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Shahraki Z, Rastkar M, Ramezanpour MR, Ghajarzadeh M. The prevalence and odds of bipolar disorder in women with polycystic ovary syndrome (PCO) disease: a systematic review and meta-analysis. Arch Womens Ment Health 2024; 27:329-336. [PMID: 38217710 DOI: 10.1007/s00737-024-01420-w] [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: 06/22/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Women with polycystic ovary syndrome (PCO) suffer from psychological difficulties like bipolar disorder. Various studies in the literature report several prevalence rates of bipolar disorder in women with PCO, while there is no systematic review in this field. So, we designed this systematic review and meta-analysis to estimate the pooled prevalence and odds of bipolar disorder in women with PCO disease. METHOD PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and references of the references, conference abstracts were comprehensively searched by two independent researchers. The search was done on May 1st, 2023. RESULTS A literature search revealed 438 records, 35 full texts were evaluated, and finally, 11 studies remained for systematic review. Totally, 73,102 women with PCO and 340,724 controls were evaluated. Among cases, 1471 had bipolar diagnosis vs. 4321 controls. The prevalence of bipolar disorder in women with PCO ranged between 0 and 27%, and the pooled prevalence was estimated as 4% (95% CI, 2-5%; I2, 99.3%, p < 0.001). The odds of bipolar disorder in women with PCO ranged between 0.98 and 8.78, and the pooled estimate was 2.06 (95% CI, 1.61-2.63) (I2, 85.6%; p < 0.001). CONCLUSIONS This systematic review and meta-analysis show that the pooled prevalence of bipolar disorder in women with PCO is 4%, and women with PCO are at a 2-fold higher risk of bipolar disorder.
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Affiliation(s)
- Zahra Shahraki
- Zabol Medical Plants Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohsen Rastkar
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Ghajarzadeh
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
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2
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Clemente MJ, Martins Silva AS, Pozzolo Pedro MO, Paiva HS, de Azevedo Marques Périco C, Torales J, Ventriglio A, Castaldelli-Maia JM. A meta-analysis and meta-regression analysis of the global prevalence of obsessive-compulsive personality disorder. Heliyon 2022; 8:e09912. [PMID: 35865977 PMCID: PMC9294057 DOI: 10.1016/j.heliyon.2022.e09912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/02/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
There is a relative dearth of research on Obsessive-Compulsive Personality Disorder (OCPD), even if it has been recognized for over 100 years. Thus, the present study aims to review the worldwide prevalence of OCPD in different populations. The search was conducted employing the PubMed database of the US National Library of Medicine and Biblioteca Virtual em Saúde (BVS) to detect available studies showing OCPD prevalence rates. All the prevalence rates were extracted and aggregated through random-effects models. Meta-regression and sensitivity analyses were performed. The final sample was composed of 46 articles, including 89,264 individuals. We found that OCPD reports a high prevalence rate, with 6.5% (95%CI = 4.3–9.1%), and reaching even higher among psychiatric and clinical patient population. OCPD has presented stable prevalence rates worldwide throughout the past 28 years. There was no gender-related effect, but OCPD prevalence rates may decrease with age increase. There is a need to investigate personality disorders epidemiology based on the recently updated classification systems (i.e., DSM-5 and ICD-11). The present meta-analysis may suggest that the current diagnostic tools may detect OCPD in a cross-sectional assessment but not throughout the life of the person. OCPD rates do not vary significantly around the globe, with a prevalence of 6.5%. Higher rates were found in psychiatric and clinical patients’ population. OCPD prevalence has been stable throughout the past 28 years. There was no genre-related effect but it may decrease with age increase. The current diagnostic instruments may detect OCPD but may not concisely and adequately evaluate its clinical impact.
