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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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Verdolini N, Borràs R, Sparacino G, Garriga M, Sagué‐Vilavella M, Madero S, Palacios‐Garrán R, Serra M, Forte MF, Salagre E, Aedo A, Salgado‐Pineda P, Salvatierra IM, Sánchez Gistau V, Pomarol‐Clotet E, Ramos‐Quiroga JA, Carvalho AF, Garcia‐Rizo C, Undurraga J, Reinares M, Martinez Aran A, Bernardo M, Vieta E, Pacchiarotti I, Amoretti S. Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood. Acta Psychiatr Scand 2022; 146:36-50. [PMID: 35170748 PMCID: PMC9305219 DOI: 10.1111/acps.13415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/29/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies. METHODS Patients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Chi-squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models. RESULTS The total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal-directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM. CONCLUSION Early characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.
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Affiliation(s)
- Norma Verdolini
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Roger Borràs
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Giulio Sparacino
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Marina Garriga
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Maria Sagué‐Vilavella
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Santiago Madero
- Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Roberto Palacios‐Garrán
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,University Hospital Santa MariaUniversity of LleidaLleidaSpain
| | - Maria Serra
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Maria Florencia Forte
- Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Estela Salagre
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Alberto Aedo
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Bipolar Disorders UnitDepartment of PsychiatrySchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Pilar Salgado‐Pineda
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
| | - Irene Montoro Salvatierra
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Hospital Universitari Institut Pere MataInstitut d'Investigació Sanitària Pere Virgili (IISPV)Universitat Rovira i VirgiliReusSpain
| | - Vanessa Sánchez Gistau
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Hospital Universitari Institut Pere MataInstitut d'Investigació Sanitària Pere Virgili (IISPV)Universitat Rovira i VirgiliReusSpain
| | - Edith Pomarol‐Clotet
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
| | - Josep Antoni Ramos‐Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Group of PsychiatryMental Health and AddictionsVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Psychiatric Genetics UnitVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Department of Psychiatry and Legal MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Andre F. Carvalho
- The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research CentreSchool of MedicineBarwon HealthDeakin UniversityGeelongVictoriaAustralia
| | - Clemente Garcia‐Rizo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Juan Undurraga
- Department of Neurology and PsychiatryFaculty of MedicineClinica Alemana Universidad del DesarrolloSantiagoChile,Early Intervention ProgramInstituto Psiquiátrico Dr. J. Horwitz BarakSantiagoChile
| | - María Reinares
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Anabel Martinez Aran
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Miguel Bernardo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Eduard Vieta
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Silvia Amoretti
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Group of PsychiatryMental Health and AddictionsVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Psychiatric Genetics UnitVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Department of Psychiatry and Legal MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
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Smit AM, Kilian S, Emsley RA, Luckhoff HK, Swartz L, Seedat S, Asmal L. Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders. S Afr J Psychiatr 2021; 27:1639. [PMID: 34230867 PMCID: PMC8252179 DOI: 10.4102/sajpsychiatry.v27i0.1639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/16/2021] [Indexed: 11/01/2022] Open
Abstract
Background Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia. Aim We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma's moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment. Setting We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38). Methods Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages. Results Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r 2 = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning. Conclusion In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.
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Affiliation(s)
- Anna M Smit
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robin A Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hilmar K Luckhoff
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Cupo L, McIlwaine SV, Daneault JG, Malla AK, Iyer SN, Joober R, Shah JL. Timing, Distribution, and Relationship Between Nonpsychotic and Subthreshold Psychotic Symptoms Prior to Emergence of a First Episode of Psychosis. Schizophr Bull 2021; 47:604-614. [PMID: 33410487 PMCID: PMC8759816 DOI: 10.1093/schbul/sbaa183] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Prospective population studies suggest that psychotic syndromes may be an emergent phenomenon-a function of severity and complexity of more common mental health presentations and their nonpsychotic symptoms. Examining the relationship between nonpsychotic and subthreshold psychotic symptoms in individuals who later developed the ultimate outcome of interest, a first episode of psychosis (FEP), could provide valuable data to support or refute this conceptualization of how psychosis develops. We therefore conducted a detailed follow-back study consisting of semistructured interviews with 430 patients and families supplemented by chart reviews in a catchment-based sample of affective and nonaffective FEP. The onset and sequence of 27 pre-onset nonpsychotic (NPS) or subthreshold psychotic (STPS) symptoms was systematically characterized. Differences in proportions were analyzed with z-tests, and correlations were assessed with negative binomial regressions. Both the first psychiatric symptom (86.24% NPS) and the first prodromal symptom (66.51% NPS) were more likely to be NPS than STPS. Patients reporting pre-onset STPS had proportionally more of each NPS than did those without pre-onset STPS. Finally, there was a strong positive correlation between NPS counts (reflecting complexity) and STPS counts (β = 0.34, 95% CI [0.31, 0.38], P < 2 e-16). Prior to a FEP, NPS precede STPS, and greater complexity of NPS is associated with the presence and frequency of STPS. These findings complement recent arguments that the emergence of psychotic illness is better conceptualized as part of a continuum-with implications for understanding pluripotential developmental trajectories and strengthening early intervention paradigms.
