to examine additional factors that may contribute to the explained variance in functioning. CONCLUSIONS This carefully ascertained cohort of BP II cases show few gender differences, except for levels of functional impairment. Interestingly, the most common problem identified with using case note diagnoses of BP II arose because of failure to record prior episodes of mania, not failure to identify hypomania.
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Affiliation(s)
- Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, NE4 5PL UK; Centre for Affective Disorders, IPPN, Kings College, London, UK.
| | - Heinz Grunze
- Formerly Institute of Neuroscience, Newcastle University, UK
| | - Thomas D Meyer
- Formerly Institute of Neuroscience, Newcastle University, UK
| | | | - Hannah Watkins
- Formerly Institute of Neuroscience, Newcastle University, UK
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Leverich GS, Grunze H, Suppes T, Keck PE, Nolen WA. Verbal abuse, like physical and sexual abuse, in childhood is associated with an earlier onset and more difficult course of bipolar disorder. Bipolar Disord 2015; 17:323-30. [PMID: 25307301 DOI: 10.1111/bdi.12268] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/01/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Physical or sexual abuse in childhood is known to have an adverse effect on the course of bipolar disorder, but the impact of verbal abuse has not been well elucidated. METHODS We examined the occurrence and frequency (never to frequently) of each type of abuse in childhood in 634 US adult outpatients (average age 40 years). Patients gave informed consent and provided information about their age of onset and course of illness prior to study entry. RESULTS Verbal abuse alone occurred in 24% of the patients. Similar to a history of physical or sexual abuse, a history of verbal abuse was related to an earlier age of onset of bipolar disorder and other poor prognosis characteristics, including anxiety and substance abuse comorbidity, rapid cycling, and a deteriorating illness course as reflected in ratings of increasing frequency or severity of mania and depression. CONCLUSIONS A lasting adverse impact of the experience of verbal abuse in childhood is suggested by its relationship to an earlier age of onset of bipolar disorder, other poor prognosis factors, and a deteriorating course of illness. Verbal abuse is a common confound in comparison groups defined by a lack of physical or sexual abuse. Ameliorating the impact of verbal abuse on the unfolding course of bipolar disorder appears to be an important target of therapeutics and worthy of attempts at primary and secondary prophylaxis. Family-based treatments that focus on psychoeducation, enhancing intra-family communication, and coping skills may be particularly helpful.
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Affiliation(s)
- Robert M Post
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC; Bipolar Collaborative Network, Bethesda, MD
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Grunze H, Kotlik E, Costa R, Nunes T, Falcão A, Almeida L, Soares-da-Silva P. Assessment of the efficacy and safety of eslicarbazepine acetate in acute mania and prevention of recurrence: experience from multicentre, double-blind, randomised phase II clinical studies in patients with bipolar disorder I. J Affect Disord 2015; 174:70-82. [PMID: 25484179 DOI: 10.1016/j.jad.2014.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/02/2014] [Accepted: 11/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Eslicarbazepine acetate (ESL) is an anticonvulsant approved as an adjunctive therapy in adults with partial-onset seizures. OBJECTIVE To evaluate the efficacy, safety and tolerability of ESL in the treatment of acute mania and prevention of recurrence in bipolar disorder I. METHODS Two 3-week multicentre, double-blind, randomised, placebo-controlled studies in acute mania (study BIA-2093-203: dose titrated by response, ESL 600-1800mg or 800-2400mg, once-daily; study BIA-2093-204: fixed doses of 600, 1200 and 1800mg, once-daily) were followed by a recurrence prevention study consisting of a 2-week open-label period (900mg, once-daily) continued by a double-blind, parallel-group, fixed dose (300, 900 and 1800mg, once-daily) period for a minimum of 6 months. The primary endpoint was changed from baseline until the end of the 3-week treatment period in Young Mania Rating Scale (YMRS) in studies BIA-2093-203 and BIA-2093-204, and the proportion of patients showing no worsening according to the Clinical Global Impressions - Bipolar Version (CGI-BP) over Part II in study BIA-2093-205. RESULTS In study BIA-2093-203 (n=160, ITT), neither dose group was statistically different from placebo in the primary endpoint, though the ESL 800-2400mg showed a greater reduction in YMRS score (p=0.0523). CGI-BP score changes for mania and overall bipolar illness indicate a significant improvement in patient symptomatology for the ESL 800-2400mg group (from preceding and worst phase) and for ESL 600-1800mg group (from worst phase only) when compared to placebo. Study BIA-2093-204 (n=38) results were inconclusive due to premature termination caused by recruitment difficulties. In study BIA-2093-205 (n=85, ITT), at least 50% of patients showed no worsening in all treatment groups (p=0.250). ESL adverse events were mostly of mild and moderate intensities and consistent with previously reported observations for ESL. CONCLUSION ESL treatment was not significantly different from placebo in manic patients in the primary outcome, but secondary outcomes may be suggestive of efficacy. The recurrence prevention study provides preliminary support for efficacy of ESL in patients recovered from an acute manic episode.
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Affiliation(s)
- Heinz Grunze
- Institute of Neuroscience, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | | | - Raquel Costa
- Department of Research and Development, BIAL - Portela & C(a), S.A., S. Mamede do Coronado, Portugal
| | - Teresa Nunes
- Department of Research and Development, BIAL - Portela & C(a), S.A., S. Mamede do Coronado, Portugal
| | - Amílcar Falcão
- Department of Pharmacology, Faculty of Pharmacy, University of Coimbra, Portugal
| | - Luis Almeida
- Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Porto, Portugal; Health Sciences Department, University of Aveiro, Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development, BIAL - Portela & C(a), S.A., S. Mamede do Coronado, Portugal; Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Porto, Portugal; MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.
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Abstract
INTRODUCTION Anticonvulsants (AC) are widely used and recommended as a treatment option in different phases of bipolar disorder (BD). In contrast to ample evidence for efficacy in acute mania, there is generally less unambiguous evidence for maintenance treatment or bipolar depression, and data on long-term tolerability in BD are sparse, although this varies greatly between different compounds. This review summarizes the clinically relevant tolerability and safety profile of ACs commonly used for the treatment of BD based on findings from randomized controlled trials (RCT). AREAS COVERED Systematic search of the English literature between January 1991 and May 2015 revealed a total of nine RCTs investigating valproate, five RCTs with carbamazepine and 8 with lamotrigine For these ACs we found information on side effect profiles for both acute and maintenance RCTs, albeit of varying quality, whereas for topiramate (five RCTs), gabapentin and esclicarbazepine acetate (one RCT each) only acute treatment RCTs have been published. Descriptive side effect profiles from open-label studies exist for several other ACs rarely used in BD, and are included in this review as a brief narrative chapter. EXPERT OPINION Whereas both valproate and carbamazepine are associated with, in part, severe adverse events, lamotrigine emerges as a relatively safe and well tolerated treatment option, especially in maintenance treatment and prevention of depressive relapse in BD. Lack of proven efficacy and side effect profile of other, less rigorously studied ACs restricts their use only to very selected BD cases.
