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Basquin L, Maruani J, Leseur J, Mauries S, Bazin B, Pineau G, Henry C, Lejoyeux M, Geoffroy PA. Study of the different sleep disturbances during the prodromal phase of depression and mania in bipolar disorders. Bipolar Disord 2024; 26:454-467. [PMID: 38653574 DOI: 10.1111/bdi.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it. METHODS Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self-report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information. RESULTS Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre-indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post-indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression. CONCLUSION This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences.
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Affiliation(s)
- Louise Basquin
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
| | - Julia Maruani
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | - Jeanne Leseur
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Sibylle Mauries
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | | | - Guillaume Pineau
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Chantal Henry
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
- Université de Paris, Paris, France
| | - Michel Lejoyeux
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
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Yang Y, Guo T, Zhao Q, Li Y, Cheung T, Zhang L, Zhu X, Jackson T, Li XH, Xiang YT. Mapping prodromal symptoms in patients with bipolar disorder: A network perspective. Psychiatry Res 2024; 335:115842. [PMID: 38479193 DOI: 10.1016/j.psychres.2024.115842] [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: 03/16/2022] [Revised: 11/20/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
Bipolar disorder (BD) is a major mental disorder that significantly impairs behavior and social functioning. This study assessed the network structure of prodromal symptoms in patients with BD prior to their index mood episode. Semi-structured interviews were conducted with the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R) to examine patients' prodromal symptoms. Network analysis was conducted to elucidate inter-relations between prodromal symptoms. A total of 120 eligible patients participated in this study. Network analysis indicated that the observed model was stable. The edge Mania3-Depression9 ('Racing thoughts' - 'Thinking about suicide', edge weight = 14.919) showed the strongest positive connection in the model, followed by the edge Mania1-depression1 ('Extremely energetic/active' - 'Depressed mood', edge weight = 14.643). The only negative correlation in the model was for Mania7-depression2 ('Overly self-confident' - 'Tiredness or lack of energy', edge weight = -1.068). Nodes Mania3 ('Racing thoughts'), Depression9 ('Thinking about suicide'), Mania1 ('Extremely energetic/active'), and Depression1 ('Depressed mood') were the most central symptoms. Both depressive and manic or hypomanic symptoms appeared in the prodromal phase. Symptoms reflecting 'Racing thoughts', 'Thinking about suicide', 'Extremely energetic/active', and 'Depressed mood' should be thoroughly assessed and targeted as crucial prodromal symptoms in interventions to reduce the risk of BD episodes.
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Affiliation(s)
- Yuan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Tong Guo
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qian Zhao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yang Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China
| | - Lei Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xuequan Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Xiao-Hong Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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3
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Álvarez-Cadenas L, García-Vázquez P, Ezquerra B, Stiles BJ, Lahera G, Andrade-González N, Vieta E. Detection of bipolar disorder in the prodromal phase: A systematic review of assessment instruments. J Affect Disord 2023; 325:399-412. [PMID: 36623571 DOI: 10.1016/j.jad.2023.01.012] [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: 11/03/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early detection of prodromal symptoms may contribute to improving the prognosis of patients with bipolar disorder (BD). The main objective of this systematic review is to present the different procedures for the identification of initial and relapse prodromes in these patients. METHODS PsycINFO, Web of Science and PubMed databases were searched using a predetermined strategy, until January 4, 2022. Then, by means of a regulated process, studies that used a BD prodrome detection procedure, in English-language and all ages participants were selected. Quantitative and qualitative studies were assessed using a modified version of the Newcastle-Ottawa Scale and by Critical Appraisals Skills Programme checklist, respectively. RESULTS Forty-five studies were selected. Of these, 26 used procedures for identifying initial prodromes (n = 8014) and 19 used procedures for detecting relapse prodromes (n = 1136). The interview was the most used method in the detection of both types of prodromes (k = 30 papers, n = 4068). It was variable in its degree of structure. Mobile applications and digital technologies are gaining importance in the detection of the relapse prodromes. LIMITATIONS A retrospective design in most papers, small samples sizes, existence of persistent subsyndromal symptoms and difficulty to identify the end of the prodrome and the onset of the disorder. CONCLUSIONS There is a wide variety of assessment instruments to detect prodromes in BD, among which the clinical interview is most frequently used. Future research should consider development of a brief tool to be applied in different formats to patients and family members.
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Affiliation(s)
- Laura Álvarez-Cadenas
- Central University Hospital of Asturias, Health Service of Principality of Asturias, Oviedo, Spain.