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Affiliation(s)
| | - Anderson Sousa Martins Silva
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | | | - Henrique Soares Paiva
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Cintia de Azevedo Marques Périco
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil.,Department of Neuroscience, Medical School, ABC Health University Center, Santo André, SP, Brazil
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - João Maurício Castaldelli-Maia
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil.,Department of Neuroscience, Medical School, ABC Health University Center, Santo André, SP, Brazil.,Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
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3
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BAYKARA S, YAKAR B, KİLİNC F, KORKMAZ S, ATMACA M. Polikistik over sendromu tanılı hastalarda borderline kişilik bozukluğu görülme sıklığı ve agresyon ile ilişkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.691630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ahmadi M, Faramarzi M, Basirat Z, Kheirkhah F, Chehrazi M, Ashabi F. Mental and personality disorders in infertile women with polycystic ovary: a case-control study. Afr Health Sci 2020; 20:1241-1249. [PMID: 33402971 PMCID: PMC7751531 DOI: 10.4314/ahs.v20i3.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility in women. Objective The current study investigated mental and personality disorders in infertile women with and without PCOS. Methods This case-control study evaluated 400 infertile women who referred to the Infertility Center in Babol city (North of Iran). Participants were categorized into the case group (201 PCOS) and the control group (199 without PCOS). All of the participants completed the Millon Clinical Multi-axial Inventory-III (MCMI-III). Results The mean scores for clinical personality patterns were significantly higher for six personality disorders (schizoid, avoidant, antisocial, depressive, sadistic, and negativistic) and for three classes of severe personality disorder patterns (schizotypal, borderline, and paranoid) in infertile women with PCOS than in women without PCOS. The mean scores for eight clinical disorders (somatoform, manic disorder, dysthymia, alcohol-dependence, drug-dependence, post-trauma stress disorder, major depression, and delusion disorder) were also higher in infertile women with PCOS than in women without PCOS. Conclusion The scores of many mental and personality disorders are higher in infertile women with PCOS than in women without PCOS. Thus, clinicians should prioritize recognizing and treating psychological problems of infertile women with PCOS.
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Affiliation(s)
- Mostafa Ahmadi
- Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mahbobeh Faramarzi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Zahra Basirat
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Farzan Kheirkhah
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mohammad Chehrazi
- Department of Biostatistics &Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Fatemeh Ashabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
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Tay CT, Teede HJ, Loxton D, Kulkarni J, Joham AE. Psychiatric comorbidities and adverse childhood experiences in women with self-reported polycystic ovary syndrome: An Australian population-based study. Psychoneuroendocrinology 2020; 116:104678. [PMID: 32361187 DOI: 10.1016/j.psyneuen.2020.104678] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/08/2019] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE PCOS is associated with increased risk for depression and anxiety but its association with other psychiatric disorders is less clear, especially in community drawn populations. We aimed to investigate the prevalence of psychiatric disorders in women with PCOS and examine the factors associated with psychiatric disorders in this population. METHOD A cross-sectional analysis of survey data was performed in community-recruited women born 1989-95 from the Australian Longitudinal Study of Women's Health (ALSWH). 760 and 7910 women with and without self-reported PCOS were included. The outcomes examined were self-reported depression, anxiety, post-traumatic stress disorder, bipolar affective disorder, obsessive compulsive disorder, borderline personality disorder and other disorders. The main explanatory variable was self-reported PCOS status. Other factors examined included adverse childhood experience scale (ACES), social support, perceived stress, sociodemographic and lifestyle factors. Chi-square tests were used to examine the differences in prevalence between groups. Logistic regression analyses were performed to assess factors associated with psychiatric disorders. RESULTS Women with PCOS reported a significantly higher prevalence of the psychiatric disorders examined, compared with women without PCOS. PCOS was significantly associated with depression (adjusted odds ratio (OR) 1.4, 95 % confidence interval (CI) 1.2-1.7), anxiety (adjusted OR 1.2, 95 % CI 1.0-1.5), post-traumatic stress disorder (adjusted OR 1.5, 95 % CI 1.1-1.9) and obsessive compulsive disorder (adjusted OR 1.8, 95 % CI 1.2-2.5). More women with PCOS reported adverse childhood experiences (ACES ≥4: 19.3 % vs 9.2 %) and this was the strongest factor associated with psychiatric disorders (ACES ≥4: adjusted OR 2.9, 95 % CI 2.4-3.5). CONCLUSIONS Women with PCOS had higher prevalence of various psychiatric conditions and adverse childhood experiences compared with women without PCOS. ACES was the strongest correlate of psychiatric disorders. These findings support PCOS is a reproductive, metabolic and psychological disorder and reinforces guideline recommendations to assess psychological wellbeing for in women with PCOS.
