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Perry A, Roberts G, Mitchell PB, Breakspear M. Connectomics of bipolar disorder: a critical review, and evidence for dynamic instabilities within interoceptive networks. Mol Psychiatry 2019; 24:1296-1318. [PMID: 30279458 PMCID: PMC6756092 DOI: 10.1038/s41380-018-0267-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/14/2018] [Accepted: 09/07/2018] [Indexed: 12/31/2022]
Abstract
The notion that specific cognitive and emotional processes arise from functionally distinct brain regions has lately shifted toward a connectivity-based approach that emphasizes the role of network-mediated integration across regions. The clinical neurosciences have likewise shifted from a predominantly lesion-based approach to a connectomic paradigm-framing disorders as diverse as stroke, schizophrenia (SCZ), and dementia as "dysconnection syndromes". Here we position bipolar disorder (BD) within this paradigm. We first summarise the disruptions in structural, functional and effective connectivity that have been documented in BD. Not surprisingly, these disturbances show a preferential impact on circuits that support emotional processes, cognitive control and executive functions. Those at high risk (HR) for BD also show patterns of connectivity that differ from both matched control populations and those with BD, and which may thus speak to neurobiological markers of both risk and resilience. We highlight research fields that aim to link brain network disturbances to the phenotype of BD, including the study of large-scale brain dynamics, the principles of network stability and control, and the study of interoception (the perception of physiological states). Together, these findings suggest that the affective dysregulation of BD arises from dynamic instabilities in interoceptive circuits which subsequently impact on fear circuitry and cognitive control systems. We describe the resulting disturbance as a "psychosis of interoception".
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Affiliation(s)
- Alistair Perry
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin/London, Germany. .,Center for Lifespan Psychology, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
| | - Gloria Roberts
- 0000 0004 4902 0432grid.1005.4School of Psychiatry, University of New South Wales, Randwick, NSW Australia ,grid.415193.bBlack Dog Institute, Prince of Wales Hospital, Randwick, NSW Australia
| | - Philip B. Mitchell
- 0000 0004 4902 0432grid.1005.4School of Psychiatry, University of New South Wales, Randwick, NSW Australia ,grid.415193.bBlack Dog Institute, Prince of Wales Hospital, Randwick, NSW Australia
| | - Michael Breakspear
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,Metro North Mental Health Service, Brisbane, QLD, Australia.
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Paterniti S, Bisserbe JC. Factors associated with false positives in MDQ screening for bipolar disorder: Insight into the construct validity of the scale. J Affect Disord 2018; 238:79-86. [PMID: 29864713 DOI: 10.1016/j.jad.2018.05.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/29/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Identifying bipolar patients in the first phases of the illness is essential to establish adequate treatment. The goal of this study was to examine the discriminant ability of the Mood Disorders Questionnaire (MDQ) in recognizing bipolar patients referred to a tertiary care structure. METHODS Between 2006 and 2012, we assessed 843 individuals referred to the Mood Disorders Program by family physicians in the community. The Structured Clinical Interview for DSM-IV-TR (SCID) was used to assess diagnoses. A nurse collected the information about lifetime symptoms of (hypo)mania in 759 individuals using the MDQ. Univariate chi-square test and logistic regression were used for the statistical analysis. RESULTS Overall, 86% of the sample had a current anxiety or depressive disorder. When compared to the diagnoses formulated through the SCID, the sensitivity of the MDQ was 75.0%, the specificity was 74%, the positive predictive value was 55%, and the negative predictive value was 88%. Among non-bipolar patients, current post-traumatic stress disorder, borderline personality disorder, current or early remission substance use disorder, and the history of childhood abuse were independently associated with false positive screening using the MDQ. LIMITATIONS Individuals with current substance use disorders were under-represented, whether or not the patients were aware of their diagnosis of bipolar disorder was not recorded, and the history of childhood abuse was collected based on an open interview. CONCLUSIONS The self-rated measure of the symptoms listed by the MDQ seems to measure a dimension shared by both bipolar disorder and other conditions characterized by affective instability and impulsivity.
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Affiliation(s)
- Sabrina Paterniti
- Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Jean-Claude Bisserbe
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Université Paris Est Créteil, Paris, France
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[Bipolar affective disorders in senescence]. Z Gerontol Geriatr 2018; 51:751-757. [PMID: 30267264 DOI: 10.1007/s00391-018-1446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Diagnostic and therapeutic measures in patients with bipolar disorders are significantly different depending on the age of those affected. Given the demographic changes and the fact that approximately one quarter of patients with bipolar disease are in old age, it is important for geriatricians to be aware of the specific aspects of bipolar disease. This review article presents the diagnostics of bipolar disorders in old people. Interactions with somatic comorbidities, which may lead to the occurrence of secondary mania, just to mention one of the characteristics of old age, are elaborated. Furthermore, age-specific differences also necessitate altered or adjusted therapy regimens, which deviate from those of younger patients.
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O'Donnell C, Di Simplicio M, Brown R, Holmes EA, Burnett Heyes S. The role of mental imagery in mood amplification: An investigation across subclinical features of bipolar disorders. Cortex 2018; 105:104-117. [DOI: 10.1016/j.cortex.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/16/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
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Is Internet Addiction a Clinical Symptom or a Psychiatric Disorder? A Comparison With Bipolar Disorder. J Nerv Ment Dis 2018; 206:644-656. [PMID: 30028359 DOI: 10.1097/nmd.0000000000000861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The general purpose of this review is to present an updated literature overview of neurobiological/clinical aspects of Internet addiction (IA), particularly of overlaps and differences with bipolar affective disorder (BPAD). Articles with clinical/neurobiological aspects of IA or similarities/differences with BPAD as main topics, from 1990 to present and written in English language, were included. Comorbidity between IA and other psychiatric disorders, including BPAD, is common. Dysfunctions in dopaminergic pathways have been found both in IA and in mood disorders. Most of investigations in IA support a chronic hypodopaminergic dysfunctional state in brain reward circuit and an excessive reward experience during mood elevation. Neuroimaging studies show prefrontal cortex abnormalities shared between addictive and bipolar patients. BPAD and IA present numerous overlaps, such as polymorphisms in nicotinic receptors genes, anterior cingulate/prefrontal cortex abnormalities, serotonin/dopamine dysfunctions, and good response to mood stabilizers. The future is to clarify diagnostic criteria to better define the IA/BPAD relationship.
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Is recurrence in major depressive disorder related to bipolarity and mixed features? Results from the BRIDGE-II-Mix study. J Affect Disord 2018; 229:164-170. [PMID: 29310066 DOI: 10.1016/j.jad.2017.12.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/28/2017] [Accepted: 12/31/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Current classifications separate Bipolar (BD) from Major Depressive Disorder (MDD) based on polarity rather than recurrence. We aimed to determine bipolar/mixed feature frequency in a large MDD multinational sample with (High-Rec) and without (Low-Rec) >3 recurrences, comparing the two subsamples. METHODS We measured frequency of bipolarity/hypomanic features during current depressive episodes (MDEs) in 2347 MDD patients from the BRIDGE-II-mix database, comparing High-Rec with Low-Rec. We used Bonferroni-corrected Student's t-test for continuous, and chi-squared test, for categorical variables. Logistic regression estimated the size of the association between clinical characteristics and High-Rec MDD. RESULTS Compared to Low-Rec (n = 1084, 46.2%), High-Rec patients (n = 1263, 53.8%) were older, with earlier depressive onset, had more family history of BD, more atypical features, suicide attempts, hospitalisations, and treatment resistance and (hypo)manic switches when treated with antidepressants, higher comorbidity with borderline personality disorder, and more hypomanic symptoms during current MDE, resulting in higher rates of mixed depression according to both DSM-5 and research-based diagnostic (RBDC) criteria. Logistic regression showed age at first symptoms < 30 years, current MDE duration ≤ 1 month, hypomania/mania among first-degree relatives, past suicide attempts, treatment-resistance, antidepressant-induced swings, and atypical, mixed, or psychotic features during MDE to associate with High-Rec. LIMITATIONS Number of MDEs for defining recurrence was arbitrary; cross-sectionality did not allow assessment of conversion from MDD to BD. CONCLUSIONS High-Rec MDD differed from Low-Rec group for several clinical/epidemiological variables, including bipolar/mixed features. Bipolarity specifier and RBDC were more sensitive than DSM-5 criteria in detecting bipolar and mixed features in MDD.
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Pirdoğan Aydın E, Dalkıran M, Özer ÖA, Karamustafalıoğlu KO. Hypomanic switch during vortioxetine treatment: a case report. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1435602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Efruz Pirdoğan Aydın
- Department of Psychiatry, Şişli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Mihriban Dalkıran
- Department of Psychiatry, Şişli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Ömer Akil Özer
- Department of Psychiatry, Şişli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
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Masi G, Milone A, Montesanto AR, Valente E, Pisano S. Non suicidal self-injury in referred adolescents with mood disorders and its association with cyclothymic-hypersensitive temperament. J Affect Disord 2018; 227:477-482. [PMID: 29156361 DOI: 10.1016/j.jad.2017.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/24/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non suicidal self-injuries (NSSIs) are deliberate self-harm behaviors without suicidal intent, usually starting in adolescence, with increasing rates of occurrence both in epidemiological and clinical samples. Several studies associated cyclothymic-hypersensitive temperament (CHT) with self-harm behaviors and suicidal risk. Aim of this study is to explore the association between NSSIs and CHT in a clinical sample of adolescents. We hypothesized that CHT may differentiate NSSI from non-NSSI adolescents with mood disorders, when other psychopathological features are controlled for. METHODS A consecutive sample of 89 adolescents with mood disorders were assessed for presence and phenomenology of NSSIs, CHT, demographics, comorbid categorical psychiatric diagnoses, dimensional psychopathology, impairment and previous suicide attempts. RESULTS NSSIs were reported in 52% of the sample, with higher rates in females and in bipolar disorder. Regression analyses showed that CHT, but not age, gender, bipolar vs depression diagnosis, functional impairment, was associated with NSSIs. DISCUSSION CHT may be in close association with NSSIs in adolescents with mood disorders. An assessment of CHT in adolescents referred for mood disorder may help to detect specific psychological features of NSSIs, which may improve diagnostic and treatment strategies. LIMITATIONS Given the cross-sectional design, a developmental relation between CHT and NSSIs cannot be determined. The small sample size and the selection bias of severely impaired patients limit the generalization of the results. More sophisticated measures of CHT may consent to explore other dimensions of the cyclothymic construct (i.e., emotional intensity, emotional reactivity, emotional stability, positive vs. negative emotions, interpersonal sensitivity, impulsivity).
