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Bartoli F, Malhi GS, Carrà G. Combining predominant polarity and affective spectrum concepts in bipolar disorder: towards a novel theoretical and clinical perspective. Int J Bipolar Disord 2024; 12:14. [PMID: 38696069 PMCID: PMC11065836 DOI: 10.1186/s40345-024-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
This is an overview of recent advances on predominant polarity conceptualization in bipolar disorder (BD). Current evidence on its operationalized definitions, possible contextualization within the affective spectrum, along with its epidemiological impact, and treatment implications, are summarized. Predominant polarity identifies three subgroups of patients with BD according to their mood recurrencies: (i) those with depressive or (ii) manic predominance as well as (iii) patients without any preponderance ('nuclear' type). A predominant polarity can be identified in approximately half of patients, with similar rates for depressive and manic predominance. Different factors may influence the predominant polarity, including affective temperaments. More generally, affective disorders should be considered as existing on a spectrum ranging from depressive to manic features, also accounting for disorders with 'ultrapredominant' polarity, i.e., unipolar depression and mania. While mixed findings emerge on its utility in clinical practice, it is likely that the construct of predominant polarity, in place of conventional differentiation between BD-I and BD-II, may be useful to clarify the natural history of the disorder and select the most appropriate interventions. The conceptualization of predominant polarity seems to reconcile previous theoretical views of both BD and affective spectrum into a novel perspective. It may provide useful information to clinicians for the early identification of possible trajectories of BD and thus guide them when selecting interventions for maintenance treatment. However, further research is needed to clarify the specific role of predominant polarity as a key determinant of BD course, outcome, and treatment response.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Division of Psychiatry, University College London, London, UK
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Bartoli F. The Diagnostic Concept of Unipolar Mania: The Missing Entity of the Affective Spectrum. J Nerv Ment Dis 2023; 211:811-813. [PMID: 37549353 DOI: 10.1097/nmd.0000000000001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
ABSTRACT Although the traditional nosological view interprets mania as strictly connected with depression in the context of manic-depressive illness, unipolar mania (UM), that is, the lifetime occurrence of mania or hypomania in the absence of depression, has been proposed as a necessary diagnostic entity. Epidemiological data estimate that at least 5% of people with type I bipolar disorder never experienced depression. These subjects are more often males with a hyperthymic temperament, a younger age at onset, and more psychotic features. Current classification systems do not formally recognize UM, but different definitions of mania without depression have been proposed. UM should be assessed according to the number of mood episodes, the predominance of manic or hypomanic episodes, and its clinical course. More generally, UM should be considered in the context of an affective spectrum including different clinical phenotypes based on the predominance of depressive or manic symptoms. Additional clinical and epidemiological research in this field is needed.
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Bartoli F, Nasti C, Palpella D, Piacenti S, Di Lella ME, Mauro S, Prestifilippo L, Crocamo C, Carrà G. Characterizing the clinical profile of mania without major depressive episodes: a systematic review and meta-analysis of factors associated with unipolar mania. Psychol Med 2023; 53:7277-7286. [PMID: 37016793 PMCID: PMC10719688 DOI: 10.1017/s0033291723000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND The diagnostic concept of unipolar mania (UM), i.e. the lifetime occurrence of mania without major depressive episodes, remains a topic of debate despite the evidence accumulated in the last few years. We carried out a systematic review and meta-analysis of observational studies testing factors associated with UM as compared to bipolar disorder with a manic-depressive course (md-BD). METHODS Studies indexed up to July 2022 in main electronic databases were searched. Random-effects meta-analyses of the association between UM and relevant correlates yielded odds ratio (OR) or standardized mean difference (SMD), with 95% confidence intervals (CIs). RESULTS Based on data from 21 studies, factors positively or negatively associated with UM, as compared to md-BD, were: male gender (OR 1.47; 95% CI 1.11-1.94); age at onset (SMD -0.25; 95% CI -0.46 to -0.04); number of hospitalizations (SMD 0.53; 95% CI 0.21-0.84); family history of depression (OR 0.55; 95% CI 0.36-0.85); suicide attempts (OR 0.25; 95% CI 0.19-0.34); comorbid anxiety disorders (OR 0.35; 95% CI 0.26-0.49); psychotic features (OR 2.16; 95% CI 1.55-3.00); hyperthymic temperament (OR 1.99; 95% CI 1.17-3.40). The quality of evidence for the association with previous suicide attempts was high, moderate for anxiety disorders and psychotic features, and low or very low for other correlates. CONCLUSIONS Despite the heterogeneous quality of evidence, this work supports the hypothesis that UM might represent a distinctive diagnostic construct, with peculiar clinical correlates. Additional research is needed to better differentiate UM in the context of affective disorders, favouring personalized care approaches.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Christian Nasti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Maria Elisa Di Lella
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Stefano Mauro
