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Hayanga B, Stafford M, Bécares L. Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis. BMC Public Health 2023; 23:178. [PMID: 36703163 PMCID: PMC9879746 DOI: 10.1186/s12889-022-14940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.
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Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
| | - Laia Bécares
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Denzel AD, Harte JM, van den Bergh M, Scherder EJA. Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders. BJPsych Open 2018; 4:18-28. [PMID: 29388907 PMCID: PMC6020278 DOI: 10.1192/bjo.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Black and minority ethnic (BME) groups are known to have higher prevalences of psychotic disorders and are over-represented in western penitentiaries and forensic psychiatric institutions. Research from regular mental healthcare settings suggests that they could show different and more severe psychotic symptoms. Aims To explore ethnic variations in severity of symptomatology of BME and non-BME detainees with psychotic disorders. METHOD In this study, 824 patients with psychotic disorders from seven different ethnic groups, imprisoned in a penitentiary psychiatric centre in the Netherlands, were compared on symptom severity and symptom representation using the BPRS-E clinical interview. Data were analysed by means of a multilevel analysis. RESULTS BME patients with psychotic disorders are over-represented in forensic psychiatry, and symptom profiles of prisoners with psychotic disorders vary by ethnicity. Additionally, severity levels of overall psychopathology differ between ethnic groups: patients with an ethnic majority status show more severe levels of psychopathology compared with BME patients. CONCLUSIONS There are differences in symptom severity and symptom profiles between BME patients and non-BME patients. Disregarding these differences could have an adverse effect on the outcome of the treatment. Possible explanations and clinical impact are discussed. Declaration of interest None.
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Affiliation(s)
- A Dorina Denzel
- Department of Clinical Neuropsychology,VU University,Amsterdam,van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands
| | - Joke M Harte
- Netherlands Institute for the Study of Crime and Law Enforcement,(NSCR);Department of Criminology,VU University Amsterdam,de Boelelaan 1105,Initium (1A-46),1081 HV Amsterdam,the Netherlands
| | - Mattis van den Bergh
- Department of Methodology and Statistics,Tilburg University,P.O. Box 90153,5000 LE Tilburg,the Netherlands
| | - Erik J A Scherder
- Professor,Department of Clinical Neuropsychology,VU University,Amsterdam,van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands
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Donfrancesco R, Di Trani M, Andriola E, Leone D, Torrioli MG, Passarelli F, DelBello MP. Bipolar Disorder in Children With ADHD: A Clinical Sample Study. J Atten Disord 2017; 21:715-720. [PMID: 25015582 DOI: 10.1177/1087054714539999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the impact of early-onset bipolar disorder (pediatric bipolar disorder [PBD]) on ADHD. METHOD We compared ADHD symptom severity, ADHD subtype distribution, and rates of comorbid and familial psychiatric disorders between 49 ADHD children with comorbid PBD and 320 ADHD children without PBD. RESULTS Children with ADHD and PBD showed higher scores in the Hyperactive and Inattentive subscales of the ADHD Rating Scale, than children with ADHD alone. The frequency of combined subtype was significantly higher in ADHD children with PBD, than in those with ADHD alone. ADHD children with PBD showed a higher rate of familial psychiatric disorders than ADHD children without PBD. The rate of conduct disorder was significantly greater in children with PBD and ADHD compared with children with ADHD alone. CONCLUSION ADHD along with PBD presents with several characteristics that distinguish it from ADHD alone, suggesting that these may be distinct disorders.
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Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates, 1950-2013. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1039-55. [PMID: 25660551 PMCID: PMC4464051 DOI: 10.1007/s00127-015-1021-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/29/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE Increased risk of schizophrenia and other psychotic disorders among black Caribbean migrants and their descendants have been described since the 1960s. It remains unclear whether this risk varies over time, between rural and urban areas, or according to methodological artefact. METHODS We conducted a systematic review of the incidence of adult-onset psychotic disorders in black Caribbean groups relative to the baseline population in England, published 1950-2013. Subject to sufficient data (N ≥ 5) we used random effects meta-analyses to estimate pooled incidence rates (IR) and rate ratios (IRR) of seven psychotic disorder outcomes, and meta-regression to inspect whether any variation was attributable to study-level methodological features, including case ascertainment, denominator reliability, choice of baseline population and study quality. RESULTS Eighteen studies met inclusion for review. Sixteen demonstrated statistically significant elevated incidence rates in the black Caribbean group, present across all major psychotic disorders, including schizophrenia and bipolar disorder. Methodological quality increased over time (p = 0.01), but was not associated with estimated IR or IRR. For schizophrenia (N = 11 studies) the pooled IRR in the black Caribbean group was 4.7 (95 % CI 3.9-5.7) relative to the baseline; no evidence of publication bias was observed. We found weak evidence to suggest schizophrenia IRRs were smaller from studies in more urban settings (odds ratio 0.98; 95 % CI 0.96-1.00; p = 0.06). CONCLUSIONS Higher incidence rates of psychotic disorders have been present for more than 60 years amongst black Caribbean ethnic groups in England, despite improved study methodologies over time. Aetiological explanations appear to more parsimoniously account for this excess than methodological biases.
