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Hsu CC, Chen SC, Liu CJ, Lu T, Shen CC, Hu YW, Yeh CM, Chen PM, Chen TJ, Hu LY. Rheumatoid arthritis and the risk of bipolar disorder: a nationwide population-based study. PLoS One 2014; 9:e107512. [PMID: 25229610 PMCID: PMC4167853 DOI: 10.1371/journal.pone.0107512] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/12/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Studies have suggested that chronic inflammation plays an essential role in the pathophysiology of both rheumatoid arthritis (RA) and bipolar disorder. The most common clinical features associated with RA are anxiety and depression. The risk of bipolar disorder among patients with RA has not been characterized adequately. OBJECTIVE To determine the association between RA and the subsequent development of bipolar disorder and examine the risk factors for bipolar disorder among patients with RA. METHODS We identified patients who were diagnosed with RA in the Taiwan National Health Insurance Research Database. A comparison cohort was created by matching patients without RA with those with RA according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts. RESULTS The RA cohort consisted of 2,570 patients, and the comparison cohort consisted of 2,570 matched control patients without RA. The incidence of bipolar disorder (incidence rate ratio = 2.13, 95% confidence interval [CI] = 1.12-4.24, P = .013) was higher among patients with RA than among control patients. Multivariate, matched regression models revealed that asthma (hazard ratio [HR] = 2.76, 95% CI 1.27-5.96, P = .010), liver cirrhosis (HR = 3.81, 95% CI = 1.04-14.02, P = .044), and alcohol use disorders (HR = 5.29, 95% CI = 1.71-16.37, P = .004) were independent risk factors for the development of bipolar disorder among patients with RA. CONCLUSION RA might increase the incidence of bipolar disorder development. Based on our data, we suggest that, following RA diagnosis, greater attention be focused on women with asthma, liver cirrhosis, and alcohol use disorder. Prospective clinical studies of the relationship between RA and bipolar disorder are warranted.
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Affiliation(s)
- Chih-Chao Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - San-Chi Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Che Shen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Yu-Wen Hu
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pan-Ming Chen
- Department of Psychiatry, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
BACKGROUND No study has investigated when preventive treatment with lithium should be initiated in bipolar disorder. AIMS To compare response rates among patients with bipolar disorder starting treatment with lithium early v. late. METHOD Nationwide registers were used to identify all patients with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed lithium during the period 1995-2012 in Denmark (n = 4714). Lithium responders were defined as patients who, following a stabilisation lithium start-up period of 6 months, continued lithium monotherapy without being admitted to hospital. Early v. late intervention was defined in two ways: (a) start of lithium following first contact; and (b) start of lithium following a diagnosis of a single manic/mixed episode. RESULTS Regardless of the definition used, patients who started lithium early had significantly decreased rates of non-response to lithium compared with the rate for patients starting lithium later (adjusted analyses: first v. later contact: P<0.0001; hazard ratio (HR) = 0.87, 95% CI 0.76-0.91; single manic/mixed episode v. bipolar disorder: P<0.0001; HR = 0.75, 95% CI 0.67-0.84). CONCLUSIONS Starting lithium treatment early following first psychiatric contact or a single manic/mixed episode is associated with increased probability of lithium response.
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Affiliation(s)
- Lars Vedel Kessing
- Lars Vedel Kessing, MD, DMSc, Psychiatric Center Copenhagen, Department O, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Eleni Vradi, MSc, Per Kragh Andersen, MSc, PhD, DMSc, Department of Biostatistics, University of Copenhagen, Denmark
| | - Eleni Vradi
- Lars Vedel Kessing, MD, DMSc, Psychiatric Center Copenhagen, Department O, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Eleni Vradi, MSc, Per Kragh Andersen, MSc, PhD, DMSc, Department of Biostatistics, University of Copenhagen, Denmark
| | - Per Kragh Andersen
- Lars Vedel Kessing, MD, DMSc, Psychiatric Center Copenhagen, Department O, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Eleni Vradi, MSc, Per Kragh Andersen, MSc, PhD, DMSc, Department of Biostatistics, University of Copenhagen, Denmark
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Roncero C, Vega P, Martínez-Raga J, Barral C, Basurte-Villamor I, Rodríguez-Cintas L, Mesías B, Grau-López L, Casas M, Szerman N. Professionals' perceptions about healthcare resources for co-occuring disorders in Spain. Int J Ment Health Syst 2014; 8:35. [PMID: 25206926 PMCID: PMC4158069 DOI: 10.1186/1752-4458-8-35] [Citation(s) in RCA: 5] [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: 07/12/2014] [Accepted: 08/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and other psychiatric disorders) constitutes an important challenge, this study compared the perceptions of health-care professionals with the existing, current state of specific resources for patients with dual pathology in Spain. METHODS Epidemiological, observational, cross-sectional, multicenter study with a large, representative sample of health care professionals attending patients with dual pathology in treatment resources throughout Spain. Participants completed a specifically designed ad-hoc on-line questionnaire about their perceptions on the existence of available resources and treatment needs for patients with dual pathology. To compare professionals' perceptions with existing available resources, the same on-line questionnaire was also completed by commissioners and managers