1
|
Pastuszak M, Cubała WJ, Kwaśny A. Residual Depressive Symptoms in Treatment-Resistant Bipolar Depression Following Short-Term Ketamine Administration. Drugs Real World Outcomes 2024:10.1007/s40801-024-00453-y. [PMID: 39269606 DOI: 10.1007/s40801-024-00453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Residual symptoms are frequently observed in a significant number of patients with depression, indicating an unmet need for effective management strategies to achieve functional recovery. OBJECTIVE This observational study aimed to evaluate the impact of ketamine infusions on depressive symptoms in patients with bipolar disorder who continued their baseline psychotropic and chronic somatic treatments. METHODS Datasets of the two consecutive real-world registries (NCT04226963 for 2019-2022; NCT05565352 from 2023 onward) for the tertiary reference center for psychiatry at the Medical University of Gdańsk (Poland) for the safety and tolerability of ketamine use in mood and anxiety disorders were retrospectively analyzed. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Residual symptoms were identified in patients who achieved a treatment response, defined as a 50% or greater reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to the seventh infusion. RESULTS Overall, 14 out of 22 patients met the criteria for response. The most commonly persistent depressive symptoms included sad mood (85.7%), view of my future (78.6%), difficulty falling asleep, and leaden paralysis/physical energy (both 71.4%), with the most severe being difficulty falling asleep (64.3%) and sad mood (42.9%). CONCLUSIONS This observational post hoc analysis indicates that the most frequently observed residual depressive symptoms were low mood, altered view of future, sleep disturbances, and low energy levels. This study should be treated with caution as causality does not apply, however, it reports on a real-world population of subjects with treatment-resistant bipolar depression. Establishing standardized definitions for residual symptoms could enhance the quality and comparability of future research in this area.
Collapse
Affiliation(s)
- Michał Pastuszak
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214, Gdańsk, Poland
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214, Gdańsk, Poland
| | - Aleksander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214, Gdańsk, Poland.
| |
Collapse
|
2
|
Jakobsen P, Côté-Allard U, Riegler MA, Stabell LA, Stautland A, Nordgreen T, Torresen J, Fasmer OB, Oedegaard KJ. Early warning signals observed in motor activity preceding mood state change in bipolar disorder. Bipolar Disord 2024; 26:468-478. [PMID: 38639725 DOI: 10.1111/bdi.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Alterations in motor activity are well-established symptoms of bipolar disorder, and time series of motor activity can be considered complex dynamical systems. In such systems, early warning signals (EWS) occur in a critical transition period preceding a sudden shift (tipping point) in the system. EWS are statistical observations occurring due to a system's declining ability to maintain homeostasis when approaching a tipping point. The aim was to identify critical transition periods preceding bipolar mood state changes. METHODS Participants with a validated bipolar diagnosis were included to a one-year follow-up study, with repeated assessments of the participants' mood. Motor activity was recorded continuously by a wrist-worn actigraph. Participants assessed to have relapsed during follow-up were analyzed. Recognized EWS features were extracted from the motor activity data and analyzed by an unsupervised change point detection algorithm, capable of processing multi-dimensional data and developed to identify when the statistical property of a time series changes. RESULTS Of 49 participants, four depressive and four hypomanic/manic relapses among six individuals occurred, recording actigraphy for 23.8 ± 0.2 h/day, for 39.8 ± 4.6 days. The algorithm detected change points in the time series and identified critical transition periods spanning 13.5 ± 7.2 days. For depressions 11.4 ± 1.8, and hypomania/mania 15.6 ± 10.2 days. CONCLUSION The change point detection algorithm seems capable of recognizing impending mood episodes in continuous flowing data streams. Hence, we present an innovative method for forecasting approaching relapses to improve the clinical management of bipolar disorder.
Collapse
Affiliation(s)
- Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | - Lena Antonsen Stabell
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andrea Stautland
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jim Torresen
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole Bernt Fasmer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Lagha M, Homri W, Dhaouadi N, Rouached S. Factors associated with sexual dysfunction in patients with bipolar disorder. L'ENCEPHALE 2024:S0013-7006(24)00108-8. [PMID: 38824047 DOI: 10.1016/j.encep.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES The aims of our study were to assess the sexual function in men with bipolar disorder type 1 in remission and to determine the various sociodemographic, clinical and therapeutic factors associated with sexual dysfunction. METHODS We conducted a cross-sectional study over an 18-month period (January 2020-June 2021) in which we included men followed up for bipolar disorder type 1 in the euthymic phase strictly defined by a score <8 on the Young Mania Rating Scale and a score ≤7 on the Hamilton Depression Rating Scale. Sexual function was assessed using the Arizona Sexual Experiences Scale (Asex) in its Arabic-validated version. RESULTS Sixty patients were included in the study. The mean age was 42.5 (SD=11.1) years. Among the patients, 68% had sexual dysfunction according to the total score of the Asex scale. According to univariate analysis, several factors were significantly associated with sexual dysfunction in patients with bipolar disorder type 1: age (P=0.001), total number of hospitalizations for thymic relapse (P=0.015), total number of depressive episodes (P=0.006) and depressive dominant polarity (P=0.046). The factors identified as modifying sexuality according to the total score of the Asex scale by multivariate analysis were age at first antipsychotic prescription: P=0.01; ORa=1.109; 95% CI [1.021-1.206] and number of hospitalizations for thymic relapse: P=0.015; ORa=1.259; 95% CI [1.046-1.546]. CONCLUSION Studies assessing factors associated with sexual dysfunction in patients with bipolar disorder type 1 in euthymia were mostly concerned with the effects of psychotropic drugs on sexual function, with factors inherent in bipolar illness itself not widely addressed in the literature. According to the results of our study, sexual dysfunction in patients with bipolar disorder in the euthymic phase is frequent and significantly associated with clinical factors inherent in the bipolar illness itself and its course.
Collapse
Affiliation(s)
- Mona Lagha
- Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisia; Service de psychiatrie C, hôpital Razi, 2010 Manouba, Tunisia.
| | - Wided Homri
- Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisia; Service de psychiatrie C, hôpital Razi, 2010 Manouba, Tunisia
| | - Naouel Dhaouadi
- Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisia
| | - Sarra Rouached
- Faculté de médecine de Tunis, université de Tunis-El-Manar, 1007 Tunis, Tunisia; Service de psychiatrie C, hôpital Razi, 2010 Manouba, Tunisia
| |
Collapse
|
4
|
Stokholm JR, Vinberg M, Faurholt-Jepsen M, Kessing LV. Study protocol: group-based psychoeducation for relatives of patients with bipolar disorder-a large scale real-world randomized controlled parallel group trial, the R-bipolar RCT. Trials 2024; 25:342. [PMID: 38783322 PMCID: PMC11119791 DOI: 10.1186/s13063-024-08172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Relatives of patients with bipolar disorder (BD) often experience emotional burden with stress and depressive symptoms that again increase the likelihood of destabilization and relapses in the patient. The effects of group-based psychoeducation have not been investigated in large-scale real-world settings. We are currently conducting a large-scale real-world randomized controlled parallel group trial (RCT) to test whether group-based psychoeducation for 200 relatives to patients with BD improves mood instability and other critical outcomes in relatives and the corresponding patients with BD. METHODS The trial is designed as a two-arm, parallel-group randomized trial with a balanced randomization 1:1 to either group-based psychoeducation or a waiting list for approximately 4 months and subsequent group-based psychoeducation. The primary outcome measure is mood instability calculated based on daily smartphone-based mood self-assessments. Other relevant outcomes are measured, including patients' reported outcomes, assessing self-assessed burden, self-efficacy, and knowledge about BD. DISCUSSION This protocol describes our currently ongoing randomized controlled trial (RCT) that aims at investigating group-based psychoeducation as an intervention for relatives of individuals diagnosed with bipolar disorder (BD). The study is the first large-scale real-world RCT to focus on a relatively short intervention of psychoeducation (6 sessions of 2 h each) in a large group of relatives (approximately 30 participants per group). With this focus, we wish to test an intervention that is feasible to implement in real-life psychiatric settings with limited budgets and time. It is also the first study to use mood instability in relatives as the primary outcome measure and to investigate whether mood instability and other affective symptoms in patients and relatives covary. It could be considered as limitations, that the trial is not blinded and does not include long-term follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT06176001. Registered on 2023-12-19. The study is approved by the data agency (P-2021-809). The project was allowed to be initiated without permission from the Scientific Ethical Committees for the Capital Region, because it according to section 1, paragraph 4 of the Committee Act was not defined as a health scientific intervention study (case number 21063013).
Collapse
Affiliation(s)
- Julie Ravneberg Stokholm
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre Northern Zealand, Hillerød, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Montejo L, Orhan M, Chen P, Eyler LT, Gildengers A, Martinez-Aran A, Nunes PV, Olagunju AT, Patrick R, Vieta E, Dols A, Jimenez E. Functioning in older adults with bipolar disorder: A report on recommendations by the International Society of bipolar disorder (ISBD) older adults with bipolar disorder (OABD) task force. Bipolar Disord 2023; 25:457-468. [PMID: 37495508 DOI: 10.1111/bdi.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Despite the importance of psychosocial functioning impairment in Bipolar Disorder (BD), its role among Older Adults with BD (OABD) is not well known. The development of guidelines for the assessment of psychosocial functioning helps to facilitate a better understanding of OABD and can lead to better tailored interventions to improve the clinical outcomes of this population. METHODS Through a series of virtual meetings, experts from eight countries in the International Society of Bipolar Disorder (ISBD) on OABD task force developed recommendations for the assessment of psychosocial functioning. RESULTS We present (1) a conceptualization of functioning in OABD and differences compared with younger patients; (2) factors related to functioning in OABD; (3) current measures of functioning in OABD and their strengths and limitations; and, (4) other potential sources of information to assess functioning. CONCLUSIONS The task force created recommendations for assessing functioning in OABD. Current instruments are limited, so measures specifically designed for OABD, such as the validated FAST-O scale, should be more widely adopted. Following the proposed recommendations for assessment can improve research and clinical care in OABD and potentially lead to better treatment outcomes.
Collapse
Affiliation(s)
- Laura Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Melis Orhan
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, the Netherlands
| | - Peijun Chen
- Department of Psychiatry, Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health System Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare, San Diego, California, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Paula Villela Nunes
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Regan Patrick
- Departments of Neuropsychology & Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| |
Collapse
|
6
|
Alloy LB, Walsh RFL, Smith LT, Maddox MA, Olino TM, Zee PC, Nusslock R. Circadian, Reward, and Emotion Systems in Teens prospective longitudinal study: protocol overview of an integrative reward-circadian rhythm model of first onset of bipolar spectrum disorder in adolescence. BMC Psychiatry 2023; 23:602. [PMID: 37592214 PMCID: PMC10436678 DOI: 10.1186/s12888-023-05094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Bipolar spectrum disorders (BSDs) are associated with a heightened sensitivity to rewards and elevated reward-related brain function in cortico-striatal circuitry. A separate literature documents social and circadian rhythm disruption in BSDs. Recently, integrated reward-circadian models of BSDs have been proposed. These models draw on work indicating that the two systems influence each other and interact to affect mood functioning. When dysregulated, reward and circadian system signaling may combine to form a positive feedback loop, whereby dysregulation in one system exacerbates dysregulation in the other. Project CREST (Circadian, Reward, and Emotion Systems in Teens) provides a first systematic test of reward-circadian dysregulation as a synergistic and dynamic vulnerability for first onset of BSD and increases in bipolar symptoms during adolescence. METHODS This NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 320 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13-16 years old, fluent in English, and without a prior BSD or hypomanic episode. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the high tail of the dimension in order to increase the likelihood of BSD onsets. At Times 1-6, every 6 months, participants will complete assessments of reward-relevant and social rhythm disruption life events and self-report and diagnostic assessments of bipolar symptoms and episodes. Yearly, at Times 1, 3, and 5, participants also will complete self-report measures of circadian chronotype (morningness-eveningness) and social rhythm regularity, a salivary dim light melatonin onset (DLMO) procedure to assess circadian phase, self-report, behavioral, and neural (fMRI) assessments of monetary and social reward responsiveness, and a 7-day ecological momentary assessment (EMA) period. During each EMA period, participants will complete continuous measures of sleep/wake and activity (actigraphy), a daily sleep diary, and three within-day (morning, afternoon, evening) measures of life events coded for reward-relevance and social rhythm disruption, monetary and social reward responsiveness, positive and negative affect, and hypo/manic and depressive symptoms. The fMRI scan will occur on the day before and the DLMO procedure will occur on the first evening of the 7-day EMA period. DISCUSSION This study is an innovative integration of research on multi-organ systems involved in reward and circadian signaling in understanding first onset of BSD in adolescence. It has the potential to facilitate novel pharmacological, neural, and behavioral interventions to treat, and ideally prevent, bipolar conditions.