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Affiliation(s)
- Eva Maria Pichler
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
| | - Georg Hattwich
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
| | - Heinz Grunze
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
| | - Moritz Muehlbacher
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
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Post RM, Altshuler L, Leverich GS, Frye MA, Suppes T, McElroy SL, Keck PE, Nolen WA, Kupka RW, Grunze H, Rowe M. Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder. Compr Psychiatry 2015; 56:21-8. [PMID: 25284280 DOI: 10.1016/j.comppsych.2014.08.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. METHODS The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900 outpatients with bipolar disorder who gave informed consent. The relationship of PPFs to the number of medical comorbidities was examined by Mann-Whitney U, Pearson r, and logistic regression. RESULTS When examined individually, each of the 6 PPFs associated with an adverse course of bipolar disorder was significantly related to the number of medical comorbidities patients had. When age, gender, and independence of their relationships to each other were controlled for via regression, 3 of the PPFs remained significant (anxiety disorder, childhood abuse, and age of onset), and having 20 or more prior episodes was a strong trend. The number of PPFs was correlated with the number of comorbidities, although the above 3 PPFs show a similar magnitude of relationship. CONCLUSION A history of childhood adversity, early age of onset of bipolar disorder, and an anxiety comorbidity were independently related to the number of medical comorbidities that patients experienced as adults. While the nature and mechanisms of this linkage remain to be further explored, the findings indicate the need for greater attention to and treatment of these 3 PPFs in hopes of ameliorating both the adverse course of bipolar illness and the burden of medical comorbidities with which they are associated.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, United States.
| | - Lori Altshuler
- UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, United States
| | | | | | - Trish Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States; Palo Alto Health Care System, Palo Alto, CA, United States
| | - Susan L McElroy
- Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - Paul E Keck
- Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - Willem A Nolen
- Universitair Medisch Centrum Groningen (UMCG), Groningen, the Netherlands
| | - Ralph W Kupka
- VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Heinz Grunze
- Newcastle University, Institute of Neuroscience, Newcastle upon the Tyne, UK
| | - Mike Rowe
- Bipolar Collaborative Network, Bethesda, MD, United States
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68
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Post RM, Altshuler L, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA. Multigenerational Positive Family History of Psychiatric Disorders Is Associated With a Poor Prognosis in Bipolar Disorder. J Neuropsychiatry Clin Neurosci 2015; 27:304-10. [PMID: 26258489 DOI: 10.1176/appi.neuropsych.14080204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The authors assessed how family history loading affected the course of illness in patients from the United States. A total of 676 outpatients with bipolar disorder from the United States rated their illness and provided a parental and grandparental history of mood disorder, substance abuse, and other clinical conditions. A positive family history for each illness was associated with almost all of the seven poor prognosis factors established in the study (abuse in childhood, early onset, anxiety and substance abuse comorbidity, rapid cycling, multiple episodes, and worsening of severity or frequency of episodes). Family history for psychiatric difficulties in parents and grandparents was associated with a more complex and difficult course of bipolar illness.
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Affiliation(s)
- Robert M Post
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Lori Altshuler
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Ralph Kupka
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Susan L McElroy
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Mark A Frye
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Michael Rowe
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Heinz Grunze
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Trisha Suppes
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Paul E Keck
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Gabriele S Leverich
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
| | - Willem A Nolen
- From the Bipolar Collaborative Network, Bethesda, MD (RMP, MR, GSL); Dept. of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC (RMP); Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (LA); Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA (LA); Dept. of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (RK); Lindner Center of HOPE, Mason, OH (SLM, PEK); Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH (SLM); Dept. of Psychiatry, Mayo Clinic, Rochester, MN (MAF); Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (HG); Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA (TS); VA Palo Alto Health Care System, Palo Alto, CA (TS); Dept. of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH (PEK); and University Medical Center, University of Groningen, Groningen, the Netherlands (WAN)
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Abstract
The role of stimulants for treating severe depression remains controversial, especially when it comes to bipolar depression. Potential benefits have to be weighed against risks, including addictive potential and treatment-emergent mania. But not all stimulants are the same. Modafinil and its R-enantiomer armodafinil seem to have positive augmentation effects when coupled with standard treatment of bipolar depression, while also having a relative low risk of addiction and manic switches. A recent hypothesis derived from the observation of hypovigilance in manic patients postulates that modafinil may also have a beneficial effect in reducing manic behaviors. Further controlled studies are needed to clarify the benefits and risks of stimulants, both in bipolar depression and mania.
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Affiliation(s)
- Heinz Grunze
- From Newcastle University, Institute of Neuroscience, Academic Psychiatry Campus of Aging and Vitality, Wolfson Research Building, Westgate Road, Newcastle upon Tyne NE4 5PL, United Kingdom
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Grunze H, Walden J. Katayama et Al.: therapeutic window of lamotrigine for mood disorders: a naturalistic retrospective study. Pharmacopsychiatry 2014; 47: 111-114. Pharmacopsychiatry 2014; 47:268-9. [PMID: 25285673 DOI: 10.1055/s-0034-1390413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Katayama and colleagues proposed in their article a therapeutic window for lamotrigine in affective disorders between 5 and 11 μg/mL. Despite potential differences in lamotrigine metabolism, the results of their retrospective study in a Japanese population match nicely with what we have previously reported in a Caucasian population with rapid cycling bipolar disorder. It is suggested that not only in epilepsy, but also in mood-disordered patients clinicians should rather consider lamotrigine plasma levels than dosage when in doubt about the efficacy of treatment.
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Affiliation(s)
- H Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - J Walden
- DRV Westfalen, Wissenschaftspark, Gelsenkirchen, Germany
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71
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Calabrese JR, Fava M, Garibaldi G, Grunze H, Krystal AD, Laughren T, Macfadden W, Marin R, Nierenberg AA, Tohen M. Methodological approaches and magnitude of the clinical unmet need associated with amotivation in mood disorders. J Affect Disord 2014; 168:439-51. [PMID: 25113957 DOI: 10.1016/j.jad.2014.06.056] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is growing research interest in studying motivational deficits in different neuropsychiatric disorders because these symptoms appear to be more common than originally reported and negatively impact long-term functional outcomes. However, there is considerable ambiguity in the terminology used to describe motivational deficits in the scientific literature. For the purposes of this manuscript, the term "amotivation" will be utilised in the context of mood disorders, since this is considered a more inclusive/appropriate term for this patient population. Other challenges impacting the study of amotivation in mood disorders, include: appropriate patient population selection; managing or controlling for potential confounding factors; the lack of gold-standard diagnostic criteria and assessment scales; and determination of the most appropriate study duration. METHODS This paper summarises the search for a consensus by a group of experts in the optimal approach to studying amotivation in mood disorders. RESULTS The consensus of this group is that amotivation in mood disorders is a legitimate therapeutic target, given the magnitude of the associated unmet needs, and that proof-of-concept studies should be conducted in order to facilitate subsequent larger investigations. The focus of this manuscript is to consider the study of amotivation, as a residual symptom of major depressive disorder (MDD) or bipolar depression (BD), following adequate treatment with a typical antidepressant or mood stabiliser/antipsychotic, respectively. DISCUSSION There is a paucity of data studying amotivation in mood disorders. This manuscript provides general guidance on the most appropriate study design(s) and methodology to assess potential therapeutic options for the management of residual amotivation in mood disorders.
