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Dini H, Bruni LE, Ramsøy TZ, Calhoun VD, Sendi MSE. The overlap across psychotic disorders: A functional network connectivity analysis. Int J Psychophysiol 2024; 201:112354. [PMID: 38670348 PMCID: PMC11163820 DOI: 10.1016/j.ijpsycho.2024.112354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/20/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024]
Abstract
Functional network connectivity (FNC) has previously been shown to distinguish patient groups from healthy controls (HC). However, the overlap across psychiatric disorders such as schizophrenia (SZ), bipolar (BP), and schizoaffective disorder (SAD) is not evident yet. This study focuses on studying the overlap across these three psychotic disorders in both dynamic and static FNC (dFNC/sFNC). We used resting-state fMRI, demographics, and clinical information from the Bipolar-Schizophrenia Network on Intermediate Phenotypes cohort (BSNIP). The data includes three groups of patients with schizophrenia (SZ, N = 181), bipolar (BP, N = 163), and schizoaffective (SAD, N = 130) and HC (N = 238) groups. After estimating each individual's dFNC, we group them into three distinct states. We evaluated two dFNC features, including occupancy rate (OCR) and distance travelled over time. Finally, the extracted features, including both sFNC and dFNC, are tested statistically across patients and HC groups. In addition, we explored the link between the clinical scores and the extracted features. We evaluated the connectivity patterns and their overlap among SZ, BP, and SAD disorders (false discovery rate or FDR corrected p < 0.05). Results showed dFNC captured unique information about overlap across disorders where all disorder groups showed similar pattern of activity in state 2. Moreover, the results showed similar patterns between SZ and SAD in state 1 which was different than BP. Finally, the distance travelled feature of SZ (average R = 0.245, p < 0.01) and combined distance travelled from all disorders was predictive of the PANSS symptoms scores (average R = 0.147, p < 0.01).
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Affiliation(s)
- Hossein Dini
- Augmented Cognition Lab, Department of Architecture, Design and Media Technology, Aalborg University, Copenhagen, Denmark
| | - Luis E Bruni
- Augmented Cognition Lab, Department of Architecture, Design and Media Technology, Aalborg University, Copenhagen, Denmark
| | - Thomas Z Ramsøy
- Department of Applied Neuroscience, Neurons Inc., Taastrup, Denmark; Faculty of Neuroscience, Singularity University, Santa Clara, CA, United States
| | - Vince D Calhoun
- Wallace H. Coulter Department of Biomedical Engineering at, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Department of Electrical and Computer Engineering at, Georgia Institute of Technology, Atlanta, GA, United States; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Mohammad S E Sendi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States; McLean Hospital and Harvard Medical School, Boston, MA, USA.
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2
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Coello K, Kuchinke OV, Kjærstad HL, Miskowiak KW, Faurholt-Jepsen M, Vinberg M, Kessing LV. Differences in clinical presentation between newly diagnosed bipolar I and II disorders: A naturalistic study. J Affect Disord 2024; 351:95-102. [PMID: 38244799 DOI: 10.1016/j.jad.2024.01.139] [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: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
AIM This naturalistic clinical study aims to investigate differences between newly diagnosed patients with bipolar type I (BDI) and bipolar type II (BDII) disorders in socio-demographic and clinical characteristics, affective symptoms, cognition, functioning and comorbidity with personality disorders. METHODS The BD diagnosis and type were confirmed using the Schedules for Clinical Assessment in Neuropsychiatry. Affective symptoms were assessed with the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Major Depressive Index, and the Altman Self-Rating Mania Scale. Functional impairment was assessed with the Functional Assessment Short Test. Cognitive impairment was evaluated by the Screen for Cognitive Impairment in Psychiatry and the Cognitive Complaints in Bipolar Disorder Rating Assessment. Finally, comorbid personality disorders were assessed with the Standardized Assessment of Personality-Abbreviated Scale and structured interview Structured Clinical Interview for DSM-disorders. RESULTS 383 newly diagnosed patients were included (BDI: n = 125; BDII: n = 258). Against expectations, we found no more depressive symptoms in BDII compared with BDI nor any differences in cognitive, childhood trauma or overall functional impairment. The only difference was lower occupational impairment in the BDII group. LIMITATIONS The self-reported measures of cognitive difficulties and childhood trauma involved potential bias (recall or other). Despite BD being newly diagnosed a diagnostic delay was observed. CONCLUSION Patients newly diagnosed with BDII and BDI had similar burdens of depressive symptoms and cognitive and overall functional impairment, however patients with BDI had lower occupational functioning. No statistically significant difference was found in prevalence of comorbid personality disorders between patients with BDI and BDII.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Oscar Vittorio Kuchinke
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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3
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Ji Y, Pearlson G, Bustillo J, Kochunov P, Turner JA, Jiang R, Shao W, Zhang X, Fu Z, Li K, Liu Z, Xu X, Zhang D, Qi S, Calhoun VD. Identifying psychosis subtypes use individualized covariance structural differential networks and multi-site clustering. Schizophr Res 2024; 264:130-139. [PMID: 38128344 DOI: 10.1016/j.schres.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 07/19/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Similarities among schizophrenia (SZ), schizoaffective disorder (SAD) and bipolar disorder (BP) including clinical phenotypes, brain alterations and risk genes, make it challenging to perform reliable separation among them. However, previous subtype identification that transcend traditional diagnostic boundaries were based on group-level neuroimaging features, ignoring individual-level inferences. METHODS 455 psychoses (178 SZs, 134 SADs and 143 BPs), their first-degree relatives (N = 453) and healthy controls (HCs, N = 220) were collected from Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP I) consortium. Individualized covariance structural differential networks (ICSDNs) were constructed for each patient and multi-site clustering was used to identify psychosis subtypes. Group differences between subtypes in clinical phenotypes and voxel-wise fractional amplitude of low frequency fluctuation (fALFF) were calculated, as well as between the corresponding relatives. RESULTS Two psychosis subtypes were identified with increased whole brain structural covariance, with decreased connectivity between amygdala-hippocampus and temporal-occipital cortex in subtype I (S-I) compared to subtype II (S-II), which was replicated under different clustering methods, number of edges and across datasets (B-SNIP II) and different brain atlases. S-I had higher emotional-related symptoms than S-II and showed significant fALFF decrease in temporal and occipital cortex, while S-II was more similar to HC. This pattern was consistently validated on relatives of S-I and S-II in both fALFF and clinical symptoms. CONCLUSIONS These findings reconcile categorical and dimensional perspectives of psychosis neurobiological heterogeneity, indicating that relatives of S-I might have greater predisposition in developing psychosis, while relatives of S-II are more likely to be healthy. This study contributes to the development of neuroimaging informed diagnostic classifications within psychosis spectrum.
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Affiliation(s)
- Yixin Ji
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China; Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing, China
| | - Godfrey Pearlson
- Departments of Psychiatry and Neuroscience, Yale School of Medicine, New Haven, CT, USA; Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA
| | - Juan Bustillo
- Departments of Neurosciences and Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Peter Kochunov
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica A Turner
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Rongtao Jiang
- Departments of Psychiatry and Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Wei Shao
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China; Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing, China
| | - Xiao Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Kaicheng Li
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaowen Liu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Xijia Xu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China; Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing, China.
| | - Shile Qi
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China; Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing, China.
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA; Department of Electrical and Computer Engineering, Georgia Tech University, Atlanta, GA, USA
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Sunaga M, Takei Y, Kato Y, Tagawa M, Suto T, Hironaga N, Sakurai N, Fukuda M. The Characteristics of Power Spectral Density in Bipolar Disorder at the Resting State. Clin EEG Neurosci 2023; 54:574-583. [PMID: 34677105 DOI: 10.1177/15500594211050487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bipolar disorder (BD) is a common psychiatric disorder, but its pathophysiology is not fully elucidated. The current study focused on its electrophysiological characteristics, especially power spectral density (PSD). Resting state with eyes opened magnetoencephalography data were collected from 21 patients with BD and 22 healthy controls. The whole brain's PSD was calculated from source reconstructed waveforms at each frequency band (delta: 1-3 Hz, theta: 4-7 Hz, alpha: 8-12 Hz, low beta: 13-19 Hz, high beta: 20-29 Hz, and gamma: 30-80 Hz). We compared PSD values on the marked vertices at each frequency band between healthy and patient groups using a Mann-Whitney rank test to examine the relationship between significantly different PSD and clinical measures. The PSD in patients with BD was significantly decreased in lower frequency bands, mainly in the default mode network (DMN) areas (bilateral medial prefrontal cortex, bilateral precuneus, left inferior parietal lobe, and right temporal cortex in the alpha band) and salience network areas (SAL; left anterior insula [AI] at the delta band, anterior cingulate cortex at the theta band, and right AI at the alpha band). No significant differences in PSD were observed at low beta and high beta. PSD was not correlated with age or other clinical scales. Altered PSDs of the DMN and SAL were observed in the delta, theta, and alpha bands. These alterations contribute to the vulnerability of BD through the disturbance of self-referential mental activity and switching between the default mode and frontoparietal networks.
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Affiliation(s)
- Masakazu Sunaga
- Gunma Prefectural Psychiatric Medical Center, Isesaki, Japan
| | - Yuichi Takei
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yutaka Kato
- Gunma University Graduate School of Medicine, Maebashi, Japan
- Tsutsuji Mental Hospital, Tatebayashi, Japan
| | - Minami Tagawa
- Gunma Prefectural Psychiatric Medical Center, Isesaki, Japan
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomohiro Suto
- Gunma Prefectural Psychiatric Medical Center, Isesaki, Japan
| | | | - Noriko Sakurai
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masato Fukuda
- Gunma University Graduate School of Medicine, Maebashi, Japan
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5
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Ioannou M, Olsson S, Bakken Wold A, Dellepiane M, Steingrímsson S. Approaching "highly sensitive person" as a cultural concept of distress: a case-study using the cultural formulation interview in patients with bipolar disorder. Front Psychiatry 2023; 14:1148646. [PMID: 37810603 PMCID: PMC10558047 DOI: 10.3389/fpsyt.2023.1148646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Background Psychiatric patients may refer to concepts neither medically accepted nor easily understood to describe their experiences when seeking medical care. These concepts may lie outside the clinician's cultural references and consequently hinder the diagnostic consultation. In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the clinical instrument Cultural Formulation Interview (CFI) was included. The CFI aims to facilitate the gathering and synthesis of culturally relevant clinical information. The notion of Cultural Concepts of Distress (CCD) was also introduced in DSM-5. The CCD include the subterms of the cultural syndrome, cultural explanation, and cultural idiom of distress. No previous study has used CFI for conceptualizing a cultural notion as a CCD. This study aimed to approach the cultural notion of being a highly sensitive person (HSP) in patients with bipolar disorder (BD) by applying the CFI. The cultural notion of HSP has garnered great interest globally, although scientific evidence is limited. No direct correlation between BD and HSP was hypothesized before or during the study process. Methods In this case study, three patients with BD who reported being HSP were interviewed using the CFI. Furthermore, the applicability of the CCD was examined based on the outcomes of the CFI using an interpretive approach. Results All three patients reported that the CFI facilitated the clinical consultation, and in one of the cases, it may also have increased the treatment engagement. Based on the synthesis of the CFI outcomes in these illustrative cases, HSP could be understood as a cultural syndrome, a cultural explanation, and a cultural idiom of distress. Conclusion By applying a person-centered perspective, CFI was used for the conceptualization of a cultural notion as a CCD (i.e., HSP in our study). Moreover, the cases highlight the complexity of illness insight in BD as a medical phenomenon when patients' illness perspectives are taken into consideration. Future studies need to further examine the clinical relevance of the CFI in the management of BD.