| | - Paula García-Vázquez
- Central University Hospital of Asturias, Health Service of Principality of Asturias, Oviedo, Spain
| | - Berta Ezquerra
- Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain
| | - Bryan J Stiles
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; IRyCIS, CIBERSAM, Madrid, Spain; Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Nelson Andrade-González
- Psychiatry and Mental Health Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; Faculty of Medicine, Alfonso X el Sabio University, Villanueva de la Cañada, Madrid, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Underlying domains of anxiety trait in a Costa Rican sample: preliminary results. ACTA ACUST UNITED AC 2020; 35:38-41. [PMID: 32863597 DOI: 10.1016/j.npbr.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Imprecision of the psychiatric phenotype might partially explain the failure of genetic research to identify genes that contribute to susceptibility of anxiety disorders. Previous research concluded two underlying constructs, worry and rumination, might explain anxiety sub-syndromic symptoms in Costa Rican patients with history of mania. The goal of the current study is to explore the presence of latent constructs for quantitative anxiety in a group of subjects with a wide diagnostic phenotype and non-affected individuals. Methods We conducted an exploratory factor analysis of anxiety trait in 709 subjects. Our sample was comprised by 419 subjects with psychiatric disorders and 290 non-affected individuals. We used principal factors extraction method with squared multiple correlations of the STAI (trait subscale). Results We found the following preliminary results: a three-factor solution with a good simple structure and statistical adequacy was obtained with a KMO of 0.92 (>0.6) and Bartlett's Test of Sphericity of 5644,44 (p<0.05). The STAI items were grouped into three factors: anxiety-absent, worry and rumination based on the characteristics of the symptoms. Conclusion Two underlying constructs, worry and rumination may explain anxiety sub-syndromic symptoms in Costa Rican subjects. Our proposed underlying structure of subsyndromal anxiety in individuals should be considered as an important factor in defining better phenotypic characterizations on a broader diagnostic concept. Worry and rumination as a phenotypic characterization may assist in genotyping; however, its predictive value on actual illness outcome still requires more research. The Genome-Wide QTL analysis for anxiety trait in the same sample is ongoing.
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Andrade-González N, Álvarez-Cadenas L, Saiz-Ruiz J, Lahera G. Initial and relapse prodromes in adult patients with episodes of bipolar disorder: A systematic review. Eur Psychiatry 2020; 63:e12. [PMID: 32093795 PMCID: PMC7315869 DOI: 10.1192/j.eurpsy.2019.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Distinguishing prodromes of bipolar disorder (BD) specific to children/adolescents, adults, and elderly patients is essential. The primary objective of this systematic review was to determine initial and relapse prodromes identifying adult patients with BD. METHODS PubMed, PsycINFO, and Web of Science databases were searched using a predetermined strategy. A controlled process of study selection and data extraction was performed. RESULTS The 22 articles selected included 1,809 adult patients with BD. Initial prodromes cited most frequently in these studies showed low specificity. Among relapse prodromes cited most frequently, more talkative than usual, increased energy/more goal-directed behavior, thoughts start to race, increased self-esteem, strong interest in sex, increase in activity, and spending too much were identified exclusively before a manic/hypomanic episode, while loss of interest and hypersomnia were detected only before a depressive episode. Initial prodromal phases lasted longer than prodromal relapse phases. In the selected studies, the most used prodrome identification procedure was the clinical interview. CONCLUSIONS For adult patients with BD, initial and relapse prodromes of manic, hypomanic, and depressive episodes were identified. It is proposed that the most frequent prodromes found in this review be incorporated into a smartphone app that monitors the functioning of people at risk of BD and patients who have already been diagnosed. Data from this app would constitute a relevant source of big data.
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Affiliation(s)
- Nelson Andrade-González
- Relational Processes and Psychotherapy Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | | | - Jerónimo Saiz-Ruiz
- Ramón y Cajal University Hospital, Madrid, Spain.,Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,IRyCIS, CIBERSAM, Madrid, Spain
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,IRyCIS, CIBERSAM, Madrid, Spain
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Haussleiter IS, Lorek S, Zeschel E, Mattausch S, Meyers M, Juckel G. At-risk symptoms of bipolar disorder in a university student cohort. Psychiatry Res 2018; 265:324-333. [PMID: 29778054 DOI: 10.1016/j.psychres.2018.05.010] [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: 07/26/2017] [Revised: 04/17/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
To assess the occurrence and frequency of bipolar at-risk symptoms in a large sample of previously undiagnosed students using the new screening tool Bochumer Screeningbogen Bipolar (BSB). 2329 students of the Ruhr-University Bochum, Germany completed online demographic data as well as various self-rating questionnaires (BSB; Hypomania Checklist 32; Altman Self-Rating Mania Scale; Beck Depression Inventory). Within the student cohort (64.4% female, mean age 24.3 years) every fifth student currently suffered from moderate to severe depressive symptoms; every sixth student had already thought about suicide and every other student reported a history of mood swings. The most frequently reported depressive symptoms included physical exhaustion, depressed mood, and tiredness. The most frequently reported (hypo)manic symptoms included physical agitation, feeling extremely energetic, and lack of concentration. The BSB showed good convergent validity with other established questionnaires capturing depressive or (hypo)manic symptoms, as well as a stable administration of underlying constructs. The BSB correlated significantly with the already established applied questionnaires. The predictive power of the BSB regarding the development of bipolar disorder cannot be correctly quantified at present. The further purpose of this exploratory web-based study should be to examine the validity of the presented measures in a longitudinal design.
