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Wang FY, McLaughlin KC, Schontz MJ, DeGrado JR, Dannemiller RE. Safety of Intravenous Push Valproate Compared with Intravenous Piggyback at a Tertiary Academic Medical Center. Clin Drug Investig 2024; 44:175-181. [PMID: 38363545 DOI: 10.1007/s40261-024-01349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Data are limited regarding the safety associated with administering valproate sodium by intravenous push (IVP) compared with intravenous piggyback (IVPB). The objective of this retrospective pre-post analysis was to compare the safety profile of valproate administration via IVPB from March to May 2022 and IVP from June to August 2022. METHODS A total of 890 IVPB and 440 IVP administrations were included. The major endpoint of this analysis was the incidence of infusion site reactions (infiltration or phlebitis). RESULTS The incidence of documented intravenous (IV) site reactions demonstrated minimal differences between both IVPB and IVP administration cohorts. Based on the Naranjo algorithm, all IVPB and IVP infusion site reactions were classified as possible or doubtful. Additional safety endpoints included bradycardia, hypotension, or sedation attributable to valproate sodium administration. Similar safety profiles were observed, including valproate-associated bradycardia, hypotension, and sedation events. All safety events were further classified as possible or doubtful by the Naranjo algorithm. Time from pharmacist verification to valproate administration was also collected. The mean time from pharmacist order verification to valproate administration was significantly faster in the IVP cohort compared to the IVPB cohort. CONCLUSION IVP valproate administration may be considered safe, allowing for more optimal clinical and operational outcomes in the acute care setting.
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Affiliation(s)
- Felicia Y Wang
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA.
| | - Kevin C McLaughlin
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
| | - Michael J Schontz
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
| | - Jeremy R DeGrado
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
| | - Robert E Dannemiller
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
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202
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Licht RW, Nielsen RE. A comment and correction. Bipolar Disord 2024; 26:191. [PMID: 38279682 DOI: 10.1111/bdi.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
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203
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Warner A, Lobban F, Holland C, Tyler E, Settle G, Rhodes V, Palmier-Claus J. What does it mean to age well with bipolar disorder? A qualitative study using photo elicitation. Psychol Psychother 2024; 97:104-121. [PMID: 37747114 DOI: 10.1111/papt.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The objective of this study is to explore what ageing well means to older adults with bipolar disorder. METHODS Older adults with bipolar disorder took photographs of aspects of their lives that they felt represented ageing well. They then completed audio-recorded photo elicitation interviews to explore what it meant to age well with bipolar disorder in detail. Data were analysed using reflexive thematic analysis. RESULTS Seventeen participants met the criteria for bipolar disorder I or II. The analysis resulted in four key themes to ageing well with bipolar disorder: (1) Lifelong learning - referring to how participants accumulated a wealth of knowledge about bipolar disorder and used this to maintain stability in later life; (2) Finding where you belong - relating to how participants prioritised finding new communities, utilised family support and refined their support networks over time to age well; (3) Recognising your value and worth - which involved participants using their strengths and experiences to support others; and (4) Continuity of support - older adults with bipolar disorder highlighted the benefits of continuous support that allowed them to be actively involved in their treatment. CONCLUSIONS Participants ageing with bipolar disorder identified unique challenges indicating that services require adaptation to meet their needs and support them to age well. Findings suggested that services should provide continuous care that allows this group to actively engage with their treatment, build upon their strengths, and develop meaningful connections with professionals and peers. This approach may enhance support for older adults with bipolar disorder and reduce the inequalities they experience.
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Affiliation(s)
- Aaron Warner
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, UK
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria Care NHS Foundation Trust, Preston, UK
| | - Carol Holland
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Elizabeth Tyler
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Geoff Settle
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Verity Rhodes
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria Care NHS Foundation Trust, Preston, UK
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204
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Miola A, Frye MA, Tondo L, Baldessarini RJ. Current Status and Treatment of Rapid Cycling Bipolar Disorder. J Clin Psychopharmacol 2024; 44:86-88. [PMID: 38230858 DOI: 10.1097/jcp.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Rapid cycling (RC) at least 4 recurrent episodes per year in bipolar disorder (BD) has been recognized since the 1970s. We now comment on our recent review of the topic and extensive RC analysis in a large clinical cohort, emphasizing therapeutics research. COMMENTS Prevalence of RC-BD averages 36% for any year versus 22% in the preceding year. Rapid cycling is not a consistent feature over many years, although average long-term, annual recurrence rates are greater in RC-BD patients. Risk of RC may be somewhat greater among women and with older ages. It is also associated with cyclothymic temperament, prominent depression, and mood-switching with antidepressant treatment and is associated with increased suicidal risk. Treatment of individual episodes in RC-BD and effective long-term prevention remain inadequately studied, although antidepressant treatment can worsen RC. Some research supports treatment with aripiprazole, lamotrigine, and lithium, and interest in second-generation antipsychotics is emerging. All such options are used in various inadequately evaluated combinations. CONCLUSIONS Rapid cycling is prevalent among BD patients but seems to vary in risk over time without evidence of progressive worsening. Treatment of acute episodes in RC-BD patients and effective long-term preventive management require much more intensive investigation.
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Affiliation(s)
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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205
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Herold M, Kovács GX, Herold R, Pótó Z, Fekete JD, Varga E, Hajnal A, Csulak T, Pethő B, Hebling D, Albert N, Tényi T. Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task. J Psychiatr Res 2024; 171:238-245. [PMID: 38316104 DOI: 10.1016/j.jpsychires.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Theory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder. METHOD 31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described. RESULTS In the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = -3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance. CONCLUSIONS Overall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.
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Affiliation(s)
- Márton Herold
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary.
| | - Gyöngyvér X Kovács
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Róbert Herold
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Zsuzsanna Pótó
- Institute of Physiotherapy and Sport Sciences, Faculty of Health Sciences, University of Pécs, Hungary
| | - Judit Diána Fekete
- Department of Languages for Biomedical Purposes and Communication, Medical School, University of Pécs, Hungary
| | - Eszter Varga
- Department of Pediatrics, Medical School, University of Pécs, Hungary
| | - András Hajnal
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Tímea Csulak
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Borbála Pethő
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Dóra Hebling
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Noémi Albert
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Hungary
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206
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Wu YK, Su YA, Li L, Zhu LL, Li K, Li JT, Mitchell PB, Yan CG, Si TM. Brain functional changes across mood states in bipolar disorder: from a large-scale network perspective. Psychol Med 2024; 54:763-774. [PMID: 38084586 DOI: 10.1017/s0033291723002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND Exploring the neural basis related to different mood states is a critical issue for understanding the pathophysiology underlying mood switching in bipolar disorder (BD), but research has been scarce and inconsistent. METHODS Resting-state functional magnetic resonance imaging data were acquired from 162 patients with BD: 33 (hypo)manic, 64 euthymic, and 65 depressive, and 80 healthy controls (HCs). The differences of large-scale brain network functional connectivity (FC) between the four groups were compared and correlated with clinical characteristics. To validate the generalizability of our findings, we recruited a small longitudinal independent sample of BD patients (n = 11). In addition, we examined topological nodal properties across four groups as exploratory analysis. RESULTS A specific strengthened pattern of network FC, predominantly involving the default mode network (DMN), was observed in (hypo)manic patients when compared with HCs and bipolar patients in other mood states. Longitudinal observation revealed an increase in several network FCs in patients during (hypo)manic episode. Both samples evidenced an increase in the FC between the DMN and ventral attention network, and between the DMN and limbic network (LN) related to (hypo)mania. The altered network connections were correlated with mania severity and positive affect. Bipolar depressive patients exhibited decreased FC within the LN compared with HCs. The exploratory analysis also revealed an increase in degree in (hypo)manic patients. CONCLUSIONS Our findings identify a distributed pattern of large-scale network disturbances in the unique context of (hypo)mania and thus provide new evidence for our understanding of the neural mechanism of BD.
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Affiliation(s)
- Yan-Kun Wu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Le Li
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Center for Cognitive Science of Language, Beijing Language and Culture University, Beijing, China
| | - Lin-Lin Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ke Li
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Ji-Tao Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Chao-Gan Yan
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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207
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Rowe AL, Perich T, Meade T. Bipolar disorder and cumulative trauma: A systematic review of prevalence and illness outcomes. J Clin Psychol 2024; 80:692-713. [PMID: 38277425 DOI: 10.1002/jclp.23650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/24/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND The experience of cumulative trauma may be common in bipolar disorder (BD). However, it is not frequently reported as most studies focus on childhood trauma without examining differences in the amount of trauma experienced. This systematic review aimed to determine the prevalence of lifetime cumulative trauma in BD as well as explore associated illness outcomes. METHODS A systematic review was completed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both the prevalence and outcomes of cumulative trauma in BD were assessed. Five electronic databases were searched (Embase, MEDLINE, PsycINFO, Web of Science, and PTSD Pubs) for records from January 2010 until December 2022. RESULTS A total of 20 studies, with 9304 participants were included in the narrative synthesis. At least one-third of BD participants had experienced cumulative trauma, with a prevalence range from 29% to 82%. The main outcomes associated with a history of cumulative trauma were earlier age of onset, longer episode duration, more lifetime mood episodes, greater likelihood of experiencing psychotic features, and higher likelihood of past suicide attempts. LIMITATIONS This review has been limited by the lack of studies directly assessing cumulative trauma in BD. CONCLUSIONS Cumulative trauma is prevalent in BD. Preliminary evidence indicates an association with a range of adverse outcomes, emphasizing the need for clinicians to obtain a detailed trauma history and to consider these risks in the management of the disorder. Future studies should report on the prevalence of cumulative trauma, particularly in adulthood as this area remains unexplored.
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Affiliation(s)
- Amy-Leigh Rowe
- School of Psychology, Western Sydney University, Penrith, Australia
| | - Tania Perich
- School of Psychology, Western Sydney University, Penrith, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Penrith, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Godin O, Olié E, Fond G, Aouizerate B, Aubin V, Bellivier F, Belzeaux R, Courtet P, Dubertret C, Haffen E, Lefrere A, Llorca PM, Polosan M, Roux P, Samalin L, Schwan R, Leboyer M, Etain B. Incidence and predictors of metabolic syndrome onset in individuals with bipolar disorders: A longitudinal study from the FACE-BD cohort. Acta Psychiatr Scand 2024; 149:207-218. [PMID: 38268142 DOI: 10.1111/acps.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a cluster of components including abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. MetS is highly prevalent in individuals with bipolar disorders (BD) with an estimated global rate of 32.6%. Longitudinal data on incident MetS in BD are scarce and based on small sample size. The objectives of this study were to estimate the incidence of MetS in a large longitudinal cohort of 1521 individuals with BD and to identify clinical and biological predictors of incident MetS. METHODS Participants were recruited from the FondaMental Advanced Center of Expertise for Bipolar Disorder (FACE-BD) cohort and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Individuals without MetS at baseline but with MetS during follow-up were considered as having incident MetS. A logistic regression model was performed to estimate the adjusted odds ratio and its corresponding 95% confidence interval (CI) for an association between each factor and incident MetS during follow-up. We applied inverse probability-of-censoring weighting method to minimize selection bias due to loss during follow-up. RESULTS Among individuals without MetS at baseline (n = 1521), 19.3% developed MetS during follow-up. Multivariable analyses showed that incident MetS during follow-up was significantly associated with male sex (OR = 2.2, 95% CI = 1.7-3.0, p < 0.0001), older age (OR = 2.14, 95% CI = 1.40-3.25, p = 0.0004), presence of a mood recurrence during follow-up (OR = 1.91, 95% CI = 1.22-3.00, p = 0.0049), prolonged exposure to second-generation antipsychotics (OR = 1.56, 95% CI = 0.99, 2.45, p = 0.0534), smoking status at baseline (OR = 1.30, 95% CI = 1.00-1.68), lifetime alcohol use disorders (OR = 1.33, 95% CI = 0.98-1.79), and baseline sleep disturbances (OR = 1.04, 95% CI = 1.00-1.08), independently of the associations observed for baseline MetS components. CONCLUSION We observed a high incidence of MetS during a 3 years follow-up (19.3%) in individuals with BD. Identification of predictive factors should help the development of early interventions to prevent or treat early MetS.