responsible for national and regional healthcare plans on drug abuse. RESULTS A total of 659 professionals, mostly psychologists (43.40%) or psychiatrists (32.93%) agreed to participate in the study. The highest degree of concordance between the perceptions of professional and the actual situation was found regarding the existence of mental health and addiction networks (either separately or unified) (74.48%), followed by specific workshops (73.08%) and sub-acute inpatient units (67.38%), specific hospitalization units (66.26%), detoxification units (63.15%) and outpatient programs (60.73%). We detected a lower degree of agreement regarding specific occupational rehabilitation centers (59.34%) day hospitals (58.93%), day centers (57.88%), outpatient intermediate resources (48.87%), psychiatric acute admission units (46.54%) and therapeutic communities (43.77%). In addition, on average, health care professionals underestimated the number of resources present in their respective communities. CONCLUSIONS Relevant differences exist between the perceptions of professional and existing available resources for dual pathology patients in Spain, thus supporting the need of additional efforts and strategies to establish a registry and clearly inform about available resources for patients with dual diagnosis.
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Affiliation(s)
- Carlos Roncero
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Pablo Vega
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Instituto de Adicciones, C/ Juan Esplandiú, 11-13, 28007 Madrid, EU Spain
| | - Jose Martínez-Raga
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Unidad Docente de Psiquiatría y Psicología Medica, Hospital Universitario Dr. Peset y Universidad de Valencia, & Universidad CEU-UCH, 46017 Valencia, EU Spain
| | - Carmen Barral
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Ignacio Basurte-Villamor
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, EU Madrid, Spain
| | - Laia Rodríguez-Cintas
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain
| | - Beatriz Mesías
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Instituto de Adicciones, C/ Juan Esplandiú, 11-13, 28007 Madrid, EU Spain
| | - Lara Grau-López
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Miguel Casas
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Nestor Szerman
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, EU Madrid, Spain
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Farren CK, Murphy P, McElroy S. A 5-Year Follow-Up of Depressed and Bipolar Patients with Alcohol Use Disorder in an Irish Population. Alcohol Clin Exp Res 2014; 38:1049-58. [DOI: 10.1111/acer.12330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Conor K. Farren
- Trinity College Dublin; St Patrick's University Hospital; Dublin Ireland
| | - Philip Murphy
- Trinity College Dublin; St Patrick's University Hospital; Dublin Ireland
| | - Sharon McElroy
- Trinity College Dublin; St Patrick's University Hospital; Dublin Ireland
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Szerman N, Vega P, Grau-López L, Barral C, Basurte-Villamor I, Mesías B, Rodríguez-Cintas L, Martínez-Raga J, Casas M, Roncero C. Dual diagnosis resource needs in Spain: a national survey of professionals. J Dual Diagn 2014; 10:84-90. [PMID: 25392250 DOI: 10.1080/15504263.2014.906195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. METHODS We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. RESULTS A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent. CONCLUSIONS According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.
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Affiliation(s)
- Nestor Szerman
- a Departament of Psychiatry Hospital Universitario Gregorio Marañon , Madrid , Spain
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Colom J, Scafato E, Segura L, Gandin C, Struzzo P. Brief interventions implementation on alcohol from the European health systems perspective. Front Psychiatry 2014; 5:161. [PMID: 25426083 PMCID: PMC4227516 DOI: 10.3389/fpsyt.2014.00161] [Citation(s) in RCA: 23] [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: 06/30/2014] [Accepted: 10/28/2014] [Indexed: 11/13/2022] Open
Abstract
Alcohol-related health problems are important public health issues and alcohol remains one of the leading risk factors of chronic health conditions. In addition, only a small proportion of those who need treatment access it, with figures ranging from 1 in 25 to 1 in 7. In this context, screening and brief interventions (SBI) have proven to be effective in reducing alcohol consumption and alcohol-related problems in primary health care (PHC) and are very cost effective, or even cost-saving, in PHC. Even if the widespread implementation of SBI has been prioritized and encouraged by the World Health Organization, in the global alcohol strategy, the evidence on long term and population-level effects is still weak. This review study will summarize the SBI programs implemented by six European countries with different socio-economic contexts. Similar components at health professional level but differences at organizational level, especially on the measures to support clinical practice, incentives, and monitoring systems developed were adopted. In Italy, cost-effectiveness analyses and Internet trials shed new light on limits and facilitators of renewed, evidence-based approaches to better deal with brief intervention in PHC. The majority of the efforts were aimed at overcoming individual barriers and promoting health professionals' involvement. The population screened has been in general too low to be able to detect any population-level effect, with a negative impact on the acceptability of the program to all stakeholders. This paper will present a different point of view based on a strategic broadening of the implemented actions to real inter-sectoriality and a wider holistic approach. Effective alcohol policies should strive for quality provision of health services and the empowerment of the individuals in a health system approach.