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Luca Prestifilippo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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Hernandorena CV, Baldessarini RJ, Tondo L, Vázquez GH. Status of Type II vs. Type I Bipolar Disorder: Systematic Review with Meta-Analyses. Harv Rev Psychiatry 2023; 31:173-182. [PMID: 37437249 DOI: 10.1097/hrp.0000000000000371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Analyze and compare the different bipolar disorder (BD) types.• Identify markers that distinguish BD types and explain how the DSM-IV defines the disorder. ABSTRACT Since the status of type II bipolar disorder (BD2) as a separate and distinct form of bipolar disorder (BD) remains controversial, we reviewed studies that directly compare BD2 to type I bipolar disorder (BD1). Systematic literature searching yielded 36 reports with head-to-head comparisons involving 52,631 BD1 and 37,363 BD2 patients (total N = 89,994) observed for 14.6 years, regarding 21 factors (with 12 reports/factor). BD2 subjects had significantly more additional psychiatric diagnoses, depressions/year, rapid cycling, family psychiatric history, female sex, and antidepressant treatment, but less treatment with lithium or antipsychotics, fewer hospitalizations or psychotic features, and lower unemployment rates than BD1 subjects. However, the diagnostic groups did not differ significantly in education, onset age, marital status, [hypo]manias/year, risk of suicide attempts, substance use disorders, medical comorbidities, or access to psychotherapy. Heterogeneity in reported comparisons of BD2 and BD1 limits the firmness of some observations, but study findings indicate that the BD types differ substantially by several descriptive and clinical measures and that BD2 remains diagnostically stable over many years. We conclude that BD2 requires better clinical recognition and significantly more research aimed at optimizing its treatment.
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Affiliation(s)
- Carolina V Hernandorena
- From Braulio A. Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina (Dr. Hernandorena); Department of Psychiatry, Queen's University (Drs. Hernandorena and Vázquez); Harvard Medical School, Boston, MA (Drs. Baldessarini and Tondo); McLean Hospital, Belmont, MA (Drs. Baldessarini, Tondo, and Vázquez); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Dr. Tondo)
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Chang CE, Wang J, Lin YT, Chiu CC, Hsieh MH, Huang MC, Lu ML, Chen HC, Chen WJ, Kuo PH. Characterization of clinical features and comorbidities between bipolar affective disorder with and without depressive episodes. Psychol Med 2023; 53:4103-4113. [PMID: 35321763 PMCID: PMC10317814 DOI: 10.1017/s0033291722000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUNDS A proportion of patients with bipolar disorder (BD) manifests with only unipolar mania (UM). This study examined relevant clinical features and psychosocial characteristics in UM compared with depressive-manic (D-M) subgroups. Moreover, comorbidity patterns of physical conditions and psychiatric disorders were evaluated between the UM and D-M groups. METHODS This clinical retrospective study (N = 1015) analyzed cases with an average of 10 years of illness duration and a nationwide population-based cohort (N = 8343) followed up for 10 years in the Taiwanese population. UM was defined as patients who did not experience depressive episodes and were not prescribed adequate antidepressant treatment during the disease course of BD. Logistic regression models adjusted for relevant covariates were used to evaluate the characteristics and lifetime comorbidities in the two groups. RESULTS The proportion of UM ranged from 12.91% to 14.87% in the two datasets. Compared with the D-M group, the UM group had more psychotic symptoms, fewer suicidal behaviors, a higher proportion of morningness chronotype, better sleep quality, higher extraversion, lower neuroticism, and less harm avoidance personality traits. Substantially different lifetime comorbidity patterns were observed between the two groups. CONCLUSIONS Patients with UM exhibited distinct clinical and psychosocial features compared with patients with the D-M subtype. In particular, a higher risk of comorbid cardiovascular diseases and anxiety disorders is apparent in patients with D-M. Further studies are warranted to investigate the underlying mechanisms for diverse presentations in subgroups of BDs.
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Affiliation(s)
- Chiao-Erh Chang
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jui Wang
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Hsien Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei J. Chen
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Wikström F, Zeberg H, Mayston R, Backlund L, Fekadu A. Prevalence and characteristics of unipolar mania in a low-income country setting: population-based data from the Butajira cohort, rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol 2023; 58:537-545. [PMID: 36565318 PMCID: PMC10066167 DOI: 10.1007/s00127-022-02399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Previous research suggests unipolar mania, i.e., bipolar disorder without depression, to be more common in low-income countries. However, longitudinal population-based studies on unipolar mania from low-income countries are lacking. This study therefore examined unipolar mania, in Butajira, Ethiopia, and associations with possible determinants. METHODS Key informants and 68,378 screenings with the Composite International Diagnostic Interviews (CIDI 2.1) identified suspected cases of bipolar disorder. Diagnosis was confirmed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) (n = 2,285). 315 participants with bipolar disorder were recruited and followed up for an average of 2.5 years. Unipolar mania was defined when illness episodes consisted of at least two manic relapses. 240 cases had sufficient data to ascertain course of disorder. RESULTS 41.7% (100 of 240 cases) of participants had unipolar mania. Unipolar mania was associated with less suicidal ideation (0% vs. 26.4%, p < 0.001), less suicidal thoughts (occasionally/often: 1%/3% vs. 19.6%/21%, p < 0.001), and less history of suicide attempt (2% vs. 11.6%, p = 0.01). The participants with unipolar mania tended to have better social functioning (OR = 2.05, p = 0.07) and less alcohol use (20.8% vs. 31.4%, p = 0.07). The study was partly based on retrospective data liable to recall bias. Some cases defined as unipolar mania in our study may later develop depression. CONCLUSION Previous cross-sectional studies finding high proportions of unipolar mania in low-income countries appear supported. Unipolar mania trended towards better social functioning and was associated with lower suicidality. Future unipolar mania specifications could inform treatment and prognostic estimates of bipolar disorder.
