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Halabi R, Gonzalez-Torres C, MacLean S, Husain MI, Pratap A, Alda M, Mulsant BH, Ortiz A. A Novel Unsupervised Machine Learning Approach to Assess Postural Dynamics in Euthymic Bipolar Disorder. IEEE J Biomed Health Inform 2024; 28:4903-4911. [PMID: 38691437 PMCID: PMC11303098 DOI: 10.1109/jbhi.2024.3394754] [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] [Indexed: 05/03/2024]
Abstract
Bipolar disorder (BD) is a mood disorder with different phases alternating between euthymia, manic or hypomanic episodes, and depressive episodes. While motor abnormalities are commonly seen during depressive or manic episodes, not much attention has been paid to postural abnormalities during periods of euthymia and their association with illness burden. We collected 24-hour posture data in 32 euthymic participants diagnosed with BD using a shirt-based wearable. We extracted a set of nine time-domain features, and performed unsupervised participant clustering. We investigated the association between posture variables and 12 clinical characteristics of illness burden. Based on their postural dynamics during the daytime, evening, or nighttime, participants clustered in three clusters. Higher illness burden was associated with lower postural variability, in particular during daytime. Participants who exhibited a mostly upright sitting/standing posture during the night with frequent nighttime postural transitions had the highest number of lifetime depressive episodes. Euthymic participants with BD exhibit postural abnormalities that are associated with illness burden, especially with the number of depressive episodes. Our results contribute to understanding the role of illness burden on posture changes and sleep consolidation in periods of euthymia.
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Goldberg JF, Ernst CL. Locked in Mania. J Acad Consult Liaison Psychiatry 2023; 64:574-575. [PMID: 38065654 DOI: 10.1016/j.jaclp.2023.06.006] [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: 03/20/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Carrie L Ernst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Zavlis O, Matheou A, Bentall R. Identifying the bridge between depression and mania: A machine learning and network approach to bipolar disorder. Bipolar Disord 2023; 25:571-582. [PMID: 36869637 DOI: 10.1111/bdi.13316] [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: 03/05/2023]
Abstract
OBJECTIVES Although the cyclic nature of bipolarity is almost by definition a network system, no research to date has attempted to scrutinize the relationship of the two bipolar poles using network psychometrics. We used state-of-the-art network and machine learning methodologies to identify symptoms, as well as relations thereof, that bridge depression and mania. METHODS Observational study that used mental health data (12 symptoms for depression and 12 for mania) from a large, representative Canadian sample (the Canadian Community Health Survey of 2002). Complete data (N = 36,557; 54.6% female) were analysed using network psychometrics, in conjunction with a random forest algorithm, to examine the bidirectional interplay of depressive and manic symptoms. RESULTS Centrality analyses pointed to symptoms relating to emotionality and hyperactivity as being the most central aspects of depression and mania, respectively. The two syndromes were spatially segregated in the bipolar model and four symptoms appeared crucial in bridging them: sleep disturbances (insomnia and hypersomnia), anhedonia, suicidal ideation, and impulsivity. Our machine learning algorithm validated the clinical utility of central and bridge symptoms (in the prediction of lifetime episodes of mania and depression), and suggested that centrality, but not bridge, metrics map almost perfectly onto a data-driven measure of diagnostic utility. CONCLUSIONS Our results replicate key findings from past network studies on bipolar disorder, but also extend them by highlighting symptoms that bridge the two bipolar poles, while also demonstrating their clinical utility. If replicated, these endophenotypes could prove fruitful targets for prevention/intervention strategies for bipolar disorders.
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Affiliation(s)
- Orestis Zavlis
- University of Manchester, Department of Social Statistics, Manchester, UK
| | - Andreas Matheou
- University of Manchester, Manchester Medical School, Manchester, UK
| | - Richard Bentall
- University of Sheffield, Department of Clinical Psychology, Sheffield, UK
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Faden J, Goldberg JF, Citrome L. Improving the pharmacotherapeutic treatment of agitation associated with bipolar disorder. Expert Opin Pharmacother 2023; 24:1811-1822. [PMID: 37581475 DOI: 10.1080/14656566.2023.2248893] [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: 06/26/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Agitation is commonly encountered in people with bipolar disorder, particularly when experiencing a manic episode. The number of approved pharmacological agents to manage acute episodes of agitation in this population is limited. AREAS COVERED A search was conducted using the US National Library of Medicine PubMed.gov resource for English-language papers of clinical trials and reviews/meta-analyses, using the text words 'bipolar disorder' AND 'agitation,' as well as any papers with both two text words in the title, without any date restrictions. EXPERT OPINION Existing pharmacologic options approved by regulatory authorities for the treatment of acute episodes of agitation associated with bipolar disorder have similar degrees of efficacy but differ in their tolerability profiles and ease of use, giving clinicians an opportunity to individualize treatment. The goal is to treat mild-moderate agitation before it evolves into severe agitation, encouraging noninvasive pharmacologic treatment options. Inhaled loxapine and sublingual dexmedetomidine are newer options with rapid onset of action and may be preferable for patients willing to cooperate with treatment.
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Affiliation(s)
- Justin Faden
- Department of Psychiatry and Behavioral Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, New York, Valhalla, USA
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Validation of the Bipolar Prodrome Symptom Interview and Scale-Abbreviated Prospective (BPSS-AP) in a clinical sample and healthy controls. J Affect Disord 2023; 324:463-468. [PMID: 36586622 DOI: 10.1016/j.jad.2022.12.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND After the existence of a bipolar disorder (BD) prodrome was established, the development of clinical rating instruments has become relevant that are sufficiently brief to be implemented in real-world clinical practice and that are designed to identify individuals at-risk for BD. This study aimed to validate a shorter version of the Bipolar Prodrome Symptom Interview and Scale (BPSS), the BPSS-Abbreviated Prospective (BPSS-AP), for use among clinical populations. METHODS Altogether, 104 adults, comprising individuals diagnosed with BD (n = 17, mania: n = 8, hypomania: n = 9), with major depressive disorder (MDD, n = 38, all currently depressed), and healthy controls (HCs, n = 49), underwent BPSS-AP interviews. The psychometric properties of the BPSS-AP were evaluated, including internal consistency, convergent validity, discriminant validity, and factor structure. RESULTS The median (IQR) age was 29 (23-38), 40 (23-55), and 25 (22-28) years, for the BD, MDD, and HC groups, respectively. The BPSS-AP showed excellent internal consistency (Cronbach's α = 0.95). Convergent validity between the BPSS-AP and Young Mania Rating Scale (YMRS) was high (r > 0.7). The BPSS-AP discriminated patients with BD from those with MDD (P < .001) and from HCs (P < .001). LIMITATIONS The study design precludes assessment of the predictive validity of the BPSS-AP. CONCLUSIONS This study found that the BPSS-AP, a more concise and feasible version of the semi-structured interview for identifying individuals at risk of developing BD, has satisfactory psychometric properties. There is room for further validation and application of the BPSS-AP in clinical settings to evaluate its utility in research and clinical care.
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Ghaemi SN, Angst J, Vohringer PA, Youngstrom EA, Phelps J, Mitchell PB, McIntyre RS, Bauer M, Vieta E, Gershon S. Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity. Int J Bipolar Disord 2022; 10:23. [PMID: 36227452 DOI: 10.1186/s40345-022-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the 1970 s, scientific research on psychiatric nosology was summarized in Research Diagnostic Criteria (RDC), based solely on empirical data, an important source for the third revision of the official nomenclature of the American Psychiatric Association in 1980, the Diagnostic and Statistical Manual, Third Edition (DSM-III). The intervening years, especially with the fourth edition in 1994, saw a shift to a more overtly "pragmatic" approach to diagnostic definitions, which were constructed for many purposes, with research evidence being only one consideration. The latest editions have been criticized as failing to be useful for research. Biological and clinical research rests on the validity of diagnostic definitions that are supported by firm empirical foundations, but critics note that DSM criteria have failed to prioritize research data in favor of "pragmatic" considerations. RESULTS Based on prior work of the International Society for Bipolar Diagnostic Guidelines Task Force, we propose here Clinical Research Diagnostic Criteria for Bipolar Illness (CRDC-BP) for use in research studies, with the hope that these criteria may lead to further refinement of diagnostic definitions for other major mental illnesses in the future. New proposals are provided for mixed states, mood temperaments, and duration of episodes. CONCLUSIONS A new CRDC could provide guidance toward an empirically-based, scientific psychiatric nosology, and provide an alternative clinical diagnostic approach to the DSM system.