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Affiliation(s)
- Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia , Barcelona , Spain
| | | | - Lidia Segura
- Program on Substance Abuse, Public Health Agency of Catalonia , Barcelona , Spain
| | | | - Pierluigi Struzzo
- Regional Centre for the training in Primary Care (Ceformed) , Monfalcone , Italy ; Department of Life Sciences, University of Trieste , Trieste , Italy
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Tesli M, Egeland R, Sønderby IE, Haukvik UK, Bettella F, Hibar DP, Thompson PM, Rimol LM, Melle I, Agartz I, Djurovic S, Andreassen OA. No evidence for association between bipolar disorder risk gene variants and brain structural phenotypes. J Affect Disord 2013; 151:291-7. [PMID: 23820096 DOI: 10.1016/j.jad.2013.06.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/07/2013] [Accepted: 06/08/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND While recent genome-wide association studies have identified several new bipolar disorder (BD) risk variants, structural imaging studies have reported enlarged ventricles and volumetric reductions among the most consistent findings. We investigated whether these genetic risk variants could explain some of the structural brain abnormalities in BD. METHODS In a sample of 517 individuals (N=121 BD cases, 116 SZ cases, 61 other psychosis cases and 219 healthy controls), we tested the potential association between nine SNPs in the genes CACNA1C, ANK3, ODZ4 and SYNE1 and eight brain structural measures found to be altered in BD, and if these were specifically affecting the BD sample. We also assessed the polygenic effect of all these 9 SNPs on the brain phenotypes. RESULTS Our most significant result was an association between the risk allele A in CACNA1C SNP rs4775913 and decreased cerebellar volume (pnom.=0.0075) in the total sample, which did not remain significant after multiple testing correction (pthreshold<0.0064). There was no evidence for diagnostic specificity for this association in the BD group. Further, no polygenic effect of these 9 SNPs was observed. LIMITATIONS Low statistical power might increase our type II error rate. CONCLUSIONS The present findings indicate that these risk SNPs do not explain a large proportion of the structural brain alterations in BD. Thus, these genes which are all related to neuronal functions must be involved in other pathophysiological aspects of BD development.
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Affiliation(s)
- Martin Tesli
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Hyperthyroidism and risk for bipolar disorders: a nationwide population-based study. PLoS One 2013; 8:e73057. [PMID: 24023669 PMCID: PMC3758264 DOI: 10.1371/journal.pone.0073057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background Thyroid disorders have long been associated with psychiatric illness, often with symptoms suggestive of mood disorders. The most common clinical features associated with hyperthyroidism are anxiety and depression. The risk of bipolar disorders, especially bipolar mania, among patients with thyroid disorders has not been well characterized. Objective We explored the relationship of hyperthyroidism and the subsequent development of bipolar disorders, and examined the risk factors for bipolar disorders in patients with hyperthyroidism. Methods We identified patients who were diagnosed with hyperthyroidism between 2000 and 2010 in the Taiwan National Health Insurance Research Database. A comparison cohort without hyperthyroidism was matched based on age, sex, and comorbidities. The occurrence of bipolar disorders was evaluated in both cohorts based on diagnosis and the use of mood stabilizer drugs. Results The hyperthyroidism cohort consisted of 21, 574 patients, and the comparison cohort consisted of 21, 574 matched control patients without hyperthyroidism. The incidence of bipolar disorders (incidence rate ratio [IRR], 2.31, 95% CI 1.80–2.99, P<.001) was higher for the hyperthyroidism patients than the control patients. Multivariate, matched regression models showed that women (HR 2.02, 95% CI 1.34–3.05, P = .001), patients with alcohol use disorders (HR 3.03, 95% CI 1.58–5.79, P = .001), and those with asthma (HR 1.70, 95% CI 1.18–2.43, P = .004) were independent risk factors for the development of bipolar disorders in hyperthyroidism patients. Conclusions Although a possibility that the diagnosis of bipolar disorders in this study actually includes "bipolar disorders due to hyperthyroidism" cannot be excluded, this study suggests that hyperthyroidism may increase the risk of developing bipolar disorders.
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