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Anna Rita Montesanto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Elena Valente
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Simone Pisano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy.
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Alciati A, Atzeni F, Grassi M, Caldirola D, Sarzi-Puttini P, Angst J, Perna G. Features of mood associated with high body weight in females with fibromyalgia. Compr Psychiatry 2018; 80:57-64. [PMID: 29035730 DOI: 10.1016/j.comppsych.2017.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/27/2017] [Accepted: 08/29/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a common syndrome whose main characteristic is chronic widespread musculoskeletal pain, the severity of which is frequently worsened by concomitant obesity. Major depression (MD), particularly as part of a bipolar spectrum disorder (BSD), is associated with both obesity and FM. OBJECTIVE To evaluate the relationship between lifetime MD, hypomanic symptoms and the body mass index (BMI) in patients with FM. METHOD Of the 115 patients originally screened, 87 women with FM finally entered the study. Forty-nine patients (57%) had a lifetime diagnosis of MD, assessed by a structured clinical interview based on DSM-IV criteria, and four of them (4.6%) had a current MD episode. Lifetime hypomanic symptoms were measured by means of the self-rated Hypomania Checklist. According to the international criteria for BMI, FM patients were classified as under/normal-weight (61%), overweight (30%) and obese (9%). RESULTS 62 patients (71.2%) with FM had a bipolar spectrum disorder (BSD). Thirty (48.3%) of them met criteria for bipolar II disorder, 32 (51,6%) for bipolar disorder NOS (18 FM patients with MD associated to sub-syndromal hypomanic syndrome and 14 with hypomanic syndrome without MD). No patient had a bipolar I disorder. Only one patient met the criteria for a major depressive disorder (MDD). There was no significant difference in mean BMI between the patients with and without a lifetime diagnosis of MD, but there was a positive association between the level of hypomanic symptoms and BMI values (p<0.009). When hypomania was considered categorically as hypomanic syndrome there was no significant effect on BMI. CONCLUSIONS Our finding adds to previous evidence indicating that hypomanic symptoms are a central feature of FM. In the case of the early identification of high-level hypomanic symptoms, body weight should be closely monitored in order to prevent obesity and its detrimental impact on females with FM.
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Affiliation(s)
- Alessandra Alciati
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy.
| | | | - Massimiliano Grassi
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | | | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy; Research Institute of Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, USA
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Bostock E, Kirkby K, Garry M, Taylor B, Hawrelak JA. Mania Associated With Herbal Medicines, Other Than Cannabis: A Systematic Review and Quality Assessment of Case Reports. Front Psychiatry 2018; 9:280. [PMID: 30034348 PMCID: PMC6043668 DOI: 10.3389/fpsyt.2018.00280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/11/2018] [Indexed: 01/22/2023] Open
Abstract
Background: DSM-5 introduced the diagnostic category of substance/medication-induced bipolar and related disorder. This systematic review examines published reports linking mania with the consumption of herbal medicines (HM), excluding cannabis. Putative pathophysiological mechanisms that may account for the reported HM being associated with mania are discussed. Methods: A systematic search of EMBASE, CINAHL, Health Source, PsychINFO, and PubMed. The quality of case reports meeting inclusion criteria was assessed using the modified Quality Assessment Scale by Agbabiaka. Results: Nineteen single and seven multiple-case reports met inclusion criteria. These yielded a study sample of 35 case reports, 28 of herbal medicine associated mania, 5 of hypomania, and two mixed states, in 17 females [age in years M(SD) = 43.1(13.2)] and 18 males [40.7(18.1)]. A total of 11 herbal medicines were implicated. Case reports by herbal medicine (number of reports) comprised: St John's wort (Hypericum perforatum) (14); Ginseng (Panax ginseng) (5); brindleberry (Garcinia cambogia) (4); ma-huang (Ephedra sinica) (3); "herbal slimming pills" (2); Herbalife products (2); Hydroxycut (1); horny goat weed (Epimedium grandiflorum) (1); "herbal body tonic" (1); celery root (Apium graveolans) (1), and a "herbal mixture" (1). All case reports were associated with use rather than withdrawal of herbal medicines. Only one case report was rated for probability of association using a standardized algorithm. Laboratory assays to confirm composition of the herbal preparation were reported in only one article describing two cases and indicating admixture of a likely causal pharmaceutical in the herbal preparation. Conclusions: Causal attributions are problematic given the limited number of reports, antidepressant co-prescribing in 7 cases, insufficient data regarding pattern and type of herbal medicine use, and lack of a reference frequency for spontaneous mania.The quality assessment scores across the 26 papers (35 case reports) were as follows: low quality (0), lower-medium quality (9), upper-medium quality (10) and high quality (7). Putative pathophysiological mechanisms were postulated for nine of the 11 herbal medicines and centered on HPA-axis activation and increased monoamine activity. Systematic study of the association between herbal medicines and the course of bipolar disorder may contribute to defining targets for pathophysiological research.
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Affiliation(s)
| | - Kenneth Kirkby
- Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Michael Garry
- Psychology, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Taylor
- Neurology, Menzies Institute for Medical Research, Hobart, TAS, Australia
| | - Jason A Hawrelak
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia.,Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, Australia
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Abstract
UNLABELLED Evaluation of pain perception in chronic pain patients with a concomitant mood-spectrum disorder. DESIGN The observational retrospective study is based on patient data collected in psychosomatic consultations held at the Gift Institute for Integrative Medicine in Pisa, Italy, from 2002 to 2014. Evoked pain stimulus threshold and tolerance were evaluated using the cold pressor test. Clinical pain intensity and Sensorial, Affective, and Evaluative dimensions were assessed using the Italian Pain Questionnaire, and Anxiety and Depressive symptoms using the Hospital Anxiety Depression Scale. Mood-spectrum disorders were diagnosed via the Mini-International Neuropsychiatric Interview, and affective temperament in accordance with Akiskal and Pinto's criteria (1999). Of a total of 627 chronic pain clinic patients, 381 were diagnosed with a concomitant mood-spectrum (MS) disorder, unipolar (US) in 61.41%. Pain threshold (t = 2.28; p < 0.05) was lower, and all clinical pain dimensions (t = 2.28; p < 0.05) increased, in MS patients compared to those without psychiatric disorders. Pain intensity (F = 3.5, p < 0.05) and cognitive pain component scores (F = 7.84; p < 0.0001) were higher in US and, to a lesser extent Bipolar Spectrum, than in subjects with other (n.112) or no psychiatric disorders (n. 134). Suicide ideation was highest in US (F = 37.20; p < 0.0001), although in BS major depressive episodes had more melancholic features (F = 46.73; P < 0.0001), and a longer history of psychiatric disorders before the pain onset than US (F = 20.31; p < 0.0001). Pain management should take into account pre-existing psychiatric disorders.
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Affiliation(s)
- Antonella Ciaramella
- Aplysia onlus, GIFT Institute for Integrative Medicine, p.za Cairoli 12, 56127, Pisa, Italy. .,Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Pisa, Italy. .,Psychosomatics consultation office, GIFT Institute for Integrative Medicine, via Mezzanina, 12, 56100, Pisa, Italy.
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What Have We Learned From the Agonist Opioid Treatment of Dual Disorder Heroin Addicts? ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Subramanian K, Sarkar S, Kattimani S. Bipolar disorder in Asia: Illness course and contributing factors. Asian J Psychiatr 2017; 29:16-29. [PMID: 29061417 DOI: 10.1016/j.ajp.2017.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/15/2017] [Accepted: 04/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Epidemiological studies analysing the course of Bipolar Disorder (BD) are relatively rare in the Asian context, contributing to the uncertainty regarding the prevalent course patterns and factors influencing such patterns. The current review identifies the regional characteristics of BD course patterns and the associated factors. METHODS A review of the existing literature was done using 'PubMed' and 'Cochrane' databases which yielded 145 studies including those from all 48 Asian countries. Relevant discussions from the Western literature were incorporated. RESULTS Regional and cross-national studies reveal a mania-predominant course in BD in Asian countries. Prolonged depressive episodes and comorbid anxiety disorders worsen the course of BD-II. Certain risk factors such as the young age of onset and greater episode frequency are useful predictors of bipolar diatheses. Substance use disorder comorbidity is more prevalent in males whereas depression and suicidal behaviours are more frequent in females with BD. Comorbid anxiety and personality disorders also encumber the illness course. Logistic reasons and ignorance of side-effects were specifically associated with poor adherence. An 'eveningness' chronotype and poor sleep quality were associated with frequent recurrences. Seasonal patterns vary among men and women, especially for depressive episodes. LIMITATIONS The effects of treatment and childhood BD course features were not discussed. CONCLUSIONS There are region-specific characteristics in bipolar illness course and factors influencing such course patterns compared to the rest of the World. Future research from Asia shall attempt to study the neurobiological underpinnings of such characteristics and plan appropriate strategies to address the same.
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Affiliation(s)
- Karthick Subramanian
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
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Yazici E, Yürümez E, Yazici AB, Gümüş YY, Erol A. Affective Temperaments in Parents of Children with Attention Deficit Hyperactivity Disorder. Noro Psikiyatr Ars 2017; 54:149-154. [PMID: 28680313 DOI: 10.5152/npa.2016.12693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/22/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of this study was to investigate affective temperaments of parents of children with ADHD and the relationship between ADHD and affective temperaments. METHODS The children diagnosed with ADHD were evaluated with a structured interview and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was filled by parents. Then parents were evaluated by a structured clinical interview for DSM-IV (SCID-I), and those with no diagnosis of psychiatric disorder (in the past and at the time of the study) were included to the study. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire was used to evaluate affective temperaments of parents. A control group of parents who has no children with ADHD was applied the same evaluation protocol. RESULTS The study was conducted with 123 parents (66 mothers, 57 fathers) of 66 children with ADHD and 119 control parents (65 mothers, 54 fathers) of 71 children without ADHD. Affective temperament scores of parents of children with ADHD were significantly higher than those of the control group. When the scores of mothers and fathers were compared separately, mothers had higher scores in all temperaments except hyperthymic temperament, and fathers had higher scores in all temperaments except anxious temperament in the ADHD group. Additionally, the T-DSM-IV-S attention deficit and hyperactivity/impulsivity scores of children were moderately correlated with most of the affective temperaments scores of their parents. CONCLUSION There is a relationship between ADHD and affective temperaments. Further studies are needed to understand the etiology, strength, and nature of this relationship.