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Affiliation(s)
- Joseph R Calabrese
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Bipolar Disorders Research Center, 10524 Euclid Avenue, 12th Floor, Cleveland, Ohio 44106, USA.
| | | | | | | | | | | | | | - Robert Marin
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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72
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Grunze H. Treatment of bipolar disorder: not another meta-analysis. Lancet Psychiatry 2014; 1:321-3. [PMID: 26360983 DOI: 10.1016/s2215-0366(14)70350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Heinz Grunze
- Institute of Neuroscience, Academic Psychiatry, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
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73
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Abstract
The majority of patients treated for bipolar disorder receive multiple psychotropic medications concurrently (polypharmacy), despite a lack of empirical evidence for any combination of three or more medications. Some patients benefit from the skillful management of a complex medication regimen, but iterative additions to a treatment regimen often do not lead to clinical improvement, are expensive, and can confound assessment of the underlying mood disorder. Given these potential problems of polypharmacy, this paper reviews the evidence supporting the use of multiple medications and seeks to identify patient personality traits that may put patients at a greater risk for ineffective complex chronic care. Patients with bipolar disorder (n = 89), ages 18 and older, were assessed on the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), and the NEO Five Factor Inventory (NEO-FFI), and completed a treatment history questionnaire to report psychotropic medication use. We found that patients with lower scores on openness had significantly more current psychotropic medications than patients with higher scores on openness (3.7 ± 1.9 vs. 2.8 ± 1.8, p < 0.05). Patients with the highest lifetime medication use had significantly lower extraversion (21.8 ± 8.9 vs. 25.4 ± 7.6, p < 0.05) and lower conscientiousness (21.9 ± 8.2 vs. 27.9 ± 8.2, p < 0.01) than those reporting lower lifetime medication use. Low levels of openness, extraversion, and conscientiousness may be associated with increased psychotropic medication use. Investigating the role of individual differences, such as patient personality traits, in moderating effective polypharmacy warrants future research.
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Affiliation(s)
- G S Sachs
- Massachusetts General Hospital,Boston, MA,USA
| | - A T Peters
- Massachusetts General Hospital,Boston, MA,USA
| | - L Sylvia
- Massachusetts General Hospital,Boston, MA,USA
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Abstract
OBJECTIVES We reviewed the treatment of bipolar mixed states using efficacy data of licensed and non-licensed physical or pharmacological treatments. METHODS We conducted a literature search to identify published studies reporting data on mixed states. Grading was done using an in-house level of evidence and we compared the efficacy with treatment recommendations of mixed states in current bipolar disorder guidelines. RESULTS A total of 133 studies reported data on mixed states, and seven guidelines differentiate the acute treatment of mixed states from pure states. The strongest evidence in treating co-occurring manic and depressive symptoms was for monotherapy with aripiprazole, asenapine, extended release carbamazepine, valproate, olanzapine, and ziprasidone. Aripiprazole was recommended in three guidelines, asenapine in one, and carbamazepine and ziprasidone in two. As adjunctive treatment, the strongest evidence of efficacy was for olanzapine plus lithium or valproate. For maintenance, there is evidence for the efficacy of monotherapy with valproate, olanzapine, and quetiapine. In the six guidelines valproate or olanzapine are first line monotherapy options; one recommends quetiapine. Recommended add-on treatments are lithium or valproate plus quetiapine. CONCLUSIONS There is a lack of studies designed to address the efficacy of medications in mixed affective symptoms. Guidelines do not fully reflect the current evidences.
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Affiliation(s)
- Heinz Grunze
- Newcastle University, Institute of Neuroscience , Newcastle upon Tyne , UK
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Born C, Amann BL, Grunze H, Post RM, Schärer L. Saving time and money: a validation of the self ratings on the prospective NIMH Life-Chart Method (NIMH-LCM). BMC Psychiatry 2014; 14:130. [PMID: 24886463 PMCID: PMC4031162 DOI: 10.1186/1471-244x-14-130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/02/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Careful observation of the longitudinal course of bipolar disorders is pivotal to finding optimal treatments and improving outcome. A useful tool is the daily prospective Life-Chart Method, developed by the National Institute of Mental Health. However, it remains unclear whether the patient version is as valid as the clinician version. METHODS We compared the patient-rated version of the Lifechart (LC-self) with the Young-Mania-Rating Scale (YMRS), Inventory of Depressive Symptoms-Clinician version (IDS-C), and Clinical Global Impression-Bipolar version (CGI-BP) in 108 bipolar I and II patients who participated in the Naturalistic Follow-up Study (NFS) of the German centres of the Bipolar Collaborative Network (BCN; formerly Stanley Foundation Bipolar Network). For statistical evaluation, levels of severity of mood states on the Lifechart were transformed numerically and comparison with affective scales was performed using chi-square and t tests. For testing correlations Pearson´s coefficient was calculated. RESULTS Ratings for depression of LC-self and total scores of IDS-C were found to be highly correlated (Pearson coefficient r = -.718; p < .001), whilst the correlation of ratings for mania with YMRS compared to LC-self were slightly less robust (Pearson coefficient r = .491; p = .001). These results were confirmed by good correlations between the CGI-BP IA (mania), IB (depression) and IC (overall mood state) and the LC-self ratings (Pearson coefficient r = .488, r = .721 and r = .65, respectively; all p < .001). CONCLUSIONS The LC-self shows a significant correlation and good concordance with standard cross sectional affective rating scales, suggesting that the LC-self is a valid and time and money saving alternative to the clinician-rated version which should be incorporated in future clinical research in bipolar disorder. Generalizability of the results is limited by the selection of highly motivated patients in specialized bipolar centres and by the open design of the study.