Collapse
Affiliation(s)
- Lauren B Alloy
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA.
| | - Rachel F L Walsh
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Logan T Smith
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Mackenzie A Maddox
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, USA
| |
Collapse
|
7
|
Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Disability and its correlates among persons with bipolar disorder: Exploratory findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Indian J Psychiatry 2023; 65:760-766. [PMID: 37645361 PMCID: PMC10461586 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_713_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Aim This study aimed to evaluate the disability and its correlates in persons with Bipolar Disorder during the remission phase. Materials and Methods As part of the multicentric study, 773 patients with bipolar disorder, currently in clinical remission, were evaluated for disability on the Indian Disability Assessment Evaluation Scale. Results About one-fifth of the participants had some level of disability in the domain of self-care, one-third had some level of disability in the interpersonal domain, one-fourth had some level of disability in communication and understanding, and a maximum proportion (43.7%) had some disability in the domain of work. Overall, about one-fifth (18.4%) were considered to have a benchmark disability (i.e., disability >40%). In terms of correlates, those with a disability had a short duration of current remission, a higher number of manic and mixed episodes, a higher mean number of total episodes, spent more time in the episodes, had lower severity of the depressive episodes, higher residual depressive and manic symptoms, had overall higher manic affective morbidity, had a higher level of cognitive deficits, and had poorer insight. Conclusion A significant proportion of patients with bipolar disorder have disability in work domain, and the presence of residual symptoms of either polarity are associated with higher level of disability.
Collapse
Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Burdwan Medical College and Hospital, Burdwan, Bardhaman, West Bengal, India
| | | | - Rajarshi Neogi
- R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
| | - Alka A. Subramanyam
- Topiwala National Medical College (Nair Hospital), Mumbai, Maharashtra, India
| | - Naresh Nebhinani
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
| | | |
Collapse
|
8
|
Pearson O, Uglik-Marucha N, Miskowiak KW, Cairney SA, Rosenzweig I, Young AH, Stokes PRA. The relationship between sleep disturbance and cognitive impairment in mood disorders: A systematic review. J Affect Disord 2023; 327:207-216. [PMID: 36739007 DOI: 10.1016/j.jad.2023.01.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment experienced by people with bipolar disorders (BD) or major depressive disorder (MDD) is associated with impaired psychosocial function and poorer quality of life. Sleep disturbance is another core symptom of mood disorders which may be associated with, and perhaps worsen, cognitive impairments. The aim of this systematic review was to critically assess the relationship between sleep disturbance and cognitive impairment in mood disorders. METHODS In this systematic review, relevant studies were identified using electronic database searches of PsychINFO, MEDLINE, Embase and Web of Science. FINDINGS Fourteen studies were included; eight investigated people with BD, five investigated people with MDD, and one included both people with MDD and people with BD. One study was an intervention for sleep disturbance and the remaining thirteen studies used either a longitudinal or cross-sectional observational design. Ten studies reported a significant association between subjectively measured sleep disturbance and cognitive impairment in people with MDD or BD after adjusting for demographic and clinical covariates, whereas no such association was found in healthy participants. Two studies reported a significant association between objectively measured (actigraphy or polysomnography) sleep abnormalities and cognitive impairment in mood disorders. One study of cognitive behavioural therapy for insomnia modified for BD (CBTI-BD) found an association between improvements in sleep and cognitive performance in BD. INTERPRETATION There is preliminary evidence to suggest a significant association between sleep disturbance and cognitive impairment in mood disorders. These findings highlight the need for further research of sleep disturbances and cognitive impairment in people with mood disorders.
Collapse
Affiliation(s)
- Oliver Pearson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF London, United Kingdom; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry & Psychology and Neuroscience, King's College London, United Kingdom.
| | - Nora Uglik-Marucha
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF London, United Kingdom
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Scott A Cairney
- Department of Psychology, University of York, York YO10 5DD, United Kingdom; York Biomedical Research Institute, University of York, York YO10 5DD, United Kingdom
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, KCL, United Kingdom; Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry & Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Paul R A Stokes
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry & Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| |
Collapse
|
9
|
Risk of Mania After Methylphenidate in Patients With Bipolar Disorder. J Clin Psychopharmacol 2023; 43:28-34. [PMID: 36584246 DOI: 10.1097/jcp.0000000000001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bipolar disorder and attention-deficit/hyperactivity disorder are common comorbidities. Attention-deficit/hyperactivity disorder is commonly treated with stimulants (eg, methylphenidate), which, however, have been suggested to cause treatment-emergent mania in patients with bipolar disorder. Here, we assessed the risk of mania, depressive episodes, and psychiatric admissions after initiation of methylphenidate treatment in patients with bipolar disorder. METHODS Using Danish health registries, we identified all individuals registered with a diagnosis of bipolar disorder from January 1, 2000, to January 1, 2018, who were treated with methylphenidate. We applied a 1-year mirror-image model to compare the occurrence of mania, depression, and psychiatric admissions in the period leading up to and after methylphenidate treatment initiation. We furthermore assessed the trend in these outcomes from 4 years before to 1 year after initiation of methylphenidate treatment. RESULTS A total of 1043 patients with bipolar disorder initiated treatment with methylphenidate. The number of manic episodes decreased by 48% after methylphenidate treatment initiation (P = 0.01), both among patients using mood stabilizers (-50%) and among patients not using mood stabilizers (-45%). The number of manic episodes, however, peaked approximately 6 months before methylphenidate. The results were similar for the secondary outcomes. CONCLUSIONS Initiation of methylphenidate treatment was not associated with an increased risk of mania in patients with bipolar disorder. A decrease in mania, depressive episodes, and psychiatric admissions was observed after methylphenidate. However, these decreases seemed to be driven by regression to the mean after clinical deterioration preceding methylphenidate treatment, rather than by the methylphenidate treatment itself.
Collapse
|
10
|
ŞEN GÖKÇEİMAM P, YAR SF, KUMSAR N. Bipolar affektif bozukluk tanılı hastalarda COVID- 19 korkusunun kalıntı belirtiler ve işlevsellik ile ilişkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1176773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Amaç: Bu çalışmada bipolar affektif bozukluk tanılı hastalarda COVID-19 korkusu ile kalıntı belirtiler ve işlevsellik düzeyleri arasındaki ilişkinin saptanması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya DSM-5’e göre bipolar affektif bozukluk tanısı bulunan, 18-65 yaş arasında ve okur yazar olan, polikliniğe kendisi başvuran ardışık 85 bipolar affektif bozukluk tanılı hasta alınmıştır. Hastalar depresif /manik belirtiler gösteren, remisyonda olup da kalıntı belirtileri olanlar olarak gruplandırılmıştır.
Bulgular: YMDÖ’ye göre ‘manik kalıntı belirtileri olan’ olarak sınıflandırılan katılımcıların bu ölçekte medyan puanı 1 ± 1,14'tü. Katılımcılar arasında manik kalıntı belirti olup olmamasına göre COVID-19 Korkusu Ölçek puanları açısından anlamlı bir fark bulunmadı. Depresif kalıntı semptomu olmayan katılımcılar, depresif kalıntı semptomu olanlara göre COVID-19 Korkusu Ölçeğinde anlamlı şekilde daha düşük puanlar göstermiştir. HAM-D Ölçeği, . İşlevsellik Kısa Değerlendirme Testi ile COVID-19 Korkusu Ölçeği puanları arasında anlamlı düzeyde pozitif korelasyon saptanmıştır
Sonuç: Depresif kalıntı semptomu olan hastalar COVID -19 korku ölçeğinde anlamlı şekilde daha yüksek puan almışlardır. Stres döneminde hastalarda dayanıklılık hastalık korkusu ve kalıntı belirtilerin çalışılması da takip ve tedavi stratejilerinin belirlenmesi açısından kıymetli olacaktır.
Collapse
Affiliation(s)
- Pınar ŞEN GÖKÇEİMAM
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ERENKÖY APPLICATION AND RESEARCH CENTER FOR PSYCHIATRIC AND NERVE DISEASES
| | | | | |
Collapse
|
11
|
Seo JY, Yeom JW, Cho CH, Son S, Ahn YM, Kim SJ, Ha TH, Cha B, Moon E, Park DY, Baek JH, Kang HJ, An H, Lee HJ. The relationship between morningness-eveningness and mood symptoms and quality of life in euthymic state of mood disorders: Results from a prospective observational cohort study. J Affect Disord 2022; 316:10-16. [PMID: 35940376 DOI: 10.1016/j.jad.2022.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The clinical importance of morningness-eveningness, especially in mood disorders, is prevailing. The differential relation of chronotype with diagnoses of early-onset mood disorders, mood symptoms, anxiety, and quality of life was evaluated. METHODS Early-onset mood disorder patients [n = 419; 146 major depressive disorder (MDD); 123 bipolar I disorder (BDI); 150 bipolar II disorder (BDII)] from the Mood Disorder Cohort Research Consortium were assessed for chronotype using the composite scale for morningness (CSM) and its association with clinical variables obtained during the clinician-verified euthymic state. RESULTS The mean total CSM of BDI was significantly higher than MDD and BDII (p < 0.001). In all types of mood disorders, higher total CSM was associated with lower Quick inventory of depressive symptomatology (p < 0.005) and higher WHO quality of life (p < 0.005). Such negative correlations between the total CSM and Montgomery-Asberg depression rating were significant in MDD and BDI (p < 0.05) and marginally significant in BDII (p = 0.077). CSM was a significant contributor to quality of life in BDI (p < 0.001) and BDII (p = 0.011), but it was not for MDD. LIMITATIONS The defined 'euthymic state' that may not fully reflect the remission of episode; limited generalizability due to clinical characteristic of early-onset mood disorder; the disparity between diurnal preference measured by the CSM and chronotype; possible effects of the last mood episode polarity and medication; and, lack of control group. CONCLUSION Less eveningness was associated with less severe depressive symptoms and better quality of life. This suggests that morningness may reduce residual depressive symptoms and recover function of patients.
