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Hanssen I, Ten Klooster P, Kraiss J, Huijbers M, Regeer E, Kupka R, Bohlmeijer E, Speckens A. Predicting which intervention works better for whom: Moderators of treatment effect of Mindfulness-Based Cognitive Therapy and Positive Psychology Intervention in patients with bipolar disorder. J Affect Disord 2024; 360:79-87. [PMID: 38788858 DOI: 10.1016/j.jad.2024.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND This study aimed to identify moderators of treatment effect (i.e. depressive symptoms and well-being) of Mindfulness-Based Cognitive Therapy (MBCT) and Positive Psychology Intervention (PPI) in patients with bipolar disorder. METHODS Data were drawn from two multicenter randomized controlled trials investigating effectiveness of MBCT vs treatment as usual (TAU; n = 144) and PPI vs TAU (n = 97) in bipolar disorder. Outcomes were assessed at baseline, posttreatment, and 12 months after baseline. Data were analyzed using separate linear regression models, comparing the pooled MBCT or PPI outcomes to TAU, and comparing MBCT to PPI. RESULTS The exploratory analyses not corrected for multiple comparisons showed a number of variables that were associated with stronger response to the interventions, including higher baseline anxiety, lower well-being, and lower levels of self-focused positive rumination, well-being, and self-compassion, and variables associated with a stronger response to either MBCT (higher levels of depression and anxiety and being married) or PPI (being male). After correcting for multiple testing, depressive symptoms appeared to be the most robust variable associated with better response to MBCT than PPI. LIMITATIONS The RCTs handled slightly different enrollment criteria and outcome measures. CONCLUSIONS The most robust finding is that patients with more severe symptomatology seem to benefit more from MBCT than PPI. CLINICAL IMPLICATIONS This is a first step to improve personalized assignment of third-wave CBT interventions for patients with bipolar disorder. However, before definite treatment assignment criteria can be formulated and implemented in clinical practice, these findings should be replicated.
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Affiliation(s)
- Imke Hanssen
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands.
| | - Peter Ten Klooster
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Jannis Kraiss
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Marloes Huijbers
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands
| | - Eline Regeer
- Altrecht Institute for Mental Health Care, Outpatient Clinical for Bipolar Disorders, Utrecht, the Netherlands
| | - Ralph Kupka
- Amsterdam University Medical Center, Vrije Universiteit, Department of Psychiatry, Amsterdam, the Netherlands
| | - Ernst Bohlmeijer
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Anne Speckens
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands
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Malhi GS, Bell E, Jadidi M, Gitlin M, Bauer M. Countering the declining use of lithium therapy: a call to arms. Int J Bipolar Disord 2023; 11:30. [PMID: 37633877 PMCID: PMC10460327 DOI: 10.1186/s40345-023-00310-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
For over half a century, it has been widely known that lithium is the most efficacious treatment for bipolar disorder. Yet, despite this, its prescription has consistently declined over this same period of time. A number of reasons for this apparent disparity between evidence and clinical practice have been proposed, including a lack of confidence amongst clinicians possibly because of an absence of training and lack of familiarity with the molecule. Simultaneously, competition has grown within the pharmacological armamentarium for bipolar disorder with newer treatments promoting an image of being safer and easier to prescribe primarily because of not necessitating plasma monitoring, which understandably is appealing to patients who then exercise their preferences accordingly. However, these somewhat incipient agents are yet to reach the standard lithium has attained in terms of its efficacy in providing prophylaxis against the seemingly inevitable recrudescence of acute episodes that punctuates the course of bipolar disorder. In addition, none of these mimics have the additional benefits of preventing suicide and perhaps providing neuroprotection. Thus, a change in strategy is urgently required, wherein myths regarding the supposed difficulties in prescribing lithium and the gravity of its side-effects are resolutely dispelled. It is this cause to which we have pledged our allegiance and it is to this end that we have penned this article.
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Affiliation(s)
- 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, St. Leonards, NSW, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- 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, St. Leonards, NSW, Australia
| | - Maedeh Jadidi
- 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, St. Leonards, NSW, Australia
| | - Michael Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Dalkner N, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Negative mood states as a correlate of cognitive performance and self-assessment of cognitive performance in bipolar disorder versus schizophrenia. Schizophr Res 2023; 252:1-9. [PMID: 36608492 PMCID: PMC9974828 DOI: 10.1016/j.schres.2022.12.034] [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: 05/12/2022] [Revised: 08/15/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Mood states have been reported to manifest a cross-sectional correlation with self-assessment accuracy across functional domains and psychiatric conditions. Ecological momentary assessment (EMA) provides a strategy to examine the momentary course and correlates of mood states. This study tested the association of moods assessed longitudinally with accuracy of immediate self-assessments of cognitive test performance in participants with schizophrenia and bipolar disorder. METHODS 240 well-diagnosed participants with schizophrenia and bipolar disorder completed a subset of tests from the MATRICS Consensus Cognitive Battery and an immediate self-assessment of cognitive performance. Differences between actual and self-reported performance were used to index the accuracy of self-assessment. Daily smartphone EMA, 3× per day for 30 days, sampled participants´ momentary moods (sad, happy, relaxed, anxious), aggregated into positive affect and negative affect (NA). RESULTS Bipolar participants had better cognitive performance, but both samples had equivalent mis-estimation. Repeated-measures analyses found that NA did not manifest significant variability over time either between or within participants in the two diagnostic groups. Within-group analyses found that higher average NA was associated with greater mis-estimation and poorer cognitive performance in participants with bipolar disorder, but not in those with schizophrenia. CONCLUSION Negative moods had a significant association with impairments in self-assessment of cognitive performance in participants with bipolar disorder. Our study did not confirm previous cross-sectional findings of more accurate self-assessment associated with greater NA in schizophrenia. These findings suggest that cross-sectional assessments, particularly self-reports, may lead to different results than aggregated data from longitudinal evaluations.
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Affiliation(s)
- Nina Dalkner
- Medical University Graz, Austria; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, USA; San Diego VA Medical Center La Jolla, CA, USA
| | | | | | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA; Bruce W. Carter VA Medical Center, Miami, FL, USA.
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Bennett CC, Ross MK, Baek E, Kim D, Leow AD. Smartphone accelerometer data as a proxy for clinical data in modeling of bipolar disorder symptom trajectory. NPJ Digit Med 2022; 5:181. [PMID: 36517582 PMCID: PMC9751066 DOI: 10.1038/s41746-022-00741-3] [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: 06/16/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Being able to track and predict fluctuations in symptoms of mental health disorders such as bipolar disorder outside the clinic walls is critical for expanding access to care for the global population. To that end, we analyze a dataset of 291 individuals from a smartphone app targeted at bipolar disorder, which contains rich details about their smartphone interactions (including typing dynamics and accelerometer motion) collected everyday over several months, along with more traditional clinical features. The aim is to evaluate whether smartphone accelerometer data could serve as a proxy for traditional clinical data, either by itself or in combination with typing dynamics. Results show that accelerometer data improves the predictive performance of machine learning models by nearly 5% over those previously reported in the literature based only on clinical data and typing dynamics. This suggests it is possible to elicit essentially the same "information" about bipolar symptomology using different data sources, in a variety of settings.
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Affiliation(s)
- Casey C. Bennett
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea ,grid.254920.80000 0001 0707 2013Department of Computing, DePaul University, Chicago, IL USA
| | - Mindy K. Ross
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois–Chicago, Chicago, IL USA
| | - EuGene Baek
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea
| | - Dohyeon Kim
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea
| | - Alex D. Leow
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois–Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Dept. of Biomedical Engineering, University of Illinois–Chicago, Chicago, IL USA
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Benacek J, Martin-Key NA, Spadaro B, Tomasik J, Bahn S. Using decision-analysis modelling to estimate the economic impact of the identification of unrecognised bipolar disorder in primary care: the untapped potential of screening. Int J Bipolar Disord 2022; 10:15. [PMID: 35680705 PMCID: PMC9184689 DOI: 10.1186/s40345-022-00261-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Patients with bipolar disorder are often unrecognised and misdiagnosed with major depressive disorder leading to higher direct costs and pressure on the medical system. Novel screening tools may mitigate the problem. This study was aimed at investigating the direct costs of bipolar disorder misdiagnosis in the general population, evaluating the impact of a novel bipolar disorder screening algorithm, and comparing it to the established Mood Disorder Questionnaire. A decision analysis model was built to quantify the utility of one-time screening for bipolar disorder in primary care adults presenting with a depressive episode. A hypothetical population of interest comprised a healthcare system of one million users, corresponding to 15,000 help-seekers diagnosed with major depressive disorder annually, followed for five years. The model was used to calculate the impact of screening for bipolar disorder, compared to no screening, in terms of accuracy and total direct costs to a third-party payer at varying diagnostic cut-offs. Decision curve analysis was used to evaluate clinical utility. Results Compared to no screening, one-time screening for bipolar disorder using the algorithm reduced the number of misdiagnoses from 680 to 260, and overall direct costs from $50,936 to $49,513 per patient, accounting for $21.3 million savings over the five-year period. The algorithm outperformed the Mood Disorder Questionnaire, which yielded 367 misdiagnoses and $18.3 million savings over the same time. Decision curve analysis showed the screening model was beneficial. Conclusions Utilisation of bipolar disorder screening strategies could lead to a substantial reduction in human suffering by reducing misdiagnosis, and also lessen the healthcare costs. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00261-9.
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Affiliation(s)
- Jiri Benacek
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Nayra A Martin-Key
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Benedetta Spadaro
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK.
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK.
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Yilmaz S, Huguet A, Kisely S, Rao S, Wang J, Baur K, Price M, O'Mahen H, Wright K. Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis. J Affect Disord 2022; 301:193-204. [PMID: 35007645 DOI: 10.1016/j.jad.2021.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment. OBJECTIVES This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression? DATA SOURCES A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html). ELIGIBILITY CRITERIA Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score. RESULTS The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size. CONCLUSIONS Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome.
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Affiliation(s)
- Sakir Yilmaz
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK.
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Canada; Departament de Psicologia, Universitat Rovira I Virgili, Spain; IWK Health Center, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Canada; University of Queensland, Psychiatry, Australia; Metro South Addiction and Mental Health Epidemiology Service, Australia
| | - Sanjay Rao
- Faculty of Medicine, Psychiatry, University of Ottawa, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | | | - Heather O'Mahen
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
| | - Kim Wright
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
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Predominant Polarity and Polarity Index of Maintenance Treatments for Bipolar Disorder: A Validation Study in a Large Naturalistic Sample in Italy. ACTA ACUST UNITED AC 2021; 57:medicina57060598. [PMID: 34200746 PMCID: PMC8230357 DOI: 10.3390/medicina57060598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Predominant polarity (PP) may be a useful course specifier in at least a significant proportion of patients with Bipolar Disorder (BD), being associated with several clinically relevant correlates. Emerging evidence suggests that the concept of PP might influence the selection of maintenance treatments, based on a drug polarity index (PI) which measures the greater antidepressive vs. antimanic preventive efficacy of mood stabilizers over long-term maintenance treatment. In this study, we aimed to validate the PI in a large sample of Italian BD patients with accurate longitudinal characterization of the clinical course, which ensured a robust definition of the PP. Materials and Methods: Our sample is comprised of 653 patients with BD, divided into groups based on the predominant polarity (manic/hypomanic predominant polarity—MPP, depressive predominant polarity—DPP and no predominant polarity). Subsequently we calculated the mean total polarity index for each group, and we compared the groups. Results: When we examined the mean PI of treatments prescribed to individuals with DPP, MPP and no predominant polarity, calculated using two different methods, we failed to find significant differences, with the exception of the PI calculated with the Popovic method and using the less stringent criterion for predominant polarity (PP50%). Conclusions: Future prospective studies are needed in order to determine whether the predominant polarity is indeed one clinical factor that might guide the clinician in choosing the right mood stabilizer for BD maintenance treatment.