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Affiliation(s)
- Lani Cupo
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Sarah V McIlwaine
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Jean-Gabriel Daneault
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada,Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Montréal, QC, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Jai L Shah
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada,To whom correspondence should be addressed; Department of Psychiatry, McGill University, Montréal, QC, Canada; tel: (514) 761-6131x2465, fax: (514) 888-4458, e-mail:
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Salazar de Pablo G, Guinart D, Cornblatt BA, Auther AM, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Lo Cascio N, Brandizzi M, Arango C, Moreno C, Van Meter A, Correll CU. Demographic and Clinical Characteristics, Including Subsyndromal Symptoms Across Bipolar-Spectrum Disorders in Adolescents. J Child Adolesc Psychopharmacol 2020; 30:222-234. [PMID: 32083495 PMCID: PMC7232658 DOI: 10.1089/cap.2019.0138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Bipolar disorder (BD) is a debilitating illness that often starts at an early age. Prevention of first and subsequent mood episodes, which are usually preceded by a period characterized by subthreshold symptoms is important. We compared demographic and clinical characteristics including severity and duration of subsyndromal symptoms across adolescents with three different bipolar-spectrum disorders. Methods: Syndromal and subsyndromal psychopathology were assessed in adolescent inpatients (age = 12-18 years) with a clinical mood disorder diagnosis. Assessments included the validated Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P). We compared phenomenology across patients with a research consensus conference-confirmed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnoses of BD-I, BD-not otherwise specified (NOS), or mood disorder (MD) NOS. Results: Seventy-six adolescents (age = 15.6 ± 1.4 years, females = 59.2%) were included (BD-I = 24; BD-NOS = 29; MD-NOS = 23) in this study. Median baseline global assessment of functioning scale score was 21 (interquartile range = 17-40; between-group p = 0.31). Comorbidity was frequent, and similar across groups, including disruptive behavior disorders (55.5%, p = 0.27), anxiety disorders (40.8%, p = 0.98), and personality disorder traits (25.0%, p = 0.21). Mania symptoms (most frequent: irritability = 93.4%, p = 0.82) and depressive symptoms (most frequent: depressed mood = 81.6%, p = 0.14) were common in all three BD-spectrum groups. Manic and depressive symptoms were more severe in both BD-I and BD-NOS versus MD-NOS (p < 0.0001). Median duration of subthreshold manic symptoms was shorter in MD-NOS versus BD-NOS (11.7 vs. 20.4 weeks, p = 0.002) and substantial in both groups. The most used psychotropics upon discharge were antipsychotics (65.8%; BD-I = 79.2%; BD-NOS = 62.1%; MD-NOS = 56.5%, p = 0.227), followed by mood stabilizers (43.4%; BD-I = 66.7%; BD-NOS = 31.0%; MD-NOS = 34.8%, p = 0.02) and antidepressants (19.7%; BD-I = 20.8%; BD-NOS = 10.3%; MD-NOS = 30.4%). Conclusions: Youth with BD-I, BD-NOS, and MD-NOS experience considerable symptomatology and are functionally impaired, with few differences observed in psychiatric comorbidity and clinical severity. Moreover, youth with BD-NOS and MD-NOS undergo a period with subthreshold manic symptoms, enabling identification and, possibly, preventive intervention of those at risk for developing BD or other affective episodes requiring hospitalization.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Daniel Guinart
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Barbara A. Cornblatt
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Andrea M. Auther
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Ricardo E. Carrión
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Maren Carbon
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L. Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Riccardo Saba
- Department of Mental Health, ASL Roma 6, Rome, Italy
| | - Nella Lo Cascio
- Prevention and Early Intervention Service, Department of Mental Health, ASL Roma 1, Rome, Italy
| | - Martina Brandizzi
- Department of Mental Health, Local Health Agency Rome 1, Inpatient Psychiatric Unit, Santo Spirito in Sassia Hospital, Rome, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Anna Van Meter
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Christoph U. Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,Address correspondence to: Christoph U. Correll, MD, Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA
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6
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Robillard R, Naismith S, Rogers N, Scott E, Ip T, Hermens D, Hickie I. Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders: Comparison of unipolar and bipolar phenotypes. Eur Psychiatry 2020; 28:412-6. [DOI: 10.1016/j.eurpsy.2013.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/20/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022] Open
Abstract
AbstractThis study evaluated the potential of circadian measures as early markers of mood disorders subtypes. Patients with bipolar disorders had significantly lower levels and later onset of melatonin secretion than those with unipolar depression. Furthermore, abnormal phase angles between sleep, melatonin and temperature were found in several patients.
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7
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Abstract
Since its earliest conceptualization, schizophrenia has been considered a disorder of "young men." Contemporary research suggests that there are sex differences in schizophrenia that are both transdiagnostic and representative of general sex/gender differences across the psychopathology spectrum. This chapter selectively summarizes representative sex/gender differences in clinical expression, epidemiology, risk factors, treatment, as well as course and outcome in schizophrenia. The consistent sex differences found, such as onset age, generic brain anomalies, and hormonal involvement, are not specific to schizophrenia or necessarily to psychopathology. It is suggested that in working with those diagnosed as meeting the current criteria for schizophrenia, clinicians adopt a transdiagnostic framework informed by sex and gender role processes.
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Affiliation(s)
- Richard Lewine
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States.
| | - Mara Hart
- Department of Psychiatry, Worcester Recovery Center and Hospital, Worcester, MA, United States
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8
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A systematic review on sleep alterations anticipating the onset of bipolar disorder. Eur Psychiatry 2019; 58:45-53. [DOI: 10.1016/j.eurpsy.2019.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/23/2019] [Accepted: 02/08/2019] [Indexed: 12/14/2022] Open
Abstract
AbstractBackground:Sleep alterations are frequent occurrence in Bipolar Disorder (BD), both in acute and interepisodic phases. Sleep alterations have been also described both long before BD onset, as aspecific risk syndromes, or as immediate prodromes of BD onset. The aim of the present study is to systematically review the relationship between sleep alterations anticipating for the full-blown onset of BD, both in general and according to specific polarities of onset.Methods:A systematic literature research according to PRISMA statement and considering: 1. prospective studies about BD patients’ offspring with sleep alterations who later developed BD. 2. prospective studies assessing patients with sleep disorders who later developed BD. 3. retrospective studies on BD patients where sleep alterations before BD onset of the disease were reported.Results:A total of 16 studies were included in this review. Sleep disturbances may frequently appear 1 year before the onset of BD or more, often during childhood or adolescence. A decreased need for sleep may precede the onset of the illness, specially a manic episode, while insomnia appears to anticipate either a manic or a depressive episode. Hypersomnia seems to precede bipolar depressive episodes.Conclusions:Sleep alterations frequently appear long before the onset of BD, and appear to be related specifically to the polarity of the index episode. The detection and treatment of sleep alterations in special high risk populations may help achieving an earlier detection of the illness.