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Affiliation(s)
- Fredrik Wikström
- Psychiatry Southwest, Karolinska University Hospital Huddinge, Stockholm, Sweden.
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, UK.
- Inst. for Molecular Medicine and Surgery, Stockholm and Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, L8:00, S-171 76, Stockholm, Sweden.
| | - Hugo Zeberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rosie Mayston
- Department of Global Health & Social Medicine, King's Global Health Institute, NE Wing, King's College London, London, UK
| | - Lena Backlund
- Inst. for Molecular Medicine and Surgery, Stockholm and Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, L8:00, S-171 76, Stockholm, Sweden
- Centre for Psychiatric Research and Health Care, Stockholm, Sweden
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
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Høj Jørgensen TS, Osler M, Jorgensen MB, Jorgensen A. Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish nationwide cohort study using sequence analysis. Lancet Psychiatry 2023; 10:12-20. [PMID: 36450298 DOI: 10.1016/s2215-0366(22)00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A key clinical problem in psychiatry is predicting the diagnostic future of patients presenting with psychopathology for the first time. The objective of this study was to establish a comprehensive map of subsequent diagnoses after a first psychiatric hospital diagnosis. METHODS Through the Danish National Patient Registry, we identified patients aged 18 years or older with an inpatient or outpatient psychiatric hospital contact and who had received one of the 20 most common first-time psychiatric diagnoses (defined at the ICD-10 two-cipher level, F00-F99) between Jan 1, 1995, and Dec 31, 2008. For each first-time diagnosis, the 20 most frequent subsequent psychiatric diagnoses (F00-F99), and death, occurring during 10 years of follow-up were identified as outcomes. To assess diagnostic stability, we used social sequence analyses, assigning a subsequent diagnosis to each state with a length of 6 months following each first-time diagnosis. The subsequent diagnosis was defined as the last diagnosis given within each 6-month period. We calculated the normalised entropy of each sequence to show the uncertainty of predicting the states in a given sequence. Cox proportional hazards models were used to assess the risk of receiving a subsequent diagnosis (at the one-cipher level, F0-F9) after each first-time diagnosis. FINDINGS The cohort consisted of 184 949 adult patients (77 129 [41·7%] men and 107 820 [58·3%] women, mean age 42·5 years [SD 18·5; range 18 to >100). Ethnicity data were not recorded. Over 10 years of follow-up, 86 804 (46·9%) patients had at least one subsequent diagnosis that differed from their first-time diagnosis. Measured by mean normalised entropy values, persistent delusional disorders (ICD-10 code F22), mental and behavioural disorders due to multiple drug use and use of other psychoactive substances (F19), and acute and transient psychotic disorders (F23) had the highest diagnostic variability, whereas eating disorders (F50) and non-organic sexual dysfunction (F52) had the lowest. The risk of receiving a subsequent diagnosis with a psychiatric disorder from an ICD-10 group different from that of the first-time diagnosis varied substantially among first-time diagnoses. INTERPRETATION These data provide detailed information on possible diagnostic outcomes after a first-time presentation in a psychiatric hospital. This information could help clinicians to plan relevant follow-up and inform patients and families on the degree of diagnostic uncertainty associated with receiving a first psychiatric hospital diagnosis, as well as likely and unlikely trajectories of diagnostic progression. FUNDING Mental Health Services, Capital region of Denmark. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.