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Affiliation(s)
- O Godin
- Fondation FondaMental, Créteil, France
- INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Université Paris Est Créteil, Créteil, France
| | - E Olié
- Fondation FondaMental, Créteil, France
- Department of Emergency Psychiatry and Acute Care, IGF, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - G Fond
- Fondation FondaMental, Créteil, France
- AP-HM, Academic Department of Psychiatry, Resistant Depression Expert Center (FondaMental Foundation), CHU La Conception, Aix-Marseille University, Marseille, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Charles Perrens, Pôle de Psychiatrie Générale et Universitaire, Laboratoire NutriNeuro (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - V Aubin
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
- Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Paris, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France
- University of Montpellier & Department of Psychiatry, CHU de Montpellier, Montpellier, France
| | - P Courtet
- Fondation FondaMental, Créteil, France
- Department of Emergency Psychiatry and Acute Care, IGF, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France
- AHPH, Departement de Psychiatrie, Hopital Louis Mourier, Colombes, France
| | - E Haffen
- Fondation FondaMental, Créteil, France
- UR 481 LINC, Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Université de Franche-Comté, Besançon, France
| | - A Lefrere
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - M Polosan
- Fondation FondaMental, Créteil, France
- University of Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - P Roux
- Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adulte et d'Addictologie, Le Chesnay, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - L Samalin
- Fondation FondaMental, Créteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - R Schwan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Inserm U1254, Université de Lorraine, Nancy, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France
- INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Université Paris Est Créteil, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMUIMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - B Etain
- Fondation FondaMental, Créteil, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
- Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Paris, France
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Yilgör A, Kurhan F. Is Childhood Trauma a Risk Factor for Resistant Epilepsy? JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1228-1244. [PMID: 37815052 DOI: 10.1177/08862605231203964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Childhood traumas have been considered risk factors for many psychiatric disorders. Recent studies demonstrated that childhood traumas can also be considered risk factors for neurological diseases. In this context, the objective of this study is to investigate the effects of childhood traumas on treatment resistance in patients with epilepsy. The study sample consisted of 85 epilepsy patients, 40 male and 45 female, who were diagnosed and followed up by a neurologist. Of these patients, 45 were being followed up with the diagnosis of refractory epilepsy, and 40 were being followed up with the diagnosis of treatment-responsive epilepsy. Cranial magnetic resonance imaging and electroencephalography were performed on all patients. In addition, all patients were administered childhood trauma questionnaire (CTQ) and Hamilton depression rating scale (HAM-D). Epilepsy patients included in the study were divided into refractory epilepsy and treatment-responsive epilepsy groups. There was no significant difference between the groups in sociodemographic characteristics. On the other hand, total CTQ and all CTQ subscale scores and HAM-D scores were significantly higher in the refractory epilepsy group than in the treatment-responsive epilepsy group. This study demonstrates that childhood traumas may contribute to treatment resistance in epilepsy patients. Therefore, it is recommended that a history of childhood traumas be routinely queried in the treatment of epilepsy patients.
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Affiliation(s)
- Abdullah Yilgör
- Faculty of Medicine, Department of Neurology, Van Yuzuncu Yil University, Turkey
| | - Faruk Kurhan
- Faculty of Medicine, Department of Psychiatry, Van Yuzuncu Yil University, Turkey
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210
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O'Connor H, Hutt Vater C, DiSalvo M, Faraone SV, Wozniak J. Stimulant Treatment and Potential Adverse Outcomes in Pediatric Populations With Bipolar Disorder: A Systematic Review of the Literature. J Atten Disord 2024; 28:740-750. [PMID: 38156605 DOI: 10.1177/10870547231218045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To explore outcomes of stimulant treatment for ADHD in pediatric populations with particular attention to bipolar disorder (BPD). METHOD We conducted a literature search of PubMed articles published prior to August 25, 2022 that focused on BPD, mania, and psychosis prior to, or as result of, stimulant treatment. We excluded studies: (1) unrelated to stimulants, (2) general stimulant research, (3) articles older than 40 years, (4) study protocols, or (5) case reports. RESULTS A total of 11 articles met all inclusion/exclusion criteria. Some reports found stimulant treatment safe and well-tolerated in children with comorbid BPD and ADHD. Others found evidence of treatment-emergent mania (TEM), discontinuation, and other adverse events with stimulant treatment. CONCLUSION Poor outcomes associated with stimulant treatment in pediatric populations with BPD necessitate work to identify patients at risk of serious stimulant-related adverse events. Our results were limited by automated search filters and a pediatric, primarily male sample.
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Affiliation(s)
| | | | | | | | - Janet Wozniak
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Bertocci MA, Rozovsky R, Wolfe M, Abdul-Waalee H, Chobany M, Malgireddy G, Hart JA, Skeba A, Brady T, Lepore B, Versace A, Chase HW, Birmaher B, Phillips ML, Diler RS. Neural markers of mania that distinguish inpatient adolescents with bipolar disorder from those with other psychopathology. Psychiatry Res 2024; 333:115747. [PMID: 38301286 PMCID: PMC10922873 DOI: 10.1016/j.psychres.2024.115747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
Pediatric bipolar disorder (BD) is difficult to distinguish from other psychiatric disorders, a challenge which can result in delayed or incorrect interventions. Using neuroimaging we aimed to identify neural measures differentiating a rarified sample of inpatient adolescents with BD from other inpatient psychopathology (OP) and healthy adolescents (HC) during a reward task. We hypothesized reduced subcortical and elevated cortical activation in BD relative to other groups, and that these markers will be related to self-reported mania scores. We examined inpatient adolescents with diagnosis of BD-I/II (n = 29), OP (n = 43), and HC (n = 20) from the Inpatient Child and Adolescent Bipolar Spectrum Imaging study. Inpatient adolescents with BD showed reduced activity in right thalamus, left thalamus, and left amygdala, relative to inpatient adolescents with OP and HC. This reduced neural function explained 21% of the variance in past month and 23% of the variance in lifetime mania scores. Lower activity in regions associated with the reward network, during reward processing, differentiates BD from OP in inpatient adolescents and explains >20% of the variance in mania scores. These findings highlight potential targets to aid earlier identification of, and guide new treatment developments for, pediatric BD.
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Affiliation(s)
- Michele A Bertocci
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA.
| | - Renata Rozovsky
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA
| | - Maria Wolfe
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | | | - Mariah Chobany
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | | | - Jonathan A Hart
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Alex Skeba
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Tyler Brady
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Brianna Lepore
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA
| | - Henry W Chase
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA
| | - Rasim S Diler
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Avenue, 120 Loeffler Building, Pittsburgh, PA 15213, USA; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
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212
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Falchi-Carvalho M, Wießner I, Silva SRB, O Maia L, Barros H, Laborde S, Arichelle F, Tullman S, Silva-Costa N, Assunção A, Almeida R, Pantrigo ÉJ, Bolcont R, Costa-Macedo JV, Arcoverde E, Galvão-Coelho N, Araujo DB, Palhano-Fontes F. Safety and tolerability of inhaled N,N-Dimethyltryptamine (BMND01 candidate): A phase I clinical trial. Eur Neuropsychopharmacol 2024; 80:27-35. [PMID: 38141403 DOI: 10.1016/j.euroneuro.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
Psychedelics are being increasingly examined for their therapeutic potential in mood disorders. While the acute effects of ayahuasca, psilocybin, and lysergic acid diethylamide (LSD) last over several hours, inhaled N,N-Dimethyltryptamine (DMT) effects last around 10 min, which might provide a cost- and time-effective alternative to the clinical application of oral psychedelics. We aimed at investigating the safety and tolerability of inhaled DMT (BMND01 candidate). We recruited 27 healthy volunteers to receive a first, lower dose and a second, higher dose (5/20 mg, 7.5/30 mg, 10/40 mg, 12.5/50 mg, or 15/60 mg) of inhaled DMT in an open-label, single-ascending, fixed-order, dose-response study design. We investigated subjective experiences (intensity, valence, and phenomenology), physiological effects (blood pressure, heart rate, respiratory rate, blood oxygen saturation, body temperature), biochemical markers (liver, kidney, and metabolic functions), and adverse events during the acute and post-acute effects of DMT. DMT dose-dependently increased intensity, valence and perceptual ratings. There was a mild, transient, and self-limited increase in blood pressure and heart rate. There were no changes in safety blood biomarkers and no serious adverse events. DMT dose-dependently enhanced subjective experiences and positive valence. Inhaled DMT might be an efficient, non-invasive, safe route of administration, which might simplify the clinical use of this substance. This is the first clinical trial to test the effects of inhaled DMT (BMND01 candidate).
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Affiliation(s)
- Marcelo Falchi-Carvalho
- Biomind Labs, Brookfield Place, 181 Bay Street, Suite 1800, Toronto, ON M5J 2T9, Canada; Department of Clinical Medicine, Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Isabel Wießner
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sérgio Ruschi B Silva
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucas O Maia
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Handersson Barros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sophie Laborde
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Flávia Arichelle
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sam Tullman
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Natan Silva-Costa
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Aline Assunção
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Raissa Almeida
- Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Érica J Pantrigo
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Raynara Bolcont
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Emerson Arcoverde
- University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Nicole Galvão-Coelho
- Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Draulio B Araujo
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Fernanda Palhano-Fontes
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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213
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Guidetti C, Serra G, Apicella M, Andracchio E, Iannoni ME, Trasolini M, Della Santa G, Maglio G, Vicari S. Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence. J Atten Disord 2024; 28:648-663. [PMID: 38327097 DOI: 10.1177/10870547231225819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To identify childhood psychopathological features that predict the onset of adolescent Bipolar (BD) versus Unipolar Major Depressive Disorder (UD) during adolescence. METHOD We analyzed clinical data from 495 juveniles diagnosed with DSM-5 UD (n = 359), and BD (n = 136), using bivariate analysis and multivariate logistic regression model. RESULTS BD subjects exhibited earlier onset of any psychiatric feature compared to UD. Antecedents associated with later BD were: oppositional defiant > specific phobias > ADHD > obsessive compulsive (OCD). Antecedents selectively associated with later UD were: social anxiety and separation anxiety. Factors significantly and independently associated with later BD diagnosis were: [a] emotional dysregulation at onset of the mood disorder; [b] first depressive episode with mixed features; [c] antecedent ADHD; [d] antecedent OCD, and [e] antecedent oppositional-defiance. CONCLUSION Identifying developmental differences in BD and UD symptoms can aid clinicians in early identification and treatment planning for bipolar disorder in youth.
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Affiliation(s)
- Clotilde Guidetti
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giulia Serra
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Apicella
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisa Andracchio
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Elena Iannoni
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Monia Trasolini
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Della Santa
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gino Maglio
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
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214
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Russell SE, Wrobel AL, Lotfaliany M, Ashton MM, Kaur R, Yocum AK, Duval ER, Diaz-Byrd C, Ehrlich TJ, Marshall DF, Berk M, McInnis MG, Dean O, Turner A. Trauma and comorbid post-traumatic stress disorder in people with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study. J Affect Disord 2024; 348:275-282. [PMID: 38163569 DOI: 10.1016/j.jad.2023.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND It is estimated that up to 50 % of people with bipolar disorder (BD) also have comorbid post-traumatic stress disorder (PTSD). However, little is known about the presentation and treatment of people with this comorbidity. METHODS Data from 577 individuals diagnosed with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study of BD were explored at baseline, year two and four. Three trauma groups were created: (i) one trauma (n = 75), (ii) multiple traumas (n = 417), and comorbid PTSD (n = 85). Measures of depression, mania, sleep, number of hospitalisations, suicide attempts, and medication use were analysed using regression modelling to determine differences between the three trauma groups. RESULTS There was an increase in depression, mania, and sleep scores and a higher number of hospitalisations in participants with comorbid PTSD compared to those experiencing one trauma. Additionally, increased mania and depression scores were reported in participants experiencing multiple traumas compared to those with one trauma. There was no difference in medication use between those who experienced one trauma compared to those with comorbid PTSD. LIMITATIONS The trauma groups may include confounding with more participants experiencing PTSD than reported in this study due to screening processes. Additionally, the severity of trauma was not recorded, therefore number of traumas was utilised as a proxy. CONCLUSION Comorbid BD and PTSD is associated with worse symptom scores compared to participants reporting one trauma. Clinical implications include the addition of trauma-informed care to clinical settings to identify PTSD to provide appropriate treatments.