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Berg AO, Aas M, Larsson S, Nerhus M, Hauff E, Andreassen OA, Melle I. Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder. Psychol Med 2015; 45:133-142. [PMID: 25065296 DOI: 10.1017/s0033291714001135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. METHOD In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. RESULTS Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations. CONCLUSIONS More childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.
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Affiliation(s)
- A O Berg
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - M Aas
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - S Larsson
- Department of Research and Development, Division of Mental Health and Addiction,Oslo University Hospital,Oslo,Norway
| | - M Nerhus
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - E Hauff
- Department of Research and Development, Division of Mental Health and Addiction,Oslo University Hospital,Oslo,Norway
| | - O A Andreassen
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - I Melle
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
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The impact of immigration and visible minority status on psychosis symptom profile. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1747-57. [PMID: 24927946 DOI: 10.1007/s00127-014-0897-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Immigrants have heightened risks of psychotic disorders, and it is proposed that migration influences symptom profiles. The purpose of this study was to investigate if either migration experience and/or visible minority status affected symptom profiles, using a cross-culturally validated five-factor model of the Positive and Negative Syndrome Scale (PANSS), in patients with broadly defined psychotic disorders. METHODS PANSS was assessed in a large catchment area based sample of patients with psychotic disorders verified with the Structured Clinical Interview for DSM-IV (n = 1,081). Symptom profiles based on Wallwork et al. five-factor model were compared for Norwegians (73 %), white immigrants (10.5 %), and visible minority groups (16.5 %). RESULTS Visible minorities were significantly younger, had less education, more often a schizophrenia diagnosis and higher PANSS positive, negative and disorganized/concrete factor scores than Norwegians and white immigrants. After controlling for confounders only the items "Delusions" and "Difficulty in abstract thinking" differed between groups. Multivariate analyses indicated that these items were not associated with immigration per se, but rather belonging to a visible minority. CONCLUSION We found mostly similarities in psychotic symptoms between immigrants and Norwegians when using a cross-culturally validated five-factor model of the PANSS. Immigration did not directly influence psychotic symptom profiles but visible minority groups had higher levels of "Delusions" and "Difficulty in abstract thinking", both symptoms that are partially context dependent.
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Prieto M, Cuéllar-Barboza A, Bobo W, Roger V, Bellivier F, Leboyer M, West C, Frye M. Risk of myocardial infarction and stroke in bipolar disorder: a systematic review and exploratory meta-analysis. Acta Psychiatr Scand 2014; 130:342-53. [PMID: 24850482 PMCID: PMC5023016 DOI: 10.1111/acps.12293] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the evidence on and estimate the risk of myocardial infarction and stroke in bipolar disorder. METHOD A systematic search using MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and bibliographies (1946 - May, 2013) was conducted. Case-control and cohort studies of bipolar disorder patients age 15 or older with myocardial infarction or stroke as outcomes were included. Two independent reviewers extracted data and assessed quality. Estimates of effect were summarized using random-effects meta-analysis. RESULTS Five cohort studies including 13 115 911 participants (27 092 bipolar) were included. Due to the use of registers, different statistical methods, and inconsistent adjustment for confounders, there was significant methodological heterogeneity among studies. The exploratory meta-analysis yielded no evidence for a significant increase in the risk of myocardial infarction: [relative risk (RR): 1.09, 95% CI 0.96-1.24, P = 0.20; I(2) = 6%]. While there was evidence of significant study heterogeneity, the risk of stroke in bipolar disorder was significantly increased (RR 1.74, 95% CI 1.29-2.35; P = 0.0003; I(2) = 83%). CONCLUSION There may be a differential risk of myocardial infarction and stroke in patients with bipolar disorder. Confidence in these pooled estimates was limited by the small number of studies, significant heterogeneity and dissimilar methodological features.