| | - Merete Osler
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - Martin Balslev Jorgensen
- Department of Public Health, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Anders Jorgensen
- Department of Public Health, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Chakrabarti S. Bipolar disorder in the International Classification of Diseases-Eleventh version: A review of the changes, their basis, and usefulness. World J Psychiatry 2022; 12:1335-1355. [PMID: 36579354 PMCID: PMC9791613 DOI: 10.5498/wjp.v12.i12.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization’s 11th revision of the International Classification of Diseases (ICD-11) including the chapter on mental disorders has come into effect this year. This review focuses on the “Bipolar or Related Disorders” section of the ICD-11 draft. It describes the benchmarks for the new version, particularly the foremost principle of clinical utility. The alterations made to the diagnosis of bipolar disorder (BD) are evaluated on their scientific basis and clinical utility. The change in the diagnostic requirements for manic and hypomanic episodes has been much debated. Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear. The ICD-11 definition of depressive episodes is substantially different, but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low. Unlike the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the ICD-11 has retained the category of mixed episodes. Although the concept of mixed episodes in the ICD-11 is not perfect, it appears to be more inclusive than the DSM-5 approach. Additionally, there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder. The initial results on the reliability and clinical utility of BD are promising, but the newly created diagnostic categories also appear to have some limitations. Although further improvement and research are needed, the focus should now be on facing the challenges of implementation, dissemination, and education and training in the use of these guidelines.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, UT, India
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Sangha N, Lyall L, Wyse C, Cullen B, Whalley HC, Smith DJ. The nosological status of unipolar mania and hypomania within UK Biobank according to objective and subjective measures of diurnal rest and activity. Bipolar Disord 2022; 24:726-738. [PMID: 35656588 PMCID: PMC9796466 DOI: 10.1111/bdi.13237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is uncertainty whether unipolar mania is a discrete sub-type of bipolar disorder. Disrupted rest/activity rhythms are a key feature of bipolar disorder (BD) but have not been well characterised in unipolar mania/hypomania (UM). We compared subjective and objective rest/activity patterns, demographic and mental health outcomes across BD, UM and control groups. METHODS UK residents aged 37-73 years were recruited into UK Biobank from 2006 to 2010. BD, UM and control groups were identified via a mental health questionnaire. Demographic, mental health and subjective sleep outcomes were self-reported. Accelerometery data were available for a subset of participants, and objective measures of sleep and activity were derived. RESULTS A greater proportion of males met UM criteria, and more females were in the BD group. Both BD and UM groups had poor mental health outcomes vs. controls. Objectively measured activity differed between all three groups: UM had highest levels of activity and BD lowest. The UM group had shorter sleep duration compared to controls. Subjective rest/activity measures showed that both mood disorder groups (compared to controls) had later chronotype preference, more disturbed sleep and increased difficulty getting up in the morning. However, the UM group were more likely to report an early chronotype compared to BD and control groups. CONCLUSIONS BD and UM share features in common, but key differences support the proposition that UM may be a distinct and more clinically homogenous disorder. UM was characterised by a higher proportion of males, early chronotype, increased activity and shorter sleep duration.
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Affiliation(s)
- Natasha Sangha
- Mental Health and Wellbeing, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Laura Lyall
- Mental Health and Wellbeing, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Cathy Wyse
- Department of BiologyMaynooth UniversityKildareIreland
| | - Breda Cullen
- Mental Health and Wellbeing, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Heather C. Whalley
- Centre for Clinical Brain Sciences, Division of PsychiatryUniversity of EdinburghEdinburghUK
| | - Daniel J. Smith
- Centre for Clinical Brain Sciences, Division of PsychiatryUniversity of EdinburghEdinburghUK
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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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Sonkurt HO, Altınöz AE, Danışman Sonkurt M, Köşger F. A distinct neurocognitive profile: unipolar mania. Nord J Psychiatry 2022; 76:358-364. [PMID: 34543165 DOI: 10.1080/08039488.2021.1977386] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Despite a growing number of studies reporting patients with a history of mania without depression have several socio-demographic and clinical differences than bipolar disorder patients, unipolar mania is recognized as bipolar I disorder in the most commonly used classification systems. Studies showing that unipolar mania is a separate clinical entity are insufficient in number, and to the best of our knowledge, there has been no study investigating the neuropsychological differences in this area. The aim of this study is to evaluate the neurocognitive differences between unipolar mania, bipolar I disorder and healthy controls, and to reveal the underlying neurocognitive differences. MATERIALS AND METHODS Cambridge Neuropsychological Test Automated Battery was applied to 18 unipolar mania, 19 bipolar I disorder patients and 21 healthy controls matched for age, sex and education levels. RESULTS Unipolar mania group had worse performance regarding visual memory and executive functions, and had specific social cognition deficits compared to both bipolar I disorder and healthy control groups. CONCLUSION The results of our study indicate that unipolar mania might have unique neurocognitive differences compared to bipolar I disorder, which might support the hypothesis that unipolar mania is a distinct neurocognitive disorder within bipolar spectrum disorders.
