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Tebeka S, Le Strat Y, Dubertret C. Is parity status associated with bipolar disorder clinical features, severity or evolution? J Affect Disord 2018; 225:201-206. [PMID: 28837954 DOI: 10.1016/j.jad.2017.08.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/29/2017] [Accepted: 08/14/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess prospectively the association of the number of past pregnancies on the evolution of bipolar disorder (BD). METHODS Data were drawn from the 2 waves of the National Epidemiologic Study of Alcohol and Related Conditions (NESARC), a representative sample of the US population of 34,653 participants. All women diagnosed with BD were included. The number of children and BD's characteristics, i.e. BD type, age of onset, hospitalization and suicide attempt, and lifetime psychiatrics comorbidity were assessed at wave 1. Mood episode and BD's characteristics were also assessed at wave 2. RESULTS In the sample of 1190 women with BD, 27% had no child, 17% had one, 25% had two 31% had three children or more. Women with at least two children were more likely to have BD I, to report hypomania and suicide attempt during the follow-up than women without child. Parity was not associated with other characteristics of BD, nor with the severity and course of the illness. LIMITATIONS Not provide information on pregnancies not ending to a delivery. CONCLUSION Parity is associated with a higher incidence of hypomania and suicide attempt during a 3-years follow-up in women with BD.
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Affiliation(s)
- Sarah Tebeka
- AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014 Paris, France
| | - Yann Le Strat
- AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014 Paris, France
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014 Paris, France
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Orhan FÖ, Kurutaş EB, Doğaner A, Türker E, Özcü SŞT, Güngör M, Çakmak S. Serum levels of GPER-1 in euthymic bipolar patients. Neuropsychiatr Dis Treat 2018; 14:855-862. [PMID: 29618927 PMCID: PMC5875407 DOI: 10.2147/ndt.s158822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Estrogen and its receptors have been suggested as playing a role in the pathogenesis of bipolar disorder (BD). Estrogen functions through the estrogen receptors alpha and beta and the recently discovered G-protein-coupled estrogen receptor-1 (GPER-1). The aim of this study was to evaluate serum GPER-1 levels in euthymic BD patients. PATIENTS AND METHODS The study population consisted of 38 euthymic outpatients meeting the criteria for BD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and 35 age- and gender-matched healthy controls. Medical histories were obtained and physical examinations and laboratory tests conducted. RESULTS Serum GPER-1 levels were measured in both patients and controls and found to be significantly higher in the BD patients than in controls. These results were not influenced by the medications in use. CONCLUSION The results of this study demonstrated that GPER-1 may play a role in BD pathophysiology.
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Affiliation(s)
- Fatma Özlem Orhan
- Department of Psychiatry, Faculty of Medicine, Kahramanmaraş Sütçüimam University, Kahramanmaras, Turkey
| | - Ergül Belge Kurutaş
- Department of Biochemistry, Faculty of Medicine, Kahramanmaraş Sütçüimam University, Kahramanmaras, Turkey
| | - Adem Doğaner
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kahramanmaraş Sütçüimam University, Kahramanmaras, Turkey
| | - Ebru Türker
- Department of Psychiatry, Faculty of Medicine, Kahramanmaraş Sütçüimam University, Kahramanmaras, Turkey
| | - Safiye Şeyma Taner Özcü
- Department of Bioengineering, Institute of Science, Kahramanmaraş Sütçüimam University, Kahramanmaras, Turkey
| | - Meltem Güngör
- Vocational High School, Toros University, Mersin, Turkey
| | - Seyfettin Çakmak
- Department of Psychiatry, Faculty of Medicine, Kahramanmaraş Sütçüimam University, Kahramanmaras, Turkey
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Slyepchenko A, Frey BN, Lafer B, Nierenberg AA, Sachs GS, Dias RS. Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study. Acta Psychiatr Scand 2017; 136:473-482. [PMID: 28846801 PMCID: PMC5630503 DOI: 10.1111/acps.12797] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown. AIMS We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD. MATERIALS & METHODS A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria. RESULTS Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001). DISCUSSION The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD. CONCLUSIONS The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.
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Affiliation(s)
- Anastasiya Slyepchenko
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada,Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada
| | - Benicio N. Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada,Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada,Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Andrew A. Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - Gary S. Sachs
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - Rodrigo S. Dias
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Brazil
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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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Azorin JM, Perret LC, Fakra E, Tassy S, Simon N, Adida M, Belzeaux R. Alcohol use and bipolar disorders: Risk factors associated with their co-occurrence and sequence of onsets. Drug Alcohol Depend 2017; 179:205-212. [PMID: 28802190 DOI: 10.1016/j.drugalcdep.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Little is known about the sequence of onsets in patients affected by comorbid alcohol use and bipolar disorder. This study examines the risk factors associated with their co-occurrence and order of onset. METHOD The demographic, clinical, and temperament characteristics as well as the course of illness were analyzed within our sample of 1090 DSM-IV bipolar I manic patients. Our sample was categorized according to the presence of comorbid alcohol use disorder and the sequence of onsets of bipolar and alcohol use disorders i.e., alcohol first (AUD-BD) and bipolar first (BD-AUD). RESULTS Regression analyses revealed that alcohol use disorder (52.5%) was associated with the male gender, additional substance use disorders, as well as an irritable and a hyperthymic temperament. The AUD-BD group (6.6%) was older than the BD-AUD group (45.8%) and showed higher rates of comorbid sedative use, organic, and anxiety disorders with higher levels of irritable temperament, and a bipolar subtype characterized by depressive polarity at onset. The BD-AUD group had high levels of hyperthymic temperament with higher rates of comorbid stimulant use disorder and a manic polarity at onset. CONCLUSIONS In the AUD-BD group, alcohol might have been used to reduce stress and tension caused by the presence of an irritable temperament as well as anxious and organic disorders, leading to first depressive episode. In the BD-AUD group, stimulant use might have triggered the first manic episode, and alcohol abuse result from mania severity.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Léa C Perret
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
| | - Eric Fakra
- Department of Psychiatry, North Hospital, Saint-Etienne, France.
| | - Sébastien Tassy
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Nicolas Simon
- Aix-Marseille University, INSERM, UMR912 (SESSTIM), Marseille, France.
| | - Marc Adida
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Raoul Belzeaux
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France; Department of Psychiatry, McGill University, Montréal, Québec, Canada.
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Sreedhar D, Kulkarni KR, Purty A, Muralidharan K, Janardhan Reddy YC, Jain S. Gender Differences in the 5 Years Course of Bipolar Disorder after a First Manic Episode: A Retrospective Review. Indian J Psychol Med 2017; 39:712-713. [PMID: 29200578 PMCID: PMC5688909 DOI: 10.4103/0253-7176.217020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Divyasree Sreedhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Karishma Rajendra Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhishek Purty
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Schönfelder S, Langer J, Schneider EE, Wessa M. Mania risk is characterized by an aberrant optimistic update bias for positive life events. J Affect Disord 2017; 218:313-321. [PMID: 28482278 DOI: 10.1016/j.jad.2017.04.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Early cognitive models of mania posit that a cognitive triad consisting of unrealistically optimistic beliefs about the self, world and future may predispose vulnerable individuals to develop manic symptoms. Hypomanic personality traits (HYP) pose such a vulnerability factor in the etiopathogenesis of mania. METHODS To test the cognitive tenet of overly optimistic views of the future, 24 individuals with high-HYP and 24 age- and sex-matched controls (low-HYP) performed a belief update paradigm, during which they estimated their personal chances to experience future positive and negative life events. Afterwards, they were presented with the statistical likelihood of each event occurring to a peer living in the same socio-cultural environment and given the chance to adjust their initial estimates. RESULTS High-HYP individuals exhibited an asymmetric belief revision for positive events, reflected by an exaggerated incorporation of better-than-expected and an impaired integration of worse-than-expected information, relative to their low-HYP control counterparts. The strength of this optimistic update bias was linked to the trait sensitivity of the behavioral approach system. Furthermore, high-HYP individuals demonstrated a more optimistic initial prediction bias, characterized by greater overestimations of their likelihood to experience positive events, and reported enhanced trait optimism. LIMITATIONS The cross-sectional study relied on an extreme-group design to define mania risk. CONCLUSIONS Due to the crucial role of future-oriented beliefs in guiding decision-making and goal-directed behavior, this optimistic update bias for positive events may cognitively underpin the mania-typical engagement in highly pleasurable activities despite warnings for harmful consequences.