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Lee TY, Lee J, Kim M, Choe E, Kwon JS. Can We Predict Psychosis Outside the Clinical High-Risk State? A Systematic Review of Non-Psychotic Risk Syndromes for Mental Disorders. Schizophr Bull 2018; 44:276-285. [PMID: 29438561 PMCID: PMC5814842 DOI: 10.1093/schbul/sbx173] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recent evidence has suggested that psychosis could develop not only in people at clinical high risk for psychosis (CHR-P) but also in those with clinical risk syndromes for emergent nonpsychotic mental disorders. The proportion of people with these clinical risk syndromes who will develop psychosis rather than to other nonpsychotic mental disorders is undetermined. Electronic databases were searched for studies reporting on clinical risk syndromes for the development of emergent nonpsychotic mental disorders. Incidence of emerging psychotic and nonpsychotic mental disorders defined on the ICD or DSM. Of a total of 9 studies relating to 3006 nonpsychotic at-risk individuals were included. Within prospective studies (n = 4, sample = 1051), the pooled incidence of new psychotic disorders across these clinical risk syndromes was of 12.9 per 1000 person-years (95% CI: 4.3 to 38.6) and that of nonpsychotic disorders (n = 3, sample = 538) was of 43.5 per 1000 person-years (95% CI: 30.9 to 61.3). Psychotic disorders may emerge outside the CHR-P paradigm, from clinical risk syndromes for incident nonpsychotic disorders, albeit at lower rates than in the CHR-P group. The clinical risk syndromes for emerging nonpsychotic disorders may exhibit a pluripotential risk of developing several types of mental disorders compared with CHR-P. If substantiated by future research, the current findings suggest that it may be useful to move beyond the current strategy of identifying individuals meeting CHR-P criteria only.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eugenie Choe
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea,To whom correspondence should be addressed; Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul 03035, Republic of Korea; e-mail:
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Duffy A, Malhi GS, Grof P. Do the Trajectories of Bipolar Disorder and Schizophrenia Follow a Universal Staging Model? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:115-122. [PMID: 27310243 PMCID: PMC5298521 DOI: 10.1177/0706743716649189] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The purpose of this study is to address the question of whether a universal staging model of severe psychiatric disorders is a viable direction for future research by examining the extant literature. METHOD A narrative review was conducted of the relevant historical, conceptual, and empirical literature pertaining to the clinical trajectory of bipolar disorder and schizophrenia and issues relevant to staging. RESULTS There is substantive evidence that classic recurrent bipolar disorder is separable from schizophrenia on the basis of family history, developmental and clinical course, treatment response, and neurobiological findings. However, because of the intrinsic heterogeneity of diagnostic categories that has been amplified by recent changes in psychiatric taxonomy, key distinctions between the groups have become obfuscated. While mapping risk and illness markers to emerging psychopathology is a logical approach and may be of value for some psychiatric disorders and/or their clinical subtypes, robust evidence supporting identifiable stages per se is still lacking. Presently, even rudimentary stages such as prodromes cannot be meaningfully applied across different disorders and no commonalities can be found for the basis of universal staging. CONCLUSIONS Advances in the prediction of risk, accurate early illness detection, and tailored intervention will require mapping biomarkers and other risk indicators to reliable clinical phases of illness progression. Given the capricious nature of mood and psychotic disorders, this task is likely to yield success only if conducted in narrowly defined subgroups of individuals at high risk for specific illnesses. This approach is diametrically opposite to that being promulgated by proponents of a universal staging model.
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Affiliation(s)
- Anne Duffy
- 1 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,2 Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada
| | - Gin S Malhi
- 3 Department of Psychiatry, Royal North Shore Hospital, New South Wales, Australia.,4 Discipline of Psychiatry and Kolling Institute, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Paul Grof
- 2 Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada.,5 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Kilian S, Burns JK, Seedat S, Asmal L, Chiliza B, Du Plessis S, Olivier MR, Kidd M, Emsley R. Factors Moderating the Relationship Between Childhood Trauma and Premorbid Adjustment in First-Episode Schizophrenia. PLoS One 2017; 12:e0170178. [PMID: 28107388 PMCID: PMC5249082 DOI: 10.1371/journal.pone.0170178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022] Open
Abstract
Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.