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Affiliation(s)
- Esra Yazici
- Department of Psychiatry, Sakarya University School of Medicine, Sakarya, Turkey
| | - Esra Yürümez
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ufuk University School of Medicine, Ankara, Turkey
| | - Ahmet Bülent Yazici
- Department of Psychiatry, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Yusuf Yasin Gümüş
- Department of Psychiatry, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Atila Erol
- Department of Psychiatry, Sakarya University School of Medicine, Sakarya, Turkey
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Mokros Ł, Witusik A, Michalska J, Łężak W, Panek M, Nowakowska-Domagała K, Antczak A, Pietras T. Sleep quality, chronotype, temperament and bipolar features as predictors of depressive symptoms among medical students. Chronobiol Int 2017; 34:708-720. [PMID: 28488895 DOI: 10.1080/07420528.2017.1316730] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The assessment of risk factors is a crucial step in the prevention and treatment of affective disorders and should encompass personal dispositions. The aim of this study was to assess the value of chronotype and temperament as independent predictors of depressive symptoms among medical students. The study surveyed 140 students of the Faculty of Medicine with a battery of questionnaires: the Beck Depression Index (BDI), Hypomania Checklist 32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), Chronotype Questionnaire and Eysenck Personality Questionnaire Revised. The results were tested using Pearson's correlation quotient and general linear model. Ten percent of the participants demonstrated a BDI score suggestive of clinically significant depressive symptoms. BDI score correlated positively with HCL-32 score. A rise in BDI was independently predicted by elevated Neuroticism and PSQI scores and morningness. Those effects were independent from each other and from other parameters of the model. The presence of depressive symptoms might be associated with bipolar features among medical students. Poor sleep quality predicted depressive symptoms, similarly to Neuroticism and independently of temperament and chronotype. Future studies on the associations between personal dispositions and mood disorders among medical students are required to help identify those at greater risk of developing affective illness. Effective prophylaxis and early intervention are warranted to ensure better treatment results.
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Affiliation(s)
- Łukasz Mokros
- a Department of Clinical Pharmacology , Medical University of Lodz , Lodz , Poland
| | - Andrzej Witusik
- b Department of Psychology , Faculty of Social Sciences, Piotrkow Trybunalski Division, Jan Kochanowski Memorial University of Humanities and Sciences , Piotrkow Trybunalski , Poland
| | - Julia Michalska
- c Clinical Pharmacology Students Scientific Circle, Department of Clinical Pharmacology , Medical University of Lodz , Lodz , Poland
| | - Wojciech Łężak
- d Department of Pharmacology and Toxicology , Medical University of Lodz , Lodz , Poland
| | - Michał Panek
- e Department of Internal Medicine , Asthma and Allergy, Medical University of Lodz , Lodz , Poland
| | - Katarzyna Nowakowska-Domagała
- f Department of Cognitive Science, Institute of Psychology , Faculty of Educational Sciences, University of Lodz , Lodz , Poland
| | - Adam Antczak
- g Department of General and Oncological Pulmonology , Medical University of Lodz , Lodz , Poland
| | - Tadeusz Pietras
- a Department of Clinical Pharmacology , Medical University of Lodz , Lodz , Poland
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Elias LR, Köhler CA, Stubbs B, Maciel BR, Cavalcante LM, Vale AMO, Gonda X, Quevedo J, Hyphantis TN, Soares JC, Vieta E, Carvalho AF. Measuring affective temperaments: a systematic review of validation studies of the Temperament Evaluation in Memphis Pisa and San Diego (TEMPS) instruments. J Affect Disord 2017; 212:25-37. [PMID: 28135688 DOI: 10.1016/j.jad.2017.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/18/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The assessment of affective temperaments has provided useful insights for the psychopathological understanding of affective disorders and for the conceptualization of bipolar spectrum disorders. The Temperament in Memphis Pisa and San Diego (TEMPS) instrument has been widely used in research, yet its psychometric properties and optimal factor structure are unclear. METHODS The PubMed/MEDLINE, PsycINFO, and EMBASE electronic databases were searched from inception until March 15th, 2016. Validation peer-reviewed studies of different versions of the TEMPS performed in adult samples were considered for inclusion. RESULTS Twenty-seven studies (N=20,787) met inclusion criteria. Several versions of the TEMPS have been validated in 14 languages across 15 countries. The 110-item self-reported version of the TEMPS has been the most studied version. Most studies (50%) supported a five factor solution although few studies performed confirmatory factor analyses. A five-factor solution has consistently been reported for the 39-item version of the TEMPS-A. Overall, evidence indicates that different versions of the TEMPS have adequate internal consistency reliability, while the TEMPS-A-110 version has acceptable test-retest reliability. The methodological quality of included studies varied. LIMITATIONS A meta-analysis could not be performed due to the heterogeneity of settings and versions of the TEMPS utilized. CONCLUSIONS Different versions of the TEMPS have been validated across different cultures. The short 39-item version of the TEMPS-A holds promise and merits further investigation. Culture-bound factors may influence the expression and/or assessment of affective temperaments with the TEMPS.
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Affiliation(s)
- Liana R Elias
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Cristiano A Köhler
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; Faculty of Health, Social care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom
| | - Beatriz R Maciel
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lígia M Cavalcante
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Antonio M O Vale
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Xénia Gonda
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary; Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary
| | - João Quevedo
- Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC 88806-000, Brazil; Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas N Hyphantis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eduard Vieta
- Bipolar Disorders Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - André F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Institute for Clinical Research and Education in Medicine, I.R.E.M., Padova, Italy.
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Fountoulakis KN, Young A, Yatham L, Grunze H, Vieta E, Blier P, Moeller HJ, Kasper S. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. Int J Neuropsychopharmacol 2017; 20:98-120. [PMID: 27815414 PMCID: PMC5408969 DOI: 10.1093/ijnp/pyw091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/20/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. METHODS The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. RESULTS The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. CONCLUSION The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
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Itagaki K, Takebayashi M, Shibasaki C, Kajitani N, Abe H, Okada-Tsuchioka M, Yamawaki S. Factors associated with relapse after a response to electroconvulsive therapy in unipolar versus bipolar depression. J Affect Disord 2017; 208:113-119. [PMID: 27764738 DOI: 10.1016/j.jad.2016.08.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND While electroconvulsive therapy (ECT) treatment for depression is highly effective, the high rate of relapse is a critical problem. The current study investigated factors associated with the risk of relapse in mood disorders in patients in which ECT was initially effective. METHOD The records of 100 patients with mood disorders (61 unipolar depression, 39 bipolar depression) who received and responded to an acute ECT course were retrospectively reviewed. Associations between clinical variables and relapse after responding to acute ECT were analyzed. The Ethics Committee of NHO Kure Medical Center approved the study protocol. RESULTS After one year, the percentage of relapse-free patients was 48.7%. There was no significant difference between patients with either unipolar or bipolar depression who were relapse-free (unipolar: 51.1%, bipolar: 45.5%, P=0.603). Valproate maintenance pharmacotherapy in unipolar depression patients was associated with a lower risk of relapse compared to patients without valproate treatment (multivariate analysis, hazard ratio: 0.091; P=0.022). Lithium treatment, reportedly effective for unipolar depression following a course of ECT, tended to lower the risk of relapse (hazard ratio: 0.378; P=0.060). For bipolar depression, no treatment significantly reduced the risk of relapse. LIMITATIONS The current findings were retrospective and based on a limited sample size. CONCLUSIONS The relapse-free rate was similar between unipolar and bipolar depression. Valproate could have potential for unipolar depression patients as a maintenance therapeutic in preventing relapse after ECT.
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Affiliation(s)
- Kei Itagaki
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama, Kure, Hiroshima 737-0023, Japan; Department of Psychiatry, NHO Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan; Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-0037 Japan
| | - Minoru Takebayashi
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama, Kure, Hiroshima 737-0023, Japan; Department of Psychiatry, NHO Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan.
| | - Chiyo Shibasaki
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama, Kure, Hiroshima 737-0023, Japan; Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-0037 Japan
| | - Naoto Kajitani
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama, Kure, Hiroshima 737-0023, Japan
| | - Hiromi Abe
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama, Kure, Hiroshima 737-0023, Japan
| | - Mami Okada-Tsuchioka
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama, Kure, Hiroshima 737-0023, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-0037 Japan.
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Dehning J, Grunze H, Hausmann A. Bupropion Maintenance Treatment in Refractory Bipolar Depression: A Case Report. Clin Pract Epidemiol Ment Health 2017; 13:43-48. [PMID: 28659991 PMCID: PMC5470062 DOI: 10.2174/1745017901713010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The optimal duration of antidepressant treatment in bipolar depression appears to be controversial due to a lack of quality evidence, and guideline recommendations are either vague or contradictive. This is especially true for second line treatments such as bupropion that had not been subject to rigourous long term studies in Bipolar Disorder. CASE PRESENTATION We report the case of a 75 year old woman who presented with treatment refractory bipolar depression. Because of insufficient response to previous mood stabilizer treatment and refractory depressive symptoms, bupropion was added to venlafaxine and lamotrigine. From there onwards, the patient improved continuously without experiencing deterioration of depression or a switch into hypomania. Our patient being on antidepressants for allmost four years experienced an obvious benefit from longterm antidepressant administration. CONCLUSION Noradrenergic/dopaminergic mechanisms of action may play a more prominent role in bipolar depression, and may still be underused as a therapeutic strategy in the acute phase as well as in long-term maintenance in at least a subgroup of bipolar patients. There is still a lack of evidence from RCTs, but this case report further supports antidepressant long-term continuation and the usefulness of a noradrenergic/dopaminergic antidepressant in the acute and maintenance treatment of bipolar disorder.