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Affiliation(s)
- S Nassir Ghaemi
- Department of Psychiatry, Tufts University, 800 Washington St, Boston, MA, 02111, USA. .,Department of Psychiatry, Harvard Medical School, Boston, USA.
| | | | - Paul A Vohringer
- Department of Psychiatry, Tufts University, 800 Washington St, Boston, MA, 02111, USA.,Department of Psychiatry, University of Chile, Santiago, Chile
| | - Eric A Youngstrom
- Departments of Psychology, Neuroscience, and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - James Phelps
- Department of Psychiatry, Good Samaritan Regional Medical Center, Corvallis, OR, USA
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuel Gershon
- Department of Psychiatry, University of Miami, Miami, USA
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Hasheminasab FS, Pourpasha M, Dehghan A, Galousalari MY, Hashemi SM, Setayesh M. Validity and reliability of the Persian version of the oropharyngeal Mucositis quality of life scale. BMC Oral Health 2021; 21:601. [PMID: 34814894 PMCID: PMC8609725 DOI: 10.1186/s12903-021-01938-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Oral mucositis is one of the serious complications of chemotherapy and/or radiotherapy that significantly affects the quality of patients’ life. The Oropharyngeal Mucositis-Specific Quality-of-Life questionnaire (OMQoL) is an acceptable instrument for measuring the quality of life in these patients. The aim of this study was to evaluate the validity and reliability of the Persian version of OMQoL questionnaire. Methods This study was a cross-sectional and multi-centric research. After translation from English to Persian, back translation, and cultural adaptation, the Persian version of the questionnaire was prepared. One hundred forty-four patients suffering from oral mucositis referred to three different university affiliated hospitals related to Zahedan, Kerman and Tehran Universities of Medical Sciences, were participated in this study. Then the questionnaire was completed by trained interviewers. The reliability was assessed by Cronbach’s alpha coefficient, and validity was measured through factor analysis, and construct validity (including discriminant validity, and convergent validity) methods. Results Cronbach's alpha in all dimensions was higher than 0.9 that indicated a perfect internal consistency. The results of factor analysis indicated that the dimensions specified in the Persian version were the same as the original version (Factor loading of all items > 0.4). The correlation coefficient for all items was more than 0.75, and the convergence validity was 100% in all dimensions. Conclusion The results of this study showed that the reliability, and validity of Persian version of OMQoL were acceptable, which can be used to measure the quality of life in patients with oral mucositis.
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Affiliation(s)
| | - Mona Pourpasha
- Department of Oral and Maxillofacial Medicine, Dentistry School, Kashan University of Medical Sciences, Kashan, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Seyed Mehdi Hashemi
- Clinical Immunology Research Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Setayesh
- Department of Traditional Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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Chen YC, Lin KC, Chen CJ, Yeh SH, Pan AW, Chen HL, Wang CH. Psychometric validation of the Chinese version of the PaArticular Scales among elderly residents in long-term care facilities with joint contractures. BMC Geriatr 2021; 21:353. [PMID: 34107873 PMCID: PMC8190856 DOI: 10.1186/s12877-021-02297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Joint contractures, which affect activity, participation, and quality of life, are common complications of neurological conditions among elderly residents in long-term care facilities. This study examined the reliability and validity of the Chinese version of the PaArticular Scales in a population with joint contractures. Methods A cross-sectional study design was used. The sample included elderly residents older than 64 years with joint contractures in an important joint who had lived at one of 12 long-term care facilities in Taiwan for more than 6 months (N = 243). The Chinese version of the PaArticular Scales for joint contractures was generated from the English version through five stages: translation, review, back-translation, review by a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the World Health Organization Quality of Life scale and the World Health Organization Disability Assessment Schedule. Results The Chinese version of the PaArticular Scales had excellent reliability, with a Cronbach α coefficient of 0.975 (mean score, 28.98; standard deviation, 17.34). An exploratory factor analysis showed three factors and one factor with an eigenvalue > 1 that explained 75.176 and 62.83 % of the total variance in the Activity subscale and Participation subscale, respectively. The subscale-to-total scale correlation analysis showed Pearson correlation coefficients of 0.881 for the Activity subscale and 0.843 for the Participation subscale. Pearson’s product-moment correlation revealed that the correlation coefficient (r) between the Chinese version of the PaArticular Scales and the World Health Organization Disability Assessment Schedule was 0.770, whereas that for the World Health Organization Quality of Life scale was − 0.553; these values were interpreted as large coefficients. Conclusions The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan and has acceptable levels of reliability and validity. However, the Chinese version must be further tested for applicability and generalizability in future studies, preferably with a larger sample and in different clinical domains. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02297-5.
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Affiliation(s)
- Yi-Chang Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan.
| | - Chen-Jung Chen
- Department of Nursing, Mackay Medical College, 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan
| | - Shu-Hui Yeh
- Institute of Long-term Care, Mackay Medical College, Taipei, Taiwan
| | - Ay-Woan Pan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University, Taipei, Taiwan
| | - Hao-Ling Chen
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University, Taipei, Taiwan
| | - Chih-Hung Wang
- Graduate Institute of Education, National Changhua University of Education, No. 1, Jin-De Road, Changhua City, Taiwan
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Ryan KA, Babu P, Easter R, Saunders E, Lee AJ, Klasnja P, Verchinina L, Micol V, Doil B, McInnis MG, Kilbourne AM. A Smartphone App to Monitor Mood Symptoms in Bipolar Disorder: Development and Usability Study. JMIR Ment Health 2020; 7:e19476. [PMID: 32960185 PMCID: PMC7539167 DOI: 10.2196/19476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/23/2020] [Accepted: 07/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is considerable scientific interest in finding new and innovative ways to capture rapid fluctuations in functioning within individuals with bipolar disorder (BD), a severe, recurrent mental disorder associated with frequent shifts in symptoms and functioning. The use of smartphones can provide valid and real-world tools for use in measurement-based care and could be used to inform more personalized treatment options for this group, which can improve standard of care. OBJECTIVE We examined the feasibility and usability of a smartphone to capture daily fluctuations in mood within BD and to relate daily self-rated mood to smartphone use behaviors indicative of psychomotor activity or symptoms of the illness. METHODS Participants were 26 individuals with BD and 12 healthy control individuals who were recruited from the Prechter Longitudinal Study of BD. All were given a smartphone with a custom-built app and prompted twice a day to complete questions of mood for 28 days. The app automatically and unobtrusively collected phone usage data. A poststudy satisfaction survey was also completed. RESULTS Our sample showed a very high adherence rate to the daily momentary assessments (91% of the 58 prompts completed). Multivariate mixed effect models showed that an increase in rapid thoughts over time was associated with a decrease in outgoing text messages (β=-.02; P=.04), and an increase in impulsivity self-ratings was related to a decrease in total call duration (β=-.29; P=.02). Participants generally reported positive experiences using the smartphone and completing daily prompts. CONCLUSIONS Use of mobile technology shows promise as a way to collect important clinical information that can be used to inform treatment decision making and monitor outcomes in a manner that is not overly burdensome to the patient or providers, highlighting its potential use in measurement-based care.
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Affiliation(s)
- Kelly Ann Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Pallavi Babu
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Rebecca Easter
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Erika Saunders
- Department of Psychiatry, Pennsylvania State University, Hershey, PA, United States
| | - Andy Jinseok Lee
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Lilia Verchinina
- Brehm Center for Diabetes Research, University of Michigan, Ann Arbor, MI, United States
| | - Valerie Micol
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Brent Doil
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States.,US Department of Veterans Affairs Health Services Research & Development, VA Depart of Veterans Affairs, Ann Arbor, MI, United States
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Lewis M, Scott J, Frangou S. Impulsivity, personality and bipolar disorder. Eur Psychiatry 2020; 24:464-9. [DOI: 10.1016/j.eurpsy.2009.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 02/15/2009] [Accepted: 03/23/2009] [Indexed: 11/28/2022] Open
Abstract
AbstractBackgroundIncreased impulsivity is a diagnostic feature of mania in bipolar disorder (BD). However it is unclear whether increased impulsivity is also a trait feature of BD and therefore present in remission. Trait impulsivity can also be construed as a personality dimension but the relationship between personality and impulsivity in BD has not been explored. The aim of this study was to examine the relationship of impulsivity to clinical status and personality characteristics in patients with BD.MethodsWe measured impulsivity using the Barratt Impulsiveness Scale (BIS-11) and personality dimensions using Eysenck Personality Questionnaire in 106 BD patients and demographically matched healthy volunteers. Clinical symptoms were assessed in all participants using the Clinical Global Impressions Scale, the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale. Based on their clinical status patients were divided in remitted (n = 36), subsyndromal (n = 25) and syndromal (n = 45).ResultsThere was no difference in BIS-11 and EPQ scores between remitted patients and healthy subjects. Impulsivity, Neuroticism and Psychoticism scores were increased in subsyndromal and syndromal patients. Within the BD group, total BIS-11 score was predicted mainly by symptoms severity followed by Psychoticism and Neuroticism scores.ConclusionsIncreased impulsivity may not be a trait feature of BD. Symptom severity is the most significant determinant of impulsivity measures even in subsyndromal patients.
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11
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Benazzi F. Reviewing the diagnostic validity and utility of mixed depression (depressive mixed states). Eur Psychiatry 2020; 23:40-8. [PMID: 17764909 DOI: 10.1016/j.eurpsy.2007.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 07/15/2007] [Accepted: 07/15/2007] [Indexed: 12/01/2022] Open
Abstract
AbstractObjectiveTo review the diagnostic validity and utility of mixed depression, i.e. co-occurrence of depression and manic/hypomanic symptoms.MethodsPubMed search of all English-language papers published between January 1966 and December 2006 using and cross-listing key words: bipolar disorder, mixed states, criteria, utility, validation, gender, temperament, depression-mixed states, mixed depression, depressive mixed state/s, dysphoric hypomania, mixed hypomania, mixed/dysphoric mania, agitated depression, anxiety disorders, neuroimaging, pathophysiology, and genetics. A manual review of paper reference lists was also conducted.ResultsBy classic diagnostic validators, the diagnostic validity of categorically-defined mixed depression (i.e. at least 2–3 manic/hypomanic symptoms) is mainly supported by family history (the current strongest diagnostic validator). Its diagnostic utility is supported by treatment response (negative effects of antidepressants). A dimensionally-defined mixed depression is instead supported by a non-bi-modal distribution of its intradepression manic/hypomanic symptoms.DiscussionCategorically-defined mixed depression may have some diagnostic validity (family history is the current strongest validator). Its diagnostic utility seems supported by treatment response.