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Affiliation(s)
- Michael Ioannou
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofia Olsson
- Region Skåne, Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Lund, Sweden
| | - Ane Bakken Wold
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marzia Dellepiane
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrímsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lu C, Zhu X, Feng Y, Ao W, Li J, Gao Z, Luo H, Chen M, Cai F, Zhan S, Li H, Sun W, Hu J. Atypical antipsychotics antagonize GABA A receptors in the ventral tegmental area GABA neurons to relieve psychotic behaviors. Mol Psychiatry 2023; 28:2107-2121. [PMID: 36754983 DOI: 10.1038/s41380-023-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
Psychosis is an abnormal mental condition that can cause patients to lose contact with reality. It is a common symptom of schizophrenia, bipolar disorder, sleep deprivation, and other mental disorders. Clinically, antipsychotic medications, such as olanzapine and clozapine, are very effective in treatment for psychosis. To investigate the neural circuit mechanism that is affected by antipsychotics and identify more selective therapeutic targets, we employed a strategy by using these effective antipsychotics to identify antipsychotic neural substrates. We observed that local injection of antipsychotics into the ventral tegmental area (VTA) could reverse the sensorimotor gating defects induced by MK-801 injection in mice. Using in vivo fiber photometry, electrophysiological techniques, and chemogenetics, we found that antipsychotics could activate VTA gamma-aminobutyric acid (GABA) neurons by blocking GABAA receptors. Moreover, we found that the VTAGABA nucleus accumbens (NAc) projection was crucially involved in such antipsychotic effects. In summary, our study identifies a novel therapeutic target for the treatment of psychosis and underscores the utility of a 'bedside-to-bench' approach for identifying neural circuits that influence psychotic disorders.
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Affiliation(s)
- Chen Lu
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 200031, Shanghai, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Xiaona Zhu
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China.
| | - Yifan Feng
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Weizhen Ao
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
- iHuman Institute, ShanghaiTech University, 201210, Shanghai, China
| | - Jie Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, China
| | - Zilong Gao
- School of Life Sciences, Westlake University, 310024, Hangzhou, China
| | - Huoqing Luo
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Ming Chen
- Institutes of Brain Science, Fudan University, 200032, Shanghai, China
| | - Fang Cai
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Shulu Zhan
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Wenzhi Sun
- Chinese Institute for Brain Research, 102206, Beijing, China.
- School of Basic Medical Sciences, Capital Medical University, 100069, Beijing, China.
| | - Ji Hu
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China.
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Liang C, Pearlson G, Bustillo J, Kochunov P, Turner JA, Wen X, Jiang R, Fu Z, Zhang X, Li K, Xu X, Zhang D, Qi S, Calhoun VD. Psychotic Symptom, Mood, and Cognition-associated Multimodal MRI Reveal Shared Links to the Salience Network Within the Psychosis Spectrum Disorders. Schizophr Bull 2023; 49:172-184. [PMID: 36305162 PMCID: PMC9810025 DOI: 10.1093/schbul/sbac158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia (SZ), schizoaffective disorder (SAD), and psychotic bipolar disorder share substantial overlap in clinical phenotypes, associated brain abnormalities and risk genes, making reliable diagnosis among the three illness challenging, especially in the absence of distinguishing biomarkers. This investigation aims to identify multimodal brain networks related to psychotic symptom, mood, and cognition through reference-guided fusion to discriminate among SZ, SAD, and BP. Psychotic symptom, mood, and cognition were used as references to supervise functional and structural magnetic resonance imaging (MRI) fusion to identify multimodal brain networks for SZ, SAD, and BP individually. These features were then used to assess the ability in discriminating among SZ, SAD, and BP. We observed shared links to functional and structural covariation in prefrontal, medial temporal, anterior cingulate, and insular cortices among SZ, SAD, and BP, although they were linked with different clinical domains. The salience (SAN), default mode (DMN), and fronto-limbic (FLN) networks were the three identified multimodal MRI features within the psychosis spectrum disorders from psychotic symptom, mood, and cognition associations. In addition, using these networks, we can classify patients and controls and distinguish among SZ, SAD, and BP, including their first-degree relatives. The identified multimodal SAN may be informative regarding neural mechanisms of comorbidity for psychosis spectrum disorders, along with DMN and FLN may serve as potential biomarkers in discriminating among SZ, SAD, and BP, which may help investigators better understand the underlying mechanisms of psychotic comorbidity from three different disorders via a multimodal neuroimaging perspective.
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Affiliation(s)
- Chuang Liang
- Department of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Godfrey Pearlson
- Department of Psychiatry and Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Juan Bustillo
- Departments of Neurosciences and Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Peter Kochunov
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica A Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Xuyun Wen
- Department of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Rongtao Jiang
- Department of Psychiatry and Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Xiao Zhang
- Department of Psychiatry, Peking University Sixth Hospital/Institute of Mental Health, Beijing, China
| | - Kaicheng Li
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xijia Xu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Daoqiang Zhang
- Department of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Shile Qi
- Department of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Vince D Calhoun
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Department of Electrical and Computer Engineering, Georgia Tech University, Atlanta, GA, USA
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8
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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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9
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Lu C, Feng Y, Li H, Gao Z, Zhu X, Hu J. A preclinical study of deep brain stimulation in the ventral tegmental area for alleviating positive psychotic-like behaviors in mice. Front Hum Neurosci 2022; 16:945912. [PMID: 36034113 PMCID: PMC9399924 DOI: 10.3389/fnhum.2022.945912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a clinical intervention for the treatment of movement disorders. It has also been applied to the treatment of psychiatric disorders such as depression, anorexia nervosa, obsessive-compulsive disorder, and schizophrenia. Psychiatric disorders including schizophrenia, bipolar disorder, and major depression can lead to psychosis, which can cause patients to lose touch with reality. The ventral tegmental area (VTA), located near the midline of the midbrain, is an important region involved in psychosis. However, the clinical application of electrical stimulation of the VTA to treat psychotic diseases has been limited, and related mechanisms have not been thoroughly studied. In the present study, hyperlocomotion and stereotyped behaviors of the mice were employed to mimic and evaluate the positive-psychotic-like behaviors. We attempted to treat positive psychotic-like behaviors by electrically stimulating the VTA in mice and exploring the neural mechanisms behind behavioral effects. Local field potential recording and in vivo fiber photometry to observe the behavioral effects and changes in neural activities caused by DBS in the VTA of mice. Optogenetic techniques were used to verify the neural mechanisms underlying the behavioral effects induced by DBS. Our results showed that electrical stimulation of the VTA activates local gamma-aminobutyric acid (GABA) neurons, and dopamine (DA) neurons, reduces hyperlocomotion, and relieves stereotyped behaviors induced by MK-801 (dizocilpine) injection. The results of optogenetic manipulation showed that the activation of the VTA GABA neurons, but not DA neurons, is involved in the alleviation of hyperlocomotion and stereotyped behaviors. We visualized changes in the activity of specific types in specific brain areas induced by DBS, and explored the neural mechanism of DBS in alleviating positive psychotic-like behaviors. This preclinical study not only proposes new technical means of exploring the mechanism of DBS, but also provides experimental justification for the clinical treatment of psychotic diseases by electrical stimulation of the VTA.
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Affiliation(s)
- Chen Lu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yifan Feng
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zilong Gao
- School of Life Sciences, Westlake University, Hangzhou, China
| | - Xiaona Zhu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- *Correspondence: Ji Hu Xiaona Zhu
| | - Ji Hu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- *Correspondence: Ji Hu Xiaona Zhu
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10
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Zerbinati L, Palagini L, Balestrieri M, Belvederi Murri M, Caruso R, D'Agostino A, Ferrara M, Ferrari S, Minervino A, Milia P, Nanni MG, Pini S, Politi P, Porcellana M, Rocchetti M, Taddei I, Toffanin T, Grassi L, Bellucci J, Bergamelli E, Attilio Campagna V, Cherubini M, Folesani F, Gancitano M, Giannetti F, Giovanna G, Gullotta B, Massa L, Montardi G. Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study. Front Psychiatry 2022; 13:959399. [PMID: 36311528 PMCID: PMC9614237 DOI: 10.3389/fpsyt.2022.959399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2-2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1-1998). METHODS We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome. RESULTS Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07). CONCLUSION CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy.
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Affiliation(s)
- Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Silvia Ferrari
- Section of Psychiatry, Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Milia
- Italian Society of Psychosomatic Medicine, Parma, Italy
| | - Maria Giulia Nanni
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matteo Porcellana
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ines Taddei
- Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, 3rd Psychiatric Clinic, Rome, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | | | - Jessica Bellucci
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Emilio Bergamelli
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | | | - Melissa Cherubini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Federica Folesani
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marta Gancitano
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesca Giannetti
- Section of Psychiatry, Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Giovanna
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Benedetta Gullotta
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lucia Massa
- Italian Society of Psychosomatic Medicine, Parma, Italy
| | - Giulia Montardi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
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11
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Marwaha S, Hett D, Johnson S, Fowler D, Hodgekins J, Freemantle N, McCrone P, Everard L, Jones P, Amos T, Singh S, Sharma V, Birchwood M. The impact of manic symptoms in first-episode psychosis: Findings from the UK National EDEN study. Acta Psychiatr Scand 2021; 144:358-367. [PMID: 33864251 DOI: 10.1111/acps.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The extant literature is inconsistent over whether manic symptoms in first-episode psychosis (FEP) impact on its development and trajectory. This study addressed the following: (1) Does Duration of Untreated Illness (DUI) and Duration of Untreated Psychosis (DUP) differ between FEP patients with and without manic symptoms? (2) Do manic symptoms in FEP have an impact on time to remission over 1 year? METHODS We used data from the National EDEN study, a longitudinal cohort of patients with FEP accessing early intervention services (EIS) in England, which measured manic, positive and negative psychotic symptoms, depression and functioning at service entry and 1 year. Data from 913 patients with FEP (639 without manic symptoms, 237 with manic symptoms) were analysed using both general linear modelling and survival analysis. RESULTS Compared to FEP patients without manic symptoms, those with manic symptoms had a significantly longer DUI, though no difference in DUP. At baseline, people with manic symptoms had higher levels of positive and negative psychotic symptoms, depression and worse functioning. At 12 months, people with manic symptoms had significantly poorer functioning and more positive psychotic symptoms. The presence of manic symptoms delayed time to remission over 1 year. There was a 19% reduced rate of remission for people with manic symptoms compared to those without. CONCLUSIONS Manic symptoms in FEP are associated with delays to treatment. This poorer trajectory persists over 1 year. They appear to be a vulnerable and under-recognised group for poor outcome and need more focussed early intervention treatment.
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Affiliation(s)
- Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | - Danielle Hett
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Linda Everard
- National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | | | - Tim Amos
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Swaran Singh
- Mental Health and Well-being, University of Warwick Medical School, Warwick University, Coventry, UK
| | | | - Max Birchwood
- Mental Health and Well-being, University of Warwick Medical School, Warwick University, Coventry, UK
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12
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Paul T, Javed S, Karam A, Loh H, Ferrer GF. A Misdiagnosed Case of Schizoaffective Disorder With Bipolar Manifestations. Cureus 2021; 13:e16686. [PMID: 34466319 PMCID: PMC8394638 DOI: 10.7759/cureus.16686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Bipolar and schizoaffective disorders are both psychiatric illnesses that share common traits, but also significant differences. Due to the close overlap in symptoms, obtaining the correct diagnosis can be difficult. The management of these patients often poses a challenge to clinicians. Five years ago, our patient was misdiagnosed with bipolar disorder with psychotic features. It was later discovered that she was suffering from schizoaffective disorder, bipolar type. The schizoaffective disorder involves symptoms of both schizophrenia and mood disorder.
