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Dagnew TM, Tseng CEJ, Yoo CH, Makary MM, Goodheart AE, Striar R, Meyer TN, Rattray AK, Kang L, Wolf KA, Fiedler SA, Tocci D, Shapiro H, Provost S, Sultana E, Liu Y, Ding W, Chen P, Kubicki M, Shen S, Catana C, Zürcher NR, Wey HY, Hooker JM, Weiss RD, Wang C. Toward AI-driven neuroepigenetic imaging biomarker for alcohol use disorder: A proof-of-concept study. iScience 2024; 27:110159. [PMID: 39021792 PMCID: PMC11253155 DOI: 10.1016/j.isci.2024.110159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/13/2024] [Accepted: 05/29/2024] [Indexed: 07/20/2024] Open
Abstract
Alcohol use disorder (AUD) is a disorder of clinical and public health significance requiring novel and improved therapeutic solutions. Both environmental and genetic factors play a significant role in its pathophysiology. However, the underlying epigenetic molecular mechanisms that link the gene-environment interaction in AUD remain largely unknown. In this proof-of-concept study, we showed, for the first time, the neuroepigenetic biomarker capability of non-invasive imaging of class I histone deacetylase (HDAC) epigenetic enzymes in the in vivo brain for classifying AUD patients from healthy controls using a machine learning approach in the context of precision diagnosis. Eleven AUD patients and 16 age- and sex-matched healthy controls completed a simultaneous positron emission tomography-magnetic resonance (PET/MR) scan with the HDAC-binding radiotracer [11C]Martinostat. Our results showed lower HDAC expression in the anterior cingulate region in AUD. Furthermore, by applying a genetic algorithm feature selection, we identified five particular brain regions whose combined [11C]Martinostat relative standard uptake value (SUVR) features could reliably classify AUD vs. controls. We validate their promising classification reliability using a support vector machine classifier. These findings inform the potential of in vivo HDAC imaging biomarkers coupled with machine learning tools in the objective diagnosis and molecular translation of AUD that could complement the current diagnostic and statistical manual of mental disorders (DSM)-based intervention to propel precision medicine forward.
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Affiliation(s)
- Tewodros Mulugeta Dagnew
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chieh-En J. Tseng
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chi-Hyeon Yoo
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Meena M. Makary
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | - Anna E. Goodheart
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Robin Striar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyler N. Meyer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna K. Rattray
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leyi Kang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kendall A. Wolf
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie A. Fiedler
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Darcy Tocci
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Scott Provost
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Eleanor Sultana
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Yan Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Ding
- Department of Computer Science, University of Massachusetts Boston, Boston, MA, USA
| | - Ping Chen
- Department of Engineering, University of Massachusetts Boston, Boston, MA, USA
| | - Marek Kubicki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiqian Shen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole R. Zürcher
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hsiao-Ying Wey
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacob M. Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roger D. Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Changning Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sperry SH, Stromberg AR, Murphy VA, Lasagna CA, McInnis MG, Menkes MW, Yocum AK, Tso IF. Longitudinal Interplay Between Alcohol Use, Mood, and Functioning in Bipolar Spectrum Disorders. JAMA Netw Open 2024; 7:e2415295. [PMID: 38848066 PMCID: PMC11161848 DOI: 10.1001/jamanetworkopen.2024.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/05/2024] [Indexed: 06/10/2024] Open
Abstract
Importance Alcohol use disorder (AUD) is present in nearly half of individuals with bipolar disorder (BD) and is associated with markedly worsening outcomes. Yet, the concurrent treatment of BD and AUD remains neglected in both research and clinical care; characterizing their dynamic interplay is crucial in improving outcomes. Objective To characterize the longitudinal alcohol use patterns in BD and examine the temporal associations among alcohol use, mood, anxiety, and functioning over time. Design, Setting, and Participants This cohort study selected participants and analyzed data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD), an ongoing cohort study that recruits through psychiatric clinics, mental health centers, and community outreach events across Michigan and collects repeated phenotypic data. Participants selected for the present study were those with a diagnosis of BD type I (BDI) or type II (BDII) who had been in the study for at least 5 years. Data used were extracted from February 2006 to April 2022, and follow-up ranged from 5 to 16 years. Main Outcomes and Measures Alcohol use was measured using the Alcohol Use Disorders Identification Test. Depression, mania or hypomania, anxiety, and functioning were measured using the 9-Item Patient Health Questionnaire, the Altman Self-Rating Mania Scale, the 7-item Generalized Anxiety Disorder assessment scale, and the Life Functioning Questionnaire, respectively. Results A total of 584 individuals (386 females (66.1%); mean [SD] age, 40 [13.6] years) were included. These participants had a BDI (445 [76.2%]) or BDII (139 [23.8%]) diagnosis, with or without a lifetime diagnosis of AUD, and a median (IQR) follow-up of 9 (0-16) years. More problematic alcohol use was associated with worse depressive (β = 0.04; 95% credibility interval [CrI], 0.01-0.07) and manic or hypomanic symptoms (β = 0.04; 95% CrI, 0.01-0.07) as well as lower workplace functioning (β = 0.03; 95% CrI, 0.00-0.06) over the next 6 months, but increased depressive and manic or hypomanic symptoms were not associated with greater subsequent alcohol use. These latter 2 associations were more pronounced in BDII than BDI (mania or hypomania: β = 0.16 [95% CrI, 0.02-0.30]; workplace functioning: β = 0.26 [95% CrI, 0.06-0.45]). Alcohol use was not associated with anxiety over time. Conclusions and Relevance This study found that alcohol use, regardless of diagnostic status, was associated with mood instability and poorer work functioning in BD, but increased mood symptoms were not associated with subsequent alcohol use. Given its prevalence and repercussions, dimensional and longitudinal assessment and management of alcohol use are necessary and should be integrated into research and standard treatment of BD.
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Affiliation(s)
- Sarah H. Sperry
- Department of Psychology, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Audrey R. Stromberg
- Department of Psychology, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Carly A. Lasagna
- Department of Psychology, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Margo W. Menkes
- Department of Psychology, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Ivy F. Tso
- Department of Psychiatry, University of Michigan, Ann Arbor
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus
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Davies EL, Puljević C, Winstock AR, Ferris JA. Regrets, I've Had a Few: Exploring Factors Associated with Getting Drunk and Regret in an International Study of People Who Drink Alcohol. Subst Use Misuse 2024; 59:775-784. [PMID: 38229240 DOI: 10.1080/10826084.2024.2302140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Excessive alcohol consumption is often followed by feelings of regret. This study aimed to explore country differences in experiences of drunkenness and regrets and predictors of experiencing a greater number of regrettable drinking occasions. METHODS This study draws on a sample of 82,821 respondents from 31 countries who completed the 2020 Global Drug Survey. Respondents were asked to report how many times in the last year they had been drunk, how many of those times they felt regret afterwards and to complete a range of sociodemographic measures. RESULTS In the last 12 months, the median times drunk was 6 and the median number of regretted occasions was 2. There was an inverse relationship between times drunk and regret. Respondents who got drunk more often regretted it a smaller percentage of the time than those who got drunk less often. Respondents from Argentina and Colombia regretted being drunk the most and Denmark the least. Being younger, in higher AUDIT categories were associated with more times drunk. Being a woman, having mental health conditions were associated with more regretted occasions.Discussion and conclusions: Country variations may reflect relative acceptability of being drunk. Those who drink more, per occasion, may become accustomed to the consequences and feel fewer regrets. Interventions promoting reduced alcohol consumption may benefit from encouraging people to consider their future regret following a drinking occasion but should account for lower levels of regret in those who get drunk more often.
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Affiliation(s)
- Emma L Davies
- Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Cheneal Puljević
- School of Public Health, The University of Queensland, Queensland, Australia
| | - Adam R Winstock
- University College London, London, UK
- Global Drug Survey, London, UK
| | - Jason A Ferris
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
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Renu K, Myakala H, Chakraborty R, Bhattacharya S, Abuwani A, Lokhandwala M, Vellingiri B, Gopalakrishnan AV. Molecular mechanisms of alcohol's effects on the human body: A review and update. J Biochem Mol Toxicol 2023; 37:e23502. [PMID: 37578200 DOI: 10.1002/jbt.23502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Alcohol consumption has been linked to numerous negative health outcomes although it has some beneficial effects on moderate dosages, the most severe of which being alcohol-induced hepatitis. The number of people dying from this liver illness has been shown to climb steadily over time, and its prevalence has been increasing. Researchers have found that alcohol consumption primarily affects the brain, leading to a wide range of neurological and psychological diseases. High-alcohol-consumption addicts not only experienced seizures, but also ataxia, aggression, social anxiety, and variceal hemorrhage that ultimately resulted in death, ascites, and schizophrenia. Drugs treating this liver condition are limited and can cause serious side effects like depression. Serine-threonine kinases, cAMP protein kinases, protein kinase C, ERK, RACK 1, Homer 2, and more have all been observed to have their signaling pathways disrupted by alcohol, and alcohol has also been linked to epigenetic changes. In addition, alcohol consumption induces dysbiosis by changing the composition of the microbiome found in the gastrointestinal tract. Although more studies are needed, those that have been done suggest that probiotics aid in keeping the various microbiota concentrations stable. It has been argued that reducing one's alcohol intake may seem less harmful because excessive drinking is a lifestyle disorder.
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Affiliation(s)
- Kaviyarasi Renu
- Department of Biochemistry, Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Haritha Myakala
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Rituraj Chakraborty
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Sharmishtha Bhattacharya
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Asmita Abuwani
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Mariyam Lokhandwala
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Balachandar Vellingiri
- Department of Zoology, Stem Cell and Regenerative Medicine/Translational Research, School of Basic Sciences, Central University of Punjab (CUPB), Bathinda, Punjab, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
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Mellick WH, Tolliver BK, Brenner HM, Anton RF, Prisciandaro JJ. Alcohol Cue Processing in Co-Occurring Bipolar Disorder and Alcohol Use Disorder. JAMA Psychiatry 2023; 80:1150-1159. [PMID: 37556131 PMCID: PMC10413222 DOI: 10.1001/jamapsychiatry.2023.2726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/04/2023] [Indexed: 08/10/2023]
Abstract
Importance Reward circuitry dysfunction is a candidate mechanism of co-occurring bipolar disorder and alcohol use disorder (BD + AUD) that remains understudied. This functional magnetic resonance imaging (fMRI) research represents the first evaluation of alcohol cue reward processing in BD + AUD. Objective To determine how alcohol cue processing in individuals with BD + AUD may be distinct from that of individuals with AUD or BD alone. Design, Setting, and Participants This cross-sectional case-control study (April 2013-June 2018) followed a 2 × 2 factorial design and included individuals with BD + AUD, AUD alone, BD alone, and healthy controls. A well-validated visual alcohol cue reactivity fMRI paradigm was administered to eligible participants following their demonstration of 1 week or more of abstinence from alcohol and drugs assessed via serial biomarker testing. Study procedures were completed at the Medical University of South Carolina. Analysis took place between June and August 2022. Main Outcomes and Measures Past-week mood symptoms were rated by clinicians using the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. The Alcohol Dependence Scale, Obsessive-Compulsive Drinking Scale, and Barratt Impulsiveness Scale were included questionnaires. Functional MRI whole-brain data were analyzed along with percent signal change within a priori regions of interest located in the ventral striatum, dorsal striatum, and ventromedial prefrontal cortex. Exploratory analyses of associations between cue reactivity and select behavioral correlates (alcohol craving, impulsivity, maximum number of alcohol drinks on a single occasion, and days since last alcohol drink) were also performed. Results Of 112 participants, 28 (25.0%) had BD + AUD, 26 (23.2%) had AUD alone, 31 (27.7%) had BD alone, and 27 (24.1%) were healthy controls. The mean (SD) age was 38.7 (11.6) years, 50 (45.5%) were female, 33 (30%) were smokers, and 37 (34.9%) reported recent alcohol consumption. Whole-brain analyses revealed a BD × AUD interaction (F = 10.64; P = .001; η2 = 0.09) within a cluster spanning portions of the right inferior frontal gyrus and insula. Region of interest analyses revealed a main association of BD (F = 8.02; P = .006; η2 = 0.07) within the dorsal striatum. In each instance, individuals with BD + AUD exhibited reduced activation compared with all other groups who did not significantly differ from one another. These hypoactivations were associated with increased impulsivity and obsessive-compulsive alcohol craving exclusively among individuals with BD + AUD. Conclusion and Relevance The findings of this study suggest conceptualizing reward dysfunction in BD + AUD by the potential interaction between blunted reward responsivity and deficient inhibitory control may help guide treatment development strategies. To this end, reduced right inferior frontal gyrus and insula alcohol cue reactivity represents a novel candidate biomarker of BD + AUD that may respond to pharmacological interventions targeting impulsivity-related neural mechanisms for improved executive control.