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Affiliation(s)
- Samantha E Russell
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Orygen, Parkville, Victoria, Australia
| | - Mojtaba Lotfaliany
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Melanie M Ashton
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Ravleen Kaur
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tobin J Ehrlich
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Orygen, Parkville, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Olivia Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, Australia
| | - Alyna Turner
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan 2308, Australia.
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215
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Shuy YK, Santharan S, Chew QH, Lin SK, Ouyang WC, Chen CK, Park SC, Jang OJ, Park JH, Chee KY, Ding KS, Chong J, Zhang L, Li K, Zhu X, Jatchavala C, Pariwatcharakul P, Kallivayalil RA, Grover S, Avasthi A, Ansari M, Maramis MM, Aung PP, Tan CH, Xiang YT, Chong MY, Park YC, Kato TA, Shinfuku N, Baldessarini RJ, Sim K. Pharmacoepidemiology and Clinical Correlates of Lithium Treatment for Bipolar Disorder in Asia. J Clin Psychopharmacol 2024; 44:117-123. [PMID: 38230861 DOI: 10.1097/jcp.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND As clinical practices with lithium salts for patients diagnosed with bipolar disorder (BD) are poorly documented in Asia, we studied the prevalence and clinical correlates of lithium use there to support international comparisons. METHODS We conducted a cross-sectional study of use and dosing of lithium salts for BD patients across 13 Asian sites and evaluated bivariate relationships of lithium treatment with clinical correlates followed by multivariate logistic regression modeling. RESULTS In a total of 2139 BD participants (52.3% women) of mean age 42.4 years, lithium salts were prescribed in 27.3% of cases overall, varying among regions from 3.20% to 59.5%. Associated with lithium treatment were male sex, presence of euthymia or mild depression, and a history of seasonal mood change. Other mood stabilizers usually were given with lithium, often at relatively high doses. Lithium use was associated with newly emerging and dose-dependent risk of tremors as well as risk of hypothyroidism. We found no significant differences in rates of clinical remission or of suicidal behavior if treatment included lithium or not. CONCLUSIONS Study findings clarify current prevalence, dosing, and clinical correlates of lithium treatment for BD in Asia. This information should support clinical decision-making regarding treatment of BD patients and international comparisons of therapeutic practices.
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Affiliation(s)
- Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sanjana Santharan
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Chih-Ken Chen
- Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | | | - Ok-Jin Jang
- Department of Psychiatry, Bugok National Hospital, Changnyong, South Korea
| | - Jun Hyuk Park
- Jeju National University Hospital, Jeju University School of Medicine, Jeju, South Korea
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Kwong Sen Ding
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan, Malasia
| | - Jamaline Chong
- Hospital Permai Johor Bahru, Ministry of Health, Johor Bahru, Malaysia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Baoding, Hebei, China
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Margarita M Maramis
- Department of Psychiatry, Dr Soetomo Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Paing Phyo Aung
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Chay Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | | | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | | | - Kang Sim
- West Region, Institute of Mental Health, Singapore
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216
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Vahapoğlu B, Aksoy Poyraz C, Özdemir A. Psychosocial Impairment in Older Patients With Bipolar I Disorder. J Psychiatr Pract 2024; 30:147-156. [PMID: 38526403 DOI: 10.1097/pra.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The goal of this study was to assess psychosocial functioning in older patients with bipolar I disorder compared with healthy subjects and to identify the psychopathological factors associated with poor functioning in patients. METHODS We recruited 68 euthymic patients with bipolar I disorder from the outpatient unit and 89 healthy controls who were older than 50 years of age. In addition to clinical variables, we used other standardized measures, including the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment Short Test, and the Montreal Cognitive Assessment. RESULTS Older patients with bipolar I disorder had poorer psychosocial functioning in general and in the domains of occupation, autonomy, and cognition than the healthy controls on the basis of previously defined Functional Assessment Short Test cutoff scores. We found that 35.3% (95% CI: 23%-47%) of the patients did not have clinically significant functional impairment, 38.2% (95% CI: 26%-50%) had mild impairment, and 26.5% (95% CI: 16%-37%) had moderate impairment. Depressive symptoms and impaired cognition were associated with poor overall functioning. CONCLUSIONS The level of psychosocial functioning was heterogeneous among the patients. Subsyndromal depressive symptoms, even at low levels, and impaired cognition predicted poor functioning in euthymic middle-aged and older patients with bipolar I disorder.
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Affiliation(s)
- Berkay Vahapoğlu
- VAHAPOĞLU and ÖZDEMIR: Bakirköy Mazhar Osman Bakirköy Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey; POYRAZ: Department of Psychiatry, İstanbul University-Cerrahpaşa Medical School, Istanbul, Turkey
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217
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Kadriu B, Deng ZD, Kraus C, Johnston JN, Fijtman A, Henter ID, Kasper S, Zarate CA. The impact of body mass index on the clinical features of bipolar disorder: A STEP-BD study. Bipolar Disord 2024; 26:160-175. [PMID: 37536999 PMCID: PMC10839568 DOI: 10.1111/bdi.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The effects of body mass index (BMI) on the core symptoms of bipolar disorder (BD) and its implications for disease trajectory are largely unexplored. OBJECTIVE To examine whether BMI impacted hospitalization rate, medical and psychiatric comorbidities, and core symptom domains such as depression and suicidality in BD. METHODS Participants (15 years and older) were 2790 BD outpatients enrolled in the longitudinal STEP-BD study; all met DSM-IV criteria for BD-I, BD-II, cyclothymia, BD NOS, or schizoaffective disorder, bipolar subtype. BMI, demographic information, psychiatric and medical comorbidities, and other clinical variables such as bipolarity index, history of electroconvulsive therapy (ECT), and history of suicide attempts were collected at baseline. Longitudinal changes in Montgomery-Åsberg Depression Rating Scale (MADRS) score, Young Mania Rating Scale (YMRS) score, and hospitalizations during the study were also assessed. Depending on the variable of interest, odds-ratios, regression analyses, factor analyses, and graph analyses were applied. RESULTS A robust increase in psychiatric and medical comorbidities was observed, particularly for baseline BMIs >35. A significant relationship was noted between higher BMI and history of suicide attempts, and individuals with BMIs >40 had the highest prevalence of suicide attempts. Obese and overweight individuals had a higher bipolarity index (a questionnaire measuring disease severity) and were more likely to have received ECT. Higher BMIs correlated with worsening trajectory of core depression symptoms and with worsening lassitude and inability to feel. CONCLUSIONS In BD participants, elevated BMI was associated with worsening clinical features, including higher rates of suicidality, comorbidities, and core depression symptoms.
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Affiliation(s)
- Bashkim Kadriu
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Zhi-De Deng
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Christoph Kraus
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
- Department of Psychiatry and Psychotherapy, Medical
University of Vienna, Vienna, Austria
| | - Jenessa N. Johnston
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
- Division of Medical Sciences, University of Victoria,
Victoria, BC, Canada
| | - Adam Fijtman
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Ioline D. Henter
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Siegfried Kasper
- Center for Brain Research Department of Molecular
Neuroscience, Medical University of Vienna, Vienna, Austria
| | - Carlos A. Zarate
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
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218
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De Prisco M, Tapoi C, Oliva V, Possidente C, Strumila R, Takami Lageborn C, Bracco L, Girone N, Macellaro M, Vieta E, Fico G. Clinical features in co-occuring obsessive-compulsive disorder and bipolar disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2024; 80:14-24. [PMID: 38128332 DOI: 10.1016/j.euroneuro.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Obsessive-compulsive disorder (OCD) frequently co-occurs with various psychiatric conditions and may impact as many as one-fifth of individuals diagnosed with bipolar disorder (BD). Despite the expanding body of literature on the coexistence of OCD and BD, there is a notable lack of comprehensive data pertaining to the distinct features of obsessive-compulsive symptoms that define this comorbidity. To bridge this knowledge gap, we conducted a systematic search of PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO until August 7th, 2023. We performed random-effects meta-analyses to compare individuals with both OCD and BD to those with OCD in terms of OCD symptomatology as well as the specific categories of obsessions and compulsions. Out of the 10,393 records initially screened, 17 studies were ultimately incorporated into the qualitative assessment, with 15 of them being included in the quantitative analysis. Individuals with OCD and BD experienced fewer lifetime contamination obsessions (OR=0.71; 95 %CI=0.53, 0.95; p = 0.021) and more sexual obsessions (OR=1.77; 95 %CI=1.03, 3.04; p = 0.04) compared to individuals with OCD without BD. No significant difference was observed for other types of obsessions or compulsions or for the severity of OCD symptoms, although BD type may play a role according to meta-regression analyses. The detection of the presence of sexual or contamination obsessions through a detailed interview may be the focus of clinical attention when assessing OCD in the context of comorbid BD. Sub-phenotyping complex clinical presentation of comorbid psychiatric disorders can aid in making more informed decisions when choosing an appropriate treatment approach.
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Affiliation(s)
- Michele De Prisco
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristiana Tapoi
- Department of Psychiatry, Professor Dr. Dimitrie Gerota Emergency Hospital, Bucharest, Romania
| | - Vincenzo Oliva
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Possidente
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier 34000, France; Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France; Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | | | - Lorenzo Bracco
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
| | - Nicolaja Girone
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Milan, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Milan, Italy
| | - Eduard Vieta
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Giovanna Fico
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences (ICN), Universitat de Barcelona (UB), C. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, C. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, Barcelona 08036, Spain
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Samalin L, Boudieu L, Llorca PM. Evaluating the efficacy and safety of the currently available once-every-two months long-acting injectable formulations of aripiprazole for the treatment of schizophrenia or as a maintenance monotherapy for bipolar I disorder in adults. Expert Rev Neurother 2024; 24:291-298. [PMID: 38299536 DOI: 10.1080/14737175.2024.2313550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION An aripiprazole long-acting injectable (LAI) antipsychotic is now available for gluteal administration every 2 months via two different formulations: aripiprazole lauroxil (AL) and aripiprazole monohydrate (Ari 2MRTU). These longer dosing regimens of aripiprazole LAI offer new potential benefits for patients. AREAS COVERED The authors review the evidence supporting the efficacy and safety of aripiprazole LAIs given every 2 months for the treatment of schizophrenia or bipolar disorder (BD) in adults. The article culminates with the authors' expert perspectives on the subject. EXPERT OPINION AL 1064 mg every 2 months has established efficacy for the treatment of schizophrenia based on pharmacokinetic bridging studies and prospective data for treatment of an acute exacerbation of schizophrenia. In an open-label trial, Ari 2MRTU showed efficacy for the treatment of schizophrenia and BD type I based on pharmacokinetic parameters (comparable to aripiprazole once-monthly 400 mg); it also showed efficacy regarding the secondary endpoints. Multiple doses of AL 1064 mg or Ari 2MRTU 960 mg are generally well tolerated, in line with the safety profile of oral aripiprazole, with the exception of the injection-site reactions. While AL may require a 1-day initiation regimen, Ari 2MRTU 960 covers all the recommended doses of oral aripiprazole (10-20 mg).
