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Cichoń L, Janas-Kozik M, Chełmecka E, Wilczyński KM, Jelonek I, Rybakowski JK. Does the clinical picture of bipolar disorder in the pediatric population depend on sex? J Affect Disord 2024; 363:501-506. [PMID: 39029674 DOI: 10.1016/j.jad.2024.07.071] [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: 01/31/2024] [Revised: 07/02/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND In the current literature the influence of sex on the clinical presentation of the bipolar disorder (BD) in adults has been indicated. It was of the interest whether such a phenomenon is also present in the pediatric population. METHODS The authors collected retrospective clinical data in 288 patients hospitalized on the psychiatry ward aged 10-17 years; 80.2 % females and 19.8 % males. RESULTS No sex differences were observed in the age of onset, the time from the onset of symptoms to the diagnosis of BD, the number of symptoms during hospital stay, or family history of psychiatric disorder (U Mann-Whitney's p > 0.05). In males the most frequently recorded first episode of BD was mania or hypomania (51 %), and in females, a depressive episode (51 %). The main reason for the hospitalization in boys was episodes of mania (63 %), then mixed episodes (30 %), and depression (7 %). Whereas girls were most often hospitalized due to mixed episodes (52 %), less frequently depression (22 %), and mania (26 %). Co-morbid psychiatric disorders were found more often in boys than in girls (63 % vs 45 %; χ2p-value>0.05). The co-occurrence of the dissocial personality, borderline, tic disorders, pervasive developmental disorders and hyperkinetic disorders was different in both sexes. LIMITATIONS The main limitations of the study are the very high proportion of female subjects and the retrospective character of the study. CONCLUSIONS It seems that the clinical presentation of BD in the pediatric population can somewhat depend on the sex of the patients.
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Affiliation(s)
- Lena Cichoń
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland.
| | - Małgorzata Janas-Kozik
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland
| | - Elżbieta Chełmecka
- Medical University of Silesia in Katowice, Department of Medical Statistics, Faculty of Pharmaceutical Sciences in Sosnowiec, Poland
| | - Krzysztof M Wilczyński
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland
| | - Ireneusz Jelonek
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poland
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Narula S, Pal A, Reddy MS, Mahajan SL. Research on clinical aspects of bipolar disorder: A review of Indian studies. Indian J Psychiatry 2024; 66:421-432. [PMID: 38919568 PMCID: PMC11195747 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_698_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/27/2024] Open
Abstract
Background Bipolar disorder is one of the severe mental disorders that are associated with significant morbidity of the patients. Despite advancements in our understanding about the disorder, it remains a challenging proposition to treat bipolar disorder, largely since the prophylactic treatment of the disorder requires assessment of complex clinical algorithms. The revisions of the classificatory systems have also changed the conceptualization of the disorder. In this background, we conducted a review of the Indian studies conducted on the clinical aspects of bipolar disorder. Methods A narrative review was conducted with focus on the literature published from India. The databases searched included PubMed, Scopus, and Google Scholar, and articles published over the last 15 years by Indian authors were included for this review. Results In our review, we could access a substantial volume of research published from India. We could identify studies that catered to most of the relevant themes in bipolar disorder including epidemiology, etiology, comorbidities, stigma, disability, clinical course, cognitive profile, pathways to care, and recovery. Conclusion The research trajectory was in line with the research conducted elsewhere in the world. However, certain dissimilarities in terms of focus could also be observed. The possible reason behind this deviation could be the difference in clinical need and unique challenges faced in the management and rehabilitation of patients in bipolar disorder in Indian scenario.