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Affiliation(s)
- Chau Thien Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia.
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Aksu E, Beyazyüz E, Albayrak Y, Potas N, Durankuş F, Uvaçin G, Beyazyüz M. Altered cooperativeness in patients with polycystic ovary syndrome. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1691357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Erson Aksu
- Vatan Hospital, Department of Gynecology and Obstetrics, İstanbul Rumeli University, İstanbul, Turkey
| | - Elmas Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Yakup Albayrak
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Nihan Potas
- Faculty of Economics and Administrative Science, Department of Healthcare Management, Ankara HacıbayramVeli University, Ankara, Turkey
| | - Ferit Durankuş
- Göztepe Education and Research Hospital, Department of Pediatrics, İstanbul Medeniyet University, İstanbul, Turkey
| | - Gamze Uvaçin
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Murat Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
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Tan RY, Grigg J, Kulkarni J. Borderline personality disorder and polycystic ovary syndrome: A review of the literature. Aust N Z J Psychiatry 2018; 52:117-128. [PMID: 28891300 DOI: 10.1177/0004867417730650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This review examines the existing evidence for the relationship between borderline personality disorder and polycystic ovary syndrome, and to identify commonalities in etiological mechanisms of borderline personality disorder and polycystic ovary syndrome that might explain the relationship between these seemingly disparate disorders. METHODS A search of Medline, EMBASE and Cochrane Central was undertaken on 5 December 2016 to identify studies investigating women with borderline personality disorder and polycystic ovary syndrome (or symptoms and markers specific to polycystic ovary syndrome). RESULTS Nine studies were identified, including three cross-sectional studies investigating symptoms of polycystic ovary syndrome in women with borderline personality disorder, two cross-sectional and one cohort study examining the prevalence of psychiatric diagnoses in women with polycystic ovary syndrome and three case reports of comorbid borderline personality disorder and polycystic ovary syndrome. CONCLUSION Overall, the literature shows women with borderline personality disorder to have higher than expected serum androgen levels and incidence of polycystic ovaries, which can be key features of polycystic ovary syndrome. However, this research is still in its infancy, which limits our understanding of this potential comorbid phenomenon. Given the emerging anecdotal and empirical evidence to date, a theoretical discussion of the potential psychoneuroendocrinological mechanism underlying the borderline personality disorder and polycystic ovary syndrome comorbidity is provided. Further rigorous studies using standardized diagnostic criteria for polycystic ovary syndrome are warranted. Specifically, the use of prospective controlled cohort studies may be able to determine the causality and temporality of observed comorbid borderline personality disorder and polycystic ovary syndrome.
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Affiliation(s)
- Raelene Ym Tan
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.,2 Monash University, Melbourne, VIC, Australia
| | - Jasmin Grigg
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
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8
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Özdemir O, Kurdoglu Z, Yıldız S, Özdemir PG, Yilmaz E. The relationship between atypical depression and insülin resistance in patients with polycystic ovary syndrome and major depression. Psychiatry Res 2017; 258:171-176. [PMID: 28168992 DOI: 10.1016/j.psychres.2016.11.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/19/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
In this study, we aimed to examine the relationship between atypical depression and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) and major depression. A total of 176 subjects (69 patients with PCOS, 58 patients with depression, and 49 healthy controls) were included in the study. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Beck Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered. Data concerning their height, weight, fasting a.m. serum levels of insulin, glucose level, and total testosterone level were collected from all participants. The body mass index (BMI) and the Homeostasis Model Assessment Insulin Resistance index (HOMA-IR) were both calculated. 34 (49.3%) of the PCOS patients met the criteria for depression. 26 (76.5%) of them had atypical depression, 8 (23.5%) had non-atypical depression. 27 (46.6%) of the 58 depressed patients had atypical depression. Insulin resistance was higher in the PCOS patients than in the control subjects and the depression patients. There was no association between atypical depression and IR in patients with PCOS and depression. We concluded that there is no relationship between IR and atypical depression.