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Affiliation(s)
| | - Bryan K. Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Helena M. Brenner
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Raymond F. Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James J. Prisciandaro
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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6
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Petersén E, Augustsson H, Berman AH. Problematic substance use among patients in a Swedish outpatient psychiatry setting: staff and manager perceptions of digital options for increased intervention access. Addict Sci Clin Pract 2023; 18:65. [PMID: 37875999 PMCID: PMC10594773 DOI: 10.1186/s13722-023-00421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Approximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study "digital interventions" comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting. METHOD The study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data. RESULTS Three themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients' technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future. CONCLUSIONS The study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems.
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Affiliation(s)
- Elisabeth Petersén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm, Sweden.
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Pozzolo Pedro MO, Pozzolo Pedro M, Martins SS, Castaldelli-Maia JM. Alcohol use disorders in patients with bipolar disorder: a systematic review and meta-analysis. Int Rev Psychiatry 2023; 35:450-460. [PMID: 38299650 DOI: 10.1080/09540261.2023.2249548] [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: 06/12/2023] [Accepted: 08/14/2023] [Indexed: 02/02/2024]
Abstract
Alcohol consumption has a key role in more than 200 diseases and health injuries, being an important factor for social and public health costs. Studies with clinical populations show an association between alcohol use disorders (AUD) and bipolar disorder. In this meta-analysis we included studies, reports, or summaries identified in Google Scholar, Lilacs, Medline, and MedCaribe that reported original data published up to 31 January 2023. We included cross-sectional and longitudinal observational studies that investigated the prevalence of AUD in patients with bipolar disorder. We calculated the prevalence rates and conducted a meta-analysis using a random effects model. The meta-analysis included 20 unique studies conducted in 12 countries, with a total sample of 32,886 individuals with bipolar disorder, comprising 17,923 women and 13,963 men, all aged 18 years or older. The prevalence of AUD in individuals with bipolar disorder was found to be 29.12%, while the prevalence of Alcohol Dependence (AD) was 15.87% and the prevalence of Alcohol Abuse (AA) was 18.74%. The high prevalence of AUD individuals with bipolar disorder is important because it highlights the need for targeted interventions to prevent and address comorbid conditions, which may improve treatment outcomes, reduce harm, and promote public health.
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Affiliation(s)
| | | | - Silvia S Martins
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - João Maurício Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
- Department of Neuroscience, Medical School, ABC Health University Center, Santo André, Brazil
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Nowakowska-Domagała K, Podlecka M, Stecz P, Lewandowska A, Sipowicz K, Kosmalski M, Pietras T, Mokros Ł. The Relationship between Selected Factors (Temperament, Bipolar Traits, Sleep Quality, Severity of Addiction) and Depressive Symptoms in Alcohol-Dependent Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4072. [PMID: 36901082 PMCID: PMC10001749 DOI: 10.3390/ijerph20054072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/11/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Clinical and epidemiological studies have demonstrated a relationship between alcohol addiction and mood disorders. Alcohol-dependent patients with depression tend to demonstrate clinically more severe manic symptoms, which complicates the process of diagnosis and therapy. However, the predictors indicating the risk of mood disorders in addicted patients remain unclear. The aim of the study was to examine the relationship between personal dispositions, bipolar traits, depth of addiction, quality of sleep, and depressive symptoms in alcohol-dependent men. The study group comprised 70 men (age M = 46.06, SD = 11.29) diagnosed with alcohol addiction. The participants completed a battery of questionnaires: BDI, HCL-32, PSQI, EPQ-R and MAST. The results were tested using Pearson's correlation quotient and general linear model. The findings indicate that some of the studied patients are likely to have mood disorders of clinically significant severity. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in alcohol-dependent patients. Among the components of sleep quality, problems with falling asleep and waking up at night appear to be most strongly associated with depressive symptoms. The intensity of depressive symptoms may relate to the intensity of certain bipolar features, such as risk-taking activity and irritability. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in the studied group.
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Affiliation(s)
- Katarzyna Nowakowska-Domagała
- Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Al. Rodzeństwa Scheiblerów 2, 90-128 Lodz, Poland
| | - Marlena Podlecka
- Institute of Psychiatry and Neurology, Department of Neurosis, Personality and Eating Disorders, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Patryk Stecz
- Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Al. Rodzeństwa Scheiblerów 2, 90-128 Lodz, Poland
| | - Aleksandra Lewandowska
- J. Babiński Specialist Psychiatric Health Care Team, Psychiatric Ward for Children, Aleksandrowska 159, 02-229 Lodz, Poland
| | - Kasper Sipowicz
- Department of Interdisciplinary Disability Studies, The Maria Grzegorzewska University in Warsaw, Szczęśliwicka 40, 02-353 Warsaw, Poland
| | - Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, Kopcinskiego Street 22, 90-153 Lodz, Poland
| | - Tadeusz Pietras
- Institute of Psychiatry and Neurology, Second Department of Psychiatry, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Łukasz Mokros
- Department of Clinical Pharmacology, Medical University of Lodz, Kopcinskiego Street 22, 90-153 Lodz, Poland
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9
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Guillen-Burgos H, Moreno-Lopez S, Acevedo-Vergara K, Pérez-Florez M, Pachón-Garcia C, Gálvez-Flórez JF. Risk of childhood trauma exposure and severity of bipolar disorder in Colombia. Int J Bipolar Disord 2023; 11:7. [PMID: 36763206 PMCID: PMC9918651 DOI: 10.1186/s40345-023-00289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is higher in developing countries. Childhood trauma exposure is a common environmental risk factor in Colombia and might be associated with a more severe course of bipolar disorder in Low-Middle Income-Countries. We carried out the first case-control study in Colombia using a structural clinical interview and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to describe the prevalence and association between trauma exposure during childhood with a severe course of illness (early age onset, rapid cycling, ideation or suicide attempt, or ≥ 3 hospitalization) in a sample of BD patients. RESULTS A total of 114 cases and 191 controls evaluated showed the following results. Cases included 61.4% BD type I and 38.6% BD type II. The median age was 31.5 years (IQR, 75-24) for BD patients and 31 years old (IQR, 38-24) for healthy controls. A higher prevalence of childhood trauma was evidenced in cases compared to controls. Emotional abuse, physical abuse, sexual abuse, physical neglect and emotional neglect evidenced a strong association with severe bipolar disorder (OR = 3.42, p < .001; OR = 4.68, p < .001; OR = 4.30, p = .003; OR = 5.10, p < .001; OR = 5.64, p < .001, respectively). CONCLUSIONS This is the first association study between childhood trauma exposure as a higher risk for a severe course of illness in BD patients in Colombian. Our findings highlight the higher prevalence of childhood trauma in bipolar patients and the strong association of childhood trauma with severe bipolar disorder. These findings are relevant for screening and evaluating childhood trauma exposure during the course of BD patients.
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Affiliation(s)
- Hernán Guillen-Burgos
- Center for Clinical and Translational Research, La Misericordia Clinica Internacional, Barranquilla, Colombia. .,School of Health Science, Universidad Simon Bolivar, Carrera 54 No 64-222, Barranquilla, Colombia. .,Instituto Cardiovascular del Cesar, Valledupar, Colombia.
| | - Sergio Moreno-Lopez
- grid.7247.60000000419370714School of Medicine, Universidad de Los Andes, Bogotá, Colombia ,Otolaryngology and Allergology Research Group, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ‐ORL), Bogotá, Colombia
| | - Kaleb Acevedo-Vergara
- Center for Clinical and Translational Research, La Misericordia Clinica Internacional, Barranquilla, Colombia
| | - Manuel Pérez-Florez
- Center for Clinical and Translational Research, La Misericordia Clinica Internacional, Barranquilla, Colombia
| | - Catherine Pachón-Garcia
- Center for Clinical and Translational Research, La Misericordia Clinica Internacional, Barranquilla, Colombia
| | - Juan Francisco Gálvez-Flórez
- Center for Clinical and Translational Research, La Misericordia Clinica Internacional, Barranquilla, Colombia ,Zerenia Clinics, Bogotá, Colombia ,Latin American Society of Liaison Psychiatry (SOLAPSIQUE), Bogotá, Colombia
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10
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Léda-Rêgo G, Studart-Bottó P, Sarmento S, Cerqueira-Silva T, Bezerra-Filho S, Miranda-Scippa Â. Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01562-5. [PMID: 36725737 DOI: 10.1007/s00406-023-01562-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
The aim was to assess the lifetime prevalence of psychiatric comorbidity (PC) in Brazilian euthymic individuals with bipolar disorder type I, and investigate its effects on clinical outcomes and functioning. A group of 179 outpatients with BD-I in the recuperation phase were assessed, of whom 75 (41.9%) had PC and 104 (58.1%) had not. Both groups were compared using sociodemographic/clinical questionnaire, Structured Clinical Interview for DSM-IV axis I and II, Sheehan Disability and Barratt Impulsiveness Scales. Patients with PC presented less religious affiliation, more history of lifetime psychotic symptoms, rapid cycling, suicide attempts, worse scores of functioning, and higher prevalence of personality disorders. Ordinal logistic regression indicated that PC was associated with increased odds of worse levels of disability. Therefore, it could be observed that patients with BD evaluated only in euthymia presented a high mental disorders comorbidity. Considering their burdensome impact, appropriate management is a challenging reality and a crucial factor in reducing morbidity and mortality associated with BD. Further longitudinal studies on their relationship may broaden interventions to reduce patient's suffering.