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Affiliation(s)
- Sandra Schönfelder
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - Johanna Langer
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany; Section for Pediatric Oncology, Haematology and Haemostaseology, University Medicine Mainz, Germany
| | - Eva Elisa Schneider
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Michèle Wessa
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
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Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre for Mental Health, Shuwaikh, Kuwait
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Mereu M, Contarini G, Buonaguro EF, Latte G, Managò F, Iasevoli F, de Bartolomeis A, Papaleo F. Dopamine transporter (DAT) genetic hypofunction in mice produces alterations consistent with ADHD but not schizophrenia or bipolar disorder. Neuropharmacology 2017; 121:179-194. [PMID: 28454982 DOI: 10.1016/j.neuropharm.2017.04.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/13/2017] [Accepted: 04/24/2017] [Indexed: 01/02/2023]
Abstract
ADHD, schizophrenia and bipolar disorder are psychiatric diseases with a strong genetic component which share dopaminergic alterations. Dopamine transporter (DAT) genetics might be potentially implicated in all these disorders. However, in contrast to DAT absence, the effects of DAT hypofunction especially in developmental trajectories have been scarcely addressed. Thus, we comprehensively studied DAT hypofunctional mice (DAT+/-) from adolescence to adulthood to disentangle DAT-dependent alterations in the development of psychiatric-relevant phenotypes. From pre-adolescence onward, DAT+/- displayed a hyperactive phenotype, while responses to external stimuli and sensorimotor gating abilities were unaltered. General cognitive impairments in adolescent DAT+/- were partially ameliorated during adulthood in males but not in females. Despite this, attentional and impulsivity deficits were evident in DAT+/- adult males. At the molecular level, DAT+/- mice showed a reduced expression of Homer1a in the prefrontal cortex, while other brain regions as well as Arc and Homer1b expression were mostly unaffected. Amphetamine treatments reverted DAT+/- hyperactivity and rescued cognitive deficits. Moreover, amphetamine shifted DAT-dependent Homer1a altered expression from prefrontal cortex to striatal regions. These behavioral and molecular phenotypes indicate that a genetic-driven DAT hypofunction alters neurodevelopmental trajectories consistent with ADHD, but not with schizophrenia and bipolar disorders.
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Affiliation(s)
- M Mereu
- Department of Pharmaceutical Science, University of Padua, Padua, Italy
| | - G Contarini
- Department of Pharmaceutical Science, University of Padua, Padua, Italy
| | - E F Buonaguro
- Section of Psychiatry. Department of Neuroscience, Reproductive and Odontostomatological Science, University School of Medicine "Federico II", Naples, Italy
| | - G Latte
- Section of Psychiatry. Department of Neuroscience, Reproductive and Odontostomatological Science, University School of Medicine "Federico II", Naples, Italy
| | - F Managò
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - F Iasevoli
- Section of Psychiatry. Department of Neuroscience, Reproductive and Odontostomatological Science, University School of Medicine "Federico II", Naples, Italy
| | - A de Bartolomeis
- Section of Psychiatry. Department of Neuroscience, Reproductive and Odontostomatological Science, University School of Medicine "Federico II", Naples, Italy
| | - F Papaleo
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy.
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Flores-Ramos M, Leff P, Fernández-Guasti A, Becerra Palars C. Is it important to consider the sex of the patient when using lithium or valproate to treat the bipolar disorder? Pharmacol Biochem Behav 2017; 152:105-111. [DOI: 10.1016/j.pbb.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/12/2023]
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Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:331-349. [PMID: 27476137 DOI: 10.1016/j.jad.2016.07.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/09/2016] [Accepted: 07/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. METHODS A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. LIMITATIONS The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. CONCLUSIONS This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
| | - Gin S Malhi
- Discipline of Psychiatry and CADE Clinic, Royal North Shore Hospital, University of Sydney, NSW, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, NSW, Australia.
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Gobinath AR, Choleris E, Galea LA. Sex, hormones, and genotype interact to influence psychiatric disease, treatment, and behavioral research. J Neurosci Res 2016; 95:50-64. [DOI: 10.1002/jnr.23872] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/08/2016] [Accepted: 07/14/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Aarthi R. Gobinath
- Centre for Brain Health, Program in Neuroscience; University of British Columbia; Vancouver British Columbia V6T1Z3 Canada
| | - Elena Choleris
- Department of Psychology; University of Guelph; Guelph Ontario N1G 2W1 Canada
| | - Liisa A.M. Galea
- Centre for Brain Health, Program in Neuroscience; University of British Columbia; Vancouver British Columbia V6T1Z3 Canada
- Department of Psychology; University of British Columbia; Vancouver British Columbia V6T1Z3 Canada
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Holtzman JN, Miller S, Hooshmand F, Wang PW, Chang KD, Goffin KC, Hill SJ, Ketter TA, Rasgon NL. Gender by onset age interaction may characterize distinct phenotypic subgroups in bipolar patients. J Psychiatr Res 2016; 76:128-35. [PMID: 26926801 DOI: 10.1016/j.jpsychires.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/11/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although bipolar disorder (BD) is a common recurrent condition with highly heterogeneous illness course, data are limited regarding clinical implications of interactions between gender and onset age. We assessed relationships between onset age and demographic/illness characteristics among BD patients stratified by gender. METHODS Demographic and unfavorable illness characteristics, descriptive traits, and clinical correlates were compared in 502 patients from Stanford University BD Clinic patients enrolled in the Systematic Treatment Enhancement Program for BD between 2000 and 2011, stratified by gender, across pre-, peri-, and post-pubertal (<12, 13-16, and >17 years, respectively) onset-age subgroups. RESULTS Among 502 BD patients, 58.2% were female, of whom 21.9% had pre-pubertal, 30.7% peri-pubertal, and 47.4% post-pubertal onset. Between genders, although demographics, descriptive characteristics, and most clinical correlates were statistically similar, there were distinctive onset-age related patterns of unfavorable illness characteristics. Among females, rates of 6/8 primary unfavorable illness characteristics were significantly higher in pre-pubertal and peri-pubertal compared to post-pubertal onset patients. However, among males, rates of only 3/8 unfavorable illness characteristics were significantly higher in only pre-pubertal versus post-pubertal onset patients, and none between peri-pubertal versus post-pubertal onset patients. LIMITATIONS Caucasian, insured, suburban, American specialty clinic-referred sample limits generalizability, onset age based on retrospective recall. DISCUSSION We describe different phenotypic presentations across age at illness onset groups according to gender. Among females and males, peri-pubertal and post-pubertal onset age groups were more different and more similar, respectively. Further investigation is warranted to assess implications of gender-by-onset-age interactions to more accurately delineate distinctive BD phenotypes.
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Affiliation(s)
- Jessica N Holtzman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Shefali Miller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Farnaz Hooshmand
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Po W Wang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiki D Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathryn C Goffin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Shelley J Hill
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie L Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Seeman MV. Gendering psychosis: the illness of Zelda Fitzgerald. MEDICAL HUMANITIES 2016; 42:65-69. [PMID: 26392268 DOI: 10.1136/medhum-2015-010734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
Psychiatric textbooks tend to describe psychosis as it is experienced by men. The well-documented illness of Zelda Fitzgerald illustrates the feminine side of psychosis. The distinctive features of Zelda's illness--its specific precipitants, the timing of its onset, the discontinuities in its course, the pronounced mood swings, the preservation of intellect and of agency, the maintenance of human ties, the association of flare-ups with immune and hormonal changes, the responsiveness to treatment, the lifelong creativity and productivity--show the female side of psychotic illness, one that is rarely described in diagnostic manuals. This paper relies on Nancy Milford's biography of Zelda, as well as on several other biographical sources and, using Zelda's own words and the words of her husband and friends, allows entry into a feminine world of psychosis, not encountered in textbooks. The expression of psychotic illness varies from person to person, its exact shape depending on many factors, most of them still undetermined, but gender is a critically important core component of variance.
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Abstract
Medication management of bipolar depression in pregnancy and lactation is best done by assessing each patient's and family's needs in detail. Keeping pregnant patients as psychiatrically stable as possible is the most important principle for clinicians. Unfortunately, there is no risk-free situation for patients with psychiatric illness. This is often the most difficult and hard to accept reality for these patients, families, and clinicians. Clinicians serve these patients best by being as transparent as possible about the risk/benefit analysis of each patient's situation with the realization that ultimately the decisions are made by the patient and family.
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Affiliation(s)
- Marla F Wald
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Civitan Building, 2213 Elba Street, Durham, NC 27705, USA.
| | - Andrew J Muzyk
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Drue Clark
- Mission Health Outpatient Clinical Pharmacy Services, Asheville, NC, USA
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66
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Tondo L, Pompili M, Forte A, Baldessarini RJ. Suicide attempts in bipolar disorders: comprehensive review of 101 reports. Acta Psychiatr Scand 2016; 133:174-86. [PMID: 26555604 DOI: 10.1111/acps.12517] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Assess reported risk of suicide attempts by patients with bipolar disorder (BD). METHOD Systematic searching yielded 101 reports from 22 countries (79 937 subjects). We analyzed for risk (%) and incidence rates (%/year) of attempts, comparing sex and diagnostic types, including by meta-analysis. RESULTS Attempt risk averaged 31.1% [CI: 27.9-34.3] of subjects, or 4.24 [3.78-4.70]%/year. In BD-I (43 studies) and BD-II subjects (30 studies), risks (29.9%, 31.4%) and incidence rates (4.01, 4.11%/year) were similar and not different by meta-analysis. Among women vs. men, risks (33.7% vs. 25.5%) and incidence (4.50 vs. 3.21%/year) were greater (also supported by meta-analysis: RR = 1.35 [CI: 1.25-1.45], P < 0.0001). Neither measure was related to reporting year, % women/study, or to onset or current age. Risks were greater with longer exposure, whereas incidence rates decreased with longer time at risk, possibly through 'dilution' by longer exposure. CONCLUSION This systematic update of international experience underscores high risks of suicide attempts among patients with BD (BD-I = BD-II; women > men). Future studies should routinely include exposure times and incidence rates by diagnostic type and sex for those who attempt suicide or not.