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Affiliation(s)
- Julia Dehning
- Department of Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Heinz Grunze
- Department of Medicine, Medical University - Psychiatry, Innsbruck, Austria
- Address correspondence to this author at the Department of Medicine, Paracelsus Medical University, Salzburg, Austria; Tel: +49-7250-60592; Fax: +49-7250-60516; E-mail:
| | - Armand Hausmann
- Department of Medicine, Paracelsus Medical University, Salzburg, Austria
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Kustov GV, Akzhigitov RG, Lebedeva AV, Pochigayeva KI, Guekht AB. Interictal dysphoric disorder: a current state of the problem. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:39-43. [DOI: 10.17116/jnevro20171179239-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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71
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Leung CM, Ungvari GS, Xiang YT. Conceptual issues behind the Chinese translations of the term 'Bipolar Disorder'. Asia Pac Psychiatry 2016; 8:256-259. [PMID: 27557337 DOI: 10.1111/appy.12253] [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: 10/16/2015] [Accepted: 07/12/2016] [Indexed: 11/29/2022]
Abstract
The paper examines the problems of the existing nomenclature in Chinese psychiatry with special reference to the Chinese translation of bipolar disorder in the context of stigma of mental illness in the Chinese culture. The development of the concept of bipolar disorder is reviewed, followed by a critical examination of the accuracy and validity of the current translation of bipolar disorder in the Chinese psychiatric literature. A new translation is suggested with consideration for literal accuracy and social acceptance.
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Affiliation(s)
- Chi-Ming Leung
- Department of Psychiatry, Shatin Hospital, Hong Kong, SAR, China.
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia.,School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Câmara RA, Köhler CA, Maes M, Nunes-Neto PR, Brunoni AR, Quevedo J, Fernandes BS, Perugi G, Hyphantis TN, Carvalho AF. Affective temperaments and emotional traits are associated with a positive screening for premenstrual dysphoric disorder. Compr Psychiatry 2016; 71:33-38. [PMID: 27607359 DOI: 10.1016/j.comppsych.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/04/2016] [Accepted: 08/15/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Preliminary evidence indicates that premenstrual dysphoric disorder (PMDD) may be frequently co-morbid with bipolar spectrum disorders. In addition, the manifestations of PMDD seem similar to a subthreshold depressive mixed state. Nevertheless, the associations between PMDD and affective temperaments and emotional traits have not been previously investigated. METHODS A consecutive sample of 514 drug-free Brazilian women (mean age: 22.8; SD=5.4years) took part in this cross-sectional study. Screening for PMDD was obtained with the validated Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST). Affective temperaments and emotional dimensions were evaluated with the Affective and Emotional Composite Temperament Scale (AFECTS). In addition, socio-demographic and data on menstrual cycle were collected. RESULTS According to the PSST, 83 (16.1%) women screened positive for PMDD, while 216 (42.0%) women had no/mild premenstrual symptoms. The cyclothymic temperament was independently associated with PMDD (OR=4.57; 95% CI: 2.11-9.90), while the euthymic temperament had an independent association with a lower likelihood of a positive screening for PMDD (OR=0.28; 95% CI: 0.12-0.64). In addition, anger and sensitivity emerged as emotional dimensions significantly associated with PMDD. CONCLUSIONS A positive screening for PMDD was associated with a predominant cyclothymic temperament, while an euthymic temperament was associated with a lower likelihood for a positive screening for PMDD. These data deserve replication in prospective studies.
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Affiliation(s)
- Rachel A Câmara
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Faculty of Medicine, State University of Londrina, Londrina, Brazil; Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands
| | - Paulo R Nunes-Neto
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - André R Brunoni
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, São Paulo, Brazil; Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - João Quevedo
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil; Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, USA
| | - Brisa S Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy; Institute of Behavioral Sciences "G. De Lisio", Pisa, Italy
| | - Thomas N Hyphantis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
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Edgcomb JB, Tseng CH, Kerner B. Medically unexplained somatic symptoms and bipolar spectrum disorders: A systematic review and meta-analysis. J Affect Disord 2016; 204:205-13. [PMID: 27371906 DOI: 10.1016/j.jad.2016.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/11/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with bipolar spectrum disorders (BSD) frequently report medically unexplained somatic symptoms. However, the prevalence and the consequences for treatment and outcome are currently unknown. METHODS To estimate the prevalence of somatic symptoms in BSD, we conducted a systematic review and meta-analysis of empirical studies published between 1980 and 2015. The odds for somatic symptoms in BSD were compared with unipolar depression (UPD) and general population or mixed psychiatric controls. Studies were retrieved from four electronic databases utilizing Boolean operations and reference list searches. Pooled data estimates were derived using random-effects methods. RESULTS Out of 2634 studies, 23 were eligible for inclusion, yielding an N of 106,785 patients. The estimated prevalence of somatic symptoms in BSD was 47.8%. The estimated prevalence of BSD in persons with somatic symptoms was 1.4%. Persons with BSD had a higher prevalence of somatic symptoms compared with population or mixed psychiatric controls (OR 1.82, 95% CI 1.14-2.92). Persons with BSD had a similar prevalence of somatic symptoms compared with UPD controls (OR 0.99, 95% CI 0.68-1.44). LIMITATIONS This study is correlational; thus causal inferences cannot be made. Reporting of somatic symptoms likely varies with BSD severity and subtype. Some studies reported insufficient information regarding comorbid medical conditions and medications. CONCLUSIONS Persons with BSD suffer from somatic symptoms at a rate nearly double that of the general population, a rate similar to persons with UPD. Our results suggest the utility of an integrated care model in which primary care and specialist physicians collaborate with mental health professionals to jointly address psychological and bodily symptoms.
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Affiliation(s)
- Juliet Beni Edgcomb
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Berit Kerner
- Berit Kerner, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Witten/Herdecke University, Witten, Germany.
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Bobrov AE, Starostina EG, Alexandrova MM. [Mental disorders in patients with acromegaly]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:18-23. [PMID: 27735894 DOI: 10.17116/jnevro20161169118-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study mental disorders in acromegaly due to somatotropinoma. MATERIAL AND METHODS The study included 115 consecutively recruited patients with acromegaly (95 female and 20 male, aged from 21 to 78 years). Acromegaly was diagnosed by endocrinologists according to current guidelines based on clinical, laboratory data and brain MRI. All patients underwent a clinical psychiatric interview based on ICD-10 criteria. The Mini-Mental State Examination scale and Hypomania-Checklist (HCL-32) were used. RESULTS Mental disorders were diagnosed in 79.1% of patients. Organic spectrum disorders were found in 46.1%, bipolar spectrum disorders in 35.7%, schizophrenia spectrum disorders in 4.3%. The patients with bipolar spectrum disorders had significantly lower serum insulin-like growth factor 1 (IGF-1) levels compared to patients with organic spectrum disorders (p=0.01). The presence of organic spectrum disorders was associated with older age and number of somatic comorbidities (р=0.0001 and 0.001). CONCLUSION The prevalence of bipolar, organic and schizophrenia spectrum disorders in patients with acromegaly exceeds that in the general population. Significantly lower IGF-1 levels in acromegalic patients with bipolar disorders, compared to those with organic disorders, can have some implications to their pathogenesis.
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Affiliation(s)
- A E Bobrov
- Pirogov Russian National Research University, Moscow, Russia, Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - E G Starostina
- Pirogov Russian National Research University, Moscow, Russia, Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - M M Alexandrova
- Pirogov Russian National Research University, Moscow, Russia, Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
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75
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Mason BL, Brown ES, Croarkin PE. Historical Underpinnings of Bipolar Disorder Diagnostic Criteria. Behav Sci (Basel) 2016; 6:bs6030014. [PMID: 27429010 PMCID: PMC5039514 DOI: 10.3390/bs6030014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/24/2016] [Accepted: 07/06/2016] [Indexed: 12/16/2022] Open
Abstract
Mood is the changing expression of emotion and can be described as a spectrum. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been documented repeatedly in human history, being first systematically described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was accepted before the end of the 19th century. Kraepelin then described “manic depressive insanity” and presented his description of a full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder. Criticism of this approach is explored through discussion of the bipolar spectrum concept and some recent examinations of the clinical validity of these DSM diagnoses are presented. The concept of bipolar disorder in children is also explored.
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Affiliation(s)
- Brittany L Mason
- Department of Psychiatry, University of Texas Southwestern Medical Center; Dallas, TX 75390, USA.
| | - E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center; Dallas, TX 75390, USA.
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55901, USA.
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76
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Ioannou M, Dellepiane M, Benvenuti A, Feloukatzis K, Skondra N, Dell'Osso L, Steingrímsson S. Swedish Version of Mood Spectrum Self-Report Questionnaire: Psychometric Properties of Lifetime and Last-week Version. Clin Pract Epidemiol Ment Health 2016; 12:14-23. [PMID: 27346997 PMCID: PMC4894833 DOI: 10.2174/1745017901612010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mood Spectrum Self Report (MOODS-SR) is an instrument that assesses mood spectrum symptomatology including subthreshold manifestations and temperamental features. There are different versions of the MOODS-SR for different time frames of symptom assessment: lifetime (MOODS-LT), last-month and last-week (MOODS-LW) versions. OBJECTIVE To evaluate the psychometric properties of the MOODS-LT the MOODS-LW. METHODS The reliability of the MOODS-LT and MOODS-LW was evaluated in terms of internal consistency and partial correlations among domains and subdomains. The known-group validity was tested by comparing out-patients with bipolar disorder (n=27), unipolar depression (n=8) healthy controls (n=68). The convergent and divergent validity of MOODS-LW were evaluated using the Montgomery Åsberg Depression Rating Scale (MADRS), the Young-Ziegler Mania Rating Scale (YMRS) in outpatients as well the General Health Questionnaire (GHQ-12) in healthy controls. RESULTS Both MOODS-LT and MOOODS-LW showed high internal consistency with the Kuder-Richardson coefficient ranging from 0.823 to 0.985 as well as consistent correlations for all domains and subdomains. The last-week version correlated significantly with MADRS (r= 0.79) and YMRS (r=0.46) in outpatients and with GHQ-12 (r= 0.50 for depression domain, r= 0.29 for rhythmicity) in healthy controls. CONCLUSION The Swedish version of the MOODS-LT showed similar psychometric properties to other translated versions. Regarding MOODS-LW, this first published psychometric evaluation of the scale showed promising psychometric properties including good correlation to established symptom assessment scales. In healthy controls, the depression and rhythmicity domain scores of the last-week version correlated significantly with the occurrence of mild psychological distress.