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Affiliation(s)
- Gabriela Léda-Rêgo
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil. .,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil.
| | - Paula Studart-Bottó
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil
| | - Stella Sarmento
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil
| | | | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil.,Department of Neurosciences and Mental Health, Medical School, UFBA, Salvador, BA, Brazil
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11
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Kaye AJ, Patel S, Meyers S, Rim D, Choi C, Ahlawat S. Outcomes of Hospitalized Acute Alcoholic Hepatitis (AH) in Patients With Bipolar 1 Disorder (B1D). Cureus 2022; 14:e25418. [PMID: 35774644 PMCID: PMC9236671 DOI: 10.7759/cureus.25418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Alcoholic hepatitis (AH) is a common cause of hospital admissions and is associated with a high mortality rate. AH occurs frequently in patients with heavy alcohol use. Alcohol use disorder (AUD) commonly presents with comorbid psychiatric disorders such as bipolar disorder. Bipolar disorder patients are also known to be at an increased risk for chronic liver diseases. Bipolar 1 disorder (B1D) is often considered the most severe presentation among different types of bipolar disorder. This study assesses the clinical outcomes of patients admitted for AH with concomitant B1D. Methods: Adult patients with AH were identified within the 2014 National Inpatient Sample (NIS) database. International Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 CM) codes were used to select for all of the diagnoses for this study. AH patients were subdivided into those with and without B1D. The outcomes of interest were sepsis, hepatic encephalopathy, acute respiratory failure, acute kidney injury, ischemic stroke, hepatic failure, coagulopathy, and inpatient mortality. A multivariate logistic regression analysis was performed to explore whether B1D is an independent predictor for the outcomes. Results: Among 4,453 patients with AH identified, 166 patients also had B1D. AH patients with comorbid B1D were seen to be younger (42.9 years old vs. 46.2 years old, p < 0.05) and more commonly female (55.4% vs. 36.5%, p < 0.05). The B1D subgroup of AH patients were found to less likely develop acute hepatic failure (adjusted odds ratio (aOR) 0.13, 95% confidence interval (CI): 0.02-0.97, p < 0.05). The adjusted odds ratios for the remaining outcomes were not statistically significant. Conclusions: Our study indicates that B1D may be an independent protective factor against acute hepatic failure in patients hospitalized with AH. This finding can be explained by frequent laboratory monitoring and psychiatric assessments performed by psychiatrists treating B1D patients, as well as the impact B1D has on cortisol release induced by hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis.
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12
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Bloch S, Holleran KM, Kash TL, Vazey EM, Rinker JA, Lebonville CL, O'Hara K, Lopez MF, Jones SR, Grant KA, Becker HC, Mulholland PJ. Assessing negative affect in mice during abstinence from alcohol drinking: Limitations and future challenges. Alcohol 2022; 100:41-56. [PMID: 35181404 PMCID: PMC8983487 DOI: 10.1016/j.alcohol.2022.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023]
Abstract
Alcohol use disorder (AUD) is frequently comorbid with mood disorders, and these co-occurring neuropsychiatric disorders contribute to the development and maintenance of alcohol dependence and relapse. In preclinical models, mice chronically exposed to alcohol display anxiety-like and depressive-like behaviors during acute withdrawal and protracted abstinence. However, in total, results from studies using voluntary alcohol-drinking paradigms show variable behavioral outcomes in assays measuring negative affective behaviors. Thus, the main objective of this review is to summarize the literature on the variability of negative affective behaviors in mice after chronic alcohol exposure. We compare the behavioral phenotypes that emerge during abstinence across different exposure models, including models of alcohol and stress interactions. The complicated outcomes from these studies highlight the difficulties of assessing negative affective behaviors in mouse models designed for the study of AUD. We discuss new behavioral assays, comprehensive platforms, and unbiased machine-learning algorithms as promising approaches to better understand the interaction between alcohol and negative affect in mice. New data-driven approaches in the understanding of mouse behavior hold promise for improving the identification of mechanisms, cell subtypes, and neurocircuits that mediate negative affect. In turn, improving our understanding of the neurobehavioral basis of alcohol-associated negative affect will provide a platform to test hypotheses in mouse models that aim to improve the development of more effective strategies for treating individuals with AUD and co-occurring mood disorders.
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Affiliation(s)
- Solal Bloch
- Department of Neuroscience, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Katherine M Holleran
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
| | - Thomas L Kash
- Bowles Center for Alcohol Studies, Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Elena M Vazey
- Department of Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Jennifer A Rinker
- Department of Neuroscience, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Christina L Lebonville
- Department of Neuroscience, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Krysten O'Hara
- Department of Neuroscience, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Marcelo F Lopez
- Department of Psychiatry & Behavioral Sciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Sara R Jones
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
| | - Kathleen A Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, United States
| | - Howard C Becker
- Department of Psychiatry & Behavioral Sciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Patrick J Mulholland
- Department of Neuroscience, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, United States.
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13
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Menculini G, Steardo L, Verdolini N, Cirimbilli F, Moretti P, Tortorella A. Substance use disorders in bipolar disorders: Clinical correlates and treatment response to mood stabilizers. J Affect Disord 2022; 300:326-333. [PMID: 34990627 DOI: 10.1016/j.jad.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/06/2021] [Accepted: 01/01/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Substance use disorders (SUD) in bipolar disorders (BD) present relevant impact on psychopathological features and illness course. The present study was aimed at analyzing the clinical correlates of this comorbidity. METHODS In- and outpatients suffering from BD were recruited. Socio-demographic and clinical characteristics were collected. Subjects underwent a psychopathological assessment evaluating affective temperaments and impulsiveness. The appraisal of treatment response to mood stabilizers was conducted with the Alda Scale. Bivariate analyses were used to compare subjects suffering from BD with (SUD-BD) or without comorbid SUD (nSUD-BD) (p<0.05). A logistic regression model was performed to identify specific correlates of SUD in BD. RESULTS Among the 161 included subjects, 63 (39.1%) were diagnosed with comorbid SUD. SUD-BD subjects showed younger age at onset (p = 0.003) and higher prevalence of BD type I diagnosis (BDI) (p<0.001). Furthermore, lifetime mixed features (p<0.001), psychotic symptoms (p<0.001), suicide attempts (p = 0.002), aggression (p = 0.003), antidepressant-induced manic switch (p = 0.003), and poor treatment response (p<0.001) were more frequent in the SUD-BD subgroup. At the logistic regression, SUD revealed a positive association with BD type I diagnosis (Odds Ratio (OR) 4.77, 95% CI 1.66-13.71, p = 0.004) and mixed features (OR 2.54, 95% CI 1.17-5.53, p = 0.019). LIMITATIONS The cross-sectional study design and the relatively small sample size may limit the generalizability of the findings. The retrospective evaluation of comorbid SUD could have biased the outcome assessment. CONCLUSIONS Subjects with BD and SUD are characterized by higher clinical severity and require careful assessment of treatment response.
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Affiliation(s)
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Norma Verdolini
- Department of Psychiatry, University of Perugia, Perugia, Italy; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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14
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Bartoli F, Callovini T, Calabrese A, Cioni RM, Riboldi I, Crocamo C, Carrà G. Disentangling the Association between ADHD and Alcohol Use Disorder in Individuals Suffering from Bipolar Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2021; 12:brainsci12010038. [PMID: 35053783 PMCID: PMC8773515 DOI: 10.3390/brainsci12010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Attention Deficit-Hyperactivity disorder (ADHD) may influence rates of Alcohol Use Disorder (AUD) among individuals suffering from Bipolar Disorder (BD). The aim of this systematic review and meta-analysis was to estimate the strength and consistency of the potential association between ADHD and AUD in BD. We searched main electronic databases for studies indexed up to November 2020. We included observational studies investigating the association between ADHD and AUD among individuals with BD. The association between ADHD and AUD was estimated using odds ratios (ORs) with 95% Confidence Intervals (CIs). Eleven studies, involving 2734 individuals with BD (516 with ADHD), were included in the meta-analysis. Individuals with both BD and ADHD had higher rates of AUD as compared with subjects with BD only (34.0% vs. 18.3%). The estimated OR of AUD for ADHD was 2.50 (95% CI: 1.91 to 3.27; I2 = 13.0%). Study-level characteristics did not influence the effect size. No risk of publication bias was estimated. Despite some limitations, this meta-analysis estimated an association between ADHD and AUD among individuals suffering from BD. At least a portion of the high rates of AUD in BD may, thereby, be related to comorbid ADHD. Longitudinal studies are needed to clarify the nature of this relationship.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
- Correspondence: ; Tel.: +39-02-5799-8644
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Riccardo M. Cioni
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; (F.B.); (A.C.); (R.M.C.); (I.R.); (C.C.); (G.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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15
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Davies EL, Puljevic C, Gilchrist G, Potts L, Zhuparris A, Maier LJ, Barratt MJ, Winstock AR, Ferris JA. Impacts of changes in alcohol consumption patterns during the first 2020 COVID-19 restrictions for people with and without mental health and neurodevelopmental conditions: A cross sectional study in 13 countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103563. [PMID: 34952280 PMCID: PMC8692164 DOI: 10.1016/j.drugpo.2021.103563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 02/07/2023]
Abstract
Background The initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and wellbeing of people with and without mental health and neurodevelopmental conditions (MHDCs). Methods Data came from the Global Drug Survey Special Edition on COVID-19 conducted in May-June 2020. Measured were; changes in drinking compared to February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on physical health, mental health, relationships, finances, work/study, and enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%). Results A third (35.3%) of respondents with MHDCs and 17.8% without MHDCs indicated that increased drinking affected their mental health negatively (p<.001); 44.2% of respondents with MHDCS compared to 32.6% without MHDCs said it affected their physical health negatively (p<.001). Reduced drinking was associated with better mental health among a fifth (21.1%) of respondents with MHDCS and 14.4% without MHDCs (p<.001). Age, relationship status, living arrangements, employment, coping and distress were significant predictors of increases in drinking. Conclusion Among people with MHDCS, reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.
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Affiliation(s)
- Emma L Davies
- Centre for Psychological Research, Oxford Brookes University, UK.
| | - Cheneal Puljevic
- Centre for Health Services Research, The University of Queensland, Australia; School of Public Health, The University of Queensland, Australia
| | | | | | | | - Larissa J Maier
- Department of Clinical Pharmacy, University of California, San Francisco, USA
| | - Monica J Barratt
- Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Vic, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia
| | | | - Jason A Ferris
- Centre for Health Services Research, The University of Queensland, Australia
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16
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Szczypiński J, Jakubczyk A, Kopera M, Trucco E, Wojnar M. Impulsivity Scale-12 and its utilization in alcohol use disorder. Drug Alcohol Depend 2021; 225:108809. [PMID: 34175785 PMCID: PMC8311392 DOI: 10.1016/j.drugalcdep.2021.108809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION One of the core symptoms of alcohol use disorder (AUD) is impulsivity. The recently published study on the Impulsivity Scale 12 (IS-12) offers a promising tool to use in clinics working with clients with AUD due to its simplicity. IS-12 includes subscales related tocognitive impulsivity and behavioral impulsivity, which are related to different aspects of AUD symptomatology. The aim of the study was to adapt IS-12 to polish and test its utility in a sample of patients diagnosed with AUD. METHODS Using a Confirmatory Factor Analysis, we compared the two-factor model of the Polish adaptation of the BIS-11 and the IS-12 on a sample of 615 patients diagnosed with AUD. Additionally, we explored the association between the IS-12's cognitive impulsivity and behavioral impulsivity subscales and depressive symptoms, AUD severity, and suicidal ideation using Structural Equation Modeling on a subsample of 450 patients with AUD. RESULTS The IS-12 demonstrated a better model fit and good reliability compared to the BIS-11. Moreover, cognitive impulsivity predicted suicidal ideation, but not AUD severity, while behavioral impulsivity predicted AUD severity, but not suicidal ideation. Both subscales of IS-12 predicted depressive symptoms. CONCLUSION Consistent with prior work, findings indicate that the second-order factor model of the BIS-11 had reliability issues and evidenced poor model fit. In contrast, the IS-12 demonstrated a satisfactory model fit and was predictive of clinical symptomatology. Thus, utilizing an easy tool, such as IS-12, might be beneficial for researchers and clinicians working with patients with AUD.