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Affiliation(s)
- Osman Özdemir
- Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van, Turkey.
| | - Zehra Kurdoglu
- Department of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Saliha Yıldız
- Yuzuncu Yil University, Faculty of Medicine, Department of Endocrinology, Van, Turkey.
| | - Pınar Güzel Özdemir
- Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van, Turkey.
| | - Ekrem Yilmaz
- Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van, Turkey.
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9
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Psychosomatic Aspects of Polycystic Ovarian Syndrome: A Review. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2017. [DOI: 10.5812/ijpbs.6595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Ozcan Dag Z, Alpua M, Isik Y, Buturak SV, Tulmac OB, Turkel Y. The evaluation of temperament and quality of life in patients with polycystic ovary syndrome. Gynecol Endocrinol 2017; 33:250-253. [PMID: 27908217 DOI: 10.1080/09513590.2016.1254610] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIMS To evaluate the temperament and quality of life (QoL) of patients with PCOS. MATERIALS AND METHODS Fifty-three adult patients with PCOS and 38 healthy controls were enrolled in the study. Demographic characteristics including age, education and body mass index (BMI) were recorded. Affective temperaments were assessed by the temperament evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) scale. The general health-related quality of life (HRQoL) instrument used in this study was short Form 36. Hospital anxiety and depression scale (HADS) were also performed. RESULTS The patients with PCOS had significantly higher rates of depressive, anxious and hyperthymic scores compared to controls. The PCOS patients had significantly lower mean SF-36 health summary scores. CONCLUSIONS TEMPS-A seems to be an easy and reliable test to evaluate temperament in PCOS patients.
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Affiliation(s)
| | | | | | - S Visal Buturak
- c Department of Psychiatry , Faculty of Medicine, Kirikkale University , Kirikkale , Turkey
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Dalrymple KL, Walsh E, Rosenstein L, Chelminski I, Zimmerman M. Modification of the medical exclusion criterion in DSM-5 social anxiety disorder: Comorbid obesity as an example. J Affect Disord 2017; 210:230-236. [PMID: 28064111 DOI: 10.1016/j.jad.2016.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/16/2016] [Accepted: 12/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The DSM 5 modified the medical exclusion criterion from DSM-IV, which now allows for a diagnosis of social anxiety disorder (SAD) to be given if the fears are related only to the medical condition (e.g., obesity) yet cause significant impairment or distress. METHODS To examine this modification, the current study compared bariatric surgery candidates with DSM-IV SAD (n=135), modified SAD (clinically significant social fears related to obesity only; n=40), and no history of Axis I disorders (n=616) on variables related to pre-surgical problematic eating behaviors, body image dissatisfaction, functional impairment, and other characteristics related to bariatric surgery. Participants were referred by their surgeon for a psychiatric evaluation as part of the clearance process, and completed a comprehensive, semi-structured diagnostic interview and self-report measures. RESULTS There were several differences between those with DSM-IV SAD and modified SAD compared to those with no disorder (e.g., on binge and emotional eating), but the two SAD groups did not differ from each other on any of the comparisons. LIMITATIONS Results may not generalize to individuals suffering from obesity in the general population or those seeking other types of weight loss treatment. Because they were seeking psychiatric clearance, they also may have underreported symptoms/problems for fear that they would not get cleared. CONCLUSIONS Overall, the modified SAD group more closely resembled the DSM-IV SAD group rather than the no disorder group, providing further support for diagnosing SAD even when the social fears are related to obesity only.