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Affiliation(s)
- Tanya Paul
- Research and Academic Affairs, Larkin Health System, South Miami, USA.,Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Sana Javed
- Psychiatry, Nishtar Medical University, Multan, PAK
| | - Alvina Karam
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Hanyou Loh
- Medicine, National University of Singapore, Singapore, SGP
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13
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Tse AC, Fok ML, Yim LC, Leung MM, Leung CM. Diagnostic conversion to bipolar disorder in unipolar depressed patients in Hong Kong: A 20-year follow-up study. J Affect Disord 2021; 286:94-98. [PMID: 33714176 DOI: 10.1016/j.jad.2021.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/03/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bipolar (BP) disorder, especially BP depression is common and yet remains enigmatic until the emergence of mania. The rates and risk factors of conversion from unipolar (UP) depression to BP disorder reported vary. OBJECTIVE To study the long-term conversion rate from UP depression to BP disorder of an inpatient sample and identify the associated risk factors. METHODS This is a retrospective longitudinal study conducted in 2017 based on review of medical records of patients admitted to a regional hospital in Hong Kong with diagnosis of major depressive disorder during the period from 1988 to 2000. RESULTS A total of 19.5% of subjects had diagnostic shift from UP depression to BP disorder at follow-up, with a mean conversion time of 10.8 years and about 1% shift annually in the first 10 years. Risk factors include family history of mental illness, young age at onset, repeated admissions, psychotic symptoms and use of electroconvulsive therapy. More unconverted UP subjects (9.0%) committed suicide than those converted to BP (3.5%). LIMITATIONS The study is limited by its retrospective design. CONCLUSIONS Conversion from UP depression to BP disorder is dictated by its biological characteristics and clinical severity. Vigilance should be held in the first decade after onset when most conversion takes place.
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Affiliation(s)
- Ansen C Tse
- Department of Psychiatry, Shatin Hospital, Hong Kong
| | - Marcella Ly Fok
- Central and North West London NHS Foundation Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Larina Cl Yim
- Department of Psychiatry, Shatin Hospital, Hong Kong
| | - Meranda Mw Leung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Chi-Ming Leung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong.
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14
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Fateh AA, Cui Q, Duan X, Yang Y, Chen Y, Li D, He Z, Chen H. Disrupted dynamic functional connectivity in right amygdalar subregions differentiates bipolar disorder from major depressive disorder. Psychiatry Res Neuroimaging 2020; 304:111149. [PMID: 32738725 DOI: 10.1016/j.pscychresns.2020.111149] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
Notwithstanding being the object of a growing field of clinical research, the investigation of the dynamic resting-state functional connectivity alterations in psychiatric illnesses is still in its early days. Current research on major depressive disorder (MDD) and bipolar disorder (BD) has evidenced abnormal resting-state functional connectivity (rsFC), especially in regions subserving emotional processing and regulation such as the amygdala. However, dynamic changes in functional connectivity within the amygdalar subregions in distinguishing BD and MDD has not yet been fully understood. In this paper, we aim at analyzing the patterns characterizing dynamic FC (dFC) in the right amygdala to investigate the differences between similarly depressed BD and MDD. A number of 40 BD patients, 61 MDD patients and 63 healthy controls (HCs) underwent functional magnetic resonance imaging (fMRI) at rest. Using the right-amygdala as seed region, we compared the dFC within three subdivisions, namely, laterobasal (LB), centromedial (CM) and superficial (SF) between all the groups. To do so, one-way ANOVA followed by post-hoc t-tests were employed. Compared to HCs, patients with BD had a decreased dFC between right LB and the left postcentral gyrus as well as an increased dFC between right CM and the right cerebellum.Compared to BD patients, patients with MDD showed a decreased dFC between right CM and the cerebellum and an increased dFC between right LB and the left postcentral gyrus. These findings present initial evidence that abnormal patterns of the right-amygdalar subregions shared by BD and MDD supports the differential pathophysiology of these disorders.
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Affiliation(s)
- Ahmed Ameen Fateh
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xujun Duan
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yang Yang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuyan Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Di Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.
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15
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Meyer TD, Crist N, La Rosa N, Ye B, Soares JC, Bauer IE. Are existing self-ratings of acute manic symptoms in adults reliable and valid?-A systematic review. Bipolar Disord 2020; 22:558-568. [PMID: 32232950 DOI: 10.1111/bdi.12906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Depression research historically uses both self- and clinician ratings of symptoms with significant and substantial correlations. It is often assumed that manic patients lack insight and cannot accurately report their symptoms. This delayed the development of self-rating scales for mania, but several scales now exist and are used in research. Our objective is to systematically review the literature to identify existing self-ratings of symptoms of (hypo)mania and to evaluate their psychometric properties. METHODS PubMed, Web of Knowledge, and Ovid were searched up until June 2018 using the keywords: "(hypo)mania," "self-report," and "mood disorder" to identify papers which included data on the validity and reliability of self-rating scales for (hypo)mania in samples including patients with bipolar disorder. RESULTS We identified 55 papers reporting on 16 different self-rating scales claiming to assess (hypo)manic symptoms or states. This included single item scales, but also some with over 40 items. Three of the scales, the Internal State Scale (ISS), Altman Self-Rating Mania Scale (ASRM), and Self-Report Manic Inventory (SRMI), provided data about reliability and/or validity in more than three independent studies. Validity was mostly assessed by comparing group means from individuals in different mood states and sometimes by correlation to clinician ratings of mania. CONCLUSIONS ASRM, ISS, and SRMI are promising self-rating tools for (hypo)mania to be used in clinical contexts. Future studies are, however, needed to further validate these measures; for example, their associations between each other and sensitivity to change, especially if they are meant to be outcome measures in studies.
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Affiliation(s)
- Thomas D Meyer
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Nicholas Crist
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Nikki La Rosa
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.,Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Biyu Ye
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jair C Soares
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Isabelle E Bauer
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
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16
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Yanes T, McInerney-Leo AM, Law MH, Cummings S. The emerging field of polygenic risk scores and perspective for use in clinical care. Hum Mol Genet 2020; 29:R165-R176. [DOI: 10.1093/hmg/ddaa136] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Genetic testing is used widely for diagnostic, carrier and predictive testing in monogenic diseases. Until recently, there were no genetic testing options available for multifactorial complex diseases like heart disease, diabetes and cancer. Genome-wide association studies (GWAS) have been invaluable in identifying single-nucleotide polymorphisms (SNPs) associated with increased or decreased risk for hundreds of complex disorders. For a given disease, SNPs can be combined to generate a cumulative estimation of risk known as a polygenic risk score (PRS). After years of research, PRSs are increasingly used in clinical settings. In this article, we will review the literature on how both genome-wide and restricted PRSs are developed and the relative merit of each. The validation and evaluation of PRSs will also be discussed, including the recognition that PRS validity is intrinsically linked to the methodological and analytical approach of the foundation GWAS together with the ethnic characteristics of that cohort. Specifically, population differences may affect imputation accuracy, risk magnitude and direction. Even as PRSs are being introduced into clinical practice, there is a push to combine them with clinical and demographic risk factors to develop a holistic disease risk. The existing evidence regarding the clinical utility of PRSs is considered across four different domains: informing population screening programs, guiding therapeutic interventions, refining risk for families at high risk, and facilitating diagnosis and predicting prognostic outcomes. The evidence for clinical utility in relation to five well-studied disorders is summarized. The potential ethical, legal and social implications are also highlighted.
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Affiliation(s)
- Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Matthew H Law
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Herston QLD 4006, Australia
- Faculty of Health, School of Biomedical Sciences, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove QLD 4059, Australia
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17
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Du Y, Hao H, Wang S, Pearlson GD, Calhoun VD. Identifying commonality and specificity across psychosis sub-groups via classification based on features from dynamic connectivity analysis. Neuroimage Clin 2020; 27:102284. [PMID: 32563920 PMCID: PMC7306624 DOI: 10.1016/j.nicl.2020.102284] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
It is difficult to distinguish schizophrenia (SZ), schizoaffective disorder (SAD), and bipolar disorder with psychosis (BPP) as their clinical diagnoses rely on symptoms that overlap. In this paper, we investigate if there is biological evidence to support the symptom-based clinical categories by looking across the three disorders using dynamic connectivity measures, and provide meaningful characteristics on which brain functional connectivity measures are commonly or uniquely impaired. Large-sample functional magnetic resonance image (fMRI) datasets from 623 subjects including 238 healthy controls (HCs), 113 SZ patients, 132 SAD patients, and 140 BPP patients were analyzed. First, we computed whole-brain dynamic functional connectivity (DFC) using a sliding-window technique, and then extracted the individual connectivity states by applying our previously proposed decomposition-based DFC analysis method. Next, with the features from the dominant connectivity state, we assessed the clinical categories by performing both four-group (SZ, SAD, BPP and healthy control groups) and pair-wise classification using a support vector machine within cross-validation. Furthermore, we comprehensively summarized the shared and unique connectivity alterations among the disorders. In terms of the classification performance, our method achieved 69% in the four-group classification and >80% in the between-group classifications for the mean overall accuracy; and yielded 66% in the four-group classification and >80% in the between-group classifications for the mean balanced accuracy. Through summarizing the features that were automatically selected in the classifications, we found that among the three symptom-related disorders, their disorder-common impairments primarily included the decreased connectivity strength between thalamus and cerebellum and the increased strength between postcentral gyrus and thalamus. The disorder-unique changes included more various brain regions, mainly in the temporal and frontal gyrus. Our work demonstrates that dynamic functional connectivity provides biological evidence that both common and unique impairments exist in psychosis sub-groups.
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Affiliation(s)
- Yuhui Du
- School of Computer & Information Technology, Shanxi University, Taiyuan, China; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
| | - Hui Hao
- School of Computer & Information Technology, Shanxi University, Taiyuan, China
| | - Shuhua Wang
- School of Computer & Information Technology, Shanxi University, Taiyuan, China
| | | | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
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18
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Long Y, Liu Z, Chan CKY, Wu G, Xue Z, Pan Y, Chen X, Huang X, Li D, Pu W. Altered Temporal Variability of Local and Large-Scale Resting-State Brain Functional Connectivity Patterns in Schizophrenia and Bipolar Disorder. Front Psychiatry 2020; 11:422. [PMID: 32477194 PMCID: PMC7235354 DOI: 10.3389/fpsyt.2020.00422] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia and bipolar disorder share some common clinical features and are both characterized by aberrant resting-state functional connectivity (FC). However, little is known about the common and specific aberrant features of the dynamic FC patterns in these two disorders. In this study, we explored the differences in dynamic FC among schizophrenia patients (n = 66), type I bipolar disorder patients (n = 53), and healthy controls (n = 66), by comparing temporal variabilities of FC patterns involved in specific brain regions and large-scale brain networks. Compared with healthy controls, both patient groups showed significantly increased regional FC variabilities in subcortical areas including the thalamus and basal ganglia, as well as increased inter-network FC variability between the thalamus and sensorimotor areas. Specifically, more widespread changes were found in the schizophrenia group, involving increased FC variabilities in sensorimotor, visual, attention, limbic and subcortical areas at both regional and network levels, as well as decreased regional FC variabilities in the default-mode areas. The observed alterations shared by schizophrenia and bipolar disorder may help to explain their overlapped clinical features; meanwhile, the schizophrenia-specific abnormalities in a wider range may support that schizophrenia is associated with more severe functional brain deficits than bipolar disorder. Together, these findings highlight the potentials of using dynamic FC as an objective biomarker for the monitoring and diagnosis of either schizophrenia or bipolar disorder.