Collapse
Affiliation(s)
- Ju Yeon Seo
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea; Chronobiology Institute, Korea University, Seoul, Republic of Korea
| | - Ji Won Yeom
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea; Chronobiology Institute, Korea University, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Chronobiology Institute, Korea University, Seoul, Republic of Korea; Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Republic of Korea; Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Serhim Son
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyon Ha
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Dong Yeon Park
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University College of Medicine, Gwangju, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea; Chronobiology Institute, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
12
|
Stalmeier TDM, Lubbers J, Cladder-Micus MB, Hanssen I, Huijbers MJ, Speckens AEM, Geurts DEM. Mindfulness based cognitive therapy (MBCT) reduces depression-related self-referential processing in patients with bipolar disorder: an exploratory task-based study. Cogn Emot 2022; 36:1255-1272. [PMID: 35916755 DOI: 10.1080/02699931.2022.2105308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Negative self-referential processing has fruitfully been studied in unipolar depressed patients, but remarkably less in patients with bipolar disorder (BD). This exploratory study examines the relation between task-based self-referential processing and depressive symptoms in BD and their possible importance to the working mechanism of mindfulness-based cognitive therapy (MBCT) for BD. The study population consisted of a subsample of patients with BD (n = 49) participating in an RCT of MBCT for BD, who were assigned to MBCT + TAU (n = 23) or treatment as usual (TAU) (n = 26). Patients performed the self-referential encoding task (SRET), which measures (1) positive and (2) negative attributions to oneself as well as (3) negative self-referential memory bias, before and after MBCT + TAU or TAU. At baseline, all three SRET measures were significantly related to depressive symptoms in patients with BD. Moreover, repeated measures analyses of variance revealed that negative self-referential memory bias diminished over time in the MBCT + TAU group, compared with the TAU group. Given the preliminary nature of our findings, future research should explore the possibly mediating role of reducing negative self-referential memory bias in preventing and treating depressive symptoms in BD through MBCT.
Collapse
Affiliation(s)
- Thalia D M Stalmeier
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Jelle Lubbers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mira B Cladder-Micus
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Imke Hanssen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Marloes J Huijbers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Anne E M Speckens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Dirk E M Geurts
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Abstract
OBJECTIVE High prevalence of insulin resistance (IR) has been reported in bipolar disorder (BD) patients. Importantly, impaired insulin sensitivity could modulate the course and treatment outcome in BD. Here, we hypothesized that insulin sensitivity could be potentially associated with the neurocognitive trajectory in euthymic BD. We aimed to examine differences in insulin sensitivity and executive function between BD patients and controls. METHODS Sixty-two patients with BD receiving mood stabilizer treatment and 62 controls, matching age, sex, and body mass index, were recruited in this study. Insulin sensitivity was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). The Wisconsin card-sorting test (WCST) was applied to test participants' ability to shift cognitive set. Group differences were measured and multivariate regression analysis was performed to examine relationships among factors. RESULTS The results indicated that the HOMA-IR (P = .048) value in the patients with BD were significantly higher than those in controls. With regards to executive function, the BD patients performed significantly poorer than the control subjects (P < .05). Moreover, the interaction effect between BD diagnosis and HOMA-IR value on the WCST-preservation errors was significant (P = .01), and post-hoc analyses showed that the cognitive abilities were worse in the BD patients with a higher IR than in the others groups. CONCLUSION Insulin sensitivity is associated with the neurocognitive performance in euthymic BD patients. Although the underlying mechanisms remain unclear, interventions to improve insulin sensitivity could potentially improve the functional outcome of BD.
Collapse
|
14
|
Dargél AA, Mosconi E, Volant S, Taieb D, Brenot P. Sexual dysfunction among males and females with bipolar disorder and healthy subjects: The burden of illness severity. Bipolar Disord 2022; 24:637-646. [PMID: 36000440 DOI: 10.1111/bdi.13249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sexual dysfunction has wide-ranging impacts on the person's functioning and quality of life, being associated with higher severity of psychiatric illnesses and poor therapeutic response. Given the paucity of data on this topic in bipolar disorder (BD), we investigated sexual functioning among males and females with BD and healthy controls (HCs) as well as whether illness severity markers and subthreshold mood symptoms were associated with sexual dysfunctions in BD patients. METHODS The study included 80 BD outpatients and 70 HCs. Sexual functioning was evaluated using the validated, gender-specific Changes in Sexual Functioning Questionnaire (CSFQ-14). RESULTS BD patients had a significantly poorer sexual functioning than HCs (p < 0.00001). The odds of sexual dysfunction doubled given a one-unit increase in the number of suicide attempts (adjusted OR = 2.01, 95% CI:1.23-3.55; p < 0.01) and increased by 60% for every additional hospitalization (p < 0.05). Greater illness duration was associated with arousal/orgasmic (p < 0.05) and overall sexual dysfunctions (p < 0.01). BD patients with more mixed or (hypo)manic episodes had a lower likelihood of libido loss and arousal/orgasmic disturbances (p < 0.01), respectively. Higher levels of subthreshold depressive symptoms increased by 20% the odds of sexual interest/frequency dysfunctions (p < 0.05), and up to 60% regarding orgasmic disturbances (p < 0.01). CONCLUSIONS Sexual functioning may be a useful proxy of illness severity as well as a relevant dimension to more deeply characterize BD patients. Further studies are warranted to replicate our findings, to evaluate temporal associations between sexual dysfunctions and illness severity across the BD mood and treatment spectrums and to explore neurobiological underpinnings of these associations.
Collapse
Affiliation(s)
- Aroldo A Dargél
- Institut Pasteur, Unité Perception et Mémoire, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Paris, France
| | - Elise Mosconi
- Centre d'étude de la Sexologie et de la Sexualité Humaine, Université Paris 5-René Descartes, Paris, France
| | - Stevenn Volant
- Hub de Bioinformatique, Biostatistique et Biologie Intégrative, Institut Pasteur, Paris, France
| | - David Taieb
- Centre d'étude de la Sexologie et de la Sexualité Humaine, Université Paris 5-René Descartes, Paris, France
| | - Philippe Brenot
- Centre d'étude de la Sexologie et de la Sexualité Humaine, Université Paris 5-René Descartes, Paris, France
| |
Collapse
|
15
|
Lubbers J, Geurts D, Hanssen I, Huijbers M, Spijker J, Speckens A, Cladder-Micus M. The effect of mindfulness-based cognitive therapy on rumination and a task-based measure of intrusive thoughts in patients with bipolar disorder. Int J Bipolar Disord 2022; 10:22. [PMID: 35960403 PMCID: PMC9374865 DOI: 10.1186/s40345-022-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Preliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). A proposed working mechanism of MBCT in attenuating depressive symptoms is reducing depressive rumination. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts in BD patients. Exploratively, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts. Methods The study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and intrusive thoughts (breathing focus task (BFT)) were assessed at baseline (full subsample) and post-treatment (MBCT + TAU; n = 15, TAU; n = 15). During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing. Results Compared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = .16, F(1, 27) = 5.15, p = 0.031; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = 0.036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts. Conclusions MBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Considering the preliminary nature of our findings, future research should replicate our findings and explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and relapse or recurrence in BD. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00269-1.
Collapse
Affiliation(s)
- Jelle Lubbers
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, The Netherlands. .,Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands.
| | - Dirk Geurts
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Imke Hanssen
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Marloes Huijbers
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Jan Spijker
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Mira Cladder-Micus
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
| |
Collapse
|
16
|
Koene J, Zyto S, van der Stel J, van Lang N, Ammeraal M, Kupka RW, van Weeghel J. The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review. Int J Bipolar Disord 2022; 10:8. [PMID: 35286505 PMCID: PMC8921376 DOI: 10.1186/s40345-022-00255-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning. Objectives The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation. Methods We applied the methodological framework as described by Arksey and O’Malley (Int J Soc Res Methodol Theory Pract 8:19–32, 2005) and Levac et al. (Implement Sci 5:1–9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results. Results The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined. Conclusion Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00255-7.
Collapse
Affiliation(s)
- Juul Koene
- University of Applied Sciences Leiden, Leiden, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Susan Zyto
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. .,Mental Health Service Organisation North Holland North, Hoorn, The Netherlands.
| | | | | | - Marion Ammeraal
- GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands.,Phrenos Center of Expertise, Utrecht, The Netherlands
| |
Collapse
|
17
|
Esan O, Fela-Thomas A. The significance of sleep quality in euthymic bipolar patients from Nigeria. S Afr J Psychiatr 2022; 28:1739. [PMID: 35281965 PMCID: PMC8905369 DOI: 10.4102/sajpsychiatry.v28i0.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Bipolar disorder is highly under-researched in Africa. Existing studies show that racial/ethnic disparities exist for sleep quality. Poor sleep quality in bipolar disorder causes significant morbidity and mortality even during periods of euthymia. Aim This study aimed to assess sleep quality and its correlates amongst euthymic patients with bipolar I disorder from Nigeria. Setting The study was carried out in a teaching hospital, and state hospital, in Ibadan, Nigeria. Method This cross-sectional study was conducted amongst 76 euthymic bipolar patients aged between 18 and 60 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for bipolar disorder. Euthymia was defined as having a score of ≤ 5 on the Young Mania Rating Scale and < 8 on the Hamilton Depression Rating Scale. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Results A total of 37 (48.7%) participants had poor quality sleep. Sleep quality was associated with marital status (p = 0.013) and suicide plan (p = 0.047). Participants with good sleep quality had higher total sleep duration, lower time to fall asleep (sleep latency), better subjective quality of sleep, were less likely to use sleep medications and had less daytime dysfunction than participants with poor sleep quality. All p-values were < 0.05. Subjective quality of sleep, ongoing use of sleep medication, daytime dysfunction were independently associated with poor sleep quality. Conclusion Poor sleep quality frequently persists during euthymic periods in patients with bipolar disorder. The correlates identified can be targeted for intervention during treatment.
Collapse
Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | | |
Collapse
|
18
|
Cañada Y, García-Blanco A, García-Portilla MP, Fuente-Tomás LDL, Navalón P, Arranz B, Sánchez-Autet M, Hervás-Marín D, Livianos L, Sierra P. Affective temperaments and sexual functioning in euthymic patients with bipolar disorder. J Psychiatr Res 2022; 146:201-209. [PMID: 35007941 DOI: 10.1016/j.jpsychires.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
Abstract
Sexual functioning in bipolar disorder (BD) is dependent on multiple clinical and demographic determinants that can eventually lead to sexual dysfunction. However, the contribution of affective temperaments remains unstudied in this population. In this cross-sectional multicentric work, we studied the impact of temperament traits on sexual functioning in 100 euthymic BD outpatients treated only with mood stabilizers with or without benzodiazepines. Temperament was evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Autoquestionnaire (TEMPS-A) and sexual functioning with the Changes on Sexual Functioning Questionnaire (CSFQ-14). The effect of temperament on sexual functioning was analyzed using Bayesian ordinal regression models, which included age, gender, BD type, dominant polarity, metabolic syndrome, marital status, and affective symptomatology. Our results showed that hyperthymic traits predicted a significantly higher CSFQ-14 score for global sexual functioning (OR = 1.222; 95% CI [1.073, 1.431]), desire (OR = 1.164; 95% CI [1.025, 1.357]), arousal (OR = 1.278; 95% CI: [1.083, 1.551]), and orgasm (OR = 1.182; 95% CI [1.037, 1.365]). We did not find a significant contribution for other types of temperaments. Better sexual functioning was also associated with a better quality of life. Our findings highlight the importance of temperament traits in sexual functioning in euthymic BD, which may have implications in sexual dysfunction prevention.