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Chen JX, Yin L, Xu HT, Zhang SY, Huang WQ, Li HJ, Li BB, Yang KB, Li Q, Berk M, Su YA. Psychometric Properties of the Chinese Version of the Bipolar Depression Rating Scale for Bipolar Disorder. Neuropsychiatr Dis Treat 2021; 17:787-795. [PMID: 33737809 PMCID: PMC7966408 DOI: 10.2147/ndt.s300761] [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: 01/06/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Unlike unipolar depression, depressive episode of bipolar disorder is often associated with clinical characteristics, such as atypical and mixed symptoms. However, there are currently no valid and reliable specific tools available to assess the specific psychiatric symptomatology of depressive episode of bipolar disorder in China. Therefore, we aimed to evaluate the psychometric properties of the Chinese version of the Bipolar Depression Rating Scale (BDRS) in Chinese patients with bipolar disorder. METHODS The sample of this study included 111 patients with bipolar disorder (30 male, 81 female). All participants were interviewed with the Chinese version of the BDRS (BDRS-C), the 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). A psychometric analysis of the BDRS was conducted. RESULTS The Cronbach's alpha coefficient of the BDRS-C reached a value of 0.869. The BDRS-C score and scores for the HAMD-17 (r = 0.819, p < 0.01), the MADRS (r = 0.882, p < 0.01) and the YMRS (r = 0.355, p < 0.01) exhibited significant positive correlations. Close correlations were observed between the mixed subscale score of the BDRS-C and the YMRS score (r = 0.784, p < 0.01). Exploratory factor analysis resulted in three factors: a primary depressive symptoms cluster, a secondary depressive symptoms cluster, and a mixed symptoms cluster. CONCLUSION The Chinese version of the BDRS has satisfactory psychometric properties. This is a valid and reliable instrument to assess depressive symptomatology in patients with bipolar disorder.
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Affiliation(s)
- Jing-Xu Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Lu Yin
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Hai-Ting Xu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Suo-Yuan Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Wen-Qian Huang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Hong-Juan Li
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Bin-Bin Li
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Ke-Bing Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, People's Republic of China
| | - Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100083, People's Republic of China
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100083, People's Republic of China
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Malhi GS, Bell E, Boyce P, Bassett D, Berk M, Bryant R, Gitlin M, Hamilton A, Hazell P, Hopwood M, Lyndon B, McIntyre RS, Morris G, Mulder R, Porter R, Singh AB, Yatham LN, Young A, Murray G. The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary. Bipolar Disord 2020; 22:805-821. [PMID: 33296123 DOI: 10.1111/bdi.13036] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To provide a succinct, clinically useful summary of the management of bipolar disorder, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on bipolar disorder. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of bipolar disorder. RESULTS The bipolar disorder summary provides a systematic approach to diagnosis, and a logical clinical framework for management. It addresses the acute phases of bipolar disorder (mania, depression and mixed states) and its longer-term management (maintenance and prophylaxis). For each phase it begins with Actions, which include important strategies that should be implemented from the outset wherever possible. These include for example, lifestyle changes, psychoeducation and psychological interventions. In each phase, the summary advocates the use of Choice medications for pharmacotherapy, which are then used in combinations along with additional Alternatives to manage acute symptoms or maintain mood stability and provide prophylaxis. The summary also recommends the use of electroconvulsive therapy (ECT) for each of the acute phases but not for maintenance therapy. Finally, it briefly considers bipolar disorder in children and its overlap in adults with borderline personality disorder. CONCLUSIONS The bipolar disorder summary provides up to date guidance regarding the management of bipolar disorder, as set out in the MDcpg2020 . The recommendations are informed by evidence and clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians but will be of interest to anyone involved in the management of patients with bipolar disorder.
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Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Michael Gitlin
- Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amber Hamilton
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Grace Morris
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Dmitrzak-Weglarz M, Szczepankiewicz A, Kapelski, Chaberska J, Kwiatkowska K, Duda J, Dziuda S, Skibinska M, Reszka E, Pawlak J. Transcripts of orphan nuclear receptor (NR4A1) & potassium channel (KCNK17) genes as new potential biomarkers for depression. Meta Gene 2020. [DOI: 10.1016/j.mgene.2020.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
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11
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Perich T, Mitchell PB, Meade T. Transdiagnostic group cognitive behaviour therapy for anxiety in bipolar disorder-a pilot feasibility and acceptability study. Pilot Feasibility Stud 2020; 6:170. [PMID: 33292713 PMCID: PMC7648280 DOI: 10.1186/s40814-020-00719-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Anxiety is prominent for many people living with bipolar disorder, yet the benefit of psychological interventions in treating this co-morbidity has been minimally explored and few studies have been conducted in a group format. This study aimed to assess the feasibility and acceptability of a transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) for people living with bipolar disorder. Methods Participants were recruited to take part in a 9-week group therapy programme designed to treat anxiety in bipolar disorder using cognitive behaviour therapy. They were assessed by structured interview (SCID-5 RV) to confirm the diagnosis of bipolar disorder and assessed for anxiety disorders. Self-report questionnaires—DASS (depression, anxiety, stress), ASRM (mania), STAI (state and trait anxiety) and Brief QOL.BD (quality of life) pre- and post-treatment were administered. Results Fourteen participants enrolled in the programme, with 10 participants (5 male; 5 female) completing the follow-up assessments. Two groups (one during working hours, the other outside working hours) were conducted. The programme appeared acceptable and feasible with a mean of 6.9 (77%) sessions attended, though five (50%) participants completed less than 3 weeks homework. Conclusion The transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) proved feasible and acceptable for participants; however, homework compliance was poor. A larger randomised pilot study is needed to assess the benefits of the intervention on symptom measures and address homework adherence, possibly through providing support between sessions or tailoring it more specifically to participant needs.
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Affiliation(s)
- Tania Perich
- School of Psychology, Western Sydney University, Sydney, Australia.
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Sydney, Australia
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12
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Cuéllar-Barboza AB, McElroy SL, Veldic M, Singh B, Kung S, Romo-Nava F, Nunez NA, Cabello-Arreola A, Coombes BJ, Prieto M, Betcher HK, Moore KM, Winham SJ, Biernacka JM, Frye MA. Potential pharmacogenomic targets in bipolar disorder: considerations for current testing and the development of decision support tools to individualize treatment selection. Int J Bipolar Disord 2020; 8:23. [PMID: 32632502 PMCID: PMC7338319 DOI: 10.1186/s40345-020-00184-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background Treatment in bipolar disorder (BD) is commonly applied as a multimodal therapy based on decision algorithms that lack an integrative understanding of molecular mechanisms or a biomarker associated clinical outcome measure. Pharmacogenetics/genomics study the individual genetic variation associated with drug response. This selective review of pharmacogenomics and pharmacogenomic testing (PGT) in BD will focus on candidate genes and genome wide association studies of pharmacokinetic drug metabolism and pharmacodynamic drug response/adverse event, and the potential role of decision support tools that incorporate multiple genotype/phenotype drug recommendations. Main body We searched PubMed from January 2013 to May 2019, to identify studies reporting on BD and pharmacogenetics, pharmacogenomics and PGT. Studies were selected considering their contribution to the field. We summarize our findings in: targeted candidate genes of pharmacokinetic and pharmacodynamic pathways, genome-wide association studies and, PGT platforms, related to BD treatment. This field has grown from studies of metabolizing enzymes (i.e., pharmacokinetics) and drug transporters (i.e., pharmacodynamics), to untargeted investigations across the entire genome with the potential to merge genomic data with additional biological information. Conclusions The complexity of BD genetics and, the heterogeneity in BD drug-related phenotypes, are important considerations for the design and interpretation of BD PGT. The clinical applicability of PGT in psychiatry is in its infancy and is far from reaching the robust impact it has in other medical disciplines. Nonetheless, promising findings are discovered with increasing frequency with remarkable relevance in neuroscience, pharmacology and biology.
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Affiliation(s)
- Alfredo B Cuéllar-Barboza
- Department of Psychiatry, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Susan L McElroy
- Lindner Center of HOPE and Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
| | - Marin Veldic
- Department of Psychiatry, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Balwinder Singh
- Department of Psychiatry, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Francisco Romo-Nava
- Lindner Center of HOPE and Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
| | - Nicolas A Nunez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alejandra Cabello-Arreola
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Miguel Prieto
- Department of Psychiatry, Universidad de los Andes, Santiago, Chile
| | - Hannah K Betcher
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Katherine M Moore
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stacey J Winham
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Joanna M Biernacka
- Department of Psychiatry, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Mark A Frye
- Department of Psychiatry, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico. .,Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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13
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Suh H, Kang TU, Moon E, Park JM, Lee BD, Lee YM, Jeong HJ, Kim SY, Lee K, Lim HJ. Similarities and Differences of Strategies between Bipolar and Depressive Disorders on Stress Coping. Psychiatry Investig 2020; 17:71-77. [PMID: 31995974 PMCID: PMC6992857 DOI: 10.30773/pi.2019.0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE As coping strategies can influence the illness course of mood disorder, they could be potential targets for psychological intervention. The current study investigated the similarities and differences in stress coping styles between bipolar disorder (BD) and depressive disorder (DD). METHODS Subjects with BD (n=135) and DD (n=100) who met the DSM-IV diagnostic criteria were included in this analysis. Coping strategies were assessed using the coping inventory for stressful situations and depressive symptoms were assessed by Beck depression inventory. RESULTS The BD group showed significantly more avoidant and task-oriented coping than the DD group (t=2.714, p=0.007; t=2.193, p=0.039). After excluding the effect of the depressive symptoms themselves (by comparing two groups in non-depressive state), the BD group still showed significantly more avoidant and task-oriented coping than the DD group (t=2.040, p=0.045; t=2.556, p=0.013), but when the symptoms of depression get greater, the difference between BD and DD coping strategies were reduced. CONCLUSION Subjects with BD tend to use more task and avoidant coping than DD subjects. But when the symptoms of depression get greater, the difference in coping strategies between BD and DD were reduced.
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Affiliation(s)
- Hwagyu Suh
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae Uk Kang
- Department of Psychiatry, Seoul Metropolitan Eunpyeung Hospital, Seoul, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Je Min Park
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Byung Dae Lee
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Min Lee
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hee Jeong Jeong
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo Yeon Kim
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kangyoon Lee
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun Ju Lim
- Department of Psychiatry and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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14
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Manelis A, Stiffler R, Lockovich JC, Almeida JR, Aslam HA, Phillips ML. Longitudinal changes in brain activation during anticipation of monetary loss in bipolar disorder. Psychol Med 2019; 49:2781-2788. [PMID: 30572969 PMCID: PMC6663653 DOI: 10.1017/s0033291718003847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) show aberrant brain activation patterns during reward and loss anticipation. We examined for the first time longitudinal changes in brain activation during win and loss anticipation to identify trait markers of aberrant anticipatory processing in BD. METHODS Thirty-four euthymic and depressed individuals with BD-I and 17 healthy controls (HC) were scanned using functional magnetic resonance imaging twice 6 months apart during a reward task. RESULTS HC, but not individuals with BD, showed longitudinal reductions in the right lateral occipital cortex (RLOC) activation during processing of cues predicting possible money loss (p-corrected <0.05). This result was not affected by psychotropic medication, mood state or the changes in depression/mania severity between the two scans in BD. Elevated symptoms of subthreshold hypo/mania at baseline predicted more aberrant longitudinal patterns of RLOC activation explaining 12.5% of variance in individuals with BD. CONCLUSIONS Increased activation in occipital cortex during negative outcome anticipation may be related to elevated negative emotional arousal during anticipatory cue processing. One interpretation is that, unlike HC, individuals with BD were not able to learn at baseline that monetary losses were smaller than monetary gains and were not able to reduce emotional arousal for negative cues 6 months later. Future research in BD should examine how modulating occipital cortical activation affects learning from experience in individuals with BD.