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Affiliation(s)
- Ida S Haussleiter
- Department of Psychiatry, LWL University Hospital Bochum, Germany; Institute of Mental Health, LWL University Hospital Bochum, Germany.
| | - Sandra Lorek
- Department of Psychiatry, LWL University Hospital Bochum, Germany; Institute of Mental Health, LWL University Hospital Bochum, Germany
| | - Eike Zeschel
- Department of Psychiatry, LWL University Hospital Bochum, Germany
| | - Svenja Mattausch
- Institute of Mental Health, LWL University Hospital Bochum, Germany
| | - Milena Meyers
- Institute of Mental Health, LWL University Hospital Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital Bochum, Germany; Institute of Mental Health, LWL University Hospital Bochum, Germany
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Contreras J, Hare E, Chavarría G, Raventós H. Quantitative genetic analysis of anxiety trait in bipolar disorder. J Affect Disord 2018; 225:395-398. [PMID: 28850853 PMCID: PMC5626643 DOI: 10.1016/j.jad.2017.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bipolar disorder type I (BPI) affects approximately 1% of the world population. Although genetic influences on bipolar disorder are well established, identification of genes that predispose to the illness has been difficult. Most genetic studies are based on categorical diagnosis. One strategy to overcome this obstacle is the use of quantitative endophenotypes, as has been done for other medical disorders. METHODS We studied 619 individuals, 568 participants from 61 extended families and 51 unrelated healthy controls. The sample was 55% female and had a mean age of 43.25 (SD 13.90; range 18-78). Heritability and genetic correlation of the trait scale from the Anxiety State and Trait Inventory (STAI) was computed by using the general linear model (SOLAR package software). RESULTS we observed that anxiety trait meets the following criteria for an endophenotype of bipolar disorder type I (BPI): 1) association with BPI (individuals with BPI showed the highest trait score (F = 15.20 [5,24], p = 0.009), 2) state-independence confirmed after conducting a test-retest in 321 subjects, 3) co-segregation within families 4) heritability of 0.70 (SE: 0.060), p = 2.33 × 10-14 and 5) genetic correlation with BPI was 0.20, (SE = 0.17, p = 3.12 × 10-5). LIMITATIONS Confounding factors such as comorbid disorders and pharmacological treatment could affect the clinical relationship between BPI and anxiety trait. Further research is needed to evaluate if anxiety traits are specially related to BPI in comparison with other traits such as anger, attention or response inhibition deficit, pathological impulsivity or low self-directedness. CONCLUSIONS Anxiety trait is a heritable phenotype that follows a normal distribution when measured not only in subjects with BPI but also in unrelated healthy controls. It could be used as an endophenotype in BPI for the identification of genomic regions with susceptibility genes for this disorder.
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Affiliation(s)
- J Contreras
- Centro de Investigación en Biología Celular y Molecular, Universidad de Costa Rica, Costa Rica.
| | - E Hare
- Genetics and Genomics Research and Breeding Program Planning, Dog Genetics LLC., Sunnyside, NY, United States
| | - G Chavarría
- Escuela de Biología, Universidad de Costa Rica, Costa Rica
| | - H Raventós
- Centro de Investigación en Biología Celular y Molecular, Universidad de Costa Rica, Costa Rica; Escuela de Biología, Universidad de Costa Rica, Costa Rica
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Van Meter AR, Burke C, Youngstrom EA, Faedda GL, Correll CU. The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes. J Am Acad Child Adolesc Psychiatry 2016; 55:543-55. [PMID: 27343882 DOI: 10.1016/j.jaac.2016.04.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/09/2016] [Accepted: 05/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to meta-analyze the prevalence of symptoms before an initial mood episode of bipolar disorder (BD) and the prevalence of subthreshold symptoms before a BD mood episode recurrence, to facilitate early identification and prevention. METHOD Systematic literature reviews were conducted in PsycINFO and PubMed for prospective or retrospective studies reporting on the prevalence and longest duration of symptoms before an initial or recurrent mood episode of BD. Random effects meta-regression explored whether geographic location, age, percentage of female individuals, and study quality moderated the overall prevalence. RESULTS In 11 studies (n = 1,078), the prodrome preceding an initial mood episode lasted 27.1 ± 23.1 months (range, 4.6-130 months). In 10 studies (n = 1,000), the subthreshold symptoms preceding a recurrent mood episode lasted 1.0 ± 0.9 months (range, 0.5-1.3 months). The most common symptoms were largely consistent with diagnostic criteria symptoms associated with the subsequent mood polarity for both the initial prodrome and the period prior to a recurrent mood episode. Few moderators of symptom prevalences emerged, and significant heterogeneity remained. CONCLUSION The initial prodromal period is sufficiently long and characterized by symptoms of the subsequent mood episode to make early identification and intervention programs feasible. Conversely, the period of subthreshold symptoms before a recurrent mood episode is short, mandating adequate psychoeducation of patients and families, monitoring of changes in sleep and activity, plus sufficiently frequent follow-up visits to identify patients before a mood episode recurrence. Future prospective investigations, designed to address the identified shortcomings in the extant literature, are needed to identify more clinically applicable information.