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Affiliation(s)
- Michael Ioannou
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marzia Dellepiane
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Antonella Benvenuti
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Nektaria Skondra
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Liliana Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Steinn Steingrímsson
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden; Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
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77
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Chang TT, Chen SL, Chang YH, Chen PS, Chu CH, Chen SH, Huang SY, Tzeng NS, Wang LJ, Wang TY, Li CL, Chung YL, Hsieh TH, Lee IH, Chen KC, Yang YK, Hong JS, Lu RB, Lee SY. The DRD3 Ser9Gly Polymorphism Predicted Metabolic Change in Drug-Naive Patients With Bipolar II Disorder. Medicine (Baltimore) 2016; 95:e3488. [PMID: 27310943 PMCID: PMC4998429 DOI: 10.1097/md.0000000000003488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with bipolar II disorder (BDII) have a higher prevalence rate of metabolic disturbance. Whether BDII itself, in addition to its current standard treatment, is a risk factor for metabolic syndrome warrants additional study. The dopamine receptor D3 (DRD3) gene, one of the candidate genes for BDII, is also involved in the dopaminergic system. We investigated whether it is related to changes in the metabolic indices of patients with BDII given 12 weeks of standard treatment.Patients with a first diagnosis of BDII (n = 117) were recruited. Metabolic profiles (cholesterol, triglycerides, fasting serum glucose, body mass index) were measured at baseline and at 2, 8, and 12 weeks. The genotype of the DRD3 Ser9Gly polymorphism (rs6280) was determined. Multiple linear regressions with generalized estimating equation methods were used.Seventy-six (65.0%) patients completed the 12-week intervention. Significant differences in triglyceride change were associated with the DRD3 Ser9Gly genotype (P = 0.03). Patients with the Ser/Ser genotype had significantly smaller triglyceride increases and a lower risk of developing metabolic syndrome than did those with the Ser/Gly+Gly/Gly genotype. However, the associations between the DRD3 Ser9Gly polymorphism with changes in triglyceride level become nonsignificant after correcting for multiple comparisons.We conclude that the DRD3 Ser9Gly polymorphism is nominally associated with changes in triglycerides and metabolic syndrome after 12 weeks of standard BDII treatment.
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Affiliation(s)
- Ting-Ting Chang
- From the Department of Psychiatry, E-Da Hospital, I-Shou University (T-TC); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University (KMU), Lipid Science and Aging Research Center, KMU, Kaohsiung (S-LC); Department of Psychiatry, National Cheng Kung University Hospital, Tainan (S-LC, Y-HC, P-SC, T-YW, C-LL, Y-LC, T-HH, I-HL, K-CC, Y-KY, R-BL, S-YL); Department of Psychology, Asia University, Taichung (Y-HC); Institute of Allied Health, College of Medicine (Y-HC, R-BL); Department of Psychiatry, College of Medicine (P-SC, T-YW, I-HL, K-CC, Y-KY, R-BL, S-YL); Addiction Research Center (P-SC, R-BL); Institute of Molecular Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C-HC); Neurobiology Laboratory, NIH/NIEHS, Research Triangle Park, North Carolina (S-HC, J-SH); Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (S-YH, N-ST); Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung (L-JW); Institute of Basic Medical Sciences, National Cheng Kung University, Tainan (Y-LC); Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin (Y-KY); Institute of Behavioral Medicine Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan (R-BL); Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan (R-BL); Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (S-YL)
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78
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Takeshima M, Oka T. Comparative analysis of affective temperament in patients with difficult-to-treat and easy-to-treat major depression and bipolar disorder: Possible application in clinical settings. Compr Psychiatry 2016; 66:71-8. [PMID: 26995239 DOI: 10.1016/j.comppsych.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/18/2015] [Accepted: 01/08/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Difficult-to-treat major depressive disorder (MDD-DT), which involves antidepressant refractoriness or antidepressant-related adverse psychiatric effects, is bipolar in nature; therefore, it may share common temperamental features with bipolar disorder. To examine this hypothesis, affective temperament was compared between MDD-DT, easy-to-treat major depressive disorder (MDD-ET), and bipolar disorder. METHODS Affective temperament was measured in 320 patients (69, 56, and 195 with MDD-ET, MDD-DT, and bipolar disorder, respectively) using the self-rated questionnaire version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), with between-group differences examined using multiple logistic regression analysis controlling for confounders. Optimal cut-off points for TEMPS-A scores to discriminate between diagnostic groups were determined using receiver-operating characteristic analysis. RESULTS Of the five temperamental domains, the mode for cyclothymic temperament score was highest, followed by those of bipolar disorder, MDD-DT, and MDD-ET. The cyclothymic temperament score discriminated significantly between bipolar disorder and MDD-DT (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.20, p=0.0022), MDD-DT and MDD-ET (OR: 1.15, 95% CI: 1.01-1.31, p=0.0334), and bipolar and major depressive disorders (OR: 1.17, 95% CI: 1.07-1.28, p=0.0003). Optimal cut-off points for the cyclothymic temperament scores to discriminate between bipolar disorder and major depressive disorder and MDD-DT and MDD-ET were 9 (sensitivity: 64.6%, specificity: 76.0%) and 6 (66.1%, 62.3%), respectively. CONCLUSIONS MDD-DT has a quantitatively stronger bipolar temperamental feature, cyclothymic temperament, relative to that of MDD-ET. Cut-off points determined in this study could be clinically helpful. Because of our study design, longitudinal changes in temperamental scores during treatment cannot be fully excluded.
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Affiliation(s)
- Minoru Takeshima
- J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan; Department of Psychiatry, Kouseiren Takaoka Hospital, 5-10 Eiraku-cyou, Takaoka City, 933-8555, Japan.
| | - Takashi Oka
- J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan.
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79
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Chen PS, Chang HH, Huang CC, Lee CC, Lee SY, Chen SL, Huang SY, Yang YK, Lu RB. A longitudinal study of the association between the GNB3 C825T polymorphism and metabolic disturbance in bipolar II patients treated with valproate. THE PHARMACOGENOMICS JOURNAL 2016; 17:155-161. [PMID: 26856249 DOI: 10.1038/tpj.2015.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
This longitudinal study aimed to investigate the associations between the polymorphisms of guanine nucleotide-binding protein subunit β-3 (GNB3) C825T and metabolic disturbance in bipolar II disorder (BP-II) patients being treated with valproate (VPA). A 100 BP-II patients received a 12-week course of VPA treatment, and their body weight and metabolic indices were measured. At baseline, the GNB3 C825T polymorphisms were associated with the triglyceride level (P=0.032) in BP-II patients. During the VPA treatment course, the polymorphisms were not only associated with body mass index (BMI) and waist circumference (P-values=0.009 and 0.001, respectively), but also with total cholesterol, triglyceride, low-density lipoprotein and leptin levels (P-values=0.004, 0.002, 0.031 and 0.015, respectively). Patients with the TT genotype had a lower BMI, smaller waist circumference, and lower levels of lipids and leptin than those with the CT or CC genotypes undergoing the VPA treatment course.
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Affiliation(s)
- P S Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - H H Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C-C Huang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C C Lee
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - S-L Chen
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - S-Y Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Y K Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - R-B Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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80
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Nakato Y, Inoue T, Nakagawa S, Kitaichi Y, Kameyama R, Wakatsuki Y, Kitagawa K, Omiya Y, Kusumi I. Confirmation of the factorial structure of the Japanese short version of the TEMPS-A in psychiatric patients and general adults. Neuropsychiatr Dis Treat 2016; 12:2173-9. [PMID: 27601911 PMCID: PMC5003593 DOI: 10.2147/ndt.s97796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) is a 110-item questionnaire that assesses five affective temperaments. However, a valid shortened version is desired for large-scale investigations to enhance the compliance of respondents. METHODS A confirmatory factor analysis was conducted among 320 psychiatric patients and 61 general adults. The participants completed the Japanese 39-item short version of the TEMPS-A, and a portion of the participants completed the 110-item version. An exploratory factor analysis with the principal factor method and varimax rotation was conducted to identify a more suitable model of the short version of the TEMPS-A. RESULTS The confirmatory factor analysis revealed that the 39-item version exhibited a poor model fit. However, we found that the 18-item version exhibited a firm five-factor structure based on the exploratory factor analysis, and this model exhibited an acceptable model fit. It had good or acceptable internal consistency (Cronbach's αs: 0.672-0.819). LIMITATIONS The majority of the subjects in the present study were patients, and the temperament data may have been affected by psychiatric symptoms. CONCLUSION A firm five-factor structure was not found in the 39-item short version of the Japanese TEMPS-A. Therefore, an 18-item version was proposed. This new 18-item version of the TEMPS-A might be useful for clinical applications and large-scale investigations.
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Affiliation(s)
- Yasuya Nakato
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Takeshi Inoue
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo; Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Shin Nakagawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Yuji Kitaichi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Rie Kameyama
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Yumi Wakatsuki
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Kan Kitagawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Yuki Omiya
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo
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81
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Abstract
Bipolar disorder constitutes a challenge for clinicians in everyday clinical practice. Our knowledge concerning this clinical entity is incomplete, and contemporary classification systems are unable to reflect the complexity of this disorder. The concept of temperament, which was first described in antiquity, provides a helpful framework for synthesizing our knowledge on how the human body works and what determines human behavior. Although the concept of temperament originally included philosophical and sociocultural approaches, the biomedical model is dominant today. It is possible that specific temperaments might constitute vulnerability factors, determine the clinical picture, or modify the course of illness. Temperaments might even act as a bridge between genes and clinical manifestations, thus giving rise to the concept of the bipolar spectrum, with major implications for mental health research and treatment. More specifically, it has been reported that the hyperthymic and the depressive temperaments are related to the more "classic" bipolar disorder, whereas cyclothymic, anxious, and irritable temperaments are related to more complex manifestations and might predict poor response to treatment, violent or suicidal behavior, and high comorbidity. Incorporating of the concept of temperament and the bipolar spectrum into the standard training of psychiatric residents might well result in an improvement of everyday clinical practice.
