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Yaghmaei S, Babamohamadi H, Shamsaei F, Ghods AA. Unheard voices: The sexual challenges of families of patients with bipolar disorder: A qualitative content analysis. Bipolar Disord 2024; 26:148-159. [PMID: 37524374 DOI: 10.1111/bdi.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The aim of this study was to explore the voices of the family members of Bipolar Disorder (BD) patients about the challenges ahead of them. METHODS In this qualitative study, 22 participants shared their experiences of sexual challenges of patients with BD through in-depth, face-to-face, semi-structured interviews. Qualitative content analysis was used for data analysis. RESULTS An overarching theme entitled "Unheard voices" reflected this experience. It comprised four main categories include sexual promiscuity, a change in sexual patterns, sexual support, and sexual indifference. The results revealed that the families of patients with BD have to deal with sexual promiscuity and change in sexual patterns in their family, and the family system attempts to respond to these changes by sexual support mechanisms and sexual indifference. CONCLUSIONS Given the significant impact of healthy sexual behaviors on the quality of life of both the individual and the family, therapists and family support systems are advised to strengthen and educate families to support their patients' sexual health and needs and protect their sexual existence; they should also address the sexual challenges faced by these families as a diagnostic and therapeutic priority, and early sexual health interventions should be provided to these families.
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Affiliation(s)
- Safura Yaghmaei
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Asghar Ghods
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Operating Room, Sorkheh School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
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Yang HS, Hsu JW, Huang KL, Tsai SJ, Bai YM, Su TP, Chen TJ, Chen MH. Risk of teenage pregnancy among adolescents with bipolar disorder: a cohort study of 35,398 adolescent girls. Eur Child Adolesc Psychiatry 2023; 32:2001-2008. [PMID: 35771292 DOI: 10.1007/s00787-022-02029-z] [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: 05/18/2021] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
Teenage pregnancy is a major public health concern. However, few studies have investigated the relationship between pediatric bipolar disorder and early pregnancy, and whether bipolar disorder medications reduce the risk of early pregnancy remains unknown. In total, 3218 adolescent girls with bipolar disorder and 32,180 controls matched for age, family income, residence, and time of enrollment were enrolled in this study from 2001 to 2009. Early pregnancy, defined as pregnancy occurring in patients younger than 20 years old, was identified during the follow-up period from enrollment until the end of 2011. After adjustment for demographic data, psychiatric comorbidities, and bipolar disorder medications, adolescent girls with bipolar disorder had 20 times the risk of early pregnancy (hazard ratio [HR] = 20.63, 95% confidence interval [CI] [15.68, 27.16]) and about 25 times the risk of repeated early pregnancy (HR = 24.59, 95% CI [15.20, 39.78]) compared with those without bipolar disorder. Long-term use of both mood stabilizers (HR = 0.34, 95% CI [0.23, 0.52]) and atypical antipsychotics (HR = 0.32, 95% CI [0.20, 0.51]) was associated with a reduced risk of early pregnancy. Bipolar disorder was associated with an increased risk of early pregnancy in adolescent girls. Bipolar disorder medications reduced this risk. The results suggest that interventions targeting the vulnerable population of adolescent girls with bipolar disorder are warranted to prevent early pregnancies.