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Affiliation(s)
- Anna Manelis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richelle Stiffler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeanette C. Lockovich
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Haris A. Aslam
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L. Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Corriger A, Pickering G. Ketamine and depression: a narrative review. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:3051-3067. [PMID: 31695324 PMCID: PMC6717708 DOI: 10.2147/dddt.s221437] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022]
Abstract
Depression is the third leading cause of disability in the world. Depressive symptoms may be reduced within several weeks after the start of conventional antidepressants, but treatment resistance concerns one-third of patients who fail to achieve recovery. Over the last 20 years, ketamine, an antagonist of the N-methyl-D-aspartate receptor, has been described to have antidepressant properties. A literature review was conducted through an exhaustive electronic search. It was restricted to Cochrane reviews, meta-analyses, and randomized controlled trials (RCTs) of ketamine for major depressive disorder and/or bipolar disorder. This review included two Cochrane reviews, 14 meta-analyses and 15 trials. Ketamine was studied versus placebo, versus other comparators and as an anesthetic adjuvant before electroconvulsive therapy. In 14 publications, ketamine provided a rapid antidepressant effect with a maximum efficacy reached at 24 hrs. Its effect lasted for 1–2 weeks after infusion, but a longer-term effect is little reported. Ketamine does not seem to improve depressive symptoms at the end of electroconvulsive sessions. Safety and tolerability profiles with ketamine at low single dose are generally good in depressed patients. However, there is a lack of data concerning ketamine with repeated administration at higher doses. The clinical use of ketamine is increasing. Intranasal (S)-ketamine has recently been approved for depression by the Food and Drug Administration. It could be a promising treatment in depressed patients with suicidal ideation. Collectively, the level of proof of efficacy remains low and more RCTs are needed to explore efficacy and safety issues of ketamine in depression.
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Affiliation(s)
- Alexandrine Corriger
- Neuro-Dol Laboratory Inserm 1107, Clermont Auvergne University, Clermont-Ferrand, France.,Clinical Pharmacology Department CPC/CIC Inserm 1405, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Gisèle Pickering
- Neuro-Dol Laboratory Inserm 1107, Clermont Auvergne University, Clermont-Ferrand, France.,Clinical Pharmacology Department CPC/CIC Inserm 1405, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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16
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Hanssen I, Huijbers MJ, Lochmann-van Bennekom MWH, Regeer EJ, Stevens AWMM, Evers SMAA, Wensing M, Kupka RW, Speckens AEM. Study protocol of a multicenter randomized controlled trial of mindfulness-based cognitive therapy and treatment as usual in bipolar disorder. BMC Psychiatry 2019; 19:130. [PMID: 31039765 PMCID: PMC6492313 DOI: 10.1186/s12888-019-2115-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite multiple pharmacological interventions, many people with bipolar disorder (BD) experience substantial residual mood symptoms, even in the absence of severe mood episodes, which have a negative impact on the course of illness and quality of life. Limited data are available on how to optimize treatment for BD, especially for those who suffer from persistent and residual depressive symptoms. Preliminary evidence suggests Mindfulness-Based Cognitive Therapy (MBCT) as a psychological treatment option for BD. This study aims to investigate whether adding MBCT to treatment as usual (TAU) will result in symptomatic and functional improvements in adults with BD compared to TAU alone. METHODS/DESIGN This study is a prospective, evaluator blinded, multicenter, randomized controlled trial of MBCT + TAU and TAU alone in 160 adults with bipolar type I and type II. Assessments will be conducted at baseline (T0), mid-treatment (Tmid), and at 3 (T1), 6 (T2), 9 (T3), 12 (T4), and 15 (T5) months follow-up. Primary outcome is post-treatment severity of depressive symptoms (Inventory of Depressive Symptomatology- Clinician administered). Secondary outcomes are severity of (hypo) manic symptoms, anxiety, relapse rates, overall functioning, positive mental health, and cost-effectiveness. As possible mediators will be assessed rumination of negative affect, dampening and rumination of positive affect, mindfulness skills, and self-compassion. DISCUSSION This study will provide valuable insight into the (cost-)effectiveness of MBCT on clinician- and self-rated symptoms of BD, relapse rates, positive mental health, and overall functioning. TRIAL REGISTRATION NCT03507647 . Registered 25th of April 2018.
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Affiliation(s)
- I. Hanssen
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - M. J. Huijbers
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | | | - E. J. Regeer
- Altrecht, Institute for Mental Health Care, Outpatient clinic for Bipolar Disorders, Nieuwe Houtenseweg 12, 3524 SH Utrecht, the Netherlands
| | - A. W. M. M. Stevens
- Dimence Mental Health, Center for Bipolar Disorders, Pikeursbaan 3, 7411 GT Deventer, The Netherlands
| | | | - M. Wensing
- Radboud University Medical Centre, Institute for Quality in Health Care, Postbus 9101, 6500 HB Nijmegen, the Netherlands
| | - R. W. Kupka
- Altrecht, Institute for Mental Health Care, Outpatient clinic for Bipolar Disorders, Nieuwe Houtenseweg 12, 3524 SH Utrecht, the Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands
| | - A. E. M. Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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17
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Poleszczyk A, Rakowicz M, Parnowski T, Antczak J, Święcicki Ł. Are there clinical and neurophysiologic predictive factors for a positive response to HF-rTMS in patients with treatment-resistant depression? Psychiatry Res 2018; 264:175-181. [PMID: 29649674 DOI: 10.1016/j.psychres.2018.03.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
Better selection of patients with treatment-resistant depression for high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) would make the procedure more efficient. The objective of this study was to search for clinical and neurophysiologic predictors of therapeutic response with a special focus on the bipolar population. Forty patients (30 bipolar) underwent 20 daily sessions of HF-rTMS. Clinical outcome measures included the 21-item Hamilton Depression Rating Scale, the Beck Depression Inventory, the Clinical Global Impression, and the Patient Global Impression. Neurophysiologic measurements included repeated estimation of the motor threshold and cortical silent period. Improvement was obtained in all psychometric scales, with no difference between unipolar and bipolar patients. Longer duration of the illness, higher number of prior hospitalizations, and more disturbed activity were associated with a worse response to rTMS, and somatic anxiety, sleep disorders, and health worries were positive predictors. In bipolar patients, longer disease duration and therapy with mirtazapine, mianserin, trazodone, hydroxyzine, and promethazine were associated with a worse response. Sleep disturbances, higher baseline motor threshold, and longer cortical silent period predicted a better response. In this study, we found several clinical and neurophysiologic predictors of better/worse responses to the standard HF-rTMS protocol. Our preliminary data need to be reproduced.
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Affiliation(s)
- Anna Poleszczyk
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Maria Rakowicz
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Tadeusz Parnowski
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Jakub Antczak
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Łukasz Święcicki
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
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18
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Ellegaard PK, Licht RW, Poulsen HE, Nielsen RE, Berk M, Dean OM, Mohebbi M, Nielsen CT. Add-on treatment with N-acetylcysteine for bipolar depression: a 24-week randomized double-blind parallel group placebo-controlled multicentre trial (NACOS-study protocol). Int J Bipolar Disord 2018; 6:11. [PMID: 29619634 PMCID: PMC6162004 DOI: 10.1186/s40345-018-0117-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Background Oxidative stress and inflammation may be involved in the development and progression of mood disorders, including bipolar disorder. Currently, there is a scarcity of useful treatment options for bipolar depressive episodes, especially compared with the efficacy of treatment for acute mania. N-Acetylcysteine (NAC) has been explored for psychiatric disorders for some time given its antioxidant and anti-inflammatory properties. The current trial aims at testing the clinical effects of adjunctive NAC treatment (compared to placebo) for bipolar depression. We will also explore the biological effects of NAC in this context. We hypothesize that adjunctive NAC treatment will reduce symptoms of depression, which will be reflected by changes in selected markers of oxidative stress. Methods and analysis In the study, we will include adults diagnosed with bipolar disorder, in a currently depressive episode. Participants will undertake a 20-week, adjunctive, randomized, double-blinded, parallel group placebo-controlled trial comparing 3 grams of adjunctive NAC daily with placebo. The primary outcome is the mean change over time from baseline to end of study on the Montgomery–Asberg Depression Rating Scale (MADRS). Among the secondary outcomes are mean changes from baseline to end of study on the Bech-Rafaelsen Melancholia Scale (MES), the Young Mania Rating Scale (YMRS), the WHO-Five Well-being Index (WHO-5), the Global Assessment of Functioning scale (GAF-F), the Global Assessment of Symptoms scale (GAF-S) and the Clinical Global Impression-Severity scale (CGI-S). The potential effects on oxidative stress by NAC treatment will be measured through urine and blood samples. DNA will be examined for potential polymorphisms related to oxidative defences. Trial registration: Registered at The European Clinical Trials Database, ClinicalTrials.gov: NCT02294591 and The Danish Data Protection Agency: 2008-58-0035.
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Affiliation(s)
- Pernille Kempel Ellegaard
- Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. .,Research Unit, Mental Health Service Esbjerg, Gl. Vardevej 101, 6715, Esbjerg N, The Region of Southern Denmark, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Rasmus Wentzer Licht
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Henrik Enghusen Poulsen
- Clinical Pharmacology, Bispebjerg Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Ernst Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Australia
| | - Olivia May Dean
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Australia
| | | | - Connie Thuroee Nielsen
- Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Mental Health Service Vejle, Odense, The Region of Southern Denmark, Denmark
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19
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Lee HH, Chang CH, Wang LJ, Wu CC, Chen HL, Lu T, Lu RB, Lee SY. The correlation between longitudinal changes in hypothalamic-pituitary-adrenal (HPA)-axis activity and changes in neurocognitive function in mixed-state bipolar II disorder. Neuropsychiatr Dis Treat 2018; 14:2703-2713. [PMID: 30410339 PMCID: PMC6199219 DOI: 10.2147/ndt.s173616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In this study, we aim to determine 1) the differences in cortisol in patients with bipolar II disorder (BD-II) and control subjects and 2) the correlation between cortisol levels and cognitive function in patients with BD-II during a 24-week follow-up period. METHODS We recruited a total of 32 BD-II patients and 30 healthy control subjects. The BD-II patients were assessed for clinical severity and serum cortisol level at baseline and at weeks 8, 16, and 24. The Brief Assessment of Cognition in Affective Disorders (BACA) was adopted to evaluate cognitive function at baseline and endpoint (week 24). Meanwhile, we assessed the controls for serum cortisol level and BACA at baseline. RESULTS We observed that the BD-II group had a higher serum cortisol level and lower BACA composite scores compared with the healthy controls at baseline. A significant correlation was found between changes in Verbal Fluency, a subset of BACA, and changes in serum cortisol level after the 24-week follow-up, controlling for age, gender, years of education, and clinical severity (P<0.001). CONCLUSION We propose that serum cortisol may be involved in the psychopathological mechanisms of cognitive decline in BD-II.