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Affiliation(s)
- Franco Benazzi
- Hecker Psychiatry Research Center, University of California at San Diego, San Diego, CA, USA.
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12
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Filgueiras A, Nunes A, Silveira L, de Assis da Silva R, da Silva R, Landeira-Fernandez J, Cheniaux E. Latent structure of the symptomatology of hospitalized patients with bipolar mania. Eur Psychiatry 2020; 29:431-6. [DOI: 10.1016/j.eurpsy.2014.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/30/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractSeveral studies have attempted to understand the dimensions of psychiatric symptoms in manic episodes, but only a few have been able to model the latent structure of mania in bipolar disorder patients using confirmatory factor analysis. The objective of the present study was to search for the best model of the symptomatology of hospitalized manic patients. To achieve this goal, 117 manic inpatients during a manic crisis participated in this research. Exploratory factor analysis was conducted followed by confirmatory factor analysis using an exploratory factor analysis solution and three other theory-based models. The exploratory factor analysis results revealed a six-factor structure: depression, suicide, insomnia, mania, psychosis, and anxiety. This solution also presented the best fit to the data when tested with confirmatory factor analysis. A five-factor solution, without suicide as a separate dimension, appeared to be more theoretically suitable. Another important finding was that anxiety was an independent dimension in mania. Some hypotheses are discussed in light of contemporary theories, and future studies should investigate this aspect further.
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13
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Johnson SL, Sandel DB, Zisser M, Pearlstein JG, Swerdlow BA, Sanchez AH, Fernandez E, Carver CS. A brief online intervention to address aggression in the context of emotion-related impulsivity for those treated for bipolar disorder: Feasibility, acceptability and pilot outcome data. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2020; 30:65-74. [PMID: 34113851 DOI: 10.1016/j.jbct.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. t Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Devon B Sandel
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Mackenzie Zisser
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Jennifer G Pearlstein
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Benjamin A Swerdlow
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Amy H Sanchez
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Ephrem Fernandez
- University of Texas San Antonio, San Antonio, Texas, United States
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Abstract
Mixed states are frequent clinical pictures in psychiatric practice but are not well described in nosologic systems. Debate exists as to defining mixed states. We review factor and cluster analytical studies and prominent clinical/conceptual models of mixed states. While mania involves standard manic symptoms and depression involves standard depressive symptoms, core additional features of the mixed state are, primarily, psychomotor activation and, secondarily, dysphoria. Those features are more pronounced in mixed mania than in mixed depression but are present in both.
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Affiliation(s)
- Sergio A Barroilhet
- Clínica Psiquiátrica Universitaria, Facultad Medicina Universidad de Chile, Santiago, Chile; Department of Psychiatry, Tufts University, School of Medicine, Tufts Medical Center, Pratt Building, 3rd Floor, 800 Washington Street, Box 1007, Boston, MA 02111, USA.
| | - S Nassir Ghaemi
- Department of Psychiatry, Tufts University, School of Medicine, Tufts Medical Center, Pratt Building, 3rd Floor, 800 Washington Street, Box 1007, Boston, MA 02111, USA; Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
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15
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Weintraub MJ, Schneck CD, Miklowitz DJ. Network analysis of mood symptoms in adolescents with or at high risk for bipolar disorder. Bipolar Disord 2020; 22:128-138. [PMID: 31729789 PMCID: PMC7085972 DOI: 10.1111/bdi.12870] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Network analyses of psychopathology examine the relationships between individual symptoms in an attempt to establish the causal interactions between symptoms that may give rise to episodes of psychiatric disorders. We conducted a network analysis of mood symptoms in adolescents with or at risk for bipolar spectrum disorders. METHODS The sample consisted of 272 treatment-seeking adolescents with or at high risk for bipolar disorder who had at least subsyndromal depressive or (hypo)manic symptoms. Based on symptom scores assessed via semi-structured interviews, we constructed the network of depressive and manic symptoms and identified the most central symptoms and symptom communities within the network. We used bootstrapping analyses to determine the reliability of network parameters. RESULTS Symptoms within the depressive and manic mood poles were more related to each other than to symptoms of the opposing mood pole. Four communities were identified, including a depressive symptom community and three manic symptom communities. Fatigue and depressed mood were the strongest individual symptoms within the overall network (ie the most highly correlated with other symptoms), followed by motor hyperactivity. Mood lability and irritability were found to be "bridge" symptoms that connected the two mood poles. CONCLUSIONS Symptoms of activity/energy (ie fatigue and hyperactivity) and depressed mood are the most prominent mood symptoms among youth with bipolar spectrum disorders. Mood lability and irritability represent potential warning signs of emergent episodes of either polarity. Targeting these central and bridge symptoms would lead to more efficient assessments and therapeutic interventions for bipolar disorder.
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Affiliation(s)
- Marc J. Weintraub
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Christopher D. Schneck
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David J. Miklowitz
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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16
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Abstract
Background. Operational definitions of mania are based on expert consensus rather than empirical data. The aim of this study is to identify the key domains of mania, as well as the relevance of the different signs and symptoms of this clinical construct. Methods. A review of latent factor models studies in manic patients was performed. Before extraction, a harmonization of signs and symptoms of mania and depression was performed in order to reduce the variability between individual studies. Results. We identified 12 studies fulfilling the inclusion criteria and comprising 3039 subjects. Hyperactivity was the clinical item that most likely appeared in the first factor, usually covariating with other core features of mania, such as increased speech, thought disorder, and elevated mood. Depressive–anxious features and irritability–aggressive behavior constituted two other salient dimensions of mania. Altered sleep was frequently an isolated factor, while psychosis appeared related to grandiosity, lack of insight and poor judgment. Conclusions. Our results confirm the multidimensional nature of mania. Hyperactivity, increased speech, and thought disorder appear as core features of the clinical construct. The mood experience could be heterogeneous, depending on the co-occurrence of euphoric (elevated mood) and dysphoric (irritability and depressive mood) emotions of varying intensity. Results are also discussed regarding their relationship with other constitutive elements of bipolar disorder, such as mixed and depressive states.
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Affiliation(s)
- Diego J Martino
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Ciudad Autónoma de Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina.,Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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17
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Smith ACM, Morse RS, Introne W, Duncan WC. Twenty-four-hour motor activity and body temperature patterns suggest altered central circadian timekeeping in Smith-Magenis syndrome, a neurodevelopmental disorder. Am J Med Genet A 2020; 179:224-236. [PMID: 30690916 DOI: 10.1002/ajmg.a.61003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 09/04/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023]
Abstract
Smith-Magenis syndrome (SMS) is a contiguous gene syndrome linked to interstitial microdeletion, or mutation of RAI1, within chromosome 17p11.2. Key behavioral features of SMS include intellectual disability, sleep-disturbances, maladaptive, aggressive and self-injurious behaviors, hyperactivity, and sudden changes in mood. A distinguishing feature of this syndrome is an inverted pattern of melatonin characterized by elevated daytime and low nighttime melatonin levels. As the central circadian clock controls the 24-hr rhythm of melatonin, we hypothesized that the clock itself may contribute to the disrupted pattern of melatonin and sleep. In this report, 24-hr patterns of body temperature, a surrogate marker of clock-timing, and continuous wrist activity were collected to examine the links between body temperature, sleep behavior, and the circadian clock. In addition, age-dependent changes in sleep behavior were explored. Actigraphy-estimated sleep time for SMS was 1 hr less than expected across all ages studied. The timing of the 24-hr body temperature (Tb-24) rhythm was phase advanced, but not inverted. Compared to sibling (SIB) controls, the SMS group had less total night sleep, lower sleep efficiency, earlier sleep onset, earlier final awake times, increased waking after sleep onset (WASO), and increased daytime nap duration. The timing of wake onset varied with age, providing evidence of ongoing developmental sleep changes from childhood through adolescence. Clarification of the circadian and developmental factors that contribute to the disrupted and variable sleep patterns in this syndrome will be helpful in identifying more effective individualized treatments.
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Affiliation(s)
- Ann C M Smith
- Office of the Clinical Director, Division of Intramural Research at the National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Rebecca S Morse
- Office of the Clinical Director, Division of Intramural Research at the National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Wendy Introne
- Office of the Clinical Director, Division of Intramural Research at the National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Wallace C Duncan
- Division of Intramural Research at the National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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18
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Basavaraju R, Mehta UM, Pascual-Leone A, Thirthalli J. Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study. Bipolar Disord 2019; 21:259-269. [PMID: 30422373 PMCID: PMC7610514 DOI: 10.1111/bdi.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The role of the "mirror neuron system" (MNS) in the pathophysiology of mood disorders is not well studied. Given its posited role in the often-impaired socio-emotional processes like intention detection, empathy, and imitation, we compared putative MNS-activity in patients with bipolar mania and healthy comparison subjects. We also examined the association between putative MNS-activity and hyper-imitative behaviors in patients. METHODS We studied 39 medication-free individuals diagnosed with mania and 45 healthy comparison subjects. TMS-evoked motor cortical reactivity was measured via single- and paired-pulse stimuli (assessing SICI-short and LICI-long interval intracortical inhibition) while subjects viewed a static image and goal-directed actions. Manic symptom severity and imitative behaviors were quantified using the Young's Mania Rating Scale and a modification of the Echolalia Questionnaire. RESULTS Two-way repeated measures analysis of variance demonstrated a significant group ×time interaction effect indicating greater facilitation of cortical reactivity during action-observation (putative MNS-activity) in the patient group as compared to the healthy group. While LICI-mediated MNS-activity had a significant association with manic symptom severity (r = 0.35, P = 0.038), SICI-mediated MNS-activity was significantly associated with incidental echolalia scores in a subgroup of 17 patients with incidental echolalia (r = 0.75, P < 0.001). CONCLUSIONS Our findings demonstrate that putative MNS-activity is heightened in mania, possibly because of disinhibition, and associated with behavioral consequences (incidental echolalia).