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Affiliation(s)
- Han-Sian Yang
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Chowdhury A, Rao BSS, Laxmi TR. Risky Decision-taking Task: a novel paradigm to assess the risk-taking behaviour in rats predisposed to early-life stress. J Neurosci Methods 2023; 392:109864. [PMID: 37080434 DOI: 10.1016/j.jneumeth.2023.109864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
One of the characteristic features of adolescence is risk-taking behavioural traits. Uncontrolled risk-taking without proper assessment may have harmful impact on mental health later in life. Therefore, it is essential to identify it early for the preventable health problems. In the present study, we have designed a novel paradigm, viz. Risky Decision-taking Task (RDTT), to evaluate the spontaneous risk-taking behavioural repertoire in adolescent rodents. The task was designed based on both risk and cognitive factors. To validate and compare the risk-taking tendency, we have used early maternal separation and isolation (MS) stress model, as it is known to increase anxiety and curiosity-like behaviour at adolescence. We have used Sprague-Dawley rats of both sexes. Rats were exposed to MS stress for 10 days daily for six hours during stress hyporesponsive period (SHRP) from postnatal day 4 to 13. These rats were subjected to RDTT during adolescence. This task is a reward-based task where the latency to collect reward in the presence or absence of a risk factor is assessed. It consists of habituation, training to find the location of small and large rewards, reward preference for small and large reward and testing period under risky situation. Rats were trained individually to retrieve the valuation-based rewards under the risky, but innate aversive environments. The results from RDTT showed that as compared to controls, MS rats from both sexes showed reduced latency to collect large reward in the presence of a risk element and a reduced risk-index which is indicative of a higher risk-taking tendency in these rats. In addition, MS rats showed a trend towards anxiety-like behaviour as compared to controls in the Light-Dark Test. These results together show decreased risk latency for the large reward and reduced risk assessment in MS rats which is suggestive of more risk-taking tendency in these rats. Thus, we propose that RDTT paradigm can be used to evaluate the spontaneous risk-taking behavioural repertoire based on innate, spontaneous aversion and cognitive factors in rats.
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Affiliation(s)
- Abanti Chowdhury
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560 029
| | - B S Shankaranarayana Rao
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560 029
| | - T R Laxmi
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560 029.
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4
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Betterly H, Musselman M, Sorrentino R. Sexual assault in the inpatient psychiatric setting. Gen Hosp Psychiatry 2023; 82:7-13. [PMID: 36893652 DOI: 10.1016/j.genhosppsych.2023.02.006] [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: 08/24/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Sexual assault in the inpatient psychiatric setting is a significant problem with serious, lasting consequences. It is important for psychiatric providers to appreciate the nature and magnitude of this problem to be able to provide an appropriate response when faced with these challenging scenarios, as well as to advocate for the implementation of preventive measures. This article provides a review of the existing literature regarding sexual behavior in the inpatient psychiatric unit, describing the epidemiology of sexual assaults in these settings, and exploring the characteristics of both victims and perpetrators, with a particular focus on factors of relevance to the inpatient psychiatric patient population. Inappropriate sexual behavior in inpatient psychiatric settings is common, however the varying definition of such throughout the literature serves as a challenge to clearly identifying the frequency of specific behaviors. The existing literature does not identify a way to reliably predict which patients are most likely to engage in sexually inappropriate behaviors on an inpatient psychiatric unit. The medical, ethical, and legal challenges that such cases present are defined, followed by a review of current management and prevention strategies, and suggested future directions for research.
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Affiliation(s)
- Holly Betterly
- Resident Physician, Department of Psychiatry, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA.