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Affiliation(s)
- S. Kilian
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - J. K. Burns
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
- Institute for Health Research, University of Exeter, Exeter, United Kingdom
| | - S. Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L. Asmal
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - B. Chiliza
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S. Du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M. R. Olivier
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M. Kidd
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - R. Emsley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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12
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Melo MCA, Garcia RF, Linhares Neto VB, Sá MB, de Mesquita LMF, de Araújo CFC, de Bruin VMS. Sleep and circadian alterations in people at risk for bipolar disorder: A systematic review. J Psychiatr Res 2016; 83:211-219. [PMID: 27661417 DOI: 10.1016/j.jpsychires.2016.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sleep and circadian abnormalities have been mostly demonstrated in bipolar patients. However, it is not clear whether these alterations are present in population at high risk for bipolar disorder (BD), indicating a possible risk factor for this condition. OBJECTIVE This systematic review aims to define current evidence about sleep and rhythm alterations in people at risk for BD and to evaluate sleep and circadian disorders as risk factor for BD. METHODS The systematic review included all articles about the topic until February 2016. Two researchers performed an electronic search of PubMed and Cochrane Library. Keywords used were 'sleep' or 'rhythm' or 'circadian' AND 'bipolar disorder' or 'mania' or 'bipolar depression' AND 'high-risk' or 'risk'. RESULTS Thirty articles were analyzed (7451 participants at risk for BD). Sleep disturbances are frequent in studies using both subjective measures and actigraphy. High-risk individuals reported irregularity of sleep/wake times, poor sleep and circadian rhythm disruption. Poor sleep quality, nighttime awakenings, and inadequate sleep are possible predictive factors for BD. A unique study suggested that irregular rhythms increase risk of conversion. People at risk for BD showed high cortisol levels in different times of day. Studies about anatomopathology, melatonin levels, inflammatory cytokines and oxidative stress were not identified. The most important limitations were differences in sleep and rhythm measures, heterogeneity of study designs, and lack of consistency in the definition of population at risk. CONCLUSION Sleep and circadian disturbances are common in people at risk for BD. However, the pathophysiology of these alterations and the impact on BD onset are still unclear.
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Van Meter AR, Burke C, Youngstrom EA, Faedda GL, Correll CU. The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes. J Am Acad Child Adolesc Psychiatry 2016; 55:543-55. [PMID: 27343882 DOI: 10.1016/j.jaac.2016.04.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/09/2016] [Accepted: 05/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to meta-analyze the prevalence of symptoms before an initial mood episode of bipolar disorder (BD) and the prevalence of subthreshold symptoms before a BD mood episode recurrence, to facilitate early identification and prevention. METHOD Systematic literature reviews were conducted in PsycINFO and PubMed for prospective or retrospective studies reporting on the prevalence and longest duration of symptoms before an initial or recurrent mood episode of BD. Random effects meta-regression explored whether geographic location, age, percentage of female individuals, and study quality moderated the overall prevalence. RESULTS In 11 studies (n = 1,078), the prodrome preceding an initial mood episode lasted 27.1 ± 23.1 months (range, 4.6-130 months). In 10 studies (n = 1,000), the subthreshold symptoms preceding a recurrent mood episode lasted 1.0 ± 0.9 months (range, 0.5-1.3 months). The most common symptoms were largely consistent with diagnostic criteria symptoms associated with the subsequent mood polarity for both the initial prodrome and the period prior to a recurrent mood episode. Few moderators of symptom prevalences emerged, and significant heterogeneity remained. CONCLUSION The initial prodromal period is sufficiently long and characterized by symptoms of the subsequent mood episode to make early identification and intervention programs feasible. Conversely, the period of subthreshold symptoms before a recurrent mood episode is short, mandating adequate psychoeducation of patients and families, monitoring of changes in sleep and activity, plus sufficiently frequent follow-up visits to identify patients before a mood episode recurrence. Future prospective investigations, designed to address the identified shortcomings in the extant literature, are needed to identify more clinically applicable information.
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Affiliation(s)
| | - Coty Burke
- University of North Carolina at Chapel Hill
| | | | - Gianni L Faedda
- Lucio Bini Mood Disorders Center, New York University Medical Center, and the Child Study Center, New York
| | - Christoph U Correll
- The Zucker Hillside Hospital, New York, Northwell Health System, and the Hofstra Northwell School of Medicine, East Garden City, NY
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Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder. J Affect Disord 2016; 189:169-75. [PMID: 26437231 DOI: 10.1016/j.jad.2015.07.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/02/2015] [Accepted: 07/14/2015] [Indexed: 01/04/2023]
Abstract
Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.
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Sanchez-Gistau V, Romero S, Moreno D, de la Serna E, Baeza I, Sugranyes G, Moreno C, Sanchez-Gutierrez T, Rodriguez-Toscano E, Castro-Fornieles J. Psychiatric disorders in child and adolescent offspring of patients with schizophrenia and bipolar disorder: A controlled study. Schizophr Res 2015; 168:197-203. [PMID: 26363969 DOI: 10.1016/j.schres.2015.08.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Early clinical manifestations predating schizophrenia (SZ) and bipolar disorder (BP) have not been fully characterized. Child offspring studies are a valuable opportunity to study the natural history of the illness from its earliest stages. However, there is limited evidence assessing young offspring of SZ and BP simultaneously. We set out to assess rates of psychiatric disorders in child and adolescent offspring of SZ and BP, relative to offspring of community controls, so as to characterize the early phenotype of the disorders comparatively. METHODS SZ and BP parents with offspring aged 7-17years were recruited through adult mental health services of two tertiary hospitals. Community control (CC) parents were recruited from the same geographical area. Ninety BP-offspring, 41 SZ-offspring and 107 CC-offspring were assessed using the K-SADS-PL by child psychiatrists blinded to parental status. Differences in prevalence of psychiatric disorders between groups were adjusted for confounders and for sibling correlation using generalised estimating equations. RESULTS We found a gradient of clinical severity and social disadvantage between SZ, BP and CC-offspring. After adjusting for socio-demographic confounders, SZ and BP-offspring presented higher rates of attention deficit hyperactivity disorder (ADHD) than CC-offspring. ADHD was more prevalent in SZ-offspring than BP-offspring, and BP-offspring presented a higher prevalence of depression than CC-offspring. CONCLUSIONS The higher rates of ADHD in SZ-offspring suggest that abnormal neurodevelopmental processes may exert a stronger influence in SZ than BP. Follow-up of these children will help elucidate the role of ADHD and depression phenotypes in predicting future transition to SZ or BP.