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Affiliation(s)
- Jan Szczypiński
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland; Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Elisa Trucco
- Department of Psychology and the Center for Children and Families, Florida International University, Miami, FL, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Zimmerman M, Balling C, Chelminski I, Dalrymple K. Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study. Psychol Med 2021; 51:1479-1490. [PMID: 32178744 DOI: 10.1017/s0033291720000215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. METHODS Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). RESULTS Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. CONCLUSIONS Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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18
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Fenger-Grøn M, Vestergaard CH, Ribe AR, Johnsen SP, Frost L, Sandbæk A, Davydow DS. Association Between Bipolar Disorder or Schizophrenia and Oral Anticoagulation Use in Danish Adults With Incident or Prevalent Atrial Fibrillation. JAMA Netw Open 2021; 4:e2110096. [PMID: 33999163 PMCID: PMC8129823 DOI: 10.1001/jamanetworkopen.2021.10096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Individuals with bipolar disorder or schizophrenia have a higher risk of adverse outcomes from cardiovascular diseases. Oral anticoagulation therapy (OAT) for patients with atrial fibrillation (AF) is needed for stroke prevention, but whether patients with bipolar disorder or schizophrenia face disparities in receiving this therapy is unknown. OBJECTIVE To assess whether bipolar disorder or schizophrenia is associated with a lower rate of OAT initiation in patients with incident AF and lower prevalence of OAT in those with prevalent AF. DESIGN, SETTING, AND PARTICIPANTS A nationwide cohort study of Danish patients with AF was conducted from January 1, 2005, to December 31, 2016, and data were analyzed from January 1 to June 15, 2020. Data from national registries included information on all redeemed prescriptions and all hospital contacts of all patients with incident or prevalent AF (age, 18-100 years) and increased risk status, defined by a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) risk score greater than or equal to 2. EXPOSURES Hospital diagnosis of bipolar disorder or schizophrenia. MAIN OUTCOMES AND MEASURES Adjusted proportion differences for OAT initiation and OAT prevalence, comparing individuals with and without bipolar disorder or schizophrenia. RESULTS Patients included with incident AF (n = 147 810) had a mean (SD) age of 76.9 (10.1) years, 78 577 (53.2%) were women, 1208 (0.8%) had bipolar disorder, and 572 (0.4%) had schizophrenia. Accounting for age, sex, and calendar time, bipolar disorder and schizophrenia were associated with significantly lower frequency of OAT initiation within 90 days after incident AF (bipolar disorder: -12.7%; 95% CI, -15.3% to -10.0%; schizophrenia: -24.5%; 95% CI, -28.3% to -20.7%) and lower OAT prevalence in patients with prevalent AF (bipolar disorder: -11.6%; 95% CI, -13.9% to -9.3% schizophrenia: -21.6%; 95% CI, -24.8% to -18.4%). Adjusting for socioeconomic factors and other comorbid conditions attenuated these associations, particularly for patients with bipolar disorder. However, schizophrenia continued to be associated with a with a lower rate of OAT initiation (-15.5%, 95% CI, -19.3% to -11.7%) and a -12.8% (95% CI, -15.9% to -9.7%) lower OAT prevalence. These associations were also present after the introduction of non-vitamin K antagonists (adjusted proportion difference in 2013-2016: -12.4%; 95% CI, -18.7% to -6.1% for initiation and -10.1%; 95% CI, -13.8% to -6.4% for prevalence). CONCLUSIONS AND RELEVANCE In this study, patients with bipolar disorder or schizophrenia were less likely to receive OAT in the setting of AF. For patients with bipolar disorder, this deficit was largely associated with socioeconomic factors and comorbidities, especially toward the end of the study period. For patients with schizophrenia, disparities in this stroke prevention therapy persistently exceeded what could be explained by other patient characteristics.
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Affiliation(s)
- Morten Fenger-Grøn
- Research Unit for General Practice, Aarhus Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Frost
- Department of Clinical Medicine, Aarhus University, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark
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Kassew T, Kiflie M, Minichil W, Dejen Tilahun A, Liyew B. Alcohol Use Disorder and Its Associate Factors Relating to Patients with Severe Mental Disorders Attending Psychiatric Follow-Ups in Northwest Ethiopia. Neuropsychiatr Dis Treat 2021; 17:1801-1810. [PMID: 34113110 PMCID: PMC8187083 DOI: 10.2147/ndt.s309704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/26/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Patients with mental disorders have high rates of co-existing alcohol use disorder and vice versa. Alcohol use disorder has emerged as a major challenge to intervene patients with severe mental disorders. It is under-recognized and has not been investigated well in low-income countries like Ethiopia. The aim of this study was to assess the prevalence and associate factors of alcohol use disorder among patients with severe mental disorders attending psychiatric follow-ups at the University of Gondar comprehensive specialized hospital, northwest Ethiopia. METHODS A total of 384 patients with severe mental disorders selected by a systematic random sampling technique took part in the interviews for this cross-sectional study. The alcohol use disorder identification test was used to assess the problem. Univariate and multivariate binary logistic regressions were computed to examine the associated factors. An adjusted odds ratio with a 95% confidence interval (CI) was used for reporting the result. RESULTS The prevalence of alcohol use disorder among patients with severe mental disorders was 36.2%. Of the participants, 23.5%, 8.6%, and 4.1% had hazardous, harmful alcohol drinking and alcohol dependency, respectively. In the multivariate analysis, male sex, younger age, psychotic and bipolar disorder diagnoses, having poor social support, moderate and high perceived stress, and current tobacco smoking were factors significantly associated with alcohol use disorder. CONCLUSION The prevalence of alcohol use disorder among patients with severe mental disorders was found to be high. Early intervention and integrating treatment services for co-existing mental disorders and alcohol use disorder is important. The special treatment, where it is offered for young male patients and those with the diagnosis of psychotic and bipolar disorders, is recommended to promote the uptake of alcohol and mental health treatment services.
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Affiliation(s)
- Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihretu Kiflie
- Department of Psychiatry, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Woredaw Minichil
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ambaye Dejen Tilahun
- Department of Emergency Medicine and Critical Care Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bikis Liyew
- Department of Emergency Medicine and Critical Care Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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20
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Bloch S, Rinker JA, Marcus MM, Mulholland PJ. Absence of effects of intermittent access to alcohol on negative affective and anxiety-like behaviors in male and female C57BL/6J mice. Alcohol 2020; 88:91-99. [PMID: 32777473 DOI: 10.1016/j.alcohol.2020.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
Alcohol use disorder is highly comorbid with other neuropsychiatric disorders such as depression and anxiety. Importantly, women and men are affected differentially by heavy drinking, with women experiencing longer negative affective states after intoxication and increased likelihood to present with comorbid mood or anxiety disorders. In rodents, several studies using different alcohol administration models have shown the development of depressive-like or anxiety-like phenotypes that emerge during abstinence. In this study, we compared the emergence of negative affective behaviors during abstinence from 7 weeks of two-bottle choice intermittent access to 20% alcohol in male and female C57BL/6J mice, a drinking paradigm little studied in this context. Half of the mice were tested 24 hours into abstinence on the elevated zero maze and 19-20 days into abstinence in a novel object in the home cage encounter test. The other half of the mice were tested 27-28 days into abstinence with the novelty-suppressed feeding test. As expected, females drank more than males across the 7 weeks of access to alcohol. Drinking history did not affect performance on these tasks, with the exception of increasing the number of open arm entries on the elevated zero maze. Interestingly, in alcohol-naïve mice, females showed fewer anxiety-like behaviors than males in the elevated zero maze and the novelty-suppressed feeding test. Our results suggest that the intermittent access model does not reliably induce negative affective behaviors on these tasks, and that behavior in female and male mice differs across these tests. Rather, intermittent alcohol drinking may induce a mild form of behavioral disinhibition. Thus, the model of alcohol access is a critical factor in determining the appearance of behavioral disturbances that emerge during abstinence.
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21
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Małkiewicz MA, Małecki A, Toborek M, Szarmach A, Winklewski PJ. Substances of abuse and the blood brain barrier: Interactions with physical exercise. Neurosci Biobehav Rev 2020; 119:204-216. [PMID: 33038347 DOI: 10.1016/j.neubiorev.2020.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/22/2020] [Accepted: 09/25/2020] [Indexed: 12/22/2022]
Abstract
Substance use disorders pose a common medical, social and financial problem. Among the pathomechanisms of substance use disorders, the disruption and increased permeability of the blood-brain barrier has been recently revealed. Physical exercise appears to be a relatively inexpensive and feasible way to implement behavioral therapy counteracting the blood-brain barrier impairment. Concomitantly, there are also studies supporting a potential protective role of selected substances of abuse in maintaining the blood-brain barrier integrity. In this review, we aim to provide a summary on the modulatory influence of physical exercise, a non-pharmacological intervention, on the blood-brain barrier alterations caused by substances of abuse. Further studies are needed to understand the precise mechanisms that underlie various effects of physical exercise in substance use disorders.
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Affiliation(s)
- Marta A Małkiewicz
- Applied Cognitive Neuroscience Lab, Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland.
| | - Andrzej Małecki
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Michal Toborek
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Biochemistry and Molecular Biology, University of Miami, Miami, USA
| | - Arkadiusz Szarmach
- 2-nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Paweł J Winklewski
- 2-nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland; Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland
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22
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Huang YK, Wang YH, Chang YC. Chronic Periodontitis Is Associated with the Risk of Bipolar Disorder: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103466. [PMID: 32429260 PMCID: PMC7277490 DOI: 10.3390/ijerph17103466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
Bipolar disorder (BD) is a psychiatric mood disturbance manifested by manic, hypomanic, or major depressive periods. Chronic inflammation was evidenced as an important etiologic factor of BD. Chronic periodontitis (CP) is an inflammatory disease triggered by bacterial products, leading to the destruction of periodontium. The relationship between BD and CP is of interest to investigate. Therefore, a nationwide population-based cohort study was used to investigate the risk of BD and CP exposure from 2001 to 2012. We identified 61,608 patients with CP from the Taiwanese National Health Insurance Research Database (NHIRD). The 123,216 controls were randomly captured and matched by age, sex, index year, and co-morbidities. The association between CP exposure and BD risk was examined by Cox proportional hazards regression models. In this study, 61,608 CP patients and 123,216 controls were followed up for 7.45 and 7.36 years, respectively. In total, 138 BD patients were identified in the CP cohort and 187 BD cases were found in the non-CP cohort. The incidence rate of BD was significantly higher in the CP cohort than in the non-CP cohort (adjusted HR: 1.46, 95% CI: 1.17–1.81) according to the multivariate Cox regression analysis. Females had a 1.47-fold increased risk (95% CI: 1.16–1.86) for BD compared to males. Taken together, CP may be associated with an increased risk of subsequent BD in Taiwan.