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Affiliation(s)
- L Tondo
- International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Lucio Bini Mood Disorder Centers, Cagliari and, Rome, Italy
| | - M Pompili
- International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,NESMOS, Sant'Andrea Medical Center, La Sapienza University of Rome, Rome, Italy
| | - A Forte
- International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,NESMOS, Sant'Andrea Medical Center, La Sapienza University of Rome, Rome, Italy
| | - R J Baldessarini
- International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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67
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Liu X, Kelsoe JR, Greenwood TA. A genome-wide association study of bipolar disorder with comorbid eating disorder replicates the SOX2-OT region. J Affect Disord 2016; 189:141-9. [PMID: 26433762 PMCID: PMC4640946 DOI: 10.1016/j.jad.2015.09.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bipolar disorder is a heterogeneous mood disorder associated with several important clinical comorbidities, such as eating disorders. This clinical heterogeneity complicates the identification of genetic variants contributing to bipolar susceptibility. Here we investigate comorbidity of eating disorders as a subphenotype of bipolar disorder to identify genetic variation that is common and unique to both disorders. METHODS We performed a genome-wide association analysis contrasting 184 bipolar subjects with eating disorder comorbidity against both 1370 controls and 2006 subjects with bipolar disorder only from the Bipolar Genome Study (BiGS). RESULTS The most significant genome-wide finding was observed bipolar with comorbid eating disorder vs. controls within SOX2-OT (p=8.9×10(-8) for rs4854912) with a secondary peak in the adjacent FXR1 gene (p=1.2×10(-6) for rs1805576) on chromosome 3q26.33. This region was also the most prominent finding in the case-only analysis (p=3.5×10(-7) and 4.3×10(-6), respectively). Several regions of interest containing genes involved in neurodevelopment and neuroprotection processes were also identified. LIMITATIONS While our primary finding did not quite reach genome-wide significance, likely due to the relatively limited sample size, these results can be viewed as a replication of a recent study of eating disorders in a large cohort. CONCLUSIONS These findings replicate the prior association of SOX2-OT with eating disorders and broadly support the involvement of neurodevelopmental/neuroprotective mechanisms in the pathophysiology of both disorders. They further suggest that different clinical manifestations of bipolar disorder may reflect differential genetic contributions and argue for the utility of clinical subphenotypes in identifying additional molecular pathways leading to illness.
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Affiliation(s)
- Xiaohua Liu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | | | - John R. Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,San Diego Veterans Affairs Healthcare System, San Diego, CA,Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA
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68
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Heilbronner U, Malzahn D, Strohmaier J, Maier S, Frank J, Treutlein J, Mühleisen TW, Forstner AJ, Witt SH, Cichon S, Falkai P, Nöthen MM, Rietschel M, Schulze TG. A common risk variant in CACNA1C supports a sex-dependent effect on longitudinal functioning and functional recovery from episodes of schizophrenia-spectrum but not bipolar disorder. Eur Neuropsychopharmacol 2015; 25:2262-70. [PMID: 26475575 DOI: 10.1016/j.euroneuro.2015.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/26/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022]
Abstract
Sex is a powerful modulator of disease susceptibility, course and outcome. The gene CACNA1C is among the best replicated vulnerability genes of bipolar disorder and schizophrenia. The aim of the present study was to investigate whether sex and a variant in CACNA1C (rs10774035 as a proxy for the well-acknowledged risk variant rs1006737) influence psychosocial adaptation in a large German patient sample with schizophrenia-spectrum (n=297) and bipolar (n=516) disorders. We analyzed Global Assessment of Functioning (GAF) scores, retrospectively collected for different time points during disease course. We investigated whether CACNA1C sex-dependently modulates longitudinal GAF scores and recovery from episodes of psychiatric disturbance in the above mentioned disorders. Psychosocial recovery was measured as difference score between the current GAF score (assessing the last remission) and the worst GAF score ever during an illness episode. Covariate- adjusted association analyses revealed a sex × rs10774035 genotype interaction on longitudinal GAF and recovery from illness episodes only in schizophrenia-spectrum but not in bipolar disorders. In schizophrenia-spectrum affected males, rs10774035 minor allele (T) carriers had higher GAF scores at three time points (premorbid, worst ever, current). In contrast, females carrying rs10774035 minor alleles had impaired recovery from schizophrenia-spectrum episodes. These results encourage further investigations of gene × sex interactions and longitudinal quantitative phenotypes to unravel the rich variety of behavioral consequences of genetic individuality.
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Affiliation(s)
- Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University Munich, Germany.
| | - Dörthe Malzahn
- Department of Genetic Epidemiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Jana Strohmaier
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Sandra Maier
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Jens Treutlein
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Thomas W Mühleisen
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich (FZJ), Jülich, Germany; Institute of Human Genetics, University of Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Sven Cichon
- Institute of Human Genetics, University of Bonn, Germany; Division of Medical Genetics, University Hospital Basel, University of Basel, Switzerland; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University Munich, Germany; Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany; Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University, Göttingen, Germany
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69
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Kerridge BT, Saha TD, Chou SP, Zhang H, Jung J, Ruan WJ, Smith SM, Huang B, Hasin DS. Gender and nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. Drug Alcohol Depend 2015; 156:47-56. [PMID: 26374990 PMCID: PMC4633313 DOI: 10.1016/j.drugalcdep.2015.08.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/16/2015] [Accepted: 08/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about sex-specific risk for nonmedical prescription opioid use (NMPOU) and DSM-5 nonmedical prescription opioid use disorder (NMPOUD). The objective of the present study was to present prevalence, correlates, psychiatric comorbidity, treatment and disability of NMPOU and DSM-5 NMPOUD among men and women. METHODS Nationally representative sample of the U.S. RESULTS Prevalences of 12-month and lifetime NMPOU were greater among men (4.4%, 13.0%) than women (3.9%, 9.8%), while corresponding rates of DSM-5 NMPOUD did not differ between men (0.9%, 2.2%) and women (0.9%, 1.9%). Regardless of time frame and sex, NMPOU and NMPOUD generally decreased with age and were lower among Blacks, Asians/Pacific Islanders and Hispanics, and respondents with lower socioeconomic status. Among men with NMPOU, rates were lower among respondents in the Northeast and South and among those previously married (lifetime). Across time frames and gender, NMPOU and NMPOUD were generally associated with other substance use disorders, posttraumatic stress and borderline, schizotypal and antisocial personality disorders, but associated with major depressive disorder, persistent depression and bipolar I disorder only among men. Disability increased with NMPOU frequency and NMPOUD severity. Only 7.6% and 8.2% of men and women with NMPOU ever received treatment, while 26.8% and 31.1% ever received treatment for NMPOUD. CONCLUSIONS NMPOU and NMPOUD are highly disabling, associated with a broad array of sex-specific and shared correlates and comorbidities and largely go untreated in the U.S. Valid assessment tools are needed that include gender as a stratification variable to identify NMPOU and NMPOUD.
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Affiliation(s)
- Bradley T. Kerridge
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, Phone: 831-246-0751
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons, and Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York, NY 10032
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Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states. Compr Psychiatry 2015; 63:15-21. [PMID: 26555487 DOI: 10.1016/j.comppsych.2015.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/05/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022] Open
Abstract
Several studies investigating bipolar disorders have shown that polarity of onset can predict differences in symptomatology, course, and prognosis. Frequently, however, research on the topic has examined only bipolar I inpatients and has not included patients with mixed onset. The aim of the present naturalistic study was to evaluate the clinical characteristics and illness course of a consecutive sample (407 outpatients, 58.7% with bipolar I (BD-I) and 41.3% with bipolar II (BD-II) disorder) according to polarity of onset: depressive (DP-o); manic/hypomanic (HM-o); or mixed--broadly defined to include agitated depression for BD-II--onset (MX-o). As compared with patients in the other two groups: a) DP-o patients (67.3%) were more frequently affected by BD-II and had lower ratings for psychotic symptoms; b) HM-o patients (17%) had a higher rate of family history for psychosis and a lower rate of suicide attempts; and c) patients in the MX-o group (15.7%) more frequently showed substance abuse and had a higher number of mixed recurrences per year. In the BD-II group, MX-o patients more frequently attempted suicide. The present study's main limitations are those of retrospective assessment of onset polarity and lack of treatment-impact evaluations over illness course. In conclusion, we confirm clinical expression differences in bipolar disorder in function of polarity of onset and underscore the importance of carefully considering broadly defined mixed state when examining polarity of onset. Further investigations are required to confirm the present study's results.