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Affiliation(s)
- M.L. Prieto
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA,Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile
| | - A.B. Cuéllar-Barboza
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA,Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México
| | - W.V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - V.L. Roger
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - F. Bellivier
- Psychiatric Department, APHP Hôpital F. Widal, Paris, France,INSERM, UMR-S1144,FondaMenta Foundation
| | - M. Leboyer
- FondaMenta Foundation,Faculté de Médecine, Université Paris Est,INSERM, U955, Psychiatrie Génétique,Département de Psychiatrie, Hôpital H. Mondor-A. Chenevier, Créteil, France
| | - C.P. West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M.A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
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Dealberto MJ. Clinical symptoms of psychotic episodes and 25-hydroxy vitamin D serum levels in black first-generation immigrants. Acta Psychiatr Scand 2013; 128:475-87. [PMID: 23405850 DOI: 10.1111/acps.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Dark-skinned immigrants have a higher risk for schizophrenia and other psychoses than other immigrants. The first British studies reported that first-generation immigrants (FGIs) from the Caribbean presented atypical psychoses. This study examines the characteristics of psychotic episodes in black FGIs to Canada. METHOD The charts of 18 FGIs from Africa and Haiti, extracted from a series of 20 black patients consecutively admitted to Psychiatry, were retrospectively reviewed regarding clinical features, diagnoses and vitamin D levels. RESULTS Young FGIs presented acute psychotic episodes with abrupt onset, florid positive symptoms, few negative symptoms and good evolution. The onset was more insidious in older FGIs. Overall, catatonia was very frequent (28%), and mood symptoms still more frequent (44%). No cognitive decline was observed during follow-up. Serum levels of 25-hydroxy vitamin D were in the insufficiency range. Supplementation at 1000 IU/day did not restore normal levels. CONCLUSION The clinical features of psychotic episodes in black FGIs are similar to those reported in dark-skinned FGIs to other countries. They are also observed in other immigrants and in non-immigrants. These atypical psychoses are possibly related to a recent vitamin D deficit. This hypothesis should be tested by clinical trials of sufficient vitamin D supplementation.
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Affiliation(s)
- M-J Dealberto
- Department of Community Health and Epidemiology, Carruthers Hall, Queen's University, Kingston, Ontario, K7L 3N6, Canada
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Subramaniam M, Abdin E, Vaingankar JA, Chong SA. Prevalence, correlates, comorbidity and severity of bipolar disorder: results from the Singapore Mental Health Study. J Affect Disord 2013; 146:189-96. [PMID: 23017543 DOI: 10.1016/j.jad.2012.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bipolar disorder (BPD) is a serious mental disorder and a leading cause of premature mortality worldwide. Prevalence and risk factors of BPD have not been well studied in multi-ethnic Asian populations. The study aimed to establish the prevalence of BPD and examine the associated socio-demographic correlates, comorbidity, severity, impairment and treatment contact in the Singapore resident population. METHODS The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of the resident (citizens and permanent residents) population in Singapore. The diagnoses were established using the World Mental Health Composite International Diagnostic Interview version 3.0 (CIDI 3.0) diagnostic modules for lifetime and 12-month prevalence of select mental illnesses including BPD. RESULTS The lifetime and 12-month prevalence estimates for BPD were 1.2% and 0.6%, respectively. More than two-thirds (69.4%) of respondents with lifetime BPD had other lifetime mental disorders, and approximately half (52.6%) of respondents with lifetime BPD also had at least one chronic physical condition; chronic pain was the most prevalent comorbid condition. LIMITATIONS The data was based on respondents' self-report and there could be an element of recall bias and under-reporting. We also did not obtain information on mixed episodes and rapid cycling disorders. CONCLUSIONS The high comorbidity, clinical severity, and role impairment associated with BPD exert a heavy toll at an individual and societal level.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, 10, Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
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Choi MR, Eun HJ, Yoo TP, Yun Y, Wood C, Kase M, Park JI, Yang JC. The effects of sociodemographic factors on psychiatric diagnosis. Psychiatry Investig 2012; 9:199-208. [PMID: 22993517 PMCID: PMC3440467 DOI: 10.4306/pi.2012.9.3.199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/27/2012] [Accepted: 04/27/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Several studies have reported that ethnic differences influence psychiatric diagnoses. Some previous studies reported that African Americans and Hispanics are diagnosed with schizophrenia spectrum disorders more frequently than Caucasians, and that Caucasians are more likely to be diagnosed with affective disorders than other ethnic groups. We sought to identify associations between sociodemographic factors and psychiatric diagnosis. METHODS We retrospectively examined the medical records of all psychiatric inpatients (ages over 18 years) treated at Kern county mental hospital (n=2,051) between July 2003 and March 2007 for demographic, clinical information, and discharge diagnoses. RESULTS African American and Hispanic males were more frequently diagnosed with schizophrenia spectrum disorders than Caucasians, whereas Caucasian females were more frequently diagnosed with affective disorders than females in the other ethnic groups, suggesting that patient ethnicity and gender may influence clinical diagnoses. Demographic variables, that is, a lower education, failure of marriage, homelessness, and low quality insurance, were found to be significantly associated with a diagnosis of schizophrenia spectrum disorders after adjusting for clinical variables. And, the presence of a family psychiatric history, failure of marriage, not-homelessness, and quality insurance were found to be associated with a diagnosis of affective disorders. CONCLUSION Our results show that these demographic factors, including ethnicity, have effects on diagnoses in psychiatric inpatients. Furthermore, these variables may help prediction of psychiatric diagnoses.