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Affiliation(s)
- Christoph Born
- Department of Psychiatry, Ludwig Maximilians-University, Nußbaumstr. 7, Munich 80336, Germany
| | - Benedikt L Amann
- FIDMAG Research Foundation Germanes Hospitalàries, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Heinz Grunze
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | | | - Lars Schärer
- Department of Psychiatry, Albert Ludwig-University, Freiburg, Germany
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Post RM, Altshuler L, Kupka R, McElroy S, Frye MA, Rowe M, Leverich GS, Grunze H, Suppes T, Keck PE, Nolen WA. More pernicious course of bipolar disorder in the United States than in many European countries: implications for policy and treatment. J Affect Disord 2014; 160:27-33. [PMID: 24709019 DOI: 10.1016/j.jad.2014.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. METHODS We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. RESULTS Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. LIMITATIONS Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. CONCLUSIONS The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.
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Affiliation(s)
- R M Post
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States; Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., United States.
| | - L Altshuler
- UCLA Mood Disorders Research Program, VA Medical Center, Los Angeles, CA, United States
| | - R Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - S McElroy
- Lindner Center of HOPE Mason, OH, United States; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - M A Frye
- Psychiatry, Mayo Clinic, Rochester, MI, United States
| | - M Rowe
- Biostatistician, Bipolar Collaborative Network, Bethesda, MD, United States
| | - G S Leverich
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States
| | - H Grunze
- Institute of Neuroscience, University of Newcastle upon Tyne, Newcastle, United Kingdom
| | - T Suppes
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - P E Keck
- Psychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Lindner Center of HOPE Mason, OH, United States
| | - W A Nolen
- University Medical Center, University of Groningen, Groningen, Netherlands
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Post RM, Leverich GS, Kupka R, Keck P, McElroy S, Altshuler L, Frye MA, Luckenbaugh DA, Rowe M, Grunze H, Suppes T, Nolen WA. Increased parental history of bipolar disorder in the United States: association with early age of onset. Acta Psychiatr Scand 2014; 129:375-82. [PMID: 24138298 DOI: 10.1111/acps.12208] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Early-onset bipolar (BP) disorder and other poor prognosis characteristics are more prevalent in patients from the United States than from the Netherlands and Germany (abbreviated as Europe). We explored the impact of parental loading for affective illness on onset and other characteristics of BP disorder. METHOD Parental history for unipolar (UP) and bipolar (BP) depression and course of illness characteristics were obtained from self-report in adults (average age 42) with BP disorder. Illness characteristics were examined by χ2 and multinomial logistic regression in relationship to the degree of parental loading: i) both parents negative; ii) one UP disorder; iii) one with BP disorder; and iv) both affected. RESULTS After controlling for many poor prognosis factors, compared with those from Europe, patients from the United States had more iii) one parent with BP disorder and iv) both parents affected. An early age of onset of BP disorder was independently associated with this increased parental loading for affective disorder. CONCLUSION Parental history of BP disorder and both parents with a mood disorder were more common in the United States than Europe and were associated with an early onset of bipolar disorder and other poor prognosis characteristics. These findings deserve replication and exploration of the potential mechanisms involved and their therapeutic implications.
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Affiliation(s)
- R M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA
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Post RM, Altshuler LL, Leverich GS, Frye MA, Suppes T, McElroy SL, Keck PE, Nolen WA, Kupka RW, Grunze H, Rowe M. More medical comorbidities in patients with bipolar disorder from the United States than from the Netherlands and Germany. J Nerv Ment Dis 2014; 202:265-70. [PMID: 24647213 DOI: 10.1097/nmd.0000000000000116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Medical comorbidities are common in patients with bipolar (BP) disorder but have not been previously examined for differences between United States and Europe. More than 900 outpatients with BP I and BP II disorder (mean age, 41 years) filled out a questionnaire including the occurrence of 30 listed medical conditions. The patients from the United States were from Los Angeles, Dallas, Cincinnati, and Bethesda, whereas those from Europe were from Utrecht, Freiberg, and Munich. Those from the United States had a significantly higher incidence of obesity and nine other medical comorbidities than those from Europe, who had only more cases of hyperthyroidism. The burden of medical comorbidities in patients with BP disorder from the United States seems higher than in patients from Europe. Given the adversities, morbidity, and early mortality associated with these conditions and their interaction with the morbidity and lethality of BP disorder itself, greater efforts at treatment and prevention of these medical comorbidities would seem indicated.
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Affiliation(s)
- Robert M Post
- *Bipolar Collaborative Network, Bethesda, MD; †UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA; ‡Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Rochester, MI; §Department of Psychiatry, SW Medical Center, University of Texas, Dallas, TX; ∥Linder Center of Hope, Mason, OH; ¶Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH; #University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands; **Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands; and ††Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK
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Vieta E, Grunze H, Azorin JM, Fagiolini A. Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5: Results from the IMPACT self-reported online survey. J Affect Disord 2014; 156:206-13. [PMID: 24439831 DOI: 10.1016/j.jad.2013.12.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/22/2013] [Accepted: 12/23/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. RESULTS Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. LIMITATIONS Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. CONCLUSIONS Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorder Programme, Institute of Neuroscience, University of Barcelona Hospital Clínic, IDIBAPS, CIBERSAM, C/Villarroel 170, Barcelona 08036, Catalonia, Spain.
| | - Heinz Grunze
- Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, NE4 5PL, UK
| | - Jean-Michel Azorin
- Hospital Ste. Marguerite, 270 Bd Sainte Marguerite, 13274 Marseille, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, School of Medicine, Siena, Italy; Department of Mental Health, University of Siena Medical Center, Siena, Italy
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Post RM, Altshuler LL, Leverich GS, Nolen WA, Kupka R, Grunze H, Frye MA, Suppes T, McElroy SL, Keck PE, Rowe M. Illness progression as a function of independent and accumulating poor prognosis factors in outpatients with bipolar disorder in the United States. Prim Care Companion CNS Disord 2014; 16:14m01677. [PMID: 25834764 PMCID: PMC4374823 DOI: 10.4088/pcc.14m01677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/08/2014] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Many patients with bipolar disorder in the United States experience a deteriorating course of illness despite naturalistic treatment in the community. We examined a variety of factors associated with this pattern of illness progression. METHOD From 1995 to 2002, we studied 634 adult outpatients with bipolar disorder (mean age of 40 years) emanating from 4 sites in the United States. Patients gave informed consent and completed a detailed questionnaire about demographic, vulnerability, and course-of-illness factors and indicated whether their illness had shown a pattern of increasing frequency or severity of manic or depressive episodes. Fifteen factors previously linked in the literature to a poor outcome were examined for their relationship to illness progression using Kruskal-Wallis test, followed by a 2-sample Wilcoxon rank sum (Mann-Whitney) test, χ(2), and logistical regression. RESULTS All of the putative poor prognosis factors occurred with a high incidence, and, with the exception of obesity, were significantly (P < .05) associated with illness progression. These factors included indicators of genetic and psychosocial risk and loss of social support, early onset, long delay to first treatment, anxiety and substance abuse comorbidity, rapid cycling in any year, and the occurrence of more than 20 prior episodes prior to entering the network. A greater number of factors were linearly associated with the likelihood of a progressively worsening course. CONCLUSIONS Multiple genetic, psychosocial, and illness factors were associated with a deteriorating course of bipolar disorder from onset to study entry in adulthood. The identification of these factors provides important targets for earlier and more effective therapeutic intervention in the hope of achieving a more benign course of bipolar disorder.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Lori L Altshuler
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Gabriele S Leverich
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Willem A Nolen
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Ralph Kupka
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Heinz Grunze
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Mark A Frye
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Trisha Suppes
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Susan L McElroy
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Paul E Keck
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
| | - Mike Rowe
- Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck)
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Abstract
Aripiprazole is a third generation atypical antipsychotic with compelling evidence as a highly effective treatment option in the management of acute manic and mixed episodes of bipolar I disorders. It has a unique mode of action, acting as a partial agonist at dopamine D2 and D3, and serotonin 5-HT1A; and exhibiting antagonistic action at the 5-HT2A and H1 receptors. Overall, it has a favorable safety and tolerability profile, with low potential for clinically significant weight gain and metabolic effects, especially compared to other well-established treatments. It also has a superior tolerability profile when used as maintenance treatment. Side effects like headache, insomnia, and extrapyramidal side effects (EPSEs), such as tremor and akathisia may be treatment limiting in some cases. It is efficacious in both acute mania and mixed states, and in the long-term prevention of manic relapses. Aripiprazole therefore, is a significant player in the current portfolio of anti-manic pharmacological treatments. The data sources for this article are from EMBASE, MEDLINE, and the clinical trial database searches for all the literature published between January 2003 and September 2013. The key search terms were "aripiprazole" combined with "bipolar disorder", "mania", "antipsychotics", "mood stabilizer", "randomized controlled trial", and "pharmacology". Abstracts and proceedings from national and international psychiatric meetings were also reviewed, along with reviews of the reference lists of relevant articles.