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Affiliation(s)
- Sharon Narula
- Department of Psychiatry, Postgraduate Institute of Medical Educations and Research, Chandigarh, India
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - MS Reddy
- Consultant Psychiatrist, ASHA Hospital, Hyderabad, Telangana, India
| | - Sudhir L. Mahajan
- Department of Psychiatry, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Shuy YK, Santharan S, Chew QH, Lin SK, Ouyang WC, Chen CK, Park SC, Jang OJ, Park JH, Chee KY, Ding KS, Chong J, Zhang L, Li K, Zhu X, Jatchavala C, Pariwatcharakul P, Kallivayalil RA, Grover S, Avasthi A, Ansari M, Maramis MM, Aung PP, Tan CH, Xiang YT, Chong MY, Park YC, Kato TA, Shinfuku N, Baldessarini RJ, Sim K. Pharmacoepidemiology and Clinical Correlates of Lithium Treatment for Bipolar Disorder in Asia. J Clin Psychopharmacol 2024; 44:117-123. [PMID: 38230861 DOI: 10.1097/jcp.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND As clinical practices with lithium salts for patients diagnosed with bipolar disorder (BD) are poorly documented in Asia, we studied the prevalence and clinical correlates of lithium use there to support international comparisons. METHODS We conducted a cross-sectional study of use and dosing of lithium salts for BD patients across 13 Asian sites and evaluated bivariate relationships of lithium treatment with clinical correlates followed by multivariate logistic regression modeling. RESULTS In a total of 2139 BD participants (52.3% women) of mean age 42.4 years, lithium salts were prescribed in 27.3% of cases overall, varying among regions from 3.20% to 59.5%. Associated with lithium treatment were male sex, presence of euthymia or mild depression, and a history of seasonal mood change. Other mood stabilizers usually were given with lithium, often at relatively high doses. Lithium use was associated with newly emerging and dose-dependent risk of tremors as well as risk of hypothyroidism. We found no significant differences in rates of clinical remission or of suicidal behavior if treatment included lithium or not. CONCLUSIONS Study findings clarify current prevalence, dosing, and clinical correlates of lithium treatment for BD in Asia. This information should support clinical decision-making regarding treatment of BD patients and international comparisons of therapeutic practices.
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Affiliation(s)
- Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sanjana Santharan
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Chih-Ken Chen
- Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | | | - Ok-Jin Jang
- Department of Psychiatry, Bugok National Hospital, Changnyong, South Korea
| | - Jun Hyuk Park
- Jeju National University Hospital, Jeju University School of Medicine, Jeju, South Korea
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Kwong Sen Ding
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan, Malasia
| | - Jamaline Chong
- Hospital Permai Johor Bahru, Ministry of Health, Johor Bahru, Malaysia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Baoding, Hebei, China
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Margarita M Maramis
- Department of Psychiatry, Dr Soetomo Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Paing Phyo Aung
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Chay Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | | | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | | | - Kang Sim
- West Region, Institute of Mental Health, Singapore
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Shuy YK, Santharan S, Chew QH, Sim K. International Trends in Lithium Use for Pharmacotherapy and Clinical Correlates in Bipolar Disorder: A Scoping Review. Brain Sci 2024; 14:102. [PMID: 38275522 PMCID: PMC10813799 DOI: 10.3390/brainsci14010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Lithium remains an effective option in the treatment of bipolar disorder (BD). Thus, we aim to characterize the pharmaco-epidemiological patterns of lithium use internationally over time and elucidate clinical correlates associated with BD using a scoping review, which was conducted using the methodological framework by Arksey and O'Malley (2005). We searched several databases for studies that examined the prescriptions for lithium and clinical associations in BD from inception until December 2023. This review included 55 articles from 1967 to 2023, which collected data from North America (n = 24, 43.6%), Europe (n = 20, 36.4%), and Asia (n = 11, 20.0%). The overall prescription rates ranged from 3.3% to 84% (33.4% before and 30.6% after the median year cutoffs). Over time, there was a decline in lithium use in North America (27.7% before 2010 to 17.1% after 2010) and Europe (36.7% before 2003 to 35.7% after 2003), and a mild increase in Asia (25.0% before 2003 to 26.2% after 2003). Lithium use was associated with specific demographic (e.g., age, male gender) and clinical factors (e.g., lower suicide risk). Overall, we found a trend of declining lithium use internationally, particularly in the West. Specific clinical correlates can support clinical decision-making for continued lithium use.