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Affiliation(s)
- Hsuan-Han Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
| | - Cheng-Ho Chang
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ching Wu
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsing-Ling Chen
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, .,Institute of Behavioral Medicine Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, .,Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, .,Department of Psychiatry, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, .,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan,
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20
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McKnight RF, Bilderbeck AC, Miklowitz DJ, Hinds C, Goodwin GM, Geddes JR. Longitudinal mood monitoring in bipolar disorder: Course of illness as revealed through a short messaging service. J Affect Disord 2017; 223:139-145. [PMID: 28753472 DOI: 10.1016/j.jad.2017.07.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/05/2017] [Accepted: 07/08/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Online self-monitoring of mood can be used to investigate differences in course patterns across patient groups. This study explored the feasibility of remote symptom capture with True Colours, a self-rated online mood monitoring tool completed on a weekly basis. METHODS Participants with bipolar disorder (N = 297) completed weekly depression and mania questionnaires over an average of 27.5 months (range 1 -81 months). Subgroups defined by sex, age, and bipolar I vs. II status were compared on time in various mood states, number of episodes, and week-to-week mood variability. RESULTS Compliance with weekly questionnaires was generally high (median, 92% of weeks). Mood symptoms occurred for an average of 55.4% of weeks across the follow-up period. Females spent more time with hypomanic/manic and depressive symptoms and had more depressive episodes compared to males. Younger participants were found to experience more hypomanic/manic episodes and showed greater variability in mood symptoms than older participants. No significant differences in mood symptoms or variability were observed between bipolar I and II patients. LIMITATIONS This was a naturalistic study with a heterogeneous cohort, and did not include a control group. True Colours does not identify mood fluctuations that may occur in the days between weekly assessments. CONCLUSIONS Monitoring moods through an online tool is both feasible and informative regarding course of illness in patients with bipolar disorder. Interventions aiming to reduce mood variability and manic/hypomanic episodes in the early phases of bipolar disorder may enhance the long-term symptomatic course of the illness.
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Affiliation(s)
- Rebecca F McKnight
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Amy C Bilderbeck
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - David J Miklowitz
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry & David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M. The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. Curr Neuropharmacol 2017; 15:359-371. [PMID: 28503107 PMCID: PMC5405614 DOI: 10.2174/1570159x14666161017233642] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features. METHOD 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features. RESULTS Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse. CONCLUSION ECT resulted to be an effective and safe treatment for all the phases of severe and drug-resistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a "last resort".
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Behavioral Science
“G. De Lisio”, Carrara-Pisa, Pisa, Italy
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Toni
- Institute of Behavioral Science
“G. De Lisio”, Carrara-Pisa, Pisa, Italy
| | | | - Chiara Socci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Lee SY, Wang LJ, Chang CH, Wu CC, Chen HL, Lin SH, Chu CL, Lu T, Lu RB. Serum DHEA-S concentration correlates with clinical symptoms and neurocognitive function in patients with bipolar II disorder: A case-controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2017; 74:31-35. [PMID: 27914864 DOI: 10.1016/j.pnpbp.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/18/2016] [Accepted: 11/29/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dysregulation of the neuroendocrine system including dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and pregnenolone may play a role in the pathophysiology of bipolar II disorder (BP-II). The aims of the current study are to determine (a) the differences in DHEA, DHEA-S and pregnenolone in patients with BP-II and controls; and (b) the correlation of levels of the above hormones, cognitive function, and clinical symptoms. METHODS Patients diagnosed with BP-II and healthy controls were recruited from psychiatric department. Blood samples were collected to measure the levels of DHEA, DHEA-S and pregnenolone in all participants, followed by assessment of cognitive function using the Brief Assessment of Cognition in Affective Disorders (BACA). RESULTS A total of 32 patients BP-II and 30 healthy control subjects were recruited. The BP-II group was found with significantly elder age, fewer years of education, and lower BACA composite scores compared to the healthy controls. The level of DHEA-S was significantly associated with performance in BACA when controlling for age, gender, years of education and having BP-II (P=0.018). The DHEA-S level was significantly correlated with mania score (r=-0.498, P=0.010). CONCLUSION Our findings support that serum level of DHEA-S may be a biomarker representing clinical manic symptoms and cognitive performance.
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Affiliation(s)
- Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine, Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Ho Chang
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Ching Wu
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsing-Ling Chen
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Hsien Lin
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Liang Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
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23
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Dell'Osso B, Grancini B, Vismara M, De Cagna F, Maggi M, Molle M, Cremaschi L, Miller S, Ketter TA, Altamura AC. Age at onset in patients with bipolar I and II disorder: a comparison of large sample studies. J Affect Disord 2016; 201:57-63. [PMID: 27177297 DOI: 10.1016/j.jad.2016.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/14/2016] [Accepted: 04/11/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bipolar Disorder (BD) is a leading cause of disability worldwide and factors contributing to its burden include chronic relapsing course, comorbidity, suicide risk, and early age at onset (AAO). In particular, recent investigation has shown that BD onset may occur earlier than previously believed, even though whether BDI and II are different in such regard is still debated. Reduced samples may, moreover, limit the confidence in the published studies, with geographic issues, in turn, representing potentially conditioning factors. The present review was aimed to select and analyze large sample studies comparing AAO in BDI vs II patients. METHODS A PubMed literature search was performed, considering English-written articles published up to December 2015, comparing AAO in BDI vs II patients with sample size≥100 subjects per group. RESULTS Seventeen studies were considered suitable for revision, with 8 studies reporting statistically significant differences and 9 not. Among studies reporting statistically significant differences, mostly conducted in Europe, 6 showed an earlier AAO in BDI, while 2 in BDII subjects. LIMITATIONS Only studies with large samples included, considering AAO as a continuous variable, and providing a comparison between the bipolar subtypes. CONCLUSIONS Our findings suggest that AAO per se does not seem to reliably differentiate BDI from BDII patients and that such variable should likely be investigated in the context of other clinical characteristics, in order to assess its overall influence over BD course. Geographic factors may, in turn, play a potential role with future investigation warranted to further explore this specific issue.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA.
| | - Benedetta Grancini
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Vismara
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca De Cagna
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Maggi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Molle
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shefali Miller
- Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - Terence A Ketter
- Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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24
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Goffin KC, Dell'Osso B, Miller S, Wang PW, Holtzman JN, Hooshmand F, Ketter TA. Different characteristics associated with suicide attempts among bipolar I versus bipolar II disorder patients. J Psychiatr Res 2016; 76:94-100. [PMID: 26921874 DOI: 10.1016/j.jpsychires.2016.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/18/2015] [Accepted: 02/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Suicide attempts are common in patients with bipolar disorder (BD), and consistently associated with female gender and certain unfavorable BD illness characteristics. Findings vary, however, regarding effects of BD illness subtype and yet other illness characteristics upon prior suicide attempt rates. We explored the effects of demographics and BD illness characteristics upon prior suicide attempt rates in patients stratified by BD illness subtype (i.e., with bipolar I disorder (BDI) versus bipolar II disorder (BDII)). METHODS Outpatients referred to the Stanford BD Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD Affective Disorders Evaluation. Rates of prior suicide attempt were compared in patients with and without diverse demographic and BD illness characteristics stratified by BD subtype. RESULTS Among 494 BD outpatients (mean ± SD age 35.6 ± 13.1 years; 58.3% female; 48.6% BDI, 51.4% BDII), overall prior suicide attempt rates in were similar in BDI versus BDII patients, but approximately twice as high in BDI (but not BDII) patients with compared to without lifetime eating disorder, and in BDII (but not BDI) patients with compared to without childhood BD onset. In contrast, current threshold-level suicidal ideation and lifetime alcohol use disorder robustly but less asymmetrically increased prior suicide attempt risk across BD subtypes. LIMITATIONS American tertiary bipolar disorder clinic referral sample, cross-sectional design. CONCLUSIONS Further studies are needed to assess the extent to which varying clinical characteristics of samples of patients with BDI and BDII could yield varying prior suicide attempt rates in patients with BDI versus BDII.
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Affiliation(s)
- Kathryn C Goffin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernardo Dell'Osso
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Shefali Miller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Po W Wang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jessica N Holtzman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Farnaz Hooshmand
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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25
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Miller JM, Everett BA, Oquendo MA, Ogden RT, Mann JJ, Parsey RV. Positron emission tomography quantification of serotonin transporter binding in medication-free bipolar disorder. Synapse 2016; 70:24-32. [PMID: 26426356 PMCID: PMC4654655 DOI: 10.1002/syn.21868] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/26/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Bipolar disorder (BD) is associated with abnormalities in the serotonin transporter (5-HTT), but specific in vivo findings have been discrepant. Using positron emission tomography (PET) and [(11)C]DASB, we compared 5-HTT binding between unmedicated depressed BD subjects and healthy volunteers (HVs). EXPERIMENTAL DESIGN 5-HTT binding in six brain regions was compared between 17 depressed, unmedicated BD subjects and 31 HVs, using the outcome measure of VT/fP (proportional to the total number of available transporters). Alternative outcome measures were examined as well. 47% of BD were BP I; and 65% reported a prior suicide attempt. PRINCIPAL OBSERVATIONS 5-HTT binding (VT/fP ) did not differ between BD and HV groups considering six brain regions of interest simultaneously (P = 0.24). In contrast, alternative outcome measures (BPF*, BPP*, and BPND*) indicated lower binding in BD compared with HV across these six regions of interest (BPF*: P = 0.047; BPP*: P = 0.032; BPND*: P = 0.031). 5-HTT binding was unrelated to suicide attempt history, depression severity, bipolar subtype, or history of past substance use disorder. CONCLUSIONS Choice of outcome measure strongly affects comparisons of serotonin transporter binding using PET with [(11)C]DASB. We do not find evidence of abnormal 5-HTT binding in bipolar depression using our primary outcome measure, VT /fP . However, we did observe lower 5-HTT binding in BD with alternative outcome measures that are frequently used with [(11)C]DASB. Relative merits and assumptions of different outcome measures are discussed. Evaluation in larger samples and during different mood states, including remission, is warranted.
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Affiliation(s)
- Jeffrey M. Miller
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
- Department of Psychiatry, Columbia University, New York, NY
| | - Benjamin A. Everett
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
| | - Maria A. Oquendo
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
- Department of Psychiatry, Columbia University, New York, NY
| | - R. Todd Ogden
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - J. John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
- Department of Psychiatry, Columbia University, New York, NY
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26
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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27
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Johnson SL, Gershon A, Starov V. Is energy a stronger indicator of mood for those with bipolar disorder compared to those without bipolar disorder? Psychiatry Res 2015; 230:1-4. [PMID: 26257089 DOI: 10.1016/j.psychres.2015.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 06/11/2015] [Accepted: 06/25/2015] [Indexed: 11/29/2022]
Abstract
Theory and research indicate that activity is fundamental to mood episodes in bipolar disorder (BD), yet researchers have not tested whether energy is more closely tethered to mood in BD compared to those without BD. Eighty-seven participants (13 with self-reported BD) completed 4396 energy and mood ratings through a mood-monitoring application. Mixed modeling analyses indicated that low energy, but not high energy, was related to mood within the BD group. Low energy could provide a strong and easily recognized indicator of negative mood states in persons with BD.