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Affiliation(s)
| | - Ali Ercan Altınöz
- Psychiatry Department, Eskişehir Osmangazi University, Odunpazarı, Turkey
| | | | - Ferdi Köşger
- Psychiatry Department, Eskişehir Osmangazi University, Odunpazarı, Turkey
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12
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Stevenson J, Miller CL, Martin K, Mohammadi L, Lawn S. Investigating the reciprocal temporal relationships between tobacco consumption and psychological disorders for youth: an international review. BMJ Open 2022; 12:e055499. [PMID: 35697442 PMCID: PMC9196180 DOI: 10.1136/bmjopen-2021-055499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate reciprocal temporal relationships between tobacco consumption and psychological disorders for youth.Design: Review DATA SOURCES: Five databases (PubMed, Embase, Scopus, CINAHL and PsycINFO) on 26 September 2019 and updated on 11 May 2021, indexing tobacco, mental illness and longitudinal.Study selection: Methods used consensus and multiple reviewers. INTERVENTIONS Cohort studies (n=49) examining tobacco and selected psychological disorders (depression, anxiety, bipolar, psychosis, borderline personality disorder) among youth, and systematic reviews (n=4) of these relationships met inclusion criteria. PRIMARY AND SECONDARY OUTCOME MEASURES Effect of tobacco on psychological disorders and effect of psychological disorders on tobacco. DATA EXTRACTION AND SYNTHESIS Independent extraction by the first author and checked by final author. Joanna Briggs Institute Critical Appraisal Tools were used for all studies.Included studies had moderate-to-high appraisal scores. We synthesised findings using vote counting for effect direction and descriptive data. RESULTS Fifty-three studies were included in the review. Thirteen of 15 studies showed a positive effect direction of tobacco on depression (p<0.001). Six of 12 studies showed a positive effect direction of depression on tobacco (p=0.016). Six of eight studies showed a positive effect direction of tobacco on anxiety (p=0.016). Eleven of 18 studies showed a positive effect direction of anxiety on tobacco (p=0.003). No effect between tobacco and bipolar, or tobacco and psychosis was found. No studies examined tobacco and borderline personality disorder. CONCLUSIONS Reciprocal relationships existed between tobacco and both depression and anxiety for youth, though causality is unconfirmed. No positive effect direction was found between tobacco and psychosis, perhaps because nicotine has conflicting effects on psychosis. For other relationships examined, evidence was weak because of low number of studies. More research to inform prevention and early intervention is needed. PROSPERO REGISTRATION NUMBER CRD42020150457.
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Affiliation(s)
- Jeremy Stevenson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Caroline Louise Miller
- Public Health, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kimberley Martin
- Public Health, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Leila Mohammadi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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13
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Comparison of serum BDNF, IL-1β, IL-6, TNF-α, CRP and leucocyte levels in unipolar mania and bipolar disorder. Acta Neuropsychiatr 2021; 33:317-322. [PMID: 34462030 DOI: 10.1017/neu.2021.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Unipolar mania is not included in the diagnostic and statistical manual of mental disorders-5 (DSM-5) as a separate diagnosis, although it is defined by widely accepted diagnostic criteria. The aim of this study was to investigate the differences between unipolar mania and bipolar disorder in terms of clinical and inflammatory parameters. METHODS The data of 495 hospitalised patients with bipolar disorder diagnoses were analysed retrospectively. Forty met the diagnostic criteria for unipolar mania. Two patients refused to participate in the study. Thirty-eight unipolar mania patients and 42 randomly selected patients with bipolar disorder diagnosis were included in the study. The two groups were compared in terms of sociodemographic, clinical characteristics, serum brain-derived neurotrophic factor, C-reactive protein (CRP), leucocyte and cytokine levels. RESULTS A total of 40 (8.08%) of 495 patients diagnosed with bipolar disorder met the unipolar mania diagnostic criteria. The number of manic episodes and the number of hospitalisations were statistically higher in the unipolar mania group than in the bipolar disorder group. Among all the manic symptoms, the incidence of symptoms such as euphoria, increased sexual interest, grandiosity and delusions were found to be statistically higher in the unipolar mania group. Interleukin (IL)-6 and CRP levels were significantly higher in the unipolar mania group than in the bipolar disorder group. CONCLUSION Unipolar mania differs from bipolar disorder in terms of clinical features and serum IL-6 and CRP levels.
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Foucher JR, Gawlik M, Roth JN, de Crespin de Billy C, Jeanjean LC, Obrecht A, Mainberger O, Clauss JME, Elowe J, Weibel S, Schorr B, Cetkovich M, Morra C, Rebok F, Ban TA, Bollmann B, Roser MM, Hanke MS, Jabs BE, Franzek EJ, Berna F, Pfuhlmann B. Wernicke-Kleist-Leonhard phenotypes
of endogenous psychoses: a review of their validity
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:37-49. [PMID: 32699504 PMCID: PMC7365293 DOI: 10.31887/dcns.2020.22.1/jfoucher] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While the ICD-DSM paradigm has been a major advance in clinical psychiatry, its usefulness for biological psychiatry is debated. By defining consensus-based disorders rather than empirically driven phenotypes, consensus classifications were not an implementation of the biomedical paradigm. In the field of endogenous psychoses, the Wernicke-Kleist-Leonhard (WKL) pathway has optimized the descriptions of 35 major phenotypes using common medical heuristics on lifelong diachronic observations. Regarding their construct validity, WKL phenotypes have good reliability and predictive and face validity. WKL phenotypes come with remarkable evidence for differential validity on age of onset, familiality, pregnancy complications, precipitating factors, and treatment response. Most impressive is the replicated separation of high- and low-familiality phenotypes. Created in the purest tradition of the biomedical paradigm, the WKL phenotypes deserve to be contrasted as credible alternatives with other approaches currently under discussion.
