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Miasso AI, Monteschi M, Giacchero KG. Bipolar affective disorder: medication adherence and satisfaction with treatment and guidance by the health team in a mental health service. Rev Lat Am Enfermagem 2009; 17:548-56. [PMID: 19820864 DOI: 10.1590/s0104-11692009000400018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 06/18/2009] [Indexed: 11/22/2022] Open
Abstract
Bipolar Affective Disorder (BAD) is a chronic disease and requires medication treatment. This study verified the adherence of people with BAD to medication and compared, among adherent and non-adherent patients, satisfaction with the health team and treatment. Twenty-one patients with BAD receiving care in a mental health unit participated in the study. The Morisky-Green test and another instrument elaborated by the researchers were used for interviews. Data were analyzed with qualitative and quantitative approaches. Results showed that the majority of patients did not adhere to the medication treatment due to 'non-intentional behavior' (negligence or forgetfulness). The majority reports satisfaction with information received regarding the medication and its effectiveness, though there were reports of collateral effects, doubts and lack of motivation to keep up the treatment. This research shows the need for strategies directed at promoting adherence to medication therapy in patients with BAD.
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da Silva Magalhães PV, Gomes FA, Kunz M, Kapczinski F. Birth-cohort and dual diagnosis effects on age-at-onset in Brazilian patients with bipolar I disorder. Acta Psychiatr Scand 2009; 120:492-5. [PMID: 19594482 DOI: 10.1111/j.1600-0447.2009.01426.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Substance use disorders and birth-cohort have been associated with an earlier onset in bipolar disorder (BD). This study aimed at evaluating the inter-relations of these factors in age-at-onset in bipolar illness. METHOD Two-hundred and thirty patients with bipolar I disorder were cross-sectionally evaluated. Patients were categorized into four age groups for analysis. Lifetime comorbidity and age-at-onset were derived from the Structured Clinical Interview for DSM-IV. RESULTS There was a strong linear association between age group and age-at-onset. Lifetime alcohol and drug use disorders were also associated with age-at-onset. Illicit drug and alcohol use disorders and age group remained significant in the multivariate model. No interactions appeared. CONCLUSION Both age group and dual diagnoses had strong and independent impacts on age-at-onset in out-patients with BD. Substance abuse may be partly accountable for earlier symptom onset, but other features of BD in younger generations are still in need to be accounted for.
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Affiliation(s)
- P V da Silva Magalhães
- Bipolar Disorders Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
Recent suggestions to extend the boundaries of bipolar disorder to a broader spectrum lead to a concept of bipolarity different from that of classical psychiatry. It has been proposed that many patients with unipolar depression are actually bipolar and that many cases of substance abuse, personality disorders, and childhood behavioral disorders lie within the spectrum. However, since this expanded notion of bipolarity has been defined entirely on the basis of phenomenology, any expansion needs to meet broader criteria for validity. Bipolar spectrum disorders have a different phenomenology, family history, and course than classical bipolar disorders and do not respond in the same way to drugs. Until further research clarifies the boundaries of bipolarity, we should be conservative about extending its scope.
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Affiliation(s)
- Joel Paris
- Department of Psychiatry, McGill University, Institute of Community and Family Psychiatry and Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada.
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Mysels D, Sullivan MA. The kappa-opiate receptor impacts the pathophysiology and behavior of substance use. Am J Addict 2009; 18:272-6. [PMID: 19444730 PMCID: PMC5846103 DOI: 10.1080/10550490902925862] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
There is increasing evidence that the kappa-opiate receptor, in addition to the mu-opiate receptor, plays an important role in substance use pathophysiology and behavior. As dopamine activity is upregulated through chronic substance use, kappa receptor activity, mediated through the peptide dynorphin, is upregulated in parallel. Dynorphin causes dysphoria and decreased locomotion, and the upregulation of its activity on the kappa receptor likely dampens the excitation caused by increased dopaminergic activity. This feedback mechanism may have significant clinical implications for treating drug dependent patients in various stages of their pathology.
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Affiliation(s)
- David Mysels
- Division on Substance Use Research, Columbia Presbyterian Medical Center/New York State Psychiatric Institution, New York, New York 10032, USA.