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Affiliation(s)
- Yicheng Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute of Central South University, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute of Central South University, Changsha, China
| | | | - Guowei Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute of Central South University, Changsha, China
| | - Zhimin Xue
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute of Central South University, Changsha, China
| | - Yunzhi Pan
- Mental Health Institute of Central South University, Changsha, China
| | - Xudong Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute of Central South University, Changsha, China
| | - Xiaojun Huang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute of Central South University, Changsha, China
| | - Dan Li
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weidan Pu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Altamura AC, Buoli M, Cesana BM, Fagiolini A, de Bartolomeis A, Maina G, Bellomo A, Dell'Osso B. Psychotic versus non-psychotic bipolar disorder: Socio-demographic and clinical profiles in an Italian nationwide study. Aust N Z J Psychiatry 2019; 53:772-781. [PMID: 30658550 DOI: 10.1177/0004867418823268] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Psychotic versus non-psychotic patients with bipolar disorder have been traditionally associated with different unfavorable clinical features. In this study on bipolar Italian patients, we aimed to compare clinical and demographic differences between psychotic and non-psychotic individuals, exploring clinical factors that may favor early diagnosis and personalized treatment. METHODS A total of 1671 patients (males: n = 712 and females: n = 959; bipolar type 1: n = 1038 and bipolar type 2: n = 633) from different psychiatric departments were compared according to the lifetime presence of psychotic symptoms in terms of socio-demographic and clinical variables. Chi-square tests for qualitative variables and Student's t-tests for quantitative variables were performed for group comparison, and a multivariable logistic regression was performed, considering the lifetime psychotic symptoms as dependent variables and socio-demographic/clinical characteristics as independent variables. RESULTS Psychotic versus non-psychotic bipolar subjects resulted to: be more frequently unemployed (p < 0.01) and never married/partnered (p < 0.01); have an earlier age at onset (p < 0.01); more frequently receive a first diagnosis different from a mood disorder (p < 0.01); have a shorter duration of untreated illness (p < 0.01); have a more frequently hypomanic/manic prevalent polarity (p < 0.01) and a prevalent manic-depressive type of cycling (p < 0.01); present a lower lifetime number of depressive episodes (p < 0.01), but have more manic episodes (p < 0.01); and less insight (p < 0.01) and more hospitalizations in the last year (p < 0.01). Multivariable regression analysis showed that psychotic versus non-psychotic bipolar patients received more frequently a first diagnosis different from bipolar disorder (odds ratio = 0.64, 95% confidence interval = [0.46, 0.90], p = 0.02) or major depressive disorder (odds ratio = 0.66, 95% confidence interval = [0.48, 0.91], p = 0.02), had more frequently a prevalent manic polarity (odds ratio = 1.84, 95% confidence interval = [1.14, 2.98], p < 0.01) and had a higher number of lifetime manic episodes (more than six) (odds ratio = 8.79, 95% confidence interval = [5.93, 13.05], p < 0.01). CONCLUSION Lifetime psychotic symptoms in bipolar disorder are associated with unfavorable socio-demographic and clinical features as well as with a more frequent initial misdiagnosis.
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Affiliation(s)
- Alfredo Carlo Altamura
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Buoli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Mario Cesana
- 2 Unit of Biostatistics and Biomathematics, University of Brescia, Brescia, Italy.,3 Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Andrea Fagiolini
- 4 Department of Mental Health and Department of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Andrea de Bartolomeis
- 5 Section of Psychiatry and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maina
- 6 Department of Mental Health, San Luigi-Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonello Bellomo
- 7 Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Bernardo Dell'Osso
- 8 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,9 CRC 'Aldo Ravelli' for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,10 UOC Psichiatria 2, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.,11 Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy
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20
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Deng W, Zhang B, Zou W, Zhang X, Cheng X, Guan L, Lin Y, Lao G, Ye B, Li X, Yang C, Ning Y, Cao L. Abnormal Degree Centrality Associated With Cognitive Dysfunctions in Early Bipolar Disorder. Front Psychiatry 2019; 10:140. [PMID: 30949078 PMCID: PMC6435527 DOI: 10.3389/fpsyt.2019.00140] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
Delayed diagnosis of bipolar disorder (BD) is common. However, diagnostic validity may be enhanced using reliable neurobiological markers for BD. Degree centrality (DC) is one such potential marker that enables researchers to visualize neuronal network abnormalities in the early stages of some neuropsychiatric disorders. In the present study, we measured resting-state DC abnormalities and cognitive deficits in order to identify early neurobiological markers for BD. We recruited 23 patients with BD who had recently experienced manic episodes (duration of illness <2 years) and 46 matched healthy controls. Our findings indicated that patients with BD exhibited DC abnormalities in frontal areas, temporal areas, the right postcentral gyrus, and the posterior lobe of the cerebellum. Moreover, correlation analysis revealed that psychomotor speed indicators were associated with DC in the superior temporal and inferior temporal gyri, while attention indicators were associated with DC in the inferior temporal gyrus, in patients with early BD. Our findings suggest that DC abnormalities in neural emotion regulation circuits are present in patients with early BD, and that correlations between attention/psychomotor speed deficits and temporal DC abnormalities may represent early markers of BD.
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Affiliation(s)
- Wenhao Deng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjin Zou
- Department of Radiology, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofei Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiongchao Cheng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijie Guan
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yin Lin
- Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohui Lao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Biyu Ye
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuan Li
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chanjuan Yang
- Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Mental Health Institute, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Cao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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21
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Hong N, Bahk WM, Yoon BH, Min KJ, Shin YC, Jon DI. Improving the Screening Instrument of Bipolar Spectrum Disorders: Weighted Korean Version of the Mood Disorder Questionnaire. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:333-338. [PMID: 30121984 PMCID: PMC6124879 DOI: 10.9758/cpn.2018.16.3.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/18/2022]
Abstract
Objective It is not easy to diagnose bipolar disorders accurately in the clinical setting. Although Korean version of the Mood Disorder Questionnaire (K-MDQ) is easily administered, it still has weakness regarding case finding. In this study, we suggest a new weighted version of the K-MDQ to increase its screening power. Methods Ninety-five patients with bipolar disorders and 346 controls (patients with schizophrenia, patients with depressive disorders, patients with anxiety disorders, and subjects without any psychiatric disease) were enrolled in this study. The subjects received brief information on the K-MDQ, and then independently completed the questionnaire. Results Using odds ratios, we constructed a new weighted K-MDQ (W-K-MDQ). Item 1 (feel so good or hyper) was weighted 7 times and item 4 (less sleep) 3.5 times. Item 7 (easily distracted) and item 11 (more interested in sex) were excluded. Part 2 (simultaneity) and 3 (functional impairment) were also excluded as in the original K-MDQ. The sensitivity of the W-K-MDQ with a cutoff value of 10 was enhanced to 0.789. The area under the receiver operating characteristic curve was increased to 0.837. Conclusion We suggested a new formula for K-MDQ using 11 of its items. The W-K-MDQ can be easily applied with good sensitivity to screen for bipolar disorders in clinical settings in Korea. Further evaluations with larger samples are needed to establish the usefulness of the W-K-MDQ.
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Affiliation(s)
- Narei Hong
- Department of Psychiatry, Hallym University College of Medicine, Anyang, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University College of Medicine, Anyang, Korea
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Maier RM, Visscher PM, Robinson MR, Wray NR. Embracing polygenicity: a review of methods and tools for psychiatric genetics research. Psychol Med 2018; 48:1055-1067. [PMID: 28847336 PMCID: PMC6088780 DOI: 10.1017/s0033291717002318] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 01/09/2023]
Abstract
The availability of genome-wide genetic data on hundreds of thousands of people has led to an equally rapid growth in methodologies available to analyse these data. While the motivation for undertaking genome-wide association studies (GWAS) is identification of genetic markers associated with complex traits, once generated these data can be used for many other analyses. GWAS have demonstrated that complex traits exhibit a highly polygenic genetic architecture, often with shared genetic risk factors across traits. New methods to analyse data from GWAS are increasingly being used to address a diverse set of questions about the aetiology of complex traits and diseases, including psychiatric disorders. Here, we give an overview of some of these methods and present examples of how they have contributed to our understanding of psychiatric disorders. We consider: (i) estimation of the extent of genetic influence on traits, (ii) uncovering of shared genetic control between traits, (iii) predictions of genetic risk for individuals, (iv) uncovering of causal relationships between traits, (v) identifying causal single-nucleotide polymorphisms and genes or (vi) the detection of genetic heterogeneity. This classification helps organise the large number of recently developed methods, although some could be placed in more than one category. While some methods require GWAS data on individual people, others simply use GWAS summary statistics data, allowing novel well-powered analyses to be conducted at a low computational burden.
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Affiliation(s)
- R. M. Maier
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - P. M. Visscher
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - M. R. Robinson
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | - N. R. Wray
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
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23
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Salamon S, Santelmann H, Franklin J, Baethge C. Test-retest reliability of the diagnosis of schizoaffective disorder in childhood and adolescence - A systematic review and meta-analysis. J Affect Disord 2018; 230:28-33. [PMID: 29360577 DOI: 10.1016/j.jad.2017.12.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/05/2017] [Accepted: 12/31/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Reliability of schizoaffective disorder (SAD) diagnoses is low in adults but unclear in children and adolescents (CAD). We estimate the test-retest reliability of SAD and its key differential diagnoses (schizophrenia, bipolar disorder, and unipolar depression). METHODS Systematic literature search of Medline, Embase, and PsycInfo for studies on test-retest reliability of SAD, in CAD. Cohen's kappa was extracted from studies. We performed meta-analysis for kappa, including subgroup and sensitivity analysis (PROSPERO protocol: CRD42013006713). RESULTS Out of > 4000 records screened, seven studies were included. We estimated kappa values of 0.27 [95%-CI: 0.07 0.47] for SAD, 0.56 [0.29; 0.83] for schizophrenia, 0.64 [0.55; 0.74] for bipolar disorder, and 0.66 [0.52; 0.81] for unipolar depression. In 5/7 studies kappa of SAD was lower than that of schizophrenia; similar trends emerged for bipolar disorder (4/5) and unipolar depression (2/3). Estimates of positive agreement of SAD diagnoses supported these results. LIMITATIONS The number of studies and patients included is low. CONCLUSIONS The point-estimate of the test-retest reliability of schizoaffective disorder is only fair, and lower than that of its main differential diagnoses. All kappa values under study were lower in children and adolescents samples than those reported for adults. Clinically, schizoaffective disorder should be diagnosed in strict adherence to the operationalized criteria and ought to be re-evaluated regularly. Should larger studies confirm the insufficient reliability of schizoaffective disorder in children and adolescents, the clinical value of the diagnosis is highly doubtful.
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Affiliation(s)
- Sarah Salamon
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany; Clinical and Experimental Neurosciences, University of Cologne, Cologne, Germany
| | - Hanno Santelmann
- Department of Obstetrics and Gynecology, University Medical Centre Freiburg, Freiburg, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany.