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Affiliation(s)
- Vanessa Sanchez-Gistau
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain.
| | - Soledad Romero
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain
| | - Dolores Moreno
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain
| | - Inmaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Gisela Sugranyes
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carmen Moreno
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Teresa Sanchez-Gutierrez
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elisa Rodriguez-Toscano
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Josefina Castro-Fornieles
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Sanchez-Gistau V, Baeza I, Arango C, González-Pinto A, de la Serna E, Parellada M, Graell M, Paya B, Llorente C, Castro-Fornieles J. The affective dimension of early-onset psychosis and its relationship with suicide. J Child Psychol Psychiatry 2015; 56:747-755. [PMID: 25256792 DOI: 10.1111/jcpp.12332] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The affective dimension has scarcely been studied in early-onset psychosis. Our aims were to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis and to examine their relationship with suicide. We also sought to establish whether the presence of premorbid antecedents or the presence of affective symptoms during the prodromal and acute phase might predict a later diagnosis of bipolar disorder (BP) or schizophrenia (SZ). METHOD Participants were 95 youths, aged 9-17 years, experiencing a first episode of a psychotic disorder (FEP) according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of the K-SADS. Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Suicidality was assessed during the acute episode and at 6 and 12 months. RESULTS Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive, 41.4% mixed and 18.9% manic symptoms. After logistic regression analysis, only the presence of depressive symptoms was significantly associated with suicidality during the 12 months following the FEP. Neither early premorbid antecedents nor the prevalence or type of affective symptoms during the FEP predicted a diagnosis of BP or SZ at 12 months. However, both depressive and manic prodromal symptoms were associated with a later diagnosis of BP. CONCLUSIONS The FEP of both SZ and BP is preceded by an identifiable prodromal phase. Early detection programs should target young people at clinical risk for the extended psychosis phenotype. The high prevalence of affective symptoms during the early phases of psychosis may encourage clinicians to identify and treat them in order to prevent suicide behaviour.
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Affiliation(s)
- Vanessa Sanchez-Gistau
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Celso Arango
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Santiago Apóstol, EHU/University of the Basque Country, Vitoria, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beatriz Paya
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Cloe Llorente
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Abstract
Bipolar disorder (BPD) essentially has its onset during adolescence and early adulthood. It has the capacity to be highly disruptive, dislocating individuals from their normal developmental trajectory and potentially causing significant long-term co-morbidity and chronicity. At a societal level the burden created is greater than schizophrenia. This is not helped by the very substantial delays in its diagnosis and appropriate treatment. Thus, there is a clear rationale for intervening earlier and at a younger age. However, the field of early intervention in BPD is in its infancy. One approach that conceptually provides a basis for early intervention is the Clinical Staging Model (used widely in general medicine). This article outlines how this model helps in an understanding of the emerging stages of BPD. It also summarises the interventions that might be appropriately introduced if a person progresses from an early to a late stage of the illness. Early intervention has a well-established record in psychotic disorders. If it can be realised for BPDs, then it may hold out hope of better outcomes for the next generation of young people at risk.
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Malhi GS, Bargh DM, Coulston CM, Das P, Berk M. Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention. Bipolar Disord 2014; 16:455-70. [PMID: 24636153 DOI: 10.1111/bdi.12133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bipolar disorder is a multifaceted illness and there is often a substantial delay between the first onset of symptoms and diagnosis. Early detection has the potential to curtail illness progression and disorder-associated burden but it requires a clear understanding of the initial bipolar prodrome. This article summarizes the phenomenology of bipolar disorder with an emphasis on the initial prodrome, the evolution of the illness, and the implications for prevention and early intervention. METHODS A literature review was undertaken using Medline, Web of Science, and a hand search of relevant literature using keywords (e.g., phenomenology, initial or early symptoms, risk factors, and predictors/prediction). Findings from the literature were reviewed and synthesized and have been put into a clinical context. RESULTS Bipolar disorder is a recurrent, persistent, and disabling illness that typically develops in adolescence or early adulthood. The literature search yielded 28 articles, in which mood lability, nonspecific, non-mood symptoms, and cyclothymic temperament were the most cited prodromal features. CONCLUSIONS A small number of key prospective studies have provided evidence in support of an initial bipolar prodrome; however, methodological differences across studies have prohibited its clear delineation. It is, therefore, not currently possible to anticipate those who will develop bipolar disorder solely on the basis of early phenomenology. Accurate characterization of the bipolar disorder prodrome through high-quality, prospective research studies with adequate control groups will ultimately facilitate prompt and accurate diagnosis.