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Affiliation(s)
- Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Sanjana Santharan
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore 539747, Singapore;
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore;
| | - Kang Sim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- West Region, Institute of Mental Health, Singapore 539747, Singapore
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Zhang L, Swaab DF. Sex differences in bipolar disorder: The dorsolateral prefrontal cortex as an etiopathogenic region. Front Neuroendocrinol 2024; 72:101115. [PMID: 37993020 DOI: 10.1016/j.yfrne.2023.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
Bipolar disorder (BD) is worldwide a prevalent mental illness and a leading risk factor for suicide. Over the past three decades, it has been discovered that sex differences exist throughout the entire panorama of BD, but the etiologic regions and mechanisms that generate such differences remain poorly characterized. Available evidence indicates that the dorsolateral prefrontal cortex (DLPFC), a critical region that controls higher-order cognitive processing and mood, exhibits biological disparities between male and female patients with psychiatric disorders, which are highly correlated with the co-occurrence of psychotic symptoms. This review addresses the sex differences in BD concerning epidemiology, cognitive impairments, clinical manifestations, neuroimaging, and laboratory abnormalities. It also provides strong evidence linking DLPFC to the etiopathogenesis of these sex differences. We emphasize the importance of identifying gene signatures using human brain transcriptomics, which can depict sexually different variations, explain sex-biased symptomatic features, and provide novel targets for sex-specific therapeutics.
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Affiliation(s)
- Lin Zhang
- Neuropsychiatric Disorders Lab, Neuroimmunology Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Dick F Swaab
- Neuropsychiatric Disorders Lab, Neuroimmunology Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
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Aghababaie-Babaki P, Malekpour MR, Mohammadi E, Saeedi Moghaddam S, Rashidi MM, Ghanbari A, Heidari-Foroozan M, Esfahani Z, Mohammadi Fateh S, Hajebi A, Haghshenas R, Foroutan Mehr E, Rezaei N, Larijani B, Farzadfar F. Global, regional, and national burden and quality of care index (QCI) of bipolar disorder: A systematic analysis of the Global Burden of Disease Study 1990 to 2019. Int J Soc Psychiatry 2023; 69:1958-1970. [PMID: 37353952 DOI: 10.1177/00207640231182358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND Bipolar disorders (BD) are significant debilitating mental problems. Here, we introduced a novel index as a representative of the quality of care delivered to BD patients worldwide. METHODS The Global Burden of Disease (GBD) 2019 study was the primary data source on BD, including prevalence, incidence, and years lived with disability (YLDs). Secondary indices were created and transformed into a single component that accounted for most of the variation, using the Principal Component Analysis (PCA) method. This component, reported on a scale of 0 to 100, was presented as the quality of care index (QCI). The QCI was estimated in different age groups and areas within a 30-year time frame. Gender disparity ratio (GDR), as the female-to-male ratio of the QCI, was reported. RESULTS The Global QCI slightly increased from 50.4 in 1990 to 53.1 in 2019. The GDR value was 0.95 in 2019. The high-middle SDI quintile had the highest QCI estimate of 63.0, and the lowest QCI value of 36.9 was regarding the low SDI quintile. Western-Pacific Region and South-East Asia had the highest and lowest QCI among WHO regions, with estimates of 70.7 and 31.2, respectively. The age group of 20 to 24 years old patients reported the lowest QCI estimate of 30.2, and the highest QCI of 59.8 was regarding 40 to 44 years old patients. CONCLUSION The QCI in BD had only a subtle increase from 1990 to 2019 and is in need of further improvement. Inequalities between different regions and age groups are considerable and require proper attention.
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Affiliation(s)
- Paria Aghababaie-Babaki
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Heidari-Foroozan
- Student Research Center Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Hajebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Liu W, Jiang X, Xin Y, Deng Z, Xie Y, Zhou Y, Wu Y, Sun Q, Kong L, Wu F, Tang Y. Sex effects on differentiating patients with major depressive disorder from bipolar disorder in depressive state: A fMRI study with follow-up. J Affect Disord 2023; 340:396-404. [PMID: 37572701 DOI: 10.1016/j.jad.2023.08.041] [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: 01/07/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is difficult to discriminate from major depressive disorder (MDD) before the appearance of mania or hypomania. This study was designed to identify whether patients with MDD and those who converted to BD are distinguishable using dynamic amplitude low-frequency fluctuations (dALFF) and describe the sex effects on the identification of the two disorders. METHODS We compared the dALFF values of 35 BD patients who converted from MDD during the 2-year follow-up, 99 MDD patients, and 130 healthy controls (HCs) using two-way ANOVA. Pearson's correlation was used to compare dALFF in dysfunctional brain regions and clinical characteristics. RESULTS A main effect of diagnosis was discovered in the frontal and occipital gyrus. For the main effect of sex, both the left middle occipital gyrus and the medial part of the superior frontal gyrus had higher dALFF values in males compared to females. An interaction of sex and diagnosis effect was observed in the right precentral gyrus. Male MDD patients exhibited a higher dALFF value than male BD patients. Additionally, we discovered a higher dALFF value in females than in males in BD patients. WCST scores were positively associated with dALFF values in the frontal and occipital gyrus in MDD patients. Meanwhile, dALFF values in the occipital gyrus positively correlated with WCST in female MDD patients only. LIMITATION Most of the participants were on medication and the sample size was small. CONCLUSIONS Our study is the first to find the non-neglectable role of sex effects in differentiating BD and MDD at an early stage.