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71
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Erol A, Winham SJ, McElroy SL, Frye MA, Prieto ML, Cuellar-Barboza AB, Fuentes M, Geske J, Mori N, Biernacka JM, Bobo WV. Sex differences in the risk of rapid cycling and other indicators of adverse illness course in patients with bipolar I and II disorder. Bipolar Disord 2015; 17:670-6. [PMID: 26529373 DOI: 10.1111/bdi.12329] [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: 03/05/2015] [Accepted: 07/24/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the independent effects of sex on the risk of rapid cycling and other indicators of adverse illness course in patients with bipolar I disorder (BP-I) or bipolar II disorder (BP-II). METHODS We analyzed data from the first 1,225 patients enrolled in the Mayo Clinic Individualized Medicine Biobank for Bipolar Disorder. Demographic and clinical variables were ascertained using standardized questionnaires; height and weight were assessed to determine body mass index (BMI). Rates of rapid cycling, cycle acceleration, and increased severity of mood episodes over time were compared between women and men overall and within subgroups defined by bipolar disorder subtype (BP-I or BP-II). Multiple logistic regression analysis was used to assess the independent effect of sex on the risk of these indicators of adverse illness course. RESULTS Women had significantly higher rates of rapid cycling than men. Overall rates of rapid cycling were higher in patients with BP-II than BP-I; and sex differences in the rate of rapid cycling were more pronounced in patients with BP-II than BP-I, although the power to detect statistically significant differences was reduced due to the lower sample size of subjects with BP-II. Female sex was a significant predictor of rapid cycling, cycle acceleration, and increased severity of mood episodes over time after adjusting for age, bipolar disorder subtype, BMI, having any comorbid psychiatric disorder, and current antidepressant use. CONCLUSIONS Female sex was associated with significantly higher risk of rapid cycling, cycle acceleration, and increased severity of mood episodes over time in a sample of 1,225 patients with bipolar disorders.
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Affiliation(s)
- Almila Erol
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Stacey J Winham
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Miguel L Prieto
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | | | - Manuel Fuentes
- Department of Psychiatry, Universite Desarrollo and Clinica Allemana, Santiago, Chile
| | - Jennifer Geske
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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72
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Birner A, Seiler S, Lackner N, Bengesser SA, Queissner R, Fellendorf FT, Platzer M, Ropele S, Enzinger C, Schwingenschuh P, Mangge H, Pirpamer L, Deutschmann H, McIntyre RS, Kapfhammer HP, Reininghaus B, Reininghaus EZ. Cerebral White Matter Lesions and Affective Episodes Correlate in Male Individuals with Bipolar Disorder. PLoS One 2015; 10:e0135313. [PMID: 26252714 PMCID: PMC4529150 DOI: 10.1371/journal.pone.0135313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of WML with clinical parameters in BD have been described, but not with the number of affective episodes, illness duration, age of onset and Body Mass Index in a well characterized group of euthymic bipolar adults. Herein, we aimed to evaluate the associations between bipolar course of illness parameters and WML measured with volumetric analysis. Methods In a cross-sectional study 100 euthymic individuals with BD as well as 54 healthy controls (HC) were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV, Hamilton-Depression, Young Mania Rating Scale and Beck’s Depression Inventory were evaluated. Results Individuals with BD had significantly more (F = 3.968, p < .05) WML (Mdn = 3710mm3; IQR = 2961mm3) than HC (Mdn = 2185mm3; IQR = 1665mm3). BD men (Mdn = 4095mm3; IQR = 3295mm3) and BD women (Mdn = 3032mm3; IQR = 2816mm3) did not significantly differ as to the WML-load or the number and type of risk factors for WML. However, in men only, the number of manic/hypomanic episodes (r = 0.72; p < .001) as well as depressive episodes (r = 0.51; p < .001) correlated positively with WML-load. Conclusions WML-load strongly correlated with the number of manic episodes in male BD patients, suggesting that men might be more vulnerable to mania in the context of cerebral white matter changes.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Nina Lackner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Robert Queissner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Martina Platzer
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Petra Schwingenschuh
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit at the University Health Network, University of Toronto, Toronto, Canada
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73
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Wölfling K, Beutel ME, Dreier M, Müller KW. Bipolar spectrum disorders in a clinical sample of patients with Internet addiction: hidden comorbidity or differential diagnosis? J Behav Addict 2015; 4:101-5. [PMID: 26132914 PMCID: PMC4500890 DOI: 10.1556/2006.4.2015.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Behavioral addictions and bipolar disorders have a certain probability of co-occurrence. While the presence of a manic episode has been defined as an exclusion criterion for gambling disorder, no such exclusion has been formulated for Internet addiction. METHODS A clinical sample of 368 treatment seekers presenting with excessive to addictive Internet use was screened for bipolar spectrum disorders using the Mood Disorder Questionnaire. Psychopathology was assessed by the Symptom Checklist 90R and a clinical interview was administered to screen for comorbid disorders. RESULTS Comorbid bipolar disorders were more frequent in patients meeting criteria for Internet addiction (30.9%) than among the excessive users (5.6%). This subgroup showed heightened psychopathological symptoms, including substance use disorders, affective disorders and personality disorders. Further differences were found regarding frequency of Internet use regarding social networking sites and online-pornography. DISCUSSION Patients with Internet addiction have a heightened probability for meeting criteria of bipolar disorders. It is not possible to draw conclusions regarding the direction of this association but it is recommended to implement screening for bipolar disorders in patients presenting with Internet addiction. CONCLUSION Similar to gambling disorder, it might prove necessary to subsume bipolar disorders as an exclusion criterion for the future criteria of Internet addiction.
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Affiliation(s)
- Klaus Wölfling
- Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Dreier
- Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kai W. Müller
- Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany,* Corresponding author: Kai W. Müller, Dipl.-Psych.; Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany; Phone: +49 (0)6131-174039; E-mail:
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74
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Rilett KC, Friedel M, Ellegood J, MacKenzie RN, Lerch JP, Foster JA. Loss of T cells influences sex differences in behavior and brain structure. Brain Behav Immun 2015; 46:249-60. [PMID: 25725160 DOI: 10.1016/j.bbi.2015.02.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/10/2015] [Accepted: 02/18/2015] [Indexed: 12/13/2022] Open
Abstract
Clinical and animal studies demonstrate that immune-brain communication influences behavior and brain function. Mice lacking T cell receptor β and δ chains were tested in the elevated plus maze, open field, and light-dark test and showed reduced anxiety-like behavior compared to wild type. Interestingly sex differences were observed in the behavioural phenotype of TCRβ-/-δ- mice. Specifically, female TCRβ-/-δ- mice spent more time in the light chamber compared to wild type females, whereas male TCRβ-/-δ- spent more time in the center of the open field compared to wild type males. In addition, TCRβ-/-δ- mice did not show sex differences in activity-related behaviors observed in WT mice. Ex vivo brain imaging (7 Tesla MRI) revealed volume changes in hippocampus, hypothalamus, amygdala, periaqueductal gray, and dorsal raphe and other brain regions between wild type and T cell receptor knockout mice. There was also a loss of sexual dimorphism in brain volume in the bed nucleus of the stria terminalis, normally the most sexually dimorphic region in the brain, in immune compromised mice. These data demonstrate the presence of T cells is important in the development of sex differences in CNS circuitry and behavior.
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Affiliation(s)
- Kelly C Rilett
- Neurosci. Grad Program, McMaster Univ., Hamilton, ON, Canada
| | - Miriam Friedel
- Mouse Imaging Ctr., Hosp. for Sick Children, Toronto, ON, Canada
| | - Jacob Ellegood
- Mouse Imaging Ctr., Hosp. for Sick Children, Toronto, ON, Canada
| | - Robyn N MacKenzie
- Psychiatry & Behavioural Neurosciences, McMaster Univ., Hamilton, ON, Canada
| | - Jason P Lerch
- Mouse Imaging Ctr., Hosp. for Sick Children, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Jane A Foster
- Psychiatry & Behavioural Neurosciences, McMaster Univ., Hamilton, ON, Canada; Brain-Body Institute, St. Joseph's Healthcare, Hamilton, ON, Canada.
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Abulseoud OA, Gawad NA, Mohamed K, Vadnie C, Camsari UM, Karpyak V, Frye MA, Choi DS. Sex differences in mania phenotype and ethanol consumption in the lateral hypothalamic kindled rat model. Transl Psychiatry 2015; 5:e534. [PMID: 25803497 PMCID: PMC4354358 DOI: 10.1038/tp.2015.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/07/2015] [Accepted: 01/20/2015] [Indexed: 01/03/2023] Open
Abstract
Sex differences have been observed in mania phenotypes in humans. However the mechanisms underlying this difference are poorly understood. Activating the lateral hypothalamus is implicated in manic-like behaviors in rodents. Using newly established lateral hypothalamus kindled (LHK) rat mania model, we investigated sex differences of manic-like behaviors and its correlation with voluntary ethanol intake. We stimulated the lateral hypothalamus bilaterally in the male and female Wistar rats over five consecutive days. We recorded and quantified kindling-induced behaviors for each individual animal. We also assessed ethanol consumption using a two-bottle choice ethanol drinking as well as circadian locomotor activity counts daily throughout the experiment. We found notable sex differences in several aspects of manic-like behaviors during kindling. Males exhibited a significantly increased locomotor activity during the light phase, and reduced rest interval. On the other hand, females displayed significantly higher ethanol consumption and more frequent rearing behavior. However, no sex differences were present in the duration of sexual, feeding or grooming behaviors or in dark-phase activity counts. The excessive alcohol intake in LHK female rats is reminiscent of clinically reported sex differences in bipolar patients while the other phenotypic sex differences such as rearing and locomotor activity are less clearly described in clinical studies. Overall, our results lend further evidence for the validity of the LHK rat as a useful model to study brain region-specific molecular changes during mania and its correlation with alcohol use disorders.