Collapse
Affiliation(s)
- Yolanda Cañada
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, Health Research Institute La Fe, Valencia, Spain
| | - Ana García-Blanco
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain; Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain.
| | - M Paz García-Portilla
- Center of Biomedical Investigation Network in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Lorena de la Fuente-Tomás
- Center of Biomedical Investigation Network in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Pablo Navalón
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
| | - Belén Arranz
- Center of Biomedical Investigation Network in Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | | | - David Hervás-Marín
- Department of Biostatistics, Health Research Institute La Fe, Valencia, Spain
| | - Lorenzo Livianos
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; CIBERESP, Group 17, Valencia, Spain
| | - Pilar Sierra
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| |
Collapse
|
19
|
Carruthers SP, Rossell SL, Murray G, Karantonis J, Furlong LS, Van Rheenen TE. Mindfulness, mood symptom tendencies and quality of life in bipolar disorder: An examination of the mediating influence of emotion regulation difficulties. J Affect Disord 2022; 298:166-172. [PMID: 34715199 DOI: 10.1016/j.jad.2021.10.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/02/2021] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to investigate dispositional mindfulness and its association with depression and manic tendencies, and subjective life quality in bipolar disorder (BD). Furthermore, this study sought to examine the potential mediating effects of emotion regulation difficulties on these relationships. METHOD Twenty-eight healthy controls (HC) and 66 clinically stable outpatients with a DSM-IV-TR diagnosis of BD completed the Mindfulness Attention Awareness Scale (MAAS), Difficulties in Emotion Regulation Scale (DERS), Seven Up (7 Up) Seven Down (7 Down) and the Quality of Life in Bipolar Disorder Questionnaire (QoL.BD). These variables were compared between groups and entered into a series of mediation analyzes using PROCESS in the BD group only. RESULTS Lower MAAS scores were detected amongst the BD patients compared to HCs. Lower MAAS scores in BD patients predicted higher 7 Up, 7 Down and lower QoL.BD scores. For the 7 Down and QoL.BD, the associations were completely mediated by DERS scores, with difficulties in strategy use and emotional clarity mediating the association between mindfulness and depressive tendencies and quality of life, respectively. No significant direct or indirect effects were detected for the 7 Up model. LIMITATIONS The cross-sectional design precludes causal inference. The MAAS conceptualises mindfulness as unidimensional. Self-report scales of depressive and manic tendencies utilised. CONCLUSIONS This study detected a significant association between dispositional mindfulness and depressive tendencies and life quality in BD, and found that these associations were influenced by emotion regulation difficulties. These findings encourage further investigation of mindfulness-based interventions in BD.
Collapse
Affiliation(s)
- Sean P Carruthers
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - James Karantonis
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Lisa S Furlong
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| |
Collapse
|
20
|
Complexity and variability analyses of motor activity distinguish mood states in bipolar disorder. PLoS One 2022; 17:e0262232. [PMID: 35061801 PMCID: PMC8782466 DOI: 10.1371/journal.pone.0262232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/20/2021] [Indexed: 02/07/2023] Open
Abstract
Changes in motor activity are core symptoms of mood episodes in bipolar disorder. The manic state is characterized by increased variance, augmented complexity and irregular circadian rhythmicity when compared to healthy controls. No previous studies have compared mania to euthymia intra-individually in motor activity. The aim of this study was to characterize differences in motor activity when comparing manic patients to their euthymic selves. Motor activity was collected from 16 bipolar inpatients in mania and remission. 24-h recordings and 2-h time series in the morning and evening were analyzed for mean activity, variability and complexity. Lastly, the recordings were analyzed with the similarity graph algorithm and graph theory concepts such as edges, bridges, connected components and cliques. The similarity graph measures fluctuations in activity reasonably comparable to both variability and complexity measures. However, direct comparisons are difficult as most graph measures reveal variability in constricted time windows. Compared to sample entropy, the similarity graph is less sensitive to outliers. The little-understood estimate Bridges is possibly revealing underlying dynamics in the time series. When compared to euthymia, over the duration of approximately one circadian cycle, the manic state presented reduced variability, displayed by decreased standard deviation (p = 0.013) and augmented complexity shown by increased sample entropy (p = 0.025). During mania there were also fewer edges (p = 0.039) and more bridges (p = 0.026). Similar significant changes in variability and complexity were observed in the 2-h morning and evening sequences, mainly in the estimates of the similarity graph algorithm. Finally, augmented complexity was present in morning samples during mania, displayed by increased sample entropy (p = 0.015). In conclusion, the motor activity of mania is characterized by altered complexity and variability when compared within-subject to euthymia.
Collapse
|
21
|
Moot W, Crowe M, Inder M, Eggleston K, Frampton C, Porter RJ. Domain-Based Functional Improvements in Bipolar Disorder After Interpersonal and Social Rhythm Therapy. Front Psychiatry 2022; 13:767629. [PMID: 35237184 PMCID: PMC8882592 DOI: 10.3389/fpsyt.2022.767629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies typically report overall change in function when assessing bipolar disorder (BD) interventions, but individual domains are not analyzed. Which aspects of functioning are impacted is clearly important and may differ between treatments. METHODS Data were analyzed from two previous clinical trials of Interpersonal and Social Rhythm Therapy (IPSRT) for BD patients. Change in total and subscale scores on the Social Adjustment Scale Self-Report (SAS-SR) from 0 to 78 weeks, were analyzed. RESULTS 152 BD patients took part in randomized controlled trials of IPSRT (n = 38) vs. Specialist Supportive Care (SSC) (n = 43), and of IPSRT (n = 41) vs. treatment as usual (TAU) which was discharge to primary care (n = 30). IPSRT was superior to TAU on change in the social and leisure activities and extended family subscales, and SAS-SR total score over 18 months. LIMITATIONS Studies were not designed to be pooled. Patients in study 1 were younger and symptomatic at baseline. Patients assigned to TAU were more likely to drop-out. Patients did not respond to subscales that were not personally applicable (work, marital, children). CONCLUSION IPSRT had a positive impact on two SAS-SR subscales compared to TAU over 18 months. Other subscales were limited by the lack of respondents due to individual applicability. Different psychotherapy may have differential effects on different domains of function. Measures of function and research into functioning in BD should include domain-based measures, and report the numbers of participants who respond to questions in each domain.
Collapse
Affiliation(s)
- William Moot
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
22
|
Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
Collapse
Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | |
Collapse
|
23
|
Aguglia A, Natale A, Fusar-Poli L, Amerio A, Bruno E, Placenti V, Vai E, Costanza A, Serafini G, Aguglia E, Amore M. Bipolar Disorder and Polysubstance Use Disorder: Sociodemographic and Clinical Correlates. Front Psychiatry 2022; 13:913965. [PMID: 35782426 PMCID: PMC9242092 DOI: 10.3389/fpsyt.2022.913965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/11/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Patients with bipolar disorder (BD) often show comorbidity with substance use disorder (SUD) with a negative impact on clinical course, prognosis, and functioning. The role of polysubstance use disorder (polySUD) is understudied. The aim of the present paper is to evaluate the sociodemographic and clinical characteristics associated with BD and comorbid SUD, focusing on polySUD, in order to phenotype this specific group of patients and implement adequate treatment and prevention strategies. METHODS A cross-sectional study was conducted involving 556 patients with a primary diagnosis of BD (376 without SUD, 101 with SUD, and 79 with polySUD). A semi-structured interview was administered to collect sociodemographic variables, clinical characteristics, and pharmacological treatment. ANOVA and chi-square tests were used to compare the three groups. Significantly different variables were then inserted in multivariate logistic regression. RESULTS Patients affected by BD and polySUD were younger, and more frequently males and single, than patients with SUD or without SUD. Indeed, the prevalence of patients affected by BD and polySUD living in residential facilities was higher than in the other groups. Moreover, earlier age at onset, higher prevalence of psychotic and residual symptoms, involuntary hospitalization, and a family history of psychiatric disorders were associated with polySUD in patients suffering from BD. Lastly, patients with BD and polySUD were more likely to take four or more medications, particularly benzodiazepines and other drugs. At the multinomial regression, younger age, male gender, early age at onset, psychotic and residual symptoms, positive family history of psychiatric disorders, and use of benzodiazepines remained significantly associated with polySUD in patients with BD. CONCLUSION Our findings show a specific profile of patients with BD and polySUD. It is important to conduct research on this topic in order to adopt specific therapeutic strategies, minimize the use of polypharmacy, and aim at full remission and mood stabilization.
Collapse
Affiliation(s)
- Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo Bruno
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Valeria Placenti
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Eleonora Vai
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
24
|
Filia KM, Cotton SM, Watson AE, Jayasinghe A, Kerr M, Fitzgerald PB. Understanding the Barriers and Facilitators to Employment for People with Bipolar Disorder. Psychiatr Q 2021; 92:1565-1579. [PMID: 34097245 DOI: 10.1007/s11126-021-09931-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
People with Bipolar Disorder (BD) consistently report a desire for employment; however, this is not reflected in employment figures. Individuals' perceptions of barriers to employment, along with endorsement of facilitators to employment remain under-investigated. We aimed to address this limitation by: (i) first examining differences in employed versus unemployed individuals (demographic, clinical, functioning); then (ii) identifying barriers and/or facilitators to employment, perception of same, and subsequent impact on employment. We assessed demographics, functioning, and illness-related characteristics in 35 participants with BD (19 employed, 16 unemployed). Participants were asked to indicate perception of common barriers and facilitators to employment. Groups did not differ regarding demographic or clinical variables. High levels of absenteeism, termination of last role and commonly perceived barriers were attributed to mental ill-health. 93.3% of unemployed participants reportedly desired employment, and more perceived barriers were observed in the unemployed group. Identified facilitators included increased support and flexible work strategies. A comprehensive understanding of perceptions of limiting and helpful factors related to employment for people with BD was obtained. These findings have implications for service provision, encouraging targeted discussion, and tailored treatment approaches to individual's unique perceptions of factors related to employment.
Collapse
Affiliation(s)
- K M Filia
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.
| | - S M Cotton
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - A E Watson
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - A Jayasinghe
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - M Kerr
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - P B Fitzgerald
- Department of Psychiatry, Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University, 888 Toorak Road, Camberwell, VIC, 3124, Australia
| |
Collapse
|
25
|
Tsapekos D, Strawbridge R, Cella M, Wykes T, Young AH. Predictors of psychosocial functioning in euthymic patients with bipolar disorder: A model selection approach. J Psychiatr Res 2021; 143:60-67. [PMID: 34455193 DOI: 10.1016/j.jpsychires.2021.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/17/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional impairment is a major target in the treatment of bipolar disorder (BD), but the magnitude and type of functional difficulties differ across patients. Findings on predictors of overall functioning and specific functional areas are inconsistent. We aimed to characterize functional difficulties and identify factors associated with global functioning and individual domains in euthymic patients. METHODS The Functional Assessment Short Test (FAST) was used to assess overall psychosocial functioning and specific functional domains in 80 euthymic participants with BD. Participants also completed a clinical interview and a cognitive assessment. Model selection with elastic net regression was performed to identify predictors of global functioning. We then examined the association of these predictors with individual functional domains using correlation. RESULTS FAST scores indicated moderate or severe impairment for 54% of the sample, with occupational functioning showing the highest impairment rate. Elastic net regression selected a model with three variables (higher residual depressive symptoms, lower executive functioning, more perceived cognitive deficits) as predictors of overall functioning. No significant associations were found between these predictors. Depressive symptoms were associated with interpersonal relationships and leisure time, executive skills with occupational functioning, and perceived deficits with cognitive functioning. CONCLUSIONS Residual depressive symptoms were the strongest predictor of overall functioning which highlights the importance of assessing and targeting subthreshold symptoms for recovery. Executive difficulties were associated with functioning, particularly occupational skills, independently of depressive symptoms. Interventions targeting these difficulties, such as cognitive and functional remediation, may be key treatment options towards facilitating functional recovery.