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Affiliation(s)
- Mal Rye Choi
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju, Republic of Korea
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Hun-Jeong Eun
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Tai P. Yoo
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Youngmi Yun
- California State University at Bakersfield, Bakersfield, CA, USA
| | - Christopher Wood
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Michael Kase
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Jong-Il Park
- Department of Psychiatry, Chonbuk National University Hospital and Research Institute of Clinical Medicine, Jeonju, Republic of Korea
| | - Jong-Chul Yang
- Department of Psychiatry, Chonbuk National University Hospital and Research Institute of Clinical Medicine, Jeonju, Republic of Korea
- Department of Psychiatry, Chonbuk National University Medical School and Institute for Medical Sciences, Jeonju, Republic of Korea
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Ethical issues in a study of bipolar disorder and HIV risk among African-American men who have sex with men: case study in the ethics of mental health research. J Nerv Ment Dis 2012; 200:236-41. [PMID: 22373761 DOI: 10.1097/nmd.0b013e318247cb43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
African-American men who have sex with men (MSM) are at increased risk of HIV infection, as are individuals with severe mental illness. This study was conducted at the behest of members of the African-American MSM community in Cleveland, Ohio, to assess the co-occurrence of HIV risk and bipolar disorder among African-American MSM. A sample of 125 participants was recruited via flyers and word of mouth at venues used by members of this community. Individuals were assessed for HIV risk and severe mental illness. Various ethical issues were presented, including participant capacity and voluntariness and the risk-benefit ratio. Divergent perspectives of the local institutional review board and the community advisory group with respect to the risks and benefits of participation required reconciliation before the study could proceed. Solutions for the resolution of such conflicts are discussed.
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Haeri S, Williams J, Kopeykina I, Johnson J, Newmark A, Cohen L, Galynker I. Disparities in diagnosis of bipolar disorder in individuals of African and European descent: a review. J Psychiatr Pract 2011; 17:394-403. [PMID: 22108396 DOI: 10.1097/01.pra.0000407962.49851.ef] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Over the past 3 decades, a wide range of studies in the United States and the United Kingdom has reported that white individuals are more likely to be diagnosed with bipolar and affective disorders, whereas black individuals appear to be at higher risk for schizophrenia spectrum diagnoses. Despite the pressing need for strategies aimed at eliminating racial and cultural disparities in diagnosis and treatment of bipolar disorder, no systematic review of the existing literature in this area has been done. This study draws together the disparate strands of information in a comprehensive overview of the research base in this area. METHODS An electronic literature search of the Medline and PsychINFO databases was conducted in October 2009, supplemented by a review of references in the identified articles, for a total of 51 articles included in this qualitative review. RESULTS Black patients have consistently been found to be more likely than white patients to be diagnosed with schizophrenia rather than bipolar disorder. Four factors were identified as potential contributors to racial disparities in diagnostic rates: clinical presentation and expression of symptoms, access to care, help-seeking behaviors, and clinician judgment. CONCLUSION Despite efforts to curtail the phenomenon, racial disparities in diagnosis of bipolar disorder persist. Racial and cultural elements may affect how patients manifest behaviors and symptoms and how these are interpreted and attributed by clinicians in the diagnostic process. As an appropriate diagnosis determines treatment options and is central to quality of care, incorrect diagnosis can potentially have a negative impact on treatment effectiveness and accuracy of prognosis.
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Berg AO, Melle I, Rossberg JI, Romm KL, Larsson S, Lagerberg TV, Andreassen OA, Hauff E. Perceived discrimination is associated with severity of positive and depression/anxiety symptoms in immigrants with psychosis: a cross-sectional study. BMC Psychiatry 2011; 11:77. [PMID: 21548949 PMCID: PMC3115847 DOI: 10.1186/1471-244x-11-77] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 05/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigration status is a significant risk factor for psychotic disorders, and a number of studies have reported more severe positive and affective symptoms among immigrant and ethnic minority groups. We investigated if perceived discrimination was associated with the severity of these symptoms among immigrants in Norway with psychotic disorders. METHODS Cross-sectional analyses of 90 immigrant patients (66% first-generation, 68% from Asia/Africa) in treatment for psychotic disorders were assessed for DSM-IV diagnoses with the Structured Clinical Interview for DSM Disorders (SCID-I, sections A-E) and for present symptom severity by The Structured Positive and Negative Syndrome Scale (SCI-PANSS). Perceived discrimination was assessed by a self-report questionnaire developed for the Immigrant Youth in Cultural Transition Study. RESULTS Perceived discrimination correlated with positive psychotic (r=0.264, p<0.05) and depression/anxiety symptoms (r=0.282, p<0.01), but not negative, cognitive, or excitement symptoms. Perceived discrimination also functioned as a partial mediator for symptom severity in African immigrants. Multiple linear regression analyses controlling for possible confounders revealed that perceived discrimination explained approximately 10% of the variance in positive and depression/anxiety symptoms in the statistical model. CONCLUSIONS Among immigrants with psychotic disorders, visible minority status was associated with perceived discrimination and with more severe positive and depression/anxiety symptoms. These results suggest that context-specific stressful environmental factors influence specific symptom patterns and severity. This has important implications for preventive strategies and treatment of this vulnerable patient group.