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Affiliation(s)
- Kristy L Dalrymple
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, United States.
| | - Emily Walsh
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Lia Rosenstein
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Iwona Chelminski
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, United States
| | - Mark Zimmerman
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, United States
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12
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Cesta CE, Månsson M, Palm C, Lichtenstein P, Iliadou AN, Landén M. Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology 2016; 73:196-203. [PMID: 27513883 DOI: 10.1016/j.psyneuen.2016.08.005] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022]
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 5-15% of reproductive-aged women and characterized by high levels of circulating androgens. Given that androgens have been implicated in the aetiology of several psychiatric disorders, it was hypothesized that women with PCOS have high risk for psychiatric comorbidity. We aimed to investigate this risk amongst women with PCOS, as well as in their siblings, to elucidate if familial factors underlie any potential associations. Using the Swedish national registers, we identified all women diagnosed with PCOS between 1990 and 2013 (n=24,385), their full-siblings (n=25,921), plus matched individuals (1:10/100) from the general population and their full-siblings. Psychiatric disorder diagnoses were identified including schizophrenia, bipolar disorder, depressive and anxiety disorders, eating disorders, personality and gender identity disorder, autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), tics, attempted and completed suicide. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression and adjusted ORs (AOR) were determined by adjustment for comorbid psychiatric disorders. Overall, women with PCOS had an increased odds of having at least one psychiatric disorder (OR=1.56 [95CI%, 1.51-1.61]). Crude ORs showed associations with nearly all psychiatric disorders included in this study. Following adjustment for comorbid psychiatric disorders, women with PCOS were still at a significantly increased risk for bulimia, schizophrenia, bipolar disorder, depressive and anxiety disorders, personality disorders, with the highest AORs for ASD (AOR=1.55 [95%CI, 1.32-1.81]) and tics (AOR=1.65 [95%CI, 1.10-2.47]). Significantly higher AORs were found for ASD in both brothers and sisters of women with PCOS, and for depressive, anxiety, and schizophrenia spectrum disorders in the sisters only. Notably, the crude ORs for attempted suicide were 40% higher in women with PCOS and 16% higher in their unaffected sisters. However, the AORs were greatly attenuated indicating that underlying psychiatric comorbidity is important for this association. Women with PCOS had higher risks for a range of psychiatric disorders not shown before. Elevated risk in their siblings suggests shared familial factors between PCOS and psychiatric disorders. This study is an important first step towards identifying the underlying mechanisms for risk of psychiatric disorders in women with PCOS. Health professionals treating women with PCOS should be aware that these patients - as well as their family members - are important targets for mental health care.
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Affiliation(s)
- Carolyn E Cesta
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden.
| | - Mattias Månsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Palm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden
| | - Anastasia N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden; Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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13
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Özdil Demiryürek E, Tekin A, Çakmak E, Temizkan O, Karamustafalıoğlu O, Gökova S, Demiryürek E. Correlations between impulsiveness and biochemical parameters in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2016; 207:5-10. [PMID: 27770705 DOI: 10.1016/j.ejogrb.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/01/2016] [Accepted: 09/07/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between anger, impulsiveness, and biochemical parameters (testosterone, insulin, insulin resistance) in women with polycystic ovary syndrome. STUDY DESIGN We recruited 84 women diagnosed with polycystic ovary syndrome according to the Rotterdam diagnostic criteria. Psychiatric interviews were performed using the Structured Clinical Interview for DSM-IV Axis I Disorders. The Barratt Impulsiveness Scale and the State Trait Anger Expression Inventory were also administered to each participant. Lastly, the women's biochemical parameters, which included total testosterone, free androgen index, dehydroepiandrosterone sulfate, insulin and insulin resistance, thyroid functions, and prolactin, were measured. RESULTS A statistically significant correlation was found between participants' increasing total testosterone levels and total impulsiveness scores, and their increasing free androgen index levels and motor and non-planning-related impulsiveness (r=0.24, p=0.027; r=0.27, p=0.015; and r=0.26, p=0.017, respectively). High insulin and insulin resistance levels were associated with high non-planning-related impulsiveness scores (r=0.26, p=0.018; and r=0.26, p=0.019). Lastly, high trait anger and anger expression scores were related to high total testosterone and insulin and insulin resistance levels. CONCLUSION Androgens and glucose dysregulation seemingly affect anger expression as well as the attentional, motor, and non-planning-related impulsiveness of women with polycystic ovary syndrome.