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Harvey AG, Talbot LS, Gershon A. Sleep Disturbance in Bipolar Disorder Across the Lifespan. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:256-277. [PMID: 22493520 PMCID: PMC3321357 DOI: 10.1111/j.1468-2850.2009.01164.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this article is to highlight the importance of the sleep-wake cycle in children, adolescents, and adults with bipolar disorder. After reviewing the evidence that has accrued to date on the nature and severity of the sleep disturbance experienced, we document the importance of sleep for quality of life, risk for relapse, affective functioning, cognitive functioning, health (sleep disturbance is implicated in obesity, poor diet, and inadequate exercise), impulsivity, and risk taking. We argue that sleep may be critically important in the complex multifactorial cause of interepisode dysfunction, adverse health outcomes, and relapse. An agenda for future research is presented that includes improving the quality of sleep measures and controlling for the impact of bipolar medications.
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Lukasiewicz M, Blecha L, Falissard B, Neveu X, Benyamina A, Reynaud M, Gasquet I. Dual Diagnosis: Prevalence, Risk Factors, and Relationship With Suicide Risk in a Nationwide Sample of French Prisoners. Alcohol Clin Exp Res 2009; 33:160-8. [DOI: 10.1111/j.1530-0277.2008.00819.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas P, Vieta E. Amisulpride plus valproate vs haloperidol plus valproate in the treatment of acute mania of bipolar I patients: a multicenter, open-label, randomized, comparative trial. Neuropsychiatr Dis Treat 2008; 4:675-86. [PMID: 18830442 PMCID: PMC2526384 DOI: 10.2147/ndt.s3135] [Citation(s) in RCA: 8] [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] [Indexed: 12/04/2022] Open
Abstract
The primary objective of this study was to compare the effectiveness of combination treatment of valproate and amisulpride with that of valproate and haloperidol in bipolar I disorder. Adult inpatients with a current manic episode fulfilling DSM-IV-TR diagnostic criteria for bipolar type I disorder were included. Patients were randomized to amisulpride (400-800 mg/day) or haloperidol (5-15 mg/day) for 3 months and all received valproate. The primary effectiveness criterion was the percentage of responders (defined by a decrease of >/=50% of the Y-MRS) in patients completing the study. Safety was evaluated by adverse event reporting, determination of extrapyramidal function and clinical examination. Sixty-two patients were randomized to receive valproate-amisulpride, and 61 to receive valproate-haloperidol. At study end, responder rates were 72.6% in the amisulpride group and 65.5% in the haloperidol group. Remission rates were 83.9% and 89.7%, respectively. At study end, neither response rates nor remission rates differed significantly between groups. Treatment-emergent adverse events occurred significantly (p = 0.009) more frequently in the haloperidol group (86.4%) than in the amisulpride group (66.1%). In conclusion, the valproate-amisulpride combination was as effective as the valproate - haloperidol combination in bipolar I patients, with a better safety profile.
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Affiliation(s)
- Pierre Thomas
- Department of Psychiatry, Fontan Hospital CHRU Lille, University of Lille 2 France.
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58
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[Management of comorbid bipolar disorder and alcohol dependence]. Presse Med 2008; 37:1132-7. [PMID: 18296020 DOI: 10.1016/j.lpm.2007.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 09/18/2007] [Accepted: 09/18/2007] [Indexed: 11/24/2022] Open
Abstract
Recent studies confirm the clear association between bipolar disorders and alcohol abuse and dependence. Lifetime prevalence of disorders associated with alcohol abuse or dependence appears to be 3 to 4 times higher in patients with bipolar disorders than in the general population. Lifetime prevalence of mood disorders in alcohol-dependent subjects is approximately 10 times higher than in the general population. Despite the strength of this association, there is little information about specific management that takes into account both disorders and their interaction. One study shows that valproate may reduce excessive alcohol consumption in bipolar alcohol-dependent patients, especially because of its stabilizing and anticonvulsant effects. Based on this study, the American Psychiatry Association (APA) recently suggested the use of valproate in the treatment of patients with comorbid bipolar disorder and alcohol dependence.