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Affiliation(s)
- Akiah O Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Ivar Rossberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin Lie Romm
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sara Larsson
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trine V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Edvard Hauff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Donfrancesco R, Miano S, Martines F, Ferrante L, Melegari MG, Masi G. Bipolar disorder co-morbidity in children with attention deficit hyperactivity disorder. Psychiatry Res 2011; 186:333-7. [PMID: 20692046 DOI: 10.1016/j.psychres.2010.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 07/05/2010] [Accepted: 07/08/2010] [Indexed: 11/30/2022]
Abstract
The present study aimed at: (1) exploring rate and clinical features of superimposed bipolar disorder (BD) in Italian children with attention deficit hyperactivity disorder (ADHD), compared with a community sample, matched for age and gender; (2) exploring predictors of BD in ADHD children, by comparing ADHD children with or without superimposed BD. We studied 173 consecutive drug-naïve outpatients with ADHD (156 males and 17 females, mean age of 9.2 ± 2.3years, age range 6-17.5 years), diagnosed with a clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL)); the control group consisted of a community-based sample of 100 healthy children. The rate of children with a diagnosis of BD was higher in the ADHD group (29/173, 16.7%) compared with controls (1/100, 1%), (P<0.001). Among the 29 children with ADHD+BD, 16 (55.2%) had a Bipolar Disorder-Not Otherwise Specified (BD-NOS), and 11 (37.9%) showed ultrarapid cycling. Compared with children with ADHD without BD, they showed a higher rate of combined sub-type (21/29, 72.4%), a higher score at ADHD-Rating Scale (total score and hyperactivity subscale), higher rates of major depression, oppositional defiant disorder and conduct disorder. In summary, children with ADHD present a higher risk for developing a superimposed BD. The identification of clinical features with an increased risk of BD can improve diagnosis, prognosis and treatments.
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Lus G, Mukaddes NM. Co-morbidity of bipolar disorder in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in an outpatient Turkish sample. World J Biol Psychiatry 2010; 10:488-94. [PMID: 19401947 DOI: 10.1080/15622970902929876] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the prevalence of bipolar disorder (BPD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to compare the clinical characteristics of a group with ADHD with a group with co-morbidity of ADHD and BPD. The study includes 121 individuals, aged 6-16 years, with a diagnosis of ADHD. Co-morbidity of BPD was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL) and the Parent-Young Mania Rating Scale (P-YMRS). The Child Behavior Checklist (CBCL) was used to assess psychopathology in two groups. Ten children (8.3%) in the ADHD sample received the additional diagnosis of BPD. The ADHD + BPD group had significantly higher scores than the ADHD group on withdrawn, anxiety/depression, social problems, thought problems, attention problems, aggression, externalization, total score items of CBCL, and on the P-YMRS. It could be concluded that BPD is not a rare co-morbid condition in children with diagnosis of ADHD and subjects with this co-morbidity show more severe psychopathology than subjects with pure ADHD. Differential diagnosis of BPD disorder in subjects with ADHD seems crucial in establishing an effective treatment program, and therefore improving mental health outcomes.
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Affiliation(s)
- Gozde Lus
- Child Psychiatry Department, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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17
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Nery-Fernandes F, Quarantini LC, Galvão-De-Almeida A, Rocha MV, Kapczinski F, Miranda-Scippa A. Lower rates of comorbidities in euthymic bipolar patients. World J Biol Psychiatry 2010; 10:474-9. [PMID: 19401946 DOI: 10.1080/15622970802688929] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study assessed the frequency of axis I psychiatric comorbidities in euthymic bipolar patients and the clinical differences between patients with and without comorbidities. METHOD In this study, 62 euthymic bipolar outpatients assessed using a clinical questionnaire underwent a structured diagnostic interview (SCID/CV-DSM-IV) as well as a symptoms evaluation (YMRS and HAM-D-17). RESULTS The lifetime frequency of patients with comorbidities was 27.4%. The most frequent comorbidities were anxiety disorders (33.7%), and the positive associated variables were more advanced age, the presence of a steady partner, a first episode of the depressive type and lifetime attempted suicide. CONCLUSIONS The lower frequency of comorbidities found in our study in comparison with those described in the literature may be due to the evaluation restricted only to euthymic patients. This suggests the importance of assessing psychiatric comorbidity in bipolar individuals while not in acute phases of the disorder.
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Affiliation(s)
- Fabiana Nery-Fernandes
- Center for Study and Treatment of Affective Disorders (CETTA), Universidade Federal da Bahia, Salvador-Ba, Brazil.