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Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Correll CU, Hauser M, Penzner JB, Auther AM, Kafantaris V, Saito E, Olvet D, Carrión RE, Birmaher B, Chang KD, DelBello MP, Singh MK, Pavuluri M, Cornblatt BA. Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. Bipolar Disord 2014; 16:478-92. [PMID: 24597782 PMCID: PMC4186919 DOI: 10.1111/bdi.12194] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/10/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of the present study was to systematically evaluate the prodrome to mania in youth. METHODS New-onset/worsening symptoms/signs of ≥ moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale-Retrospective. RESULTS The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ≥ 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3-14.4], being present for ≥ 4 months in 65.4% of subjects. Among prodromal symptoms reported in ≥ 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ≥ 1 (84.6%), ≥ 2 (48.1%), or ≥ 3 (26.9%) 'specific' subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0-14.0), 3.5 ± 3.5 months (95% CI: 2.0-4.9), and 3.0 ± 3.2 months (95% CI: 1.0-5.0) for ≥ 1, ≥ 2, or ≥ 3 specific symptoms, respectively. CONCLUSIONS In youth with BD-I, a relatively long, predominantly slow-onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Hofstra North Shore-LIJ School of Medicine, Hempstead, NY; The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
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Correll CU, Olvet DM, Auther AM, Hauser M, Kishimoto T, Carrión RE, Snyder S, Cornblatt BA. The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. Bipolar Disord 2014; 16:505-22. [PMID: 24807784 PMCID: PMC4160534 DOI: 10.1111/bdi.12209] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/22/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the psychometric properties of the Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P), the first specific interview for emerging bipolar disorder (BD) symptoms. METHODS A total of 205 youth aged 12-23 years and/or their caregivers underwent BPSS-P interviews: 129 patients with mood spectrum disorders [depression spectrum disorder (n = 77), mood disorder not otherwise specified (NOS) (n = 27), BD-NOS (n = 14), bipolar I disorder (BD-I)/bipolar II disorder (BD-II)/cyclothymia (n = 11), 34 with non-mood spectrum disorders, and 42 healthy controls (HCs)]. We used Cronbach's α to assess internal consistency; intra-class correlation (ICC) for inter-rater reliability; Spearman's rho for convergent validity with the Young Mania Rating Scale (YMRS), General Behavior Inventory-10-item Mania Form (GBI-M-10), and Cyclothymic-Hypersensitive Temperament (CHT) scale; and analysis of variance for discriminatory power between diagnostic groups. RESULTS Internal consistency was good to very good for the BPSS-P Mania (Cronbach's α = 0.87), Depression (Cronbach's α = 0.89), and General Symptom indices (Cronbach's α = 0.74). Inter-rater reliability was high for the BPSS-P Total score (ICC = 0.939), and BPSS-P Mania (ICC = 0.934), Depression (ICC = 0.985), and General (ICC = 0.981) indices. Convergent validity was large (ρ ≥ 0.50) between the BPSS-P Mania Index and YMRS, GBI-M-10, and CHT; BPSS-P Depression Index and Montgomery-Åsberg Depression Rating Scale (MADRS) and CHT; and BPSS-P General Index and GBI-M-10 and CHT. Expectedly, convergent validity was small (ρ = 0.10 to < 0.30) between the BPSS-P Mania Index and MADRS, and BPSS-P Depression Index and YMRS. Furthermore, the BPSS-P and its subscales discriminated each patient group from HCs and from non-mood spectrum patients (except for the BPSS-P General Index). Moreover, the BPSS-P Total score discriminated BD-I/BD-II/cyclothymia from depression spectrum patients, and the BPSS-Mania Index differentiated all three bipolar spectrum groups from depression spectrum patients. CONCLUSIONS The BPSS-P has good to excellent psychometric properties. Its use across multiple settings and predictive validity requires further investigation.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Albert Einstein College of Medicine, Bronx, NY
| | - Doreen M Olvet
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY
| | - Andrea M Auther
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
| | - Marta Hauser
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
| | - Taishiro Kishimoto
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Ricardo E Carrión
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
| | - Stephanie Snyder
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
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Conus P, Macneil C, McGorry PD. Public health significance of bipolar disorder: implications for early intervention and prevention. Bipolar Disord 2014; 16:548-56. [PMID: 24127825 DOI: 10.1111/bdi.12137] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 05/27/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder (BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder. METHODS The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression. RESULTS BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD. CONCLUSIONS Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder.
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Affiliation(s)
- Philippe Conus
- Service de Psychiatrie Générale, Département Universitaire de Psychiatrie CHUV, Lausanne University, Clinique de Cery, Prilly, Switzerland
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Abstract
In the past, preventive measures for psychoses have focused mainly on schizophrenic disorders. Bipolar disorders are often diagnosed and treated with a significant delay. The expansion of preventive measures for bipolar disorders aims at minimizing the substantial negative consequences associated with the disease. Some of the shared aspects of prevention in psychoses and bipolar disorders are that the first symptoms commonly appear during adolescence and early adulthood and that there is a symptomatic overlap between the disorders. To improve efforts to seek early help, public information about mental illness, low threshold services as well as cooperation between adult, child and adolescent psychiatry are needed for this target group. One differences is that psychotic symptoms play a minor role in bipolar disorders. Specific biological markers, such as disturbances of sleep and circadian rhythm and clinical characteristics, such as substance use and behavioral problems in childhood and youth supplement (subsyndromal) clinical symptoms in a multifactorial risk model. Besides severity and frequency of symptoms, specific periodic course patterns are crucial. Strategies of early intervention require a careful consideration of risks and benefits. Two aims should be distinguished: the improvement of current symptomatology and the prevention of conversion to bipolar disorder. Currently, studies evaluating risks and benefits of such interventions are first conducted. Expertise and resources for early recognition of psychoses and bipolar disorders should be pooled. Common standards are the basis for advancement and implementation of preventive strategies for bipolar disorders.
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Benti L, Manicavasagar V, Proudfoot J, Parker G. Identifying early indicators in bipolar disorder: a qualitative study. Psychiatr Q 2014; 85:143-53. [PMID: 24174009 DOI: 10.1007/s11126-013-9279-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The identification of early markers has become a focus for early intervention in bipolar disorder. Using a retrospective, qualitative methodology, the present study compares the early experiences of participants with bipolar disorder to those with unipolar depression up until their first diagnosed episode. The study focuses on differences in early home and school environments as well as putative differences in personality characteristics between the two groups. Finally we a compare and contrast prodromal symptoms in these two populations. Thirty-nine participants, 20 diagnosed with unipolar depression and 19 diagnosed with bipolar disorder, took part in the study. A semi-structured interview was developed to elicit information about participants' experiences prior to their first episode. Participants with bipolar disorder reported disruptive home environments, driven personality features, greater emotion dysregulation and adverse experiences during the school years, whereas participants with depression tended to describe more supportive home environments, and more compliant and introvert personality traits. Retrospective data collection and no corroborative evidence from other family members. No distinction was made between bipolar I and bipolar II disorder nor between melancholic and non-melancholic depression in the sample. Finally the study spanned over a 12-month period which does not allow for the possibility of diagnostic reassignment of some of the bipolar participants to the unipolar condition. These findings indicate that there may be benefits in combining both proximal and distal indicators in identifying a bipolar disorder phenotype which, in turn, may be relevant to the development of early intervention programs for young people with bipolar disorder.