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Affiliation(s)
- Jack R Foucher
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France ; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Julian N Roth
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Clément de Crespin de Billy
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Ludovic C Jeanjean
- IICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Alexandre Obrecht
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France
| | - Olivier Mainberger
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France. CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Julie M E Clauss
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France. SAGE - CNRS UMR 7363, FMTS, University of Strasbourg, France
| | - Julien Elowe
- Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Route de Benex, Prangins, Switzerland
| | - Sébastien Weibel
- IPôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Benoit Schorr
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Carlos Morra
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of StInstitute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Sanatorio Morra, Córdoba, Argentina
| | - Federico Rebok
- "Servicio de Emergencia", Acute Inpatient Unit, Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - Thomas A Ban
- International Network for the History of Neuropsychopharmacology (INHN), Córdoba, Argentina
| | - Barbara Bollmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Germany
| | - Mathilde M Roser
- Department of Psychiatry, Mondor Hospital France, Creteil, France
| | - Markus S Hanke
- Universitäre psychiatrische Dienste Bern, Spiez, Switzerland
| | - Burkhard E Jabs
- Klinik für Psychiatrie and Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
| | - Ernst J Franzek
- Yes We Can Clinics, Department of Research and Development, Eindhoven, The Netherlands
| | - Fabrice Berna
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany; Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Route de Benex, Prangins, Switzerland
| | - Bruno Pfuhlmann
- IKlinik für Psychiatrie and Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
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Angst J, Ajdacic-Gross V, Rössler W. Bipolar disorders in ICD-11: current status and strengths. Int J Bipolar Disord 2020; 8:3. [PMID: 31956923 PMCID: PMC6970089 DOI: 10.1186/s40345-019-0165-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background The Clinical descriptions and diagnostic guidelines for the ICD-11 Classification of mental and behavioural disorders should soon be finalized. To measure their potential impact, the new proposed definitions of bipolar disorders in ICD-11 were applied to data from the Zurich cohort study and compared with the definitions of ICD-10 and DSM-5. Results We found little difference between ICD-11 and ICD-10 in the identification of subjects with bipolar disorders, but compared to DSM-5 a considerable increase in the diagnosis of hypomanic episodes and therefore of bipolar-II disorders. Conclusions Compared to ICD-10 and DSM-5 the definition of hypomanic episodes according to ICD-11 represents important progress. A higher prevalence of BP-II disorder makes sense from a clinical point of view. Further transcultural research is needed into whether out-patient treatment should be included as a criterion for hypomania. Pure mania is unfortunately missing as an independent and codable disorder in the international diagnostic manuals, whether ICD-11 or DSM-5.
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Affiliation(s)
- Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of São Paulo, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
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16
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Faut-il annoncer un diagnostic de trouble bipolaire à un patient qui n’a jamais connu la dépression ? Une revue systématique actualisée sur la manie récurrente. Presse Med 2019; 48:1306-1318. [DOI: 10.1016/j.lpm.2018.06.020] [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: 04/05/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022] Open
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17
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Angst J, Rössler W, Ajdacic-Gross V, Angst F, Wittchen HU, Lieb R, Beesdo-Baum K, Asselmann E, Merikangas KR, Cui L, Andrade LH, Viana MC, Lamers F, Penninx BW, de Azevedo Cardoso T, Jansen K, Dias de Mattos Souza L, Azevedo da Silva R, Kapczinski F, Grobler C, Gholam-Rezaee M, Preisig M, Vandeleur CL. Differences between unipolar mania and bipolar-I disorder: Evidence from nine epidemiological studies. Bipolar Disord 2019; 21:437-448. [PMID: 30475430 DOI: 10.1111/bdi.12732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Although clinical evidence suggests important differences between unipolar mania and bipolar-I disorder (BP-I), epidemiological data are limited. Combining data from nine population-based studies, we compared subjects with mania (M) or mania with mild depression (Md) to those with BP-I with both manic and depressive episodes with respect to demographic and clinical characteristics in order to highlight differences. METHODS Participants were compared for gender, age, age at onset of mania, psychiatric comorbidity, temperament, and family history of mental disorders. Generalized linear mixed models with adjustment for sex and age as well as for each study source were applied. Analyses were performed for the pooled adult and adolescent samples, separately. RESULTS Within the included cohorts, 109 adults and 195 adolescents were diagnosed with M/Md and 323 adults and 182 adolescents with BP-I. In both adult and adolescent samples, there was a male preponderance in M/Md, whereas lifetime generalized anxiety and/panic disorders and suicide attempts were less common in M/Md than in BP-I. Furthermore, adults with mania revealed bulimia/binge eating and drug use disorders less frequently than those with BP-I. CONCLUSIONS The significant differences found in gender and comorbidity between mania and BP-I suggest that unipolar mania, despite its low prevalence, should be established as a separate diagnosis both for clinical and research purposes. In clinical settings, the rarer occurrence of suicide attempts, anxiety, and drug use disorders among individuals with unipolar mania may facilitate successful treatment of the disorder and lead to a more favorable course than that of BP-I disorder.