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18
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Racial/Ethnic group differences in bipolar symptomatology in a community sample of persons with bipolar I disorder. J Nerv Ment Dis 2010; 198:16-21. [PMID: 20061864 DOI: 10.1097/nmd.0b013e3181c818c5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To better understand the problems associated with diagnosis of bipolar disorder, especially problems related to race and ethnicity, this study compared whites, African Americans, and Latinos with bipolar I disorder in the presentation of manic symptoms, depressive episodes, functional impairments (Short Form-12), and self-reports of schizophrenia diagnosis. Data for this study were derived from the 2001 National Epidemiologic Survey on Alcohol and Related Conditions, which are nationally representative of United States households. African Americans and Latinos expressed similar rates in presentation of 14 out of 16 manic symptoms compared with whites, with the exception of grandiosity/self-esteem, in which they were more likely to exhibit this symptom compared with whites. Higher rates of depressive episodes were observed among whites, and these episodes occurred significantly earlier compared with African Americans and Latinos. Latinos had slightly higher vitality scores on the SF-12 measures after adjusting for sociodemographic and clinical factors, but no other differences across the groups were observed. Overall, these data show that the expression and functional impairments of bipolar I disorder is very similar across racial ethnic groups using this community-based sample. This is the first community-based study making such comparisons, with results suggesting that provider biases are more likely to explain problems in misdiagnosis than fundamental differences in the presentation of bipolar disorder across racial/ethnic groups.
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Bhavsar V, Bhugra D. Bethlem's Irish: migration and distress in nineteenth-century London. HISTORY OF PSYCHIATRY 2009; 20:184-198. [PMID: 19856682 DOI: 10.1177/0957154x08091817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Association between migration and mental illness is widely reported. This study aimed to gain insight into the mental health of Irish migrants into Britain in the years 1843-53. Casebooks from the period were examined for Irish ethnicity, and clinical profiles were compared with those of age-matched control samples. Irish-born patients were found to have a greater proportion of diagnoses of mania than controls (p < or = 0.01). They were more likely to be admitted for 12 months or longer (p < or = 0.001) and more likely to receive religious attributions for illnesses by the treating physician. The more common diagnosis of mania in the Irish group can be explained in terms of the effects of migration, differences in idioms of distress, or in terms of prejudice.
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20
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Brunelle J, Consoli A, Tanguy ML, Huynh C, Perisse D, Deniau E, Guilé JM, Gérardin P, Cohen D. Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents: a chart review. Eur Child Adolesc Psychiatry 2009; 18:185-93. [PMID: 19129964 DOI: 10.1007/s00787-008-0715-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 07/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O'Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. OBJECTIVE To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. METHODS A total of 80 subjects, aged 12-20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic and clinical data were extracted by reviewing patients' charts. We used a multivariate analysis to evaluate short-term outcome predictors. RESULTS The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirty-three (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. CONCLUSION These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.
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Affiliation(s)
- Julie Brunelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpétrière, 47 Bd de l'Hôpital, PARIS cedex 13, France
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21
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Fajutrao L, Locklear J, Priaulx J, Heyes A. A systematic review of the evidence of the burden of bipolar disorder in Europe. Clin Pract Epidemiol Ment Health 2009; 5:3. [PMID: 19166608 PMCID: PMC2646705 DOI: 10.1186/1745-0179-5-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 01/23/2009] [Indexed: 11/10/2022]
Abstract
Background Bipolar disorder is recognized as a major mental health issue, and its economic impact has been examined in the United States. However, there exists a general scarcity of published studies and lack of standardized data on the burden of the illness across European countries. In this systematic literature review, we highlight the epidemiological, clinical, and economic outcomes of bipolar disorder in Europe. Methods A systematic review of publications from the last 10 years relating to the burden of bipolar disorder was conducted, including studies on epidemiology, patient-related issues, and costs. Results Data from the UK, Germany, and Italy indicated a prevalence of bipolar disorder of ~1%, and a misdiagnosis rate of 70% from Spain. In one study, up to 75% of patients had at least one DSM-IV comorbidity, commonly anxiety disorders and substance/alcohol abuse. Attempted suicide rates varied between 21%–54%. In the UK, the estimated rate of premature mortality of patients with bipolar I disorder was 18%. The chronicity of bipolar disorder exerted a profound and debilitating effect on the patient. In Germany, 70% of patients were underemployed, and 72% received disability payments. In Italy, 63%–67% of patients were unemployed. In the UK, the annual costs of unemployment and suicide were £1510 million and £179 million, respectively, at 1999/2000 prices. The estimated UK national cost of bipolar disorder was £4.59 billion, with hospitalization during acute episodes representing the largest component. Conclusion Bipolar disorder is a major and underestimated health problem in Europe. A number of issues impact on the economic burden of the disease, such as comorbidities, suicide, early death, unemployment or underemployment. Direct costs of bipolar disorder are mainly associated with hospitalization during acute episodes. Indirect costs are a major contributor to the overall economic burden but are not always recognized in research studies.