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Affiliation(s)
- Rakshathi Basavaraju
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Urvakhsh M. Mehta
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Alvaro Pascual-Leone
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jagadisha Thirthalli
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
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19
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Sánchez-Blázquez P, Cortés-Montero E, Rodríguez-Muñoz M, Garzón J. Sigma 1 Receptor Antagonists Inhibit Manic-Like Behaviors in Two Congenital Strains of Mice. Int J Neuropsychopharmacol 2018; 21:938-948. [PMID: 29860313 PMCID: PMC6165958 DOI: 10.1093/ijnp/pyy049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/04/2018] [Accepted: 05/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background Several currently available animal models reproduce select behavioral facets of human mania as well as the abnormal glutamatergic neurotransmission and dysregulation of glycogen synthase kinase 3β that accompanies this disease. Methods In this study, we addressed the therapeutic potential of ligands of sigma receptor type 1 (σ1R) in 2 putative models of mania: the "manic" Black Swiss outbred mice from Taconic farms (BStac) and mice with the 129 genetic background and histidine triad nucleotide-binding protein 1 (HINT1) deletion (HINT1-/- mice) that exhibit bipolar-like behaviors. Results The activity of control mice, which do not exhibit manic-like behaviors in the forced swim test, was significantly enhanced by MK801, an inhibitor of glutamate N-methyl-D-aspartate receptor activity, an effect that was not or barely observed in manic-like mice. Typical mood stabilizers, such as glycogen synthase kinase 3β inhibitors, but not σ1R ligands, reduced the N-methyl-D-aspartate receptor-mediated behaviors in control mice. Notably, σ1R antagonists S1RA, PD144418, BD1047, and BD1063, but not σ1R agonists PRE084 and PPCC, attenuated the manic-like behaviors of BStac and HINT1-/- mice by increasing antiactivity behaviors. The antimanic effects of a single administration of σ1R antagonists persisted for at least 24 hours, and these drugs did not alter the behavior of the "bipolar" HINT1-/- mice during pro-depressive episodes. Conclusions σ1R antagonists exhibit a selective normalizing effect on specific behavioral domains of mania without altering control (normal) or depressive-like behaviors.
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Affiliation(s)
- Pilar Sánchez-Blázquez
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid, Spain
| | - Elsa Cortés-Montero
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid, Spain
| | - María Rodríguez-Muñoz
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid, Spain
| | - Javier Garzón
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid, Spain
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20
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Neurocognition in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia. J Affect Disord 2017; 222:169-176. [PMID: 28709024 DOI: 10.1016/j.jad.2017.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND It has been suggested that patients with bipolar disorder with psychotic symptoms (BD-P) have larger neurocognitive impairment than patients with bipolar disorder without a history of psychotic symptoms (BD-NP). The objective of this study was to compare neurocognitive performance of BD-P and BD-NP relative to a group of patients with schizophrenia (SZ), and healthy controls (HC). METHODS Neurocognitive function was examined in 100 subjects with bipolar I disorder (50 BD-P, 50 BD-NP), 50 SZ, and 51 HC. All patients with BD fulfilled criteria for euthymia, while all SZ patients were stabilised for at least the previous 3 months. RESULTS Patients with BD-P and BD-NP performed worse than HC in all neurocognitive measures, except for sustained attention. Differences between BD-P and BD-NP were subtle and circumscribed to the working memory domain (effect size: 0.29). SZ performed worse than BD-NP in the neurocognitive composite index (NCI) and in the working memory domain. There were no differences between SZ and BD-P in any neurocognitive measure. LIMITATIONS The relatively small sample size, the cross-sectional design and, that patients were receiving pharmacological treatment are the main limitations of this study. CONCLUSIONS Our findings show that the three groups of patients have a large neurocognitive impairment. Differences are quantitative and only present in some neurocognitive domains, such as working memory. These results suggest that patients with BD and SZ can benefit from the same strategies of cognitive remediation.
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21
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Verdolini N, Perugi G, Samalin L, Murru A, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Barbuti M, Guiso G, Popovic D, Vieta E, Pacchiarotti I. Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features. Acta Psychiatr Scand 2017; 136:362-372. [PMID: 28741646 DOI: 10.1111/acps.12777] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate aggressiveness during a major depressive episode (MDE) and its relationship with bipolar disorder (BD) in a post hoc analysis of the BRIDGE-II-MIX study. METHOD A total of 2811 individuals were enrolled in this multicenter cross-sectional study. MDE patients with (MDE-A, n = 399) and without aggressiveness (MDE-N, n = 2412) were compared through chi-square test or Student's t-test. A stepwise backward logistic regression model was performed. RESULTS MDE-A group was more frequently associated with BD (P < 0.001), while aggressiveness was negatively correlated with unipolar depression (P < 0.001). At the logistic regression, aggressiveness was associated with the age at first depressive episode (P < 0.001); the severity of mania (P = 0.03); the diagnosis of BD (P = 0.001); comorbid borderline personality disorder (BPD) (P < 0.001) but not substance abuse (P = 0.63); no current psychiatric treatment (P < 0.001); psychotic symptoms (P = 0.007); the marked social/occupational impairment (P = 0.002). The variable most significantly associated with aggressiveness was the presence of DSM-5 mixed features (P < 0.001, OR = 3.815). After the exclusion of BPD, the variable of lifetime suicide attempts became significant (P = 0.013, OR = 1.405). CONCLUSION Aggressiveness seems to be significantly associated with bipolar spectrum disorders, independently from BPD and substance abuse. Aggressiveness should be considered as a diagnostic criterion for the mixed features specifier and a target of tailored treatment strategy.
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Affiliation(s)
- N Verdolini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - G Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - L Samalin
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Psychiatry, CHU Clermont-Ferrand, University of Auvergne, EA 7280, Clermont-Ferrand, France.,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - A Murru
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Angst
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - J-M Azorin
- AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - C L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - A H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Barbuti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - G Guiso
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Medical Sciences and Public Health, University of Cagliari and Psychiatric Clinic, University Hospital, Cagliari, Italy
| | - D Popovic
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Psychiatry B, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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22
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Kim BN, Kwon SM. Initial Psychometric Properties of the Korean Altman Self-Rating Mania Scale: Preliminary Validation Study in a Non-Clinical Sample. Psychiatry Investig 2017; 14:562-567. [PMID: 29042880 PMCID: PMC5639123 DOI: 10.4306/pi.2017.14.5.562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/05/2016] [Accepted: 08/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to examine the reliability and validity of the Korean Altman Self-Rating Mania Scale (K-ASRM) in a large sample of Korean non-clinical undergraduates. METHODS Participants (n=1,091) filled out the K-ASRM with other self-report questionnaires assessing bipolarity, mood symptoms and affect. Reliability test, exploratory factor analysis and correlation analyses were conducted to examine its psychometric properties. RESULTS The reliability of the K-ASRM was adequate (Cronbach's α=0.73, item-to-total correlation 0.53-0.78) and the exploratory factor analysis yielded one factor of mania. The K-ASRM demonstrated significant associations with measures of hypomanic personality (r=0.33), lifetime history of hypomanic symptoms (r=0.23). Also, the K-ASRM was significantly correlated with positive affect (r=0.53), negative affect (r=-0.17) and depressive symptoms (r=-0.35). CONCLUSION These results suggest preliminary possibility that the K-ASRM can be utilized as self-rating tool for mania in Korea as well as future directions for further validation.
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Affiliation(s)
- Bin-Na Kim
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
| | - Seok-Man Kwon
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
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23
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Tohen M, Gold AK, Sylvia LG, Montana RE, McElroy SL, Thase ME, Rabideau DJ, Nierenberg AA, Reilly-Harrington NA, Friedman ES, Shelton RC, Bowden CL, Singh V, Deckersbach T, Ketter TA, Calabrese JR, Bobo WV, McInnis MG. Bipolar mixed features - Results from the comparative effectiveness for bipolar disorder (Bipolar CHOICE) study. J Affect Disord 2017; 217:183-189. [PMID: 28411507 DOI: 10.1016/j.jad.2017.03.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/09/2017] [Accepted: 03/28/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND DSM-5 changed the criteria from DSM-IV for mixed features in mood disorder episodes to include non-overlapping symptoms of depression and hypomania/mania. It is unknown if, by changing these criteria, the same group would qualify for mixed features. We assessed how those meeting DSM-5 criteria for mixed features compare to those meeting DSM-IV criteria. METHODS We analyzed data from 482 adult bipolar patients in Bipolar CHOICE, a randomized comparative effectiveness trial. Bipolar diagnoses were confirmed through the MINI International Neuropsychiatric Interview (MINI). Presence and severity of mood symptoms were collected with the Bipolar Inventory of Symptoms Scale (BISS) and linked to DSM-5 and DSM-IV mixed features criteria. Baseline demographics and clinical variables were compared between mood episode groups using ANOVA for continuous variables and chi-square tests for categorical variables. RESULTS At baseline, the frequency of DSM-IV mixed episodes diagnoses obtained with the MINI was 17% and with the BISS was 20%. Using DSM-5 criteria, 9% of participants met criteria for hypomania/mania with mixed features and 12% met criteria for a depressive episode with mixed features. Symptom severity was also associated with increased mixed features with a high rate of mixed features in patients with mania/hypomania (63.8%) relative to those with depression (8.0%). LIMITATIONS Data on mixed features were collected at baseline only and thus do not reflect potential patterns in mixed features within this sample across the study duration. CONCLUSIONS The DSM-5 narrower, non-overlapping definition of mixed episodes resulted in fewer patients who met mixed criteria compared to DSM-IV.