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Affiliation(s)
- Kiran Kumar Sayyaparaju
- Newcastle University, Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, UK
| | - Heinz Grunze
- Newcastle University, Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, UK
- Correspondence: Heinz Grunze, Newcastle University, Institute of Neuroscience, Academic Psychiatry, Campus of Aging and Vitality, Wolfson Research Centre, Westgate Road, Newcastle upon Tyne, UK, Tel +44 0 191 208 1372, Fax +44 0 191 208 1387, Email
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Greece
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Barron E, Sharma A, Le Couteur J, Rushton S, Close A, Kelly T, Grunze H, Nicol Ferrier I, Le Couteur A. Family environment of bipolar families: a UK study. J Affect Disord 2014; 152-154:522-5. [PMID: 24091305 DOI: 10.1016/j.jad.2013.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 08/09/2013] [Accepted: 08/10/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Aspects of family environment (FE) such as family support, organisational structure and levels of conflict can increase risk of Bipolar Disorder (BD) in offspring of BD parents. METHODS The family environment of 16 BD and 23 healthy control (HC) families was assessed using the Family Environment Scale (FES). Canonical Correspondence Analysis (CCA) was used to determine the degree of variation in scores on the FES dimensions within each family and a Generalised Linear Modelling (GLM) approach was used to investigate the extent to which scores on the different FES dimensions differed between families. RESULTS On the FES, BD families experienced an environment with higher levels of conflict and lower levels of expressiveness, organisation, intellectual-cultural orientation and active-recreational orientation than healthy control families. Differences in FES scores were driven by presence of parental BD and total number of children in the family. However, socio-economic status (SES) was not found to have an effect in this study. LIMITATIONS As an American instrument the FES may not have been sensitive enough to the cultural context of a UK sample. The relatively small sample size used may have limited the statistical power of the study. CONCLUSIONS Greater numbers of children have the same effect on levels of conflict as the presence of BD, while SES does not appear to be as important a factor in FE as previously thought. Our results suggest that family based interventions focusing on psychoeducation and improved communication within these families may address issues of conflict, organisation and expressiveness.
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Post RM, Altshuler L, Leverich G, Nolen W, Kupka R, Grunze H, Frye M, Suppes T, McElroy S, Keck P, Rowe M. More stressors prior to and during the course of bipolar illness in patients from the United States compared with the Netherlands and Germany. Psychiatry Res 2013; 210:880-6. [PMID: 24021999 DOI: 10.1016/j.psychres.2013.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 02/08/2023]
Abstract
Considerable data suggest that compared to some European countries, in the U.S. there are more childhood onset bipolar disorders, more adverse courses of illness, and greater treatment resistance. Psychosocial variables related to these findings have not been adequately explored. Therefore we analyzed psychosocial stressors in three time domains: childhood; the year prior to illness Onset; and the Last Episode from questionnaires in 968 outpatients (mean age 41) with bipolar I or II disorder; 676 from four sites in the U.S. and 292 from three in the Netherlands and Germany (abbreviated here as Europe). Compared to the Europeans, those from the U.S. had significantly more stressors in childhood and prior to the last episode. Stressors prior to the last episode were related to: childhood stressors; an earlier age at illness onset; anxiety and substance abuse comorbidity; lower income; both parents having an affective illness; and feeling more stigma. These data suggest a greater prevalence of adverse life events in childhood and over the course of bipolar illness in the U.S. compared to the Netherlands and Germany. Clinical, therapeutic, and public health approaches to these illness-relevant stressors require further exploration.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda MD; Clinical Professor Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C.; Bipolar Collaborative Network, Bethesda, MD, USA.