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Affiliation(s)
- Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Felix Angst
- Rehabilitation Clinic, Bad Zurzach, Switzerland
| | - Hans Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Psychiatric University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Rosalind Lieb
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Eva Asselmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Laura H Andrade
- Section of Psychiatric Epidemiology (LIM 23), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Maria C Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil
| | - Femke Lamers
- Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Brenda Wjh Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Karen Jansen
- Health and Behavior Graduate Program, Catholic University of Pelotas, Pelotas, Brazil
| | | | | | - Flavio Kapczinski
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christoffel Grobler
- Elizabeth Donkin Hospital, Port Elizabeth, South Africa.,Nelson Mandela University, Port Elizabeth, South Africa
| | - Mehdi Gholam-Rezaee
- Department of Psychiatry, University Hospital of Lausanne, Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne, Prilly, Switzerland
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Consider lithium as an option for the treatment of bipolar disorder in appropriate patients. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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de la Vega D, Piña A, Peralta FJ, Kelly SA, Giner L. A Review on the General Stability of Mood Disorder Diagnoses Along the Lifetime. Curr Psychiatry Rep 2018; 20:29. [PMID: 29607445 DOI: 10.1007/s11920-018-0891-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to review the most recent literature regarding diagnostic stability of mood disorders, focusing on epidemiological, clinical-psychopathological, and neurobiological data for unipolar and bipolar affective disorders. RECENT FINDINGS Unipolar depression follows a chronic course in at least half of all cases and presents a considerable diagnostic stability across all age ranges. Studies using latent class analysis are allowing improved profiling of depressive subtypes and assessment of their prevalence. Advances have been made in our understanding of the neurobiological underpinnings of depression, with data highlighting the roles of amyloid deposits, the ApoE4 allele, and atrophy of the anterior hippocampus or frontal cortex. The diagnostic instability of bipolar disorder is manifest in the early years, seen in both the extent of diagnostic delay and the high rate of diagnostic conversion from unipolar depression. Regarding disruptive mood dysregulation disorder, we have little data to date, but those which exist indicate a high rate of comorbidity and minimal diagnostic stability for this disorder. Diagnostic stability varies substantially among mood disorders, which would be related to the validity of current diagnostic categories and our diagnostic accuracy.
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Affiliation(s)
- Diego de la Vega
- Servicio Andaluz de Salud, Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, 41009, Seville, Spain.
| | - Ana Piña
- Servicio Andaluz de Salud, Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, 41009, Seville, Spain
| | - Francisco J Peralta
- Servicio Andaluz de Salud, Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, 41009, Seville, Spain
| | - Sam A Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
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20
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Ho DY. Madness as creative energy: Self-observations during episodes of unipolar mood elevation. COGENT PSYCHOLOGY 2017. [DOI: 10.1080/23311908.2017.1316006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Loonen AJM, Kupka RW, Ivanova SA. Circuits Regulating Pleasure and Happiness in Bipolar Disorder. Front Neural Circuits 2017; 11:35. [PMID: 28588455 PMCID: PMC5439000 DOI: 10.3389/fncir.2017.00035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/08/2017] [Indexed: 01/21/2023] Open
Abstract
According to our model, the motivation for appetitive-searching vs. distress-avoiding behaviors is regulated by two parallel cortico-striato-thalamo-cortical (CSTC) re-entry circuits that include the core and the shell parts of the nucleus accumbens, respectively. An entire series of basal ganglia, running from the caudate nucleus on one side to the centromedial amygdala on the other side, control the intensity of these reward-seeking and misery-fleeing behaviors by stimulating the activity of the (pre)frontal and limbic cortices. Hyperactive motivation to display behavior that potentially results in reward induces feelings of hankering (relief leads to pleasure); while, hyperactive motivation to exhibit behavior related to avoidance of aversive states results in dysphoria (relief leads to happiness). These two systems collaborate in a reciprocal fashion. We hypothesized that the mechanism inducing the switch from bipolar depression to mania is the most essential characteristic of bipolar disorder. This switch is attributed to a dysfunction of the lateral habenula, which regulates the activity of midbrain centers, including the dopaminergic ventral tegmental area (VTA). From an evolutionary perspective, the activity of the lateral habenula should be regulated by the human homolog of the habenula-projecting globus pallidus, which in turn might be directed by the amygdaloid complex and the phylogenetically old part of the limbic cortex. In bipolar disorder, it is possible that the system regulating the activity of this reward-driven behavior is damaged or the interaction between the medial and lateral habenula may be dysfunctional. This may lead to an adverse coupling between the activities of the misery-fleeing and reward-seeking circuits, which results in independently varying activities.