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Davis MI. Ethanol-BDNF interactions: still more questions than answers. Pharmacol Ther 2008; 118:36-57. [PMID: 18394710 DOI: 10.1016/j.pharmthera.2008.01.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 01/08/2008] [Indexed: 01/02/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) has emerged as a regulator of development, plasticity and, recently, addiction. Decreased neurotrophic activity may be involved in ethanol-induced neurodegeneration in the adult brain and in the etiology of alcohol-related neurodevelopmental disorders. This can occur through decreased expression of BDNF or through inability of the receptor to transduce signals in the presence of ethanol. In contrast, recent studies implicate region-specific up-regulation of BDNF and associated signaling pathways in anxiety, addiction and homeostasis after ethanol exposure. Anxiety and depression are precipitating factors for substance abuse and these disorders also involve region-specific changes in BDNF in both pathogenesis and response to pharmacotherapy. Polymorphisms in the genes coding for BDNF and its receptor TrkB are linked to affective, substance abuse and appetitive disorders and therefore may play a role in the development of alcoholism. This review summarizes historical and pre-clinical data on BDNF and TrkB as it relates to ethanol toxicity and addiction. Many unresolved questions about region-specific changes in BDNF expression and the precise role of BDNF in neuropsychiatric disorders and addiction remain to be elucidated. Resolution of these questions will require significant integration of the literature on addiction and comorbid psychiatric disorders that contribute to the development of alcoholism.
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Affiliation(s)
- Margaret I Davis
- Section on Synaptic Pharmacology, Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892, USA.
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60
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Bailly D. Troubles bipolaires et abus de substances. Encephale 2007. [DOI: 10.1016/s0013-7006(07)78682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ballerini A, Boccalon RM, Boncompagni G, Casacchia M, Margari F, Minervini L, Righi R, Russo F, Salteri A, Frediani S, Rossi A, Scatigna M. Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey. Ann Gen Psychiatry 2007; 6:29. [PMID: 17983468 PMCID: PMC2186309 DOI: 10.1186/1744-859x-6-29] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 11/05/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications. METHODS A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. RESULTS Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay. CONCLUSION Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.
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Affiliation(s)
- Andrea Ballerini
- Servizio Psichiatrico Diagnosi e Cura, Santa Maria Nuova Hospital, Firenze, Italy.
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Joyce PR, Light KJ, Rowe SL, Kennedy MA. Bipolar disorder not otherwise specified: comparison with bipolar disorder I/II and major depression. Aust N Z J Psychiatry 2007; 41:843-9. [PMID: 17828658 DOI: 10.1080/00048670701579058] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the personality, clinical and comorbidity characteristics of subjects meeting diagnostic criteria for bipolar disorder not otherwise specified (BDNOS) to those with major depression and bipolar I or II disorder. METHODS A family-based study was undertaken on the molecular genetics of depression and personality, in which the proband had been treated for depression, regardless of history, of hypomania or mania. RESULTS The 25 subjects with BDNOS were different to the 297 subjects with major depression and similar to 75 subjects with bipolar I or II disorder on social phobia, obsessive-compulsive disorder and substance dependence comorbidity. The BDNOS subjects also had personality traits more akin to the bipolar I or II disorder subjects, especially borderline personality traits and self transcendence. CONCLUSIONS Subjects with BDNOS, based on a history of 1-3 day recurrent hypomanias, should be included within a broader bipolar spectrum.
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Affiliation(s)
- Peter R Joyce
- University of Otago Christchurch, Christchurch, New Zealand.
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63
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Modestin J, Kayser-Rapold S, Wehrli MV, Neuenschwander M, Malti T. A comparative study on dual patients with affective disorder. J Affect Disord 2007; 102:109-14. [PMID: 17267047 DOI: 10.1016/j.jad.2006.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 12/14/2006] [Accepted: 12/17/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The main purpose of the study was to investigate whether there are differences between dual patients with affective disorders regarding the different kinds of substances abused - a topic which has hardly been dealt with in the literature. METHODS Clinical charts of 94 dual and 94 non-dual patients, matched for sex, age, and diagnosis, were scrutinized and the data of both groups compared with each other, with regard to the substance of abuse. RESULTS A total of 17.4% of all patients with affective disorders were found to be dual patients and the proportion of dual patients was equal among patients with unipolar disorder, bipolar disorder, and dysthymia. Only a few significant differences were found between dual and non-dual patients; more differences were identified when the dual group was divided into patients abusing alcohol (59%), opioids/cocaine (22%), and sedatives/hypnotics (19%). In particular, the group of patients abusing illegal drugs was found to be younger and to show more behavioral pathology. All three groups of dual patients differed regarding the onset of their affective illness. LIMITATIONS Retrospective study of clinical records. CONCLUSIONS There are differences between dual patients with affective disorders abusing different substances. The choice of a particular substance of abuse appears to be the function of the age of onset of the disorder.