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85
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Pacchiarotti I, Bond DJ, Baldessarini RJ, Nolen WA, Grunze H, Licht RW, Post RM, Berk M, Goodwin GM, Sachs GS, Tondo L, Findling RL, Youngstrom EA, Tohen M, Undurraga J, González-Pinto A, Goldberg JF, Yildiz A, Altshuler LL, Calabrese JR, Mitchell PB, Thase ME, Koukopoulos A, Colom F, Frye MA, Malhi GS, Fountoulakis KN, Vázquez G, Perlis RH, Ketter TA, Cassidy F, Akiskal H, Azorin JM, Valentí M, Mazzei DH, Lafer B, Kato T, Mazzarini L, Martínez-Aran A, Parker G, Souery D, Ozerdem A, McElroy SL, Girardi P, Bauer M, Yatham LN, Zarate CA, Nierenberg AA, Birmaher B, Kanba S, El-Mallakh RS, Serretti A, Rihmer Z, Young AH, Kotzalidis GD, MacQueen GM, Bowden CL, Ghaemi SN, Lopez-Jaramillo C, Rybakowski J, Ha K, Perugi G, Kasper S, Amsterdam JD, Hirschfeld RM, Kapczinski F, Vieta E. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013; 170:1249-62. [PMID: 24030475 PMCID: PMC4091043 DOI: 10.1176/appi.ajp.2013.13020185] [Citation(s) in RCA: 436] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. METHOD An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. RESULTS There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. CONCLUSIONS Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
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86
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McAllister-Williams RH, Smith E, Anderson IM, Barnes J, Gallagher P, Grunze HCR, Haddad PM, House AO, Hughes T, Lloyd AJ, McColl EMM, Pearce SHS, Siddiqi N, Sinha B, Speed C, Steen IN, Wainright J, Watson S, Winter FH, Ferrier IN. Study protocol for the randomised controlled trial: antiglucocorticoid augmentation of anti-Depressants in Depression (The ADD Study). BMC Psychiatry 2013; 13:205. [PMID: 23914988 PMCID: PMC3750720 DOI: 10.1186/1471-244x-13-205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 07/25/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Some patients with depression do not respond to first and second line conventional antidepressants and are therefore characterised as suffering from treatment refractory depression (TRD). On-going psychosocial stress and dysfunction of the hypothalamic-pituitary-adrenal axis are both associated with an attenuated clinical response to antidepressants. Preclinical data shows that co-administration of corticosteroids leads to a reduction in the ability of selective serotonin reuptake inhibitors to increase forebrain 5-hydroxytryptamine, while co-administration of antiglucocorticoids has the opposite effect. A Cochrane review suggests that antiglucocorticoid augmentation of antidepressants may be effective in treating TRD and includes a pilot study of the cortisol synthesis inhibitor, metyrapone. The Antiglucocorticoid augmentation of anti-Depressants in Depression (The ADD Study) is a multicentre randomised placebo controlled trial of metyrapone augmentation of serotonergic antidepressants in a large population of patients with TRD in the UK National Health Service. METHODS/DESIGN Patients with moderate to severe treatment refractory Major Depression aged 18 to 65 will be randomised to metyrapone 500 mg twice daily or placebo for three weeks, in addition to on-going conventional serotonergic antidepressants. The primary outcome will be improvement in Montgomery-Åsberg Depression Rating Scale score five weeks after randomisation (i.e. two weeks after trial medication discontinuation). Secondary outcomes will include the degree of persistence of treatment effect for up to 6 months, improvements in quality of life and also safety and tolerability of metyrapone. The ADD Study will also include a range of sub-studies investigating the potential mechanism of action of metyrapone. DISCUSSION Strengths of the ADD study include broad inclusion criteria meaning that the sample will be representative of patients with TRD treated within the UK National Health Service, longer follow up, which to our knowledge is longer than any previous study of antiglucocorticoid treatments in depression, and the range of mechanistic investigations being carried out. The data set acquired will be a rich resource for a range of research questions relating to both refractory depression and the use of antiglucocorticoid treatments. TRIAL REGISTRATION Current Controlled Trials: ISRCTN45338259; EudraCT Number: 2009-015165-31.
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Affiliation(s)
- R Hamish McAllister-Williams
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Eleanor Smith
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian M Anderson
- Greater Manchester West Mental Health NHS Foundation Trust and Neuroscience and Psychiatry Unit, Manchester University, Manchester, UK
| | - Jane Barnes
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Heinz CR Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust and Neuroscience and Psychiatry Unit, Manchester University, Manchester, UK
| | - Allan O House
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Hughes
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Adrian J Lloyd
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine MM McColl
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Simon HS Pearce
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Baxi Sinha
- Tees, Esk and Wear Valleys NHS Foundation Trust, Edward Pease Way, Darlington, County Durham, UK
| | - Chris Speed
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - I Nick Steen
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - June Wainright
- Mental Health Research Network, North East Hub service user and carer group, Newcastle, UK
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona H Winter
- Mental Health Research Network, North East Hub service user and carer group, Newcastle, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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87
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Kraemer S, Minarzyk A, Eppendorfer S, Henneges C, Hundemer HP, Wilhelm S, Grunze H. Comparably high retention and low relapse rates in different subpopulations of bipolar patients in a German non-interventional study. BMC Psychiatry 2013; 13:193. [PMID: 23866017 PMCID: PMC3724595 DOI: 10.1186/1471-244x-13-193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/07/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although a range of pharmacotherapeutical options are available for the treatment of bipolar disorder, patient non-adherence to prescribed treatment regimens and early treatment discontinuation remain among the primary obstacles to effective treatment. Therefore, this observational study assessed time on mood stabilizing medication and retention rates in patients with bipolar disorder (BD). METHODS In an 18-month, prospective, multicenter, non-interventional study conducted in Germany 761 outpatients (≥18 years) with BD and on maintenance therapy were documented. For analysis, patients were stratified by baseline medication: monotherapy olanzapine (OM, N = 186), lithium (LM, N = 152), anticonvulsants (N = 216), other mood stabilizing medication (OMS, N = 44); combination therapy olanzapine/lithium (N = 47), olanzapine/anticonvulsant (N = 68), other combinations (OC, N = 48). Continuation on medication was assessed as retention rates with 95% confidence intervals. Time to discontinuation and relapse-free time were calculated by Kaplan-Meier analysis. A relapse was defined as increase to CGI-BP >3, worsening of CGI-BP by ≥2 points, hospitalization or death related to BD. A Cox regression was calculated for the discontinuation of mood stabilizing therapy (reference: OM). Logistic regression models with stepwise forward selection were used to explore possible predictors of maintenance of treatment and relapse. RESULTS After 540 days (18 months), the overall retention rate of baseline medication was 87.7%, without notable differences between the cohorts. The overall mean time on mood stabilizing treatment was 444.7 days, with a range of 377.5 (OMS) to 481 (LM) by cohort. 74.0% of all patients were without relapse, with rates between the cohorts ranging from 58.4% (OC) to 80.2% (LM). CONCLUSIONS Retention rates exceeded controlled trial results in all treatment cohorts, in addition to other explanations possibly reflecting that the physicians were expertly adapting treatment regimens to the individual patient's disease characteristics and special needs.
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Affiliation(s)
- Susanne Kraemer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Anette Minarzyk
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Steffen Eppendorfer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Carsten Henneges
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Hans-Peter Hundemer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Stefan Wilhelm
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Heinz Grunze
- Newcastle University; Institute of Neuroscience, Newcastle, UK
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88
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Severus E, Lipkovich I, Seemüller F, Obermeier M, Grunze H, Bernhard B, Dittmann S, Riedel M, Möller HJ. The potential role of Marginal Structural Models (MSMs) in testing the effectiveness of antidepressants in the treatment of patients with major depression in everyday clinical practice. World J Biol Psychiatry 2013; 14:386-95. [PMID: 22098147 DOI: 10.3109/15622975.2011.619205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To better evaluate the effectiveness of antidepressant drugs in the treatment of major depression in clinical practice. METHODS A simulation experiment was used to illustrate an application of marginal structural models (MSMs) via inverse probability of treatment weighting (IPTW) approach in the context of non-randomized data on N = 1,000 depressed subjects, initially subjected to "watchful waiting". In simulation we assumed that subjects with worse intermediate outcome have a higher probability of being subsequently assigned to antidepressant treatment while those who receive antidepressant treatment are more likely to reach remission and less likely to reach relapse state. The outcomes from multiple (500) simulated data sets are analyzed using simple unadjusted analysis based on logistic regression and using MSM. RESULTS In contrast to unadjusted analysis, but consistent with the treatment assumptions, using MSM via IPTW results in strong evidence of the effectiveness of the antidepressant treatment. Furthermore MSM via IPTW substantially reduces the probability of wrongly rejecting the null hypothesis. However, the instability of weights due to the sparse data and incorrectly specified MSM may still result in inflation of Type I error rates. CONCLUSIONS MSMs may allow evaluating the causal effects associated with antidepressant treatment from the data observed in clinical practice.