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Affiliation(s)
- Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA.
| | - Alexandra K Gold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Rebecca E Montana
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Dustin J Rabideau
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Noreen A Reilly-Harrington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Richard C Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Vivek Singh
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Terence A Ketter
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph R Calabrese
- Bipolar Disorders Research Center, University Hospital's Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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24
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Abstract
BACKGROUND AND OBJECTIVES Phenomenological studies on mood disorder are rare in Nepal which prompted us to undertake the current factor analytical study of mania. MATERIALS AND METHODS It was a cross-sectional descriptive study for which we did purposive sampling technique according to certain inclusion and exclusion criteria. The study sample consists of fifty patients, who fulfilled the International Classification of Diseases, Tenth Edition (ICD-10) diagnostic criteria for Manic Episode and/or Bipolar Affective Disorder-current episode mania. Tools used were ICD-10 Diagnostic Criteria for Research, Young's Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Principal component factor analysis was applied to the 35 symptoms taken from YMRS and BPRS. RESULTS Factor analysis revealed the presence of four main factors, which explained 51.082% of the total variance. These are "pure mania" which isolated 11 manic symptoms, "dysphoric mania" which isolated five depressive symptoms, "hostile mania" which isolated six symptoms, and the fourth factor, we called it "delirious mania," isolated four symptoms. CONCLUSION The identified factors and subtypes are a useful conceptualization of atypical features among patients with acute mania. Further validation studies are required to determine whether the identified subtypes are of clinical and theoretical importance.
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Affiliation(s)
- Sanjeev Shah
- Department of Psychiatry, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Tapas Kumar Aich
- Department of Psychiatry, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Sandip Subedi
- Department of Psychiatry, Universal College of Medical Sciences, Bhairahawa, Nepal
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25
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Abstract
Various terms have been used to describe mania when it is accompanied by depressive symptoms. In this article, we attempt to define and discuss 3 of these terms: dysphoric mania, mixed state, and mania with mixed features specifier. We conclude that whatever term is used, it is important to be aware that mania is more often unpleasant than pleasant, and that the unpleasantness is not limited to depression.
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26
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Fountoulakis KN, Young A, Yatham L, Grunze H, Vieta E, Blier P, Moeller HJ, Kasper S. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. Int J Neuropsychopharmacol 2017; 20:98-120. [PMID: 27815414 PMCID: PMC5408969 DOI: 10.1093/ijnp/pyw091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/20/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. METHODS The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. RESULTS The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. CONCLUSION The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
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Prognostic Value of Affective Symptoms in First-Admission Psychotic Patients. Int J Mol Sci 2016; 17:ijms17071039. [PMID: 27376266 PMCID: PMC4964415 DOI: 10.3390/ijms17071039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 01/09/2023] Open
Abstract
Background: Very little research has been conducted in patients with first-episode psychosis using a dimensional approach. Affective dimensional representations might be useful to predict the clinical course and treatment needs in such patients. Methods: Weincluded 112 patients with first-episode psychosis in a longitudinal-prospective study with a five-year follow-up (N = 82). Logistic analyses were performed to determine the predictive factors associated with depressive, manic, activation, and dysphoric dimensions. Results: High scores on the depressive dimension were associated with the best prognosis. On the other hand, high scores on the activation dimension and the manic dimension were associated with a poorer prognosis in terms of relapses. Only the dysphoric dimension was not associated with syndromic or functional prognosis. Conclusion: Ourresults suggest that the pattern of baseline affective symptoms helps to predict the course of psychotic illness. Therefore, the systematic assessment of affective symptoms would enable us to draw important conclusions regarding patients’ prognosis. Interventions for patients with high scores on manic or activation dimensions could be beneficial in decreasing relapses in first-episode psychosis.
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 473] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Fernandez E, Johnson SL. Anger in psychological disorders: Prevalence, presentation, etiology and prognostic implications. Clin Psychol Rev 2016; 46:124-35. [DOI: 10.1016/j.cpr.2016.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/14/2015] [Accepted: 04/25/2016] [Indexed: 01/21/2023]
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Shansis FM, Reche M, Capp E. Evaluating response to mood stabilizers in patients with mixed depression: A study of agreement between three different mania rating scales and a depression rating scale. J Affect Disord 2016; 197:1-7. [PMID: 26950019 DOI: 10.1016/j.jad.2016.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/18/2016] [Accepted: 02/26/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate agreement between three pairs formed by one of three mania scales (Young Mania Rating Scale [YMRS], Bech-Rafaelsen Mania Scale [BRMS], or the Clinician-Administered Rating Scale for Mania [CARS-M]) and a single depression scale (21-item Hamilton Depression Rating Scale [21-HAM-D]) for evaluation of response to mood stabilizers in patients with mixed bipolar disorder. METHODS Between 2010 and 2014, 68 consecutive bipolar type I and II outpatients with mixed depression as per DSM-IV-TR and Cincinnati criteria were included in this 8-week open-label trial to randomly receive carbamazepine, lithium carbonate, or valproic acid as monotherapy. RESULTS Patterns of response (defined as a reduction of at least 50% in one of the mania scales and on the 21-HAM-D) were strikingly similar: 21-HAM-D+YMRS=22.1%, 21-HAM-D+BRMS=20.6%, and 21-HAM-D+CARS-M=23.5% (p<0.368). Assessment of agreement revealed very high kappa coefficients: 21-HAM-D+YMRS vs. 21-HAM-D+CARS-M, kappa=0.87; 21-HAM-D+YMRS vs. 21-HAM-D+BRMS, kappa=0.78; 21-HAM-D+CARS-M vs. 21-HAM-D+BRMS, kappa=0.91 (p<0.001). LIMITATIONS The decision to combine a depression rating scale with any one mania rating scale to assess treatment response in patients with mixed depression is questionable. CONCLUSIONS The present study suggests that any one of the three tested mania rating scales (YMRS, BRMS, and CARS-M) can be combined with the 21-HAM-D to assess treatment response in patients with mixed bipolar disorder. This should give clinicians an added measure of confidence in using this strategy until valid, and specific instruments are developed for assessment of mixed states.
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Affiliation(s)
- Flávio Milman Shansis
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), School of Medicine, Porto Alegre, RS, Brazil; Teaching and Research Program in Mood Disorders (PROPESTH), Hospital Psiquiátrico São Pedro, Porto Alegre, RS, Brazil.
| | - Mateus Reche
- Teaching and Research Program in Mood Disorders (PROPESTH), Hospital Psiquiátrico São Pedro, Porto Alegre, RS, Brazil; Postgraduate Program in Obstetrics and Gynecology, UFRGS, School of Medicine, Porto Alegre, RS, Brazil
| | - Edison Capp
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), School of Medicine, Porto Alegre, RS, Brazil; Postgraduate Program in Obstetrics and Gynecology, UFRGS, School of Medicine, Porto Alegre, RS, Brazil; Service of Obstetrics and Gynecology, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Obstetrics and Gynecology, UFRGS, School of Medicine, Porto Alegre, RS, Brazil; Department of Gynecological Endocrinology and Reproductive Medicine, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Morrison AP, Law H, Barrowclough C, Bentall RP, Haddock G, Jones SH, Kilbride M, Pitt E, Shryane N, Tarrier N, Welford M, Dunn G. Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Steven H Jones
- The Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
| | - Martina Kilbride
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Pitt
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Shryane
- School of Social Sciences, University of Manchester, Manchester, UK
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Mary Welford
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
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Schwartz S, Schultz S, Reider A, Saunders EFH. Daily mood monitoring of symptoms using smartphones in bipolar disorder: A pilot study assessing the feasibility of ecological momentary assessment. J Affect Disord 2016; 191:88-93. [PMID: 26655117 PMCID: PMC4799837 DOI: 10.1016/j.jad.2015.11.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/26/2015] [Accepted: 11/11/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Personal device technology has facilitated gathering data in real-time using Ecological momentary assessment (EMA). We hypothesized that using smartphones to measure symptoms in auto-generated surveys twice a day would be feasible in a group with bipolar disorder (BD). A second exploratory objective of this study was to compare potential differences in core symptoms between BD and healthy control (HC) groups. METHODS A two-arm, parallel group, observational study was designed to measure completion rates of surveys of symptoms of mood, energy, speed of thought, impulsivity, and social stress in BD (N=10) and HC (N=10) participants. The surveys were auto-generated twice a day for fourteen days, and subjects could also perform self-generated surveys. Completion rates were compared between BD and HC groups. Scores were averaged for each participant over the 14 day period, and group medians were compared. RESULTS Median completion rates did not differ between groups: 95% in BD, 88% in HC (p=0.68); the median completion rate of auto-generated surveys in the BD group was 79% and in the HC group was 71% (p=0.22). The BD group had significantly lower median mood score (p=0.043) and energy score (p=0.007) than the HC group. Median scores of speed of thoughts (p=0.739), impulsivity (p=0.123) and social stress (p=0.056) did not significantly differ between BD and HC. The BD group had significantly higher range of variability of group median mood (p=0.043), speed of thoughts (p=0.002) and impulsivity (p=0.005) scores over the course of 14 days than HC, while range of variability of energy (p=0.218) and social stress (p=0.123) scores did not differ. Results were not significantly different between auto-generated and self-generated surveys for BD or HC. LIMITATIONS This pilot study was conducted for a short time and with a small sample. CONCLUSIONS This study demonstrates feasibility of using EMA with a smartphone to gather data on BD symptoms.