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Affiliation(s)
- Liberty Fajutrao
- Health Economics and Outcomes, AstraZeneca R&D, Södertälje, Sweden.
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22
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Toward the delineation of mania subtypes in the French National EPIMAN-II Mille Cohort. Comparisons with prior cluster analytic investigations. Eur Arch Psychiatry Clin Neurosci 2008; 258:497-504. [PMID: 18574610 DOI: 10.1007/s00406-008-0823-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/15/2008] [Indexed: 01/30/2023]
Abstract
BACKGROUND Knowledge about psychopathologic presentations of mania in current clinical practice has to be refined in order to improve diagnosis and treatment. METHODS One thousand ninety manic patients included in the French National Study EPIMAN-II Mille were submitted to a cluster analysis on the basis of multiple variables related to the history of bipolar illness and symptoms of the current episode. RESULTS Four clusters were identified: "classic mania" (29.3% of patients) with less severe mania; "psychotic mania" (22.7%) with psychotic symptoms, more severe mania, younger age and social impairment; "depressive mania" (30.4%) characterized by female gender, suicide attempts, high number of previous episodes and residual symptoms; and "dual mania" (17.6%) characterized by male gender, substance use, earlier onset and poor compliance. Patients groups also differed in manic symptoms, marital status, stressors preceding illness onset, prior diagnoses, first episode polarity and temperamental characteristics. LIMITATIONS Cross-sectional assessment of patients. CONCLUSIONS In comparing our findings with those of four prior cluster analytic studies, we integrate clinical characteristics of mania subtypes found in this very large representative French sample in contemporary practice, we suggest how such convergence of data may help improve earlier recognition, differential response to different treatments, and prevention of these subtypes. We finally suggest that such subtyping might provide clues to phenotype delineation suitable for pharmacogenetic investigations.
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23
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Diler RS, Uguz S, Seydaoglu G, Erol N, Avci A. Differentiating bipolar disorder in Turkish prepubertal children with attention-deficit hyperactivity disorder. Bipolar Disord 2007; 9:243-51. [PMID: 17430299 DOI: 10.1111/j.1399-5618.2007.00347.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) in children are frequently comorbid conditions. Because the coexistence of ADHD and mania seriously complicates the course of the condition and the treatment of children, diagnosing or missing this comorbidity has important clinical implications. There are very few systematic studies on the subject in the literature and BPD in children is not recognized or studied in most countries other than the USA. We aimed to differentiate Turkish prepubertal children with ADHD from those with comorbid ADHD and BPD and compare their clinical characteristics. METHODS A total of 147 treatment- and drug-naïve children, aged 7 to 13 years, who had been consecutively referred to the ADHD clinic, were evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Child Behavior Checklist (CBCL) 4-18 and the Parent-Young Mania Rating Scale (P-YMRS) prior to the clinical interview. RESULTS Twelve children (8.2%) had comorbid bipolar disorder (ADHD + BPD). The ADHD + BPD group had significantly higher rates of depressive disorders, oppositional defiant disorder, panic disorder and a family history of bipolar disorder compared with the ADHD group. The ADHD + BPD group had significantly more problems on the CBCL scale (anxiety/depression, social problems, thought problems, aggression, externalization, and total score) and on the P-YMRS (all items except for insight) compared with the ADHD group. CONCLUSIONS We conclude that ADHD + BPD in Turkish children represents a clinical picture different to that of ADHD alone, in which the clinical characteristics resemble those of children reported in the literature. Further long-term follow-up studies are needed in larger clinical and community samples.
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Affiliation(s)
- Rasim Somer Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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24
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Azorin JM, Akiskal H, Akiskal K, Hantouche E, Châtenet-Duchêne L, Gury C, Lancrenon S. Is psychosis in DSM-IV mania due to severity? The relevance of selected demographic and comorbid social-phobic features. Acta Psychiatr Scand 2007; 115:29-34. [PMID: 17201863 DOI: 10.1111/j.1600-0447.2006.00841.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We tested whether factors other than episode severity contributed to psychosis in mania. METHOD Psychiatrists collected systematic clinical data on 1090 hospitalized DSM-IV manic patients in France, and completed the Mania Rating Scale (MRS) and the Scale for the Assessment of Positive Symptoms (SAPS). RESULTS Using DSM-IV specifiers, 21.9% were non-severe, 28.2% severe without psychosis, and 49.9% severe with psychosis. On the MRS, patients with psychosis scored significantly higher (P < 0.0001) than non-severe, but did not differ from the severe without psychosis. We found significant correlations between both the Hallucination and the Delusion subscores of the SAPS and the MRS, as well as correlations between age, single marital status, comorbid social phobia and psychotic mania. CONCLUSION Apart from episode severity, social isolation - associated with younger age, single marital status and social phobia - seems to make a contribution to the origin of manic psychosis largely independent from such severity.