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Affiliation(s)
- Yung-Kai Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: ; Tel.: +886-4-24718668 (ext. 55011); Fax: +886-4-24759065
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23
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Mosheva M, Serretti A, Stukalin Y, Fabbri C, Hagin M, Horev S, Mantovani V, Bin S, Mattiaccio A, Nivoli A, Vieta E, Popovic D. Association between CANCA1C gene rs1034936 polymorphism and alcohol dependence in bipolar disorder. J Affect Disord 2020; 261:181-186. [PMID: 31634677 DOI: 10.1016/j.jad.2019.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a highly heritable and disabling mental illness, commonly associated with substance abuse, being alcohol abuse the most frequent. Comorbid BD and substance abuse disorders are often associated with high levels of health service utilization and destabilization of the course of illness resulting in poor treatment outcomes. Although recent genome-wide association studies have detected a number of risk genes for BD, the data is still sparse and inconclusive for those genes that may contribute to the increased risk of comorbid alcohol abuse (AA) in BD. The primary aim of the present study was to investigate the effects of 46 single-nucleotide polymorphisms (SNPs) within eight genes on different phenotypes of BD patients, such as comorbid alcohol abuse. We further assessed clinical variables associated with AA. METHODS One-hundred fifty-eight BD I and II patients were enrolled in a naturalistic cohort study. Genomic DNA of 92 patients was extracted from whole blood using standard procedures and 46 tag SNPs in eight genes of interest (ANK, CACNA1C, CACNB2, FKBP5, GRM7, ITIH3, SYNE1 and TCF4) were genotyped. RESULTS Seventy-one patients out of 158 (45%) satisfied diagnostic criteria for comorbid AA. Among 46 SNPs analyzed, the only SNP associated with comorbid AA was rs1034936 polymorphism in the CANCA1C gene. This polymorphism was also associated with lifetime cocaine abuse, manic switch and current atypical antipsychotics. CONCLUSIONS Our findings suggest a role of rs1034936 CACNA1C gene variant in BD-AA group. Despite their preliminary nature, the present results may provide new insight on mechanisms underlying AA in BD.
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Affiliation(s)
- Mariela Mosheva
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Yelena Stukalin
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michal Hagin
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel
| | - Sagi Horev
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel; Semmelewis University, Budapest, Hungary
| | - Vilma Mantovani
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Sofia Bin
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Alessandro Mattiaccio
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Alessandra Nivoli
- Clinica Psichiatrica, Dipartimento di Medicina Clinica e Sperimentale, University of Sassari, Italy
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Spain
| | - Dina Popovic
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel.
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Tsuboi T, Suzuki T, Azekawa T, Adachi N, Ueda H, Edagawa K, Katsumoto E, Kubota Y, Goto E, Hongo S, Watanabe Y, Kato M, Yasui-Furukori N, Yoshimura R, Nakagawa A, Kikuchi T, Watanabe K. Factors Associated with Non-Remission in Bipolar Disorder: The Multicenter Treatment Survey for Bipolar Disorder in Psychiatric Outpatient Clinics (MUSUBI). Neuropsychiatr Dis Treat 2020; 16:881-890. [PMID: 32280229 PMCID: PMC7127845 DOI: 10.2147/ndt.s246136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to identify factors associated with non-remission in bipolar disorder. PATIENTS AND METHODS The multicenter treatment survey for bipolar disorder in psychiatric outpatient clinics (MUSUBI) study used a questionnaire administered at 176 clinics throughout Japan from September to October 2016. Clinic psychiatrists performed a retrospective medical record survey of consecutive cases with bipolar disorder. Patients were considered to be in remission if they met all of the following criteria: they were not in a mixed state, their manic or depressive symptoms were either borderline or nonexistent (corresponding to 2 or 1 points on the Clinical Global Impressions Scale, Bipolar Version), and their psychiatrists clinically considered them to be in remission. Enrolled patients were classified into remitters group and non-remitters group and demographic and clinical characteristics were contrasted between the groups. Non-remitters were compared with remitters, using a series of logistic regression analyses. RESULTS A total of 3130 patients (1420 men; mean age: 50.3 years) were included in this study; 1307 patients (41.8%) were in remission. Of the remaining 1823 patients, 1260 (40.3%) had mild to severe depression, 261 (8.3%) suffered from manic or hypomanic episodes, and 302 (9.6%) were in a mixed state. Logistic regression analyses found the following eight factors to be significantly correlated with non-remission in patients with bipolar disorder: female gender, younger age, unemployed status, rapid cycling pattern, comorbid alcohol/substance abuse, poorer social function, lithium non-use, and antidepressant use. CONCLUSION The MUSUBI study, the largest nationwide investigation on bipolar disorder, identified eight clinically relevant factors associated with non-remission in bipolar patients. They have important clinical implications; further prospective studies are necessary to replicate these findings and to guide better managements for those in serious needs.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.,The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| | - Takefumi Suzuki
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Kouji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | | | - Masaki Kato
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Norio Yasui-Furukori
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan
| | - Reiji Yoshimura
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Atsuo Nakagawa
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshiaki Kikuchi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.,The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
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25
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Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry 2019; 6:1068-1080. [PMID: 31630984 PMCID: PMC7006178 DOI: 10.1016/s2215-0366(19)30222-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile; Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Katherine M Keyes
- Department of Epidemiology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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26
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Fletcher K, Murray G. Beyond Pharmacotherapy for Bipolar Disorder: The Role of Adjunctive Psychological Treatments. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190808-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Barbuti M, Mazzarini L, Vieta E, Azorin JM, Angst J, Bowden CL, Mosolov S, Young AH, Perugi G. Relationships between recurrence and polarity in major depressive disorders: Pooled analysis of the BRIDGE and BRIDGE-II-MIX cohorts. J Affect Disord 2019; 256:250-258. [PMID: 31195243 DOI: 10.1016/j.jad.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/11/2019] [Accepted: 06/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND current classifications of mood disorders focus on polarity rather than recurrence, separating bipolar disorder from major depressive disorder (MDD). The aim of the present study is to explore the possible relationships between number and frequency of depressive episodes and clinical variables associated to bipolarity, in a large sample of MDD patients. METHODS the clinical characteristics of 7055 patients with MDD were analyzed and compared according to the number and frequency of depressive episodes. Two stepwise backward logistic regression model were used to identify the predictive value of clinical features based on the presence of high number (≥3 episodes) and high frequency (≥3 episodes/year) of depressive episodes. RESULTS high-recurrence and high-frequency MDD patients showed greater family history for bipolar disorder, higher prevalence of psychotic features, more suicide attempts, higher rates of treatment resistance and mood switches with antidepressants (ADs) and higher rates of bipolarity diagnosis according to Angst criteria, compared to low-recurrence and low-frequency patients. Logistic regressions showed that a brief current depressive episode, a previous history of treatment resistance and AD-induced mood switches, a diagnosis of bipolarity and comorbid borderline personality disorder were the variables associated with both high-recurrence and high-frequency depression. LIMITATIONS the study participating centers were not randomly selected and several variables were retrospectively assessed. CONCLUSIONS even in the absence of hypomanic/manic episodes, high-recurrence and high-frequency MDD seem to be in continuity with the bipolar spectrum disorders in terms of clinical features and, perhaps, treatment response.
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Affiliation(s)
- Margherita Barbuti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Lorenzo Mazzarini
- NESMOS Department, School of Medicine and Psychology, Sapienza University, Rome, Italy; Salvator Mundi International Hospital, Rome, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Jules Angst
- Department of Psychiatry, Psychotherapy, and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
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Prisciandaro JJ, Mellick W, Mitaro E, Tolliver BK. An evaluation of the impact of co-occurring anxiety and substance use disorder on bipolar disorder illness outcomes in STEP-BD. J Affect Disord 2019; 246:794-799. [PMID: 30623826 PMCID: PMC6563327 DOI: 10.1016/j.jad.2018.12.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/01/2018] [Accepted: 12/23/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorder (AD) and substance use disorder (SUD) highly co-occur with bipolar disorder (BD). AD and/or SUD co-occurrence is associated with poorer clinical outcomes in BD. However, respective associations between AD and/or SUD diagnoses and BD outcomes require clarification. Baseline data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were therefore utilized to investigate independent and simultaneous contributions of ADs and SUDs on clinical variables in BD. METHODS Two latent factors, "pathological anxiety" and "substance use problems," were derived from presence/absence of lifetime AD and SUD diagnoses. Latent dimensions' associations with clinical variables, obtained from the Affective Disorders Evaluation, Mini-International Neuropsychiatric Interview and Range of Impaired Functioning, were estimated via structural equation modeling (SEM). RESULTS Modeled independently, pathological anxiety and substance use problems were significantly associated with several variables. Yet when modeled simultaneously, pathological anxiety's associations with functional impairment, past-year rapid cycling, and past-year %time spent anxious and depressed remained while most variables' associations with substance use problems became non-significant. The only significant latent-factor interaction evidenced was for age of BD onset. LIMITATIONS Analyses were limited to lifetime diagnoses and causality may not be inferred given cross-sectional data. CONCLUSIONS ADs and SUDs impact on BD was mostly additive rather than synergistic. Findings highlight the potentially understated importance of treating inter-episodic anxiety in BD as it may exacerbate mood symptoms, increasing functional impairment and risk for subsequent mood episodes.
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Affiliation(s)
- James J Prisciandaro
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Charleston, SC 29425, United States.
| | - William Mellick
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Charleston, SC 29425, United States
| | - Emily Mitaro
- University of Georgia, Department of Psychology, Athens, GA 30602, United States
| | - Bryan K Tolliver
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Charleston, SC 29425, United States
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Tensae DW, Solomon H, Boru B, Getinet W. Prevalence and correlates of alcohol use disorders among bipolar patients at Amanuel Mental Specialized Hospital, Addis Ababa (Ethiopia): A cross-sectional institution based study. J Public Health Afr 2018; 9:829. [PMID: 30854177 PMCID: PMC6379785 DOI: 10.4081/jphia.2018.829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 07/05/2018] [Indexed: 01/21/2023] Open
Abstract
At this time, alcohol use is increasing in African countries. The prevalence of alcohol use disorders (AUDs) remains unknown in patients with psychiatric disorders. This study aimed to assess the prevalence of AUDs among individuals with bipolar disorder in the outpatient department at Amanuel Mental Specialized Hospital. An institution-based cross sectional study was conducted among 412 bipolar patients attending the outpatient department at Amanuel Mental Specialized Hospital from May – July 2015.Participants were selected using a systematic random sampling technique. Semi-structured questionnaires were used to collect socio-demographic and clinical data. Alcohol use disorder was measured using the Alcohol Use Disorders Identification Test (AUDIT-10). Binary logistic regression analysis was performed. The prevalence of alcohol use disorder was found to be 24.5%. Those affected were predominantly female (58.5%). Being18-29 years of age(AOR=3.86, 95% CI: 1.34, 11.29), being 30-44 years of age (AOR=4.99, 95%CI: 1.85, 13.46), being unable to read and write (AOR=5.58, 95%CI: 2.026, 13.650), having a secondary education (AOR=3.198, 95%CI: 1.149, 8.906), being a farmer (AOR=4.54, 95%CI: 1.67, 12.32), being employed by the government (AOR=3.53, 95%CI: 1.36, 4.15), being a day labourer (AOR=3.5, 95%CI: 1.14, 10.77), use of other substances during past 12 months (AOR=2.06, 95%CI: 1.06, 3.99), having a family history of alcohol use (AOR=2.18, 95%CI: 1.29, 3.68), having discontinued medication (AOR=2.78, 95%CI: 1.52, 5.07), having suicidal thoughts (AOR=4.56, 95%CI: 2.43, 8.54), and having attempted suicide (AOR=5.67, 95%CI: 3.27, 9.81) were statistically significant to alcohol use disorder using multivariate logistic analysis. The prevalence of co-morbid alcohol use disorder was high. This finding suggests that screening for risky alcohol use should be integrated into routine hospital outpatient care. Further, preventive measures against alcohol use disorder should be established.