| | - Meghan Musselman
- Assistant Professor of Psychiatry and Behavioral Science, Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA 19140, USA
| | - Renée Sorrentino
- Clinical Assistant Professor, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Chen PH, Tsai SY, Pan CH, Chen YL, Su SS, Chen CC, Kuo CJ. Prevalence and 5-year trend of incidence for medical illnesses after the diagnosis of bipolar disorder: A nationwide cohort study. Aust N Z J Psychiatry 2022; 56:1164-1176. [PMID: 34558298 DOI: 10.1177/00048674211046891] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Medical comorbidities are prevalent in patients with bipolar disorder. Evaluating longitudinal trends of the incidence of medical illnesses enables implementation of early prevention strategies to reduce the high mortality rate in this at-risk population. However, the incidence risks of medical illnesses in the early stages of bipolar disorder remain unclear. This study investigated the incidence and 5-year trend of medical illnesses following bipolar disorder diagnosis. METHODS We identified 11,884 patients aged 13-40 years who were newly diagnosed as having bipolar disorder during 1996-2012 and 47,536 age- and sex-matched controls (1:4 ratio) who represented the general population from Taiwan's National Health Insurance Research Database. We estimated the prevalence and incidence of individual medical illnesses yearly across the first 5 years after the index date. The adjusted incidence rate ratio was calculated to compare the occurrence of specific medical illnesses each year between the bipolar disorder group and control group using the Poisson regression model. RESULTS Apart from the prevalence, the adjusted incidence rate ratios of most medical illnesses were >1.00 across the first 5-year period after bipolar disorder diagnosis. Cerebrovascular diseases, ischaemic heart disease, congestive heart failure, other forms of heart disease, renal disease and human immunodeficiency virus infection exhibited the highest adjusted incidence rate ratios during the first year. Except for that of renal disease, the 5-year trends of the adjusted incidence rate ratios decreased for cerebrovascular diseases, cardiovascular diseases (e.g. ischaemic heart disease, other forms of heart disease, and vein and lymphatic disease), gastrointestinal diseases (e.g. chronic hepatic disease and ulcer disease) and communicable diseases (e.g. human immunodeficiency virus infection, upper respiratory tract infection and pneumonia). CONCLUSION Incidence risks of medical illnesses are increased in the first year after bipolar disorder diagnosis. Clinicians must carefully evaluate medical illnesses during this period because the mortality rates from medical illnesses are particularly high in people with bipolar disorder.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chun-Hung Pan
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychology, National Chengchi University, Taipei
| | - Yi-Lung Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Counseling Psychology, Chinese Culture University, Taipei
| | - Sheng-Siang Su
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Psychiatry, Mackay Memorial Hospital, Taipei.,Department of Psychiatry, Mackay Medical College, Taipei
| | - Chian-Jue Kuo
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
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6
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Rydahl KFK, Brund RBK, Medici CR, Straarup KMN, Straszek SPV, Østergaard SD. Bipolar disorder and regretted behavior in relation to use of social media and online dating. Bipolar Disord 2022; 24:27-38. [PMID: 34862700 DOI: 10.1111/bdi.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Individuals with bipolar disorder are prone to risk-taking behavior that is subsequently regretted. Here, we investigated whether this also occurs in relation to the use of social media and online dating. METHODS A questionnaire-based survey focusing on the use of social media and online dating was conducted among individuals attending an outpatient clinic for bipolar disorder, and among individuals attending two general practices in the same region (controls). The association between bipolar disorder and self-reported regretted behavior on social media/online dating sites was investigated using logistic regression with adjustment for age and sex. RESULTS A total of 124 individuals with bipolar disorder and 196 individuals without affective disorder from the general practices (controls) formed the study sample. Among the individuals with bipolar disorder who used social media, 66% reported regretted behavior as a consequence of this use, whereas only 31% of the controls reported such behavior. The corresponding numbers for individuals who used online dating were 65% for those with bipolar disorder and 31% for the controls. Following adjustment for age and sex, bipolar disorder was associated with elevated risk of regretted behavior in relation to the use of both social media (adjusted odds ratio: 3.6, 95% CI: 2.2, 5.9) and online dating (adjusted odds ratio: 4.1, 95% CI: 2.1, 8.0). CONCLUSIONS These findings suggest that risk-taking behavior and subsequent regret among individuals with bipolar disorder extend to social media and online dating. Cautious use of these platforms may be particularly relevant for individuals with bipolar disorder.