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82
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Late onset mania as an organic syndrome: A review of case reports in the literature. J Affect Disord 2015; 188:226-31. [PMID: 26368947 DOI: 10.1016/j.jad.2015.08.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/07/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
AIMS Although First Episode Mania presenting over the age of 50 is reported in several cases, there has been little systematic compilation of these case reports. We report a review of case reports on these subjects. METHODS We undertook a literature search on MEDLINE, PsychInfo and EMBASE to identify case reports of first episode of mania or hypomania presenting over the age of 50. RESULTS 35 cases were identified. 29/35 (82%) had a suspected underlying organic cause. Organic causes included vascular causes, iatrogenic drug use, electrolyte imbalance, dementia and thyroid disease. Vascular risk factors were present in 17/35 cases (48%). In 10/35 (28%) of cases organic treatment contributed to successful remission of the manic episode. LIMITATIONS As evidently not all cases have been reported the main limitation is that of publication bias for this paper. Any such hypothesis generated from studying these cases would require replication in prospective longitudinal trials of this cohort of patients. CONCLUSIONS This review of case reports appears to add to evidence of late onset mania having an organic basis. Whether this is a separate organic syndrome remains to be established. Our provisional findings suggest that such patients should have a thorough medical and psychiatric screening in identifying an underlying cause.
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83
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The bipolarity of light and dark: A review on Bipolar Disorder and circadian cycles. J Affect Disord 2015; 185:219-29. [PMID: 26241867 DOI: 10.1016/j.jad.2015.07.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bipolar Disorder is characterized by episodes running the full mood spectrum, from mania to depression. Between mood episodes, residual symptoms remain, as sleep alterations, circadian cycle disturbances, emotional deregulation, cognitive impairment and increased risk for comorbidities. The present review intends to reflect about the most recent and relevant information concerning the biunivocal relation between bipolar disorder and circadian cycles. METHODS It was conducted a literature search on PubMed database using the search terms "bipolar", "circadian", "melatonin", "cortisol", "body temperature", "Clock gene", "Bmal1 gene", "Per gene", "Cry gene", "GSK3β", "chronotype", "light therapy", "dark therapy", "sleep deprivation", "lithum" and "agomelatine". Search results were manually reviewed, and pertinent studies were selected for inclusion as appropriate. RESULTS Several studies support the relationship between bipolar disorder and circadian cycles, discussing alterations in melatonin, body temperature and cortisol rhythms; disruption of sleep/wake cycle; variations of clock genes; and chronotype. Some therapeutics for bipolar disorder directed to the circadian cycles disturbances are also discussed, including lithium carbonate, agomelatine, light therapy, dark therapy, sleep deprivation and interpersonal and social rhythm therapy. LIMITATIONS This review provides a summary of an extensive research for the relevant literature on this theme, not a patient-wise meta-analysis. CONCLUSIONS In the future, it is essential to achieve a better understanding of the relation between bipolar disorder and the circadian system. It is required to establish new treatment protocols, combining psychotherapy, therapies targeting the circadian rhythms and the latest drugs, in order to reduce the risk of relapse and improve affective behaviour.
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84
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Łojko D, Buzuk G, Owecki M, Ruchała M, Rybakowski JK. Atypical features in depression: Association with obesity and bipolar disorder. J Affect Disord 2015; 185:76-80. [PMID: 26148463 DOI: 10.1016/j.jad.2015.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/11/2015] [Accepted: 06/14/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Depression with atypical features amounts to a significant proportion of depressed patients. Studies have shown its association with bipolarity and, recently, with obesity. In this study, we investigated atypical features of depression in relation to overweight/obesity in three diagnostic categories: unipolar depression, bipolar depression and dysthymia. METHODS Out of 512 depressed patients screened, we recruited 182 research subjects, consisting of 91 pairs, matched by age, gender and diagnosis, in which one member of the pair was within the normal weight range (BMI≤25) and the other was either overweight or obese (BMI>25). There were 35 pairs with unipolar depression, 27 with bipolar depression and 29 with dysthymia. Symptoms of atypical depression, such as increased appetite, hypersomnia, leaden paralysis, longstanding pattern of interpersonal rejection sensitivity, and, a significant weight gain in the past 3 months, were assessed. RESULTS All the symptoms of atypical depression were significantly more pronounced in those depressed patients with a BMI>25, compared with depressed subjects with a normal weight. Except for hypersomnia, these symptoms scored significantly higher in women compared to men. Among the diagnostic categories, symptoms of atypical depression were significantly higher in patients with bipolar disorder compared with both major depressive disorder and dysthymia. LIMITATIONS The preponderance of women, the assessment of atypical depression by adaptation of the DSM criteria, entirely Polish population, specificity of selection criteria. CONCLUSIONS The results demonstrated a higher intensity of atypical depression's symptoms in overweight/obese depressed patients. They also confirm the association between obesity and bipolarity.
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Affiliation(s)
- Dorota Łojko
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Grzegorz Buzuk
- Department of Psychiatry and Addiction Treatment, "L.Bierkowski" Ministry and Internal Affairs and Administration Health Care Centre, Poznan, Poland
| | - Maciej Owecki
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
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85
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Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. J Affect Disord 2015; 183:119-33. [PMID: 26005206 DOI: 10.1016/j.jad.2015.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 12/16/2022]
Abstract
Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities.
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86
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Dell'Aglio JC, Basso LA, Argimon IIDL, Arteche A. Systematic review of the prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015; 35:99-105. [PMID: 25923299 DOI: 10.1590/s2237-60892013000200002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/28/2013] [Indexed: 11/22/2022]
Abstract
This paper describes the findings of a systematic literature review aimed at providing an overview of the lifetime prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. Databases MEDLINE, ProQuest, Psychnet, and Web of Science were browsed for papers published in English between 1999 and May 2012 using the following search string: bipolar disorders OR bipolar spectrum disorders AND prevalence OR cross-sectional OR epidemiology AND population-based OR non-clinical OR community based. The search yielded a total of 434 papers, but only those published in peer-reviewed journals and with samples aged ≥ 18 years were included, resulting in a final sample of 18 papers. Results revealed rather heterogeneous findings concerning the prevalence of bipolar disorders and bipolar spectrum disorders. Lifetime prevalence of bipolar disorder ranged from 0.1 to 7.5%, whereas lifetime prevalence of bipolar spectrum disorders ranged from 2.4 to 15.1%. Differences in the rates of bipolar disorder and bipolar spectrum disorders may be related to the consideration of subthreshold criteria upon diagnosis. Differences in the prevalence of different subtypes of the disorder are discussed in light of diagnostic criteria and instruments applied.
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Affiliation(s)
| | - Lissia Ana Basso
- WP Centro de Psicoterapia Cognitivo-Comportamental, Santa Maria, RS, Brazil
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87
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Dolenc B, Dernovšek MZ, Sprah L, Tavcar R, Perugi G, Akiskal HS. Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder. J Affect Disord 2015; 174:13-8. [PMID: 25474481 DOI: 10.1016/j.jad.2014.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/09/2014] [Accepted: 11/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression. METHODS 100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A). RESULTS The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile. LIMITATIONS We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers. CONCLUSION Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour.
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Affiliation(s)
- B Dolenc
- Sociomedical Institute, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana, Slovenia.
| | | | - L Sprah
- Sociomedical Institute, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana, Slovenia
| | - R Tavcar
- University Psychiatric Clinic, Ljubljana, Slovenia
| | - G Perugi
- Institute of Behavioural Sciences, "G. De Lisio", Department of Psychiatry, University of Pisa, Pisa, Italy
| | - H S Akiskal
- International Mood Disorder Centre, Department of Psychiatry at the University of California, San Diego, La Jolla, USA
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88
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Mula M. The Clinical Spectrum of Bipolar Symptoms in Epilepsy: A Critical Reappraisal. Postgrad Med 2015; 122:17-23. [DOI: 10.3810/pgm.2010.07.2171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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89
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Wang LJ, Lee SY, Chen SL, Chang YH, Chen PS, Huang SY, Tzeng NS, Chen KC, Lee IH, Wang TY, Yang YK, Lu RB. A potential interaction between COMT and MTHFR genetic variants in Han Chinese patients with bipolar II disorder. Sci Rep 2015; 5:8813. [PMID: 25744938 PMCID: PMC4351536 DOI: 10.1038/srep08813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/23/2014] [Indexed: 11/09/2022] Open
Abstract
Bipolar II disorder (BP-II), characterized by recurrent dysregulation of mood, is a serious and chronic psychiatric illness. However, BP-II is commonly under-recognized, even in psychiatric settings. Because dopaminergic disturbance is thought to be involved in the development of bipolar disorder (BPD), it seems essential to investigate dopamine-related genes like the catechol-O-methyltransferase (COMT) gene, which are involved in dopamine metabolism, and the methylenetetrahydrofolate reductase (MTHFR) gene, which may affect COMT methylation and COMT function. The current study examined the association and interaction of the COMT Val158Met and MTHFR C677T variants with BP-II. Nine hundred seventy-eight participants were recruited: 531 with BP-II and 447 healthy controls. The genotypes of the COMT and MTHFR polymorphisms were determined using a polymerase chain reaction-restriction fragment length polymorphism analysis. Logistic regression analysis showed a significant interaction effect of the COMT Val158Met Val/Val genotype and the MTHFR C677T C/T + T/T genotype (P = 0.039) for the protective effect on the odds of developing BP-II. Our findings support preliminary evidence that the COMT and MTHFR genes interact in BP-II, and they imply the connection of both dopaminergic pathways and methylation pathways in the pathogenesis of BP-II.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Shiou-Lan Chen
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Hsuan Chang
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - I. Hui Lee
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Yun Wang
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
- Institute of Behavioral Medicine, college of medicine, National Cheng Kung University, Tainan, Taiwan
- Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institute, Miaoli, Taiwan
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90
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Lolich M, Vázquez GH, Zapata S, Akiskal KK, Akiskal HS. Affective temperaments in tango dancers. J Affect Disord 2015; 173:27-30. [PMID: 25462392 DOI: 10.1016/j.jad.2014.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Links between affective temperaments and folk culture have been infrequently explored systematically. Creativity and personality and temperament studies, conversely, have reported several associations. Tango is one of the most typical Argentinean folk dance-musical repertoires. The main purpose of this study is to compare affective temperaments between Argentinean professional tango dancers and the general population. METHODS TEMPS-A was administered to a sample of 63 professional tango dancers and 63 comparison subjects from the general population who did not practice tango. Subscale median scores and total median scores with non-parametric statistics were analyzed. RESULTS Median scores on hyperthymic subscale (p ≤ 0.001), irritable subscale (p=0.05) and total median score were significantly higher among tango dancers compared to controls (p ≤ 0.001). LIMITATIONS Self-report measures were used. A larger sample size would have provided greater statistical power for data analysis. Besides, the naturalistic study design did not allow controlling for other clinical variables and limited the generalization of results to broader populations. CONCLUSIONS Our data adds new evidence for the hypothesis that artistic performance is related to one's temperament. Tango passionata, which has both melancholic and vigorous (including "upbeat") features, seems to impart tango dancers' hyperthymic and irritable temperament features. Our study supports the increasing literature on the validity of utilizing temperament as a sub-affective traits in relation to artistic creativity and performing arts.