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Affiliation(s)
| | | | - Berhanu Boru
- Department of Nursing, College of Medicine and Health Sciences, University of Gondar
| | - Wondale Getinet
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Banach E, Pawlak J, Kapelski P, Szczepankiewicz A, Rajewska-Rager A, Skibinska M, Czerski P, Twarowska-Hauser J, Dmitrzak-Weglarz M. Clock genes polymorphisms in male bipolar patients with comorbid alcohol abuse. J Affect Disord 2018; 241:142-146. [PMID: 30121446 DOI: 10.1016/j.jad.2018.07.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/29/2018] [Accepted: 07/30/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Psychiatric comorbidity affects 24-65% patients with bipolar disorder (BD), 45% of which have alcohol abuse/dependence (AAD). Despite the fact that BD has an equal incidence in both genders, AAD more often occurs in men. We hypothesized that the presence of BD and AAD, reported as a secondary diagnosis, may result from a common genetic background. However, specific genetic factors predispose to gender differences. METHODS Based on the relationship between circadian clock genes pathway and BD/AAD we decided to test the connection of four core clock genes with common genetic background of both diseases. We analyzed 436 patients with BD, among which 17% were diagnosed with AAD. The control group consisted of 417 healthy subjects. We analyzed 44 SNPs of the previously described core molecular clock genes: CLOCK, ARNTL, TIMELESS and PER3. RESULT We found association of ARNTL gene (rs11600996) and PER3 gene (rs228642) polymorphisms with an increased risk of BD/AAD in a group of male patients. We also found that two other polymorphisms of PER3 gene, rs228682 and rs2640909, were associated with both AAD and family history of affective disorders. LIMITATIONS Possible factors that could have influenced the results are: relatively small sample size, gender disproportion and unverifiable data form the patient interview. CONCLUSIONS Our study confirms the existence of a link between clock genes and increased risk of alcohol abuse/dependence in male patients and the accumulation of risk genes in patients with a positive family history.
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Affiliation(s)
- Ewa Banach
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland; Laboratory of Neurobiology, Department of Molecular and Cellular Neurobiology, Nencki Institute, Warsaw PL-02-093, Poland.
| | - Joanna Pawlak
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Pawel Kapelski
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Aleksandra Szczepankiewicz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland; Laboratory of Molecular and Cell Biology, Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Maria Skibinska
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Piotr Czerski
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Joanna Twarowska-Hauser
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Monika Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poland
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Stump TA, Eng ML. The development and psychometric properties of the bipolar disorders knowledge scale. J Affect Disord 2018; 238:645-650. [PMID: 29957482 DOI: 10.1016/j.jad.2018.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/23/2018] [Accepted: 05/27/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Bipolar Disorder (BD) presents in 1-4% of the world's population, carrying significant financial and functional consequences. Beyond the direct disease burden, patients with BD experience a high degree of both internal and external stigma. Additionally, medication adherence tends to be poor in patients with BD. Knowledge appears to play a role in mitigating both stigma and non-adherence, but these relationships have not been fully elucidated. The Bipolar Disorder Knowledge Scale (BDKS) was designed to explore the role of knowledge and better define such relationships. This research provides the evidence for the reliability and validity of the scale. METHODS Forty-seven items were developed to assess knowledge of BD. The 47-item survey was sent out to two groups: first a group of 43 pharmacists with BCPP credentials from the College of Psychiatric and Neurologic Pharmacists (CPNP) who were recruited from the CPNP directory, and second a group of 250 members of the general public who were recruited using Qualtrics Online Sample service. Participants were surveyed on their education status, health literacy, BD diagnostic status, and exposure to patients with BD. Participants then completed the 47-item scale. After 48 h 100 members from the original general public group were sent the same survey to assess test-retest reliability. For each item a difficulty index to evaluate how well participants performed on the item and a discrimination index to determine how well each item performed in high-scorers versus low scorers were calculated. Additionally, Cronbach's alpha was calculated to determine internal consistency validity and a Pearson correlation was run to determine test-retest reliability. Items were removed based on the results from the difficulty index, discrimination index, and Cronbach's alpha. Finally the pharmacist final scores were compared to the general public using an unpaired t-test to assess whether content experts were more likely to perform better on the scale. Following item removal, the scale was finalized at 25-items. RESULTS The mean score for the scale was 34.48 (71.83%; SD: 5.50) and the Cronbach's alpha was 0.773 before item analysis. Following item analysis, 22 items were dropped leaving 25 items on the final version of the scale. The remaining items retained a difficulty index below 90% and a discrimination index above 20%. The mean of the 25-item scale was 18.40 (73.6%; SD: 4.13) for the general public and 23.20 (92.8%; SD: 1.36) for the pharmacists group (p < 0.001). The Cronbach's alpha for the finalized scale was 0.760, indicating a high-degree of internal consistency. While this is lower than the original alpha, this may be explained by the reduced number of scale items. A 25-item scale is much more practical and the items on the scale retain stronger item analysis statistics. Finally, the Pearson Correlation for the group who underwent the test-retest procedure was 0.841 (p < 0.001) indicating strong test-retest reliability. CONCLUSION The BDKS is a 25-item true-false scale that takes approximately 5-10 min to complete. The scale assesses knowledge of BD with items targeting diagnosis, etiology, disease course, symptoms, treatment, and life impact. The scale has shown strong internal consistency and test-retest reliability in a general population and will be useful for evaluating knowledge of BD as it relates to stigma, non-adherence, and other variables.
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Affiliation(s)
- Trevor A Stump
- Department of Pharmacy, Summa Health, Akron, OH, United States
| | - Marty L Eng
- School of Pharmacy, Cedarville University, 251 N. Main Street, Cedarville.45314, OH, United States.
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Maremmani AGI, Bacciardi S, Somers JM, Nikoo M, Schütz C, Jang KL, Krausz M. Substance Dependence Among Bipolar, Unipolar Depression and Psychotic Homeless: A Canadian National Study. Front Psychiatry 2018; 9:701. [PMID: 30618874 PMCID: PMC6305348 DOI: 10.3389/fpsyt.2018.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/03/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Homeless individuals are often mischaracterized as members of a homogeneous population that suffers from a wide mental health and addiction issues, with little consideration of potentially important differences within or between samples. The aim of the present study was to investigate the comorbidy of alcohol and/or substance dependence (ASD) and major psychiatric diagnoses (bipolar disorder, unipolar depression, and psychotic disorder) in a large Canadian sample of homeless individuals, and to examine potential sources of variability including location and ethnicity. Materials and Methods: A sample of 1,585 homeless individuals were assessed for alcohol and/or substance dependence and bipolar disorder, unipolar depression and psychotic disorder with the Mini-International Neuropsychiatric Interview (version 6.0). Regional and ethnic differences in major psychiatric diagnoses between homeless with and without ASD were examined using univariate (i.e., chi-square) and multivariate (i.e., logistic regression) statistics. Results: Members of the sample with ASD were found to be younger, Aboriginal, less well-educated, and born in the Americas. They were more significantly more prevalent in Western Canada and less prevalent in Central and Eastern Canada. The odds of having ASD were higher among people affected by bipolar disorder and (to a less extent) unipolar depression. Limitations: Data collected were self-reported and no urinalyses were performed. We considered diagnosis of ASD according to the previous 12 months only. Conclusions: Homeless people with major mental illness are at high risk for concurrent ASD, however the prevalence of ASD varies significantly between cities, and based on ethnicity and specific psychiatric diagnosis (with greater prevalence in individuals affected by bipolar disorder and, to a less extent, unipolar depression). Clinicians, administrators and policy makers should develop and deliver services based on careful assessment of the local population.
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Affiliation(s)
- Angelo G I Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy.,Local Health Unit (Versilia Zone), Department of Psychiatry, North-Western Tuscany Region, Viareggio, Italy
| | - Silvia Bacciardi
- "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Julian M Somers
- Somers Research Group, Faculty of Health Science, Simon Fraser University, Barnaby, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Azorin JM, Perret LC, Fakra E, Tassy S, Simon N, Adida M, Belzeaux R. Alcohol use and bipolar disorders: Risk factors associated with their co-occurrence and sequence of onsets. Drug Alcohol Depend 2017; 179:205-212. [PMID: 28802190 DOI: 10.1016/j.drugalcdep.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Little is known about the sequence of onsets in patients affected by comorbid alcohol use and bipolar disorder. This study examines the risk factors associated with their co-occurrence and order of onset. METHOD The demographic, clinical, and temperament characteristics as well as the course of illness were analyzed within our sample of 1090 DSM-IV bipolar I manic patients. Our sample was categorized according to the presence of comorbid alcohol use disorder and the sequence of onsets of bipolar and alcohol use disorders i.e., alcohol first (AUD-BD) and bipolar first (BD-AUD). RESULTS Regression analyses revealed that alcohol use disorder (52.5%) was associated with the male gender, additional substance use disorders, as well as an irritable and a hyperthymic temperament. The AUD-BD group (6.6%) was older than the BD-AUD group (45.8%) and showed higher rates of comorbid sedative use, organic, and anxiety disorders with higher levels of irritable temperament, and a bipolar subtype characterized by depressive polarity at onset. The BD-AUD group had high levels of hyperthymic temperament with higher rates of comorbid stimulant use disorder and a manic polarity at onset. CONCLUSIONS In the AUD-BD group, alcohol might have been used to reduce stress and tension caused by the presence of an irritable temperament as well as anxious and organic disorders, leading to first depressive episode. In the BD-AUD group, stimulant use might have triggered the first manic episode, and alcohol abuse result from mania severity.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Léa C Perret
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
| | - Eric Fakra
- Department of Psychiatry, North Hospital, Saint-Etienne, France.
| | - Sébastien Tassy
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Nicolas Simon
- Aix-Marseille University, INSERM, UMR912 (SESSTIM), Marseille, France.
| | - Marc Adida
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
| | - Raoul Belzeaux
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France; Department of Psychiatry, McGill University, Montréal, Québec, Canada.