Collapse
Affiliation(s)
- Dimosthenis Tsapekos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| |
Collapse
|
26
|
Carruthers S, Michelini G, Kitsune V, Hosang GM, Brandeis D, Asherson P, Kuntsi J. Early neurophysiological stimulus processing during a performance-monitoring task differentiates women with bipolar disorder from women with ADHD. Psychiatry Res 2021; 303:114088. [PMID: 34252636 DOI: 10.1016/j.psychres.2021.114088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/21/2022]
Abstract
Adults with attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder (BD) may display similar cognitive impairments and clinical symptoms, which might reflect shared mechanisms. Initial evidence indicates disorder-specific and overlapping neurophysiological alterations using event-related potentials (ERPs) in individuals with BD or ADHD during attentional tasks, but it is unknown whether impairments generalize across other processes and tasks. We conduct the first comparison between women with ADHD (n = 20), women with BD (n = 20) and control women (n = 20) on ERPs from a performance-monitoring flanker task. The BD group showed a significantly attenuated frontal ERP of conflict monitoring (N2) compared to the ADHD group across both low-conflict (congruent) and high-conflict (incongruent) task conditions, and compared to controls in the high-conflict condition. However, when controlling for an earlier attentional ERP (frontal N1), which was significantly reduced in participants with BD compared to participants with ADHD and controls, N2 group differences were no longer significant. These results indicate that ERP differences in conflict monitoring may be attributable to differences in earlier attentional processes. These findings identify neural differences in early attention between BD and ADHD which precede conflict monitoring processes, potentially pointing to distinct neural mechanisms implicated in the two disorders.
Collapse
Affiliation(s)
- Sophie Carruthers
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Giorgia Michelini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK; Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Viryanaga Kitsune
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Georgina M Hosang
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London, London, UK
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.
| |
Collapse
|
27
|
O'Rourke N, Sixsmith A, Michael T, Bachner YG. Is the 4-factor model of symptomology equivalent across bipolar disorder subtypes? Int J Bipolar Disord 2021; 9:24. [PMID: 34337680 PMCID: PMC8326238 DOI: 10.1186/s40345-021-00229-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/13/2021] [Indexed: 01/21/2023] Open
Abstract
Background Research with the BDSx (Bipolar Disorder Symptom Scale) suggests a 4-factor structure of responses: two depression (cognitive, somatic) and two hypo/mania factors (elation/loss of insight, affrontive symptoms). The two depression and two hypo/mania factors are correlated; and affrontive symptoms of hypo/mania (e.g., furious, disgusted, argumentative) are positively correlated with both depression factors suggesting pathways for mixed symptom presentation. This grouping of affrontive symptoms of hypo/mania organically emerged in exploratory research and has subsequently been supported in confirmatory analyses between samples and over time. The BDSx has been clinically validated with BD outpatients. Results Over 19 days, we recruited an international sample of 784 adults with BD using micro-targeted, social media advertising (M = 44.48 years, range 18–82). All participants indicated that they had BD (subtype, if known) and had been diagnosed with BD (month, year). This sample size was sufficient to confirm the 4-factor model across subtypes and compare the three (BD I, BD II, BD NOS). Responses to 19 of 20 BDSx items were psychometrically consistent across BD subtypes. Only responses to the ‘hopeless’ item were significantly higher for those with BD II. Conclusions When comparing models, it appears that affrontive symptoms are significantly and uniformly associated with hypo/mania and both depression factors across subtypes. In contrast to BD diagnostic criteria, this suggests that affrontive symptoms are central to the clinical presentation of hypo/mania and mixed symptomology across BD subtypes.
Collapse
Affiliation(s)
- Norm O'Rourke
- Department of Public Health and Multidisciplinary Center for Research On Aging, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel.
| | - Andrew Sixsmith
- STAR Institute, Simon Fraser University, Vancouver, BC, Canada
| | - Tal Michael
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yaacov G Bachner
- Department of Public Health and Multidisciplinary Center for Research On Aging, Ben-Gurion University of the Negev, P.O. Box 653, 8410501, Be'er Sheva, Israel
| |
Collapse
|
28
|
Karaş H, Çarpar E, Küçükgöncü S, Kaşer M. Associations of Attachment and Coping Styles With Social Functioning in Patients With Bipolar Disorder I. J Nerv Ment Dis 2021; 209:578-584. [PMID: 34397758 DOI: 10.1097/nmd.0000000000001352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT The aim of this study was to investigate the relationship of attachment and coping mechanisms with social functioning in patients with bipolar disorder (BD). Sixty-three patients with BD type I and 63 healthy controls were evaluated. Structured Clinical Interview for DSM-IV Axis I Disorders, Hamilton Depression Rating Scale, Young Mania Rating Scale, Experiences in Close Relationships Questionnaire II, Coping Orientation to Problems Experienced (COPE) inventory, and Social Functioning Scale were used. In the BD group, adaptive coping style scores and attachment avoidance scores were significantly lower than the control group, but mean scores of maladaptive coping styles were higher than the control group. Regression analysis showed that positive reinterpretation and growth, active coping, use of emotional social support, planning, religious activities, and mental disengagement subscales of COPE were significantly associated with social functioning. Psychosocial interventions to strengthen adaptive coping mechanisms may help improve the social functioning in patients with BD.
Collapse
Affiliation(s)
- Hakan Karaş
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Elif Çarpar
- Hellesdon Hospital, Norfolk and Suffolk NHS Trust, Norfolk, England
| | - Suat Küçükgöncü
- Psychiatry Department, Maltepe University Medicine Faculty, Istanbul, Turkey
| | | |
Collapse
|
29
|
Chen WY, Huang MC, Lee YC, Chang CE, Lin SK, Chiu CC, Liu HC, Kuo CJ, Weng SH, Chen PY, Kuo PH. The Heterogeneity of Longitudinal Cognitive Decline in Euthymic Bipolar I Disorder With Clinical Characteristics and Functional Outcomes. Front Psychiatry 2021; 12:684813. [PMID: 34366918 PMCID: PMC8335543 DOI: 10.3389/fpsyt.2021.684813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022] Open
Abstract
We characterized the heterogeneity and risk factors of cognitive decline in euthymic bipolar disorder (BD), and their magnitude of associations with subjective daily functions. In this retrospective cohort, BD type I patients (N = 128) were followed for an average of 6.5 years. Intelligence quotient (IQ) at index date was recorded, and premorbid IQ was estimated. We used Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognition at follow-up. We evaluated current functions with World Health Organization Disability Assessment Schedule 2.0. Clinical and sociodemographic factors were examined for their independent effects on longitudinal cognitive decline. In addition, we employed multivariate adaptive regression spline to detect inflection points for the nature of slope changes in cognitive decline among BD patients. During follow-up years, 21 BD patients (16.4%) showed longitudinal cognitive decline. In cognitive decline group, all cognitive domains of BAC-A were significantly worsened. We found that density of episodes with psychotic features was an independent risk factor for cognitive decline after adjusted for age, gender and dose of mood stabilizer. After the age of 42 years, a steeper cognitive change was observed in the cognitive decline group. The correlation pattern between cognitive domains and functional outcomes differed between patients with and without cognitive decline. The present study characterized cognitive heterogeneity longitudinally in BD patients. As density of episodes play roles for cognitive decline, our results emphasize the importance of relapse prevention. Our findings provide hints for future personalized interventions and facilitating genetic and biological studies for dissecting the heterogeneity of bipolar illness.
Collapse
Affiliation(s)
- Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ya-Chin Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chiao-Erh Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Ku Lin
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Han Weng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Po-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
30
|
Madden JM, Araujo-Lane C, Foxworth P, Lu CY, Wharam JF, Busch AB, Soumerai SB, Ross-Degnan D. Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder. J Affect Disord 2021; 281:41-50. [PMID: 33290926 DOI: 10.1016/j.jad.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cost-sharing disproportionately affects people with chronic illnesses needing more care. Our qualitative study examined lived experiences navigating insurance benefits and treatment for bipolar disorder, which requires ongoing access to behavioral specialists and psychotropic medications. METHODS Forty semi-structured telephone interviews with individuals with bipolar disorder and employer-sponsored health insurance, or their family caregivers, explored health care needs, coverage details, out-of-pocket (OOP) costs, and perspectives on value. An iterative analytic approach identified salient themes. RESULTS Most individuals in our sample faced an annual insurance deductible, from $350-$10,000. OOP costs for specialist visits ranged from $0-$450 and for monthly psychotropic medications from $0-$1650. Acute episodes and care for comorbidities, including medication side effects, added to cost burdens. Medication nonadherence due to OOP costs was rare; respondents frequently pointed to the necessity of medications: "whatever it takes to get those"; "it's a life or death situation." Respondents also prioritized visits to psychiatrist prescribers, though visits were maximally spaced because of cost. Psychotherapy was often deemed unaffordable and forgone, despite perceived need. Interviewees cited limited networks and high out-of-network costs as barriers to specialists. Cost-sharing sometimes led to debt, skimping on nonbehavioral care or other necessities, exacerbated or prolonged mood symptoms, and stress at home. LIMITATIONS Volunteer respondents may not fully represent the target population. CONCLUSIONS Many people with bipolar disorder in US employer-sponsored plans experience undertreatment, hardship, and adverse health consequences due to high cost-sharing. More nuanced insurance benefit designs should accommodate the needs of individuals with complex conditions.
Collapse
Affiliation(s)
- Jeanne M Madden
- Northeastern University School of Pharmacy, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA.
| | - Carina Araujo-Lane
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | | | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - Alisa B Busch
- McLean Hospital and Department of Health Care Policy, Harvard Medical School, USA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| |
Collapse
|
31
|
Munuera C, Roux P, Weil F, Passerieux C, M'Bailara K. Determinants of the remission heterogeneity in bipolar disorders: The importance of early maladaptive schemas (EMS). J Affect Disord 2020; 277:857-868. [PMID: 33065827 DOI: 10.1016/j.jad.2020.08.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/16/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND A crucial health issue is to understand the remission heterogeneity of Bipolar Disorders by considering symptomatology as well as functioning. A new perspective could be elements of the construction of individual identity. This exploratory study aimed to explore the remission heterogeneity of patients with BD in terms of Early Maladaptive Schemas (EMS) by preferring a person-oriented approach. METHODS This study included euthymic patients recruited into the FACE-BD cohort. The remission was assessed by the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale for its symptomatic dimension and by the Functioning Assessment Short Test for its functional dimension. The activation of the eighteen EMS was assessed by the Young Schema Questionnaire 3 Short Form. Clustering was performed to identify profiles according to the patients' remission. Clusters identified were compared on the EMS activation by using analysis of variance and post-hoc tests. RESULTS Among the 100 euthymic patients included, four profiles of remission were identified: cluster 1 "Global Remission" (34%), cluster 2 "Hypomanic residual" (20%), cluster 3 "Depressive residual and functional impairment" (36%) and cluster 4 "Global handicap" (10%). Two out of three EMS discriminated against these profiles. The activation of specific EMS clarifies the singularity of each remission profile. LIMITATIONS For the symptomatic dimension, cut-offs chosen could be discussed as well as the scale assessing residual depressive symptoms. CONCLUSIONS This study participates in a comprehensive model of remission by integrating the symptomatology, the functioning, and the EMS. Identifying and treating EMS may improve patients remission to reach recovery.