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Affiliation(s)
- Sheri L Johnson
- Department of Psychology, University of California, 3210 Tolman Hall, Berkeley, CA 94720-1650, USA.
| | - Anda Gershon
- Stanford University, School of Medicine, Stanford, CA, USA
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28
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Henry C, Etain B, Godin O, Dargel AA, Azorin JM, Gard S, Bellivier F, Bougerol T, Kahn JP, Passerieux C, Aubin V, Courtet P, Leboyer M. Bipolar patients referred to specialized services of care: Not resistant but impaired by sub-syndromal symptoms. Results from the FACE-BD cohort. Aust N Z J Psychiatry 2015; 49:898-905. [PMID: 25991763 DOI: 10.1177/0004867415585582] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A national network of expert centers for bipolar disorders was set up in France to provide support, mainly for psychiatrists, who need help for managing bipolar disorder patients. The aims of this article are to present the main characteristics of the patients referred to an expert center in order to highlight the major disturbances affecting these patients and to understand the most significant difficulties encountered by practitioners dealing with bipolar disorder patients. METHODS Patients were evaluated by trained psychiatrists and psychologists, with standardized and systematic assessment using interviews and self-report questionnaires. RESULTS All patients (n = 839) met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for bipolar disorder I (48.4%), bipolar disorder II (38.1%) or bipolar disorder-not otherwise specified (13.5%). Mean illness duration was 17 years (±11.3), with 41.9% of patients having a history of suicide attempts. Lifetime comorbidities were 43.8% for anxiety disorders and 32.8% for substance abuse. At the point of inclusion, most patients (76.2%) were not in an acute phase, being considered to have a syndromal remission, but which still required referral to a tertiary system of care. Among these patients, 37.5% had mild to moderate residual depressive symptoms (Montgomery and Asberg Depression Rating Scale ranging from 7 to 19) despite 39% receiving an antidepressant. However, 47.8% were considered to be poorly adherent to medication; 55% showed evidence of sleep disturbances, with half being overweight; 68.1% of patients showed poor functioning (Functioning Assessment Short Test ⩾ 12) with this being linked to residual depressive symptoms, sleep disturbances and increased body mass index. CONCLUSIONS It appears that bipolar disorder patients referred to an expert center in most cases do not suffer from a severe or resistant illness but they rather have residual symptoms, including subtle but chronic perturbations that have a major impact on levels of functioning. The longitudinal follow-up of these patients will enable a better understanding of the evolution of such residual symptoms.
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Affiliation(s)
- Chantal Henry
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France
| | - Bruno Etain
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France
| | - Ophelia Godin
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France UPMC Université Paris 06, UMRS 943, Paris, France
| | - Aroldo Ayub Dargel
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Instituto Nacional de Ciência e Tecnologia-Translacional em Medicina (INCT) e Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Jean-Michel Azorin
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, Marseille, France Aix-Marseille Université, CNRS, CRN2M UMR 7286, Marseille, France
| | - Sébastien Gard
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Service de psychiatrie adulte, Bordeaux, France
| | - Frank Bellivier
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France AP-HP, GH Saint-Louis-Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, France
| | - Thierry Bougerol
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Université Joseph Fourier, Grenoble, France CHU de Grenoble, Grenoble, France Grenoble Institut des Neurosciences (GIN) Inserm U836, La Tronche, France
| | - Jean-Pierre Kahn
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Université de Lorraine, Nancy, France
| | - Christine Passerieux
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Centre Hospitalier de Versailles, Le Chesnay, France Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Valerie Aubin
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Centre Hospitalier Princesse Grace, Monaco
| | - Philippe Courtet
- Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Psychiatric Emergency Department, CHRU Montpellier, Montpellier, France Inserm U1061, Université Montpellier, Montpellier, France
| | - Marion Leboyer
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France
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Ushkalova AV, Kostyukova EG, Mosolov SN. [A comparative study of different types of pharmacotherapy in treatment of depressive phase of bipolar II disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:23-30. [PMID: 25909803 DOI: 10.17116/jnevro20151151223-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A comparative evaluation of the efficacy and safety of different types of pharmacotherapy: antidepressant monotherapy (agomelatine or sertraline), mood stabilizer monotherapy (valproate) and combination therapy (valproate + sertraline) in bipolar II disorder patients with major depressive episode. MATERIAL AND METHODS A 6-week open randomized study included 89 inpatients and outpatients. Basic criteria of efficacy were ≥50% reduction of HAMD total score and remission (≤7 points) to the end of the study. RESULTS At the end of the study (day 42), the highest number of patients with 50% reduction of HAMD total score was noted in the sertraline (65%) and combination therapy (60%) groups, in the valproate group it was 57.1%, and the lowest - in agomelatine group (42.9%), but the differences were not statistically significant. Remission was observed in 45% patients in combination therapy group compared with 33.3% in valproate group, 32.1% in agomelatine group and only 20% in group of sertraline, but the differences between the groups also were not significant. CONCLUSION Antidepressants (agomelatine and sertraline) have demonstrated fast but insufficient influence on the reduction of depression in the patients. Treatment with sertraline rarely led to remission and was frequently associated with high rate of switch into hypomania. Valproate therapy was moderately effective and well-tolerated without risk of switching. Combination of valproic acid with sertraline had the highest efficacy and was fairly well tolerated.
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Affiliation(s)
| | | | - S N Mosolov
- Moscow Research Institute of Psychiatry, Moscow
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Cermolacce M, Belzeaux R, Adida M, Azorin JM. [Affective disorders: endocrine and metabolic comorbidities]. Encephale 2015; 40 Suppl 3:S33-9. [PMID: 25550238 DOI: 10.1016/s0013-7006(14)70129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Links between affective and endocrine-metabolic disorders are numerous and complex. In this review, we explore most frequent endocrine-metabolic comorbidities. On the one hand, these comorbidities imply numerous iatrogenic effects from antipsychotics (metabolic side-effects) or from lithium (endocrine side-effects). On the other hand, these comorbidities are also associated with affective disorders independently from medication. We will successively examine metabolic syndrome, glycemic disturbances, obesity and thyroid disorders among patients with affective disorders. Endocrinemetabolic comorbidities can be individually encountered, but can also be associated. Therefore, they substantially impact morbidity and mortality by increasing cardiovascular risk factors. Two distinct approaches give an account of processes involved in these comorbidities: common environmental factors (iatrogenic effects, lifestyle), and/or shared physiological vulnerabilities. In conclusion, we provide a synthesis of important results and recommendations related to endocrine-metabolic comorbidities in affective disorders : heavy influence on morbidity and mortality, undertreatment of somatic diseases, importance of endocrine and metabolic side effects from main mood stabilizers, impact from sex and age on the prevalence of comorbidities, influence from previous depressive episodes in bipolar disorders, and relevance of systematic screening for subclinical (biological) disturbances.
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Affiliation(s)
- M Cermolacce
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France; Laboratoire de Neurosciences Cognitives, UMR CNRS 6155 & Aix-Marseille Université, Fédération 3C, Marseille, France.
| | - R Belzeaux
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - J-M Azorin
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
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Moon E, Chang JS, Choi S, Ha TH, Cha B, Cho HS, Park JM, Lee BD, Lee YM, Choi Y, Ha K. Characteristics of stress-coping behaviors in patients with bipolar disorders. Psychiatry Res 2014; 218:69-74. [PMID: 24803186 DOI: 10.1016/j.psychres.2014.03.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 01/29/2014] [Accepted: 03/30/2014] [Indexed: 11/17/2022]
Abstract
Appropriate stress-coping strategies are needed to improve the outcome in the treatment of bipolar disorders, as stressful life events may aggravate the course of the illness. The aim of this study was to compare stress-coping behaviors between bipolar patients and healthy controls. A total of 206 participants comprising 103 bipolar patients fulfilling the Diagnostic and Statistical Manual for Axis I disorder fourth edition (DSM-IV) diagnostic criteria for bipolar I and II disorders and controls matched by age and sex were included in this study. Stress-coping behaviors were assessed using a 53-item survey on a newly-designed behavioral checklist. The characteristics of stress-coping behaviors between the two groups were compared by using t-test and factor analysis. Social stress-coping behaviors such as 'journey', 'socializing with friends', and 'talking something over' were significantly less frequent in bipolar patients than controls. On the other hand, pleasurable-seeking behaviors such as 'smoking', 'masturbation', and 'stealing' were significantly more frequent in bipolar patients than controls. These results suggest that bipolar patients may have more maladaptive stress-coping strategies than normal controls. It is recommended to develop and apply psychosocial programs to reduce maladaptive stress-coping behaviors of bipolar patients.
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Affiliation(s)
- Eunsoo Moon
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jae Seung Chang
- Mood Disorder Clinic and Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sungwon Choi
- Department of Psychology, Duksung Women׳s University, Seoul, Republic of Korea
| | - Tae Hyon Ha
- Mood Disorder Clinic and Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hyun Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je Min Park
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Byung Dae Lee
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Min Lee
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Yoonmi Choi
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyooseob Ha
- Mood Disorder Clinic and Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Institute of Human Behavioral Medicine, Medical Research Center, Seoul, Republic of Korea; Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea.
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Gao W, Jiao Q, Lu S, Zhong Y, Qi R, Lu D, Xiao Q, Yang F, Lu G, Su L. Alterations of regional homogeneity in pediatric bipolar depression: a resting-state fMRI study. BMC Psychiatry 2014; 14:222. [PMID: 25095790 PMCID: PMC4149208 DOI: 10.1186/s12888-014-0222-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/23/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) has attracted increasing attentions due to its high prevalence and great influence on social functions of children and adolescents. However, the pathophysiology underlying PBD remains unclear. In the present study, the resting-state functional magnetic resonance imaging (fMRI) was used to detect abnormalities of baseline brain functions in depressed PBD youth. METHODS Seventeen youth with PBD-depression aged 10 - 18 years old and 18 age- and sex-matched normal controls were recruited in this study. The fMRI data under resting state were obtained on a Siemens 3.0 Tesla scanner and were analyzed using the regional homogeneity (ReHo) method. Correlations between the ReHo values of each survived area and the severity of depression symptoms in patients were further analyzed. RESULTS As compared with the control group, PBD-depression patients showed decreased ReHo in the medial frontal gyrus, bilateral middle frontal gyrus and middle temporal gyrus, and the right putamen. Significant negative correlations of the mood and feelings questionnaire scores with mean ReHo values in the medial frontal gyrus and the right middle frontal gyrus in PBD-depression patients were observed. CONCLUSION Our results suggest that extensive regions with altered baseline brain activities are existed in PBD-depression and these brain regions mainly locate in the fronto-limbic circuit and associated striatal structures. Moreover, the present findings also add to our understanding that there could be unique neuropathophysiological mechanisms underlying PBD-depression.