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Affiliation(s)
- Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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Wicki B, Vienneau D, Schäffer B, Müller TJ, Raub U, Widrig J, Pervilhac C, Röösli M. Acute effects of military aircraft noise on sedative and analgesic drug administrations in psychiatric patients: A case-time series analysis. ENVIRONMENT INTERNATIONAL 2024; 185:108501. [PMID: 38368719 DOI: 10.1016/j.envint.2024.108501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Existing evidence suggests that psychiatric patients are highly noise sensitive, and that noise exposure increases the risk for adverse mental health outcomes, such as psychiatric hospitalizations and even suicide. To investigate acute effects of noise in this vulnerable population, we assessed short-term associations between fighter jet noise and on-demand sedative and analgesic drug administrations in a psychiatric clinic located close to a military airfield in Switzerland. METHODS We applied a case time series analysis with an hourly time resolution using distributed-lag models. Analysis was adjusted for long-term and seasonal trends, day of week, time of day, time-varying weather conditions and the week of stay. Noise exposure (hourly A-weighted equivalent continuous sound pressure levels (LAeq)) was modelled using detailed flight plans and noise footprints for different fighter jet and route combinations. Outcome data were available from the clinic's records. OUTCOMES During the study period (06/2016-12/2021), 23,486 flights occurred. 5,968 clinical stays with a median length of 41 days (IQR: 28d, 50d) were recorded. The odds ratio (OR) for medication administration over the lag period of 3 hours after exposure was 1.016 (95 %CI: 1.006, 1.026) per 10 dB LAeq for sedatives and 1.032 (95 %CI: 1.016, 1.048) per 10 dB for analgesics. Effects were larger in multimorbid patients. INTERPRETATION Case time series analysis is a novel method to investigate transient associations in observational data while minimizing risk of bias. Using an objectively recorded outcome measure, our results demonstrate that psychiatric patients are a vulnerable population, in which noise exposure can lead to symptom exacerbations and adverse events.
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Affiliation(s)
- Benedikt Wicki
- Swiss TPH (Swiss Tropical and Public Health Institute), Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Danielle Vienneau
- Swiss TPH (Swiss Tropical and Public Health Institute), Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Beat Schäffer
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - Thomas J Müller
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy University of Bern, Bern, Switzerland; Private Clinic Meiringen, Meiringen, Switzerland
| | - Ulrich Raub
- Private Clinic Meiringen, Meiringen, Switzerland
| | | | - Charlotte Pervilhac
- Private Clinic Meiringen, Meiringen, Switzerland; Institute of Psychology, Health Psychology and Behavioural Medicine, University of Bern, Bern, Switzerland
| | - Martin Röösli
- Swiss TPH (Swiss Tropical and Public Health Institute), Allschwil, Switzerland; University of Basel, Basel, Switzerland
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McIntyre RS, Bubolic S, Zhang Z, MacKenzie EM, Therrien F, Miguelez M, Boucher M. Effects of Adjunctive Brexpiprazole on Individual Depressive Symptoms and Functioning in Patients With Major Depressive Disorder and Anxious Distress: Post Hoc Analysis of Three Placebo-Controlled Studies. J Clin Psychopharmacol 2024; 44:133-140. [PMID: 38421922 DOI: 10.1097/jcp.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE/BACKGROUND Anxiety symptoms in major depressive disorder (MDD) are frequent, and they decrease response to antidepressant treatment (ADT), and affect patient functioning. This post hoc analysis examined the efficacy of adjunctive brexpiprazole on individual depressive symptoms and functioning in patients with MDD with anxious distress. METHODS/PROCEDURES Data were included from three 6-week, randomized, double-blind, placebo-controlled studies of adjunctive brexpiprazole in patients with MDD and inadequate response to ADTs (ClinicalTrials.gov identifiers: NCT01360645, NCT01360632, NCT02196506). Patients were stratified using proxy criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, anxious distress. Changes in Montgomery-Åsberg Depression Rating Scale item scores and Sheehan Disability Scale mean score from baseline to week 6 were determined for ADT + brexpiprazole (2 and 2-3 mg) versus ADT + placebo. FINDINGS/RESULTS At baseline, 450 of 746 patients (60.3%, 2 mg analysis) and 670 of 1162 patients (57.7%, 2-3 mg analysis) had anxious distress. In patients with anxious distress, ADT + brexpiprazole 2 mg or 2 to 3 mg showed greater improvements than ADT + placebo (P < 0.05) on the Montgomery-Åsberg Depression Rating Scale items of apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, lassitude, inability to feel, and pessimistic thoughts (Cohen d effect sizes, 0.18-0.44), and on Sheehan Disability Scale mean score (effect sizes, 0.21-0.23). IMPLICATIONS/CONCLUSIONS Adjunctive brexpiprazole is efficacious in reducing core depressive symptoms, sleep, and appetite, as well as improving functioning, in patients with MDD and anxious distress who have inadequate response to ADTs.
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Affiliation(s)
- Roger S McIntyre
- From the Brain and Cognition Discovery Foundation and University of Toronto, Toronto, ON, Canada
| | - Suzy Bubolic
- Otsuka Canada Pharmaceutical Inc, Saint-Laurent, QC, Canada
| | - Zhen Zhang
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
| | | | | | - Maia Miguelez
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
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Beunders AJM, Regeer EJ, van Eijkelen M, Mathijssen H, Nijboer C, Schouws SNTM, van Oppen P, Kok AAL, Kupka RW, Dols A. Bipolarity in Older individuals Living without Drugs (BOLD): Protocol and preliminary findings. J Affect Disord 2024; 348:160-166. [PMID: 38154581 DOI: 10.1016/j.jad.2023.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/01/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Although clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment. METHODS The mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed. RESULTS BD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning. LIMITATIONS Our findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias. CONCLUSION A group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).
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Affiliation(s)
- Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Eline J Regeer
- Altrecht GGZ Mental Health Care Institute, Outpatient Clinic for Bipolar Disorders, Utrecht, the Netherlands
| | - Marieke van Eijkelen
- Plusminus (Dutch Patient Association for Bipolar Disorder); MIND (Dutch online platform for mental health), Utrecht, the Netherlands
| | - Henk Mathijssen
- Plusminus (Dutch Patient Association for Bipolar Disorder); MIND (Dutch online platform for mental health), Utrecht, the Netherlands
| | | | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
| | - Patricia van Oppen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Almar A L Kok
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Ralph W Kupka
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Altrecht GGZ Mental Health Care Institute, Outpatient Clinic for Bipolar Disorders, Utrecht, the Netherlands
| | - Annemiek Dols
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress, Amsterdam, the Netherlands.
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Blanken MAJT, Oudega ML, Almeida OP, Schouws SNTM, Orhan M, Beunders AJM, Klumpers UMH, Sonnenberg C, Blumberg HP, Eyler LT, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Rajji T, Rej S, Sarna K, Sutherland A, Yala J, Vieta E, Tsai S, Briggs FBS, Sajatovic M, Dols A. Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project. Am J Geriatr Psychiatry 2024; 32:326-338. [PMID: 37981507 DOI: 10.1016/j.jagp.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Sex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. METHODS This Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. RESULTS Regarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. CONCLUSION Our findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.
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Affiliation(s)
- Machteld A J T Blanken
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Mardien L Oudega
- Department of Psychiatry (MLO), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam Public Health, Mental Health Program, GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Osvaldo P Almeida
- Medical School (OPA), University of Western Australia, Perth, Australia
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Melis Orhan
- Department of Clinical Psychology (MO), Leiden University, Leiden, The Netherlands
| | - Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Ursula M H Klumpers
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Caroline Sonnenberg
- GGZ Parnassia NH, Specialized Mental Health Care (CS), Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry (HPB), Yale School of Medicine, New Haven, CT
| | - Lisa T Eyler
- Department of Psychiatry (LTE), University of California San Diego, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA
| | - Brent P Forester
- Division of Geriatric Psychiatry (BPF), McLean Hospital, Harvard Medical School, Boston, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry (OVF), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry (AG), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benoit H Mulsant
- Department of Psychiatry (BHM) and Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division (TR), Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine (KS), Cleveland, OH
| | - Ashley Sutherland
- Department of Psychiatry (AS), University of California San Diego, San Diego, CA
| | - Joy Yala
- Case Western Reserve University School of Medicine (JY), Cleveland, OH
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit (EV), Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Shangying Tsai
- Department of Psychiatry (ST), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Farren B S Briggs
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Annemiek Dols
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands; Department of Psychiatry (AD), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Nguata M, Orwa J, Kigen G, Kamaru E, Emonyi W, Kariuki S, Newton C, Ongeri L, Mwende R, Gichuru S, Atwoli L. Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study. Front Psychiatry 2024; 15:1301976. [PMID: 38501084 PMCID: PMC10945606 DOI: 10.3389/fpsyt.2024.1301976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/06/2024] [Indexed: 03/20/2024] Open
Abstract
Background Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya. Methods This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables. Results We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use. Conclusion The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods.
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Affiliation(s)
- Monica Nguata
- Department of Post Traumatic Stress Disorder (PTSD) Tnx, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - James Orwa
- Department of Population Health, Medical College of East Africa Aga Khan University, Nairobi, Kenya
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
| | - Edith Kamaru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Wilfred Emonyi
- Department of Immunology, Moi University School of Medicine, Eldoret, Kenya
| | - Symon Kariuki
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Charles Newton
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Linnet Ongeri
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rehema Mwende
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Stella Gichuru
- Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya
| | - Lukoye Atwoli
- Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya
- Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya
- Brain and Mind Institute, the Aga Khan University, Nairobi, Kenya
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Yrondi A, Javelot H, Nobile B, Boudieu L, Aouizerate B, Llorca PM, Charpeaud T, Bennabi D, Lefrere A, Samalin L. French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN) guidelines for the management of patients with partially responsive depression and treatment-resistant depression: Update 2024. L'ENCEPHALE 2024:S0013-7006(24)00019-8. [PMID: 38369426 DOI: 10.1016/j.encep.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The purpose of this update is to add newly approved nomenclatures and treatments as well as treatments yet to be approved in major depressive disorder, thus expanding the discussions on the integration of resistance factors into the clinical approach. METHODS Unlike the first consensus guidelines based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) developed an update of these guidelines for the management of partially responsive depression (PRD) and treatment-resistant depression (TRD). The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for PRD and TRD. RESULTS The recommendations addressed three areas judged as essential for updating the previous 2019 AFPBN guidelines for the management of patients with TRD: (1) the identification of risk factors associated with TRD, (2) the therapeutic management of patients with PRD and TRD, and (3) the indications, the modalities of use and the monitoring of recent glutamate receptor modulating agents (esketamine and ketamine). CONCLUSION These consensus-based guidelines make it possible to build bridges between the available empirical literature and clinical practice, with a highlight on the 'real world' of the clinical practice, supported by a pragmatic approach centred on the experience of specialised prescribers in TRD.
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Affiliation(s)
- Antoine Yrondi
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; Inserm, UPS, ToNIC, service de psychiatrie et psychologie médicale, Centre expert dépression résistante, Toulouse NeuroImaging Center, université de Toulouse, CHU de Toulouse, Toulouse, France
| | - Hervé Javelot
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; EPSAN, Centre de Ressources et d'Expertise en PsychoPharmacologie du Grand'Est (CREPP GE), Brumath, France; UR7296, laboratoire de pharmacologie, faculté de médecine de Strasbourg, Centre de recherche en biomédecine de Strasbourg (CRBS), Strasbourg, France
| | - Bénédicte Nobile
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, Montpellier, France; Inserm, CNRS, IGF, University of Montpellier, Montpellier, France
| | - Ludivine Boudieu
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Department of Psychiatry, CHU of Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Bruno Aouizerate
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; Centre hospitalier Charles-Perrens, université de Bordeaux, Bordeaux, France; Inrae, NutriNeuro, U1286, University of Bordeaux, Bordeaux, France
| | - Pierre-Michel Llorca
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; Department of Psychiatry, CHU of Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Thomas Charpeaud
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Clinique du Grand Pré, Durtol, France
| | - Djamila Bennabi
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; Centre d'investigation clinique, CIC-Inserm-1431, centre hospitalier universitaire de Besançon, Besançon, France
| | - Antoine Lefrere
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; UMR7289, CNRS, pôle de psychiatrie, institut de neurosciences de la Timone, Aix-Marseille université Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - Ludovic Samalin
- French Society for Biological Psychiatry and Neuropsychopharmacology (AFPBN), Saint-Germain-en-Laye, France; Fondation FondaMental, Créteil, France; Department of Psychiatry, CHU of Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France.