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Affiliation(s)
- Jiri Modestin
- Department of Psychiatry, Burghölzli Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland.
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van Laar M, van Dorsselaer S, Monshouwer K, de Graaf R. Does cannabis use predict the first incidence of mood and anxiety disorders in the adult population? Addiction 2007; 102:1251-60. [PMID: 17624975 DOI: 10.1111/j.1360-0443.2007.01875.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS To investigate whether cannabis use predicted the first incidence of mood and anxiety disorders in adults during a 3-year follow-up period. DESIGN AND PARTICIPANTS Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective study in the adult population of 18-64 years. The analysis was carried out on 3881 people who had no life-time mood disorders and on 3854 people who had no life-time anxiety disorders at baseline. MEASUREMENTS Life-time cannabis use and DSM-III-R mood and anxiety disorders, assessed with the Composite International Diagnostic Interview (CIDI). FINDINGS After adjustment for strong confounders, any use of cannabis at baseline predicted a modest increase in the risk of a first major depression (odds ratio 1.62; 95% confidence interval 1.06-2.48) and a stronger increase in the risk of a first bipolar disorder (odds ratio 4.98; 95% confidence interval 1.80-13.81). The risk of 'any mood disorder' was elevated for weekly and almost daily users but not for less frequent use patterns. However, dose-response relationships were less clear for major depression and bipolar disorder separately. None of the associations between cannabis use and anxiety disorders remained significant after adjustment for confounders. CONCLUSIONS The associations between cannabis use and the first incidence of depression and bipolar disorder, which remained significant after adjustment for strong confounders, warrant research into the underlying mechanisms.
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Affiliation(s)
- Margriet van Laar
- Trimbos Institute, Netherlands National Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Tsai SJ. Increased central brain-derived neurotrophic factor activity could be a risk factor for substance abuse: Implications for treatment. Med Hypotheses 2007; 68:410-4. [PMID: 16824691 DOI: 10.1016/j.mehy.2006.05.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 05/18/2006] [Indexed: 01/19/2023]
Abstract
Drug addiction is a common psychiatric disorder with complex genetic, psychological and social contributing factors. While the midbrain dopaminergic system is crucial for acute reward and the initiation of addiction, evidence suggests that there are permanent neuronal changes at the cellular and molecular levels that underlie the addictive process. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family and the most abundant neurotrophins in the brain, plays a key role in the survival and differentiation of midbrain dopaminergic (DA) neurons. Evidence from animal and clinical studies suggests that increased central BDNF activity may be implicated in the pathogenesis of drug addiction. For example, BDNF infusion into rat midbrain enhances the rewarding effects of cocaine as measured by the condition place preference paradigm. In contrast, cocaine-conditioned place preference was reduced in heterozygous BDNF knockout mice. In humans, the 66Val allele of the BDNF-gene Val66Met polymorphism is associated with higher BDNF secretion in response to neuronal stimulation compared with the 66Met allele. We found higher BDNF 66Val homozygote frequency in people with drug addiction compared with normal controls. Furthermore, plasma BDNF concentrations of methamphetamine users were significantly higher than controls. The increased central BDNF activity hypothesis of drug addiction may provide new insights for improved therapeutic strategies for the prevention and treatment of drug addiction. Several strategies to decrease central BDNF activity that have potential use in the treatment of drug addiction are proposed.
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Affiliation(s)
- Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201 Shih-Pai Road, Sec. 2, Taipei 11217, Taiwan.
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Frank E, Boland E, Novick DM, Bizzarri JV, Rucci P. Association between illicit drug and alcohol use and first manic episode. Pharmacol Biochem Behav 2006; 86:395-400. [PMID: 17188743 PMCID: PMC1876823 DOI: 10.1016/j.pbb.2006.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 10/30/2006] [Accepted: 11/16/2006] [Indexed: 11/25/2022]
Abstract
In light of the established influence of substance use on the onset, course, and outcome of bipolar disorder, we performed a retrospective chart review of patients with bipolar I disorder participating in a randomized controlled trial to further investigate the relationship between alcohol and substance use and first onset of mania. A total of 59.4% (N=101) of the 170 participants were determined to have a history of substance and/or alcohol use. Among the 101 participants with SU, use was coded in 10 (9.9%) as immediately preceding, in 50 (49.5%) as preceding mania, in 7 (6.9%) as following mania, and in 34 (33.7%) as indeterminable. Of the 10 participants with immediately preceding use, 5 experienced their first manic episode immediately after discontinuing a substance. Our findings support earlier reports detailing the high prevalence of substance use among patients with bipolar disorder. Treatments targeting alcohol and substance use among individuals with bipolar disorder are clearly needed, as are prophylactic treatments targeting adolescents and young adults who are at risk for either bipolar disorder or alcohol and substance related disorders.