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Affiliation(s)
- Stefani Schwartz
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States.
| | - Summer Schultz
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States.
| | - Aubrey Reider
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States.
| | - Erika F H Saunders
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States; University of Michigan Department of Psychiatry, Ann Arbor, MI, United States; University of Michigan Depression Center, Ann Arbor, MI, United States.
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Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder. J Affect Disord 2016; 189:169-75. [PMID: 26437231 DOI: 10.1016/j.jad.2015.07.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/02/2015] [Accepted: 07/14/2015] [Indexed: 01/04/2023]
Abstract
Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.
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Johnson SL, Gershon A, Starov V. Is energy a stronger indicator of mood for those with bipolar disorder compared to those without bipolar disorder? Psychiatry Res 2015; 230:1-4. [PMID: 26257089 DOI: 10.1016/j.psychres.2015.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 06/11/2015] [Accepted: 06/25/2015] [Indexed: 11/29/2022]
Abstract
Theory and research indicate that activity is fundamental to mood episodes in bipolar disorder (BD), yet researchers have not tested whether energy is more closely tethered to mood in BD compared to those without BD. Eighty-seven participants (13 with self-reported BD) completed 4396 energy and mood ratings through a mood-monitoring application. Mixed modeling analyses indicated that low energy, but not high energy, was related to mood within the BD group. Low energy could provide a strong and easily recognized indicator of negative mood states in persons with BD.
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Affiliation(s)
- Sheri L Johnson
- Department of Psychology, University of California, 3210 Tolman Hall, Berkeley, CA 94720-1650, USA.
| | - Anda Gershon
- Stanford University, School of Medicine, Stanford, CA, USA
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Johnson SL, Tharp JA, Peckham AD, McMaster KJ. Emotion in bipolar I disorder: Implications for functional and symptom outcomes. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 125:40-52. [PMID: 26480234 DOI: 10.1037/abn0000116] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Despite the centrality of emotion disturbance in neurobiological models of bipolar disorder, the behavioral literature has not yet clearly identified the most central aspects of emotion disturbance in bipolar disorder. Toward this aim, we gathered a battery of emotion-related measures in 67 persons diagnosed with bipolar I disorder as assessed with the SCID and a well-matched control group of 58 persons without a history of mood disorders. Those with bipolar disorder were interviewed monthly until they achieved remission, and then tested on emotion measures. A subset of 36 participants with bipolar disorder completed symptom severity interviews at 12-month follow-up. Factor analyses indicated 4 emotion factor scores: Negative Emotion, Positive Emotion, Reappraisal, and Suppression. Bivariate analyses suggested that bipolar disorder was tied to a host of emotion disturbances, but multivariate analyses suggested that bipolar disorder was particularly tied to elevations of Negative Emotion. High Negative Emotion, low Positive Emotion, and high Suppression were conjointly related to lower functioning. Reappraisal predicted declines in depression over time for those with bipolar disorder. Findings highlight the importance of considering the overall profile of emotion disturbance in bipolar disorder. Emotion and emotion regulation appear central to a broad range of outcomes in bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- Department of Psychology, University of California at Berkeley
| | - Jordan A Tharp
- Department of Psychology, University of California at Berkeley
| | | | - Kaja J McMaster
- Department of Psychology, University of California at Berkeley
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Burke A, Vorster A. Prevalence rates of comorbid disorders in attention deficit hyperactivity disorder adults. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2015. [DOI: 10.1177/0081246315602429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although there has been extensive research on attention deficit hyperactivity disorder as a clinical disorder in adulthood, many clinicians remain sceptical about the validity of this disorder. Among the many reasons for this are comorbid conditions which may complicate the disorder. The aim of this study was to determine the prevalence rates of other disorders among a group of adults with attention deficit hyperactivity disorder, based on participants’ scores on the Million Clinical Multiaxial Inventory-III. In order to meet this aim, the Million Clinical Multiaxial Inventory -III results of a group of adults with attention deficit hyperactivity disorder ( n = 51) were analysed. In terms of Cluster B personality disorders, the following prevalence rates were found for the attention deficit hyperactivity disorder group: 23% Borderline, 27.4% Antisocial, 19.6% Histrionic, and 19.6% Narcissistic. As far as comparing prevalence rates of possible comorbid conditions, as found in this study, with those of previous studies, the results compare well to those conditions that are reported as the most prevalent in other studies. However, the wide range of clinical and personality disorders that are associated with attention deficit hyperactivity disorder indicate that there are no typical comorbid disorders.
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Affiliation(s)
- Alban Burke
- Department of Psychology, University of Johannesburg, South Africa
| | - Adri Vorster
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, South Africa
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Pathak G, Ibrahim BA, McCarthy SA, Baker K, Kelly MP. Amphetamine sensitization in mice is sufficient to produce both manic- and depressive-related behaviors as well as changes in the functional connectivity of corticolimbic structures. Neuropharmacology 2015; 95:434-47. [PMID: 25959066 DOI: 10.1016/j.neuropharm.2015.04.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 04/21/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
It has been suggested that amphetamine abuse and withdrawal mimics the diverse nature of bipolar disorder symptomatology in humans. Here, we determined if a single paradigm of amphetamine sensitization would be sufficient to produce both manic- and depressive-related behaviors in mice. CD-1 mice were subcutaneously dosed for 5 days with 1.8 mg/kg d-amphetamine or vehicle. On days 6-31 of withdrawal, amphetamine-sensitized (AS) mice were compared to vehicle-treated (VT) mice on a range of behavioral and biochemical endpoints. AS mice demonstrated reliable mania- and depression-related behaviors from day 7 to day 28 of withdrawal. Relative to VT mice, AS mice exhibited long-lasting mania-like hyperactivity following either an acute 30-min restraint stress or a low-dose 1 mg/kg d-amphetamine challenge, which was attenuated by the mood-stabilizers lithium and quetiapine. In absence of any challenge, AS mice showed anhedonia-like decreases in sucrose preference and depression-like impairments in the off-line consolidation of motor memory, as reflected by the lack of spontaneous improvement across days of training on the rotarod. AS mice also demonstrated a functional impairment in nest building, an ethologically-relevant activity of daily living. Western blot analyses revealed a significant increase in methylation of histone 3 at lysine 9 (H3K9), but not lysine 4 (H3K4), in hippocampus of AS mice relative to VT mice. In situ hybridization for the immediate-early gene activity-regulated cytoskeleton-associated protein (Arc) further revealed heightened activation of corticolimbic structures, decreased functional connectivity between frontal cortex and striatum, and increased functional connectivity between the amygdala and hippocampus of AS mice. The effects of amphetamine sensitization were blunted in C57BL/6J mice relative to CD-1 mice. These results show that a single amphetamine sensitization protocol is sufficient to produce behavioral, functional, and biochemical phenotypes in mice that are relevant to bipolar disorder.
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Affiliation(s)
- G Pathak
- University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - B A Ibrahim
- University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | | | - K Baker
- Pfizer, Neuroscience, Groton, CT 06340, USA
| | - M P Kelly
- University of South Carolina School of Medicine, Columbia, SC 29209, USA.
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Patterns of response to aripiprazole, lithium, haloperidol, and placebo across factor scores of mania. Int J Bipolar Disord 2015; 3:11. [PMID: 25945321 PMCID: PMC4418976 DOI: 10.1186/s40345-015-0026-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/31/2015] [Indexed: 12/03/2022] Open
Abstract
Background A previous factor analysis of Young Mania Rating Scale and Montgomery-Åsberg Depression Rating Scale items identified composite factors of depression, mania, sleep disturbance, judgment/impulsivity, and irritability/hostility as major components of psychiatric symptoms in acute mania or mixed episodes in a series of trials of antipsychotics. However, it is unknown whether these factors predict treatment outcome. Methods Data from six double-blind, randomized, controlled clinical trials with aripiprazole in acute manic or mixed episodes in adults with bipolar I disorder were pooled for this analysis and the previously identified factors were examined for their value in predicting treatment outcome. Treatment efficacy was assessed for aripiprazole (n = 1,001), haloperidol (n = 324), lithium (n = 155), and placebo (n = 694) at baseline, days 4, 7, and 10, and then weekly to study end. Mean change in factor scores from baseline to week 3 was assessed by receiver operating characteristics curves for percentage factor change at day 4 and week 1. Results Subjects receiving aripiprazole, haloperidol, and lithium significantly improved mania factor scores versus placebo. Factors most predictive of endpoint efficacy for aripiprazole were judgment/impulsivity at day 4 and mania at week 1. Optimal factor score improvement for outcome prediction was approximately 40% to 50%. Early efficacy predicted treatment outcome across all factors; however, response at week 1 was a better predictor than response at day 4. Conclusions This analysis confirms clinical benefits in early treatment/assessment for subjects with bipolar mania and suggests that certain symptom factors in mixed or manic episodes may be most predictive of treatment response.