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226
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Steffens DC. Treatment-Resistant Depression in Older Adults. N Engl J Med 2024; 390:630-639. [PMID: 38354142 PMCID: PMC10885705 DOI: 10.1056/nejmcp2305428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
A 67-year-old woman with a history of obesity, chronic low back pain, and recurrent episodes of major depression presents with mild depressive symptoms of more than 2 years’ duration, with worsening symptoms over the past 4 months. She was receiving sertraline at a stable dose of 100 mg per day until 3 months ago, when she initially presented for her worsening depressive symptoms. At that time, sertraline was tapered off, and treatment with extra-long extended-release bupropion (bupropion XL) was started at a dose of 150 mg daily and was increased to 300 mg daily 3 weeks later. Despite having taken the higher dose of bupropion XL for more than 2 months, the patient continues to have low mood, loss of interest in usual pleasurable activities, trouble falling asleep, wakefulness several times during the night, diminished energy, poor appetite, difficulty concentrating, and intrusive thoughts of being “better off dead,” but she does not have active suicidal thinking. Her nine-question Patient Health Questionnaire (PHQ-9) score is 17 (on a scale of 0 to 27, with higher scores indicating greater severity of depressive symptoms). How would you evaluate and treat this patient?
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Affiliation(s)
- David C Steffens
- From the Department of Psychiatry, University of Connecticut School of Medicine, Farmington
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227
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Nuñez NA, Coombes BJ, Beaupre LM, Ozerdem A, Resendez MG, Romo-Nava F, Bond DJ, Veldic M, Singh B, Moore KM, Betcher HK, Kung S, Prieto ML, Fuentes M, Ercis M, Miola A, Sanchez Ruiz JA, Jenkins G, Batzler A, Leung JG, Cuellar-Barboza A, Tye SJ, McElroy SL, Biernacka JM, Frye MA. Pharmacogenomic overlap between antidepressant treatment response in major depression & antidepressant associated treatment emergent mania in bipolar disorder. Transl Psychiatry 2024; 14:93. [PMID: 38351009 PMCID: PMC10864308 DOI: 10.1038/s41398-024-02798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
There is increasing interest in individualizing treatment selection for more than 25 regulatory approved treatments for major depressive disorder (MDD). Despite an inconclusive efficacy evidence base, antidepressants (ADs) are prescribed for the depressive phase of bipolar disorder (BD) with oftentimes, an inadequate treatment response and or clinical concern for mood destabilization. This study explored the relationship between antidepressant response in MDD and antidepressant-associated treatment emergent mania (TEM) in BD. We conducted a genome-wide association study (GWAS) and polygenic score analysis of TEM and tested its association in a subset of BD-type I patients treated with SSRIs or SNRIs. Our results did not identify any genome-wide significant variants although, we found that a higher polygenic score (PGS) for antidepressant response in MDD was associated with higher odds of TEM in BD. Future studies with larger transdiagnostic depressed cohorts treated with antidepressants are encouraged to identify a neurobiological mechanism associated with a spectrum of depression improvement from response to emergent mania.
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Affiliation(s)
- Nicolas A Nuñez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Manuel Gardea Resendez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - David J Bond
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Katherine M Moore
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hannah K Betcher
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Simon Kung
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Miguel L Prieto
- Department of Psychiatry, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Manuel Fuentes
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mete Ercis
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Miola
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Gregory Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Anthony Batzler
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Susannah J Tye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Queensland Brain Institute, The University of Queensland, St. Lucia, QLD, Australia
| | - Susan L McElroy
- Lindner Center of HOPE/University of Cincinnati, Cincinnati, OH, USA
| | - Joanna M Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
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228
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Coello K, Mäkinen IJO, Kjærstad HL, Faurholt-Jepsen M, Miskowiak KW, Poulsen HE, Vinberg M, Kessing LV. Oxidation of DNA and RNA in young patients with newly diagnosed bipolar disorder and relatives. Transl Psychiatry 2024; 14:81. [PMID: 38331875 PMCID: PMC10853262 DOI: 10.1038/s41398-024-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Excessive oxidative stress-generated nucleoside damage seems to play a key role in bipolar disorder (BD) and may present a trait phenomenon associated with familial risk and is one of the putative mechanisms explaining accelerated atherosclerosis and premature cardiovascular diseases (CVD) in younger patients with BD. However, oxidative stress-generated nucleoside damage has not been studied in young BD patients and their unaffected relatives (UR). Therefore, we compared oxidative stress-generated damage to DNA and RNA in young patients newly diagnosed with BD, UR, and healthy control individuals (HC). Systemic oxidative stress-generated DNA and RNA damage levels were compared by analyzing urinary levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine and 8-oxo-7,8-dihydroguanosine in participants aged 15-25 years, including 133 patients newly diagnosed with BD, 57 UR, and 83 HC. Compared with HC, damage to DNA was 21.8% higher in BD patients (B = 1.218, 95% CI = 1.111-1.335, p = <0.001) and 22.5% higher in UR (B = 1.225, 95% CI = 1.090-1.377, p = <0.002), while damage to RNA was 14.8% higher in BD patients (B = 1.148, 95% CI = 1.082-1.219, p = <0.001) and 14.0% higher in UR (B = 1.140, 95% CI = 1.055-1.230, p = < 0.001) in models adjusted for sex and age after correction for multiple comparison. Levels did not differ between patients with BD and UR. Our findings support higher oxidative stress-generated nucleoside damage being a trait phenomenon in BD associated with familial risk and highlight the importance of early diagnosis and treatment to prevent illness progression and development of premature CVD.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark.
| | - Ilari Jaakko Olavi Mäkinen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital North Zealand Hillerød, Hillerød, Denmark
- Research Unit, Copenhagen University Hospital North Zealand Hillerød, Hillerød, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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229
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Gupta N, Gupta M. Off-label psychopharmacological interventions for autism spectrum disorders: strategic pathways for clinicians. CNS Spectr 2024; 29:10-25. [PMID: 37539695 DOI: 10.1017/s1092852923002389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The prevalence of autism spectrum disorder (ASD) continues to see a trend upward with a noticeable increase to 1 in 36 children less than 8 years of age in the recent MMWR. There are many factors linked to the substantially increased burden of seeking mental health services, and clinically these individuals are likely to present for impairments associated with co-occurring conditions. The advances in cutting-edge research and the understanding of co-occurring conditions in addition to psychosocial interventions have provided a window of opportunity for psychopharmacological interventions given the limited availability of therapeutics for core symptomatology. The off-label psychopharmacological treatments for these co-occurring conditions are central to clinical practice. However, the scattered evidence remains an impediment for practitioners to systematically utilize these options. The review collates the crucial scientific literature to provide stepwise treatment alternatives for individuals with ASD; with an aim to lead practitioners in making informed and shared decisions. There are many questions about the safety and tolerability of off-label medications; however, it is considered the best practice to utilize the available empirical data in providing psychoeducation for patients, families, and caregivers. The review also covers experimental medications and theoretical underpinnings to enhance further experimental studies. In summary, amidst the growing clinical needs for individuals with ASD and the lack of approved clinical treatments, the review addresses these gaps with a practical guide to appraise the risk and benefits of off-label medications.
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Affiliation(s)
| | - Mayank Gupta
- Southwood Psychiatric Hospital, Pittsburgh, PA, USA
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230
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Spoelma MJ, Leidreiter J, Bayes A, Jebejian A, Parker G. A naturalistic effectiveness study of maintenance therapies for the bipolar disorders. Acta Psychiatr Scand 2024; 149:98-109. [PMID: 38072004 PMCID: PMC10952660 DOI: 10.1111/acps.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/13/2023] [Accepted: 11/26/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Treatment decision-making for individuals with bipolar disorder can be difficult. Recommendations from clinical practice guidelines can be affected by multiple methodological limitations, while pharmaco-epidemiological data suggest great variety in prescription practices across regions. Given these inconsistencies, this study aimed to provide an alternative perspective on the effectiveness of common bipolar disorder maintenance treatments through considering naturalistic data. METHODS A total of 246 individuals with bipolar disorder (84 bipolar I [BP-I], 162 bipolar II [BP-II]) were recruited through clinics and/or websites. All were euthymic and had trialled at least one mood stabiliser. They completed an online survey containing questions on demographics, clinical variables, symptomatology, and the effectiveness/side effect profiles of any mood stabilisers (MSTs) or atypical antipsychotics (AAPs) that they have taken. RESULTS Lithium and lamotrigine were the most commonly prescribed MSTs and the most effective at mood stabilisation. Lithium and lamotrigine appeared marginally more effective for BP-I and BP-II respectively, however, only the latter difference was statistically significant. Furthermore, lamotrigine had the more favourable side effect profile. Amongst the AAPs, quetiapine and olanzapine were the most commonly prescribed, but they were negligibly superior to other AAPs. CONCLUSION This study clearly established a preference for lamotrigine in the maintenance treatment of BP-II. While the literature consistently emphasises the primacy of lithium in bipolar disorder treatment, its side effect profile as observed in this study remains a concern. Future research considering moderators of treatment response and concomitant medications could help to identify further nuances to consider for treatment decision-making.
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Affiliation(s)
- Michael J. Spoelma
- Discipline of Psychiatry and Mental Health, School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Black Dog InstituteSydneyNew South WalesAustralia
| | | | - Adam Bayes
- Discipline of Psychiatry and Mental Health, School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Black Dog InstituteSydneyNew South WalesAustralia
| | | | - Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Gordon Private HospitalSydneyNew South WalesAustralia
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231
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Singh B, Yocum AK, Strawbridge R, Burdick KE, Millett CE, Peters AT, Sperry SH, Fico G, Vieta E, Verdolini N, Godin O, Leboyer M, Etain B, Tso IF, Coombes BJ, McInnis MG, Nierenberg AA, Young AH, Ashton MM, Berk M, Williams LJ, Keramatian K, Yatham LN, Overs BJ, Fullerton JM, Roberts G, Mitchell PB, Andreassen OA, Andreazza AC, Zandi PP, Pham D, Biernacka JM, Frye MA. Patterns of pharmacotherapy for bipolar disorder: A GBC survey. Bipolar Disord 2024; 26:22-32. [PMID: 37463846 PMCID: PMC10794603 DOI: 10.1111/bdi.13366] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To understand treatment practices for bipolar disorders (BD), this study leveraged the Global Bipolar Cohort collaborative network to investigate pharmacotherapeutic treatment patterns in multiple cohorts of well-characterized individuals with BD in North America, Europe, and Australia. METHODS Data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities were provided from each participating cohort. Individual site and regional pooled proportional meta-analyses with generalized linear mixed methods were conducted to identify prescription patterns. RESULTS This study included 10,351 individuals from North America (n = 3985), Europe (n = 3822), and Australia (n = 2544). Overall, participants were predominantly female (60%) with BD-I (60%; vs. BD-II = 33%). Cross-sectionally, mood-stabilizing anticonvulsants (44%), second-generation antipsychotics (42%), and antidepressants (38%) were the most prescribed medications. Lithium was prescribed in 29% of patients, primarily in the Australian (31%) and European (36%) cohorts. First-generation antipsychotics were prescribed in 24% of the European versus 1% in the North American cohort. Antidepressant prescription rates were higher in BD-II (47%) compared to BD-I (35%). Major limitations were significant differences among cohorts based on inclusion/exclusion criteria, data source, and time/year of enrollment into cohort. CONCLUSIONS Mood-stabilizing anticonvulsants, second-generation antipsychotics, and antidepressants were the most prescribed medications suggesting prescription patterns that are not necessarily guideline concordant. Significant differences exist in the prescription practices across different geographic regions, especially the underutilization of lithium in the North American cohorts and the higher utilization of first-generation antipsychotics in the European cohorts. There is a need to conduct future longitudinal studies to further explore these differences and their impact on outcomes, and to inform and implement evidence-based guidelines to help improve treatment practices in BD.