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Affiliation(s)
- Esra Özdil Demiryürek
- Psychiatry Department, Sakarya University, Sakarya Training and Research Hospital, Turkey
| | - Atilla Tekin
- Psychiatry Department, Bolu Mental and Psychiatric Disease Hospital, Turkey.
| | - Engin Çakmak
- Psychiatry Department, Şişli Hamidiye Etfal Training and Research Hospital, Turkey
| | - Osman Temizkan
- Gynaecology and Obstetrics Department, Şişli Hamidiye Etfal Training and Research Hospital, Turkey
| | | | - Sibel Gökova
- Gynaecology and Obstetrics Department, Şişli Hamidiye Etfal Training and Research Hospital, Turkey
| | - Enes Demiryürek
- Neurology Department, Sakarya University, Sakarya Training and Research Hospital, Turkey
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Kayhan F, Alptekin H, Kayhan A. Mood and anxiety disorders in patients with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol 2016; 199:192-7. [DOI: 10.1016/j.ejogrb.2016.02.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
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15
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Blay SL, Aguiar JVA, Passos IC. Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis. Neuropsychiatr Dis Treat 2016; 12:2895-2903. [PMID: 27877043 PMCID: PMC5108561 DOI: 10.2147/ndt.s91700] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. METHODS PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive-compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. RESULTS Six studies were included in the meta-analysis; of these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR) =2.76; 95% confidence interval (CI) 1.26 to 6.02; Log OR =1.013; P=0.011). The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR =3.51; 95% CI 1.97 to 6.24; Log OR =1.255; P<0.001). CONCLUSION Anxiety and depression symptoms are more prevalent in patients with PCOS.
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Affiliation(s)
- Sergio Luís Blay
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | | | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
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16
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Correa JB, Sperry SL, Darkes J. A case report demonstrating the efficacy of a comprehensive cognitive-behavioral therapy approach for treating anxiety, depression, and problematic eating in polycystic ovarian syndrome. Arch Womens Ment Health 2015; 18:649-54. [PMID: 25627019 DOI: 10.1007/s00737-015-0506-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
Abstract
Despite elevated prevalence of anxiety and depression among women with polycystic ovarian syndrome (PCOS), there is a dearth of evidence-based psychotherapies to treat mood-related symptoms among this population. This case report describes the efficacy of The PCOS Workbook in treating symptoms of anxiety, depression, and problematic eating in a 19-year-old female previously diagnosed with PCOS. Using the cognitive-behavioral framework presented in the workbook, the participant experienced a significant reduction in symptoms of anxiety, depression, problematic eating, and general psychosocial dysfunction while simultaneously losing a significant amount of weight during treatment. Six months after the termination of treatment, the participant maintained several improvements in psychological functioning, although she did report a resumption of problematic eating and experience weight regain. These findings provide initial empirical support for the efficacy of this manualized psychotherapy at improving psychosocial functioning in women with PCOS. Recommendations on ways to best utilize this resource and enhance its long-term efficacy, particularly when intervening for problematic eating, are also discussed.
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Affiliation(s)
- John B Correa
- Department of Psychology, University of South Florida, 4202 East Fowler Avenue, PCD 4118G, Tampa, FL, 33620, USA
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17
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Hung JH, Hu LY, Tsai SJ, Yang AC, Huang MW, Chen PM, Wang SL, Lu T, Shen CC. Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PLoS One 2014; 9:e97041. [PMID: 24816764 PMCID: PMC4016227 DOI: 10.1371/journal.pone.0097041] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. A higher prevalence of psychiatric comorbidities, including depressive disorder, anxiety disorder, and bipolar disorder has been proved in patients with PCOS. However, a clear temporal causal relationship between PCOS and psychiatric disorders has not been well established. OBJECTIVE We explored the relationship between PCOS and the subsequent development of psychiatric disorders including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder. METHODS We identified patients who were diagnosed with PCOS by an obstetrician-gynecologist in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without PCOS who were matched according to age and sex. The occurrence of subsequent new-onset psychiatric disorders was evaluated in both cohorts based on diagnoses made by psychiatrists. RESULTS The PCOS cohort consisted of 5431 patients, and the comparison cohort consisted of 21,724 matched control patients without PCOS. The incidence of depressive disorder (hazard ratio [HR] 1.296, 95% confidence interval [CI] 1.084-.550), anxiety disorder (HR 1.392, 95% CI 1.121-1.729), and sleep disorder (HR 1.495, 95% CI 1.176-1.899) were higher among the PCOS patients than among the patients in the comparison cohort. In addition, a higher incidence of newly diagnosed depressive disorder, anxiety disorder, and sleep disorder remained significantly increased in all of the stratified follow-up durations (0-1, 1-5, ≥5 y). CONCLUSIONS PCOS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder. The risk of newly diagnosed bipolar disorder, which has often been reported in the literature to be comorbid with PCOS, was not significantly elevated.