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Affiliation(s)
- Klara F K Rydahl
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - René B K Brund
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Clara R Medici
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Krista M N Straarup
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Sune P V Straszek
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren D Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hindley G, Bahrami S, Steen NE, O'Connell KS, Frei O, Shadrin A, Bettella F, Rødevand L, Fan CC, Dale AM, Djurovic S, Smeland OB, Andreassen OA. Characterising the shared genetic determinants of bipolar disorder, schizophrenia and risk-taking. Transl Psychiatry 2021; 11:466. [PMID: 34497263 PMCID: PMC8426401 DOI: 10.1038/s41398-021-01576-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023] Open
Abstract
Increased risk-taking is a central component of bipolar disorder (BIP) and is implicated in schizophrenia (SCZ). Risky behaviours, including smoking and alcohol use, are overrepresented in both disorders and associated with poor health outcomes. Positive genetic correlations are reported but an improved understanding of the shared genetic architecture between risk phenotypes and psychiatric disorders may provide insights into underlying neurobiological mechanisms. We aimed to characterise the genetic overlap between risk phenotypes and SCZ, and BIP by estimating the total number of shared variants using the bivariate causal mixture model and identifying shared genomic loci using the conjunctional false discovery rate method. Summary statistics from genome wide association studies of SCZ, BIP, risk-taking and risky behaviours were acquired (n = 82,315-466,751). Genomic loci were functionally annotated using FUMA. Of 8.6-8.7 K variants predicted to influence BIP, 6.6 K and 7.4 K were predicted to influence risk-taking and risky behaviours, respectively. Similarly, of 10.2-10.3 K variants influencing SCZ, 9.6 and 8.8 K were predicted to influence risk-taking and risky behaviours, respectively. We identified 192 loci jointly associated with SCZ and risk phenotypes and 206 associated with BIP and risk phenotypes, of which 68 were common to both risk-taking and risky behaviours and 124 were novel to SCZ or BIP. Functional annotation implicated differential expression in multiple cortical and sub-cortical regions. In conclusion, we report extensive polygenic overlap between risk phenotypes and BIP and SCZ, identify specific loci contributing to this shared risk and highlight biologically plausible mechanisms that may underlie risk-taking in severe psychiatric disorders.
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Affiliation(s)
- Guy Hindley
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway.
- Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
| | - Shahram Bahrami
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Kevin S O'Connell
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Oleksandr Frei
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
- Center for Bioinformatics, Department of Informatics, University of Oslo, Blindern, 0316, Oslo, Norway
| | - Alexey Shadrin
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Francesco Bettella
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Chun C Fan
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, 92093, USA
| | - Anders M Dale
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Olav B Smeland
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway.
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Williams SC, Davey-Rothwell MA, Tobin KE, Latkin C. People Who Inject Drugs and Have Mood Disorders-A Brief Assessment of Health Risk Behaviors. Subst Use Misuse 2017; 52:1181-1190. [PMID: 28574740 PMCID: PMC5578394 DOI: 10.1080/10826084.2017.1302954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders. OBJECTIVES Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs. METHODS With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n = 113) or depression (n = 237) to a comparison group with no history of diagnosed mental illness (n = 446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms. RESULTS While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance: People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.
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Affiliation(s)
| | | | - Karin E Tobin
- a Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - Carl Latkin
- a Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
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Abstract
OBJECTIVE Rates of HIV remain elevated in select populations such as those with severe mental illness and also among those who abuse cocaine, a vehicle through which risky sexual behavior may occur. The objective of the present narrative review was to synthesize the literature regarding stimulant use and its association with sexual risk among individuals with severe mental illness. METHODS This narrative review of the literature utilized Boolean search logic and the PsycINFO and PsycARTICLES databases to identify articles that explored the relationships among stimulant use, risky sexual behavior, and severe mental illness. Only one article was identified that examined a stimulant other than cocaine. Thus, the review was further limited to the impact that cocaine has on risky sexual behavior among those with severe mental illness. RESULTS Of the 87 abstracts obtained, 58 underwent a full text review and eight were included in the final review. Studies had a mean sample size of 110 and predominantly consisted of male (64%) outpatients. Study designs were largely cross-sectional and almost exclusively relied on retrospective participant report of sexual behavior and drug use. The extant literature indicates a positive association between cocaine and risky sexual behavior among those with a diagnosed severe mental illness. Risky behaviors associated with cocaine included reporting a greater number of partners as well as a higher degree of involvement in the sex trade. The positive association observed between cocaine and partner-related risk, however, did not extend to condom use. CONCLUSIONS Further research that utilizes better defined and operationalized constructs to investigate relationships among stimulant use, severe mental illness, and sexual risk, particularly condom use, is warranted and is necessary to advance the field.