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Affiliation(s)
- Balwinder Singh
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine E Burdick
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amy T Peters
- Dauten Family Center for Bipolar Treatment Innovation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Ophelia Godin
- INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Univ Paris Est Créteil, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), APHP, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Marion Leboyer
- INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Univ Paris Est Créteil, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), APHP, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Bruno Etain
- Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, AP-HP, Paris, France
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Melanie M Ashton
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lana J Williams
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Bronwyn J Overs
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gloria Roberts
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel Pham
- The Milken Institute, Washington, District of Columbia, USA
| | - Joanna M Biernacka
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, AP-HP, Paris, France
| | - Mark A Frye
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
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232
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Licht RW, Nielsen RE. Invited commentary to Professor Belmaker's letter on lithium treatment for bipolar disorder. Bipolar Disord 2024; 26:93-94. [PMID: 38151476 DOI: 10.1111/bdi.13400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
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233
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Tan RHS, Koh YS, Vaingankar JA, Abdin E, Sambasivam R, Chong SA, Subramaniam M. Treatment delays for mental disorders in Singapore: results from the Singapore Mental Health Study 2016. Soc Psychiatry Psychiatr Epidemiol 2024; 59:375-383. [PMID: 36786835 DOI: 10.1007/s00127-023-02440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Although the trajectory of mental disorders can be improved with timely treatment, many people defer treatment-seeking. This study aimed to examine the prevalence and correlates of treatment delays for mental disorders in Singapore, as well as perceived effectiveness of treatment received. METHODS A total of 6126 respondents, aged 18 and above, participated in the Singapore Mental Health Study 2016-a cross-sectional, nationwide study conducted in Singapore from 2016 to 2018. Lifetime treatment contact for mood, anxiety, and alcohol use disorders (AUD) was assessed using the World Mental Health-Composite International Diagnostic Interview (Version 3.0). Multivariable logistic regression was conducted to examine correlates of delayed treatment. RESULTS A total of 137 participants had made lifetime treatment contact for a mental disorder. The proportion of respondents who received delayed treatment (i.e., at least one year after onset of disorder) was 60.8% for any disorder, 59.5% for mood disorders, 56.3% for anxiety disorders, and 92.7% for AUD. The median delay was 5 years for mood disorders, one year for anxiety disorders, and 4 years for AUD. Treatment delay was significantly associated with older age, higher educational qualification, lifetime AUD, and earlier age of onset of disorder. 58.4% of respondents with lifetime treatment contact had received treatment that they considered effective. CONCLUSION The high prevalence and long durations of treatment delay underscore the need to encourage help-seeking for mental disorders, especially since treatment is generally perceived to be helpful. Our findings also highlight several population groups more susceptible to receiving delayed treatment.
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Affiliation(s)
- Rachel Hsiao Shen Tan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Yen Sin Koh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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Ardila CM, López-Valencia A, González-Arroyave D. Severe Sinus Dysfunction in the Context of Chronic Lithium Intoxication and Poorly Controlled Hypothyroidism. Cureus 2024; 16:e55127. [PMID: 38558727 PMCID: PMC10979516 DOI: 10.7759/cureus.55127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Cardiotoxicity associated with lithium is not a common event; however, it is potentially life-threatening, manifesting electrocardiographically with sinoatrial blocks, high-degree atrioventricular blocks, QT prolongation, and ventricular tachyarrhythmias. This case report presents a patient with severe sinus dysfunction in a clinically severe presentation secondary to cardiogenic shock. The patient sought medical attention for a one-week history of non-anginal chest pain, dizziness without syncope, generalized weakness, and somnolence progressing to bedridden status in the days preceding hospital admission. Laboratory findings revealed elevated blood levels of lithium and thyroid-stimulating hormone (TSH), along with concomitant Acute Kidney Injury Network (AKIN) II acute kidney injury. Subsequently, the patient was admitted to the intensive care unit, where persistent extreme sinus bradycardia of 30 bpm (beats per minute) with sinus pauses without ischemic changes was observed. The patient received supportive treatment, including renal replacement therapy, resulting in complete recovery of hemodynamic status without the need for long-term cardiac conduction devices.
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Efthimiou O, Taipale H, Radua J, Schneider-Thoma J, Pinzón-Espinosa J, Ortuño M, Vinkers CH, Mittendorfer-Rutz E, Cardoner N, Tanskanen A, Fusar-Poli P, Cipriani A, Vieta E, Leucht S, Tiihonen J, Luykx JJ. Efficacy and effectiveness of antipsychotics in schizophrenia: network meta-analyses combining evidence from randomised controlled trials and real-world data. Lancet Psychiatry 2024; 11:102-111. [PMID: 38215784 DOI: 10.1016/s2215-0366(23)00366-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND There is debate about the generalisability of results from randomised clinical trials (RCTs) to real-world settings. Studying outcomes of treatments for schizophrenia can shed light on this issue and inform treatment guidelines. We therefore compared the efficacy and effectiveness of antipsychotics for relapse prevention in schizophrenia and estimated overall treatment effects using all available RCT and real-world evidence. METHODS We conducted network meta-analyses using individual participant data from Swedish and Finnish national registries and aggregate data from RCTs. The target population was adults (age >18 and <65 years) with schizophrenia and schizoaffective disorder with stabilised symptoms. We analysed each registry separately to obtain hazard ratios (HRs) and 95% CIs for relapse within 6 months post-antipsychotic initiation as our main outcome. Interventions studied were antipsychotics, no antipsychotic use, and placebo. We compared HRs versus a reference drug (oral haloperidol) between registries, and between registry individuals who would be eligible and ineligible for RCTs, using the ratio of HRs. We synthesised evidence using network meta-analysis and compared results from our network meta-analysis of real-world data with our network meta-analysis of RCT data, including oral versus long-acting injectable (LAI) formulations. Finally, we conducted a joint real-world and RCT network meta-analysis. FINDINGS We included 90 469 individuals from the Swedish and Finnish registries (mean age 45·9 [SD 14·6] years; 43 025 [47·5%] women and 47 467 [52·5%] men, ethnicity data unavailable) and 10 091 individuals from 30 RCTs (mean age 39·6 years [SD 11·7]; 3724 [36·9%] women and 6367 [63·1%] men, 6022 White [59·7%]). We found good agreement in effectiveness of antipsychotics between Swedish and Finnish registries (HR ratio 0·97, 95% CI 0·88-1·08). Drug effectiveness versus no antipsychotic was larger in RCT-eligible than RCT-ineligible individuals (HR ratio 1·40 [1·24-1·59]). Efficacy versus placebo in RCTs was larger than effectiveness versus no antipsychotic in real-world (HR ratio 2·58 [2·02-3·30]). We found no evidence of differences between effectiveness and efficacy for between-drug comparisons (HR ratio vs oral haloperidol 1·17 [0·83-1·65], where HR ratio >1 means superior effectiveness in real-world to RCTs), except for LAI versus oral comparisons (HR ratio 0·73 [0·53-0·99], indicating superior effectiveness in real-world data relative to RCTs). The real-world network meta-analysis showed clozapine was most effective, followed by olanzapine LAI. The RCT network meta-analysis exhibited heterogeneity and inconsistency. The joint real-world and RCT network meta-analysis identified olanzapine as the most efficacious antipsychotic amongst those present in both RCTs and the real world registries. INTERPRETATION LAI antipsychotics perform slightly better in the real world than according to RCTs. Otherwise, RCT evidence was in line with real-world evidence for most between-drug comparisons, but RCTs might overestimate effectiveness of antipsychotics observed in routine care settings. Our results further the understanding of the generalisability of RCT findings to clinical practice and can inform preferential prescribing guidelines. FUNDING None.
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Affiliation(s)
- Orestis Efthimiou
- Institute of Primary Health Care, University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Heidi Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Radua
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain; Early Psychosis, Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Justo Pinzón-Espinosa
- Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Sant Pau Mental Health Group, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Clinical Psychiatry, School of Medicine, University of Panama, Panama; Adult Outpatient Clinic, Fundació Pere Mata Terres de l'Ebre, Amposta, Tarragona, Spain
| | - Maria Ortuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Christiaan H Vinkers
- Department of Psychiatry and Anatomy & Neurosciences, Amsterdam University Medical Centre, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, Netherlands; GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Narcís Cardoner
- Sant Pau Mental Health Group, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Fusar-Poli
- Early Psychosis, Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Psychology, Hospital Clinic, Neurosciences Institute, University of Barcelona, Barcelona, Catalonia, Spain
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, Netherlands; GGZ inGeest Mental Health Care, Amsterdam, Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Outpatient Second Opinion Clinic, GGNet Mental Health, Warnsveld, Netherlands.
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Kumar M, Acharya R, Mallik N, Pal A, Ghosal MK. A prospective study of suicidal behavior in young patients of depressive episodes with hidden bipolarity exposed to selective serotonin reuptake inhibitor. Indian J Psychiatry 2024; 66:195-198. [PMID: 38523768 PMCID: PMC10956594 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_221_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/22/2023] [Accepted: 01/15/2024] [Indexed: 03/26/2024] Open
Abstract
Background Treatment of depressive episodes in young patients is challenging owing to several reasons such as poor diagnostic stability and atypical presentation. Evidence regarding treating such patients with antidepressants such as selective serotonin reuptake inhibitor (SSRI) is not clear. Methods Fifty patients aged 10-24 years diagnosed with depressive episodes and drug-free for at least 3 months were rated on Beck's Depression Inventory (BDI), The Mood Disorder Questionnaire (MDQ), and Beck Scale for Suicidal Ideation (BSS). The scores of BSS and BDI were compared across four timeframes (weeks 0, 2, 4, and 6) for MDQ-positive and negative patients by using the generalized estimating equations model. Results Patients who were MDQ-positive (11 patients) tended to score higher on BDI (at weeks 2 and 4) and BSS (at weeks 2, 4, and 6) as compared to MDQ-negative patients (39 patients). After being started on SSRI, MDQ-positive patients showed a poorer response as compared to the other group. The small sample size and short follow-up duration were the major limitations. Conclusions Close clinical monitoring with regular follow-up during antidepressant initiation is recommended to reduce the risk of suicidality.
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Affiliation(s)
- Manoj Kumar
- Department of Psychiatry, ESIC Medical College, Faridabad, Haryana, India
| | - Rudraprasad Acharya
- Department of Psychiatry, Diamond Harbour Medical College and Hospital, West Bengal, India
| | - Nitu Mallik
- Department of Psychiatry, College of Medicine and JNM Hospital, Kalyani, West Bengal, India
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Malay Kumar Ghosal
- Department of Psychiatry, Medical College and Hospital, Kolkata, West Bengal, India
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237
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Wolfe C, McCoin N. Bipolar Disorders in the Emergency Department. Emerg Med Clin North Am 2024; 42:115-124. [PMID: 37977743 DOI: 10.1016/j.emc.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Affective disorders affect the way that people think and feel and are classified into unipolar disorders and bipolar disorders. Bipolar disorders represent a spectrum of these chronic mental health illnesses. Patients with bipolar disorder have high recurrence of acute symptoms, and on average spend 20% of their life in exacerbations characterized by mania, depression, or psychosis. Given the increased morbidity and mortality associated with bipolar disorders, it is imperative that the emergency physician remain vigilant when these patients seek emergency care.
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Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, Tristar Skyline Medical Center, 3443 Dickerson Pike, Suite 230, Nashville, TN 37207, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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238
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Jorgensen A, Larsen EN, Sloth MMB, Kessing LV, Osler M. Prescription patterns in unipolar depression: A nationwide Danish register-based study of 113,175 individuals followed for 10 years. Acta Psychiatr Scand 2024; 149:88-97. [PMID: 37990476 DOI: 10.1111/acps.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Evidence-based use of antidepressant medications is of major clinical importance. We aimed to uncover precription patterns in a large cohort of patients with unipolar depression. MATERIAL AND METHODS Using Danish nationwide registers, we identified individuals with a first-time hospital diagnosis of unipolar depression between January 1st, 2001, and December 31st, 2016. Redemeed prescriptions of antidepressants from five years before to five years after diagnosis were retreived. Lithium and relevant antipsychotics were included. Data were analyzed with descriptive statistics including sunburst plots. Cox regressions were used to rank the risk of treatment failure according to antidepressant category and depression severity, as measured by hazard ratios of drug shift. RESULTS The full study population consisted of 113,175 individuals. Selective Serotonin Reuptake Inhibitors was the predominantly prescribed first-line group, both before (55.4%) and after (47.7%) diagnosis and across depression severities. Changes of treatment strategy were frequent; 60.8%, 33.7%, and 17.1% reached a second, third, and fourth treatment trial after the hospital diagnosis, respectively. More than half of patients continued their pre-diagnosis antidepressant after diagnosis. The risk of change of treatment strategy was generally lower in mild-moderate depression and higher in severe depression, with tricyclic antidepressants carrying the highest risk in the former and the lowest risks in the latter. Overall, prescribing were often not in accordance with guidelines. CONCLUSION These findings uncover a potential for improving the clinical care for patients with unipolar depression through optimization of the use of marketed antidepressants.