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Naglich A, Adinoff B, Brown ES. Pharmacological Treatment of Bipolar Disorder with Comorbid Alcohol Use Disorder. CNS Drugs 2017; 31:665-674. [PMID: 28669022 DOI: 10.1007/s40263-017-0449-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Bipolar disorder (BD) spectrum and alcohol use disorders (AUDs) commonly occur together. Comorbidity between the two conditions predisposes patients to elevated risks of adverse outcomes, including hospitalization and suicide, compared with either condition alone. Despite the consistent relationship observed between BD and AUD, the underlying cause remains incompletely characterized. Few trials conducted have been able to identify promising interventions for patients with these disease states. The antipsychotic quetiapine has been evaluated most commonly as a therapeutic agent for patients with BD and AUD followed by naltrexone and acamprosate. Randomized controlled trials of quetiapine have consistently reported a lack of efficacy for the treatment of patients with BD and AUD. Trials of acamprosate have also been negative but small in size. Results of the sole randomized controlled trial of naltrexone have found large treatment effect sizes, but no statistically significant difference between treatment groups. Other agents including the antipsychotic aripiprazole, mood stabilizing agents including lamotrigine, lithium, and divalproex, and the antiepileptic agent topiramate have also been evaluated for the treatment of BD and AUD with mixed findings. The lone statistically significant treatment effect was observed in a randomized, placebo-controlled trial of divalproex added on to lithium which demonstrated a reduction in alcohol use. This review summarizes the available clinical evidence and current guideline recommendations for the treatment of comorbid BD and AUD, and provides discussion and recommendations based on the current literature.
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Affiliation(s)
- Andrew Naglich
- VA North Texas Healthcare System, 4500 S Lancaster Rd, Dallas, TX, 75216, USA
| | - Bryon Adinoff
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8849, USA
| | - E Sherwood Brown
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8849, USA.
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Pary R, Patel M, Lippmann S. Depression and Bipolar Disorders in Patients With Alcohol Use Disorders. Fed Pract 2017; 34:37S-41S. [PMID: 30766306 PMCID: PMC6375498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This review details methods for meeting the challenges of diagnosing and treating mood disorders that coexist with substance use disorders.
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Affiliation(s)
- Raymond Pary
- is a psychiatrist at Louisville VAMC in Kentucky. is a psychiatry resident, is a professor, and Dr. Pary is an associate professor, all at the University of Louisville, Kentucky
| | - Mitesh Patel
- is a psychiatrist at Louisville VAMC in Kentucky. is a psychiatry resident, is a professor, and Dr. Pary is an associate professor, all at the University of Louisville, Kentucky
| | - Steven Lippmann
- is a psychiatrist at Louisville VAMC in Kentucky. is a psychiatry resident, is a professor, and Dr. Pary is an associate professor, all at the University of Louisville, Kentucky
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Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:321-330. [PMID: 27426694 DOI: 10.1016/j.jad.2016.06.051] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/17/2016] [Accepted: 06/19/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are common in people with a bipolar disorder (BD). This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in persons with BD based on national or international surveys of household populations. METHODS Studies published from 1990 to Dec 31, 2015 were identified from MEDLINE, EMBASE. psychINFO, and CINAHL databases and reference lists. We calculated prevalence rates and conducted meta-analysis with random-effects model. RESULTS We identified 9 unique surveys of which two surveys were repeated 10 years later using independent samples. The total sample size was 218,397 subjects. The mean prevalence for any illicit drug use disorder was 17%, for alcohol use disorder (AUD) it was 24% and SUD it was 33%. The strongest associations were found between BD and illicit drug use (pooled odds ratio (OR) 4.96, 95% CI 3.98-6.17) followed closely by BD and AUD (OR 4.09, 95% CI 3.37-4.96). The association was higher for BD respondents using illicit drugs compared to bipolar II respondents (ORs 7.48 vs. 3.30). LIMITATIONS Some of the meta-analysis grouped illicit substances together without taking into consideration types of substance use which may differ widely between countries and over time. All included studies were cross-sectional so onset and causality can not be determined. CONCLUSIONS The meta-analysis revealed that people with an alcohol use disorder were 4.1 times of greater risk of having a BD compared to those without an AUD. The risks were even higher for illicit drug users where they were 5.0 times of greater risk of having BD compared to non-users. These data confirm strong associations between co-occurring SUDs and BD, indicating a need for more informative studies to help develop better interventions in treating persons with BD and comorbid SUDs.
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Dervaux A, Laqueille X. Bipolar disorder: defining symptoms and comorbidities. Lancet 2016; 388:869. [PMID: 27597465 DOI: 10.1016/s0140-6736(16)31430-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Alain Dervaux
- Service d'addictologie, Centre Hospitalier Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France.
| | - Xavier Laqueille
- Service d'addictologie, Centre Hospitalier Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France
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Abstract
Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn't the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of "marketing" their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence
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Tolliver BK, Anton RF. Assessment and treatment of mood disorders in the context of substance abuse. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246792 PMCID: PMC4518701 DOI: 10.31887/dcns.2015.17.2/btolliver] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.
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Affiliation(s)
- Bryan K Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Roncero C, Szerman N, Terán A, Pino C, Vázquez JM, Velasco E, García-Dorado M, Casas M. Professionals' perception on the management of patients with dual disorders. Patient Prefer Adherence 2016; 10:1855-1868. [PMID: 27698553 PMCID: PMC5034926 DOI: 10.2147/ppa.s108678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.
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Affiliation(s)
- Carlos Roncero
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
- Correspondence: Carlos Roncero, Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain, Tel +34 93 489 4294, Fax +34 93 489 4587, Email
| | - Néstor Szerman
- Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Terán
- Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain
| | - Carlos Pino
- Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain
| | - José María Vázquez
- Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain
| | - Elena Velasco
- Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain
| | | | - Miguel Casas
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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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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Singh S, Forty L, di Florio A, Gordon-Smith K, Jones I, Craddock N, Jones L, Smith DJ. Affective temperaments and concomitant alcohol use disorders in bipolar disorder. J Affect Disord 2015; 186:226-31. [PMID: 26253903 DOI: 10.1016/j.jad.2015.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alcohol misuse (AM) is more common in bipolar disorder (BD) than within the general population but the mechanisms of this association are unclear. We hypothesized that certain affective temperaments (including hyperthymic, cyclothymic, anxious, depressive and/or irritability) might represent 'fundamental states' contributing to risk of both AM and BD and we aimed to assess whether extremes of these five affective temperaments were associated with BD and concomitant AM status. METHODS Our sample comprised 1420 individuals with BD who were recruited into a clinical-genetic study conducted by the Bipolar Disorder Research Network. Phenotypic assessments, including evaluation for AM and the 32-item TEMPS-A questionnaire, were conducted. Binary logistic regression was used to determine the effect of TEMPS-A scores on the likelihood of concomitant AM, with adjustment for confounders. RESULTS Mean scores for four affective temperaments (hyperthymic, cyclothymic, depressive and irritable) were higher in cases (BD+AMs) than controls (BD only) (p<0.001). Hyperthymic and irritable temperaments in particular significantly increased the odds of concomitant AM within the BD sample after adjustment for potential confounders. LIMITATIONS The definition of AM was not directly based on formal diagnostic classification systems. A retrospective, cross-sectional design was used. Our findings may not generalize to other countries and cultures. CONCLUSIONS Higher scores on measures of hyperthymic and irritable temperament may contribute to the association between AM and BD. Assessing affective temperaments early in the course of BD may help to predict the development of an AM problem in vulnerable individuals.
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Affiliation(s)
- Sukhmeet Singh
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
| | - Liz Forty
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Arianna di Florio
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Katherine Gordon-Smith
- Department of Psychiatry, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Ian Jones
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Nick Craddock
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Lisa Jones
- Department of Psychiatry, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
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Comorbidity Between Psychiatric Diseases and Alcohol Use Disorders: Impact of Adolescent Alcohol Consumption. CURRENT ADDICTION REPORTS 2015. [DOI: 10.1007/s40429-015-0076-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Balanzá-Martínez V, Crespo-Facorro B, González-Pinto A, Vieta E. Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates. Front Physiol 2015; 6:108. [PMID: 25904869 PMCID: PMC4387475 DOI: 10.3389/fphys.2015.00108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/17/2015] [Indexed: 12/20/2022] Open
Abstract
Bipolar disorder (BD) and alcohol use disorders (AUDs) are usually comorbid, and both have been associated with significant neurocognitive impairment. Patients with the BD-AUD comorbidity (dual diagnosis) may have more severe neurocognitive deficits than those with a single diagnosis, but there is paucity of research in this area. To explore this hypothesis more thoroughly, we carried out a systematic literature review through January 2015. Eight studies have examined the effect of AUDs on the neurocognitive functioning of BD patients. Most studies found that BD patients with current or past history of comorbid AUDs show more severe impairments, especially in verbal memory and executive cognition, than their non-dual counterparts. Greater neurocognitive dysfunction is another facet of this severe comorbid presentation. Implications for clinical practice and research are discussed. Specifically, the application of holistic approaches, such as clinical staging and systems biology, may open new avenues of discoveries related to the BD-AUD comorbidity.
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Affiliation(s)
- Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry, Deparment of Medicine, School of Medicine, La Fe University and Polytechnic Hospital, University of Valencia, CIBERSAM, ISNPR Valencia, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria-IDIVAL, CIBERSAM Santander, Spain
| | - Ana González-Pinto
- Álava University Hospital, CIBERSAM, University of the Basque Country Kronikgune, Vitoria, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM Barcelona, Spain
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Chitty KM, Lagopoulos J, Hickie IB, Hermens DF. A longitudinal proton magnetic resonance spectroscopy study investigating oxidative stress as a result of alcohol and tobacco use in youth with bipolar disorder. J Affect Disord 2015; 175:481-7. [PMID: 25679204 DOI: 10.1016/j.jad.2015.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/15/2015] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
Alcohol and tobacco have been suggested to be "aggravating factors" for neuroprogression in bipolar disorder (BD), however the impact of these substances on the underlying neurobiology is limited. Oxidative stress is a key target for research into neuroprogression in BD and in accordance with this model, our previous cross-sectional studies have found that risky alcohol and tobacco use in BD is associated with increased oxidative stress, investigated via in vivo glutathione (GSH) measured by proton magnetic resonance spectroscopy ((1)H-MRS) in the anterior cingulate cortex (ACC). What remains unknown is whether the negative impact on GSH levels can be modified as a result of limiting alcohol and tobacco use. Thirty BD patients were included in the study. (1)H-MRS and tobacco and alcohol measures were conducted at baseline and follow-up assessments (15.5±4.6 months apart). Pearson׳s correlations were performed between percentage change in GSH concentration and changes in alcohol/tobacco use. Regression analyses were then conducted to further explore the significant correlations. An increase in GSH was associated with a decrease in alcohol consumption (r=-0.381, p<0.05) and frequency of tobacco use (-0.367, p=0.05). Change in alcohol consumption, tobacco use and age were significant predictors of change in GSH concentration (F (3, 26)=3.69, p<0.05). Due to the high comorbidity of alcohol and tobacco use in the sample, the individual effects of these substances on GSH levels could not be determined. This study offers longitudinal evidence that changing risky drinking patterns and tobacco use early in the course of BD is associated with improvements in antioxidant capacity, and therefore may be specific targets for early intervention and prevention of neuroprogression in BD.