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Affiliation(s)
- O A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - N A Gawad
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - K Mohamed
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - C Vadnie
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - U M Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - V Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - M A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - D-S Choi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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Gender differences in the treatment of patients with bipolar disorder: a study of 7354 patients. J Affect Disord 2015; 174:303-9. [PMID: 25532077 DOI: 10.1016/j.jad.2014.11.058] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/10/2014] [Accepted: 11/29/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gender differences in treatment that are not supported by empirical evidence have been reported in several areas of medicine. Here, the aim was to evaluate potential gender differences in the treatment for bipolar disorder. METHODS Data was collected from the Swedish National Quality Assurance Register for bipolar disorder (BipoläR). Baseline registrations from the period 2004-2011 of 7354 patients were analyzed. Multiple logistic regression analysis was used to study the impact of gender on interventions. RESULTS Women were more often treated with antidepressants, lamotrigine, electroconvulsive therapy, benzodiazepines, and psychotherapy. Men were more often treated with lithium. There were no gender differences in treatment with mood stabilizers as a group, neuroleptics, or valproate. Subgroup analyses revealed that ECT was more common in women only in the bipolar I subgroup. Contrariwise, lamotrigine was more common in women only in the bipolar II subgroup. LIMITATIONS As BipoläR contains data on outpatient treatment of persons with bipolar disorder in Sweden, it is unclear if these findings translate to inpatient care and to outpatient treatment in other countries. CONCLUSIONS Men and women with bipolar disorder receive different treatments in routine clinical settings in Sweden. Gender differences in level of functioning, bipolar subtype, or severity of bipolar disorder could not explain the higher prevalence of pharmacological treatment, electroconvulsive therapy, and psychotherapy in women. Our results suggest that clinicians׳ treatment decisions are to some extent unduly influenced by patients׳ gender.
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77
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Kember RL, Georgi B, Bailey-Wilson JE, Stambolian D, Paul SM, Bućan M. Copy number variants encompassing Mendelian disease genes in a large multigenerational family segregating bipolar disorder. BMC Genet 2015; 16:27. [PMID: 25887117 PMCID: PMC4382929 DOI: 10.1186/s12863-015-0184-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/19/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bipolar affective disorder (BP) is a common, highly heritable psychiatric disorder characterized by periods of depression and mania. Using dense SNP genotype data, we characterized CNVs in 388 members of an Old Order Amish Pedigree with bipolar disorder. We identified CNV regions arising from common ancestral mutations by utilizing the pedigree information. By combining this analysis with whole genome sequence data in the same individuals, we also explored the role of compound heterozygosity. RESULTS Here we describe 541 inherited CNV regions, of which 268 are rare in a control population of European origin but present in a large number of Amish individuals. In addition, we highlight a set of CNVs found at higher frequencies in BP individuals, and within genes known to play a role in human development and disease. As in prior reports, we find no evidence for an increased burden of CNVs in BP individuals, but we report a trend towards a higher burden of CNVs in known Mendelian disease loci in bipolar individuals (BPI and BPII, p = 0.06). CONCLUSIONS We conclude that CNVs may be contributing factors in the phenotypic presentation of mood disorders and co-morbid medical conditions in this family. These results reinforce the hypothesis of a complex genetic architecture underlying BP disorder, and suggest that the role of CNVs should continue to be investigated in BP data sets.
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Affiliation(s)
- Rachel L Kember
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Benjamin Georgi
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Joan E Bailey-Wilson
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Baltimore, MD, USA.
| | - Dwight Stambolian
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Steven M Paul
- Appel Alzheimer's Disease Research Institute, Mind and Brain Institute, Weill Cornell Medical College, New York, NY, USA.
| | - Maja Bućan
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
BACKGROUND AND AIMS Although comorbid anxiety disorders (AD) are quite frequent in bipolar disorders (BD), data on how this comorbidity affects BD are limited. In the present study, we aimed to investigate the frequency of comorbid AD in Turkish patients with bipolar disorder-I (BD-I) and the effects of comorbid AD on the course of BD-I. METHODS 114 patients with BD-I were included in the study. All patients were diagnosed by a psychiatrist. The patients were divided into two groups as BD-I patients with lifetime comorbid AD (BDI-CAD) or those without comorbid AD (BDI). RESULTS 37 (32.46%) patients had one or more comorbid lifetime AD. The numbers of admissions to the outpatient clinic within calendar year 2013 (P = 0.014), the number of lifetime mood episodes (P = 0.019) and the duration of BD (P = 0.007) were higher in the BDI-CAD group compared with the BDI group. There was a strong relationship between the duration of the disorder and the number of episodes (r = 0.583, P < 0.001). Partial correlation analyses showed that the number of admission to the outpatient clinic correlated significantly with the frequency of episodes (P = 0.007, r = 0.282). CONCLUSION We found that the patients with BDI-CAD use the healthcare system more frequently than the BDI patients. This suggests that AD comorbidity may have a negative influence on the course of BD-I and it is a factor that should be considered in the clinical follow-up.
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Affiliation(s)
- Sadiye Visal Buturak
- a Sadiye Visal Buturak, M.D., Assistant Professor, Kirikkale University Faculty of Medicine, Department of Physchiatry , Kirikkale , Turkey
| | - Orhan Murat Koçak
- b Orhan Murat Koçak, M.D., Associate Professor, Kirikkale University Faculty of Medicine, Department of Physchiatry , Kirikkale , Turkey
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Miller LJ, Ghadiali NY, Larusso EM, Wahlen KJ, Avni-Barron O, Mittal L, Greene JA. Bipolar disorder in women. Health Care Women Int 2014; 36:475-98. [PMID: 25315819 DOI: 10.1080/07399332.2014.962138] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.
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Affiliation(s)
- Laura J Miller
- a Department of Psychiatry, Loyola Stritch School of Medicine, Edward Hines Jr. VA Hospital , Hines , Illinois , USA
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Lijffijt M, Rourke ED, Swann AC, Zunta-Soares GB, Soares JC. Illness-course modulates suicidality-related prefrontal gray matter reduction in women with bipolar disorder. Acta Psychiatr Scand 2014; 130:374-87. [PMID: 25039251 DOI: 10.1111/acps.12314] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Explore interrelationships between suicide attempt history (Objective 1) or suicide attempt severity (Objective 2) with prefrontal cortex gray matter (PFCGM ) volume and illness-course in patients with bipolar disorder (BD). METHOD Ninety-three women with BD-I or -II diagnosis (51 with and 42 without suicide attempt history) underwent structural MRI and filled out questionnaires. Measured were GM volumes of 11 PFC regions, BD illness-course, and attempt history and severity. Effects were examined with repeated measures GLM or logit analyses. RESULTS Objective 1: Attempt history was associated with increased trait impulsivity and aggression, and higher prevalence of BD-I, past drug use disorder, and past psychiatric hospitalization. PFCGM volume was lower in patients with than without attempt history in those with past psychiatric hospitalization. PFCGM volume was higher in patients with than without attempt history in those without hospitalization. Higher trait aggression predicted attempt history. Objective 2: Increased frontal pole volume and younger age at first hospitalization predicted many suicide attempts. CONCLUSION Attempt history in patients with BD related to PFCGM volume reduction or increase. Volume modulation by psychiatric hospitalization could reflect effects of illness-course or care. Attempt severity was not related to volume reduction. Research on suicidality-brain relationships should include illness-course and attempt severity measures.
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Affiliation(s)
- M Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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81
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Kim SW, Berk L, Kulkarni J, Dodd S, de Castella A, Fitzgerald PB, Amminger GP, Berk M. Impact of comorbid anxiety disorders and obsessive-compulsive disorder on 24-month clinical outcomes of bipolar I disorder. J Affect Disord 2014; 166:243-8. [PMID: 25012437 DOI: 10.1016/j.jad.2014.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study investigated the impact of comorbid obsessive-compulsive disorder (OCD) and four anxiety disorders [panic disorder (PD), agoraphobia, social anxiety disorder (SAD), and generalized anxiety disorder (GAD)] on the clinical outcomes of bipolar disorder. METHODS This study analysed data of 174 patients with bipolar I disorder who participated in the prospective observational study. Participants were assessed every 3 months for 24 months. The primary outcome measure was the achievement of symptomatic remission, defined by a total score on the Young Mania Rating Scale (YMRS) of ≤12 and a total score on the 21-item Hamilton Depression Rating Scale (HAMD-21) of ≤8. RESULTS Comorbidity was associated with decreased likelihood of remission. However, the impact of individual disorders on outcome differed according to clinical and treatment situations. Most comorbid anxiety disorders and OCD had a negative effect on remission during the first year of evaluation, as measured by the HAMD-21, and in patients taking a conventional mood stabilizer alone. However, the association with poorer outcome was observed only for a few specific comorbid disorders in the second year (GAD and OCD), as measured by YMRS-defined remission (OCD), and in patients with olanzapine therapy (GAD and OCD). LIMITATIONS Follow-up evaluation of comorbid disorders was lacking. CONCLUSIONS Comorbid anxiety disorders and OCD negatively influenced the clinical course of bipolar disorder. Specifically, OCD had a consistently negative impact on the outcome of bipolar I disorder regardless of clinical situation. Effective strategies for the control of these comorbidities are required to achieve better treatment outcomes.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Lesley Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia
| | - G Paul Amminger
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia; Orygen Youth Health Research Centre, Parkville 3052, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia; Orygen Youth Health Research Centre, Parkville 3052, VIC, Australia; Florey Institute for Neuroscience and Mental Health, Parkville 3052, VIC, Australia.