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Affiliation(s)
- Ellen Frank
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Grunebaum MF, Galfalvy HC, Nichols CM, Caldeira NA, Sher L, Dervic K, Burke AK, Mann JJ, Oquendo MA. Aggression and substance abuse in bipolar disorder. Bipolar Disord 2006; 8:496-502. [PMID: 17042888 DOI: 10.1111/j.1399-5618.2006.00349.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The goal of this retrospective study was to examine factors differentiating persons with bipolar disorder who did or did not have comorbid lifetime substance use disorders (SUD) at an index assessment. We also explored the chronology of onset of mood and SUD. METHODS We studied 146 subjects with DSM-defined bipolar disorder. Subgroups with and without lifetime SUD were compared on demographic and clinical measures. RESULTS Substance abuse disorders in this bipolar sample were associated with male sex, impulsive-aggressive traits, comorbid conduct and Cluster B personality disorders, number of suicide attempts and earlier age at onset of a first mood episode. In a multivariable logistic regression analysis, male sex and aggression and possibly earlier age at mood disorder onset were associated with SUD. In those with or without SUD, the first mood episode tended to be depressive and to precede the onset of SUD. CONCLUSIONS In persons with bipolar disorder, an earlier age of onset and aggressive traits appear to be factors associated with later development of comorbid SUD.
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Affiliation(s)
- Michael F Grunebaum
- Department of Neuroscience, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.
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Brooks JO, Hoblyn JC, Kraemer HC, Yesavage JA. Factors associated with psychiatric hospitalization of individuals diagnosed with dementia and comorbid bipolar disorder. J Geriatr Psychiatry Neurol 2006; 19:72-7. [PMID: 16690991 DOI: 10.1177/0891988706286215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to determine risk factors of psychiatric hospitalization among a Veterans Administration database of patients with dementia and comorbid bipolar disorder (D+BD). Patients with D+BD had a greater prevalence of psychiatric hospitalization (28% vs 4%). The strongest predictor of psychiatric hospitalization was the presence of an alcohol use disorder (51% risk); patients without alcohol use disorders but under the age of 70 had the next highest risk (33% risk). However, patients with an alcohol use disorder had shorter psychiatric hospitalizations than those without. Compared with patients without BD, D+BD patients were more likely to have alcohol use disorders (15% vs 3%) and any other substance use problem (10% vs 1%). In patients diagnosed with dementia and bipolar disorder, the strongest risk factor for psychiatric hospitalization was an alcohol abuse disorder. These findings suggest that disorders with increased frequency in BD affect the course of dementia.
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Affiliation(s)
- John O Brooks
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California 94304, USA.
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69
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Adamson SJ, Todd FC, Sellman JD, Huriwai T, Porter J. Coexisting psychiatric disorders in a New Zealand outpatient alcohol and other drug clinical population. Aust N Z J Psychiatry 2006; 40:164-70. [PMID: 16476135 DOI: 10.1080/j.1440-1614.2006.01764.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the extent of psychiatric disorder and mental health service utilization in a representative outpatient alcohol and other drug (AOD) treatment sample in New Zealand. METHOD A total of 105 patients were randomly recruited from two outpatient AOD treatment services in New Zealand and completed a diagnostic interview within the first 2 months of treatment. Axis I psychiatric diagnoses were made using the computerized Composite International Diagnostic Interview (CIDI-Auto), and were supplemented by the South Oaks Gambling Scale (SOGS) and the conduct disorder and antisocial personality disorder section of the Diagnostic Interview for Genetic Studies (DIGS). RESULTS Seventy-four per cent of the sample had a current non-substance or gambling axis I disorder, with a lifetime rate of 90%. The most commonly diagnosed of these coexisting psychiatric disorders were major depressive episode (34%), social phobia (31%) and posttraumatic stress disorder (31%). Past contact with mental health services was common, while contact at the time of baseline assessment was uncommon. CONCLUSIONS Coexisting psychiatric disorder was the rule and not the exception in this sample. AOD patients are clearly part of the larger population of mental health patients. AOD services need to be capable of comprehensive assessment and treatment planning, which includes coexisting psychiatric disorders, and should work toward better integration with other mental health services.