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Affiliation(s)
- Liliane Benti
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia Florey Institute of Neuroscience and Mental Health, Department of Psychiatry and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Australia
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Salvatore P, Baldessarini RJ, Khalsa HMK, Vázquez G, Perez J, Faedda GL, Amore M, Maggini C, Tohen M. Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients. Acta Psychiatr Scand 2014; 129:275-85. [PMID: 23837831 PMCID: PMC3797176 DOI: 10.1111/acps.12170] [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] [Accepted: 05/28/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE As initial episode type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode types. METHOD We studied 263 first-episode, adult, DSM-IV-TR type I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first lifetime manic vs. other (mixed, depressive, or non-affective) major psychotic episodes. RESULTS We identified 32 antecedents arising at early, intermediate or later times, starting 12.3±10.7 years prior to first lifetime major psychotic episodes. Based on multivariate modeling, antecedents associated significantly and independently with other (n=113) more than manic (n=150) first lifetime major psychotic episodes ranked by odds ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early-to-intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding manic more than other first psychotic episodes included more late behavioral problems and more risk of familial BD-I. CONCLUSION Clinical antecedents in adult, BD-I patients, beginning a decade before first major episodes and progressing through sequential stages were dissimilar in manic vs. other first psychotic episodes.
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Affiliation(s)
- Paola Salvatore
- Department of Psychiatry & Neuroscience Program, Harvard Medical School, Boston, MA 02115
,International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
,Section of Psychiatry, Department of Neuroscience, University of Parma, 43100 Parma, Italy
| | - Ross J. Baldessarini
- Department of Psychiatry & Neuroscience Program, Harvard Medical School, Boston, MA 02115
,International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
| | - Hari-Mandir K. Khalsa
- International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
| | - Gustavo Vázquez
- International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
,Department of Neuroscience, University of Palermo, Buenos Aires, Capital Federal 1175, Argentina
| | - Jesus Perez
- International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
,CAMEO Early Intervention Services, Department of Psychiatry, University of Cambridge, Cambridge CB21-5EE, United Kingdom
| | - Gianni L. Faedda
- International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
,‘Lucio Bini’ Mood Disorders Center, New York, NY 10022
,Department of Child Psychiatry, New York University School of Medicine, New York, NY 10016
| | - Mario Amore
- Psychiatric Clinic, Department of Neuroscience, Ophthalmology & Genetics, University of Genoa, 16132 Genoa, Italy
| | - Carlo Maggini
- International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
,Section of Psychiatry, Department of Neuroscience, University of Parma, 43100 Parma, Italy
| | - Mauricio Tohen
- International Consortium for Psychotic & Bipolar Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478
,Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 48229
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Pfennig A, Correll CU, Marx C, Rottmann-Wolf M, Meyer TD, Bauer M, Leopold K. Psychotherapeutic interventions in individuals at risk of developing bipolar disorder: a systematic review. Early Interv Psychiatry 2014; 8:3-11. [PMID: 23968367 DOI: 10.1111/eip.12082] [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: 05/15/2013] [Accepted: 07/15/2013] [Indexed: 12/21/2022]
Abstract
AIM Accumulating data show that patients with bipolar disorder (BD) experience substantial symptomatology months or years before full manifestation. Based on the need for early preventive interventions in BD as well as data suggesting effectiveness of psychotherapeutic interventions for BD, we aimed to review the evidence for psychotherapeutic treatments in help-seeking individuals considered at risk for BD (At-Risk-BD). METHODS Searching PubMed and PsycINFO, clinical trial registries and recently published systematic reviews, a systematic review was performed of psychoeducational and psychotherapeutic intervention studies in At-Risk-BD individuals. RESULTS Only three completed studies were identified, two of which were randomized trials (n = 77) and one was an open pilot study (n = 13). Two ongoing studies (projected n = 150 and n = 100, respectively) were found in trial registries. The available evidence suggests potential effectiveness of multi-family psychoeducational psychotherapy and family-focussed therapy for symptom reduction and prevention of BD conversion. CONCLUSIONS Psychotherapeutic treatments are a reasonable starting point for At-Risk-BD subjects when symptom severity, distress and impairment are sufficiently significant to initiate treatment. Ongoing studies will further clarify the effectiveness and timing of psychotherapeutic interventions for At-Risk-BD individuals and whether or not they should be given alone or in conjunction with other treatments. Large multi-site studies with standardized procedures/manuals are needed to advance the field.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische University Dresden, Dresden, Germany
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27
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Martin DJ, Smith DJ. Is there a clinical prodrome of bipolar disorder? A review of the evidence. Expert Rev Neurother 2014; 13:89-98. [DOI: 10.1586/ern.12.149] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Noto MN, de Souza Noto C, de Jesus DR, Zugman A, Mansur RB, Berberian AA, Leclerc E, McIntyre RS, Correll CU, Brietzke E. Recognition of bipolar disorder type I before the first manic episode: challenges and developments. Expert Rev Neurother 2014; 13:795-806; quiz 807. [DOI: 10.1586/14737175.2013.811132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Zanini M, Castro J, Coelho FM, Bittencourt L, Bressan RA, Tufik S, Brietzke E. Do sleep abnormalities and misaligned sleep/circadian rhythm patterns represent early clinical characteristics for developing psychosis in high risk populations? Neurosci Biobehav Rev 2013; 37:2631-7. [PMID: 24096189 DOI: 10.1016/j.neubiorev.2013.08.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/24/2013] [Accepted: 08/28/2013] [Indexed: 02/04/2023]
Abstract
Sleep architecture changes, such as slow-wave sleep (SWS) percentage variations and reductions in latency and density of rapid eye movement (REM), are found in most patients with schizophrenia and are considered to be an important part of the pathophysiology of the disorder. In addition to these sleep parameters changes, disruptions in sleep homeostasis and the sleep/circadian rhythm also occur in these patients. Sleep/circadian rhythm abnormalities negatively affect neocortical plasticity and cognition and often precede the diagnosis of the illness. Thus, it has been suggested that the sleep/circadian rhythm might be involved in the pathophysiology of psychosis. Recent advances in the identification of individuals at a high risk for developing schizophrenia allow us to investigate several neurobiological processes involved in the development of psychosis. In this article, we review the current evidence of the effects of sleep parameter abnormalities, disruptions in sleep homeostasis and misalignments of sleep circadian rhythm on the early stages of schizophrenia. In addition, we discuss the preliminary evidence of sleep and circadian rhythm abnormalities during the prodromal stages of psychosis and propose that these abnormalities can be explored as potential predictors, as an adjunct to clinical diagnosis, of developing a psychotic disorder in at risk populations.