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82
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Baek JH, Cha B, Moon E, Ha TH, Chang JS, Kim JH, Choi JE, Kang BJ, Hong KS, Ha K. The effects of ethnic, social and cultural factors on axis I comorbidity of bipolar disorder: results from the clinical setting in Korea. J Affect Disord 2014; 166:264-9. [PMID: 25012440 DOI: 10.1016/j.jad.2014.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ethnic, social and cultural factors contribute to axis I comorbid conditions in bipolar disorder (BPD). Korea has strict laws against illicit drugs and a relatively permissive prevailing attitude toward alcohol. The present study aimed to explore the lifetime axis I comorbidity rate in patients with BPD in Korea. METHODS Clinically stable patients with bipolar I (n=222) and bipolar II (n=194) disorders were recruited from four tertiary medical centers in Korea. The subjects׳ diagnoses and axis I comorbid conditions were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and the Korean version of the Diagnostic Interview for Genetic Studies (K-DIGS). The lifetime prevalence of anxiety disorders, substance use disorders and eating disorders was explored. The prevalence of these axis I comorbid conditions was compared with data from prior studies in other countries and to data concerning the general Korean population. RESULTS A total of 45.1% of all subjects had at least one axis I comorbid condition. Anxiety disorders (30.2%) were the most common comorbidity, followed by alcohol use disorders (16.8%). Males with BPD showed a higher rate of alcohol dependence compared to the general male population and females with BPD showed a greater risk of having alcohol use disorder compared to the general female population. The rate of drug use disorder was extremely low (1.7%), and only one subject had an illicit-drug-related problem. LIMITATION Cross-sectional studies. CONCLUSION Comorbid conditions of Korean patients with BPD showed a distinct pattern, which is associated with the ethnic, social and cultural characteristics in Korea.
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Affiliation(s)
- Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University College of Medicine, Pusan, Republic of Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Jae Seung Chang
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Jeong Hyun Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Jung Eun Choi
- Department of Psychiatry, Seoul Municipal Eunpyeong Hospital, San6 Eungam2-Dong, Eunpyeong-Gu, Seoul 122-913, Republic of Korea
| | - Bong Jin Kang
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea; Seoul National Hospital, Seoul, Republic of Korea.
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Affiliation(s)
- Kay A Wilhelm
- Faces in the Street, St Vincent's Health Urban Mental Health and Wellbeing Research, Sydney, Australia School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Parker G, Fletcher K, McCraw S, Synnott H, Friend P, Mitchell PB, Hadzi-Pavlovic D. Screening for bipolar disorder: does gender distort scores and case-finding estimates? J Affect Disord 2014; 162:55-60. [PMID: 24767006 DOI: 10.1016/j.jad.2014.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gender differences in rates of bipolar disorder have been described, with most studies reporting males as over-represented in those diagnosed with a bipolar I disorder and females over-represented in those diagnosed with a bipolar II disorder. This could reflect true differences in prevalence or measurement error emerging from screening or case-finding measures. We examine the possible contribution of the latter by examining one screening measure-the Mood Swings Questionnaire (MSQ). METHODS We analyse MSQ data from a large sample of age- and gender-matched bipolar I and bipolar II patients (and their composite group). Gender differences were examined in terms of prevalence and severity of MSQ symptoms, MSQ sub-scales scores and total MSQ scores, employing univariate and differential item functioning (DIF) analyses. RESULTS Both male and female bipolar I patients reported higher total MSQ and higher mysticism MSQ sub-scale scores than their male and female bipolar II counterparts. There were no gender differences when bipolar I, bipolar II and composite bipolar groups were separately examined on both total and sub-scale MSQ scores, suggesting that gender does not impact on MSQ scoring. When item analyses of bipolar I and II groups were undertaken separately, a number of differences emerged, but as few were consistent across bipolar sub-types such differences could reflect chance and failure to control for multiple comparisons. The over-representation of some items in females and some in males may have contributed to the comparable total and sub-scale scores. LIMITATIONS Large sample size and only one measure (i.e. MSQ) examined. CONCLUSION As total and sub-scale MSQ scores were uninfluenced by gender we can conclude that this screening test is not confounded by gender and, if representative of other such screening measures, would indicate that any differential prevalence of the bipolar disorders identified in community studies possibly reflects gender differences in their occurrence rather than artefactual consequences of screening measures having a gender bias.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia.
| | - Kathryn Fletcher
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
| | - Stacey McCraw
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
| | - Howe Synnott
- Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
| | - Paul Friend
- Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
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McPherson S, Barbosa-Leiker C, Daratha K, Short R, McDonell MG, Alicic R, Roll J, Tuttle K. Association of co-occurring serious mental illness with emergency hospitalization in people with chronic kidney disease. Am J Nephrol 2014; 39:260-7. [PMID: 24663040 DOI: 10.1159/000360095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/27/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Chronic kidney disease (CKD) and serious mental illness (SMI) are both associated with an increased risk for repeated hospitalization. The objective of this study was to determine if co-occurring SMI exacerbates the risk for subsequent hospitalization, particularly through the emergency department (ED), among people with CKD. METHODS People hospitalized in Washington State from April 2006 to December 2008 were separated into cohorts with diagnoses of CKD (n = 31,166), SMI (defined by schizophrenia and/or mood disorder; n = 20,167) or CKD with co-occurring SMI (n = 717), and a reference cohort without either diagnosis (n = 548,532). Main outcomes were rehospitalization for condition(s) other than mental illness: (1) through the ED; (2) any admission, and (3) admission resulting in death. Cox regression was used to analyze time to main outcomes controlling for prespecified covariates associated with rehospitalization. RESULTS The risk of rehospitalization via the ED was increased for people with CKD (hazard ratio, HR = 1.24, 95% confidence interval, CI = 1.21-1.28, p < 0.001) and co-occurring SMI (HR = 1.33, 95% CI = 1.29-1.38, p < 0.001) cohorts, but was significantly greater in the combined cohort (HR = 1.55, 95% CI = 1.40-1.73, p < 0.001). Similarly, the risk of any rehospitalization was increased for CKD (HR = 1.21, 95% CI = 1.17-1.25, p < 0.001) and co-occurring SMI (HR = 1.14, 95% CI = 1.11-1.17, p < 0.001) cohorts, while a significantly greater risk was observed for the combined cohort (HR = 1.36, 95% CI = 1.24-1.48, p < 0.001). The risk of rehospitalization resulting in death was not significantly increased in the combined cohort. CONCLUSION In people with CKD, co-occurring SMI increased the risk of experiencing rehospitalization, particularly through the ED. Studies of strategies to address SMI in the CKD population are needed to mitigate the risk of repeat hospital admissions.
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Bücker J, Popuri S, Muralidharan K, Kozicky JM, Baitz HA, Honer WG, Torres IJ, Yatham LN. Sex differences in cognitive functioning in patients with bipolar disorder who recently recovered from a first episode of mania: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). J Affect Disord 2014; 155:162-8. [PMID: 24238868 DOI: 10.1016/j.jad.2013.10.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies investigating bipolar disorder (BD) showed that healthy patterns of sex differences in cognitive functioning are altered within this population, but is it unknown whether these alterations are present in BD patients early in their course of illness. METHODS Patients with bipolar I disorder (36 males, 38 female), who had recently experienced their first manic or mixed episode were tested along with healthy controls (39 males, 59 females) similar in age, sex and premorbid IQ. Cognitive function was assessed through a comprehensive neuropsychological test battery. RESULTS Significant group effects were found in a majority of administered tests (p<0.05) with patients performing worse than healthy controls. Significant sex effects (p<0.05) were observed on tasks of spatial working memory and sustained attention, with males performing better than females. No significant group by sex interaction was found in any of the tasks administered. LIMITATIONS The cognitive battery employed in this study may not have been optimally sensitive in detecting sex differences. CONCLUSIONS The results suggest that unlike patients with long standing multi-episode BD or schizophrenia, healthy cognitive sex differences are maintained in patients with early BD, following recovery from a first-episode of mania. These findings highlight the progressive nature of the illness and provide justification for an early intervention.
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Affiliation(s)
- Joana Bücker
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1; Bipolar Disorder Program and Laboratory of Molecular Psychiatry, National Institute for Translational Medicine, INCT-TM Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Swetha Popuri
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1
| | - Kesavan Muralidharan
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1; Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Jan-Marie Kozicky
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1
| | | | - William G Honer
- Centre for Complex Disorders, University of British Columbia, Vancouver, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1.
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Abstract
BACKGROUND It appears that the female reproductive events and hormonal treatments may impact the course of bipolar disorder in women. In particular, childbirth is known to be associated with onset of affective episodes in women with bipolar disorder. During the female reproductive events the sex hormones, e.g. estrogen, are fluctuating and particularly postpartum there is a steep fall in the levels of serum estrogen. The role of estrogen in women with bipolar disorder is, however, not fully understood. AIM The main objective of this review is to evaluate the possible relation between serum estrogen levels and women with bipolar disorder including studies of the anti manic effects of the selective estrogen receptor modulator tamoxifen. METHOD A systematically literature search on PubMed was conducted: two studies regarding the connection between serum estrogen levels and women with bipolar disorder were identified. Furthermore, four studies were found concerning the antimanic effects of tamoxifen. RESULTS Both studies in the estrogen studies showed very low levels of estrogen in women with postpartum psychosis and significant improvement of symptoms after treatment with estrogen. The four tamoxifen studies found that tamoxifen was effective in producing antimanic effects. CONCLUSION These results indicate that estrogen fluctuations may be an important factor in the etiology of bipolar disorder and it is obvious that more research on this topic is needed to clarify the role of estrogen in women with bipolar disorder.