Collapse
Affiliation(s)
- Caroline Munuera
- Laboratoire de psychologie, EA4139, Université́ de Bordeaux, 3ter place de la Victoire, Bordeaux, France
| | - Paul Roux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux; CESP, Team "Developmental Psychiatry", Université Paris-Saclay, Inserm, 12 Avenue Paul Vaillant Couturier, 94807, Villejuif
| | - François Weil
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux
| | - Christine Passerieux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux; CESP, Team "Developmental Psychiatry", Université Paris-Saclay, Inserm, 12 Avenue Paul Vaillant Couturier, 94807, Villejuif
| | - Katia M'Bailara
- Laboratoire de psychologie, EA4139, Université́ de Bordeaux, 3ter place de la Victoire, Bordeaux, France; Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121 rue de la Béchade, Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France.
| |
Collapse
|
32
|
Samalin L, Godin O, Olié E, Etain B, Henry C, Pelletier A, Poinso F, Encely L, Mazer N, Roux P, Loftus J, Gard S, Bennabi D, Polosan M, Schwitzer T, Aubin V, Schwan R, Passerieux C, Bougerol T, Dubertret C, Aouizerate B, Haffen E, Courtet P, Bellivier F, Leboyer M, Llorca PM, Belzeaux R. Evolution and characteristics of the use of valproate in women of childbearing age with bipolar disorder: Results from the FACE-BD cohort. J Affect Disord 2020; 276:963-969. [PMID: 32745833 DOI: 10.1016/j.jad.2020.07.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/19/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Valproate is associated with teratogenic and neurodevelopmental effects. Several agencies have restricted the conditions of its prescription in bipolar disorders (BD). We aimed to assess the evolution of valproate prescription and the clinical profile of BD women of childbearing age receiving valproate. METHODS Based on a large national cohort, we included all BD women 16-50 years old. Sociodemographic, clinical and pharmacological data were recorded. Logistic regression analyses were used to describe variables associated with valproate prescription. RESULTS Of the 1018 included women 16-50 years old, 26.9% were treated with valproate with a mean daily dosage of 968 mg. The prevalence of BD women using valproate was 32.6% before May 2015 and 17.3% after May 2015 (p<0.001), the date of French regulatory publication of restriction of valproate prescription. The multivariate analysis revealed that the inclusion period after May 2015 (OR=0.54, CI 95% 0.37-0.78, p=0.001), the age lower than 40 years (OR=0.65, CI 95% 0.43-0.98, p=0.040) and the number of lifetime mood episodes (OR=0.98, CI 95% 0.95-0.99, p=0.040) were the variables negatively associated with the use of valproate. LIMITATIONS Study could be underpowered to determine a clinical profile associated with valproate prescription. CONCLUSIONS The regulatory change in BD women of childbearing age had a significant impact on valproate prescription, even if the prescription rate remains high. Important efforts are needed to help clinicians and patients to improve quality of care in BD women of childbearing age.
Collapse
Affiliation(s)
- L Samalin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France.
| | - O Godin
- Fondation Fondamental, Créteil, France; INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - E Olié
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, PSNREC, University Montpellier, INSERM, Montpellier, France
| | - B Etain
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - C Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, Université Descartes, Paris, France
| | - A Pelletier
- Fondation Fondamental, Créteil, France; AP-HP, DMU IMPACT, Psychiatry and Addictology of Mondor University Hospital, University Paris-Est-Créteil, Créteil, France
| | - F Poinso
- Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - L Encely
- Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - N Mazer
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, France
| | - P Roux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Universitaire de psychiatrie d'adulte et d'addictologie, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Equipe « PsyDev », CESP, Université Paris-Saclay, Inserm, 94807 Villejuif, France
| | - J Loftus
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - S Gard
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - D Bennabi
- Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, France
| | - M Polosan
- Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - T Schwitzer
- Fondation Fondamental, Créteil, France; Centre Psychothérapique de Nancy, Pôle Hospitalo-universitaire de Psychiatrie d'Adultes du Grand Nancy, Laxou F-54520, France
| | - V Aubin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - R Schwan
- Fondation Fondamental, Créteil, France; Centre Psychothérapique de Nancy, Pôle Hospitalo-universitaire de Psychiatrie d'Adultes du Grand Nancy, Laxou F-54520, France
| | - C Passerieux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Universitaire de psychiatrie d'adulte et d'addictologie, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Equipe « PsyDev », CESP, Université Paris-Saclay, Inserm, 94807 Villejuif, France
| | - T Bougerol
- Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - C Dubertret
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, France
| | - B Aouizerate
- Fondation Fondamental, Créteil, France; Department of Clinical and Academic Psychiatry, Charles-Perrens Hospital, Bordeaux, France; NutriNeuro, UMR INRA 1286, University of Bordeaux, Bordeaux, France
| | - E Haffen
- Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, France
| | - P Courtet
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, PSNREC, University Montpellier, INSERM, Montpellier, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; AP-HP, DMU IMPACT, Psychiatry and Addictology of Mondor University Hospital, University Paris-Est-Créteil, Créteil, France
| | | | - P M Llorca
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - R Belzeaux
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| |
Collapse
|
33
|
Orhan M, Korten N, Kupka R, van Oppen P, Stek M, Vieta E, Schouws S, van Ballegooijen W, Dols A. Reliability and validity of the functioning assessment short test for older adults with bipolar disorder (FAST-O). Int J Bipolar Disord 2020; 8:28. [PMID: 33006669 PMCID: PMC7532249 DOI: 10.1186/s40345-020-00193-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Many frequently used instruments fail to assess psychosocial functioning in patients with bipolar disorder. The Functioning Assessment Short Test (FAST) was developed in order to tackle this problem and to assess the main functioning problems experienced by patients with bipolar disorder. However, the original FAST is not fully applicable in older adults due to the domain of occupational functioning. The aim of our study was to validate an adapted version for Older adults (FAST-O) in a group of older adults with bipolar disorder (OABD). Methods 88 patients aged 50 years and over diagnosed with bipolar disorder were included. We adapted the items in the area of “work-related functioning” of the FAST into items assessing “societal functioning”. Several measurements were conducted in order to analyse the psychometric qualities of the FAST-O (confirmatory factor analysis for internal structure, Cronbach’s alpha for internal consistency, Spearman’s rho for concurrent validity, Mann–Whitney U test for discriminant validity). Results Mean age in the study sample was 65.3 (SD = 7.5) and 57.3% was female. The internal structure was most similar to the internal structure of the original FAST. The internal consistency was excellent (Cronbach’s alpha = .93). The concurrent validity when correlated with the Social and Occupational Functioning Assessment Scale was low, but significant. The FAST-O was also able to distinguish between euthymic and symptomatic OABD patients. Conclusions The FAST-O has strong psychometric qualities. Based on our results, we can conclude that the FAST-O is a short, efficient solution in order to replace global rating scales or extensive test batteries in order to assess daily functioning of older psychiatric patients in a valid and reliable manner.
Collapse
Affiliation(s)
- Melis Orhan
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands. .,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Nicole Korten
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Ralph Kupka
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus, VUMC, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Godin O, Leboyer M, Mazroui Y, Aouizerate B, Azorin JM, Raoul B, Bellivier F, Polosan M, Courtet P, Dubertret C, Henry C, Kahn JP, Loftus J, Olié E, Passerieux C, Costagliola D, Etain B, Llorca P, Barteau V, Bensalem S, Laaidi M, Laouamri H, Souryis K, Hotier S, Pelletier A, Drancourt N, Sanchez J, Saliou E, Hebbache C, Petrucci J, Willaume L, Bourdin E, Carminati M, Etain B, Marlinge E, Meheust J, Antoniol B, Desage A, Gard S, Jutant A, Mbailara K, Minois I, Zanouy L, Abettan C, Bardin L, Cazals A, Deffinis B, Ducasse D, Gachet M, Henrion A, Martinerie E, Molière F, Noisette B, Tarquini G, Belzeaux R, Correard N, Consoloni JL, Groppi F, Lescalier L, Montant J, Rebattu M, Viglianese N, Cohen R, Milazzo M, Wajsbrot-Elgrabli O, Bougerol T, Fredembach B, Garçon S, Grignon P, Perrin A, Galliot A, Grévin I, Cannavo A, Kayser N, Roux P, Aubin V, Cussac I, Dupont M, Medecin I, Mazer N, Portalier C. Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Aust N Z J Psychiatry 2020; 54:985-996. [PMID: 32779531 DOI: 10.1177/0004867420945796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders. METHODS We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning. RESULTS Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85. CONCLUSION This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.
Collapse
Affiliation(s)
- Ophelia Godin
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Yassin Mazroui
- Laboratoire de Probabilités, Statistiques et Modélisation (LPSM), Sorbonne Université, Paris, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Jean-Michel Azorin
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Belzeaux Raoul
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U1216, Grenoble, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, Paris, France
| | - Chantal Henry
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Pierre Kahn
- Fondation FondaMental, Créteil, France.,Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Nancy, France
| | - Josephine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Emilie Olié
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team 'DevPsy', Villejuif, France
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Léda-Rêgo G, Bezerra-Filho S, Miranda-Scippa Â. Functioning in euthymic patients with bipolar disorder: A systematic review and meta-analysis using the Functioning Assessment Short Test. Bipolar Disord 2020; 22:569-581. [PMID: 32243046 DOI: 10.1111/bdi.12904] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. METHODS Meta-analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand-searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two-step meta-analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed-effects model for categorical variables. RESULTS In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. CONCLUSIONS This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.
Collapse
Affiliation(s)
- Gabriela Léda-Rêgo
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.,Department of Neurosciences and Mental Health, Medical School, UFBA, Salvador, Brazil
| |
Collapse
|
36
|
Lin CJ, Huang YH, Huang KY, Wu SI, Chang YH, Yeh HM, Chang CH, Lin IC, Huang HC, Sun FJ, Berk M, Liu SI. A Randomized Controlled Trial of Transcultural Validation of Group-Based Psychosocial Intervention for Patients with Bipolar Disorder. Psychiatry Res 2020; 290:113139. [PMID: 32512353 DOI: 10.1016/j.psychres.2020.113139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022]
Abstract
Adjunctive psychosocial interventions are part of the preferred method to treat bipolar disorder (BD). This study aimed to conduct a randomized control and protocol-guided trial, in order to evaluate the feasibility and effectiveness of adjunctive group-based treatments for Chinese outpatients with BD. A single-blind trial in which 68 outpatients with BD were randomly assigned to either treatment as usual (TAU) or to an experimental group with 12 additional weekly sessions and 3 monthly booster sessions. Participants were assessed at baseline for mood condition, suicidal ideation, medication adherence, and quality of life (QoL), with follow-up assessments every 3 months over a 1-year period. The overall retention rate of this study was 89.7%. The results showed significant differences between groups for the variables evaluated, which included achieving euthymia, decrease of depression symptoms, and improvement of QoL. No improvements in medication adherence, reduction in manic symptoms, or suicidal ideation was observed. The results of this study support the transcultural validity and efficacy of group-based psychosocial intervention as anadjunct to TAU among Chinese outpatients with BD to promote improvements during the course of the illness including achieving euthymia, reducing depressive symptoms, and improving QoL.