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Affiliation(s)
- Anton J. M. Loonen
- Groningen Research Institute of Pharmacy, University of GroningenGroningen, Netherlands
- GGZ WNB, Mental Health HospitalBergen op Zoom, Netherlands
| | - Ralph W. Kupka
- Department of Psychiatry, VU University Medical CenterAmsterdam, Netherlands
| | - Svetlana A. Ivanova
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Mental Health Research InstituteTomsk, Russia
- Department of Ecology and Basic Safety, National Research Tomsk Polytechnic UniversityTomsk, Russia
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Treatment of Bipolar Disorder in a Lifetime Perspective: Is Lithium Still the Best Choice? Clin Drug Investig 2017; 37:713-727. [DOI: 10.1007/s40261-017-0531-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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23
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Angst J. Difficulties of diagnosing mood disorders correctly. Acta Psychiatr Scand 2017; 135:271-272. [PMID: 28272833 DOI: 10.1111/acps.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Abstract
Bipolar disorders are a group of psychiatric disorders with profound negative impact on affected patients. Even if their symptomatology has long been recognized, diagnostic criteria have changed over time and diagnosis often remains difficult. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), issued in May 2013, comprises several changes regarding the diagnosis of bipolar disorders compared to the previous edition. Diagnostic categories and criteria for bipolar disorders show some concordance with the internationally also widely used Tenth Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). However, there are also major differences that are worth highlighting. The aim of the following text is to depict and discuss those.
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Rajkumar RP. Recurrent unipolar mania: A comparative, cross-sectional study. Compr Psychiatry 2016; 65:136-40. [PMID: 26774002 DOI: 10.1016/j.comppsych.2015.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/03/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION A significant number of patients experience recurrent episodes of mania without depressive episodes. Evidence from the available literature suggests that these patients differ from typical "bipolar" or "manic-depressive" patients, but results have been inconsistent. The current study aims to add to this literature by comparing the demographic, clinical and risk factor profiles of patients with recurrent mania with and without depression. METHODS 66 patients with a diagnosis of bipolar I disorder were divided into "unipolar mania" (recurrent mania alone, MA) and "bipolar" (both mania and depression, MD) sub-groups. Comorbid diagnoses were assessed using the Mini International Neuropsychiatric Interview (MINI), and genetic and environmental risk factors were explored using the Diagnostic Interview for Genetic Studies (DIGS), Childhood Trauma Questionnaire (CTQ), and an additional questionnaire designed for the purpose of the study. Differences between the MA and MD groups in terms of demographic variables, clinical profile, comorbidities and antecedent risk factors were explored. RESULTS Patients with both mania and depression had higher frequencies of lifetime suicide attempts, antidepressant treatment, and catatonic symptoms. There was some evidence of an association between overcrowding in childhood and the presence of depressive episodes. No other differences in demographic, clinical or risk factor variables could be found between the two groups. DISCUSSION Our results are consistent with the view that unipolar mania is not a distinctive disorder, or even a distinctive subtype of bipolar disorder. However, this conclusion is provisional as it is based only on clinical and demographic data.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry 605 006, India.
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Abstract
As a natural phenomenon, mania without major depression will of course survive DSM-5 and ICD-11, but following its integration as a diagnosis into bipolar-I disorder (BP-I) in those manuals, BP-I will be more heterogeneous and, paradoxically, will include a unipolar disorder. Furthermore, unipolar mania will no longer be adequately identified and coded as an independent disorder in public health statistics. Mania without major depression, with prevalence rates of 1.7-1.8 %, is even more common than schizophrenia. This brief review of our current, still insufficient, knowledge suggests strongly that pure unipolar mania, as well as mania with minor depressive disorders, should remain important elements of the three-dimensional mood spectrum. Research should focus on dimensional and not on simplified categorical models, which entail a considerable loss of information.
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Affiliation(s)
- Jules Angst
- Psychiatric Hospital, University of Zurich, Lenggstrasse 31, P.O. Box 1931, 8032, Zurich, Switzerland.
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Rogers J, Mirams J, Patel R. A neuroplastic deafferentation hypothesis for bipolar disorder. Med Hypotheses 2015; 85:858-62. [PMID: 26459976 PMCID: PMC4655863 DOI: 10.1016/j.mehy.2015.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/10/2015] [Accepted: 09/20/2015] [Indexed: 12/04/2022]
Abstract
Bipolar disorder, characterised by extreme cyclical variations in mood between depression and mania, is a common, debilitating and sometimes fatal psychiatric condition with an unclear aetiology. In this paper we propose a hypothesis for the development of bipolar disorder through which neuroplastic changes in response to an index depressive episode leads to the amplification of subthreshold pleasurable stimuli that then drive conversion into a manic state. This ‘pleasure deafferentation hypothesis’ is reached through a discussion of the neuroscientific basis of deafferentation at the level of the neuron and its role in the development of various neurological and psychiatric phenomena before a case for deafferentation as applied to bipolar disorder is justified and its implications discussed.
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Affiliation(s)
- Jonathan Rogers
- Medical Academic Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom.
| | - Jamie Mirams
- Medical Academic Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom
| | - Rashmi Patel
- Medical Academic Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom
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