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24
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D’Addario C, Palazzo MC, Benatti B, Grancini B, Pucci M, Di Francesco A, Camuri G, Galimberti D, Fenoglio C, Scarpini E, Altamura AC, Maccarrone M, Dell’Osso B. Regulation of gene transcription in bipolar disorders: Role of DNA methylation in the relationship between prodynorphin and brain derived neurotrophic factor. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:314-321. [PMID: 28830794 PMCID: PMC5859566 DOI: 10.1016/j.pnpbp.2017.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/04/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022]
Abstract
Bipolar Disorder (BD) is a prevalent and disabling condition, determined by gene-environment interactions, possibly mediated by epigenetic mechanisms. The present study aimed at investigating the transcriptional regulation of BD selected target genes by DNA methylation in peripheral blood mononuclear cells of patients with a DSM-5 diagnosis of type I (BD-I) and type II (BD-II) Bipolar Disorders (n=99), as well as of healthy controls (CT, n=42). The analysis of gene expression revealed prodynorphin (PDYN) mRNA levels significantly reduced in subjects with BD-II but not in those with BD-I, when compared to CT. Other target genes (i.e. catechol-O-methyltransferase (COMT), glutamate decarboxylase (GAD67), serotonin transporter (SERT) mRNA levels remained unaltered. Consistently, an increase in DNA methylation at PDYN gene promoter was observed in BD-II patients vs CT. After stratifying data on the basis of pharmacotherapy, patients on mood-stabilizers (i.e., lithium and anticonvulsants) were found to have lower DNA methylation at PDYN gene promoter. A significantly positive correlation in promoter DNA methylation was observed in all subjects between PDYN and brain derived neurotrophic factor (BDNF), whose methylation status had been previously found altered in BD. Moreover, among key genes relevant for DNA methylation establishment here analysed, an up-regulation of DNA Methyl Transferases 3b (DNMT3b) and of the methyl binding protein MeCP2 (methyl CpG binding protein 2) mRNA levels was also observed again just in BD-II subjects. A clear selective role of DNA methylation involvement in BD-II is shown here, further supporting a role for BDNF and its possible interaction with PDYN. These data might be relevant in the pathophysiology of BD, both in relation to BDNF and for the improvement of available treatments and development of novel ones that modulate epigenetic signatures.
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Affiliation(s)
- Claudio D’Addario
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden,Correspondence to: Claudio D’Addario, Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy,
| | - Maria Carlotta Palazzo
- Centro Sant’Ambrogio Ordine Ospedaliero San Giovanni di Dio Fatebenefratelli, Milano, Italy
| | - Beatrice Benatti
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Benedetta Grancini
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Mariangela Pucci
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy
| | - Andrea Di Francesco
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - Giulia Camuri
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Daniela Galimberti
- Department of Neurology, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Fenoglio
- Department of Neurology, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Elio Scarpini
- Department of Neurology, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - A. Carlo Altamura
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Mauro Maccarrone
- Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy,European Center for Brain Research, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Bernardo Dell’Osso
- Department of Psychiatry, Università degli Studi di Milano, Fondazione IRRCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA,Correspondence to: Bernardo Dell’Osso, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy,
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25
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 909] [Impact Index Per Article: 151.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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Stiles BM, Fish AF, Vandermause R, Malik AM. The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text]. J Am Psychiatr Nurses Assoc 2018; 24:415-425. [PMID: 29952230 DOI: 10.1177/1078390318784360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN An integrative review was conducted using standard criteria for evaluating research articles. RESULTS Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
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Affiliation(s)
- Brandie M Stiles
- 1 Brandie M. Stiles, PhD, MSN, PMHNP-BC, University of Missouri-St. Louis, St. Louis, MO, USA; Centerpointe Hospital, St. Louis, MO, USA
| | - Anne F Fish
- 2 Anne F. Fish, PhD, RN, FAHA, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Roxanne Vandermause
- 3 Roxanne Vandermause, PhD, RN, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Azfar M Malik
- 4 Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA
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Margraf J, Cwik JC, Pflug V, Schneider S. Strukturierte klinische Interviews zur Erfassung psychischer Störungen über die Lebensspanne. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000430] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Psychische Störungen können über die ganze Lebensspanne auftreten. Strukturierte klinische Interviews sind zentrale Hilfsmittel für ihre rasche, zuverlässige und umfassende Diagnostik. Im deutschsprachigen Raum stehen mit den Verfahren der DIPS-Familie Interviews zur Diagnostik psychischer Störungen über die gesamte Lebensspanne zur Verfügung, die seit den 90er Jahren regelmäßig aktualisiert wurden. Ihre Reliabilität, Validität und Akzeptanz wurde wiederholt in großen Stichproben aus ambulanten, stationären und Forschungssettings überprüft. Die Einführung des DSM-5 erforderte eine umfassende Überarbeitung der DIPS-Interviews, deren wesentliche Merkmale dargestellt werden. Um die breitere Verwendung von strukturierten klinischen Interviews zu fördern, werden die Verfahren der DIPS-Familie neu als „Open Access-Dokumente“ zur Verfügung gestellt. Abschließend werden weitere Entwicklungen zu Training, Dissemination und Computerisierung im Ausblick angesprochen.
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Affiliation(s)
- Jürgen Margraf
- Ruhr-Universität Bochum, Fakultät für Psychologie, Forschungs- und Behandlungszentrum für psychische Gesundheit
| | - Jan Christopher Cwik
- Ruhr-Universität Bochum, Fakultät für Psychologie, Forschungs- und Behandlungszentrum für psychische Gesundheit
| | - Verena Pflug
- Ruhr-Universität Bochum, Fakultät für Psychologie, Forschungs- und Behandlungszentrum für psychische Gesundheit
| | - Silvia Schneider
- Ruhr-Universität Bochum, Fakultät für Psychologie, Forschungs- und Behandlungszentrum für psychische Gesundheit
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28
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Meyer TD, Castelao E, Gholamrezaee M, Angst J, Preisig M. Hypomania Checklist-32 - cross-validation of shorter versions screening for bipolar disorders in an epidemiological study. Acta Psychiatr Scand 2017; 135:539-547. [PMID: 28281293 DOI: 10.1111/acps.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Self-reports such as Hypomania Checklist (HCL-32) can be used to enhance recognition of bipolar disorders, but they are often too long and only validated in clinical samples. The objectives of this study are therefore to test whether (i) the HCL-32 can be used for screening in the community and (ii) whether two previously suggested shorter versions would do as well. METHOD Data stemmed from the CoLaus|PsyColaus, a prospective cohort study which included randomly selected residents aged 35-66 years from an urban area. Participants underwent semistructured interviews to assess DSM-IV disorders and 1712 of them completed the HCL-32. RESULTS Forty individuals (2.3%) were diagnosed as having BD. Compared to others, participants with BD scored significantly higher on the HCL-32. The HCL-32 had a sensitivity of 0.78 and specificity of 0.68. Very similar figures were found for two previously proposed shorter versions with 16 and 20 items. The results of confirmatory factor analysis and item response theory (IRT) models supported the postulated two-factor structure for the three HCL versions. CONCLUSION Despite the low base rate of BD in this sample, the screening properties of the HCL-32 remained almost as good. Importantly, two previously proposed shorter versions performed as well, suggesting that those could be used without losing essential information.
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Affiliation(s)
- T D Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Castelao
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - M Gholamrezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - M Preisig
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
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Feng Y, Wang YY, Huang W, Ungvari GS, Ng CH, Wang G, Yuan Z, Xiang YT. Comparison of the 32-item Hypomania Checklist, the 33-item Hypomania Checklist, and the Mood Disorders Questionnaire for bipolar disorder. Psychiatry Clin Neurosci 2017; 71:403-408. [PMID: 28094461 DOI: 10.1111/pcn.12506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/14/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022]
Abstract
AIM Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD) and hence reliable and culturally appropriate screening tools are needed. This study compared the 32-item Hypomania Checklist (HCL-32), the 33-item Hypomania Checklist (HCL-33), and the Mood Disorders Questionnaire (MDQ) for BD. METHODS Altogether, 350 depressed patients were included. The HCL-32, HCL-33, and MDQ were completed by patients to identify manic and/or hypomanic symptoms. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve among the HCL-32, HCL-33, and MDQ for BD and MDD were calculated and compared, using cut-offs suggested by respective validation studies. RESULTS Of the three scales, the MDQ had the highest sensitivity and NPV (sensitivity = 0.90, 0.81, and 0.90 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; NPV = 0.78, 0.86, and 0.86 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively), while the HCL-33 had the highest specificity and PPV (specificity = 0.74, 0.69, and 0.66 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; PPV = 0.74, 0.55, and 0.56 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively). CONCLUSION Compared to both HCL scales, the MDQ had higher sensitivity and lower specificity in screening for BD. These results contradict previous findings in Western populations. As a screening instrument for BD in Chinese clinical settings, the MDQ appears to be appropriate.
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Affiliation(s)
- Yuan Feng
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.,China Clinical Research Center for Mental Disorders, Beijing, China.,Center of Depression, Beijing Institute for Brain Disorders, Beijing, China.,Department of Psychiatry, Capital Medical University, Beijing, China
| | - Yuan-Yuan Wang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wei Huang
- Department of Psychiatry, Harbin First Specialist Hospital, Heilongjiang, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia.,School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Gang Wang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.,China Clinical Research Center for Mental Disorders, Beijing, China.,Center of Depression, Beijing Institute for Brain Disorders, Beijing, China.,Department of Psychiatry, Capital Medical University, Beijing, China
| | - Zhen Yuan
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
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Zhang L, Yu X, Fang YR, Ungvari GS, Ng CH, Chiu HFK, Li HC, Yang HC, Tan QR, Xu XF, Wang G, Xiang YT. Duration of untreated bipolar disorder: a multicenter study. Sci Rep 2017; 7:44811. [PMID: 28327583 PMCID: PMC5361090 DOI: 10.1038/srep44811] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/15/2017] [Indexed: 11/09/2022] Open
Abstract
Little is known about the demographic and clinical differences between short and long duration of untreated bipolar disorder (DUB) in Chinese patients. This study examined the demographic and clinical features of short (≤2 years) and long DUB (>2 years) in China. A consecutively recruited sample of 555 patients with bipolar disorder (BD) was examined in 7 psychiatric hospitals and general hospital psychiatric units across China. Patients' demographic and clinical characteristics were collected using a standardized protocol and data collection procedure. The mean DUB was 3.2 ± 6.0 years; long DUB accounted for 31.0% of the sample. Multivariate analyses revealed that longer duration of illness, diagnosis of BD type II, and earlier misdiagnosis of BD for major depressive disorder or schizophrenia were independently associated with long DUB. The mean DUB in Chinese BD patients was shorter than the reported figures from Western countries. The long-term impact of DUB on the outcome of BD is warranted.