Collapse
Affiliation(s)
- Chen-Ju Lin
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Health and Welfare Policy, National Yang-Ming University
| | - Yu-Hsin Huang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Kuo-Yang Huang
- Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, MacKay Medical College, Taipei, Taiwan
| | - Yi-Hung Chang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiao-Mei Yeh
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - I-Chieh Lin
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Michael Berk
- School of Medicine, Deakin University, Victoria, Australia
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
37
|
Grover S, Chakrabarti S, Sahoo S. Prevalence and clinical correlates of residual symptoms in remitted patients with bipolar disorder: An exploratory study. Indian J Psychiatry 2020; 62:295-305. [PMID: 32773873 PMCID: PMC7368443 DOI: 10.4103/psychiatry.indianjpsychiatry_760_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/30/2020] [Accepted: 04/10/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This cross-sectional study aimed to evaluate the prevalence and factors associated with residual symptoms (both depressive and manic) in subjects with bipolar disorder (BD). MATERIALS AND METHODS A total of 844 subjects diagnosed BD with an illness of 2 years' duration and minimum of two lifetime episodes and in clinical remission were evaluated for residual symptoms using Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Based on the severity of residual symptoms, the study groups were divided into four groups. RESULTS Sixty-nine percent of the subjects had residual depressive symptoms (i.e., HAM-D score in the range of 1-7) and 59% had residual manic symptoms (i.e., YMRS score in the range of 1-7). The most common residual depressive symptom was psychic anxiety (34%) followed by impaired insight (29%). The most common manic symptom was poor insight (31%) followed by sleep disturbances (25%). Subjects with both sets of residual symptoms had onset of BD at a relatively young age, when compared to those with only residual depressive symptoms. Presence of any comorbid physical illness and substance abuse disorder was significantly higher in those with both sets of residual symptoms. CONCLUSIONS The present study suggests that a substantial proportion of patients with BD have residual symptoms of both types. Comorbid physical illness and substance use were associated with residual symptoms. Identification and management of residual symptoms are highly essential to improve the overall outcome of patients with BD.
Collapse
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
38
|
Liang S, Yu W, Ma X, Luo S, Zhang J, Sun X, Luo X, Zhang Y. Psychometric properties of the MATRICS Consensus Cognitive Battery (MCCB) in Chinese patients with major depressive disorder. J Affect Disord 2020; 265:132-138. [PMID: 32090734 DOI: 10.1016/j.jad.2020.01.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Major depression disorder (MDD) is often associated with cognitive impairment. The development of an accurate and effective battery to measure cognitive deficit is necessary for both research and clinical practice in MDD. Our study was designed to test the psychometric properties of the MATRICS Consensus Cognitive Battery (MCCB) in patients with MDD. METHOD Forty-eight patients with MDD, forty-three euthymic patients with bipolar disorder (BD) and thirty-two remitted patients with schizophrenia (SCH) were recruited from Tianjin Anding Hospital in Tianjin, China. The MCCB, the Montreal Cognitive Assessment (MoCA) and the Hamilton Depression Rating Scale-17 (HDRS-17) were administered to assess cognitive impairment and depressive symptoms at both baseline and one month later. RESULT Our findings showed that the MCCB had good internal consistency and acceptable reliability in Chinese MDD patients. Our findings revealed a high correlation between the MCCB and the MoCA, indicating good concurrent validity of the MCCB. Furthermore, the MCCB showed high discriminant ability between MDD patients and healthy controls, and a principal component analysis of the MCCB in MDD patients revealed four domains with acceptable internal structure. LIMITATIONS We did not consider confounding factors, such as the course, severity of symptoms and medication treatments, which might bias the cognitive assessment. In addition, the use of the MoCA as a reference scale for mild cognitive impairment could weaken the concurrent validity of the MCCB in MDD patients. CONCLUSION Our findings demonstrated that the MCCB may be clinically useful as a cognitive impairment rating battery in Chinese patients with MDD.
Collapse
Affiliation(s)
- Sixiang Liang
- Tianjin Anding Hospital, Tianjin 300222, China; The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wenwen Yu
- Tianjin Anding Hospital, Tianjin 300222, China
| | - Xiaojuan Ma
- Tianjin Medical College, Tianjin 300222, China
| | - Shuqing Luo
- Department of Obstetrics, Baoding Second Central Hospital, Hebei 072750, China
| | - Jian Zhang
- Tianjin Anding Hospital, Tianjin 300222, China
| | - Xia Sun
- Tianjin Anding Hospital, Tianjin 300222, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, United States
| | - Yong Zhang
- Tianjin Anding Hospital, Tianjin 300222, China.
| |
Collapse
|
39
|
García-Blanco A, García-Portilla MP, Fuente-Tomás LDL, Batalla M, Sánchez-Autet M, Arranz B, Safont G, Arqués S, Livianos L, Sierra P. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020; 17:930-940. [PMID: 32139195 DOI: 10.1016/j.jsxm.2020.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. AIM To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. METHODS A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify potential confounding variables, and linear regression models were used to study the association of the CSFQ-14 with QoL. MAIN OUTCOME MEASURES Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed. RESULTS The A group had better total SF scores than the L group and the L+B group. Relative to the A group, the L and L+B groups had worse sexual desire; the L group had worse sexual arousal; and the L+A group and the L+B group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL. CLINICAL IMPLICATIONS Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF. STRENGTHS & LIMITATIONS Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner. CONCLUSIONS Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticonvulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) improves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative effects on SF in patients with BD. García-Blanco A, García-Portilla MP, Fuente-Tomás L de la, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020;17:930-940.
Collapse
Affiliation(s)
| | - María P García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Lorena de la Fuente-Tomás
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - María Batalla
- La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Belén Arranz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Gemma Safont
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Lorenzo Livianos
- La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; CIBERESP-17, Valencia, Spain
| | - Pilar Sierra
- La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
| |
Collapse
|
40
|
Barichello T, Giridharan VV, Bhatti G, Sayana P, Doifode T, Macedo D, Quevedo J. Inflammation as a Mechanism of Bipolar Disorder Neuroprogression. Curr Top Behav Neurosci 2020; 48:215-237. [PMID: 33040314 DOI: 10.1007/7854_2020_173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a severe, debilitating psychiatric condition with onset in adolescence or young adulthood and often follows a relapsing and remitting course throughout life. The concept of neuroprogression in BD refers to the progressive path with an identifiable trajectory that takes place with recurrent mood episodes, which eventually leads to cognitive, functional, and clinical deterioration in the course of BD. Understanding the biological basis of neuroprogression helps to explain the subset of BD patients who experience worsening of their disorder over time. Additionally, the study of the neurobiological mechanisms underpinning neuroprogression will help BD staging based on systems biology. Replicated epidemiological studies have suggested inflammatory mechanisms as primary contributors to the neuroprogression of mood disorders. It is known that dysregulated inflammatory/immune pathways are often associated with BD pathophysiology. Hence, in this chapter, we focus on the evidence for the involvement of inflammation and immune regulated pathways in the neurobiological consequences of BD neuroprogression. Herein we put forth the evidence of immune markers from autoimmune disorders, chronic infections, and gut-brain axis that lead to BD neuroprogression. Further, we highlighted the peripheral and central inflammatory components measured along with BD progression.
Collapse
Affiliation(s)
- Tatiana Barichello
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA. .,Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil. .,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Vijayasree Vayalanellore Giridharan
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gursimrat Bhatti
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Pavani Sayana
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Tejaswini Doifode
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Danielle Macedo
- Neuropsychopharmacology Laboratory, Drug Research, and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil.,National Institute for Translational Medicine (INCT-TM, CNPq), Ribeirao Preto, Brazil
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, University of Southern Santa Catarina-UNESC, Criciúma, SC, Brazil.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
41
|
Rubensson A, Salzmann‐Erikson M. A document analysis of how the concept of health is incorporated in care plans when using the nursing diagnosis classification system (
NANDA
‐I) in relation to individuals with bipolar disorder. Scand J Caring Sci 2019; 33:986-994. [DOI: 10.1111/scs.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anton Rubensson
- Ward 53, Inpatient Care Unit for Patients with Bipolar Disorder Section for Affective Disorders Northern Stockholm Psychiatry Stockholm Sweden
| | - Martin Salzmann‐Erikson
- Department of Health and Caring Sciences Faculty of Health and Occupational Studies University of Gävle Gävle Sweden
| |
Collapse
|
42
|
Munuera C, Weil F, Minois I, Zanouy L, Gard S, Roux P, M'Bailara K. [Exploring Early Maladaptative Schema (EMS) in adults with bipolar disorder: A systematic review of the scientific literature]. Encephale 2019; 46:65-77. [PMID: 31767255 DOI: 10.1016/j.encep.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Clinical heterogeneity during euthymic states is a crucial issue in bipolar disorders. Indeed, actual data are not sufficient to understand why some patients are unharmed by subthreshold symptoms and have functional impairments whereas others have a functional remission but have subthreshold symptoms. Based on the Ball model, cognitive and schematic vulnerability interact with genetic vulnerability and trigger affective symptoms with the intervention of stressful life events. Furthermore, according to this model, adjustment and adaptation to illness assessed by functional outcome and illness experience are associated with this cognitive and schematic vulnerability. So, theoretical arguments support that childhood adversity and temperamental deregulation characterize patients with bipolar disorders. Thus, the aim of this study is to systematically review studies of Early Maladaptive Schemas in bipolar disorder, to determine whether Early Maladaptive Schemas have specificity in bipolar disorder in comparison with other populations, and to identify which Early Maladaptive Schemas could be activated. The challenge of this review is to identify if the taking of early maladaptive schemas into account could allow us to better identify, understand and manage bipolar disorders. METHODS This systematic review was led according to the Preferred Reporting Items for Systematic review and Meta-Analysis statement on the electronic databases Cochrane, PsycArticles, Psychology and Behavioral Sciences Collection, PsycInfo, PubMed, ScienceDirect and Scopus with « early maladaptive schemas » AND « bipolar disorder » as keywords. Only studies meeting eligibility criteria concerning publication status, language, population and outcomes were included after several screenings on basis of title, abstract and full-text. Then, we carried out data extraction in accordance with criteria defined in principle (about characteristics of participants, objectives, materiel and methods, principle results and bias). RESULTS Among 39 records identified, a total of 10 studies met eligibility criteria for inclusion in this review. Synthesizing findings across the studies revealed three important topics. First, early maladaptive schemas appear as potential cognitive characteristics that clinicians have to investigate in clinical practice. Indeed, patients with bipolar disorders present greater activation of the early maladaptive schemas in comparison with people who have no disorder. This point supports the first part of Ball's theoretical model that considers schemas as a vulnerability to bipolarity. Secondly, early maladaptive schemas are relevant to distinguish bipolar disorders from unipolar depression and borderline personality disorder. A greater and a lower activation are respectively identified among bipolar disorders. Thirdly, supporting the second part of Ball's model, early maladaptive schemas play a key role in recovery regarding their impact on the course of bipolarity, in particular on suicidality and functional impairment. Finally, these dysfunctional schemas allow us to understand the clinical heterogeneity of bipolar disorder, and among others, about the type of bipolarity. These results have several implications, but there are some limits in this systematic review. First, no French study has been done. Then, reduced sample sizes in these studies increased the risk to conclude wrongly to an activation difference between groups. Furthermore, probably due to the variety of methods and populations, we could not identify an homogeneous pattern of early activated maladaptive schemas. Overall, scientific approaches used in these studies are based on statistical models using mean and standard deviation. These types of statistical analyses are the main limit because they cannot represent the heterogeneity of early maladaptive schemas profiles. CONCLUSIONS Schema theory proves to be a relevant approach in bipolar disorders, and early maladaptive schemas appear to be important to take into account in clinical practice. Nevertheless, in order to propose schemas therapy appropriately, it is necessary to specify if early maladaptive schemas are activated and to specify therapeutic indications because of clinical heterogeneity. Moreover, data do not yet allow us to understand the disparity of profiles during the inter-episode period. Indeed, a French research perspective is being considered that will prefer a person-oriented approach.