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Affiliation(s)
| | - Coty Burke
- University of North Carolina at Chapel Hill
| | | | - Gianni L Faedda
- Lucio Bini Mood Disorders Center, New York University Medical Center, and the Child Study Center, New York
| | - Christoph U Correll
- The Zucker Hillside Hospital, New York, Northwell Health System, and the Hofstra Northwell School of Medicine, East Garden City, NY
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Beentjes TAA, Goossens PJJ, Jongerden IP. Nurses' Experience of Maintaining Their Therapeutic Relationship With Outpatients With Bipolar Disorder and Their Caregivers During Different Stages of a Manic Episode: A Qualitative Study. Perspect Psychiatr Care 2016; 52:131-8. [PMID: 25772270 DOI: 10.1111/ppc.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/19/2015] [Accepted: 02/11/2015] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Caregivers often consult community mental health (CMH) nurses when they recognize prodromes of mania in the outpatient. The purpose of this study was to determine nurses' experiences of their therapeutic relationship and nursing interventions to outpatients and caregivers during different stages of mania. DESIGN AND METHODS A qualitative study was conducted. Nine nurses were interviewed. FINDINGS CMH nurses experienced dual loyalty when facing conflicting interests. They strived to stay connected to patients and caregivers with an open and nonjudgmental attitude. In euthymic episodes, nurses anticipated by developing good relationships with both and by making relapse prevention plan. PRACTICE IMPLICATIONS Early involvement of caregivers in the treatment is recommended.
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Affiliation(s)
- Titus A A Beentjes
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.,Saxion University of Applied Science, Faculty of Health, Deventer, the Netherlands.,Dimence Group Mental Health Care Center, Bipolar Specialists Center, Deventer, the Netherlands.,Nursing Science Program, Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J J Goossens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.,Dimence Mental Health Care Centre, Bipolar Specialists Center, Deventer, the Netherlands.,Ghent University, Department of Nursing Sciences, Ghent, Belgium.,GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, the Netherlands
| | - Irene P Jongerden
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.,Clinical Health Sciences Program, University Medical Center Utrecht, Utrecht, the Netherlands
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Munk-Olsen T, Pedersen HS, Laursen TM, Fenger-Grøn M, Vedsted P, Vestergaard M. Use of primary health care prior to a postpartum psychiatric episode. Scand J Prim Health Care 2015; 33:127-33. [PMID: 26174691 PMCID: PMC4834500 DOI: 10.3109/02813432.2015.1041832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Childbirth is a strong trigger of psychiatric episodes. Nevertheless, use of primary care before these episodes is not quantified. The aim was to study the use of general practice in Denmark from two years before to one year after childbirth in women who developed postpartum psychiatric disorders. DESIGN A matched cohort study was conducted including women who gave birth in the period 1996-2010. Women were divided into four groups: (i) all mothers with postpartum psychiatric episodes 0-3 months after birth, n = 939; 2: All mothers with a postpartum psychiatric episode 3-12 months after birth, n = 1 436; and (iii) two comparison groups of mothers, total n = 6 630 among 320 620 eligible women. SETTING Denmark. SUBJECTS Women born in Denmark after 1 January 1960, restricting the cohort to women who gave birth to their first singleton child between 1 January 1996 and 20 October 2010. MAIN OUTCOME MEASURES The main outcome measures were consultation rates, consultation rate ratios, and rate differences. RESULTS Women who developed a psychiatric episode after childbirth had higher GP consultation rates before, during, and after the pregnancy. Women with a psychiatric episode 0-3 months postpartum had 6.89 (95% CI 6.60; 7.18) mean number of consultations during pregnancy, corresponding to 1.52 (95% CI 1.22; 1.82) more visits than the comparison group. CONCLUSION Women with a postpartum psychiatric episode had higher use of GP-based primary health care services years before the childbirth, and in this specific group of patients childbirth itself triggered a marked increase in the number of GP contacts postpartum.
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Affiliation(s)
- Trine Munk-Olsen
- National Centre for Register-based Research, Department of Economics and Business; School of Business and Social Sciences, Aarhus University, Denmark, The Initiative for Integrative Psychiatric Research (iPSYCH)
- Correspondence: Trine Munk-Olsen, National Centre for Register-based Research, Department of Economics and Business; School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark. Tel: + 45 871 65749. Fax: + 45 871 64601. E-mail:
| | - Henrik Søndergaard Pedersen
- Research Unit for General Practice, Department of Public Health, Faculty of Health, Aarhus University, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Department of Economics and Business; School of Business and Social Sciences, Aarhus University, Denmark, The Initiative for Integrative Psychiatric Research (iPSYCH)
| | - Morten Fenger-Grøn
- Research Unit for General Practice, Department of Public Health, Faculty of Health, Aarhus University, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Faculty of Health, Aarhus University, Denmark
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Latalova K, Prasko J, Kamaradova D, Jelenova D, Ociskova M, Sedlackova Z. Internet psychoeducation for bipolar affective disorder: basis for preparation and first experiences. Psychiatr Q 2014; 85:241-55. [PMID: 24307178 DOI: 10.1007/s11126-013-9286-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is growing evidence that patients with bipolar affective disorder (BAD), who use medication, respond well to further psychotherapeutic interventions. Internet-based psychoeducation is typically centered on the interaction between a client and therapist via the Internet. Multiple methods were required to investigate existing psychoeducational and psychotherapeutic strategies used on patients suffering from BAD. Systematic reviews and original reports of all trials of psychoeducation in BAD patients were retrieved. Patients with BAD, who were hospitalized in a psychiatric department or attended a day hospital program, were exposed to the first version of the program during the treatment, and then questioned about understandability, comprehensibility, and usefulness of each lecture. Twelve modules of the Internet E-Program for BAD were developed and the intervention was a pilot tested with twelve patients. Internet psychoeducation program for BAD is an intervention designed for universal implementation that addresses heightened learning needs of patients suffering from BAD. It is designed to promote confidence and reduce the number of episodes of the disorder by providing skills in monitoring warning signs, planning daily activities and practicing communication skills.