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Affiliation(s)
- Todd M Bishop
- a Center of Excellence for Suicide Prevention, Canandaigua VAMC , Canandaigua , New York , USA.,b Department of Psychiatry , University of Rochester Medical Center , Rochester , New York , USA
| | - Stephen A Maisto
- c Department of Psychology , Syracuse University , Syracuse , New York , USA.,d Center for Integrated Healthcare, Syracuse VAMC , Syracuse , New York , USA
| | - Suzanne Spinola
- c Department of Psychology , Syracuse University , Syracuse , New York , USA.,d Center for Integrated Healthcare, Syracuse VAMC , Syracuse , New York , USA
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10
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Marengo E, Martino DJ, Igoa A, Fassi G, Scápola M, Urtueta Baamonde M, Strejilevich SA. Sexual risk behaviors among women with bipolar disorder. Psychiatry Res 2015; 230:835-8. [PMID: 26564549 DOI: 10.1016/j.psychres.2015.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/08/2015] [Accepted: 10/20/2015] [Indexed: 01/13/2023]
Abstract
The aim of this study was to investigate sexual health and sexual risk behaviors for sexually transmitted infections (STI) among women with bipolar disorder (BDW). Sixty-three euthymic women diagnosed with bipolar disorder type I, II or not otherwise specified were included and matched with a control group of 63 healthy women. Demographic and clinical data, structured sexual health measures and extensive assessment of sexual risk behavior were obtained and compared between groups. BDW had casual partners, were in non-monogamous sexual partnerships and had sex with partners with unknown HIV condition more frequently than healthy control women. History of two or more STI was more frequent among BDW. Inclusion of sexual behavior risk assessment among BDW in treatment is necessary to better identify those women with higher risk for STI and to take measures to improve their sexual health.
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Affiliation(s)
- Eliana Marengo
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Guillermo Fassi
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - María Scápola
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Mariana Urtueta Baamonde
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina.
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11
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Black CL, Goldstein KE, LaBelle DR, Brown CW, Harmon-Jones E, Abramson LY, Alloy LB. Behavioral approach system sensitivity and risk taking interact to predict left-frontal EEG asymmetry. Behav Ther 2014; 45:640-50. [PMID: 25022775 PMCID: PMC4100074 DOI: 10.1016/j.beth.2014.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/31/2023]
Abstract
The Behavioral Approach System (BAS) hypersensitivity theory of bipolar disorder (BD; Alloy & Abramson, 2010; Depue & Iacono, 1989) suggests that hyperreactivity in the BAS results in the extreme fluctuations of mood characteristic of BD. In addition to risk conferred by BAS hypersensitivity, cognitive and personality variables may play a role in determining risk. We evaluated relationships among BAS sensitivity, risk taking, and an electrophysiological correlate of approach motivation, relative left-frontal electroencephalography (EEG) asymmetry. BAS sensitivity moderated the relationship between risk taking and EEG asymmetry. More specifically, individuals who were high in BAS sensitivity showed left-frontal EEG asymmetry regardless of their level of risk-taking behavior. However, among individuals who were moderate in BAS sensitivity, risk taking was positively associated with asymmetry. These findings suggest that cognitive and personality correlates of bipolar risk may evidence unique contributions to a neural measure of trait-approach motivation. Clinical implications of these findings are discussed.
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Erez G, Pilver CE, Potenza MN. Gender-related differences in the associations between sexual impulsivity and psychiatric disorders. J Psychiatr Res 2014; 55:117-25. [PMID: 24793538 PMCID: PMC4165523 DOI: 10.1016/j.jpsychires.2014.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/12/2014] [Accepted: 04/10/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences. METHOD We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version. RESULTS The prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89-6.14, Axis-II:2.10-10.02; Men, Axis-I:1.92-6.21, Axis-II:1.63-6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders. CONCLUSION The robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.