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Affiliation(s)
- Wen Liu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Yide Xin
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Zijing Deng
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China
| | - Yu Xie
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Yifang Zhou
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China
| | - Yifan Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Lingtao Kong
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China
| | - Feng Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University Shenyang 110001, Liaoning, PR China; Department of Gerontology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China.
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Khoso AB, Noureen A, Un Nisa Z, Hodkinson A, Elahi A, Arshad U, Naz A, Bhatti MM, Asif M, Husain MO, Husain MI, Chaudhry N, Husain N, Chaudhry IB, Panagioti M. Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis. BJPsych Open 2023; 9:e179. [PMID: 37814419 PMCID: PMC10594255 DOI: 10.1192/bjo.2023.570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia. AIMS To estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia. METHOD In this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic. RESULTS The pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths. CONCLUSIONS One in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia.
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Affiliation(s)
- Ameer B. Khoso
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Amna Noureen
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Zaib Un Nisa
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Anam Elahi
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, UK
| | - Usman Arshad
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Anum Naz
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Muqaddas Asif
- Division of Substance-Related and Addiction Disorders, Pakistan Institute of Living and Learning, Lahore, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Nasim Chaudhry
- Division of Neurodevelopmental Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Imran B. Chaudhry
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
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Miguel N, Marquez-Arrico JE, Jodar M, Navarro JF, Adan A. Neuropsychological functioning of patients with major depression or bipolar disorder comorbid to substance use disorders: A systematic review. Eur Neuropsychopharmacol 2023; 75:41-58. [PMID: 37453267 DOI: 10.1016/j.euroneuro.2023.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Major depression disorder (MDD) and bipolar disorder (BD) are usual comorbidities in patients with substance use disorders (SUD), a condition known as dual disorder (DD). MDD, BD and SUD are associated with cognitive impairment, potentially leading to a greater functional impairment in the context of DD. OBJECTIVES To review the existing data on the cognitive impairment in DD patients with comorbid MDD or BD, considering the influence of the depressive symptomatology. METHODS Following the PRISMA protocol 19 studies were selected from the last 17 years, 13 of which focused on BD, five on MDD and one included both diagnoses. RESULTS Studies based in BD+SUD showed that the most affected cognitive domains were attention and executive functions, but not all of them found a greater impairment due to the comorbidity. While fewer studies were found for depression, MDD+SUD works point to a similar impairment cognitive pattern. Furthermore, depression improvement could be associated to better cognitive performance. LIMITATIONS More standardized research is needed regarding the influence of depression on cognitive performance of DD patients, especially on those with comorbid MDD. Factors such as main substance, abstinence, or MDD/BD-related variables should be considered. Unstudied factors, like gender or circadian rhythms, are proposed to improve knowledge in this area. CONCLUSIONS Current studies suggest that DD could potentiate cognitive impairment in BD, MDD and SUD. However, additional research is needed to improve the understanding of comorbidity to apply more individualized therapies in the treatment of these patients, considering the interference of their neurocognitive functioning.
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Affiliation(s)
- Nuria Miguel
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
| | - Julia E Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Spain
| | - Mercè Jodar
- Neurology Service, Hospital Universitari Parc Taulí, Sabadell, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud mental (CIBERSAM), Instituto de salud Carlos III, Madrid, Spain
| | | | - Ana Adan
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Spain.