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Affiliation(s)
- Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic,
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Zeschel E, Correll CU, Haussleiter IS, Krüger-Özgürdal S, Leopold K, Pfennig A, Bechdolf A, Bauer M, Juckel G. The bipolar disorder prodrome revisited: Is there a symptomatic pattern? J Affect Disord 2013; 151:551-560. [PMID: 23932736 DOI: 10.1016/j.jad.2013.06.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/16/2013] [Accepted: 06/17/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To assess the phenomenology and course of pre-(hypo)manic and pre-depressed prodromal symptoms, including mood swings, as precursors of bipolar disorder (BD) in a German multi-center study. METHODS Semi-structured interviews [Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R); Semi-structured Interview for Mood Swings] were administered to patients within 8 years of BD (BD I, BD II) onset. RESULTS Forty two outpatients were included (40.5% male, mean age 35.1±10.0 years, illness onset at 30.5±9.5 years). Feeling extremely energetic (85.7%), racing thoughts (78.6%), physical agitation (76.2%), overtalkativeness (71.4%), and low sleep requirement (71.4%) occurred most frequently prior to the first (hypo)manic episode, whereas depressed mood (83.0%), reduced vitality (81.0%), physical exhaustion (78.6%), tiredness (76.2%), and insomnia (66.7%) preceded pre-depressively. Mood lability (p=.006), odd ideas (p=.003) and the psychosis index score (p=.003) differed significantly in prevalence depending on the episodes' mood. Extremely energetic (p=.046), overtalkativeness (p<.001), and racing thoughts (p=.013) lasted significantly longer prior to depression. Neither severity nor frequency of prodromal symptoms differed significantly. Most of the symptoms emerged during the proximal prodromal phase. Links between mood swings and subsequent BD were found. LIMITATIONS Symptoms were evaluated retrospectively with self-reporting tools in bipolar patients from academic treatment settings without comparison to clinical controls. CONCLUSIONS Not only specific depressive or manic but also general symptoms occurred prior to both affective episodes. The pre-depressive prodrome lasted longer than the pre-manic one, but severity and frequency did not differ significantly. Mood swings and disturbed diurnal rhythm occurred prior to both episodes as early signs of BD.
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Affiliation(s)
- Eike Zeschel
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany.
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Ida S Haussleiter
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany
| | - Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany
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Young AH, Hale A. Patients with bipolar disorder in a bipolar clinic setting: practical steps. Acta Psychiatr Scand Suppl 2013:19-24. [PMID: 23581789 DOI: 10.1111/acps.12120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - A. Hale
- University of Kent; Canterbury; UK
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Perich T, Mitchell PB, Loo C, Hadzi-Pavlovic D, Roberts G, Frankland A, Lau P, Wright A. Clinical and demographic features associated with the detection of early warning signs in bipolar disorder. J Affect Disord 2013; 145:336-40. [PMID: 22980404 DOI: 10.1016/j.jad.2012.08.014] [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] [Received: 07/24/2012] [Revised: 08/14/2012] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
Abstract
AIM The detection of early warning signs is a major component of many psychological interventions for assisting in the management of bipolar disorder. The aim of this study was to assess whether the ability to detect early warning signs was associated with clinical and demographic characteristics in a bipolar disorder clinic sample. METHOD Two-hundred-and-one participants with DSM-IV bipolar I or II disorder aged over 18 years of age were recruited through a specialized bipolar disorder clinic. Participants were administered a structured interview by psychiatrists asking participants about any early warning signs, and features of the phenomenology, course and treatment of bipolar disorder. RESULTS Participants were significantly more likely to recognise both hypo/manic and depressive early warning signs rather than only one type of mood episode. The ability to detect signs of both hypo/mania and depression was greater in younger participants. The ability to detect signs of depression was associated with more prior depressive episodes and a lesser likelihood of prior hospitalisations whilst a history of mixed mood was associated with a greater likelihood of detecting depressive symptoms. The ability to recognise signs of hypo/mania was greater in those reporting a history of visual hallucinations (during depressive and/or manic episodes). LIMITATIONS Cross-sectional design and previous experience with psychotherapy was not assessed. CONCLUSION These findings provide useful clinical data pertinent to psychological interventions for bipolar disorder. Longitudinal studies are needed to further examine how the ability to recognise early warning signs may be associated with longer term outcome.