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Affiliation(s)
- Jeng-Hsiu Hung
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 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
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C. Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Min-Wei Huang
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Pan-Ming Chen
- Department of Psychiatry, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan
| | - Shu-Li Wang
- Department of Dental Laboratory Technology, entral Taiwan University of Science and Technology, Taichung, 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
- Department of information magagement, National Chung-Cheng University, Chiayi, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Scaruffi E, Gambineri A, Cattaneo S, Turra J, Vettor R, Mioni R. Personality and psychiatric disorders in women affected by polycystic ovary syndrome. Front Endocrinol (Lausanne) 2014; 5:185. [PMID: 25429283 PMCID: PMC4228916 DOI: 10.3389/fendo.2014.00185] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/12/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among fertile women. Studies show reduced quality of life, anxiety, depression, body dissatisfaction, eating disorder, and sexual dysfunction, but the etiology of these disturbs remains still debated. The aim of our study is to verify whether this hyperandrogenic syndrome characterizes a strong psycho(patho)logical personality. METHOD Sixty PCOS subjects (mean age 25.8 ± 4.7 years) were evaluated by anthropometric, metabolic, hormonal, clinical, and psychological parameters. After the certainty of the diagnosis of PCOS, the Rorschach test, according to Exner's comprehensive system (CS) and the Millon Clinical Multiaxial Inventory-III (MCMI-III) were administered to each patient. The control group, on which the comparison was carried out, was composed by 40 healthy and aged compared women who were exclusively administered the Rorschach test according to CS. RESULTS MCMI-III evidenced axis II DSM-IV personality disorders [4.1% schizoid, depressive, sadistic, negativistic (passive-aggressive), and masochistic, 6.1% avoiding, 12.2% dependent, 20.4% histrionic, 16.3% narcissistic, 2.0% obsessive-compulsive], and axis I DSM-IV psychiatric disorders: 10.2% anxiety, 2.0% somatoform disorder and bipolar disorder, 16.3% major depressive disorder. Finally, we found 44.9% delusional disorder and 4.1% thought disorder. Rorschach test's results show 53.1% reduced coping abilities and social skills, 55.1% depression, 30.6% perceptual distortion and cognitive slippage, 24.5% constantly alert and worry, 8.1% at risk for suicide, and finally about 50% of our patients had chronic stress. CONCLUSION PCOS women have relevant personality and psychiatric disorders, when compared with normal subjects.
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Affiliation(s)
| | - Alessandra Gambineri
- Division of Endocrinology, Department of Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefania Cattaneo
- Scuola Universitaria Interfacoltà in Scienze Motorie (SUISM), University of Turin, Turin, Italy
| | - Jenni Turra
- Clinical Medical 3, Department of Medicine, Hospital of Padua, University of Padua, Padua, Italy
| | - Roberto Vettor
- Clinical Medical 3, Department of Medicine, Hospital of Padua, University of Padua, Padua, Italy
| | - Roberto Mioni
- Clinical Medical 3, Department of Medicine, Hospital of Padua, University of Padua, Padua, Italy
- *Correspondence: Roberto Mioni, Clinica Medica 3, Università di Padova, 9th floor Monoblocco, Azienda Ospedaliera di Padova Via Giustiniani 2, Padova 35128, Italy e-mail:
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