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Affiliation(s)
- Emanuel Severus
- Department of Psychiatry, University of Munich, Munich, Germany
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89
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Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14:334-85. [PMID: 23879318 DOI: 10.3109/15622975.2013.804195] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. METHODS The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. RESULTS This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. CONCLUSIONS To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
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90
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Amann BL, Wesuls R, Landin Romero R, Grunze H. [De-escalation and atypical antipsychotics in the treatment of acute mania]. Fortschr Neurol Psychiatr 2013; 81 Suppl 1:S9-16. [PMID: 23681717 DOI: 10.1055/s-0033-1335241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Agitation is a severe clinical state which represents a therapeutic challenge and often forms part of manic or mixed episodes. Therapeutic options for acute mania have been limited for many years to lithium and typical antipsychotics. Besides anticonvulsants, atypical antipsychotics have been increasingly introduced in the last decade after proving their efficacy in this indication. To avoid intramuscular administration and excessive sedation, a therapeutic contact to the often agitated patient is required. De-escalation techniques can be helpful in this respect but also reduce aggressive behaviour on the ward, improve compliance, reduce relapse rates and lead to a better outcome in the long-term course of the illness. Therefore, a basic knowledge about de-escalation techniques in acute manic patients is an important clinical tool which will be critically reviewed. Furthermore, the efficacy and tolerability of atypical antipsychotics in acute mania, such as olanzapine, zotepine, risperidone, quetiapine, ziprasidone, aripiprazole, paliperidone and asenapine are discussed.
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Affiliation(s)
- B L Amann
- FIDMAG Research Foundation, Germanes Hospitalàries, Barcelona, Spain.
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91
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Schaub A, Neubauer N, Bernhard B, Born C, Möller HJ, Grunze H. [Cognitive-psychoeducational group programme for bipolar disorder: pilot study with two-year follow-up]. Fortschr Neurol Psychiatr 2013; 81 Suppl 1:S30-4. [PMID: 23681715 DOI: 10.1055/s-0033-1335242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
52 patients with bipolar disorder were treated with psychopharmacotherapy and a cognitive psychoeducational group programme that was established at the Department of Psychiatry and Psychotherapy of the Ludwig Maximilian University, Munich, Germany. The programme covers psychoeducation, identifying and coping with depressive and manic symptoms, relapse prevention and establishing a stable life style. 96 % rated the group to be helpful and felt well informed about their illness. There were significant gains in knowledge (F = 25,714, p < 0.001) and improvements in the severity of the illness (CGI; F = 68,255, p < 0.001) post-treatment. With regard to sociodemographic and clinical variables, only the level of work qualification showed a differential treatment response: patients with higher qualifications had a more favourable course of the illness (F = 4,125, p = 0.048). At one and two year follow-up 25 % and, respectively, 30 % of the sample had to be readmitted. A higher number of previous hospitalisations (p = 0.010) and male sex (p = 0.031) turned out to be significant predictors of relapse (R² = 0.358, p = 0.004) at two year follow-up. This disorder-specific group programme represents a key component of treatment offering emotional support for patients and their relatives. Patients are to be involved in the treatment process and need information about the illness, its psychosocial and pharmacological treatment as well as help in learning practical skills to improve their living with the disease. Being integrated and committed to a supporting network may increase their quality of life.
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Affiliation(s)
- A Schaub
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München, Germany.
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92
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Seemüller F, Berger M, Musil R, Severus E, Dittmann S, Born C, Schaub A, Dargel S, Grunze H. [The challenge of treating bipolar outpatients]. Fortschr Neurol Psychiatr 2013; 81 Suppl 1:S35-9. [PMID: 23681716 DOI: 10.1055/s-0033-1335275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The course of bipolar illness comprises a wide range, which may vary between one single episode once every five years and a severe ultra rapid cycling course with mood changes within days. Even with optimal pharmacological treatment the functional outcome in bipolar patients is still poor. Underlying pathomechanisms are not fully understood yet. This article addresses three possible illness specific-aspects: cognitive defects, high relapse frequency and poor adherence. Causes as well as therapeutic interventions for these therapeutic pitfalls are summarised.
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Affiliation(s)
- F Seemüller
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München, Germany
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93
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Post RM, Altshuler LL, Leverich GS, Frye MA, Suppes T, McElroy SL, Keck PE, Nolen WA, Kupka RW, Grunze H, Rowe M. Role of childhood adversity in the development of medical co-morbidities associated with bipolar disorder. J Affect Disord 2013; 147:288-94. [PMID: 23337654 DOI: 10.1016/j.jad.2012.11.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/01/2012] [Accepted: 11/06/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A role for childhood adversity in the development of numerous medical conditions in adults has been described in the general population, but has not been examined in patients with bipolar disorder who have multiple medical comorbidities which contribute to their premature mortality. METHODS More than 900 outpatients (average age 41) with bipolar disorder completed questionnaires that included information about the occurrence of verbal, physical, or sexual abuse in childhood and whether their parents had a mood or substance abuse disorder, or a history of suicidality. These factors were combined to form a total childhood adversity score, which was then related to one or more of 30 medical conditions patients rated as present or absent. RESULTS The child adversity score was significantly related to the total number of medical comorbidities a patient had (p<.001), as well as to 11 specific medical conditions that could be modeled in a logistic regression (p<.03). These included: asthma, arthritis, allergies, chronic fatigue syndrome, chronic menstrual irregularities, fibromyalgia, head injury (without loss of consciousness), hypertension, hypotension, irritable bowel syndrome, and migraine headaches. LIMITATIONS The contribution of parental diagnosis to childhood adversity is highly inferential. CONCLUSIONS These data link childhood adversity to the later occurrence of multiple medical conditions in adult outpatients with bipolar disorder. Recognition of these relationships and early treatment intervention may help avert a more severe course of not only bipolar disorder but also of its prominent medical comorbidities and their combined adverse effects on patients'health, wellbeing, and longevity.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, 5415 West Cedar Lane Suite 201B, Bethesda, MD 20814, USA.