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Affiliation(s)
- Tania Perich
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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15
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Olvet DM, Burdick KE, Cornblatt BA. Assessing the potential to use neurocognition to predict who is at risk for developing bipolar disorder: a review of the literature. Cogn Neuropsychiatry 2013; 18:129-45. [PMID: 23137046 PMCID: PMC3578087 DOI: 10.1080/13546805.2012.724193] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of early intervention strategies has recently been recognised in the field of psychiatry. Although early intervention strategies in schizophrenia have been extensively studied, recent efforts to identify individuals who are at increased risk for other disorders, such as bipolar disorder, have gained significant interest. There is some available data to suggest that cognitive deficits may precede the onset of mania; therefore, it would be beneficial to identify cognitive predictors of bipolar disorder in an effort to facilitate early intervention. METHODS We conducted a literature review of conscript, cohort, high-risk, family-based and first-episode mania studies that assessed neurocognition in order to ascertain potential cognitive predictors of bipolar disorder. RESULTS There is little evidence that individuals at risk for bipolar disorder exhibit deficits in global measures of neurocognition, such as IQ. However, deficits in specific neurocognitive domains, including verbal memory and executive function, appear to represent potential predictors of bipolar disorder. CONCLUSIONS These conclusions are preliminary; however, they provide a starting point for future work. Additional efforts towards understanding both the clinical and cognitive prodrome will be important in elucidating the pathophysiology of bipolar disorder.
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Affiliation(s)
- Doreen M. Olvet
- The Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System, Glen Oaks, New York, 11004, USA,The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, 11030, USA
| | | | - Barbara A. Cornblatt
- The Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System, Glen Oaks, New York, 11004, USA,The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, 11030, USA,The Albert Einstein College of Medicine, Bronx, New York, 10461, USA
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Ryu V, Song DH, Ha R, Ha K, Cho HS. Prodromes and coping types in bipolar patients with nonpsychotic or psychotic mania. Compr Psychiatry 2012; 53:732-9. [PMID: 22099704 DOI: 10.1016/j.comppsych.2011.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 09/19/2011] [Accepted: 10/03/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Bipolar disorder is a recurrent and cyclical illness frequently accompanied by psychotic symptoms. Detecting prodromes and enhancing coping skills for prodromal symptoms in bipolar patients are very important for relapse prevention. Psychotic features in bipolar patients are related to poor prognosis. We aimed to investigate the differences in prodromal symptoms and coping styles in psychotic and nonpsychotic bipolar patients. METHODS Eighty-three euthymic bipolar patients with or without a history of manic psychosis were interviewed about their demographic, diagnostic, and clinical information and completed a 40-item checklist for prodromal symptoms. After the interview, they completed the Coping Inventory for Prodromes of Mania. RESULTS The differences between the psychotic patients and the nonpsychotic patients were found in the prodromal durations, and a few prodromal symptoms such as afraid of going crazy (P = .03), energetic-very active (P = .01), and hearing hallucination (P = .02). The psychotic patients showed a higher score of denial or blame than the nonpsychotic ones (1.92 ± 0.73 in nonpsychosis, 2.32 ± 0.84 in psychosis; P = .03). Logistic regression revealed that the duration of prodromes (P = .02) and hearing hallucination (P = .01) were related to the presence of psychotic features. CONCLUSION Psychotic patients had a tendency to use denial or blame coping strategy and to experience attenuated psychotic symptoms a little more during the prodromal period. Timely psychosocial approaches for detecting signs and enhancing coping strategies would improve the outcomes.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, College of Medicine, Konyang University, Daejeon, South Korea
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17
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Sahoo MK, Chakrabarti S, Kulhara P. Detection of prodromal symptoms of relapse in mania and unipolar depression by relatives and patients. Indian J Med Res 2012; 135:177-83. [PMID: 22446859 PMCID: PMC3336848 DOI: pmid/22446859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND & OBJECTIVES Detection of prodromal symptoms among patients with mania by their immediate relatives has been seldom examined. We carried out this study to examine the ability to detect and report prodromol symptoms of manic relapses by patients themselves and their relatives. METHODS The ability of patients and their relatives to detect prodromal symptoms was examined among 60 remitted patients, 30 each with DSM-IV diagnoses of bipolar disorder and recurrent depressive disorder, with recent manic/depressive relapses, and their 60 immediate relatives, using an instrument composed of items from common symptom-scales, as well as by unstructured interview. RESULTS Seventy per cent of patients with mania reported prodromes prior to relapse. This was significantly (P<0.01) less than the proportion of their relatives (97%), as well as the proportion of patients with unipolar depression (93%), reporting prodromal symptoms (P<0.05) among patients. Mean duration of the prodromal period reported by patients with mania was about 20 days (median-10 days); relatives reported durations which were longer by about 5 days. Prodromes of unipolar depression (mean 42.7 days; median- 21 days), were significantly longer than of mania, when reported by patients, but not by their relatives. Differences in reporting of prodromes, between relatives and patients seen in mania, were not observed in unipolar depression. The number and type of prodromal symptoms of mania reported was similar among patients and relatives. INTERPRETATION & CONCLUSIONS Our findings showed that relatives of patients with mania were better at detecting prodromes of relapse; thus, input from relatives can improve the early detection of prodromal symptoms to prevent relapses of bipolar disorder.