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Affiliation(s)
- Weijia Gao
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No. 139 Renmin Road, Changsha, 410011 Hunan China ,Department of Child Psychology, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Qing Jiao
- Department of Radiology, Taishan Medical University, Taian, Shandong China
| | - Shaojia Lu
- Department of Mental Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Yuan Zhong
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002 Jiangsu China ,Department of Psychology, Nanjing Normal University, Nanjing, Jiangsu China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002 Jiangsu China
| | - Dali Lu
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No. 139 Renmin Road, Changsha, 410011 Hunan China
| | - Qian Xiao
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No. 139 Renmin Road, Changsha, 410011 Hunan China
| | - Fan Yang
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No. 139 Renmin Road, Changsha, 410011 Hunan China
| | - Guangming Lu
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No, 139 Renmin Road, Changsha 410011, Hunan, China.
| | - Linyan Su
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No. 139 Renmin Road, Changsha, 410011 Hunan China
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Maripuu M, Wikgren M, Karling P, Adolfsson R, Norrback KF. Relative hypo- and hypercortisolism are both associated with depression and lower quality of life in bipolar disorder: a cross-sectional study. PLoS One 2014; 9:e98682. [PMID: 24932586 PMCID: PMC4059634 DOI: 10.1371/journal.pone.0098682] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/06/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depression in unipolar and bipolar disorders is associated with hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity. Also, unipolar disorder has recently been shown to exhibit HPA-axis hypoactivity. We studied for the first time how HPA-axis hypo- and hyperactivity relate to depression and disease burden in bipolar disorder. We were interested in studying hypocortisolism; characterized by increased HPA-axis negative feedback sensitivity and lower basal cortisol levels together with the opposite HPA-axis regulatory pattern of hypercortisolism. METHODS This cross-sectional study includes 145 type 1 and 2 bipolar outpatients and 145 matched controls. A dexamethasone-suppression-test (DST) measures the negative feedback sensitivity and a weight-adjusted very-low-dose DST was employed, which is sensitive in identifying hypocortisolism and hypercortisolism. The 25th and 75th percentiles of control post-DST values were used as cut-offs identifying patients exhibiting relative hypo-, and hypercortisolism. Self-report questionnaires were employed: Beck-Depression-Inventory (BDI), Montgomery-Åsberg-Depression-Rating-Scale (MADRS-S), World-Health-Organization-Quality-of-Life-Assessment-100 and Global-Assessment-of-Functioning. RESULTS Patients exhibiting relative hypocortisolism expectedly exhibited lowered basal cortisol levels (p = 0.046). Patients exhibiting relative hypercortisolism expectedly exhibited elevated basal levels (p<0.001). Patients exhibiting relative hypocortisolism showed 1.9-2.0 (BDI, p = 0.017, MADRS-S, p = 0.37) and 6.0 (p<0.001) times increased frequencies of depression and low overall life quality compared with patients exhibiting mid post-DST values (eucortisolism). Adjusted Odds Ratios (OR:s) for depression ranged from 3.8-4.1 (BDI, p = 0.006, MADRS-S, p = 0.011) and was 23.4 (p<0.001) for life quality. Patients exhibiting relative hypercortisolism showed 1.9-2.4 (BDI, p = 0.017, MADRS-S, p = 0.003) and 4.7 (p<0.001) times higher frequencies of depression and low overall life quality compared with patients exhibiting eucortisolism. Adjusted OR:s for depression ranged from 2.2-2.7 (BDI, p = 0.068, MADRS-S, p = 0.045) and was 6.3 (p = 0.008) for life quality. LIMITATIONS The cross-sectional design and lack of pre-established reference values of the DST employed. CONCLUSIONS Relative hypocortisolism and relative hypercortisolism were associated with depression and lower life quality, providing novel insights into the detrimental role of stress in bipolar disorder.
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Affiliation(s)
- Martin Maripuu
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
- * E-mail:
| | - Mikael Wikgren
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rolf Adolfsson
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Karl-Fredrik Norrback
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Mosolov S, Ushkalova A, Kostukova E, Shafarenko A, Alfimov P, Kostyukova A, Angst J. Bipolar II disorder in patients with a current diagnosis of recurrent depression. Bipolar Disord 2014; 16:389-99. [PMID: 24580856 DOI: 10.1111/bdi.12192] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The prevalence of bipolar II disorder (BD-II) in Russia has never been studied. Therefore, we sought to identify patients meeting diagnostic criteria for BD-II among patients with a current diagnosis of recurrent depressive disorder (RDD) through the use of the Russian versions of the Hypomania Checklist (HCL-32) and Bipolarity Index scales for differentiating between BD-II and RDD. METHODS In a non-interventional diagnostic study, we selected 409 patients aged between 18 and 65 years from two medical settings with (i) a current diagnosis of RDD, (ii) an illness duration of at least three years, and (iii) at least two affective episodes. The diagnosis was based on clinical assessment and confirmed by the Russian version of the Mini International Neuropsychiatric Interview. All patients were assessed by the HCL-32, the Bipolarity Index, and the Personal and Social Performance Scale. RESULTS Among patients with a current diagnosis of RDD, 40.8% had a diagnosis of bipolar disorder (bipolar I disorder: 4.9%; BD-II: 35.9%). The average time lag from onset to a correct diagnosis of BD-II was 15 years and patients were treated only with antidepressants. The sensitivity of the Russian version of the HCL-32 at the optimal cutoff point (≥14.0) was 83.7%, and its specificity was 71.9%. The Bipolarity Index showed significant differences between the total scores of the patients with BD-II and RDD (31.8 versus 20.2; p < 0.0001). The optimal threshold was ≥22.0 (sensitivity 73.5%; specificity 72.3%). CONCLUSIONS In Russia, diagnostic errors are an important cause of the non-detection of bipolar disorder, particularly BD-II. The Russian version of the HCL-32 and the Bipolarity Index, as additional tools, could be useful for bipolarity screening.
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Affiliation(s)
- Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
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Carvalho AF, Nunes-Neto PR, Castelo MS, Macêdo DS, Dimellis D, Soeiro-de-Souza MG, Soczynska JK, McIntyre RS, Hyphantis TN, Fountoulakis KN. Screening for bipolar depression in family medicine practices: prevalence and clinical correlates. J Affect Disord 2014; 162:120-7. [PMID: 24767016 DOI: 10.1016/j.jad.2014.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/15/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning. METHODS In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire. RESULTS The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression. LIMITATIONS The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed. CONCLUSIONS Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
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Affiliation(s)
- André F Carvalho
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil.
| | - Paulo R Nunes-Neto
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Milena S Castelo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil
| | - Danielle S Macêdo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Dimos Dimellis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Márcio G Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of Sao Paulo (IPq-HC-FMUSP), Brazil
| | - Joanna K Soczynska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Thomas N Hyphantis
- Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pan PY, Lee MS, Lo MC, Yang EL, Yeh CB. Olanzapine is superior to lamotrigine in the prevention of bipolar depression: a naturalistic observational study. BMC Psychiatry 2014; 14:145. [PMID: 24885966 PMCID: PMC4035822 DOI: 10.1186/1471-244x-14-145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/15/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bipolar disorder is a highly recurrent disease and has great impact on the function of patients. Depressive symptoms consist of more than 50% of life time during the illness and may lead to self harm or suicidal behaviors. Little is known about the antidepressant effects of olanzapine, an atypical antipsychotic, as monotherapy despite its indication for preventing manic episodes. In contrast, lamotrigine, a mood stabilizer, has been proven to be effective in preventing depression in patients with bipolar disorder. However, no studies have compared the efficacy between lamotrigine and olanzapine in the maintenance treatment of bipolar disorder. This enriched naturalistic study was implemented to assess the effectiveness of olanzapine and lamotrigine as monotherapy in the prevention of recurrence of bipolar disorder. METHODS Patients with bipolar disorder in a euthymic state (Young's Mania Rating Scale (YMRS) score <12, and 21-item Hamilton Depression Rating Scale (HAM-D) score <7) for at least two months, having already received either olanzapine or lamotrigine as the maintenance treatment were recruited. The patients maintained with olanzapine (n = 22) were applied to olanzapine group whereas those maintained with lamotrigine (n = 29) were applied to lamotrigine group. They were followed up for 12 months. Differences in the efficacy between olanzapine and lamotrigine in recurrence prevention were analyzed. The Kaplan-Meier method was used to generate time-to-recurrence curves, and differences between the two groups were compared using the log-rank test. RESULTS Olanzapine had a significantly lower recurrence rate of depressive episodes than lamotrigine (20.0% vs. 57.7%, χ2 = 6.62, p = .010). However, olanzapine and lamotrigine had similar mania (15.0% vs. 0%, χ2 = 4.17, p = .075, Fisher's exact test) and any mood episode (35.0% vs. 57.7%, χ2 = 2.33, p = .127) recurrence rates. Olanzapine was significantly superior to lamotrigine in the time to recurrence of depressive episodes (χ2 = 4.55, df = 1, p = .033), but there was no difference in the time to recurrence of any mood episode (χ2 = 1.68, df = 1, p = .195). CONCLUSIONS This prospective naturalistic study suggests that olanzapine is more effective than lamotrigine in the prevention of depressive episodes in patients with bipolar disorder. Future large-scale randomized studies are warranted to validate our results. TRIAL REGISTRATION ClinicalTrials.gov ID NCT01864551.
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Affiliation(s)
- Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei 114, Taiwan, R.O.C
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, No.161, Min-quan E. Road, Sec. 6, Nei-Hu District, Taipei 114, Taiwan, R.O.C
| | - Miao-Chi Lo
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei 114, Taiwan, R.O.C
| | - En-Lin Yang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei 114, Taiwan, R.O.C
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No, 325, Cheng-Kung Road, Sec, 2, Nei-Hu District, Taipei 114, Taiwan, R,O,C.
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Born C, Amann BL, Grunze H, Post RM, Schärer L. Saving time and money: a validation of the self ratings on the prospective NIMH Life-Chart Method (NIMH-LCM). BMC Psychiatry 2014; 14:130. [PMID: 24886463 PMCID: PMC4031162 DOI: 10.1186/1471-244x-14-130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/02/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Careful observation of the longitudinal course of bipolar disorders is pivotal to finding optimal treatments and improving outcome. A useful tool is the daily prospective Life-Chart Method, developed by the National Institute of Mental Health. However, it remains unclear whether the patient version is as valid as the clinician version. METHODS We compared the patient-rated version of the Lifechart (LC-self) with the Young-Mania-Rating Scale (YMRS), Inventory of Depressive Symptoms-Clinician version (IDS-C), and Clinical Global Impression-Bipolar version (CGI-BP) in 108 bipolar I and II patients who participated in the Naturalistic Follow-up Study (NFS) of the German centres of the Bipolar Collaborative Network (BCN; formerly Stanley Foundation Bipolar Network). For statistical evaluation, levels of severity of mood states on the Lifechart were transformed numerically and comparison with affective scales was performed using chi-square and t tests. For testing correlations Pearson´s coefficient was calculated. RESULTS Ratings for depression of LC-self and total scores of IDS-C were found to be highly correlated (Pearson coefficient r = -.718; p < .001), whilst the correlation of ratings for mania with YMRS compared to LC-self were slightly less robust (Pearson coefficient r = .491; p = .001). These results were confirmed by good correlations between the CGI-BP IA (mania), IB (depression) and IC (overall mood state) and the LC-self ratings (Pearson coefficient r = .488, r = .721 and r = .65, respectively; all p < .001). CONCLUSIONS The LC-self shows a significant correlation and good concordance with standard cross sectional affective rating scales, suggesting that the LC-self is a valid and time and money saving alternative to the clinician-rated version which should be incorporated in future clinical research in bipolar disorder. Generalizability of the results is limited by the selection of highly motivated patients in specialized bipolar centres and by the open design of the study.
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Affiliation(s)
- Christoph Born
- Department of Psychiatry, Ludwig Maximilians-University, Nußbaumstr. 7, Munich 80336, Germany
| | - Benedikt L Amann
- FIDMAG Research Foundation Germanes Hospitalàries, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Heinz Grunze
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | | | - Lars Schärer
- Department of Psychiatry, Albert Ludwig-University, Freiburg, Germany
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Powell TR, McGuffin P, D'Souza UM, Cohen-Woods S, Hosang GM, Martin C, Matthews K, Day RK, Farmer AE, Tansey KE, Schalkwyk LC. Putative transcriptomic biomarkers in the inflammatory cytokine pathway differentiate major depressive disorder patients from control subjects and bipolar disorder patients. PLoS One 2014; 9:e91076. [PMID: 24618828 PMCID: PMC3949789 DOI: 10.1371/journal.pone.0091076] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/06/2014] [Indexed: 12/12/2022] Open
Abstract
Mood disorders consist of two etiologically related, but distinctly treated illnesses, major depressive disorder (MDD) and bipolar disorder (BPD). These disorders share similarities in their clinical presentation, and thus show high rates of misdiagnosis. Recent research has revealed significant transcriptional differences within the inflammatory cytokine pathway between MDD patients and controls, and between BPD patients and controls, suggesting this pathway may possess important biomarker properties. This exploratory study attempts to identify disorder-specific transcriptional biomarkers within the inflammatory cytokine pathway, which can distinguish between control subjects, MDD patients and BPD patients. This is achieved using RNA extracted from subject blood and applying synthesized complementary DNA to quantitative PCR arrays containing primers for 87 inflammation-related genes. Initially, we use ANOVA to test for transcriptional differences in a 'discovery cohort' (total n = 90) and then we use t-tests to assess the reliability of any identified transcriptional differences in a 'validation cohort' (total n = 35). The two most robust and reliable biomarkers identified across both the discovery and validation cohort were Chemokine (C-C motif) ligand 24 (CCL24) which was consistently transcribed higher amongst MDD patients relative to controls and BPD patients, and C-C chemokine receptor type 6 (CCR6) which was consistently more lowly transcribed amongst MDD patients relative to controls. Results detailed here provide preliminary evidence that transcriptional measures within inflammation-related genes might be useful in aiding clinical diagnostic decision-making processes. Future research should aim to replicate findings detailed in this exploratory study in a larger medication-free sample and examine whether identified biomarkers could be used prospectively to aid clinical diagnosis.