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Affiliation(s)
- Galit Erez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Shalvata Mental Health Center, Hod Hasharon, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Corey E. Pilver
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut,Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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Mania and sexual risk: associations with behavioral self-regulation. J Affect Disord 2013; 150:1076-81. [PMID: 23721925 DOI: 10.1016/j.jad.2013.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/19/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Risky sexual behavior among young adults is a central public health concern. Hallmark cognitive effects of mania involve grandiose extrinsic goal-setting, which may be part of a tendency to approach rewarding cues while underestimating potential negative consequences. Poor impulse control also reflects a tendency to seek reward and rely on emotional decision-making. In contrast, effortful control is associated with adaptive decision making. METHODS Participants (n=595) completed measures of impulsivity, risk for mania, and risky sexual behavior. Relationships between risk for mania, behavioral self-regulation, and risky sexual behavior were examined in a negative binomial hurdle model. RESULTS For the hurdle portion, sensation-seeking was positively associated with the likelihood of engaging in risky sexual behavior. Effortful control was inversely associated with the likelihood of engaging in risky sexual behavior, but only among those high in risk for mania. Among those endorsing engagement in risky sex, urgency was positively, and effortful control negatively, associated with frequency of risky sex. Risk for mania was positively associated with frequency of risky sex, but only for those low in effortful control. LIMITATIONS Findings were among a homogeneous, young adult, nonclinical population, limiting generalizability. Examining these associations among a clinical population in an active manic episode is warranted. CONCLUSION Results suggest high levels of effortful control may diminish the hallmark effects of mania on cognition thereby reducing engagement in risky sexual behavior. Treatments targeting emotion-based rash action and effortful decision making may be particularly important for those experiencing manic symptoms.
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Rudolph AE, Linton S, Dyer TP, Latkin C. Individual, network, and neighborhood correlates of exchange sex among female non-injection drug users in Baltimore, MD (2005-2007). AIDS Behav 2013; 17:598-611. [PMID: 22983502 DOI: 10.1007/s10461-012-0305-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The "HIV risk environment" has been characterized as a dynamic interplay between structural and network factors. However, most HIV prevention research has not examined the independent and combined impact of network and structural factors. We aimed to identify individual, network, and neighborhood correlates of exchange sex (≥1 exchange sex partner, past 90 days) among female non-injection drug users (NIDUs). We used baseline data from 417 NIDUs enrolled in a randomized HIV prevention trial in Baltimore (2005-2007). Surveys ascertained demographic variables, drug/sex risk behaviors, neighborhood perceptions, and social/sexual network characteristics. Correlates of exchange sex were identified with descriptive statistics and log-binomial regression. Our findings suggest that sex and drug relationships among female NIDUs are interlinked and may be difficult to modify without altering social norms. Strengthening ties that provide social support but not drug support and reducing ties that provide both drug and social support may facilitate reductions in individual-level HIV-risk behaviors.
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Affiliation(s)
- Abby E Rudolph
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, 92093-0507, USA.
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Bipolar disorder is associated with HIV transmission risk behavior among patients in treatment for HIV. AIDS Behav 2012; 16:2267-71. [PMID: 22614744 DOI: 10.1007/s10461-012-0203-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined HIV transmission risk behavior among 63 patients with bipolar disorder (BD), major depressive disorder, and no mood disorder; half had substance use disorders (SUDs). Patients with BD were more likely than others to report unprotected intercourse with HIV-negative partners and <95 % adherence to antiretroviral medications. In multivariate models, BD and SUD were independent predictors of both risk behaviors. Participants with poorer medication adherence were more likely to have detectable HIV viral loads and unprotected intercourse with HIV-negative partners. Patients with BD deserve careful evaluation and HIV prevention services to reduce HIV transmission risk behaviors.
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