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Affiliation(s)
- Simon J Adamson
- National Addiction Centre, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, New Zealand.
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Serretti A, Olgiati P, Colombo C. Influence of postpartum onset on the course of mood disorders. BMC Psychiatry 2006; 6:4. [PMID: 16438725 PMCID: PMC1373619 DOI: 10.1186/1471-244x-6-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 01/26/2006] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To ascertain the impact of postpartum onset (PPO) on the subsequent time course of mood disorders. METHODS This retrospective study compared per year rates of excited (manic or mixed) and depressive episodes between fifty-five women with bipolar (N = 22) or major depressive (N = 33) disorders with first episode occurring postpartum (within four weeks after childbirth according to DSM-IV definition) and 218 non-postpartum onset (NPPO) controls. Such patients had a traceable illness course consisting of one or more episodes alternating with complete symptom remission and no additional diagnoses of axis I disorders, mental retardation or brain organic diseases. A number of variables reported to influence the course of mood disorders were controlled for as possible confounding factors RESULTS Bipolar women with postpartum onset disorder had fewer excited episodes (p = 0.005) and fewer episodes of both polarities (p = 0.005) compared to non-postpartum onset subjects. No differences emerged in the rates of depressive episodes. All patients who met criteria for rapid cycling bipolar disorder (7 out of 123) were in the NPPO group. Among major depressives, PPO patients experienced fewer episodes (p = 0.016). With respect to clinical and treatment features, PPO-MDD subjects had less personality disorder comorbidity (p = 0.023) and were less likely to be on maintenance treatment compared to NPPO comparison subjects (p = 0.002) CONCLUSION Such preliminary findings suggest that PPO mood disorders may be characterized by a less recurrent time course. Future research in this field should elucidate the role of comorbid personality disorders and treatment. Moreover it should clarify whether PPO disorders are also associated with a more positive outcome in terms of social functioning and quality of life.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Vita-Salute University, San Raffaele Institute, Milan, Italy
| | - Paolo Olgiati
- Department of Psychiatry, Vita-Salute University, San Raffaele Institute, Milan, Italy
| | - Cristina Colombo
- Department of Psychiatry, Vita-Salute University, San Raffaele Institute, Milan, Italy
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71
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Schaffer A, Cairney J, Cheung A, Veldhuizen S, Levitt A. Community survey of bipolar disorder in Canada: lifetime prevalence and illness characteristics. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:9-16. [PMID: 16491979 DOI: 10.1177/070674370605100104] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study reports on the lifetime prevalence and illness characteristics of bipolar disorder (BD) in a large, representative sample of Canadians. METHOD Data were obtained from the Canadian Community Health Survey: Mental Health and Well-Being. This representative, cross-sectional survey, conducted by Statistics Canada in 2002, examines the mental health of Canadians aged 15 years and over. The national response rate was 77%. We determined the prevalence rate of BD, correlates of a bipolar diagnosis, and illness characteristics. RESULTS The weighted lifetime prevalence rate of BD was 2.2% (95% confidence interval [CI], 1.94% to 2.37%). Younger age, low income adequacy, lifetime anxiety disorder, and presence of a substance use disorder in the past 12 months were each significantly associated with the presence of a BD diagnosis (P < 0.001 for each). The largest effect found was for the presence of an anxiety disorder (odds ratio 7.94; 95% CI, 6.35 to 9.92). A lifetime history of anxiety disorder was reported by 51.8% (955% CI, 47.1% to 56.5%) of the respondents with BD, with both panic disorder and agoraphobia each being more frequent among women, compared with men (P = 0.01 and P < 0.001, respectively). The mean age at onset of illness was 22.5 years, SD 12.0. CONCLUSIONS According to the estimated lifetime prevalence of BD found in this study, over 500 000 Canadians likely suffer from this condition. Identifying those at highest risk for BD may assist in developing more effective community-based identification and intervention strategies.
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Affiliation(s)
- Ayal Schaffer
- Sunnybrook and Women's College Health Sciences Center, University of Toronto, Toronto, Ontatrio.