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94
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Grunze H, Grunze A, Amann BL. [Differential diagnosis of and pharmacotherapy for bipolar disorder]. Fortschr Neurol Psychiatr 2013; 81 Suppl 1:S3-8. [PMID: 23681714 DOI: 10.1055/s-0033-1335240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bipolar disorders constitute a group of frequent, chronic psychiatric illnesses with a most severe impact on the patient's life. The course can be very individual and heterogeneous, the best known and most frequent manifestations include the classical bipolar I and bipolar II disorders. However, in Germany even typical bipolar I disorders are underdiagnosed and, consequently, undertreated. This is true despite the fact that the number of pharmacological treatment options has rapidly increased during recent years, both in the field of anticonvulsants and atypical antipsychotics. This supplies us today with new therapeutic strategies, not only for acute mania, but also for bipolar depression and maintenance treatment, and it is feasible to assume that there will be more options available within the next few years.
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Affiliation(s)
- H Grunze
- Academic Psychiatry, Institute of Neuroscience, Newcastle upon Tyne, UK.
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95
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Abstract
During recent years, marked progress has been made both in structural and functional neuroimaging of affective disorders. Structural changes in the limbic system, prefrontal cortex and subcortical regions including their fascicular connections appear to correlate with affective disorders in most, but not all studies. Especially for bipolar disorder, there still is a considerable heterogeneity among the results. Functional neuroimaging (fMRI, SPECT, PET) underlines the importance of paralimbic, cortical and subcortical structures in mood regulation; however, the methodology of these studies is still in its infancy meaning that the results of these studies are not always reproducible. However, in summary it can be expected that with improving methodology functional neuroimaging will play an increasing role in affective, including bipolar, disorders in the near future.
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Affiliation(s)
- A Grunze
- East CMHT, NTW NHS Foundation Trust, Newcastle upon Tyne, UK.
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96
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Affiliation(s)
- Akshya Vasudev
- London Health Sciences Centre, Victoria Hospital; University of Western Ontario; 800 Commissioners Road East PO BOX 5010 London Ontario Canada
| | - Alan J Thomas
- Newcastle University; Institute for Ageing and Health; Campus for Ageing and Vitality Newcastle Upon Tyne UK NE4 5PL
| | - Heinz Grunze
- Newcastle University; Institute of Neuroscience, Department of Psychiatry; Royal Victoria Infirmary, Leazes Wing Queen Victoria Rd Newcastle upon Tyne Tyne and Wear UK
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97
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Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry 2013; 14:154-219. [PMID: 23480132 DOI: 10.3109/15622975.2013.770551] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES These guidelines are based on a first edition that was published in 2004, and have been edited and updated with the available scientific evidence up to October 2012. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the long-term treatment of bipolar disorder in adults. METHODS Material used for these guidelines are based on a systematic literature search using various data bases. Their scientific rigor was categorised into six levels of evidence (A-F) and different grades of recommendation to ensure practicability were assigned. RESULTS Maintenance trial designs are complex and changed fundamentally over time; thus, it is not possible to give an overall recommendation for long-term treatment. Different scenarios have to be examined separately: Prevention of mania, depression, or an episode of any polarity, both in acute responders and in patients treated de novo. Treatment might differ in Bipolar II patients or Rapid cyclers, as well as in special subpopulations. We identified several medications preventive against new manic episodes, whereas the current state of research into the prevention of new depressive episodes is less satisfactory. Lithium continues to be the substance with the broadest base of evidence across treatment scenarios. CONCLUSIONS Although major advances have been made since the first edition of this guideline in 2004, there are still areas of uncertainty, especially the prevention of depressive episodes and optimal long-term treatment of Bipolar II patients.
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Affiliation(s)
- Heinz Grunze
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.
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98
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Abstract
OBJECTIVE This article reviews the characteristics of bipolar disorder and approaches to minimise physical health risks, as well as treatment options, and their influence on patient quality of life (QoL). METHOD The content of this article is based on the proceedings of a 1-day standalone symposium in November 2011 exploring how to establish a bipolar clinic within the context of existing services in the UK's National Health Service. RESULTS Bipolar disorder is a common mental disorder and often under-recognised in patients with major depressive episodes. Patients are largely dependent on family and carers to lead normal lifestyles and have difficulties maintaining relationships. Mental health and physical health are closely linked, with risk factors such as weight gain, metabolic syndrome, smoking and diabetes contributing to cardiovascular disease and early death. Antipsychotics may induce treatment-related comorbidities, thus further contributing to a low QoL of patients. Symptoms of comorbidity or depression are frequently relieved through self-medication and substance abuse, thus increasing patient health and suicide risk. Therefore, regular health monitoring and patient education in risk factor minimisation are required. CONCLUSION Early pharmacotherapeutic and psychoeducational interventions are required to improve treatment outcomes, as well as improving patient understanding of ways to minimise comorbidity development.
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Benninghoff J, Grunze H, Schindler C, Genius J, Schloesser RJ, van der Ven A, Dehning S, Wiltfang J, Möller HJ, Rujescu D. Ziprasidone--not haloperidol--induces more de-novo neurogenesis of adult neural stem cells derived from murine hippocampus. Pharmacopsychiatry 2013; 46:10-5. [PMID: 22592505 DOI: 10.1055/s-0032-1311607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Here, we present a stem-cell based study on the de-novo generation of beta-III-tubulin-positive neurons after treatment with the classic antipsychotic drug haloperidol or after treatment with the second-generation antipsychotic (SGA) ziprasidone. METHODS Adult neural stem cells (ANSC) dissociated from the adult mouse hippocampus were expanded in cell culture with basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF). ANSC differentiated upon withdrawal of EGF and bFGF. RESULTS AND DISCUSSION Ziprasidone generated significantly more beta-III-tubulin-positive neurons than haloperidol during the differentiation of adult neural stem cells isolated from murine hippocampus (ANSC). We assume that this net increase in neurogenesis by ziprasidone relies on this drug's 5-HT1A receptor affinity, which is not present in the haloperidol molecule, since the inactivation by WAY100621 impeded this process. These data could possibly suggest a clinical relevance for studying antipsychotic drugs in the stem cell paradigm employed in this study.
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Affiliation(s)
- J Benninghoff
- Department of Psychiatry, LMU-University of Munich, Munich, Germany. jens.benninghoff @lvr.de
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Grunze H. [Are atypical antipsychotic drugs the first line treatment for bipolar disorders? For]. Nervenarzt 2012; 83:1190-1. [PMID: 22911320 DOI: 10.1007/s00115-012-3618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- H Grunze
- Campus of Aging and Vitality, Wolfson Research Centre, Newcastle University, Institute of Neuroscience, Academic Psychiatry, Westgate Road, NE4 5PL, Newcastle upon Tyne, United Kingdom.
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