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Affiliation(s)
- M K Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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18
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Principal domains of quantitative anxiety trait in subjects with lifetime history of mania. J Affect Disord 2012; 136:e69-e75. [PMID: 21774991 PMCID: PMC3940478 DOI: 10.1016/j.jad.2011.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 05/31/2011] [Accepted: 06/23/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND High comorbidity rates for anxiety have been documented in subjects with history of mania or hypomania. We explored the presence of latent constructs of quantitative anxiety in subjects who have a history of mania or hypomania. METHODS We conducted an exploratory factor analysis of anxiety trait in 212 subjects who have a lifetime history of at least one manic/hypomanic syndrome. Participants were originally recruited for a Costa Rican sibling pair genetic study of Bipolar Disorder. We used principal factors extraction method with squared multiple correlations (SAS/SAT Professional software) of the STAI (trait subscale). RESULTS A three-factor solution with a good simple structure and statistical adequacy was obtained with a KMO of 0.84 (>0.6) and Bartlett's Test of Sphericity of 2.4668E-162 (p<0.05). Items were grouped into anxiety-absent factor and the anxiety-present symptoms in two additional factors based on the nature of the symptoms, worry and rumination. LIMITATIONS Comorbid disorders could affect the interaction of anxiety score with manic/hypomanic symptoms. Some statistical parameters (mood status independence, score distribution and correlation between trait score and quantitative mania/hypomania) were not taken into consideration to extract the factors. Because anxiety dimensions were explored on individuals with history of mania or hypomania and not in healthy subjects, comparison of our results with other studies can draw confusing conclusions. CONCLUSIONS Two underlying constructs, worry and rumination may explain anxiety sub-syndromic symptoms in Costa Rican patients with history of mania or hypomania.
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19
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Lobban F, Solis-Trapala I, Symes W, Morriss R. Early warning signs checklists for relapse in bipolar depression and mania: utility, reliability and validity. J Affect Disord 2011; 133:413-22. [PMID: 21640385 DOI: 10.1016/j.jad.2011.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/26/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recognising early warning signs (EWS) of mood changes is a key part of many effective interventions for people with Bipolar Disorder (BD). This study describes the development of valid and reliable checklists required to assess these signs of depression and mania. METHODS Checklists of EWS based on previous research and participant feedback were designed for depression and mania and compared with spontaneous reporting of EWS. Psychometric properties and utility were examined in 96 participants with BD. RESULTS The majority of participants did not spontaneously monitor EWS regularly prior to use of the checklists. The checklists identified most spontaneously generated EWS and led to a ten fold increase in the identification of EWS for depression and an eight fold increase for mania. The scales were generally reliable over time and responses were not associated with current mood. Frequency of monitoring for EWS correlated positively with social and occupational functioning for depression (beta=3.80, p=0.015) and mania (beta=3.92, p=0.008). LIMITATIONS The study is limited by a small sample size and the fact that raters were not blind to measures of mood and function. CONCLUSIONS EWS checklists are useful and reliable clinical and research tools helping to generate enough EWS for an effective EWS intervention.
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre, School of Health and Medicine, Lancaster University, United Kingdom.
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20
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Mitchell PB, Hadzi-Pavlovic D, Loo CK. Course and outcome of bipolar disorder. Curr Top Behav Neurosci 2011; 5:1-18. [PMID: 25236546 DOI: 10.1007/7854_2010_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bipolar disorder (BPD) is capricious illness. For some, it is a condition of few episodes; for others, it is unremitting. For some, elevated moods predominate; for others, depression is the major key. For a minority, the condition is predictably cyclical; for most, it is unpredictably chaotic. This chapter examines those studies that have attempted to draw coherence from this enigmatic disorder. Where possible, we will focus on data derived from prospective longitudinal investigations, while using as necessary the more limited retrospective or cross-sectional reports. For the sake of parsimony, we will limit discussion to those studies that have used the conservative historical definitions of BPD (as used in DSM-IIIR, DSM-IV, and ICD-10), eschewing the recent controversial concepts of "pediatric" BPD and "soft BPD spectrum."
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Affiliation(s)
- Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,
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21
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Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: A cross-sectional study. Int J Nurs Stud 2010; 47:1201-7. [DOI: 10.1016/j.ijnurstu.2010.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 01/20/2010] [Accepted: 01/31/2010] [Indexed: 11/23/2022]
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Comparing clinical and neurocognitive features of the schizophrenia prodrome to the bipolar prodrome. Schizophr Res 2010; 123:59-63. [PMID: 20716479 PMCID: PMC2939255 DOI: 10.1016/j.schres.2010.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/05/2010] [Accepted: 07/08/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is an increased interest in early intervention strategies for severe mental disorders with hopes of mitigating the emergence and impact of the illness. Individuals at clinical high-risk (CHR) for schizophrenia have been primarily identified by the presence of attenuated positive symptoms. Although bipolar disorder and schizophrenia may have overlapping etiologies, few studies have investigated the potential prodrome in bipolar disorder. We sought to determine if there is a prodrome to bipolar disorder and if clinical or neurocognitive measures could distinguish between the bipolar and schizophrenia prodromes. METHODS We examined subjects who were initially identified as CHR for schizophrenia during the prodromal phase of the illness and followed them prospectively. Unexpectedly, eight subjects developed bipolar disorder. Baseline data from subjects who eventually developed bipolar disorder (pre-BP; N=8), schizophrenia or a psychotic disorder (pre-SZ; N=24) and a non-converter comparison group (NCC; N=115) were compared. RESULTS The pre-BP and pre-SZ groups did not differ on attenuated positive symptom severity, global measures of functioning or on the global neurocognitive score. Compared to NCC individuals, both pre-BP and pre-SZ patients reported more severe attenuated positive symptoms and were more likely to be on antipsychotic medication at baseline. The pre-SZ group had a significantly lower current IQ and was significantly more impaired than the NCC group on the overall neurocognitive score. CONCLUSIONS This study provides preliminary support for a bipolar prodrome, which may be indistinguishable from the schizophrenia prodrome based on clinical and neurocognitive measures currently used in high-risk schizophrenia programs.