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72
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Abstract
Individuals with bipolar disorder are at an increased risk of criminal arrest compared with those in the population at large. The combination of manic symptoms and substance abuse seem to be the primary illness factors for this increased risk, and the public mental health system has faced challenges in treating these patients successfully in community settings. To decrease the risk for arrest in bipolar patients, clinicians can screen and refer patients for substance use disorders, stabilize mania in hospital settings, and take measures to improve outpatient adherence in the postmanic hospitalization period. Psychiatric advance directives, new developments in civil commitment law, and mental health courts are legal mechanisms that may be critical in preventing the criminalization of those with bipolar disorder.
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Affiliation(s)
- Cameron D Quanbeck
- Department of Psychiatry and Behavioral Sciences, Division of Psychiatry and the Law, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.
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73
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Abstract
The search for susceptibility genes for bipolar disorder (BD) depends on appropriate definitions of the phenotype. In this paper, we review data on diagnosis and clinical features of BD that could be used in genetic studies to better characterize patients or to define homogeneous subgroups. Clinical symptoms, long-term course, comorbid conditions, and response to prophylactic treatment may define groups associated with more or less specific loci. One such group is characterized by symptoms of psychosis and linkage to 13q and 22q. A second group includes mainly bipolar II patients with comorbid panic disorder, rapid mood switching, and evidence of chromosome 18 linkage. A third group comprises typical BD with an episodic course and favourable response to lithium prophylaxis. Reproducibility of cognitive deficits across studies raises the possibility of using cognitive profiles as endophenotypes of BD, with deficits in verbal explicit memory and executive function commonly reported. Brain imaging provides a more ambiguous data set consistent with heterogeneity of the illness.
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Affiliation(s)
- G M MacQueen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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74
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Abstract
SUDs are common in people with BPD. The reasons for this association are not well understood and may be related to several factors. When present,SUDs in BPD patients seem to be associated with a poor prognosis. The treatment of patients with BPD and an SUD has been the subject of relatively little investigation, but medications that are effective mood stabilizers seem to decrease substance use in some reports.
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Affiliation(s)
- E Sherwood Brown
- Psychoneuroendocrine Research Program, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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75
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Renner JA. How to train residents to identify and treat dual diagnosis patients. Biol Psychiatry 2004; 56:810-6. [PMID: 15556127 DOI: 10.1016/j.biopsych.2004.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 04/12/2004] [Accepted: 04/16/2004] [Indexed: 12/01/2022]
Abstract
Medical training has failed to address the needs of patients with comorbid substance use and psychiatric disorders. Addiction teaching is limited and often fails to change the negative attitudes of many physicians. In many psychiatry residencies, addiction training occurs on inpatient or detoxification units and the focus is on screening, detoxification, and referral. Most residents do not gain adequate experience in the long-term management of dual-diagnosis patients. Successful clinical care is based on three critical elements (the "clinician's triad"): an adequate knowledge base, a positive attitude toward the patient and the benefits of treatment, and a sense of responsibility for the clinical problem. The Boston University Psychiatry Residency has designed an addiction training program to address these three issues. In addition to a comprehensive addiction seminar series, there are several unique features. The required clinical rotation occurs in an outpatient dual-diagnosis clinic and permits residents to follow a caseload of patients for 12 months. Extensive experience is gained in motivational interviewing, cognitive behavioral therapy, and pharmacotherapy. Self-directed learning approaches are used to maximize the educational experience on services that lack addiction faculty. Guidelines are provided for establishing a similar program and for more effective approaches to resident teaching.
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Affiliation(s)
- John A Renner
- Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 02114, USA
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O'Brien CP, Charney DS, Lewis L, Cornish JW, Post RM, Woody GE, Zubieta JK, Anthony JC, Blaine JD, Bowden CL, Calabrese JR, Carroll K, Kosten T, Rounsaville B, Childress AR, Oslin DW, Pettinati HM, Davis MA, Demartino R, Drake RE, Fleming MF, Fricks L, Glassman AH, Levin FR, Nunes EV, Johnson RL, Jordan C, Kessler RC, Laden SK, Regier DA, Renner JA, Ries RK, Sklar-Blake T, Weisner C. Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: a call to action. Biol Psychiatry 2004; 56:703-13. [PMID: 15556110 DOI: 10.1016/j.biopsych.2004.10.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Charles P O'Brien
- Department of Psychiatry, University of Pennsylvania School of Medicine, 3900 Chestnut Street, Philadelphia, PA 19104-6178, USA.
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