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Affiliation(s)
- Ninja Meinhard
- Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen , Blegdamsvej 9, DK-2100 Copenhagen , Denmark
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Sex dependence of cognitive functions in bipolar disorder. ScientificWorldJournal 2014; 2014:418432. [PMID: 24616627 PMCID: PMC3926268 DOI: 10.1155/2014/418432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/11/2013] [Indexed: 01/05/2023] Open
Abstract
The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions.
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89
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Hardoon S, Hayes JF, Blackburn R, Petersen I, Walters K, Nazareth I, Osborn DPJ. Recording of severe mental illness in United Kingdom primary care, 2000-2010. PLoS One 2013; 8:e82365. [PMID: 24349267 PMCID: PMC3861391 DOI: 10.1371/journal.pone.0082365] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/23/2013] [Indexed: 11/19/2022] Open
Abstract
Background There is increasing emphasis on primary care services for individuals with severe mental illnesses (SMI), including schizophrenia, bipolar disorder, and other non-organic psychotic disorders. However we lack information on how many people receive these different diagnoses in primary care. Primary care databases offer an opportunity to explore the recording of new SMI diagnoses in representative general practices. Methods We used data from The UK Health Improvement Network (THIN) primary care database including longitudinal patient records for individuals aged over 16 years from 437 general practices. We determined the annual GP recorded rate of first diagnosis of SMI by age, gender, social deprivation and urbanicity between 2000 and 2010. Results We identified 10,520 individuals with a first record of schizophrenia, bipolar disorder or other non-organic psychosis among 4,164,794 patients. This corresponded to a rate of first diagnosis of 46.4 per 100,000 person years at risk (PYAR) (95% CI 45.4 to 47.4) in the 16–65 age group. The rate of first record of schizophrenia was 9.2 per 100,000 PYAR (95% CI 8.7 to 9.6) in this age group, bipolar disorder was 15.0 per 100,000 PYAR (95% CI 14.4 to 15.5) and other non-organic psychotic disorder was 22.3 per 100,000 PYAR (95% CI 21.6 to 23.0). Conclusions The rates of GP recorded SMI in primary care records were broadly comparable to incidence rates from previous epidemiological studies of SMI and show similar patterns by socio-demographic characteristics. However there were some differences by specific diagnoses. GPs may be recording rates that are higher than those used to commission services.
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Affiliation(s)
- Sarah Hardoon
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Joseph F Hayes
- Mental Health Sciences Unit, University College London, London, United Kingdom
- * E-mail:
| | - Ruth Blackburn
- Mental Health Sciences Unit, University College London, London, United Kingdom
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - David P. J. Osborn
- Mental Health Sciences Unit, University College London, London, United Kingdom
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Azorin JM, Belzeaux R, Kaladjian A, Adida M, Hantouche E, Lancrenon S, Fakra E. Risks associated with gender differences in bipolar I disorder. J Affect Disord 2013; 151:1033-40. [PMID: 24060589 DOI: 10.1016/j.jad.2013.08.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previous studies have demonstrated that bipolar patients may differ in several features according to gender, but a number of the differences found remain controversial. METHODS The demographic, illness course, clinical, comorbidity and temperament characteristics of a total of 1090 consecutive DSM-IV bipolar I manic inpatients were compared according to gender. RESULTS Bipolar illness in women was characterised by the predominance of depression, as indicated by a depressive polarity at onset, higher rates of mixed mania, more suicidal behaviour, and a greater number of temperaments with depressive propensities. In contrast, the manic component was found to predominate in men. Men also had an earlier onset of their illness. Women displayed more comorbidities with eating, anxiety, and endocrine/metabolic disorders, whereas men were more comorbid with alcoholism and other forms of substance abuse, neurological, and cancer disorders. The following independent variables were associated with male gender: being single (+), depressive temperament (-), excessive alcohol use (+), cyclothymic temperament (-), excessive other substance use (+), mood congruent psychotic features (+), and manic polarity at onset (+). LIMITATIONS The retrospective design and the sample being potentially not representative of the bipolar disorder population are limitations. CONCLUSIONS Findings from this study tend to confirm most of the differences previously observed among bipolar men and women. Furthermore, these results draw attention to the risks that may be specifically linked to gender differences in bipolar I patients.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
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91
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Geoffroy PA, Bellivier F, Scott J, Boudebesse C, Lajnef M, Gard S, Kahn JP, Azorin JM, Henry C, Leboyer M, Etain B. Bipolar disorder with seasonal pattern: clinical characteristics and gender influences. Chronobiol Int 2013; 30:1101-7. [PMID: 23931033 DOI: 10.3109/07420528.2013.800091] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bipolar disorder (BD) has a multifactorial etiology with heterogeneous clinical presentations. Around 25% of BD patients may present with a depressive seasonal pattern (SP). However, there are limited scientific data on the prevalence of SP, its clinical manifestations, and any gender influence. Four hundred and fifty-two BD I and II cases (62% female), recruited from three French university-affiliated psychiatric departments, were assessed for SP. Clinical, treatment, and sociodemographic variables were obtained from structured interviews. One hundred and two (23%) cases met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for SP, with similar frequency according to gender. Multivariate analysis showed a significant association between SP and BD II (odds ratio [OR] = 1.99, p = 0.01), lifetime history of rapid cycling (OR = 2.05, p = 0.02), eating disorders (OR = 2.94, p = 0.003), and total number of depressive episodes (OR = 1.13, p = 0.002). Seventy-one percent of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR = 2.89, p = 0.017) and total number of depressive episodes (OR = 1.21, p = 0.0018) in males but with rapid cycling (OR = 3.02, p = 0.0027) and eating disorders (OR = 2.60, p = 0.016) in females. This is the first study to identify different associations between SP and clinical characteristics of BD according to gender. The authors suggest that SP represents a potentially important specifier of BD. These findings indicate that seasonality may reflect increased severity or complexity of disorder.
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92
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Gender-based differences in oxidative stress parameters do not underlie the differences in mood disorders susceptibility between sexes. Eur Psychiatry 2013; 29:58-63. [PMID: 23850061 DOI: 10.1016/j.eurpsy.2013.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to determine whether any gender-related difference exists concerning oxidative stress parameters in a population of 231 subjects, and if these changes might be related to gender-associated differences in major depressive disorder (MDD) or bipolar disorder (BD) vulnerability. This is a case-control nested in a population-based study. The initial psychopathology screen was performed with the Mini-International Neuropsychiatric Interview and the diagnostic was further confirmed with the Structured Clinical Interview for DSM-IV. Blood samples were obtained after the interview and the oxidative stress parameters such as uric acid, advanced oxidation protein product (PCC) and lipid hydroperoxides (TBARS) were determined. Our results indicated a higher prevalence of MDD and BD in women when compared to men. In addition, significant gender differences were found in the levels of PCC (0.27±0.27 vs. 0.40±0.31nmol CO/mg protein, men vs. women, respectively; P=0.02) and uric acid (4.88±1.39mg/dL vs. 3.53±1.02mg/dL, men vs. women, respectively; P=0.0001), but not in TBARS (0.013±0.01nmol/mg of protein vs. 0.017±0.02nmol/mg of protein, men vs. women respectively; P=0.243). After sample stratification by gender, no association was found between oxidative stress parameters and clinical diagnosis of MDD and BD for women (P=0.516 for PCC; P=0.620 for TBARS P=0.727 for uric acid) and men (P=0.367 for PCC; P=0.372 for TBARS P=0.664 for uric acid). In this study, women seem more susceptible to oxidative stress than male. However, these gender-based differences do not seem to provide a biochemical basis for the epidemiologic differences in mood disorders susceptibility between sexes.
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93
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Paterson A, Parker G, Fletcher K, Graham R. Beyond the baby blues: perspectives of women diagnosed with a mood disorder on children, pregnancy and medication. Australas Psychiatry 2013; 21:160-4. [PMID: 23426100 DOI: 10.1177/1039856212465346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to explore the views of women diagnosed with a mood disorder about children, medication and pregnancy. METHOD Female patients from the Black Dog Institute were invited to complete a questionnaire regarding their views about pregnancy, children and medication during pregnancy. Diagnostic groupings were derived by assessing DSM-IV criteria for mood disorders. Unipolar and bipolar patient responses were analysed to determine any differences between groups. RESULTS Women with bipolar disorder were more concerned than those with a unipolar condition about the impact pregnancy would have on their mood, as well as the potential for their offspring to inherit a mood condition. Both groups of women expressed concerns regarding the child-rearing environment, and stated that knowing the risk their child could have of developing a mood disorder would encourage them to be more vigilant parents. CONCLUSION While both groups were concerned about the environment in which they would raise their child and wanted to be vigilant parents, women diagnosed with a bipolar condition expressed stronger opinions regarding the impact that their pregnancy could have on their mood disorder, and passing the mood disorder onto their children.