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Affiliation(s)
- Ling Zhang
- The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders &Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Xin Yu
- Peking University Institute of Mental Health (the sixth Hospital) &National Clinical Research Center for Mental Disorders &the key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia.,School of Psychiatry &Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hui-Chun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang province, China
| | - Hai-Chen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Shenzhen, Guangdong province, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi province, China
| | - Xiu-Feng Xu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders &Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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31
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Cwik JC, Margraf J. Information order effects in clinical psychological diagnoses. Clin Psychol Psychother 2017; 24:1142-1154. [PMID: 28276173 DOI: 10.1002/cpp.2080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 11/06/2022]
Abstract
Despite the wide application and long history of diagnostic systems, several sources of diagnostic errors remain in the criterion-based diagnosing of mental disorders. The aim of this study was to investigate whether the presentational order of diagnosis-relevant information and pretreatment reports predict diagnostic errors. One hundred twenty psychotherapists participated in the present online study. The study employed a 2 (symptom presentation: core symptoms at vignette's beginning vs. core symptoms at the end of the case vignette) × 2 (pretreatment report: receiving a pretreatment report with an incongruent diagnosis to the case vignette vs. receiving no pretreatment report) between-subjects experimental design, with random assignment. Participants were asked to make diagnoses after reading three case vignettes describing patients with different disorder constellations. Additionally, participants rated their confidence in the diagnoses and their estimation of the severity of each diagnosed condition. Results indicated that order of symptom descriptions predicted the correctness of diagnostic decisions, with a recency effect causing more fully correct diagnostic decisions in cases where diagnostic information was presented last. Receiving incongruent pretreatment reports was predictive for diagnostic errors. In conclusion, the results of this study indicate that diagnoses of mental disorders can depend on the way symptoms are presented or reported. KEY PRACTITIONER MESSAGE Therapists' diagnostic decisions are not influenced by pretreatment reports. Diagnostic decisions are affected by information order effects. Diagnostic accuracy of psychotherapists is debatable. High rate of misdiagnoses in case vignette with comorbid disorders.
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Affiliation(s)
- Jan Christopher Cwik
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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32
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Zhang L, Yang HC, Xu XF, Fang YR, Yu X, Tan QR, Li HC, Ungvari GS, Ng CH, Wang G, Xiang YT. Demographic and clinical differences between early- and late-onset bipolar disorders in a multicenter study in China. Psychiatry Res 2016; 246:688-691. [PMID: 27825780 DOI: 10.1016/j.psychres.2016.10.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/02/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022]
Abstract
Little is known about the demographic and clinical differences between early-onset (EOB) and late-onset bipolar disorders (LOB) in Chinese patients. This multi-center study examined the demographic and clinical characteristics of EOB (≤21 years) and LOB (>21 years) in China. A consecutively recruited sample of 555 patients with bipolar disorder (BD) from 7 psychiatric hospitals and general hospital psychiatric units across China was examined. Patients' demographic and clinical characteristics were collected using a standardized protocol and data collection procedure. There were 181 (34.8%) patients with EOB and 339 (65.2%) with LOB. Univariate analyses revealed that compared to the LOB group, the EOB group were more likely to be older, unemployed, have a longer illness duration, have BD-I and misdiagnosed as schizophrenia but were less likely to be misdiagnosed as major depressive disorder and receiving antidepressants. Multivariate analyses revealed that unemployment and longer duration of illness were independently associated with EOB. The clinical differences between early-onset and late-onset BD patients in China were largely consistent with those found in Western countries. Early-onset BD appear to be associated with poorer outcomes. Prospective studies examining the long-term outcomes in relation to age-at-onset are needed.
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Affiliation(s)
- Ling Zhang
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Hai-Chen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Shenzhen, Guangdong province, China
| | - Xiu-Feng Xu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Yu
- Peking University Institute of Mental Health (the sixth Hospital) & National Clinical Research Center for Mental Disorders & the key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi province, China
| | - Hui-Chun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang province, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia / Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Cwik JC, Papen F, Lemke JE, Margraf J. An Investigation of Diagnostic Accuracy and Confidence Associated with Diagnostic Checklists as Well as Gender Biases in Relation to Mental Disorders. Front Psychol 2016; 7:1813. [PMID: 27920738 PMCID: PMC5118628 DOI: 10.3389/fpsyg.2016.01813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022] Open
Abstract
This study examines the utility of checklists in attaining more accurate diagnoses in the context of diagnostic decision-making for mental disorders. The study also aimed to replicate results from a meta-analysis indicating that there is no association between patients’ gender and misdiagnoses. To this end, 475 psychotherapists were asked to judge three case vignettes describing patients with Major Depressive Disorder (MDD), Generalized Anxiety Disorder, and Borderline Personality Disorder. Therapists were randomly assigned to experimental conditions in a 2 (diagnostic method: with using diagnostic checklists vs. without using diagnostic checklists) × 2 (gender: male vs. female case vignettes) between-subjects design. Multinomial logistic and linear regression analyses were used to examine the association between the usage of diagnostic checklists as well as patients’ gender and diagnostic decisions. The results showed that when checklists were used, fewer incorrect co-morbid diagnoses were made, but clinicians were less likely to diagnose MDD even when the criteria were met. Additionally, checklists improved therapists’ confidence with diagnostic decisions, but were not associated with estimations of patients’ characteristics. As expected, there were no significant associations between gender and diagnostic decisions.
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Affiliation(s)
- Jan C Cwik
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Fabienne Papen
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Jan-Erik Lemke
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
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Bergsholm P. Is schizophrenia disappearing? The rise and fall of the diagnosis of functional psychoses: an essay. BMC Psychiatry 2016; 16:387. [PMID: 27829400 PMCID: PMC5103459 DOI: 10.1186/s12888-016-1101-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The categories of functional psychoses build on views of influential professionals. There have long been four main categories - affective, schizophrenic, schizoaffective/cycloid/reactive/polymorphic, and delusional/paranoid psychoses. The last three are included in "psychotic disorders". However, this dichotomy and the distinctions between categories may have been over-estimated and contributed to lack of progress. TEN TOPICS RELEVANT FOR THE DIAGNOSIS OF FUNCTIONAL PSYCHOSES 1. The categories of functional psychoses have varied with time, place and professionals' views, with moving boundaries, especially between schizophrenia and affective psychoses. 2. Catatonia is most often related to affective and organic psychoses, and paranoia is related to grandiosity and guilt, calling in question catatonic and paranoid schizophrenia. Arguments exist for schizophrenia being a "misdiagnosis". 3. In some countries schizophrenia has been renamed, with positive consequences. 4. The doctrine of "unitary psychosis", which included abnormal affect, was left in the second half of the 1800s. 5. This was followed by a dichotomy between schizophrenia and affective psychoses and broadening of the schizophrenia concept, whereas affective symptoms were strongly downgraded. 6. Many homogeneous psychoses with mixtures of schizophrenic and affective symptoms were described and related to "psychotic disorders", although they might as well be affective disorders. 7. Critique of the extensive schizophrenia concept led to, in DSM-III and ICD-10, affective symptoms being exclusion criteria for schizophrenia and acceptance of mood-incongruent psychotic symptoms in affective psychoses. 8. However, affective symptoms are often difficult to acknowledge, diagnosis is often done on the basis of tradition and previous education, and patients' affect characterized accordingly. 9. DSM-5 is up-dated with separate chapters for catatonia and psychotic symptoms, and removal of the subtypes of schizophrenia. However, time may be running out for categorical psychosis diagnoses, which may be replaced by continuum, spectrum, dimensional and research domain criteria, in line with new biological data 10. This is supported by treatment responses across categories. CONCLUSION The time-consuming works on diagnosis of psychoses may have hampered progress. Chronic mood disorders may appear as schizophrenic or paranoid psychosis, end-stages like heart failure in heart diseases. This underscores the importance of early and optimal treatment of mood disorders.
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Affiliation(s)
- Per Bergsholm
- Department of Psychiatry, District General Hospital of Førde, Box 1000, 6807, Førde, Norway.
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Santelmann H, Franklin J, Bußhoff J, Baethge C. Interrater reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression - A systematic review and meta-analysis. Schizophr Res 2016; 176:357-363. [PMID: 27461400 DOI: 10.1016/j.schres.2016.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/05/2016] [Accepted: 07/15/2016] [Indexed: 12/22/2022]
Abstract
Schizoaffective disorder is a common diagnosis in clinical practice but its nosological status has been subject to debate ever since it was conceptualized. Although it is key that diagnostic reliability is sufficient, schizoaffective disorder has been reported to have low interrater reliability. Evidence based on systematic review and meta-analysis methods, however, is lacking. Using a highly sensitive literature search in Medline, Embase, and PsycInfo we identified studies measuring the interrater reliability of schizoaffective disorder in comparison to schizophrenia, bipolar disorder, and unipolar disorder. Out of 4126 records screened we included 25 studies reporting on 7912 patients diagnosed by different raters. The interrater reliability of schizoaffective disorder was moderate (meta-analytic estimate of Cohen's kappa 0.57 [95% CI: 0.41-0.73]), and substantially lower than that of its main differential diagnoses (difference in kappa between 0.22 and 0.19). Although there was considerable heterogeneity, analyses revealed that the interrater reliability of schizoaffective disorder was consistently lower in the overwhelming majority of studies. The results remained robust in subgroup and sensitivity analyses (e.g., diagnostic manual used) as well as in meta-regressions (e.g., publication year) and analyses of publication bias. Clinically, the results highlight the particular importance of diagnostic re-evaluation in patients diagnosed with schizoaffective disorder. They also quantify a widely held clinical impression of lower interrater reliability and agree with earlier meta-analysis reporting low test-retest reliability.
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Affiliation(s)
- Hanno Santelmann
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Kerpener Str. 62, 50937 Cologne, NRW, Germany.
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Medical School, Kerpener Str. 62, 50937 Cologne, NRW, Germany.
| | - Jana Bußhoff
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Kerpener Str. 62, 50937 Cologne, NRW, Germany.
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Kerpener Str. 62, 50937 Cologne, NRW, Germany.
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Mason BL, Brown ES, Croarkin PE. Historical Underpinnings of Bipolar Disorder Diagnostic Criteria. Behav Sci (Basel) 2016; 6:bs6030014. [PMID: 27429010 PMCID: PMC5039514 DOI: 10.3390/bs6030014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/24/2016] [Accepted: 07/06/2016] [Indexed: 12/16/2022] Open
Abstract
Mood is the changing expression of emotion and can be described as a spectrum. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been documented repeatedly in human history, being first systematically described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was accepted before the end of the 19th century. Kraepelin then described “manic depressive insanity” and presented his description of a full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder. Criticism of this approach is explored through discussion of the bipolar spectrum concept and some recent examinations of the clinical validity of these DSM diagnoses are presented. The concept of bipolar disorder in children is also explored.
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Affiliation(s)
- Brittany L Mason
- Department of Psychiatry, University of Texas Southwestern Medical Center; Dallas, TX 75390, USA.
| | - E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center; Dallas, TX 75390, USA.
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55901, USA.
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Tedeschi GJ, Cummins SE, Anderson CM, Anthenelli RM, Zhuang YL, Zhu SH. Smokers with Self-Reported Mental Health Conditions: A Case for Screening in the Context of Tobacco Cessation Services. PLoS One 2016; 11:e0159127. [PMID: 27391334 PMCID: PMC4938618 DOI: 10.1371/journal.pone.0159127] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/28/2016] [Indexed: 01/30/2023] Open
Abstract
Background People with mental health conditions (MHC) smoke at high rates and many die prematurely from smoking-related illnesses. Smoking cessation programs, however, generally do not screen for MHC. This study examined the utility of MHC screening in a large tobacco quitline to determine whether self-reported MHC predicts service utilization and quitting behaviors. Methods & Findings A brief set of question on MHC was embedded in the routine intake of a state quitline, and 125,261 smokers calling from June 2012 to September 2015 were asked the questions. Quit attempt rate and 6-month success rate were analyzed for a random subset of participants. Overall, 52.2% of smokers reported at least one MHC. Demographic patterns like gender or ethnic difference in self-reported MHC were similar to that in the general population. Depression disorder was reported most often (38.6%), followed by anxiety disorder (33.8%), bipolar disorder (17.0%), drug/alcohol abuse (11.9%), and schizophrenia (7.9%). Among those reporting any MHC, about two-thirds reported more than 1 MHC. Smokers with MHC received more counseling than smokers with no MHC. Quit attempt rates were high for all three groups (>70%). The probability of relapse was greater for those with more than one MHC than for those with one MHC (p<0.005), which in turn was greater than those with no MHC (p < .01). The six-month prolonged abstinence rates for the three conditions were, 21.8%, 28.6%, and 33.7%, respectively. The main limitation of this study is the use of a non-validated self-report question to assess MHC, even though it appears to be useful for predicting quitting behavior. Conclusions Smokers with MHC actively seek treatment to quit. Smoking cessation services can use a brief set of questions to screen for MHC to help identify smokers in need of more intensive treatment to quit smoking.