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Prisciandaro JJ, Tolliver BK. Evidence for the continuous latent structure of mania and depression in out-patients with bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Psychol Med 2015; 45:2595-2603. [PMID: 25881582 PMCID: PMC4751879 DOI: 10.1017/s0033291715000513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence supporting the continuous latent structure of mood phenomena has not been incorporated into psychiatric diagnostic systems, in part because the evidence has been incomplete. For example, no studies have investigated the boundary between 'sick' and 'well' periods in individuals with bipolar disorder, despite agreement that characterization of mood disorders as having a discrete episodic course is inaccurate. The present study examined the validity of mood episode symptom thresholds in out-patients with bipolar disorder using multiple methodologies: taxometrics and information-theoretic latent distribution modeling (ITLDM), to evaluate the continuity/discontinuity of mood symptoms; and structural equation mixture modeling (SEMM), to evaluate the continuity/discontinuity of associations between mood symptoms and general functioning. METHOD A total of 3721 out-patients with bipolar disorder from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were available for analysis. Data were collected at participants' baseline STEP-BD visit. Taxometric [maximum covariance/means above minus below a cut (MAXCOV/MAMBAC) with simulated comparison data], ITLDM and SEMM methods were applied twice, once to the Montgomery-Åsberg Depression Rating Scale and again to the Young Mania Rating Scale. RESULTS Taxometric results unequivocally supported a continuous interpretation of the data. ITLDM results favored many valued 'discrete metrical' models, suggesting that mood symptoms have continuous, but potentially non-normally distributed, latent structures in out-patients with bipolar disorder. Finally, SEMM results demonstrated that latent associations between mood symptoms and general functioning were linear. CONCLUSIONS Results from the present study argue against the validity of DSM mood episode thresholds and argue for a graded continuum of care of bipolar symptom management.
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Affiliation(s)
- J J Prisciandaro
- Department of Psychiatry and Behavioral Sciences,Medical University of South Carolina,Charleston,SC,USA
| | - B K Tolliver
- Department of Psychiatry and Behavioral Sciences,Medical University of South Carolina,Charleston,SC,USA
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Investigating the mechanism(s) underlying switching between states in bipolar disorder. Eur J Pharmacol 2015; 759:151-62. [PMID: 25814263 DOI: 10.1016/j.ejphar.2015.03.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/03/2015] [Accepted: 03/12/2015] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a unique disorder that transcends domains of function since the same patient can exhibit depression or mania, states with polar opposite mood symptoms. During depression, people feel helplessness, reduced energy, and risk aversion, while with mania behaviors include grandiosity, increased energy, less sleep, and risk preference. The neural mechanism(s) underlying each state are gaining clarity, with catecholaminergic disruption seen during mania, and cholinergic dysfunction during depression. The fact that the same patient cycles/switches between these states is the defining characteristic of BD however. Of greater importance therefore, is the mechanism(s) underlying cycling from one state - and its associated neural changes - to another, considered the 'holy grail' of BD research. Herein, we review studies investigating triggers that induce switching to these states. By identifying such triggers, researchers can study neural mechanisms underlying each state and importantly how such mechanistic changes can occur in the same subject. Current animal models of this switch are also discussed, from submissive- and dominant-behaviors to kindling effects. Focus however, is placed on how seasonal changes can induce manic and depressive states in BD sufferers. Importantly, changing photoperiod lengths can induce local switches in neurotransmitter expression in normal animals, from increased catecholaminergic expression during periods of high activity, to increased somatostatin and corticotrophin releasing factor during periods of low activity. Identifying susceptibilities to this switch would enable the development of targeted animal models. From animal models, targeted treatments could be developed and tested that would minimize the likelihood of switching.
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Güclü O, Şenormancı Ö, Aydın E, Erkıran M, Köktürk F. Phenomenological subtypes of mania and their relationships with substance use disorders. J Affect Disord 2015; 174:569-73. [PMID: 25560193 DOI: 10.1016/j.jad.2014.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of the present study was to determine the distinct clusters of subtypes among patients with bipolar disorder (BD) and the relationship between the clinical features of BD patients, particularly substance use disorders (SUDs) and the clusters. METHOD The present study initially assessed 96 inpatients who were hospitalized in the psychiatric clinic of Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, for a BD manic episode. All patients were evaluated during the initial 3 days of their admission using the Young Mania Rating Scale (YMRS), the Montgomery-Asberg Depression Rating Scale (MADRS),the Scale for the Assessment of Positive Symptoms (SAPS), the Michigan Alcoholism Screening Test (MAST) and a sociodemographic questionnaire. The factor structures of the psychopathological scale items were determined with factor analyses and based on the factor loadings, cluster analyses were performed. The relationships among the clusters and the clinical variables were then evaluated. RESULTS The factor analyses generated three factors: increased psychomotor activity, dysphoria, and psychosis. A hierarchical cluster analysis was applied to the three factor loadings, and revealed that factor 1 (increased psychomotor activity) was high in cluster 1 and that the effects of factors 2 (dysphoria) and 3 (psychosis) were high in cluster 2. Within cluster 1 (Psychomotor elevation), 39% of patients were diagnosed with an alcohol use disorder while 31.6% of patients in the cluster 2 (dysphoric-psychotic) were diagnosed with both alcohol and cannabis use disorders. Within cluster 2 (dysphoric-psychotic), 47.4% of patients had one suicide attempt and 21.1% of patients had two or more attempts during their lifetime. CONCLUSION There was a significant difference in the presence of SUDs between patients with psychomotor elevation and patients in dysphoric-psychotic cluster. This may be point out that pure manic patients with BD self-medicate using the sedative effects of alcohol and the causal relationship between cannabis and psychosis. Using a dimensional approach to study BD may enhance detection of the biological correlates of BD and improve the treatment and outcomes of the disorder.
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Affiliation(s)
- Oya Güclü
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey.
| | - Ömer Şenormancı
- Department of Psychiatry, School of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Erkan Aydın
- Bahçelievler State Hospital Psychiatry, İstanbul, Turkey
| | - Murat Erkıran
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey
| | - Firuzan Köktürk
- Department of Statistics, School of Medicine, Bülent Ecevit University, Zonguldak, Turkey
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The inter-relationship between mood, self-esteem and response styles in adolescent offspring of bipolar parents: an experience sampling study. Psychiatry Res 2015; 225:563-70. [PMID: 25529261 DOI: 10.1016/j.psychres.2014.11.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/22/2014] [Accepted: 11/22/2014] [Indexed: 11/21/2022]
Abstract
The response styles theory of depression (Nolen-Hoeksema, 1991) proposes three main strategies individuals employ in response to low mood: rumination, active coping (distraction and problem-solving) and risk taking. Although recent research has suggested this theory has utility in understanding the symptoms of bipolar disorder (BD), the role of these processes in conferring vulnerability to the condition is poorly understood. Twenty-three adolescent children of patients with BD and 25 offspring of well parents completed the Experience Sampling Method (ESM; Csikszentmihalyi and Larson, 1987) diary for six days. Longitudinal analyses were carried out to examine inter-relationships between mood, self-esteem and response styles. Increased negative as well as positive mood resulted in greater rumination in both groups. Low self-esteem triggered greater risk-taking at the subsequent time point in the at-risk group, while negative affect instigated increased active coping in the control group. In both groups, engagement in risk-taking improved mood at the subsequent time point, whilst rumination dampened self-esteem. Differential longitudinal associations between mood, self-esteem and response styles between at-risk and control children suggest early psychological vulnerability in the offspring of BD parents, with important indications for early intervention.
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Young JW, Geyer MA. Developing treatments for cognitive deficits in schizophrenia: the challenge of translation. J Psychopharmacol 2015; 29:178-96. [PMID: 25516372 PMCID: PMC4670265 DOI: 10.1177/0269881114555252] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schizophrenia is a life-long debilitating mental disorder affecting tens of millions of people worldwide. The serendipitous discovery of antipsychotics focused pharmaceutical research on developing a better antipsychotic. Our understanding of the disorder has advanced however, with the knowledge that cognitive enhancers are required for patients in order to improve their everyday lives. While antipsychotics treat psychosis, they do not enhance cognition and hence are not antischizophrenics. Developing pro-cognitive therapeutics has been extremely difficult, however, especially when no approved treatment exists. In lieu of stumbling on an efficacious treatment, developing targeted compounds can be facilitated by understanding the neural mechanisms underlying altered cognitive functioning in patients. Equally importantly, these cognitive domains will need to be measured similarly in animals and humans so that novel targets can be tested prior to conducting expensive clinical trials. To date, the limited similarity of testing across species has resulted in a translational bottleneck. In this review, we emphasize that schizophrenia is a disorder characterized by abnormal cognitive behavior. Quantifying these abnormalities using tasks having cross-species validity would enable the quantification of comparable processes in rodents. This approach would increase the likelihood that the neural substrates underlying relevant behaviors will be conserved across species. Hence, we detail cross-species tasks which can be used to test the effects of manipulations relevant to schizophrenia and putative therapeutics. Such tasks offer the hope of providing a bridge between non-clinical and clinical testing that will eventually lead to treatments developed specifically for patients with deficient cognition.