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Affiliation(s)
- Kate M Chitty
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia.
| | - Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia
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Shad MU, Prasad K, Forman SD, Haas GL, Walker JD, Pisarov LA, Goldstein G. Insight and neurocognitive functioning in bipolar subjects. Compr Psychiatry 2015; 56:112-20. [PMID: 25439524 DOI: 10.1016/j.comppsych.2014.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Insight concerning having a mental illness has been found to influence outcome and effectiveness of treatment. It has been studied mainly in the area of schizophrenia with few studies addressing other disorders. This study evaluates insight in individuals with bipolar disorder using the Scale to Assess Unawareness of Mental Disorder (SUMD), a comprehensive interview for evaluation of awareness of illness and attribution of symptoms. The hypothesis was that in bipolar disorder level of awareness may be associated with numerous factors including neurocognitive function, structural changes in the frontal lobes and hippocampus evaluated by MRI, neurocognitive status, severity of mania and other psychiatric symptoms and comorbid alcoholism. METHOD In order to evaluate this hypothesis 33 individuals with DSM-IV diagnosed bipolar disorder, some with and some without comorbid alcoholism, were administered the SUMD and a number of other procedures including a quantitative MRI measuring volume of the frontal lobes and hippocampus, a brief battery of neurocognitive tests, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale. The data were analyzed by comparing participants with and without alcoholism on these procedures using t tests and by linear multiple regression, with SUMD ratings of awareness and attribution as the dependent variables and variable sets from the other procedures administered as multivariate independent variables. RESULTS The median score obtained from the SUMD for current awareness was in a range between full awareness and uncertainty concerning presence of a mental disorder. For attribution, the median score indicated that attribution was usually made to the illness itself. None of the differences between participants with and without comorbid alcoholism were significant for the SUMD awareness and attribution scores, neurocognitive or MRI variables. The multiple regression analyses only showed a significant degree of association between the SUMD awareness score and the Young Mania Rating Scale (r(2)=.632, p<.05). A stepwise analysis indicated that items assessing degree of insight, irritability, and sleep disturbance met criteria for entry into the regression equation. None of the regression analyses for the SUMD attribution item were significant. CONCLUSIONS Apparently unlike the case for schizophrenia, most of the participants, all of whom had bipolar disorder, were aware of their symptoms and correctly related them to a mental disorder. Hypotheses concerning the relationships between degree of unawareness and possible contributors to its development including comorbid alcoholism, cognitive dysfunction and structural reduction of gray matter in the frontal region and hippocampus, were not associated with degree of unawareness but symptoms of mania were significantly associated. The apparent reason for this result is that the sample obtained a SUMD modal awareness score of 1 or 2, reflecting the area between full awareness and uncertainty about having a mental disorder. None of the participants were rated as having a 5 response reflecting the belief that s/he does not have a mental disorder.
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Affiliation(s)
- Mujeeb U Shad
- Mental Illness, Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Konasale Prasad
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Steven D Forman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA; VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA; VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Jon D Walker
- VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Liubomir A Pisarov
- VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Gerald Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA; VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA.
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Zimmerman M, Gazarian D. Is research on borderline personality disorder underfunded by the National Institute of Health? Psychiatry Res 2014; 220:941-4. [PMID: 25446463 DOI: 10.1016/j.psychres.2014.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/20/2014] [Accepted: 09/28/2014] [Indexed: 11/17/2022]
Abstract
The relationship between bipolar disorder and borderline personality disorder has generated intense interest. Similar to patients with bipolar disorder, patients with borderline personality disorder are frequently hospitalized, are chronically unemployed, abuse substances, attempt and commit suicide. However, one significant difference between the two disorders is that patients with borderline personality disorder are often viewed negatively by mental health professionals. In the present paper we examined whether this negative bias against borderline personality disorder might be reflected in the level of research funding on the disorder. We searched the National Institute of Health (NIH) Research Portfolio Online Portfolio Reporting Tool (RePORT) for the past 25 years and compared the number of grants funded and the total amount of funding for borderline personality disorder and bipolar disorder. The yearly mean number of grants receiving funding was significantly higher for bipolar disorder than for borderline personality disorder. Results were the same when focusing on newly funded grants. For every year since 1990 more grants were funded for bipolar disorder than borderline personality disorder. Summed across all 25 years, the level of funding for bipolar disorder was more than 10 times greater than the level of funding for borderline personality disorder ($622 million vs. $55 million). These findings suggest that the level of NIH research funding for borderline personality disorder is not commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder.
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Yoshimasu K, Mure K, Hashimoto M, Takemura S, Tsuno K, Hayashida M, Kinoshita K, Takeshita T, Miyashita K. Genetic alcohol sensitivity regulated by ALDH2 and ADH1B polymorphisms as indicator of mental disorders in Japanese employees. Alcohol Alcohol 2014; 50:39-45. [PMID: 25411394 DOI: 10.1093/alcalc/agu080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Alcohol-related disorders (ARD) have been shown to be accompanied by a variety of other comorbid mental disorders. This study evaluated the associations between a variety of mental disorders and genetic alcohol sensitivity. METHODS A total of 1944 Japanese workers were interviewed regarding their mental disorders by the Mini-International Neuropsychiatric Interview (M.I.N.I.). We investigated the relationship of ADH1B rs1229984 and ALDH2 rs671 polymorphisms' combination with mental disorder risks. Logistic regression analysis was used to evaluate the associations between those polymorphisms and mental disorders, adjusting for sex, age, and job rank. RESULTS The degree of alcohol sensitivity was classified into five groups according to the combination of ADH1B and ALDH2 genotypes (Group I-V in order starting from the lowest alcohol sensitivity). Those with ALDH2 *1/*1 and ADH1B *1/*1 or with ALDH2 *1/*1 and ADH1B *1/*2,*2/*2 (low sensitivity) were significantly or nearly significantly associated with an increased risk of ARD compared with those with ALDH2 *1/*2 and ADH1B *1/*2,*2/*2 as a reference. Those with ALDH2 *1/*1 and ADH1B *1/*1 were also likely to be at an increased risk of any mental disorder except ARD, as well as disorders without comorbid ARD. This tendency was more apparent among women (OR 11.94, 95% CI 0.73-195.63) and non-drinkers (OR 5.43, 95% CI 1.05-28.23). CONCLUSION The genotype combination of ALDH2 *1/*1 and ADH1B *1/*1 is significantly associated with an increased risk of any mental disorder, especially ARD. Non-drinkers or women with ALDH2 *1/*1 and ADH1B *1/*1 are likely to suffer from any mental disorder except ARD.
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Affiliation(s)
- Kouichi Yoshimasu
- Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kanae Mure
- Department of Public Health, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Marowa Hashimoto
- Department of Public Health, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shigeki Takemura
- Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kanami Tsuno
- Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mariko Hayashida
- Department of Pharmacy, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Kenji Kinoshita
- Department of Pharmacy, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Tatsuya Takeshita
- Department of Public Health, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazuhisa Miyashita
- Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan
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Lin WS, Hu LY, Liu CJ, Hsu CC, Shen CC, Wang YP, Hu YW, Tsai CF, Yeh CM, Chen PM, Su TP, Chen TJ, Lu T. Gastroesophageal reflux disease and risk for bipolar disorder: a nationwide population-based study. PLoS One 2014; 9:e107694. [PMID: 25255080 PMCID: PMC4177834 DOI: 10.1371/journal.pone.0107694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 08/14/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Studies have shown that chronic inflammation may play a vital role in the pathophysiology of both gastroesophageal reflux disease (GERD) and bipolar disorder. Among patients with GERD, the risk of bipolar disorder has not been well characterized. OBJECTIVE We explored the relationship between GERD and the subsequent development of bipolar disorder, and examined the risk factors for bipolar disorder in patients with GERD. METHODS We identified patients who were diagnosed with GERD in the Taiwan National Health Insurance Research Database. A comparison cohort without GERD was matched according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts based on diagnosis and the prescription of medications. RESULTS The GERD cohort consisted of 21,674 patients, and the comparison cohort consisted of 21,674 matched control patients without GERD. The incidence of bipolar disorder (incidence rate ratio [IRR] 2.29, 95% confidence interval [CI] 1.58-3.36, P<.001) was higher among GERD patients than among comparison cohort. Multivariate, matched regression models showed that the female sex (hazard ratio [HR] 1.78, 95% CI 1.76-2.74, P = .008), being younger than 60 years old (HR 2.35, 95% CI 1.33-4.16, P = .003), and alcohol use disorder (HR 4.89, 95% CI 3.06-7.84, P = .004) were independent risk factors for the development of bipolar disorder among GERD patients. CONCLUSIONS GERD may increase the risk of developing bipolar disorder. Based on our data, we suggest that attention should be focused on female patients younger than 60 years, and patients with alcohol use disorder, following a GERD diagnosis.
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Affiliation(s)
- Wan-Shan Lin
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chao Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Che Shen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Taipei, Taiwan
| | - Yen-Po Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Endoscopy Center of Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Wen Hu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Fen Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pan-Ming Chen
- Department of Psychiatry, Su-Ao and Yuanshan Branch, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Hsu CC, Chen SC, Liu CJ, Lu T, Shen CC, Hu YW, Yeh CM, Chen PM, Chen TJ, Hu LY. Rheumatoid arthritis and the risk of bipolar disorder: a nationwide population-based study. PLoS One 2014; 9:e107512. [PMID: 25229610 PMCID: PMC4167853 DOI: 10.1371/journal.pone.0107512] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/12/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Studies have suggested that chronic inflammation plays an essential role in the pathophysiology of both rheumatoid arthritis (RA) and bipolar disorder. The most common clinical features associated with RA are anxiety and depression. The risk of bipolar disorder among patients with RA has not been characterized adequately. OBJECTIVE To determine the association between RA and the subsequent development of bipolar disorder and examine the risk factors for bipolar disorder among patients with RA. METHODS We identified patients who were diagnosed with RA in the Taiwan National Health Insurance Research Database. A comparison cohort was created by matching patients without RA with those with RA according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts. RESULTS The RA cohort consisted of 2,570 patients, and the comparison cohort consisted of 2,570 matched control patients without RA. The incidence of bipolar disorder (incidence rate ratio = 2.13, 95% confidence interval [CI] = 1.12-4.24, P = .013) was higher among patients with RA than among control patients. Multivariate, matched regression models revealed that asthma (hazard ratio [HR] = 2.76, 95% CI 1.27-5.96, P = .010), liver cirrhosis (HR = 3.81, 95% CI = 1.04-14.02, P = .044), and alcohol use disorders (HR = 5.29, 95% CI = 1.71-16.37, P = .004) were independent risk factors for the development of bipolar disorder among patients with RA. CONCLUSION RA might increase the incidence of bipolar disorder development. Based on our data, we suggest that, following RA diagnosis, greater attention be focused on women with asthma, liver cirrhosis, and alcohol use disorder. Prospective clinical studies of the relationship between RA and bipolar disorder are warranted.
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Affiliation(s)
- Chih-Chao Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - San-Chi Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Che Shen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Yu-Wen Hu
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pan-Ming Chen
- Department of Psychiatry, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
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