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Affiliation(s)
- Anders Jorgensen
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Emma Neble Larsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Merete Osler
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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239
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Belge JB, Sabbe BGCC. Long-acting second-generation injectable antipsychotics for the maintenance treatment of bipolar disorder: a narrative review. Expert Opin Pharmacother 2024; 25:295-299. [PMID: 38465894 DOI: 10.1080/14656566.2024.2329743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/08/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Non-adherence to medication significantly affects bipolar disorder outcomes. Long-Acting Injectable antipsychotics show promise by ensuring adherence and averting relapses. AREAS COVERED This narrative review sought to evaluate the efficacy of second-generation injectable antipsychotics in bipolar disorder through searches in Embase, MEDLINE, and PsycInfo for randomized controlled trials and mirror-image studies.Risperidone and aripiprazole Long-Acting Injectables demonstrated effectiveness in preventing mood recurrences compared to placebos in adults with bipolar disorder. They showed superiority in preventing mania/hypomania relapses over placebos but did not appear to significantly outperform active oral controls. Notably, active controls seem to be more effective in preventing depression relapses than Long-Acting Injectables. Mirror-Image studies point toward the reduction of hospitalization rates following LAI initiation. EXPERT OPINION The available evidence points thus toward the efficacy of LAIs, especially in managing manic episodes and reducing hospitalizations, The current evidence does not however immediately support prioritizing LAIs over oral medications in bipolar disorder treatment. More high-quality studies, especially comparing LAIs directly with active controls, are crucial to gain a comprehensive understanding of their efficacy. These findings highlight the need for further research to guide clinicians in optimizing treatment strategies for bipolar disorder.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Gonzalez-Torres C, Mulsant BH, Husain MI, Alda M, Young RC, Ortiz A. Challenges in defining treatment-resistant mania in adults: A systematic review. Bipolar Disord 2024; 26:7-21. [PMID: 37963496 PMCID: PMC10922285 DOI: 10.1111/bdi.13383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To review the definitions of treatment-resistant mania (TRM) in the literature and propose criteria for an operationalized definition. METHODS A systematic search of five databases (MEDLINE, EMBASE, PsychInfo, Cochrane Central, and CINAHL) and data extraction of eligible articles. RESULTS In total, 47 articles addressing the concept of TRM were included, comprising 16 case reports, 11 case series, 3 randomized clinical trials, 8 open-label clinical trials, 1 experimental study, 7 narrative reviews, and 1 systematic review. While reviews discussed several challenges in defining TRM, definitions varied substantially based on different criteria for severity of mania, duration of mania, and use of specific therapeutic agents with minimal dosages and duration of treatment. Only a handful of the reviewed articles operationalized these criteria. CONCLUSION While the concept of TRM has been discussed in the literature for over three decades, we could not find an agreed-upon operationalized definition based on specific criteria. We propose and discuss a possible definition that could be used by clinicians to guide their practice and by researchers to assess the prevalence of TRM and develop and test interventions targeting TRM.
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Affiliation(s)
- Christina Gonzalez-Torres
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M. Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Robert C. Young
- Department of Psychiatry, Weil Cornell Medicine, New York, New York, US
| | - Abigail Ortiz
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Strawbridge R, Young AH. Lithium: how low can you go? Int J Bipolar Disord 2024; 12:4. [PMID: 38289425 PMCID: PMC10828288 DOI: 10.1186/s40345-024-00325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Allan H Young
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
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Luo J, Wu Y, Liu M, Li Z, Wang Z, Zheng Y, Feng L, Lu J, He F. Differentiation between depression and bipolar disorder in child and adolescents by voice features. Child Adolesc Psychiatry Ment Health 2024; 18:19. [PMID: 38287442 PMCID: PMC10826007 DOI: 10.1186/s13034-024-00708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) and bipolar disorder (BD) are serious chronic disabling mental and emotional disorders, with symptoms that often manifest atypically in children and adolescents, making diagnosis difficult without objective physiological indicators. Therefore, we aimed to objectively identify MDD and BD in children and adolescents by exploring their voiceprint features. METHODS This study included a total of 150 participants, with 50 MDD patients, 50 BD patients, and 50 healthy controls aged between 6 and 16 years. After collecting voiceprint data, chi-square test was used to screen and extract voiceprint features specific to emotional disorders in children and adolescents. Then, selected characteristic voiceprint features were used to establish training and testing datasets with the ratio of 7:3. The performances of various machine learning and deep learning algorithms were compared using the training dataset, and the optimal algorithm was selected to classify the testing dataset and calculate the sensitivity, specificity, accuracy, and ROC curve. RESULTS The three groups showed differences in clustering centers for various voice features such as root mean square energy, power spectral slope, low-frequency percentile energy level, high-frequency spectral slope, spectral harmonic gain, and audio signal energy level. The model of linear SVM showed the best performance in the training dataset, achieving a total accuracy of 95.6% in classifying the three groups in the testing dataset, with sensitivity of 93.3% for MDD, 100% for BD, specificity of 93.3%, AUC of 1 for BD, and AUC of 0.967 for MDD. CONCLUSION By exploring the characteristics of voice features in children and adolescents, machine learning can effectively differentiate between MDD and BD in a population, and voice features hold promise as an objective physiological indicator for the auxiliary diagnosis of mood disorder in clinical practice.
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Affiliation(s)
- Jie Luo
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, People's Republic of China
| | - Yuanzhen Wu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, People's Republic of China
| | - Mengqi Liu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, People's Republic of China
| | - Zhaojun Li
- Beijing Institute of Technology, School of Integrated Circuits and Electronics, Zhongguancun South Street 5 Hao, Hai Dian Qu, Beijing, 100081, China
| | - Zhuo Wang
- Beijing Institute of Technology, School of Integrated Circuits and Electronics, Zhongguancun South Street 5 Hao, Hai Dian Qu, Beijing, 100081, China
| | - Yi Zheng
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, People's Republic of China
| | - Lihui Feng
- Beijing Institute of Technology, School of Optics and Photonics, Zhongguancun South Street 5 Hao, Hai Dian Qu, Beijing, 100081, China
| | - Jihua Lu
- Beijing Institute of Technology, School of Integrated Circuits and Electronics, Zhongguancun South Street 5 Hao, Hai Dian Qu, Beijing, 100081, China.
| | - Fan He
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, People's Republic of China.
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Shuy YK, Santharan S, Chew QH, Sim K. International Trends in Lithium Use for Pharmacotherapy and Clinical Correlates in Bipolar Disorder: A Scoping Review. Brain Sci 2024; 14:102. [PMID: 38275522 PMCID: PMC10813799 DOI: 10.3390/brainsci14010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Lithium remains an effective option in the treatment of bipolar disorder (BD). Thus, we aim to characterize the pharmaco-epidemiological patterns of lithium use internationally over time and elucidate clinical correlates associated with BD using a scoping review, which was conducted using the methodological framework by Arksey and O'Malley (2005). We searched several databases for studies that examined the prescriptions for lithium and clinical associations in BD from inception until December 2023. This review included 55 articles from 1967 to 2023, which collected data from North America (n = 24, 43.6%), Europe (n = 20, 36.4%), and Asia (n = 11, 20.0%). The overall prescription rates ranged from 3.3% to 84% (33.4% before and 30.6% after the median year cutoffs). Over time, there was a decline in lithium use in North America (27.7% before 2010 to 17.1% after 2010) and Europe (36.7% before 2003 to 35.7% after 2003), and a mild increase in Asia (25.0% before 2003 to 26.2% after 2003). Lithium use was associated with specific demographic (e.g., age, male gender) and clinical factors (e.g., lower suicide risk). Overall, we found a trend of declining lithium use internationally, particularly in the West. Specific clinical correlates can support clinical decision-making for continued lithium use.
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Affiliation(s)
- Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Sanjana Santharan
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore 539747, Singapore;
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore;
| | - Kang Sim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- West Region, Institute of Mental Health, Singapore 539747, Singapore
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Zeng P, Zhang H, Lu L, Li Y, Yu T, Zhang J, Zhou H. The causal relationship of female infertility and psychiatric disorders in the European population: a bidirectional two-sample Mendelian randomization study. BMC Womens Health 2024; 24:54. [PMID: 38243216 PMCID: PMC10797979 DOI: 10.1186/s12905-024-02888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Infertility affects many couples globally, causing physical, emotional, and financial burdens. While observational studies suggest a link between psychiatric disorders and female infertility, causal relationships remain uncertain. Mendelian randomization analysis, using genome-wide association studies data, minimizes confounding factors and reverse causation, providing valuable insights into causal associations. METHODS We conducted Mendelian randomization analysis to explore the potential causal relationship between female infertility and psychiatric disorders. Genome-wide association studies summary data for female infertility (112,105 individuals of European ancestry, comprising 11,442 cases and 100,663 controls), depression (807,553 individuals of European ancestry, comprising 246,363 cases and 561,190 controls), anxiety (21,763 individuals of European ancestry, comprising 7,016 cases and 14,745 controls), bipolar disorder (51,710 individuals of European ancestry, comprising 20,352 cases and 31,358 controls), and eating disorders (72,517 individuals of European ancestry, comprising 16,992 cases and 55,525 controls) were utilized. Instrumental variables were selected based on significant single nucleotide polymorphisms associated with each phenotype. We assessed instrumental variable strength, examined confounding factors, and employed inverse variance weighting, weighted median, and MR-Egger approaches for analysis. RESULTS Our analysis included 85 single nucleotide polymorphisms for female infertility and 62 single nucleotide polymorphisms for psychiatric disorders. Results suggest a potential causal relationship between depression and female infertility, with both inverse variance weighting and weighted median methods showing increased infertility risk in depressed patients. Evidence is weak regarding bipolar disorder not increasing female infertility risk. We found no evidence supporting causal links between anxiety, eating disorders, and female infertility. Similarly, no causal relationship was found between female infertility and psychiatric disorders in the opposite direction. Sensitivity analyses and tests for heterogeneity and polymorphism supported result robustness. CONCLUSIONS This analysis provides evidence for a potential causal relationship between depression and female infertility. Addressing depression in infertile women may improve fertility outcomes. Further research is needed to explore underlying mechanisms and potential interventions for improving fertility outcomes in women with psychiatric disorders.