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Shahini N, Salimi Z, Kiani D, Raftari A, Ziaee M. Relationship of serum estradiol and progesterone with symptoms and sex difference in schizophrenia: A cross-sectional study in Iran. Front Psychiatry 2023; 14:1075780. [PMID: 36970277 PMCID: PMC10030605 DOI: 10.3389/fpsyt.2023.1075780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/25/2023] [Indexed: 03/29/2023] Open
Abstract
Background Schizophrenia is a devastating disease characterized by frequent relapses, cognitive decline, and emotional and functional disability, with unknown causes. The phenomenology and clinical course of schizophrenic disorders are different between the two genders, which is thought to be related mainly to the effects of steroid sex hormones on the nervous system. Regarding inconsistencies in the studies, we aimed to compare the levels of estradiol and progesterone between schizophrenia patients and healthy individuals. Methods This cross-sectional study was conducted on 66 patients referred to the specialized clinical psychiatric ward of a teaching hospital in the north of Iran, for 5 months in 2021. Thirty-three schizophrenia patients confirmed by a psychiatrist based on DSM5 criteria were included in the case group, and 33 individuals without a psychiatric disease were included in the control group. We completed a demographic information checklist for each patient, along with the Simpson-Angus extrapyramidal side effect scale (SAS) for drug side effects and the positive and negative syndrome scale (PANSS) for the severity of the disease symptoms. Then, a 3-ml blood sample was taken from each participant to determine the serum levels of estradiol and progesterone. The data were analyzed by SPSS16 software. Results Thirty-four (51.5%) and 32 (48.5%) participants in this study were male and female, respectively. The mean serum level of estradiol was 22.33 ± 13.65 pm/dl in schizophrenia patients and 29.36 ± 21.32 pm/dl in the control group, showing no significant difference between the two groups (P = 0.4). However, the mean serum level of progesterone was significantly lower in schizophrenia patients (0.37 ± 1.39 pm/dl) than in control subjects (3.15 ± 5.73 pm/dl) (P < 0.001). The PANSS and SAS scores were not significantly correlated with the level of sex hormones (P > 0.05). Serum estradiol and progesterone levels based on sex significantly differed between the two groups (except for female estradiol). Conclusion Considering the hormonal differences between schizophrenia patients and control subjects, determining hormonal levels in these patients and using complementary hormonal therapies with estradiol or similar compounds can be beneficial as the starting point of schizophrenia treatment, where therapeutic responses can draw the future developmental framework.
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Affiliation(s)
- Najmeh Shahini
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
- Clinical Research Development Unit (CRDU), 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zanireh Salimi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dorsa Kiani
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
- Dorsa Kiani,
| | - Ahmad Raftari
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
| | - Maliheh Ziaee
- Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
- *Correspondence: Maliheh Ziaee,
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Sex-specific associations between lifetime diagnosis of bipolar disorder and cardiovascular disease: A cross-sectional analysis of 257,673 participants from the UK Biobank. J Affect Disord 2022; 319:663-669. [PMID: 36162675 DOI: 10.1016/j.jad.2022.09.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/10/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sex is seldom considered as a potential moderator of the impact of bipolar disorder (BD) on cardiovascular disease (CVD) risk. We aimed to characterize the sex-specific association of CVD and BD using data from the UK Biobank. METHODS In a cross-sectional analysis, we compared the odds ratio between women and men with BD for seven CVD diagnoses (coronary artery disease, myocardial infarction, angina, atrial fibrillation, heart failure, stroke, and essential hypertension) and four cardiovascular biomarkers (arterial stiffness index, low-density lipoprotein, C-reactive protein, and HbA1c) in 293 participants with BD and 257,380 psychiatrically healthy controls in the UK Biobank. RESULTS After adjusting for age, we found a two- to three-fold stronger association among women than among men between BD and rates of coronary artery disease, heart failure, and essential hypertension, with a significant sex-by-diagnosis interactions. The association remained significant after controlling for self-reported race, education, income, and smoking status. After controlling for potential confounders, there was no significant association between sex and any cardiovascular biomarkers. LIMITATIONS These analyses could not disentangle effects of BD from its treatment. CONCLUSIONS Our results underscore the importance of incorporating sex and mental illness in risk estimation tools for CVD, and improving screening for, and timely treatment of, CVD in those with BD. Future research is needed to better understand the contributors and mechanisms of sex differences related to CVD risk in BD.