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Affiliation(s)
- Timothy R. Powell
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Peter McGuffin
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Ursula M. D'Souza
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Sarah Cohen-Woods
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Georgina M. Hosang
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Charlotte Martin
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Keith Matthews
- Division of Neuroscience, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Richard K. Day
- Division of Neuroscience, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Anne E. Farmer
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Katherine E. Tansey
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Leonard C. Schalkwyk
- King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
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Stephen Rich J, Martin PR. Co-occurring psychiatric disorders and alcoholism. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:573-588. [PMID: 25307597 DOI: 10.1016/b978-0-444-62619-6.00033-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Alcohol use disorder (AUD), a term that comprises both alcohol abuse and alcohol dependence, is a highly prevalent psychiatric disorder. Over 50% of treated AUD patients also suffer from other psychiatric disorder(s). Detailed study has revealed disorders across multiple psychiatric domains with rates of co-occurrence far greater than chance, suggesting a synergistic relationship. The basis of this synergy is explored along with its multiple forms, including behavioral and neurobiologic. Specific topics include the predisposition to both AUD and co-occurring psychopathology, the vulnerability to environmental risk factors that exacerbate these predispositions, and the nature of reinforcement in acute intoxication. Co-occurrence can also modify and exacerbate the neuroadaptations underpinning chronic dependence and relapse, the manifestations of acute and protracted withdrawal, emergence of medical and psychiatric complications, and ultimately the potential for relapse. The outcomes of co-occurrence as well as the unique impact it has on proper treatment are also discussed. Throughout, the significance of recognizing co-occurrence is emphasized since, both neurobiologically and clinically, the synergies between co-occurring disorders yield a result far more complex than a mere sum of the component disorders.
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Affiliation(s)
- J Stephen Rich
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter R Martin
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.
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Llorca PM, Camus V, Courtet P, Gourion D, Lukasiewicz M, Coulomb S. [Current status and management of patients with bipolar disorder in France: the MONTRA survey]. Encephale 2013; 39:212-23. [PMID: 23726753 DOI: 10.1016/j.encep.2013.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The objectives were to assess the characteristics of patients with bipolar disorder (BD) and to evaluate the prescribing practices. METHODS MONTRA is a quantitative survey conducted between December 2010 and February 2011. Data were extracted by the psychiatrists from the medical files of BD patients seen on four consecutive days of consulting. RESULTS Four hundred and thirty-nine psychiatrists included 2529 patients (inpatients, n=319; outpatients from mental clinics, n=1090; outpatients consulting in private practice, n=1020). In the total patient population (mean age: 47 years; women, 58%), BD was distributed as follows: BD type I, 56%; BD type II, 40%; other types of BD, 4%; rapid cyclers, 10%. The prevalence of psychiatric comorbidities was high (anxiety disorders, 48%; abuse and dependence on toxic substances, 17 and 10% respectively), 36% of the patients had a history of suicide attempt and the risk of suicide, when assessed, was 6%. In about half the patients (48%), the polarity of the initial bipolar episode was of the depressive type (versus 39% for the manic/hypomanic type). Outpatients were globally independent and did not require assistance in the management of their disease or its treatment whereas the social and professional lives of inpatients were negatively affected by their condition. Based on the psychiatrist's declarations, 39 to 50% of the outpatients were symptom-free, 36 to 40% were in the intercurrent phase with residual symptoms, 11 to 17% presented either a manic or depressive acute BP episode, and 3 to 4% were in a mixed state; among inpatients, 52% presented an acute episode either manic or depressive, 38% were in the intercurrent phase and 9% were in a mixed state. In the symptomatic patients from the total population (61%), the most prevalent symptoms were depressive and corresponded to acute symptoms (patients with a depressive episode, 14%) or residual symptoms (patients in the intercurrent phase, 27%). The predominant depressive polarity was observed in both hospitalized and outpatients. The pharmacological treatment of BD included polytherapy in 73% of the patients. In the manic episodes (n=126), the patients were treated with a Mood Stabilizer (MS, 56%) or an atypical antipsychotic (AAP, 52%) in association. In the depressive episodes (n=342), the patients received an antidepressant drug associated with a MS or an AAP (70%). In symptom-free or symptomatic intercurrent periods (n=1943), the patients were treated with a MS (49-58%) or an AAP (37-49%), in association. CONCLUSION BD patients evaluated in our survey were in majority diagnosed with BD type I, associated with considerable comorbidity. In the symptomatic patients, the most prevalent symptoms, either acute or residual, were of the depressive type. In the majority of the patients, whatever the clinical status, polytherapy was prescribed for the BD.
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Affiliation(s)
- P-M Llorca
- Service de psychiatrie B, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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Schoeyen HK, Melle I, Sundet K, Aminoff SR, Hellvin T, Auestad BH, Morken G, Andreassen OA. Occupational outcome in bipolar disorder is not predicted by premorbid functioning and intelligence. Bipolar Disord 2013; 15:294-305. [PMID: 23527993 DOI: 10.1111/bdi.12056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 01/23/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Bipolar disorder (BD), over the long term, can manifest a variety of outcomes depending on a number of different conditions. There is a need for further knowledge regarding preventive factors as well as predictors of the disabling course of the disorder. Studies regarding the impact on functional outcome of premorbid and current general intellectual function [intelligence quotient (IQ)] and premorbid functioning in BD patients are sparse. The present study addressed the role of premorbid functioning [assessed with the Premorbid Adjustment Scale (PAS)], intelligence, course of illness, and sociodemographics on occupational outcome in BD. METHODS Bipolar disorder patients were recruited consecutively from psychiatric units (outpatient and inpatient) in four major hospitals in Oslo, Norway [(N = 226: 64.4% bipolar I disorder (BD-I); 30.1% bipolar II disorder (BD-II); 5.5% bipolar disorder not otherwise specified (BD-NOS); 38.6% males]. The associations between current IQ, premorbid IQ [assessed using the National Adult Reading Test (NART)], PAS, clinical and sociodemographic characteristics, and receipt of disability benefit were analysed using descriptive statistics and logistic regression analyses. RESULTS The number of hospitalizations for depressive episodes and illness duration was associated with a higher risk of receipt of disability benefit. PAS, premorbid and current IQ, as well as decline in IQ, did not explain the higher risk of receipt of disability benefits. CONCLUSIONS Severe clinical course of BD was associated with receipt of disability benefit. Occupational outcome was unrelated to PAS, premorbid and current IQ, as well as decline in IQ. This suggests that the persistence of severe clinical symptoms, rather than global cognitive functioning, determines occupational outcome in BD and emphasizes the protective potential of early and continuous clinical treatment.
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Affiliation(s)
- Helle K Schoeyen
- Moodnet Research Group, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
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Silva MT, Zimmermann IR, Galvao TF, Pereira MG. Olanzapine plus fluoxetine for bipolar disorder: a systematic review and meta-analysis. J Affect Disord 2013; 146:310-8. [PMID: 23218251 DOI: 10.1016/j.jad.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/28/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Olanzapine plus fluoxetine combination (OFC) is one of the current approaches for treating the depressive phase of bipolar disorder. Our objective was to synthesize the evidence on the efficacy of OFC therapy in bipolar depressed patients. METHODS We searched for randomized controlled trials (RCTs) on MEDLINE, Embase and other databases. Independent researchers selected the studies and extracted the data. The GRADE approach was used to assess the quality of the evidence. The Mantel-Haenszel random effect model was used to perform the meta-analyses. RESULTS From 627 unique records retrieved, four RCTs were included (1330 patients). OFC improved the response compared to olanzapine (relative risk [RR]=1.58; 95% confidence interval [95% CI]: 1.27, 1.97) and to placebo (RR=1.99; 95% CI: 1.49, 2.65) but not to lamotrigine (low-quality evidence). Similar results were found for remission and relapse rates. No differences were identified for levels of depression and mania symptoms (low-quality evidence) and incidence of mania (moderate-quality evidence). Adverse effects were more common in patients treated with OFC than in those treated with lamotrigine (RR=1.13; 95% CI: 1.04, 1.23), but no difference was found relative to the patients treated with olanzapine (low-quality evidence). LIMITATIONS Despite the totality of the evidence included, there are few RCTs available regarding the efficacy of OFC therapy for bipolar depression. The risk of attrition and reporting bias is also a concern. CONCLUSIONS OFC therapy improved the response, remission, and relapse rates among other outcomes. However, a worse profile of adverse reactions was observed in some comparisons. These data clarify the therapeutic use of OFC as an option to olanzapine in bipolar depression. The quality of the evidence could be improved by additional comparisons and higher rates of treatment adherence.
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43
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da Silva J, Gonçalves-Pereira M, Xavier M, Mukaetova-Ladinska EB. Affective disorders and risk of developing dementia: systematic review. Br J Psychiatry 2013; 202:177-86. [PMID: 23457181 DOI: 10.1192/bjp.bp.111.101931] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Affective disorders are associated with cognitive disturbances but their role as risk factors for dementia is still not fully investigated. AIMS To evaluate the risk of developing dementia in individuals with a history of affective disorder. METHOD We conducted a systematic review of case-control and cohort studies addressing the risk of developing dementia in people with affective disorders. To the best of our knowledge, this is the first systematic review that has included studies evaluating this risk specifically in people with bipolar disorder. RESULTS Fifty-one studies were included. Most of the studies found an increased risk for developing dementia in individuals with depression. Greater frequency and severity of depressive episodes seem to increase this risk. The evidence is contradictory regarding whether there is a difference in risk in people with early- or late-onset depression. The few available risk estimates for dementia in people with bipolar disorder suggest an even higher risk than for those with depression. CONCLUSIONS Affective disorders appear to be associated with an increased risk of developing dementia, and one that is dependent on clinical and demographic variables. Depression may be both a prodrome and a risk factor for dementia. Future research should aim to elucidate the mechanisms that mediate these links.
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Affiliation(s)
- Joaquim da Silva
- Department of Mental Health and CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, FCM, UNL, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal.
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Bersani FS, Girardi N, Sanna L, Mazzarini L, Santucci C, Kotzalidis GD, Sani G, De Rossi P, Raccah RN, Caltagirone SS, Battipaglia M, Capezzuto S, Bersani G, Girardi P. Deep transcranial magnetic stimulation for treatment-resistant bipolar depression: a case report of acute and maintenance efficacy. Neurocase 2013; 19:451-7. [PMID: 22827578 DOI: 10.1080/13554794.2012.690429] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Deep Transcranial Magnetic Stimulation (dTMS) is currently being evaluated as a possible treatment for several neuropsychiatric disorders and has been demonstrated as a safe and effective procedure. This case presents a patient with bipolar depression that has been treated with 20 daily consecutive dTMS sessions and with one dTMS session every 2 weeks for the following 3 months. Depressive symptoms improved rapidly and response was maintained during the next 6 months; cognitive performances also improved. This report suggests that add-on dTMS may help overcoming drug-resistance in bipolar depression and protect from subsequent bipolar episodes of any polarity.