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Affiliation(s)
- J-M Azorin
- Ste Marguerite Hospital, University of Marseilles, Marseilles, France
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25
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Abstract
BACKGROUND Migration is a risk factor for the development of schizophrenia. AIMS To examine whether migration is also a risk factor for bipolar affective disorder, unipolar depressive disorder and mood disorders in general. METHOD Medline was searched for population-based incidence studies concerning mood disorders among migrants and mean relative risks were computed using a mixed-effects statistical model. RESULTS Only a few studies of unipolar depressive disorder were retrieved. The mean relative risk of developing bipolar affective disorder among migrants was 2.47 (95% CI 1.33-4.59). However, after excluding people of African-Caribbean origin in the UK this risk was no longer significantly increased. The mean relative risk of mood disorders of unspecified polarity was 1.25 (95% CI 1.04-1.49) and that of any mood disorder was 1.38 (95% CI 1.17-1.62). CONCLUSIONS There is no conclusive evidence for a large increase in the risk of mood disorders associated with migration.
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Affiliation(s)
- Sanne G H A Swinnen
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre Utrecht, The Netherlands
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Sherazi R, McKeon P, McDonough M, Daly I, Kennedy N. What's new? The clinical epidemiology of bipolar I disorder. Harv Rev Psychiatry 2006; 14:273-84. [PMID: 17162652 DOI: 10.1080/10673220601070047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The last few decades have seen a rapid change in our understanding of the epidemiology of bipolar disorder, which has only recently started to achieve major research attention. This article reviews recent developments. In addition to electronic searches using MEDLINE and PsycLIT, references from articles were identified, major journals hand searched, and major textbooks of psychiatry and epidemiology reviewed. Studies may have overestimated the prevalence of mania, and underestimated incidence. The incidence of mania may be increasing in recent generations, but the data remain inconclusive. Age at onset of mania is earlier than previously believed, and there are gender differences in epidemiology and clinical course. Ethnic differences in epidemiology and clinical course of bipolar disorder are highlighted. Comorbid alcohol and substance abuse are common in patients suffering from bipolar disorder and are associated with a more severe clinical course and a worse outcome. Urban living and lower socioeconomic and single marital status may be risk factors for developing bipolar disorder.
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Tyrer S. What does history teach us about factors associated with relapse in bipolar affective disorder? Presentation at Hilton hotel, Gateshead, 2 September 2005 at Symposium entitled managing The aftermath of mania. J Psychopharmacol 2006; 20:4-11. [PMID: 16551666 DOI: 10.1177/1359786806063070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When investigating treatments for any chronic condition it is essential to know the usual course of the illness concerned. The natural history of bipolar affective disorder has only been established relatively recently. This review examines the factors that affect the course of bipolar disorder from an historical perspective. These include the affective nature of the episodes and the influence of psychotic symptoms, age at onset of illness, length of episodes and cycles, gender, ethnicity, concurrent drug and alcohol use, occupational status and factors leading to chronicity. The pioneering work of Kraepelin and Angst established that episodes of illness in bipolar disorder increased in frequency over time and that earlier age of onset predicted more frequent episodes. More recent work has established that female subjects have a later onset of illness, that the frequency of episodes often decreases over time and that rapid cycling has a poorer response to treatment. Suggested criteria for inclusion of subjects into trials examining manic relapse are listed based on the findings from earlier work.
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Affiliation(s)
- Stephen Tyrer
- Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Consedine NS, Magai C, Kudadjie-Gyamfi EK, Longfellow JK, Ungar TM, King AR. Stress versus discrete negative emotions in the prediction of physical complaints: Does predictive utility vary across ethnic groups? ACTA ACUST UNITED AC 2006; 12:541-57. [PMID: 16881755 DOI: 10.1037/1099-9809.12.3.541] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reports of stress and negative emotion are important predictors of health. However, whether discrete emotions or stress measures are more useful, whether they contribute independently to outcome, and whether they relate to health equally across ethnic groups remain unclear. In the current study, 207 US-born European American, US-born African American, Black English-speaking Caribbean, and Dominican men aged 40 years and older completed measures of somatic symptoms, trait emotions, and stress. Sadness and stress independently predicted symptom reports, even when examined concurrently, and with demographics controlled; trait anger did not predict symptoms. Moreover, the relations between trait emotions and symptoms varied across groups. Levels of sadness were associated with greater symptoms among US-born European American and Dominican men, but negatively associated among Black English-speaking Caribbean men, and the relations for anger also differed marginally across groups. The results underscore the importance of differentiating among discrete emotions and stress and considering ethnic interactions when examining reports of somatic symptomology. We suggest that the impact of psychological characteristics on health must be considered within cultural and ethnic contexts to be fully understood.
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