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No Sex Differences in Self-Reported Childhood Maltreatment in Major Depressive and Bipolar Disorders: A Retrospective Study. Brain Sci 2022; 12:brainsci12060804. [PMID: 35741691 PMCID: PMC9220896 DOI: 10.3390/brainsci12060804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background: We investigated, for the first time, whether there are any sex differences in retrospective self-reported childhood maltreatment (CM) in Italian adult patients with major depressive disorder (MDD) or bipolar disorder (BD). Furthermore, the potential impacts of patients’ age on the CM self-report were investigated. Methods: This retrospective study used the data documented in the electronic medical records of patients who were hospitalized for a 4-week psychiatric rehabilitation program. CM was assessed using the 28-item Childhood Trauma Questionnaire (CTQ), which evaluates emotional, physical, and sexual abuse, as well as emotional and physical neglect. The linear and logistic regression models were used (α = 0.01). Results: Three hundred thirty-five patients with MDD (255 women and 80 men) and 168 with BD (97 women and 71 men) were included. In both samples, considerable CM rates were identified, but no statistically significant sex differences were detected in the variety of CTQ-based CM aspects. There was a significant association, with no sex differences, between increasing patients’ age and a decreasing burden of CM. Conclusion: Both women and men with MDD or BD experienced a similar and considerable CM burden. Our findings support routine CM assessment in psychiatric clinical practice.
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Menculini G, Steardo L, Sciarma T, D'Angelo M, Lanza L, Cinesi G, Cirimbilli F, Moretti P, Verdolini N, De Fazio P, Tortorella A. Sex Differences in Bipolar Disorders: Impact on Psychopathological Features and Treatment Response. Front Psychiatry 2022; 13:926594. [PMID: 35757228 PMCID: PMC9226371 DOI: 10.3389/fpsyt.2022.926594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sex differences were demonstrated in bipolar disorders (BD) concerning epidemiological, clinical, and psychopathological characteristics, but consensus is lacking. Moreover, data concerning the influence of sex on treatment response in BD is contrasting. The present cross-sectional study aimed to analyze sex differences in a population of BD subjects, with specific focus on psychopathological features and treatment response. MATERIALS AND METHODS Subjects diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th version (DSM-5) were recruited. Socio-demographic and clinical characteristics were collected. The Hamilton Rating Scale for Depression, the Mania Rating Scale (MRS), the brief version of the Temperament Evaluation of Memphis, Pisa and San Diego-Münster version (briefTEMPS-M), and the Barratt Impulsiveness Scale-11 items (BIS-11) were used for psychopathological assessment. Treatment response was appraised with the Alda Scale. We performed bivariate analyses to compare socio-demographic, clinical, and psychopathological characteristics between men and women (p < 0.05). A logistic regression was run to analyze features that were significantly associated with female sex. RESULTS Among the recruited 219 BD subjects, 119 (54.3%) were females. Women had a lower scholarity (p = 0.015) and were less frequently employed (p = 0.001). As for psychopathological features, a higher MRS total score (p < 0.001) was detected among women, as well as higher BIS-11 total score (p = 0.040), and briefTEMPS-M score for anxious temperament (p = 0.006). Men showed higher prevalence of DSM-5 mixed features (p = 0.025), particularly during a depressive episode (p = 0.014). Women reported longer duration of untreated illness (DUI) (p < 0.001). There were no sex differences in the Alda Scale total score when considering the whole sample, but this was significantly higher among men (p = 0.030) when evaluating subjects treated with anticonvulsants. At the logistic regression, female sex was positively associated with longer DUI (p < 0.001; OR 1.106, 95% CI 1.050-1.165) and higher MRS total score (p < 0.001; OR 1.085, 95% CI 1.044-1.128) and negatively associated with employment (p = 0.003; OR 0.359, 95% CI 0.185-0.698) and DSM-5 mixed features (p = 0.006; OR 0.391, 95% CI 0.200-0.762). CONCLUSIONS The clinical presentation of BD may differ depending on sex. The severity of BD should not be neglected among women, who may also display worse treatment response to anticonvulsants.
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Affiliation(s)
- Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Tiziana Sciarma
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Martina D'Angelo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Laura Lanza
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gianmarco Cinesi
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Federica Cirimbilli
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Patrizia Moretti
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Norma Verdolini
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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