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Hunt JI, Case BG, Birmaher B, Stout RL, Dickstein DP, Yen S, Goldstein TR, Goldstein BI, Axelson DA, Hower H, Strober M, Ryan N, Swenson L, Topor DR, Gill MK, Weinstock LM, Keller MB. Irritability and elation in a large bipolar youth sample: relative symptom severity and clinical outcomes over 4 years. J Clin Psychiatry 2013; 74:e110-7. [PMID: 23419232 PMCID: PMC3600607 DOI: 10.4088/jcp.12m07874] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess whether relative severity of irritability symptoms versus elation symptoms in mania is stable and predicts subsequent illness course in youth with DSM-IV bipolar I or II disorder or operationally defined bipolar disorder not otherwise specified. METHOD Investigators used the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children to assess the most severe lifetime manic episode in bipolar youth aged 7-17 years who were recruited from 2000 to 2006 as part of the Course and Outcomes of Bipolar Youth prospective cohort study (N = 361), conducted at university-affiliated mental health clinics. Subjects with at least 4 years of follow-up (N = 309) were categorized as irritable-only (n = 30), elated-only (n = 42), or both irritable and elated (n = 237) at baseline. Stability of this categorization over follow-up was the primary outcome. The course of mood symptoms and episodes, risk of suicide attempt, and functioning over follow-up were also compared between baseline groups. RESULTS Most subjects experienced both irritability and elation during follow-up, and agreement between baseline and follow-up group assignment did not exceed that expected by chance (κ = 0.03; 95% CI, -0.06 to 0.12). Elated-only subjects were most likely to report the absence of both irritability and elation symptoms at every follow-up assessment (35.7%, versus 26.7% of irritable-only subjects and 16.9% of those with both irritability and elation; P = .01). Baseline groups experienced mania or hypomania for a similar proportion of the follow-up period, but irritable-only subjects experienced depression for a greater proportion of the follow-up period than did subjects who were both irritable and elated (53.9% versus 39.7%, respectively; P = .01). The groups did not otherwise differ by course of mood episode duration, polarity, bipolar diagnostic type, suicide attempt risk, or functional impairment. CONCLUSIONS Most bipolar youth eventually experienced both irritability and elation irrespective of history. Irritable-only youth were at similar risk for mania but at greater risk for depression compared with elated-only youth and youth who had both irritability and elation symptoms.
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Yang HC, Xiang YT, Liu TB, Han R, Wang G, Hu C, Li LJ, Wang XP, Peng HJ, Si TM, Fang YR, Yuan CM, Lu Z, Hu J, Chen ZY, Huang Y, Sun J, Li HC, Zhang JB, Angst J. Hypomanic symptoms assessed by the HCL-32 in patients with major depressive disorder: a multicenter trial across China. J Affect Disord 2012; 143:203-7. [PMID: 22840613 DOI: 10.1016/j.jad.2012.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/03/2012] [Accepted: 06/03/2012] [Indexed: 11/15/2022]
Abstract
AIM To investigate the results of the Hypomania Checklist-32 (HCL-32) administered as a screening instrument in clinical settings to mood disorders patients in the depressive phase. METHODS A total of 1487 patients diagnosed and being treated for major depressive disorder (MDD) in 13 mental health centers across China were self-rated by the HCL-32 and independently examined by the Mini International Neuropsychiatric Interview (MINI). RESULTS After examination by the MINI, 309 (20.8%) of the 1487 patients clinically diagnosed as having MDD satisfied DSM-IV criteria for bipolar disorder (BD): 118 (7.9%) for bipolar I disorder (BD-I) and 191 (12.8%) for bipolar II disorder (BD-II). The mean HCL-32 score of the BD patients was statistically higher than that of patients with unipolar depression (UD, major depressive disorder), BD-II higher than UD, while no significant difference between BD-I and BD-II. The HCL-32 distinguished between BD and UD (best cutoff score 14), between BD-II and UD (best cutoff 12). At the optimum cutoff of 12 between BD and UD, the sensitivity was 0.86, specificity 0.69. LIMITATIONS No standardized instruments were used to measure the severity of depressive symptoms. Depressed patients with a previous history of BD were excluded from this study. CONCLUSIONS The HCL-32 results in this multicenter study of patients in the depressive phase were similar to those of earlier, generally smaller-scale studies which subjects could be in any mood phases. A score of 12 could be used as the optimum cutoff between BD and UD to improve screening for BD-II if the HCL-32 was applied in clinical settings in China.
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Affiliation(s)
- Hai-Chen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Guangdong province, China
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Abstract
The effective treatment of depression in people with bipolar disorder remains a clinical challenge. The role of antidepressant medication in treating bipolar depression has been controversial. While early studies and meta-analyses supported a role for antidepressant medication, more recent, high quality randomized controlled trials in bipolar depression have generally not demonstrated efficacy for antidepressant medications. Although the risk of affective switch and long-term de-stabilization remains a concern when using antidepressant medications in bipolar disorder, the magnitude of this risk has been difficult to ascertain with confidence. Maintenance use of antidepressant medication has generally not demonstrated a favorable risk-benefit ratio. Future studies should explore the patient characteristics and response patterns that predict a more favorable response profile to antidepressants amongst patients with bipolar disorder so that the medications can be rationally used in those who are most likely to benefit.
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Affiliation(s)
- Michelle M Sidor
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Lu RB, Chen SL, Lee SY, Chang YH, Chen SH, Chu CH, Tzeng NS, Lee IH, Chen PS, Yeh TL, Huang SY, Yang YK, Hong JS. Neuroprotective and neurogenesis agent for treating bipolar II disorder: add-on memantine to mood stabilizer works. Med Hypotheses 2012; 79:280-3. [PMID: 22677298 PMCID: PMC3622707 DOI: 10.1016/j.mehy.2012.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/18/2012] [Accepted: 04/27/2012] [Indexed: 12/29/2022]
Abstract
Bipolar disorder, characterized by a dysregulation of mood, impulsivity, risky behavior and interpersonal problems, is a recurrent and often becomes chronic psychiatric illness. However, bipolar subtypes are not often recognized in psychiatric settings, especially bipolar II subtype, until Akiskal and Angst made clear definition to bipolar I (BP-I) and bipolar II (BP-II) disorder in 1999. More and more studies, not only on family inheritance, diagnosis, but also on disease process have been reported that BP-I and BP-II are two different disorders with distinct pathological mechanisms. In general, patients with BP-II express less symptoms and have shorter hypomania stages than BP-I. According to a longitudinal research, patients with BP-II have poor recovery than do BP-I patients. Memantine used to be recognized as a noncompetitive N-methyl-d-aspartate receptor antagonist. However, it was found to have neuroprotective and neurogenesis effect in several neurodegenerative diseases in the past years. We found that memantine could inhibit brain inflammatory response through its action on neuroglial cells and provide neurotrophic effect. The above evidences of benefit on auto-immune system with memantine would support that memantine as add-on therapy to valproate might be more effective than valproate alone on improvement of the neuron degeneration in bipolar disorders. Review articles indicate that not only the mood stabilizers provide with good neuroprotection, but the memantine also have conspicuous anti-autoimmune and neurogenesis effect. Therefore, we propose that drugs with neuroprotective effect and neurotrophic effect may treat neurodegenerative diseases including BP-II. The combination treatment of mood stabilizers memantine may not only augment and improve the remedy for bipolar disorders, but also repair the damaged neurons and neurogenesis through activation of astroglial cell and release of neurotrophic factors.
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Affiliation(s)
- Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
- Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
| | - Shiou-Lan Chen
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Sheng-Yu Lee
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Yun-Hsuan Chang
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
| | - Shih-Heng Chen
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Chun-Hsieh Chu
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | | | - I Hui Lee
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Po See Chen
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Tzung Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, NIEHS/NIH, USA
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
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Subthreshold symptoms in bipolar disorder: impact on neurocognition, quality of life and disability. J Affect Disord 2012; 136:650-9. [PMID: 22051075 DOI: 10.1016/j.jad.2011.10.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 10/08/2011] [Accepted: 10/08/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To provide empirical evidence of the effect of subthreshold symptomatology (both depressive and manic) on psychosocial functioning, neurocognition and quality of life in bipolar disorder. METHODS A total of 133 participants were enrolled for this study (bipolar patients, n=103; healthy controls, n=30). Patients were divided into two groups according to their levels of subthreshold symptomatology: the subsyndromic group was constituted by those patients with upper levels of subthreshold symptomatology (HDRS≥4 and YMRS≥3) and the asymptomatic group represented the patients with lower scores (HDRS≤3 and YMRS≤2). All participants were administered a comprehensive neuropsychological battery. Moreover the patients answered the SF-36 (Quality of Life, QoL) and were interviewed with the WHODAS-2 (Psychosocial functioning and disability). One-way ANOVA were used in order to compare the differences between the three groups. RESULTS The analyses revealed that both patients groups, albeit free of acute symptoms of mania or depression, differed in terms of functioning and disability assessed with the WHODAS-2. Specifically, the total global score of disability was higher for the subsyndromic group indicating more impairment (p=0.008). The same pattern of impairment was found for three of its domains: "understanding and communicating" (p=0.013); "self-care" (p=0.035) and "getting along with others" (p=0.024). The subsyndromic group also scored lower when compared to their counterparts in the Mental Component of QoL of the SF-36 (p=0.045). Finally, in the neuropsychological performance verbal learning and memory was found to be impaired regardless the levels of subthreshold symptomatology, suggesting that this variable is a robust indicator of neuropsychological impairment in BD patients. CONCLUSIONS This report presents empirical data suggesting a moderate impact of subthreshold symptoms on functioning/disability and QoL and a discrete impact on neuropsychological impairment.
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Berk M, Dean O, Cotton SM, Gama CS, Kapczinski F, Fernandes BS, Kohlmann K, Jeavons S, Hewitt K, Allwang C, Cobb H, Bush AI, Schapkaitz I, Dodd S, Malhi GS. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: an open label trial. J Affect Disord 2011; 135:389-94. [PMID: 21719110 DOI: 10.1016/j.jad.2011.06.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Evidence is accumulating to support the presence of redox dysregulation in a number of psychiatric disorders, including bipolar disorder. This dysregulation may be amenable to therapeutic intervention. Glutathione is the predominant non-enzymatic intracellular free radical scavenger in the brain, and the most generic of all endogenous antioxidants in terms of action. N-acetylcysteine (NAC) is a glutathione precursor that effectively replenishes brain glutathione. Given the failure of almost all modern trials of antidepressants in bipolar disorder to demonstrate efficacy, and the limited efficacy of mood stabilisers in the depressive phase of the disorder, this is a major unmet need. METHOD This study reports data on the treatment of 149 individuals with moderate depression during the 2 month open label phase of a randomised placebo controlled clinical trial of the efficacy of 1g BID of NAC that examined the use of NAC as a maintenance treatment for bipolar disorder. RESULTS In this trial, the estimated mean baseline Bipolar Depression Rating Scale (BDRS) score was 19.7 (SE=0.8), and the mean BDRS score at the end of the 8 week open label treatment phase was 11.1 (SE=0.8). This reduction was statistically significant (p<0.001). Improvements in functioning and quality of life were similarly evident. CONCLUSION These open label data demonstrate a robust decrement in depression scores with NAC treatment. Large placebo controlled trials of acute bipolar depression are warranted.
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Affiliation(s)
- Michael Berk
- Department of Psychiatry, The University of Melbourne, Parkville, Australia.
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