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Affiliation(s)
- Pengfei Zeng
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hanxiao Zhang
- Faculty of Medicine, Université Paris-Saclay, Villejuif, France
| | - Liyue Lu
- School of Shuguang Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanting Li
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tong Yu
- Department of Gynecology, Guangan Hospital of Traditional Chinese Medicine, Guangan, Sichuan, China
| | - Jun Zhang
- Department of Gynecology, Meishan Women and Children's Hospital Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, Sichuan, China
| | - Hang Zhou
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Kessing LV. Why is lithium [not] the drug of choice for bipolar disorder? a controversy between science and clinical practice. Int J Bipolar Disord 2024; 12:3. [PMID: 38228882 DOI: 10.1186/s40345-023-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND During over half a century, science has shown that lithium is the most efficacious treatment for bipolar disorder but despite this, its prescription has consistently declined internationally during recent decades to approximately 35% ever use or less of patients with bipolar disorder. CONTENT This narrative review provides an overview of the decreasing use of lithium in bipolar disorder internationally, shortly summarises the evidence for lithium's acute and prophylactic effects in bipolar disorder, discuss the challenges in relation to lithium including side effects, long-term risks and myths around lithium and provides two detailed examples on how specialised care models may result in successful increase of the use of lithium to 70% of patients with bipolar disorder largescale and improve care regionally and nationally. CONCLUSIONS Decades of scientific investigations and education and teaching of clinicians and the public has not increased the use of lithium on a population-based large scale. It is argued that lithium should be the drug of choice for maintenance therapy as the single first-line treatment and that organizational changes are needed with specialised care for bipolar disorder to systematically and long-term change the use of lithium on a large-scale population-level.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Anona K, Olaomi O, Udegbe E, Uwumiro F, Tuaka EB, Okafor N, Adeyinka A, Obijuru C, Okpujie V, Bojerenu M, Opeyemi M. Co-occurrence of bipolar disorder and personality disorders in the United States: Prevalence, suicidality, and the impact of substance abuse. J Affect Disord 2024; 345:1-7. [PMID: 37848089 DOI: 10.1016/j.jad.2023.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND This study investigates prevalence rates of specific personality disorders (PDs) in individuals with bipolar disorder (BD) and their impact on substance abuse and suicidality, addressing existing gaps in the literature. METHODS Using Nationwide Inpatient Sample data (2016-2020), adult hospitalizations for BD with coexisting PDs were analyzed. Study variables were defined using ICD-10-CM codes. Prevalence of PD were reported as cases per 100,000 BD admissions. Regression models assessed the association between substance abuse and suicidality. RESULTS About 993,000 admissions for BD were analyzed. The cohort was predominantly Caucasian (70.5 %) with higher female representation (54.5 %). The mean age was 41 years. 89.4 % of individuals had a Charlson Comorbidity Index score ≤ 1. The most common diagnostic subtype was manic episode of BD with or without psychotic features (32.3 %). Coexisting PDs were observed in 12.2 % of the population, with borderline PD (8.2 %) and antisocial PD (2.6 %) being most prevalent. Substance abuse was common (44.8 %), with cannabis (23.8 %), alcohol (19.4 %), cocaine (10.5 %), and opioids (9.6 %) being most reported. Substance abuse was higher in individuals with BD and PD (50 %) compared to BD alone (44.1 %). 596 suicide attempts were recorded (60 per 100,000 BD admissions). Substance abuse and coexisting PD in bipolar individuals elevated the likelihood of attempts (P < 0.001). LIMITATIONS Use of administrative data (retrospective, inpatient); treatment not studied. CONCLUSION The study reveals a notable prevalence of PDs in individuals with BD, with increased likelihood of substance abuse and suicide attempts in those with coexisting BD and PD compared to BD alone.
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Affiliation(s)
- Kenechukwu Anona
- Greater Manchester Mental Health National Health Service Foundation Trust, UK
| | | | | | - Fidelis Uwumiro
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
| | - Ebere-Bank Tuaka
- Rivers State University Teaching Hospital, Port Harcourt, Nigeria
| | - Nnenna Okafor
- All Saints University College of Medicine, Belair Kingstown, Saint Vincent and the Grenadines
| | | | - Chinwendu Obijuru
- College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu State, Nigeria
| | - Victory Okpujie
- College of Medicine, University of Benin, Benin City, Edo State, Nigeria
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247
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Anmella G, Mas A, Sanabra M, Valenzuela-Pascual C, Valentí M, Pacchiarotti I, Benabarre A, Grande I, De Prisco M, Oliva V, Fico G, Giménez-Palomo A, Bastidas A, Agasi I, Young AH, Garriga M, Corponi F, Li BM, de Looff P, Vieta E, Hidalgo-Mazzei D. Electrodermal activity in bipolar disorder: Differences between mood episodes and clinical remission using a wearable device in a real-world clinical setting. J Affect Disord 2024; 345:43-50. [PMID: 37865347 DOI: 10.1016/j.jad.2023.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Bipolar disorder (BD) lacks objective measures for illness activity and treatment response. Electrodermal activity (EDA) is a quantitative measure of autonomic function, which is altered in manic and depressive episodes. We aimed to explore differences in EDA (1) inter-individually: between patients with BD on acute mood episodes, euthymic states and healthy controls (HC), and (2) intra-individually: longitudinally within patients during acute mood episodes of BD and after clinical remission. METHODS A longitudinal observational study. EDA was recorded using a research-grade wearable in patients with BD during acute manic and depressive episodes and at clinical remission. Euthymic BD patients and HC were recorded during a single session. We compared EDA parameters derived from the tonic (mean EDA, mEDA) and phasic components (EDA peaks per minute, pmEDA, and EDA peaks mean amplitude, pmaEDA). Inter- and intra-individual comparisons were computed respectively with ANOVA and paired t-tests. RESULTS 49 patients with BD (15 manic, 9 depressed, and 25 euthymic), and 19 HC were included. Patients with bipolar depression showed significantly reduced mEDA (p = 0.003) and pmEDA (p = 0.001), which increased to levels similar to euthymia or HC after clinical remission (mEDA, p = 0.011; pmEDA, p < 0.001; pmaEDA, p < 0.001). Manic patients showed no differences compared to euthymic patients and HCs, but a significant reduction of tonic and phasic EDA parameters after clinical remission (mEDA, p = 0.035; pmEDA, p = 0.004). LIMITATIONS Limited sample size, high inter-individual variability of EDA parameters, limited comparability to previous studies and non-adjustment for medication. CONCLUSION EDA ecological monitoring might provide several opportunities for early detection of depressive symptoms, and might aid at assessing early response to treatments in mania and bipolar depression.
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain.
| | - Ariadna Mas
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Miriam Sanabra
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Clàudia Valenzuela-Pascual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Marc Valentí
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Antoni Benabarre
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Iria Grande
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Michele De Prisco
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Vincenzo Oliva
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Anna Bastidas
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Agasi
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Allan H Young
- Centre for Affective Disorders (CfAD), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Marina Garriga
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | | | - Bryan M Li
- School of informatics, University of Edinburgh, UK
| | - Peter de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Fivoor, Science and Treatment Innovation, Expert centre "De Borg", Den Dolder, the Netherlands
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Benacek J, Lawal N, Ong T, Tomasik J, Martin-Key NA, Funnell EL, Barton-Owen G, Olmert T, Cowell D, Bahn S. Identification of Predictors of Mood Disorder Misdiagnosis and Subsequent Help-Seeking Behavior in Individuals With Depressive Symptoms: Gradient-Boosted Tree Machine Learning Approach. JMIR Ment Health 2024; 11:e50738. [PMID: 38206660 PMCID: PMC10811571 DOI: 10.2196/50738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Misdiagnosis and delayed help-seeking cause significant burden for individuals with mood disorders such as major depressive disorder and bipolar disorder. Misdiagnosis can lead to inappropriate treatment, while delayed help-seeking can result in more severe symptoms, functional impairment, and poor treatment response. Such challenges are common in individuals with major depressive disorder and bipolar disorder due to the overlap of symptoms with other mental and physical health conditions, as well as, stigma and insufficient understanding of these disorders. OBJECTIVE In this study, we aimed to identify factors that may contribute to mood disorder misdiagnosis and delayed help-seeking. METHODS Participants with current depressive symptoms were recruited online and data were collected using an extensive digital mental health questionnaire, with the World Health Organization World Mental Health Composite International Diagnostic Interview delivered via telephone. A series of predictive gradient-boosted tree algorithms were trained and validated to identify the most important predictors of misdiagnosis and subsequent help-seeking in misdiagnosed individuals. RESULTS The analysis included data from 924 symptomatic individuals for predicting misdiagnosis and from a subset of 379 misdiagnosed participants who provided follow-up information when predicting help-seeking. Models achieved good predictive power, with area under the receiver operating characteristic curve of 0.75 and 0.71 for misdiagnosis and help-seeking, respectively. The most predictive features with respect to misdiagnosis were high severity of depressed mood, instability of self-image, the involvement of a psychiatrist in diagnosing depression, higher age at depression diagnosis, and reckless spending. Regarding help-seeking behavior, the strongest predictors included shorter time elapsed since last speaking to a general practitioner about mental health, sleep problems disrupting daily tasks, taking antidepressant medication, and being diagnosed with depression at younger ages. CONCLUSIONS This study provides a novel, machine learning-based approach to understand the interplay of factors that may contribute to the misdiagnosis and subsequent help-seeking in patients experiencing low mood. The present findings can inform the development of targeted interventions to improve early detection and appropriate treatment of individuals with mood disorders.
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Affiliation(s)
- Jiri Benacek
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Nimotalai Lawal
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Tommy Ong
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Erin L Funnell
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
| | | | - Tony Olmert
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
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249
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Guo Q, Jia J, Sun XL, Yang H, Ren Y. Comparing the metabolic pathways of different clinical phases of bipolar disorder through metabolomics studies. Front Psychiatry 2024; 14:1319870. [PMID: 38264633 PMCID: PMC10804847 DOI: 10.3389/fpsyt.2023.1319870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
This study identified the metabolic biomarkers for different clinical phases of bipolar disorder (BD) through metabolomics. BD patients were divided into three groups: patients with BD and depressive episodes (BE, n = 59), patients with BD and mania/hypomania episodes (BH, n = 16), patients with BD and mixed episodes (BM, n = 10), and healthy controls (HC, n = 10). Serum from participants was collected for metabolomic sequencing, biomarkers from each group were screened separately by partial least squares analysis, and metabolic pathways connected to the biomarkers were identified. Compared with the controls, 3-D-hydroxyacetic acid and N-acetyl-glycoprotein showed significant differences in the BE, BH, and BM groups. This study suggests that different clinical types of BD share the same metabolic pathways, such as pyruvate, glycolysis/gluconeogenesis, and ketone body metabolisms. In particular, abnormal glycine, serine, and threonine metabolism was specific to BM; β-glucose, glycerol, lipids, lactate, and acetoacetate metabolites were specific to depressive episodes; the guanidine acetic acid metabolites specific to BH; and the acetic and ascorbic acids were metabolites specific to manic and BM. We screened potential biomarkers for different clinical phases of BD, which aids in BD typing and provides a theoretical basis for exploring the molecular mechanisms of BD.
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Affiliation(s)
- Qin Guo
- Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiao Jia
- Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiao Li Sun
- Department of Mental Health, Shanxi Bethune Hospital, Taiyuan, China
| | - Hong Yang
- Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yan Ren
- Department of Mental Health, Shanxi Bethune Hospital, Taiyuan, China
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250
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Fujimura T, Taira D, Uchida Y, Takahashi K, Yamasuji K, Shimizu K, Nagai Y, Yoshinari N, Hirata T, Fujimoto K, Kurosawa Y, Yasuda S, Yoshikawa A, Takeshita Y, Ito M, Kakiuchi C, Kato T. Factors associated with self-perceived treatment-resistance in bipolar disorder. Medicine (Baltimore) 2024; 103:e36217. [PMID: 38181296 PMCID: PMC10766301 DOI: 10.1097/md.0000000000036217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024] Open
Abstract
Patients with bipolar disorder often report self-perceived treatment resistance. However, it is not known to what extent it is due to actual treatment resistance. The Juntendo University provides "Bipolar Disorder Treatment Rebuilding Program," in which patients with self-reported treatment resistant bipolar disorder are hospitalized for 2 weeks and undergo detailed examinations. In this study, we report our experience with the initial 43 patients hospitalized during the one and half years after the launch of the program. Among the patients who underwent full assessment, only one was regarded as having genuine treatment-resistant bipolar disorder without comorbidity. In other cases, ten were not diagnosed with bipolar disorder, 3 had organic brain diseases, 12 had comorbid mental disorders and its symptoms were regarded as treatment-resistant bipolar symptoms by the patients, and 18 did not receive adequate treatment because attendant physicians did not adhere to the treatment guidelines or patients did not adhere to the treatment because of lack of insight. The number of participants was not large, and selection bias hampered the generalization of the findings. Insight and adherence were assessed without the use of validated tools. We could not verify recovery after adequate treatment because of the limited hospitalization period. The findings suggest that most patients with self-perceived treatment-resistant bipolar disorder may not have genuine treatment-resistant bipolar disorder. These results shed light on the difficulties of public education of bipolar disorder and importance of providing appropriate services for diagnosis and treatment of bipolar disorder in the community.
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Affiliation(s)
- Toshimasa Fujimura
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Daiki Taira
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Uchida
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Keitaro Takahashi
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Kanako Yamasuji
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Kentaro Shimizu
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhito Nagai
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Naoto Yoshinari
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoe Hirata
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuma Fujimoto
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Yui Kurosawa
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Seita Yasuda
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Akane Yoshikawa
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihide Takeshita
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Masanobu Ito
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Chihiro Kakiuchi
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Tadafumi Kato
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
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