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Affiliation(s)
- JW Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - MA Geyer
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
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van Enkhuizen J, Henry BL, Minassian A, Perry W, Milienne-Petiot M, Higa KK, Geyer MA, Young JW. Reduced dopamine transporter functioning induces high-reward risk-preference consistent with bipolar disorder. Neuropsychopharmacology 2014; 39:3112-22. [PMID: 25005251 PMCID: PMC4229584 DOI: 10.1038/npp.2014.170] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 11/10/2022]
Abstract
Individuals with bipolar disorder (BD) exhibit deleterious decision making, negatively impacting their lives. Such aberrant decision making can be quantified using the Iowa Gambling Task (IGT), which requires choosing between advantageous and disadvantageous options based on different reward/punishment schedules. The mechanisms underlying this behavioral deficit are unknown, but may include the reduced dopamine transporter (DAT) functioning reported in BD patients. Using both human and mouse IGTs, we tested whether reduced DAT functioning would recreate patterns of deficient decision making of BD patients. We assessed the IGT performance of 16 BD subjects (7 female) and 17 healthy control (HC) subjects (12 female). We recorded standard IGT performance measures and novel post-reward and post-punishment decision-making strategies. We characterized a novel single-session mouse IGT using C57BL/6J mice (n = 44). The BD and HC IGT performances were compared with the effects of chronic (genetic knockdown (KD; n = 31) and wild-type (n = 28) mice) and acute (C57BL/6J mice (n = 89) treated with the DAT inhibitor GBR12909) reductions of DAT functioning in mice performing this novel IGT. BD patients exhibited impaired decision making compared with HC subjects. Both the good-performing DAT KD and GBR12909-treated mice exhibited poor decision making in the mouse IGT. The deficit of each population was driven by high-reward sensitivity. The single-session mouse IGT measures dynamic risk-based decision making similar to humans. Chronic and acute reductions of DAT functioning in mice impaired decision-making consistent with poor IGT performance of BD patients. Hyperdopaminergia caused by reduced DAT may impact poor decision making in BD patients, which should be confirmed in future studies.
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Affiliation(s)
- Jordy van Enkhuizen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Brook L Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - William Perry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Morgane Milienne-Petiot
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kerin K Higa
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Research Service, VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA, Tel: +1 619 543 3582, Fax: +1 619 735 9205, E-mail:
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Ruggero CJ, Kotov R, Watson D, Kilmer JN, Perlman G, Liu K. Beyond a single index of mania symptoms: structure and validity of subdimensions. J Affect Disord 2014; 161:8-15. [PMID: 24751301 DOI: 10.1016/j.jad.2014.02.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/28/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND DSM-5 portrays mania as unitary despite evidence of distinct symptom clusters. Studies investigating the structure of mania have been inconsistent, in part because many relied on instruments not designed for this question. The present work used a clinical interview designed for structural analysis in order to identify and validate subdimensions specific to mania symptoms. METHODS Psychiatric outpatients (N=422) and undergraduates with a history of mental health treatment (N=306) were interviewed with a comprehensive measure of mood and anxiety that included 24 manic symptoms. Patients completed additional measures of symptoms and functioning, and a semi-structured diagnostic interview. RESULTS A 4-factor model of mania replicated across independent samples and was superior in fit to competing models, including the unidimensional model implied whenever researchers or clinicians use only a total score for mania. The factors were only moderately correlated, and three of the four ("Irritability" was the exception) showed a strong criterion, convergent and discriminant validity, suggesting they are specific to mania. Subdimensions showed distinct and meaningful associations with functioning. LIMITATIONS Symptoms of psychosis and depression are important features of manic episodes, but were not included in the present study since they lack specificity to mania. CONCLUSIONS Mania is multifaceted. At least three subdimensions specific to mania were identified ("Euphoric Activation," "Hyperactive Cognition" and "Reckless Overconfidence"). Use of subdimensions, in addition to overall mania severity, may enhance the ability of studies to detect meaningful biological correlates of bipolar disorder. Moreover, their different associations with functioning suggest assessing subdimensions has clinical utility as well.
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Affiliation(s)
- Camilo J Ruggero
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA.
| | - Roman Kotov
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, USA
| | - Jared N Kilmer
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Greg Perlman
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, USA
| | - Keke Liu
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
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Perugi G, Medda P, Swann AC, Reis J, Rizzato S, Mauri M. Phenomenological subtypes of severe bipolar mixed states: a factor analytic study. Compr Psychiatry 2014; 55:799-806. [PMID: 24582325 DOI: 10.1016/j.comppsych.2014.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/15/2014] [Accepted: 01/21/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The correct identification of bipolar mixed states (MS) has important implications for clinical practice. The aim of the study was to define the multidimensional psychopathological structure of severe MS. To our knowledge, no factor analytical studies including only patients with MS, have been conducted before. METHODS In the first week of hospitalization, we evaluated by HAM-D-17, YMRS, BPRS and CGI, 202 Bipolar I inpatients with MS according to DSM-IV criteria referred for an ECT trial. A Principal-component analysis followed by Varimax rotation was performed on the 24-item BPRS. The relationships among different symptomatological subtypes and other clinical characteristics were explored. RESULTS Six interpretable factors were extracted: Psychotic-positive symptoms, Mania, Disorientation-Unusual Motor Behaviour, Depression, Negative Symptoms and Anxiety. On the basis of the highest z-scores, we found 6 "dominant" BPRS factor groups, that were statistically distinct and without significant overlap in the main symptomatological presentation. Only 29 (14.4%) of our patients could be described as "Dominant Manic" and 48 (23.8%) as "Dominant Depressive"; most importantly 125 (61.9%) were neither predominately-manic nor predominately-depressive. Variables including age, number of previous episodes, suicidal behavior and HAM-D and YMRS scores significantly differentiated the subtypes. CONCLUSION At least in the most severe forms, MS appears to represent more than the superposition of affective symptoms of opposite polarity. Anxiety, perplexity, psychotic experiences, motor disturbances and grossly disorganized behavior seem to arise from protracted intra-episodic instability and presence of a drive state influencing the mood state and the emotional resonance.
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Affiliation(s)
- Giulio Perugi
- Clinica Psichiatrica, Dipartmento di Medicina Sperimentale, University of Pisa, Pisa, Italy.
| | - Pierpaolo Medda
- Clinica Psichiatrica, Dipartmento di Medicina Sperimentale, University of Pisa, Pisa, Italy
| | - Alan C Swann
- Department of Psychiatry, The University of Texas Health Science Center, Houston, TX, USA
| | - Joao Reis
- Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria - CHLN, Lisboa, Portugal - Faculdade de Medicina de Lisboa, Universidade de Lisboa
| | - Salvatore Rizzato
- Clinica Psichiatrica, Dipartmento di Medicina Sperimentale, University of Pisa, Pisa, Italy
| | - Mauro Mauri
- Clinica Psichiatrica, Dipartmento di Medicina Sperimentale, University of Pisa, Pisa, Italy
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Vieta E, Grunze H, Azorin JM, Fagiolini A. Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5: Results from the IMPACT self-reported online survey. J Affect Disord 2014; 156:206-13. [PMID: 24439831 DOI: 10.1016/j.jad.2013.12.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/22/2013] [Accepted: 12/23/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. RESULTS Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. LIMITATIONS Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. CONCLUSIONS Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorder Programme, Institute of Neuroscience, University of Barcelona Hospital Clínic, IDIBAPS, CIBERSAM, C/Villarroel 170, Barcelona 08036, Catalonia, Spain.
| | - Heinz Grunze
- Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, NE4 5PL, UK
| | - Jean-Michel Azorin
- Hospital Ste. Marguerite, 270 Bd Sainte Marguerite, 13274 Marseille, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, School of Medicine, Siena, Italy; Department of Mental Health, University of Siena Medical Center, Siena, Italy
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Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:1281-93. [PMID: 24290461 PMCID: PMC4530123 DOI: 10.1016/j.jaac.2013.08.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/23/2013] [Accepted: 09/20/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy. METHOD We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes. RESULTS In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23). CONCLUSIONS Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.
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Clinical subtypes of severe bipolar mixed states. J Affect Disord 2013; 151:1076-82. [PMID: 24074482 DOI: 10.1016/j.jad.2013.08.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of the present study was to identify different clinical subtypes in severe, treatment resistant bipolar mixed state (MS). METHOD The sample comprised 202 Bipolar I patients currently in MS referred for an Electro-convulsive Therapy (ECT) trial and evaluated in the first week of hospitalization and one week after the ECT course. Principal component factor analysis (PCA) followed by Varimax rotation was performed on 21 non-overlapping items selected from Hamilton rating-scale for depression (HAMD) and from Young mania rating-scale (YMRS) at baseline evaluation. Cluster subtypes derived from the factor scores were compared in clinical variables and final HAMD, YMRS, Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scores. RESULTS The principal-component analysis extracted 6 interpretable factors explaining 55.9% of the total variance. Cluster analysis identified four groups, including respectively 63 (31.2%) subjects with Agitated-Irritable Mixed-Depression, 59 (29.2%) with Psychotic Mixed-Mania, 17 (8.5%) with Anxious-Irritable-Psychotic Mixed-Mania, and 63 (31.2%) with Retarded-Psychotic Mixed-Depression. The four clusters were statistically distinct and did not show significant overlap in the main symptomatological presentation. Cluster subtypes reported differences in number of past mood episodes, duration of the current episode, suicide attempts, lifetime comorbidity with panic and eating disorders, baseline and final rating-scale scores and rate of remission after ECT trial. CONCLUSIONS Our study indicates that, at least in severe treatment resistant MS, multiple depressive and manic subtypes can be observed with substantial differences in terms of clinical presentation, course, associated comorbidities and treatment response.
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