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Affiliation(s)
- María Lolich
- Department of Neuroscience, University of Palermo, Buenos Aires, Argentina.
| | - Gustavo H Vázquez
- Department of Neuroscience, University of Palermo, Buenos Aires, Argentina
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Lin K, Xu G, Lu W, Ouyang H, Dang Y, Guo Y, So KF, Lee TM. Neuropsychological performance of patients with soft bipolar spectrum disorders. Bipolar Disord 2015; 17:194-204. [PMID: 25048414 DOI: 10.1111/bdi.12236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/09/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES There is much evidence that shows that a substantial number of individuals with DSM-IV-defined unipolar depression (UP) manifest hypomanic sub-syndrome and bipolar diathesis. Other definitions have conceptualized the term soft bipolar spectrum (SBP) for these individuals. Little is known about the cognitive profiles of individuals with SBP. We hypothesized that they are representative of individuals with bipolar II disorder and are different from that of 'strict' UP. METHODS Consecutive referrals suffering major depressive episodes were categorically assigned to groups of either bipolar I disorder (n = 98), bipolar II disorder (n = 138), or UP (n = 300). Based on the SBP criteria by Akiskal and Pinto (17), patients with UP were subdivided into 81 SBP and 219 strict UP. We administered self- and clinician-administered scales to evaluate affective temperaments, and neuropsychological tests to assess seven cognitive domains. RESULTS Patients with SBP performed significantly better than strict UP patients in the domains of processing speed (p = 0.002), visual-spatial memory (p = 0.017), and verbal working memory (p = 0.017). Compared to patients with bipolar I disorder, patients with SBP were significantly better in set shifting (p < 0.001) and visual-spatial memory (p = 0.042). Patients with SBP performed similarly to patients with bipolar II disorder in all of the cognitive domains tested (p > 0.05). There was a group × cognitive domain interaction effect between bipolar I disorder, bipolar II disorder, SBP, and strict UP groups [Pillai's F = 2.231, df = (18,1437), p = 0.002]. CONCLUSIONS Our data suggest that patients with SBP differ from patients with UP not only in external validators (e.g., family history of bipolar disorder) and hypomanic symptoms, but also in neuropsychological performance and that the profiles of cognitive functioning were different across bipolar I disorder and 'bipolar II spectrum' that subsumes bipolar II disorder and SBP.
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Affiliation(s)
- Kangguang Lin
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Department of Psychiatry, Guangzhou Psychiatric Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong
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92
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Fornaro M, De Berardis D, De Pasquale C, Indelicato L, Pollice R, Valchera A, Perna G, Iasevoli F, Tomasetti C, Martinotti G, Koshy AS, Fasmer OB, Oedegaard KJ. Prevalence and clinical features associated to bipolar disorder-migraine comorbidity: a systematic review. Compr Psychiatry 2015; 56:1-16. [PMID: 25306379 DOI: 10.1016/j.comppsych.2014.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prevalence and clinical features associated with bipolar disorders (BDs)-migraine comorbidity have been reported inconsistently across different studies, therefore warranting a systematic review on the matter. METHODS A systematic review was conducted in accordance with the PRISMA statement searching major electronic databases for documents indexed between January, 2000 and July, 2014. Eligible studies were those including quantitative data on prevalence rates and clinical features associated to BD-migraine comorbidity; case reports excluded. Three authors independently conducted searches, quality assessment of the studies and data extraction. RESULTS Several cross-sectional studies, and a handful of retrospective follow-up studies or non-systematic reviews assessed the prevalence and/or the clinical correlates of migraine-BD comorbidity. High prevalence rates and a significant burden of BD-migraine comorbidity were common findings, particularly in case of BD-II women (point-prevalence rates up to 77%), migraine with aura (up to 53%) and/or cyclothymic temperament (up to 45% of the cases). LIMITATIONS Some of the biases encountered in a few studies accounted by the present review may nonetheless have hampered the generalizability of the overall conclusions drawn herein. CONCLUSIONS BD-migraine comorbidity may comprise of a sub-phenotype of BDs requiring patient-tailored therapeutic interventions to achieve an optimal outcome. Specifically, additional studies including longitudinal follow-up studies are aimed in order to shed further light on the actual prevalence rates and clinical features associated to BD-migraine comorbidity, with a special emphasis towards the clinically suggestive potential connection between mixed features, bipolar depression, migraine, and increased risk for suicidality. PROSPERO registration number: CRD42014009335.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy.
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | | | - Luisa Indelicato
- Department of Education Science, University of Catania, Catania, Italy.
| | - Rocco Pollice
- Service for Monitoring and early Intervention against psychoLogical and mEntal suffering in young people" (SMILE), L'Aquila University, Italy.
| | - Alessandro Valchera
- Hermanas Hospitalarias, Villa San Giuseppe Hospital, 63100 Ascoli Piceno, Italy.
| | - Giampaolo Perna
- Department of Clinical Neuroscience, Villa San Benedetto Menni, Hermanas Hospitalarias, Albese con Cassano, Como, Italy.
| | - Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - Carmine Tomasetti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, University "G. d'Annunzio" of Chieti, 66013 Chieti, Italy.
| | - Ann Sarah Koshy
- St. John's National Academy of Health Sciences, Bangalore, India.
| | - Ole Bernt Fasmer
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway.
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Abstract
Compared with bipolar disorder, borderline personality disorder (BPD) is as frequent (if not more frequent), as impairing (if not more impairing), and as lethal (if not more lethal). Yet, BPD has received less than one-tenth the funding from the National Institutes of Health than has bipolar disorder. More than other reviewers of the literature on the interface between bipolar disorder and BPD, Paris and Black (Paris J and Black DW (2015) Borderline Personality Disorder and Bipolar Disorder: What is the Difference and Why Does it Matter? J Nerv Ment Dis 203:3-7) emphasize the clinical importance of correctly diagnosing BPD and not overdiagnosing bipolar disorder, with a focus on the clinical feature of affective instability and how the failure to recognize the distinction between sustained and transient mood perturbations can result in misdiagnosing patients with BPD as having bipolar disorder. The review by Paris and Black, then, is more of an advocacy for BPD than other reviews in this area have been. In the present article, the author will illustrate how the bipolar disorder research community has done a superior job of advocating for and "marketing" their disorder compared with researchers of BPD. Specifically, researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, written commentaries about the problem with underdiagnosis, developed and promoted several screening scales to improve diagnostic recognition, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these issues and thus have been less successful in highlighting the public health significance of the disorder.
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94
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Cyclothymic temperament rather than polarity is associated with hopelessness and suicidality in hospitalized patients with mood disorders. J Affect Disord 2015; 170:161-5. [PMID: 25240844 DOI: 10.1016/j.jad.2014.08.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of the present study was to assess sociodemographic and clinical differences between inpatients with major mood disorders (bipolar disorder - BD - and major depression - MDD) and the cyclothymic phenotype (CYC), and pure BDs or MDDs. METHODS Participants were 281 adult inpatients (134 men and 147 women) consecutively admitted to the Department of Psychiatry of the Sant׳Andrea University Hospital in Rome, Italy, between January 2008 and June 2010. The patients completed the Hamilton Scale for Depression (HAMD17), the Young Mania Rating Scale, the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire), and the Beck Hopelessness Scale. RESULTS 38.7% of the MDD patients and 48.3% of the BD patients satisfied criteria to be included in the cyclothymic groups. Above 92% of the patients with the cyclothymic phenotype reported suicidal ideation at the item #3 of the HAMD17. Furthermore, patients with the cyclothymic phenotype reported higher hopelessness than other patients. LIMITATIONS Our results are potentially limited by the small number of MDD-CYC patients included in the sample. CONCLUSIONS Our results support the clinical usefulness of the concept of soft bipolar spectrum. Patients with the cyclothymic phenotype differ from pure MDD patients and BD patients for temperamental profile and clinical variables.