Collapse
Affiliation(s)
- C Munuera
- Laboratoire de psychologie, EA4139, Université de Bordeaux, 3(ter) place de la Victoire, 33076 Bordeaux, France
| | - F Weil
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2, avenue de la Source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - I Minois
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - L Zanouy
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - S Gard
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - P Roux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2, avenue de la Source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - K M'Bailara
- Laboratoire de psychologie, EA4139, Université de Bordeaux, 3(ter) place de la Victoire, 33076 Bordeaux, France; Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France.
| |
Collapse
|
43
|
Caruso D, Meyrel M, Krane-Gartiser K, Benard V, Benizri C, Brochard H, Geoffroy PA, Gross G, Maruani J, Prunas C, Yeim S, Palagini L, Dell’Osso L, Leboyer M, Bellivier F, Etain B. Eveningness and poor sleep quality contribute to depressive residual symptoms and behavioral inhibition in patients with bipolar disorder. Chronobiol Int 2019; 37:101-110. [DOI: 10.1080/07420528.2019.1685533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Danila Caruso
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Manon Meyrel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Karoline Krane-Gartiser
- Department of Mental Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Victoire Benard
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Chloé Benizri
- INSERM U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - Héléna Brochard
- Pôle sectoriel, Centre Hospitalier Fondation Vallée, Gentilly, France
| | - Pierre-Alexis Geoffroy
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
- Département de psychiatrie et d’addictologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Gregory Gross
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
| | - Julia Maruani
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
| | - Cecilia Prunas
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sunthavy Yeim
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marion Leboyer
- Université Paris Est Créteil, Faculté de Médecine, Creteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d’Addictologie, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
- Fondation FondaMental, Créteil, France
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Université de Paris, Paris, France
- Fondation FondaMental, Créteil, France
| |
Collapse
|
44
|
Zhang X, Cheng X, Chen J, Zhang B, Wu Q, Deng W, Li X, Lin Y, Yang C, Cao L. Association of subthreshold manic symptoms and cognitive impairments in euthymic patients with bipolar disorder I. Psychiatry Res 2019; 278:303-308. [PMID: 31255953 DOI: 10.1016/j.psychres.2019.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Cognitive impairments exist during the euthymic period of bipolar disorder (BD). However, the impact of clinical factors (e.g., subthreshold symptoms and body mass index) on cognitive function in euthymic patients with bipolar disorder I is inconsistent. This cross-sectional study included 83 patients with euthymic BD I and 115 healthy controls. The Repeatable Battery for the Assessment of Neuropsychological Status indices were used to assess cognitive function. We assessed the relationship between cognitive function and clinical impact factors. Performance in language abilities, attention, and immediate memory was worse in euthymic BD I. Spearman's correlation revealed that indices for immediate memory and attention were negatively correlated with subthreshold manic symptoms, and indices for delayed memory were positively correlated with years of education. Linear regressions indicated that subthreshold manic symptoms were the best predictors of immediate memory and attention. Years of education predicted performance in most cognitive domains, except immediate memory. Individuals with euthymic BD I exhibited cognitive deficits in language learning, attention, and immediate memory. Our study highlights the importance of the effect of subthreshold manic symptoms on cognitive function in remitted BD; these symptoms should receive more attention and be targeted in personalized clinical therapeutic interventions.
Collapse
Affiliation(s)
- Xiaofei Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Xiongchao Cheng
- Department of Medical Psychology, Guilin Mental Health Center, Fuli Road 4, Guilin, Guangxi Zhuang Autonomous Region, 541000, China.
| | - Jianshan Chen
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Bin Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Qiuxia Wu
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Wenhao Deng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Xuan Li
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Yin Lin
- Department of Psychology, Shenzhen Children's Hospital, Yitian Road 7019, Futian district, Shenzhen, 518000, China.
| | - Chanjuan Yang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Liping Cao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| |
Collapse
|
45
|
Lifetime Psychotic Symptoms, Subthreshold Depression and Cognitive Impairment as Barriers to Functional Recovery in Patients with Bipolar Disorder. J Clin Med 2019; 8:jcm8071046. [PMID: 31323795 PMCID: PMC6679346 DOI: 10.3390/jcm8071046] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 01/01/2023] Open
Abstract
(1) Background: bipolar disorder (BD) is a chronic disease that often leads to functional impairment. The objective of this study is to elucidate which variables are associated with better functional outcomes in a sample of euthymic patients with BD. (2) Methods: patients were recruited at the Hospital Clinic of Barcelona and they underwent a clinical interview, a functional assessment, and a comprehensive neuropsychological evaluation. After that, patients were divided into two groups according to the Functioning Assessment Short Test total score: functionally remitted vs. functionally impaired. Following this, a multivariate logistic regression was run in order to identify clinical, demographic and cognitive factors associated with functional remission. (3) Results: a total of 420 euthymic patients with BD were assessed for this study, distributed as follows: functionally remitted (n = 221) and functionally impaired (n = 199). Finally, the multivariate logistic regression revealed that only five variables significantly contributed to the model, including: lifetime history of psychotic symptoms (the variable that contributed the most to the model), followed by the Hamilton Depression total score, and cognitive performance (executive functions and verbal memory). (4) Conclusions: treatments to ensure a good functional outcome in BD should specially prevent psychosis, target subthreshold depressive symptoms and enhance cognition, more specifically executive functions and verbal memory.
Collapse
|
46
|
Bonnín CDM, Reinares M, Martínez-Arán A, Jiménez E, Sánchez-Moreno J, Solé B, Montejo L, Vieta E. Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. Int J Neuropsychopharmacol 2019; 22:467-477. [PMID: 31093646 PMCID: PMC6672628 DOI: 10.1093/ijnp/pyz018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
Collapse
Affiliation(s)
- Caterina del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,Correspondence: Anabel Martínez-Arán, PhD, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Catalonia ()
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| |
Collapse
|
47
|
Fekih‐Romdhane F, Jendoubi J, Saguem BN, Ridha R, Cheour M. The link between sleep disturbances and suicidal thoughts and behaviors in remitted bipolar I patients. J Clin Psychol 2019; 75:1643-1657. [DOI: 10.1002/jclp.22793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Feten Fekih‐Romdhane
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Jihen Jendoubi
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Bochra Nourhène Saguem
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Rym Ridha
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| | - Majda Cheour
- Faculty of Medicine of TunisTunis El Manar University Tunisia
- Psychiatry Department "E"Razi HospitalMannouba Tunisia
| |
Collapse
|
48
|
Zhang Y, Ma X, Liang S, Yu W, He Q, Zhang J, Bian Y. Social cognition and interaction training (SCIT) for partially remitted patients with bipolar disorder in China. Psychiatry Res 2019; 274:377-382. [PMID: 30852431 DOI: 10.1016/j.psychres.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/03/2019] [Accepted: 03/03/2019] [Indexed: 12/20/2022]
Abstract
Bipolar disorder (BD) is associated with functional impairment. Social Cognition and Interaction Training (SCIT) has been shown to be feasible and effective at improving social functioning in patients with schizophrenia. We aimed to explore the association between SCIT and improvements in the clinical symptoms and functioning of partially remitted patients with BD in China. Seventy-four BD patients were randomly assigned to the SCIT and psychoeducation (Control) groups. All subjects participated in group interventions weekly for 8 weeks. Furthermore, the participants were administered the Young Mania Rating Scale (YMRS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Function Assessment Short Test (FAST) and neurocognitive measures at baseline and after eight weeks. There were no differences in demographics, the HDRS-17, YRMS, and FAST scores or neurocognitive measures between the groups at baseline (p>0.05). The repeated-measures analysis revealed that SCIT resulted in greater improvement in the HDRS, YMRS, and FAST scores (including six domains) (p<0.01) and two neurocognitive measures (p<0.05) compared to psychoeducation. Our findings suggest that SCIT is a feasible and promising intervention for the clinical symptoms and functioning of partially remitted patients with BD. Further longitudinal studies are needed to observe the long-term impact of SCIT on emotional and functional improvement in these patients.
Collapse
Affiliation(s)
- Yong Zhang
- Tianjin Anding Hospital, Tianjin 300222, China.
| | - Xiaojuan Ma
- Tianjin Medical College, Tianjin 300222, China
| | | | - Wenwen Yu
- Tianjin Anding Hospital, Tianjin 300222, China
| | | | - Jian Zhang
- Tianjin Anding Hospital, Tianjin 300222, China
| | - Yanhui Bian
- Tianjin Anding Hospital, Tianjin 300222, China
| |
Collapse
|
49
|
Martins DS, Hasse-Sousa M, Petry-Perin C, Arrial-Cordeiro RT, Rabelo-da-Ponte FD, Lima FM, Rosa AR, Bücker J, Gama CS, Czepielewski LS. Perceived childhood adversities: Impact of childhood trauma to estimated intellectual functioning of individuals with bipolar disorder. Psychiatry Res 2019; 274:345-351. [PMID: 30851597 DOI: 10.1016/j.psychres.2019.02.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 01/18/2023]
Abstract
Maltreatments in childhood may have implications for neurodevelopment that could remain throughout life. Childhood trauma seems to be associated with the onset of bipolar disorder (BD), and its occurrence might accentuate the overall disease impairments related to cognitive deficits in BD. We aimed to evaluate the effects of a history of childhood trauma to estimated intellectual functioning (IQ) of individuals with BD. We included 72 subjects with BD during euthymia. Participants underwent a clinical interview and were assessed through the Childhood Trauma Questionnaire (CTQ) and Wechsler Abbreviated Scale of Intelligence (WASI). Most prevalent trauma subtypes were emotional abuse and neglect (54.1%). A linear regression model that included perceived childhood trauma, family history of severe mental disorders, age at diagnosis and psychotic symptoms during the first episode as main factors showed that only childhood trauma had a significant effect in predicting estimated IQ. Therefore, the history of childhood trauma in individuals with BD may play a role in intellectual development, suggesting that adversities during development result in decreased general cognitive abilities. These results reinforce the need to promote early interventions to protect childhood and to promote the well-being of children, contributing to the growth of healthy adults.
Collapse
Affiliation(s)
- Dayane Santos Martins
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Mathias Hasse-Sousa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Carolina Petry-Perin
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Raissa Telesca Arrial-Cordeiro
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Francisco Diego Rabelo-da-Ponte
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Flavia Moreira Lima
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Adriane Ribeiro Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi; Department of Pharmacology, Programa de Pós-Graduação em Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joana Bücker
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Clarissa S Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi
| | - Letícia Sanguinetti Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, Rio Grande do Sul 90035-903, Brazi.
| |
Collapse
|
50
|
Identifying cognitive subgroups in bipolar disorder: A cluster analysis. J Affect Disord 2019; 246:252-261. [PMID: 30590288 DOI: 10.1016/j.jad.2018.12.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/04/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence has shown heterogeneity of cognitive function among patients with bipolar disorder (BD). Our study aims to replicate recent findings of cognitive subgroups, as well as we assessed subjective cognitive difficulties and functioning in each cluster. METHODS Hierarchical cluster analysis was conducted to examine whether there were distinct neurocognitive subgroups based on neurocognitive battery. Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and Functioning Assessment Short Test (FAST) were used to assess subjective cognitive difficulties and functional impairment. RESULTS We found three distinct subgroups: a first cluster with intact cognition (n = 30, 43.5%), a second cluster with selective cognitive impairment (n = 23, 33.3%), and a third cluster with globally cognitive impairment (n = 16, 23.3%). The intact group had more years of education (p < .001) and higher estimated IQ (p < .001) than globally and selectively impaired subgroups. Additionally, they were younger (p = .011), had an earlier age at bipolar diagnosis (p < .037) and earlier age of first hospitalization (p < .035) compared to individuals with globally cognitive impairment. LIMITATIONS This is a cross-sectional design with a small sample including only patients from a tertiary hospital. CONCLUSION Our results give support to the existence of a continuum of severity from patients without impairment to those with poor cognitive functioning. Patients in the intact group seem to have higher cognitive reserve than other two groups. However, they also experienced cognitive complaints and some degree of functional impairment. These findings suggest the importance of using a combo of instruments (e.g., objective and subjective cognitive measures plus functioning instruments) for a complete assessment of patients with BD.
Collapse
|