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Contreras J, Hare E, Pacheco A, Escamilla M, Raventos H. Is subclinical anxiety an endophenotype for bipolar I patients? A study from a Costa Rican sample. J Affect Disord 2010; 122:267-72. [PMID: 19733400 PMCID: PMC3762570 DOI: 10.1016/j.jad.2009.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 07/20/2009] [Accepted: 07/21/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although genetic influences on bipolar I disorder are well established, localization of genes that predispose to the illness has been difficult. Some genes predisposing to bipolar I disorder may be transmitted without expression of the categorical clinical phenotype. One strategy to overcome this obstacle is the use of quantitative endophenotypes, as has been done for other medical disorders. METHODS We analyzed 30 bipolar I extended families (300 subjects, average family size 10.34 members, range: 2-31) and 20 unrelated healthy controls from a Costa Rican sample. Heritability and genetic correlation of the state and trait scale from the Anxiety State and Trait Inventory was computed by using the general linear model (SOLAR package software). We also assessed variation of both scores among groups (patients, relatives and controls) and tested independence of affection status. RESULTS Heritability for state is 0.45 (SE=0.11, p=0.0000001) and for trait is 0.89 (SE=0.06, p=6.22e-29). Genetic correlation for state and trait is 0.29, (SE=0.12, p=0.038-3.19e-8). Bipolar I patients showed the highest trait score (F=12.17 [5,24], p=0.002), (bipolar I patients>relatives with other pathologies, >healthy relatives>unrelated healthy controls) with normal distribution in healthy individuals and no difference regarding depression and mania current status, (F=0.230, df=1, p=0.632 and F=1.401, df=1, p=0.238, respectively), contrary to the state score. LIMITATIONS Confounding factors such as comorbid disorders could affect the interaction of subclinical anxiety with mania. Due to our limited budget we were not able to re-evaluate the subjects and conduct a test retest to assess the STAI reliability and mood state independence of anxiety traits over different times. Further research is needed to evaluate if anxiety traits are specially related to bipolar I disorder in comparison with other traits such as anger, attention or response inhibition deficit, pathological impulsivity or low self-directedness. CONCLUSIONS Anxiety state and trait are heritable and share some genetic factors but only trait showed normal distribution in healthy subjects, mood current status independence and significant liability for bipolar I disorder. A stair-step distribution of trait anxiety scores in the family members and controls based on their genetic proximity to affected individuals and diagnostic status suggests that trait anxiety could be an endophenotype in these bipolar I families.
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Affiliation(s)
- Javier Contreras
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
| | - Elizabeth Hare
- Psychiatric Genetics Research Center, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Adriana Pacheco
- Centro de Investigación en Biologia Celular y Molecular, University of Costa Rica. San Jose, CR
| | - Michael Escamilla
- Psychiatric Genetics Research Center, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Henriette Raventos
- Centro de Investigación en Biologia Celular y Molecular, University of Costa Rica. San Jose, CR
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Goldberg JF, McLeod LD, Fehnel SE, Williams VS, Hamm LR, Gilchrist K. Development and psychometric evaluation of the Bipolar Functional Status Questionnaire (BFSQ). Bipolar Disord 2010; 12:32-44. [PMID: 20148865 DOI: 10.1111/j.1399-5618.2009.00775.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Persistently impaired psychosocial functioning has been recognized in many individuals with bipolar disorder. However, existing measures of functional disability have been adapted for use in bipolar disorder based mainly on those developed for use in other conditions. The present study involved the development and validation of a new patient self-report measure specific to bipolar disorder, the Bipolar Functional Status Questionnaire (BFSQ). METHODS Relevant constructs were identified, evaluated, and refined through an expert advisory panel in conjunction with patient interviews. Questionnaire items were vetted through iterative patient interviews. Psychometric properties were determined based on patient responses from implementation of the proposed 33-item questionnaire in an 11-site study of 596 patients with bipolar disorder across varied phases of illness. RESULTS Eight constructs were identified as fundamental to functional status in bipolar disorder: cognitive function, sleep, role functioning, emotional functioning, energy/vitality, social functioning, personal management, and sexual functioning. Psychometric validation supported item reduction to a 24-item unidimensional scale, with high internal consistency (coefficient alpha's = 0.93-0.95), high test-retest reliability (intraclass correlation coefficient = 0.86, 95% confidence interval = 0.82-0.89), strong convergent validity with other functional disability measures (r's > 0.70), and highly significant discriminant validity across illness phases, with large effect sizes (Cohen's d > 0.70). CONCLUSIONS The BFSQ is a psychometrically sound self-report measure that can be used to effectively quantify functional status across different clinical states in patients with bipolar disorder.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
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