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94
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Cotton SM, Lambert M, Berk M, Schimmelmann BG, Butselaar FJ, McGorry PD, Conus P. Gender differences in first episode psychotic mania. BMC Psychiatry 2013; 13:82. [PMID: 23497439 PMCID: PMC3602146 DOI: 10.1186/1471-244x-13-82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients. METHODS Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures. RESULTS Males with FEPM had increased likelihood of substance use (OR = 13.41, p <.001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge. CONCLUSIONS Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.
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Affiliation(s)
- Sue M Cotton
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia.
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,School of Medicine, Deakin University, Geelong, Australia,Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Felicity J Butselaar
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland
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95
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Abstract
OBJECTIVE The best known neurobehavioral effects of testosterone are on sexual function and aggression. However, testosterone and other androgens may be involved in the pathophysiology of mood disorders and suicidal behavior. This is the first study to examine whether there is a relation between testosterone levels and clinical parameters in bipolar suicide attempters. METHODS Patients with a DSM-IV diagnosis of a bipolar disorder (16 males and 51 females), in a depressive or mixed episode with at least one past suicide attempt were enrolled. Demographic and clinical parameters, including lifetime suicidal behavior, were assessed and recorded. Plasma testosterone was assayed using a double antibody radioimmunoassay procedure. RESULTS The number of major depressive episodes, the maximum lethality of suicide attempts, and the testosterone levels were higher in men compared to women. Current suicidal ideation scores were higher in women compared to men. Controlling for sex, we found that testosterone levels positively correlated with the number of manic episodes and the number of suicide attempts. CONCLUSION Our findings are consistent with previous observations of the association between testosterone levels and parameters of mood and behavior. This study suggests that testosterone levels may be related to the course of bipolar disorder and suicidal behavior. Further studies of the role of testosterone in the neurobiology of mood disorders and suicidal behavior are merited.
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96
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Pedraza RS, Losada JR, Jaramillo LE. [Age at Onset as a Marker of Subtypes of Manic-Depressive Illness]. REVISTA COLOMBIANA DE PSIQUIATRIA 2012; 41:576-587. [PMID: 26572113 DOI: 10.1016/s0034-7450(14)60030-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 06/13/2012] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. OBJECTIVE To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. METHODS Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. RESULTS According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. CONCLUSIONS In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics.
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Affiliation(s)
- Ricardo Sánchez Pedraza
- Médico psiquiatra, profesor titular de la Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Jorge Rodríguez Losada
- Médico psiquiatra, profesor asociado de la Universidad Nacional de Colombia, Bogotá, Colombia
| | - Luis Eduardo Jaramillo
- Médico psiquiatra, profesor asociado de la Universidad Nacional de Colombia, Bogotá, Colombia
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97
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Grigoroiu-Serbanescu M, Wickramaratne PJ, Mihailescu R, Prelipceanu D, Sima D, Codreanu M, Grimberg M, Elston RC. Paternal age effect on age of onset in bipolar I disorder is mediated by sex and family history. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:567-79. [PMID: 22592928 DOI: 10.1002/ajmg.b.32063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 04/25/2012] [Indexed: 12/13/2022]
Abstract
This study investigated for the first time in the psychiatric literature the effect of parental age on age-of-onset (AO) in bipolar I disorder (BPI) in relation to proband sex and family history (FH) for major psychoses in a sample of 564 BPI probands. All probands, 72.68% of their first-degree and 12.13% of their second-degree relatives were directly interviewed. The FH-method was used for all unavailable relatives. The diagnoses were made according to DSM-IV(TR) . The impact of parental age on proband early/late AO was evaluated through logistic regression with the cut-off for early AO determined through commingling analysis. We found evidence for a significant influence of increasing paternal age, and especially age ≥ 35 years, on AO of BPI disorder in the total sample (OR = 0.54, CI: 0.35-0.80), in the female subsample (OR = 0.44, CI: 0.25-0.78), in the sporadic subsample (OR = 0.64, CI: 0.38-0.95), and in the subsample with FH of recurrent unipolar major depression (Mdd-RUP) (OR = 0.55, CI: 0.34-0.87). No significant effect of paternal age on disease AO was found in patients with FH of bipolar (BP), schizoaffective disorders (SA), or schizophrenia (SCZ), nor in males. Mean age was significantly higher in fathers of sporadic cases and of cases with FH of Mdd-RUP than in fathers of cases with FH of BP/SA/SCZ (P = 0.011). Maternal age had no significant effect either in the total sample or in subsamples defined by proband sex or FH. In conclusion, in our sample increasing paternal age lowered the onset of BPI selectively, the effect being related to the female sex and FH-type.
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Affiliation(s)
- Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania.
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98
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Martínez-Ortega JM, Jurado D, Gutiérrez-Rojas L, Molero P, Ramos MA, Gurpegui M. Stability of sex differences by diagnosis in psychiatric hospitalizations. Psychiatry Res 2012; 198:161-3. [PMID: 22397920 DOI: 10.1016/j.psychres.2011.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 10/05/2011] [Accepted: 11/26/2011] [Indexed: 10/28/2022]
Abstract
We examined sex differences in the distribution of psychiatric diagnoses among hospitalized patients, controlling for socio-demographic variables. The sample included 1865 psychiatric inpatients consecutively admitted during a 9-year period. The finding of a higher proportion of men among patients hospitalized for schizophrenia or substance use disorder and a higher proportion of women among those admitted for affective disorders, including bipolar disorder, was stable over time. A better understanding of these differences may help to establish more effective treatment strategies.
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Affiliation(s)
- José M Martínez-Ortega
- Department of Psychiatry, Faculty of Medicine, University of Granada, Av. Madrid 11, E-18071 Granada, Spain.
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99
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Jogia J, Dima D, Frangou S. Sex differences in bipolar disorder: a review of neuroimaging findings and new evidence. Bipolar Disord 2012; 14:461-71. [PMID: 22631625 DOI: 10.1111/j.1399-5618.2012.01014.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The sex of an individual is known to modulate the clinical presentation of bipolar disorder (BD), but little is known as to whether there are significant sex-by-diagnosis interactions on the brain structural and functional correlates of BD. METHODS We conducted a literature review of magnetic resonance imaging (MRI) studies in BD, published between January 1990 and December 2010, reporting on the effects of sex and diagnosis. In the absence of any functional MRI (fMRI) studies, this review was supplemented by original data analyses focusing on sex-by-diagnosis interactions on patterns of brain activation obtained during tasks of working memory, incentive decision-making, and facial affect processing. RESULTS We found no support for a sex-by-diagnosis interaction in global gray or white matter volume. Evidence regarding regional volumetric measures is limited, but points to complex interactions between sex and diagnosis with developmental and temperamental factors within limbic and prefrontal regions. Sex-by-diagnosis interactions were noted in the pattern of activation within the basal ganglia during incentive decision-making and within ventral prefrontal regions during facial affect processing. CONCLUSIONS Potential sex-by-diagnosis interactions influencing the brain structural and functional correlates of disease expression in BD have received limited attention. Our data suggest that the sex of an individual modulates structure and function within subcortical and cortical regions implicated in disease expression.
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Affiliation(s)
- Jigar Jogia
- Department of Psychosis Studies, Section of Neurobiology of Psychosis, Institute of Psychiatry, King's College London, London, UK
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100
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Chang YH, Chen SL, Chen SH, Chu CH, Lee SY, Yang HF, Tzeng NS, Lee IH, Chen PS, Yeh TL, Huang SY, Chou KR, Yang YK, Ko HC, Lu RB, Angst J. Low anxiety disorder comorbidity rate in bipolar disorders in Han Chinese in Taiwan. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:194-7. [PMID: 21996277 DOI: 10.1016/j.pnpbp.2011.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/27/2011] [Accepted: 09/28/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Studies report high comorbidity of lifetime anxiety disorders with bipolar disorders in Western patients, but it is unclear in Taiwan. The authors explored the comorbidity of anxiety disorders in different bipolar disorder subtypes in Han Chinese in Taiwan. METHODS Three hundred twenty-five patients with bipolar disorder (bipolar I: 120; bipolar II: 205) disorder were recruited from two general medical outpatient services. They were evaluated and their diagnoses confirmed by a psychiatrist using the Chinese version of the Modified Schedule of Affective Disorder and Schizophrenia-Lifetime. The exclusion criteria were: any DSM-IV-TR Axis I diagnosis, other than bipolar disorder, being outside the 18-65-year-old age range, any other major and minor mental illnesses except anxiety disorder, any neurological disorders or organic mental disorders. RESULTS Thirty-two (26.7%) of patients were comorbid with lifetime anxiety disorder and bipolar I, 80 (39.0%) with lifetime anxiety disorder and bipolar II, 7 (5.8%) were comorbid with two or more anxiety disorders and bipolar I, and 27 (13.2%) with two or more anxiety disorders and bipolar II. CONCLUSION That more than twice as many bipolar II than bipolar I patients reported two or more anxiety disorders implies that the complication is more prevalent in bipolar II patients.
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Affiliation(s)
- Yun-Hsuan Chang
- Division of Clinical Psychology, Institute of Allied Health Sciences, Department of Psychiatry, College of Medicine, National Cheng Kung University, and National Cheng Kung University Hospital, Tainan, Taiwan
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