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Affiliation(s)
- Gary J. Tedeschi
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Sharon E. Cummins
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Christopher M. Anderson
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Robert M. Anthenelli
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
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Santelmann H, Franklin J, Bußhoff J, Baethge C. Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta-analysis of rediagnosis studies. Bipolar Disord 2016; 18:233-46. [PMID: 27226263 DOI: 10.1111/bdi.12388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/09/2016] [Accepted: 04/09/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The diagnosis of schizoaffective disorder (SAD) is well established in clinical practice but is heavily disputed on theoretical grounds. We analyzed the extent and direction of diagnostic shift in SAD patients. METHODS We searched Medline, Embase, and PsycINFO systematically for all studies documenting two diagnostic assessments at different points in time (rediagnosis studies) and used meta-analytic methods to quantify diagnostic shift. Multiple prespecified and post-hoc subgroup analyses (e.g., rater blinding) and meta-regressions (e.g., year of publication) were carried out. RESULTS We included 31 studies out of 4,415 articles screened: 27 studies on the shift from and 23 studies on the shift to SAD (median time span was two years). A total of 36% of patients with a diagnosis of SAD at first assessment switch, many to schizophrenia (19%), 14% to affective disorders, and 6% to other disorders. Among patients diagnosed with SAD at second assessment, 55% had received a different diagnosis at first assessment, a large portion of whom had been initially diagnosed with affective disorder (24%), schizophrenia (18%), and other disorders (12%). CONCLUSIONS Diagnostic shift in SAD patients is substantial. Psychiatrists need to reassess the diagnosis during the course of the illness and to adjust treatment. Slightly more diagnoses of SAD are changed to schizophrenia than to affective disorders, and among patients rediagnosed with SAD, fewer have been diagnosed with schizophrenia than with affective disorders. Thus, at the diagnostic level, there seems to be a slight trend toward schizophrenia during the course of functional psychoses.
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Affiliation(s)
- Hanno Santelmann
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jana Bußhoff
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
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Leung CM, Yim CL, Yan CTY, Chan CC, Xiang YT, Mak ADP, Fok MLY, Ungvari GS. The Bipolar II Depression Questionnaire: A Self-Report Tool for Detecting Bipolar II Depression. PLoS One 2016; 11:e0149752. [PMID: 26963908 PMCID: PMC4786156 DOI: 10.1371/journal.pone.0149752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/04/2016] [Indexed: 01/26/2023] Open
Abstract
Bipolar II (BP-II) depression is often misdiagnosed as unipolar (UP) depression, resulting in suboptimal treatment. Tools for differentiating between these two types of depression are lacking. This study aimed to develop a simple, self-report screening instrument to help distinguish BP-II depression from UP depressive disorder. A prototype BP-II depression questionnaire (BPIIDQ-P) was constructed following a literature review, panel discussions and a field trial. Consecutively assessed patients with a diagnosis of depressive disorder or BP with depressive episodes completed the BPIIDQ-P at a psychiatric outpatient clinic in Hong Kong between October and December 2013. Data were analyzed using discriminant analysis and logistic regression. Of the 298 subjects recruited, 65 (21.8%) were males and 233 (78.2%) females. There were 112 (37.6%) subjects with BP depression [BP-I = 42 (14.1%), BP-II = 70 (23.5%)] and 182 (62.4%) with UP depression. Based on family history, age at onset, postpartum depression, episodic course, attacks of anxiety, hypersomnia, social phobia and agoraphobia, the 8-item BPIIDQ-8 was constructed. The BPIIDQ-8 differentiated subjects with BP-II from those with UP depression with a sensitivity/specificity of 0.75/0.63 for the whole sample and 0.77/0.72 for a female subgroup with a history of childbirth. The BPIIDQ-8 can differentiate BP-II from UP depression at the secondary care level with satisfactory to good reliability and validity. It has good potential as a screening tool for BP-II depression in primary care settings. Recall bias, the relatively small sample size, and the high proportion of females in the BP-II sample limit the generalization of the results.
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Affiliation(s)
- Chi Ming Leung
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
- * E-mail: (CML); (YTX)
| | - Chi Lap Yim
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | | | - Cheuk Chi Chan
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
- * E-mail: (CML); (YTX)
| | - Arthur D. P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marcella Lei-Yee Fok
- King's College London, King's Health Partners, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gabor S. Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
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Santelmann H, Franklin J, Bußhoff J, Baethge C. Test-retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression--a systematic review and meta-analysis. Bipolar Disord 2015; 17:753-68. [PMID: 26498139 DOI: 10.1111/bdi.12340] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/05/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Schizoaffective disorder is a frequent diagnosis, and its reliability is subject to ongoing discussion. We compared the diagnostic reliability of schizoaffective disorder with its main differential diagnoses. METHODS We systematically searched Medline, Embase, and PsycInfo for all studies on the test-retest reliability of the diagnosis of schizoaffective disorder as compared with schizophrenia, bipolar disorder, and unipolar depression. We used meta-analytic methods to describe and compare Cohen's kappa as well as positive and negative agreement. In addition, multiple pre-specified and post hoc subgroup and sensitivity analyses were carried out. RESULTS Out of 4,415 studies screened, 49 studies were included. Test-retest reliability of schizoaffective disorder was consistently lower than that of schizophrenia (in 39 out of 42 studies), bipolar disorder (27/33), and unipolar depression (29/35). The mean difference in kappa between schizoaffective disorder and the other diagnoses was approximately 0.2, and mean Cohen's kappa for schizoaffective disorder was 0.50 (95% confidence interval: 0.40-0.59). While findings were unequivocal and homogeneous for schizoaffective disorder's diagnostic reliability relative to its three main differential diagnoses (dichotomous: smaller versus larger), heterogeneity was substantial for continuous measures, even after subgroup and sensitivity analyses. CONCLUSIONS In clinical practice and research, schizoaffective disorder's comparatively low diagnostic reliability should lead to increased efforts to correctly diagnose the disorder.
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Affiliation(s)
- Hanno Santelmann
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jana Bußhoff
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
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Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study. J Affect Disord 2015; 182:70-5. [PMID: 25978716 DOI: 10.1016/j.jad.2015.04.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND A number of data show the negative role of duration of untreated illness (DUI) on outcome in mood disorders, but no investigation has been carried out about the impact of this variable in bipolar disorder (BD) with psychotic symptoms. Clinical experience shows that many bipolar patients with psychotic symptoms receive other diagnoses and often are chronically treated with first generation antipsychotics, with the effect to reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI. Purpose of the study was to define the rate of misdiagnosis and the impact of DUP/DUI on outcome of bipolar patients with psychotic symptoms. METHOD Clinical information (DUP, DUI, first received diagnosis) about bipolar outpatients with psychotic symptoms (N=240) were extrapolated through a retrospective review of the clinical charts, Lombardy database and, if necessary, through clinical interviews with patients and their relatives. Outcome measures included psychiatric and substance abuse comorbidity, occupational status, Global Assessment of Functioning (GAF), number of hospitalizations and of suicidal attempts, number of depressive/manic recurrences. Patients were divided in two groups according to the DUP (1 year) and DUI (8 years) median, and the groups were compared through analyses of variance (ANOVAs) for continuous variables or χ(2) tests for dichotomous ones. Multivariate analysis of variance (MANOVA) with duration of illness as covariate was then performed to eliminate the effect of this variable. Finally, binary logistic regressions were performed considering age at onset, DUI, DUP as independent variables and outcome variables as dependent ones (presence of hospitalizations/suicidal attempts, GAF scores<50, occupational status). RESULTS Most of patients (61.5%) received a first diagnosis different from BD with the most frequent DSM-diagnosis being delusional disorder (17.9%). Patients with longer DUP were not different in outcome measures with respect to patients with shorter DUP. Patients with a DUI >8 years presented higher number of hospitalizations (F=6.04, p=0.015), higher number of manic recurrences (F=5.25, p=0.023), higher number of depressive recurrences (F=7.13, p=0.008) and lower GAF scores (F=17.74, p<0.001). Statistical significance persisted for number of hospitalizations (p<0.001) and GAF scores (p=0.003) after MANOVA. Finally binary logistic regression showed that a longer DUI was predictive of GAF scores<50 (F=17.74, p<0.001). DISCUSSION More than half of bipolar patients with psychotic symptoms receive a different diagnosis at first contact with psychiatric services. DUI (but not DUP) is a predictor of outcome in bipolar patients with psychotic symptoms. This indicates that an early diagnosis and proper treatment with a mood stabilizer (or an atypical antipsychotic with mood stabilizing effects) may improve long-term outcome of these patients. In the light of the naturalistic design of the present paper, these results have to be considered as preliminary and have to be confirmed by prospective controlled studies.
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Calhoun VD, Miller R, Pearlson G, Adalı T. The chronnectome: time-varying connectivity networks as the next frontier in fMRI data discovery. Neuron 2014; 84:262-74. [PMID: 25374354 PMCID: PMC4372723 DOI: 10.1016/j.neuron.2014.10.015] [Citation(s) in RCA: 851] [Impact Index Per Article: 85.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 12/12/2022]
Abstract
Recent years have witnessed a rapid growth of interest in moving functional magnetic resonance imaging (fMRI) beyond simple scan-length averages and into approaches that capture time-varying properties of connectivity. In this Perspective we use the term "chronnectome" to describe metrics that allow a dynamic view of coupling. In the chronnectome, coupling refers to possibly time-varying levels of correlated or mutually informed activity between brain regions whose spatial properties may also be temporally evolving. We primarily focus on multivariate approaches developed in our group and review a number of approaches with an emphasis on matrix decompositions such as principle component analysis and independent component analysis. We also discuss the potential these approaches offer to improve characterization and understanding of brain function. There are a number of methodological directions that need to be developed further, but chronnectome approaches already show great promise for the study of both the healthy and the diseased brain.