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95
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Singh MK, Ketter T, Chang KD. Distinguishing bipolar disorder from other psychiatric disorders in children. Curr Psychiatry Rep 2014; 16:516. [PMID: 25315116 DOI: 10.1007/s11920-014-0516-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pediatric onset bipolar disorder (BD) is a challenging diagnosis with potentially debilitating outcomes. This review aims to critically evaluate recently published literature relevant to the diagnosis of BD in youth, emphasizing interesting and important new findings characterizing pediatric BD and reporting updates in the diagnostic and statistical manual relevant to this disorder in youth. Challenges regarding the diagnosis of BD will be discussed, in addition to important distinctions with other childhood disorders, including other bipolar spectrum disorders; major depressive disorder; dysthymia; disruptive mood dysregulation disorder (DMDD); attention-deficit/hyperactivity disorder (ADHD) and other disruptive behavioral disorders; anxiety disorders, including post-traumatic stress disorder (PTSD); psychotic disorders; autism spectrum disorders; substance use disorders; and borderline personality disorder. The review concludes with a comment on past research limitations and future directions in the field.
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Affiliation(s)
- Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA,
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96
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Depression means different things: A qualitative study of psychiatrists' conceptualization of depression in the palliative care setting. Palliat Support Care 2014; 13:1223-30. [PMID: 25331292 DOI: 10.1017/s1478951514001187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Medical practitioners conceptualize depression in different ways, which adds to the challenges of its diagnosis and treatment, as well as research in the palliative care setting. Psychiatric assessment is often considered the "gold standard" for diagnosis, therefore how psychiatrists conceptualize depression in this setting is pertinent. Our study aimed to investigate this issue. METHOD Psychiatrists working in palliative care in Australia were individually interviewed using a semistructured approach. Nine participants were interviewed to reach data saturation. Interview transcripts were analyzed for themes. RESULTS Three overarching themes were identified: (1) depression means different things; (2) depression is conceptualized using different models; and (3) depression is the same concept within and outside of the palliative care setting. Participants explicitly articulated the heterogeneous nature of depression and described a different breadths of concepts, ranging from a narrow construct of a depressive illness to a broader one that encompassed depressive symptoms and emotions. However, depressive illness was a consistent concept, and participants considered this in terms of phenotypic subtypes. Participants used three models (spectral, dichotomous, and mixed) to relate various depressive presentations. SIGNIFICANCE OF RESULTS Psychiatrists did not subscribe to a unitary model of depression but understood it as a heterogeneous concept comprised of depressive illness and other less clearly defined depressive presentations. Given the influence of psychiatric opinion in the area of depression, these findings may serve as a platform for further discussions to refine the concepts of depression in the palliative care setting, which in turn may improve diagnostic and treatment outcomes.
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97
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Ghouse AA, Sanches M, Zunta-Soares GB, Soares JC. Lifetime mood spectrum symptoms among bipolar patients and healthy controls: a cross sectional study with the Mood Spectrum Self-Report questionnaire. J Affect Disord 2014; 166:165-7. [PMID: 25012426 PMCID: PMC4406378 DOI: 10.1016/j.jad.2014.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/25/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The "spectrum" model has advantages for the conceptualization of mental disorders, representing a complementary approach to the currently available categorical systems. We carried out a study in order to assess lifetime mood symptoms among patients with bipolar disorder (BD) and healthy controls from a dimensional perspective. METHODS The Mood Spectrum Self-Report instrument (MOODS-SR) was administered to 101 bipolar patients (52 BD I, 32 BD II, and 17 BD NOS, 36 males/65 females, mean age+SD=36.10±13.34 years) and 38 healthy controls (16 males/22females, mean age+SD=35.18±13.70 years). The scores of the different MOOD-SR scales and subscales among patients and controls were compared using non-parametric tests (Mann-Whitney and Kruskal-Wallis). RESULTS Bipolar patients scored significantly higher than healthy controls on the total MOOD-SR scores (BD: mean±SD=98.65±22.17; HC: mean±SD=12.92±10.72; p<0.01) and all subdomains. Multiple comparisons revealed lower scores among controls when compared to each one of the subtypes of BD, also regarding the total scores and all subdomains (p<0.01). Comparisons across the different subtypes of BD revealed statistically significant higher scores among BD I patients when compared to BD II and BD NOS patients, only in regard to the total MOOD-SR scores (BD I: mean±SD=102.94±22.79; BD II: mean±SD=93.53±21.97; BD NOS: mean±SD= 94.88±18.68; p=0.03) and two subdomains: mood mania and energy mania. CONCLUSIONS These results, although preliminary, suggest that even though the MOODS-SR seems effective in distinguishing BD patients from HC, it is not as good in discriminating different subtypes of BD, especially in respect to lifetime depressive symptoms. LIMITATIONS Our sample size was small, and comprised by outpatients. The MOOD-SR measures only lifetime symptoms and does not take into account the progression of mood symptoms or the current mood state of patients.
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Affiliation(s)
- Amna. A. Ghouse
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Giovana B. Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Jair C. Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
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98
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Koukopoulos׳ diagnostic criteria for mixed depression: a validation study. J Affect Disord 2014; 164:14-8. [PMID: 24856547 DOI: 10.1016/j.jad.2014.03.054] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/17/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mixed depression (MxD) is one subtype of depressive experiences within the depressive spectrum. MxD definition is debated among experts. Koukopoulos׳ proposed diagnostic criteria focused primarily on psychic agitation, marked irritability, and intense mood lability as markers of a mixed depressive episode. The present study validates Koukopoulos׳ criteria as diagnostic for MxD. METHODS A sample of 435 patients from the International Mood Network (IMN), multi-center, international network of sites, and the Centro LucioBini of Rome was analyzed. Koukopoulos׳ criteria were assessed in all patients. RESULTS The most prevalent MxD criteria were "absence of psychomotor retardation" (84%), "mood lability or marked reactivity" (78%), and "psychic agitation or inner tension" (75%). Multivariable predictors of a MxD (+) diagnosis were: higher current CGI (OR=1.23, 95% CI 1.23, 2.84), lower rates of previous bipolar type I diagnosis (OR=0.54, 95% CI -3.28, -0.13), mixed symptoms on the index episode (OR=10.02, 95% CI 2.32, 24.12), rapid cycling course (OR=2.6 95% CI 1.45, 3.56), past substance abuse (OR=3.02, 95% CI 2.01, 5.67) and lower education status (OR=0.44, 95% CI -3.23, -0.98). This model showed a sensitivity of 76.4%, specificity of 86.3%, negative predictive value of 75%, and positive predictive value of 86%. LIMITATIONS An external validation of these criteria in an independent sample is warranted. CONCLUSION A broad definition of mixed depression was internally validated with multiple diagnostic validators and was sensitively and specifically predicted. Contrary to DSM-5, Koukopoulos׳ broad criteria include agitation, irritability and mood lability as core features.
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99
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A three-year longitudinal study of affective temperaments and risk for psychopathology. J Affect Disord 2014; 164:94-100. [PMID: 24856560 DOI: 10.1016/j.jad.2014.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Affective temperaments are presumed to underlie bipolar psychopathology. The TEMPS-A has been widely used to assess affective temperaments in clinical and non-clinical samples. Cross-sectional research supports the association of affective temperaments and mood psychopathology; however, longitudinal research examining risk for the development of bipolar disorders is lacking. The present study examined the predictive validity of affective temperaments, using the TEMPS-A, at a three-year follow-up assessment. METHODS The study interviewed 112 participants (77% of the original sample) at a three-year follow-up of 145 non-clinically ascertained young adults psychometrically at-risk for bipolar disorders, who previously took part in a cross-sectional examination of affective temperaments and mood psychopathology. RESULTS At the reassessment, 29 participants (26%) met criteria for bipolar spectrum disorders, including 13 participants who transitioned into disorders during the follow-up period (14% of the originally undiagnosed sample). Cyclothymic/irritable and hyperthymic temperaments predicted both total cases and new cases of bipolar spectrum disorders at the follow-up. Cyclothymic/irritable temperament was associated with more severe outcomes, including DSM-IV-TR bipolar disorders, bipolar spectrum psychopathology, major depressive episodes, and substance use disorders. Hyperthymic temperament was associated with bipolar spectrum psychopathology and hypomania, whereas dysthymic temperament was generally unassociated with psychopathology and impairment. LIMITATIONS The present sample of young adults is still young relative to the age of onset of mood psychopathology. CONCLUSIONS These results provide the first evidence of the predictive validity of affective temperaments regarding risk for the development of bipolar psychopathology. Affective temperaments provide a useful construct for understanding bipolar psychopathology.
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Bae M, Lee K, Baek JH, Kim JS, Cho Y, Ryu S, Ha K, Hong KS. Lifetime experiences of hypomanic symptoms are associated with delayed and irregular sleep-wake cycle and seasonality in non-clinical adult samples. Compr Psychiatry 2014; 55:1111-5. [PMID: 24666716 DOI: 10.1016/j.comppsych.2014.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Disturbances of the sleep-wake cycle and seasonality have been reported in patients with bipolar disorder (BD). Considering that BD seems to be a spectrum condition in terms of clinical and biological characteristics, circadian and seasonal rhythm related to BD could be detected in non-clinical individuals with subthreshold bipolarity. The aim of this study was to screen past hypomanic symptoms in non-clinical samples and investigate their association with deviated sleep-wake cycle and seasonality. METHODS Lifetime history of hypomanic symptoms was assessed with the Hypomania Checklist-32 (HCL-32). Circadian preference, variability of sleep-wake time and seasonal changes in mood and behavior were evaluated on a lifetime-basis in non-clinical adult samples (n=313), using the Composite Scale of Morningness (CSM), the Sleep Timing Questionnaire (STQ), and the Seasonal Pattern Assessment Questionnaire (SPAQ). RESULTS Two subdomains of hypomanic symptoms were identified through factor analysis of HCL-32, i.e., "active/elated" factor and "irritable/risk-taking" factor. The HCL-32 total score (p<0.001) and the "active/elated" factor score (p=0.028) were weakly correlated only with seasonality, whereas the "irritable/risk-taking" factor score was associated not only with seasonality (p<0.001), but also with evening preference (p<0.001) and irregularity of sleep-wake times (p=0.001~0.011). CONCLUSION Circadian and seasonal characteristics related to BD are also associated with a past history of hypomanic symptoms in non-clinical samples, especially "irritable/risk-taking" symptoms, suggesting the existence of subclinical presentation of BD and their biological traits.
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Affiliation(s)
- Moonoh Bae
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Sun Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Korea
| | - Youngah Cho
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Korea; Seoul National Hospital, Seoul, Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea; Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
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