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Affiliation(s)
- Vince D Calhoun
- The Mind Research Network & LBERI, Albuquerque, NM 87106, USA; Department of ECE, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Robyn Miller
- The Mind Research Network & LBERI, Albuquerque, NM 87106, USA
| | | | - Tulay Adalı
- Department of CSEE, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
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McCraw S, Parker G, Graham R, Synnott H, Mitchell PB. The duration of undiagnosed bipolar disorder: effect on outcomes and treatment response. J Affect Disord 2014; 168:422-9. [PMID: 25108774 DOI: 10.1016/j.jad.2014.07.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/12/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are commonly long delays between the onset of bipolar disorder (BP), seeking of treatment and acquiring a bipolar disorder diagnosis. Whether a longer duration of undiagnosed bipolar disorder (DUBP) leads to an inferior treatment response is unclear in the literature. METHOD We conducted two studies with independent samples of BP patients who had received a first-time diagnosis of BP - first investigating whether DUBP was related to clinical and social outcomes at the time of assessment (n=173) and, second, whether response to mood stabiliser medication was affected by DUBP when assessed three months following assessment and intervention (n=64). RESULTS Participants׳ mean DUBP was 18-20 years (from the onset of mood episodes). After controlling for age, a longer DUBP was associated with employment difficulties, whereas a shorter DUBP was associated with a history of engaging in self-harm behaviours, as well as a reduced likelihood of experiencing social costs as consequence of the mood disorder. The majority of study variables were statistically unrelated to DUBP. In a multivariate analysis, age was the only predictor variable to make a significant contribution to the DUBP (33%). Across the 3-month intervention period, participants improved significantly on all but one outcome measure. The participants׳ likelihood to improve, become worse or experience minimal/no change over the study period was not significantly related to the DUBP. LIMITATIONS Self-reporting poses a risk to measurement precision. Being a naturalistic observation, no specific dose of medication was prescribed. The small sample of BP I patients provided insufficient statistical power to undertake meaningful separate analyses of the BP I and BP II participants. CONCLUSION Early detection and intervention remains important for helping to reduce morbidity and risks associated with untreated BP. However, the variation in DUBP was mostly a function of age and did not substantially affect clinical status at assessment, or lead to an inferior response to mood stabilising medication.
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Affiliation(s)
- Stacey McCraw
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Rebecca Graham
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | | | - P B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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Meyer TD, Schrader J, Ridley M, Lex C. The Hypomania Checklist (HCL) - systematic review of its properties to screen for bipolar disorders. Compr Psychiatry 2014; 55:1310-21. [PMID: 24746530 DOI: 10.1016/j.comppsych.2014.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Bipolar disorders (BDs) are often not recognised with potentially drastic consequences for the individuals and their families. In clinical practice self-reports can be used to screen to enhance recognition. We therefore present a systematic review of the screening properties for the Hypomania Checklist (HCL-32). METHODS A systematic literature search was conducted to identify all relevant studies looking at the screening properties of the HCL-32 in adults. RESULTS Out of 196 papers 21 papers reported data on 22 independent samples. We narratively reviewed these studies. Weighted estimated Sensitivity was 80% regardless of whether a BD diagnosis was compared to unipolar depression or any other non-bipolar diagnosis. Specificity indicated that the HCL-32 was better when comparing BD to unipolar depression (65.3%) than to any other diagnostic category (57.3%). Fewer studies provided estimates for predictive powers, leading to less reliable overall estimates for these indicators. CONCLUSIONS Despite some limitations, using the HCL-32 as a first screening in patients seeking help for depression can be recommended, but should never be used on its own for diagnosing. Future research should examine whether screening properties can be improved by developing an algorithm incorporating the negative consequences reported for different areas in the HCL-32.
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Affiliation(s)
- Thomas D Meyer
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.
| | - Julia Schrader
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK; Department of Psychology, Eberhard Karls University, Tübingen, Germany
| | - Matthew Ridley
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK; School of Psychology, University of Nottingham, UK
| | - Claudia Lex
- Villach General Hospital, Department of Psychiatry, Austria
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Hong N, Bahk WM, Yoon BH, Shin YC, Min KJ, Jon DI. Characteristics of bipolar symptoms in psychiatric patients: pattern of responses to the Korean version of the Mood Disorder Questionnaire. Asia Pac Psychiatry 2014; 6:120-6. [PMID: 23857745 DOI: 10.1111/j.1758-5872.2012.00224.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/07/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bipolar disorders are relatively frequent but easily misdiagnosed. The Korean version of the Mood Disorder Questionnaire (K-MDQ) is a screening instrument for bipolar disorders. The aim of this study was to establish the pattern of responses to the K-MDQ for several psychiatric disorders. METHODS The subjects for this study were 345 patients with bipolar disorders, schizophrenia, depressive disorders or anxiety disorders, as determined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and 96 controls from five hospitals. The subjects completed the questionnaire by themselves. RESULTS The total K-MDQ score was higher in the bipolar disorder group than the other groups. Although the mean K-MDQ score differed significantly between the bipolar disorder group and the other groups, the distributions of total scores for the groups overlapped, and in particular with the schizophrenia group. The area under the receiver operating characteristics curve was relatively high for the bipolar disorder group and the other subjects, but it was less than 0.8 between the bipolar disorder group, and the schizophrenia and control groups. DISCUSSION There are some distinguishing features of the K-MDQ pattern for each disorder, but their similarities were significant. This made it difficult to differentially diagnose the disorder using only the total K-MDQ score. The diagnostic power of the K-MDQ can only be improved in the clinical setting by utilizing reinforcing criteria to diagnose bipolar disorders. Clinicians should be cautious in their interpretation of the K-MDQ, and the use of additional data is essential.
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Affiliation(s)
- Narei Hong
- Department of Psychiatry, College of Medicine, Hallym University, Anyang, Korea
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Smith S, Hay EH, Farhat N, Rekaya R. Genome wide association studies in presence of misclassified binary responses. BMC Genet 2013; 14:124. [PMID: 24369108 PMCID: PMC3879434 DOI: 10.1186/1471-2156-14-124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 12/17/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Misclassification has been shown to have a high prevalence in binary responses in both livestock and human populations. Leaving these errors uncorrected before analyses will have a negative impact on the overall goal of genome-wide association studies (GWAS) including reducing predictive power. A liability threshold model that contemplates misclassification was developed to assess the effects of mis-diagnostic errors on GWAS. Four simulated scenarios of case-control datasets were generated. Each dataset consisted of 2000 individuals and was analyzed with varying odds ratios of the influential SNPs and misclassification rates of 5% and 10%. RESULTS Analyses of binary responses subject to misclassification resulted in underestimation of influential SNPs and failed to estimate the true magnitude and direction of the effects. Once the misclassification algorithm was applied there was a 12% to 29% increase in accuracy, and a substantial reduction in bias. The proposed method was able to capture the majority of the most significant SNPs that were not identified in the analysis of the misclassified data. In fact, in one of the simulation scenarios, 33% of the influential SNPs were not identified using the misclassified data, compared with the analysis using the data without misclassification. However, using the proposed method, only 13% were not identified. Furthermore, the proposed method was able to identify with high probability a large portion of the truly misclassified observations. CONCLUSIONS The proposed model provides a statistical tool to correct or at least attenuate the negative effects of misclassified binary responses in GWAS. Across different levels of misclassification probability as well as odds ratios of significant SNPs, the model proved to be robust. In fact, SNP effects, and misclassification probability were accurately estimated and the truly misclassified observations were identified with high probabilities compared to non-misclassified responses. This study was limited to situations where the misclassification probability was assumed to be the same in cases and controls which is not always the case based on real human disease data. Thus, it is of interest to evaluate the performance of the proposed model in that situation which is the current focus of our research.
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Affiliation(s)
| | | | | | - Romdhane Rekaya
- Department of Animal and Dairy Science, The University of Georgia, Athens, GA, USA.
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Pagel T, Baldessarini RJ, Franklin J, Baethge C. Heterogeneity of schizoaffective disorder compared with schizophrenia and bipolar disorder. Acta Psychiatr Scand 2013; 128:238-50. [PMID: 23465195 DOI: 10.1111/acps.12109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Low diagnostic reliability, the need to meet criteria of two disorders, and its status as residual diagnosis in clinical practice led us to hypothesize that schizoaffective disorder (SAD) is characterized by considerable heterogeneity, particularly in comparison with schizophrenia (SZ) and bipolar disorder (BD). As this has not been investigated the aim of this study is to test whether heterogeneity is larger in SAD than in SZ and BD. METHOD Systematic search for studies simultaneously comparing all three diagnoses regarding demographic, clinical, psychometric (clinical rating scales and IQ tests), and biological parameters; comparison of heterogeneity as measured by standard deviation (SD). RESULTS Standard deviation of SAD samples (N = 47) was smaller than in both differential diagnoses. SDs were 7% higher in BD than in SAD (SZ: 2% higher); in studies employing DSM-IIIR/-IV pooled SD was 4% higher in BD (8% lower in SZ). Differences between diagnoses were limited to the comparison of SAD and BD, and became smaller when only psychotic BD was considered. CONCLUSION Heterogeneity of SZ and BD is not smaller than that of SAD. SAD seems not to be more diverse than other functional psychoses. Results are preliminary because of the novelty of the approach and to the small number of studies.
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Affiliation(s)
- T Pagel
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
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Abstract
The diagnosis of bipolar disorder (BD) is predominantly clinical. Some authors have suggested that BD is underdiagnosed and that many patients, particularly those with major depressive disorder, actually have BD. Some studies have suggested that BD is wrongly diagnosed, probably because of the idea of a "bipolar spectrum." To address this potential overdiagnosis, clinicians should carefully and systematically assess whether symptoms are included in diagnostic criteria and include the individual context of the patient.
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Pagel T, Baldessarini RJ, Franklin J, Baethge C. Characteristics of patients diagnosed with schizoaffective disorder compared with schizophrenia and bipolar disorder. Bipolar Disord 2013; 15:229-39. [PMID: 23528024 DOI: 10.1111/bdi.12057] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/13/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Information on basic demographic and clinical characteristics of schizoaffective disorder is sparse and subject to sampling bias and low diagnostic reliability. In the present study we aimed to: (i) estimate the demographic and clinical descriptors in schizoaffective disorder patients and (ii) compare the findings with those with schizophrenia and bipolar disorder. METHODS To minimize sampling bias and low reliability, we systematically reviewed studies that simultaneously compared schizoaffective, schizophrenia, and bipolar disorder patients. We estimated demographic, clinical, and psychometric characteristics based on weighted pooling, and compared disorders by meta-analysis. We also estimated whether schizoaffective disorder is closer to schizophrenia or to bipolar disorder. RESULTS We identified 50 studies that included 18312 patients. Most characteristics of the 2684 schizoaffective disorder patients fell between those of 4814 diagnosed with bipolar disorder and 10814 with schizophrenia. However, the schizoaffective group had the highest proportion of women (52%), had the youngest age at illness onset (23.3 ± 3.8 years), and had the highest standardized ratings of psychosis and depression. Differences in pooled parameters between schizoaffective versus schizophrenia and versus bipolar disorder subjects were similar. Values for patients with schizoaffective disorders mostly were intermediate between schizophrenia and bipolar disorder. However, the majority of studies showed schizoaffective patients to be more like schizophrenia than bipolar disorder patients in seven out of nine demographic and clinical categories as well as in five out of eight psychometric measures. These results remained similar when we restricted the analyses to studies with psychotic bipolar disorder patients only or to studies using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IIIR and DSM-IV only. CONCLUSIONS The present study provided estimates of important characteristics of schizoaffective disorder - as balanced as possible in summarizing the findings from observational studies as unbiased as possible. The results did not support the hypothesis that schizoaffective disorder is primarily an affective disorder. The stronger resemblance of schizoaffective disorder to schizophrenia than to bipolar disorder needs further investigation.
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Affiliation(s)
- Tobias Pagel
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
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Drancourt N, Etain B, Lajnef M, Henry C, Raust A, Cochet B, Mathieu F, Gard S, Mbailara K, Zanouy L, Kahn JP, Cohen RF, Wajsbrot-Elgrabli O, Leboyer M, Scott J, Bellivier F. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatr Scand 2013; 127:136-44. [PMID: 22901015 DOI: 10.1111/j.1600-0447.2012.01917.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples. METHOD In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined. RESULTS The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania). CONCLUSION Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.
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Affiliation(s)
- N Drancourt
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
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