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Affiliation(s)
- Marcio Zanini
- Programa de Reconhecimento e Intervencao em Indivíduos em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
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30
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Cotton SM, Lambert M, Berk M, Schimmelmann BG, Butselaar FJ, McGorry PD, Conus P. Gender differences in first episode psychotic mania. BMC Psychiatry 2013; 13:82. [PMID: 23497439 PMCID: PMC3602146 DOI: 10.1186/1471-244x-13-82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients. METHODS Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures. RESULTS Males with FEPM had increased likelihood of substance use (OR = 13.41, p <.001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge. CONCLUSIONS Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.
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Affiliation(s)
- Sue M Cotton
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia.
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,School of Medicine, Deakin University, Geelong, Australia,Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Felicity J Butselaar
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland
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Scott EM, Hermens DF, Naismith SL, Guastella AJ, De Regt T, White D, Lagopoulos J, Hickie IB. Distinguishing young people with emerging bipolar disorders from those with unipolar depression. J Affect Disord 2013; 144:208-15. [PMID: 22877963 DOI: 10.1016/j.jad.2012.06.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/19/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND To facilitate early intervention, there is a need to distinguish unipolar versus bipolar illness trajectories in adolescents and young adults with adult-type mood disorders. METHODS Detailed clinical and neuropsychological evaluation of 308 young persons (aged 12 to 30 years) with moderately severe unipolar and bipolar affective disorders. RESULTS Almost 30% (90/308) of young people (mean age=19.4±4.4yr) presenting for care with affective disorders met criteria for a bipolar-type syndrome (26% with bipolar I). Subjects with bipolar- and unipolar-type syndromes were of similar age (19.8 vs. 19.2yr) and reported comparable ages of onset (14.5 vs. 14.3yr). Clinically, those subjects with unipolar and bipolar-type disorders reported similar levels of psychological distress, depressive symptoms, current role impairment, neuropsychological dysfunction and alcohol or other substance misuse. Subjects with unipolar disorders reported more social anxiety (p<0.01). Subjects with bipolar disorders were more likely to report a family history of bipolar (21% vs. 11%; [χ(2)=4.0, p<.05]) or psychotic (19% vs. 9%; [χ(2)=5.5, p<.05]), or substance misuse (35% vs. 23%; [χ(2)=3.9, p<.05]), but not depressive (48% vs. 53%; χ(2)=0.3, p=.582]) disorders. CONCLUSIONS Young subjects with bipolar disorders were best discriminated by a family history of bipolar, psychotic or substance use disorders. Early in the course of illness, clinical features of depression, or neuropsychological function, do not readily differentiate the two illness trajectories.
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Affiliation(s)
- Elizabeth M Scott
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallet Street, Camperdown, NSW 2050, Australia
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Olvet DM, Burdick KE, Cornblatt BA. Assessing the potential to use neurocognition to predict who is at risk for developing bipolar disorder: a review of the literature. Cogn Neuropsychiatry 2013; 18:129-45. [PMID: 23137046 PMCID: PMC3578087 DOI: 10.1080/13546805.2012.724193] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of early intervention strategies has recently been recognised in the field of psychiatry. Although early intervention strategies in schizophrenia have been extensively studied, recent efforts to identify individuals who are at increased risk for other disorders, such as bipolar disorder, have gained significant interest. There is some available data to suggest that cognitive deficits may precede the onset of mania; therefore, it would be beneficial to identify cognitive predictors of bipolar disorder in an effort to facilitate early intervention. METHODS We conducted a literature review of conscript, cohort, high-risk, family-based and first-episode mania studies that assessed neurocognition in order to ascertain potential cognitive predictors of bipolar disorder. RESULTS There is little evidence that individuals at risk for bipolar disorder exhibit deficits in global measures of neurocognition, such as IQ. However, deficits in specific neurocognitive domains, including verbal memory and executive function, appear to represent potential predictors of bipolar disorder. CONCLUSIONS These conclusions are preliminary; however, they provide a starting point for future work. Additional efforts towards understanding both the clinical and cognitive prodrome will be important in elucidating the pathophysiology of bipolar disorder.
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Affiliation(s)
- Doreen M. Olvet
- The Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System, Glen Oaks, New York, 11004, USA,The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, 11030, USA
| | | | - Barbara A. Cornblatt
- The Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System, Glen Oaks, New York, 11004, USA,The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, 11030, USA,The Albert Einstein College of Medicine, Bronx, New York, 10461, USA
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Hauser M, Correll CU. The significance of at-risk or prodromal symptoms for bipolar I disorder in children and adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:22-31. [PMID: 23327753 PMCID: PMC4010197 DOI: 10.1177/070674371305800106] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While in the early identification and intervention of psychosis-specific instruments and risk criteria have been generated and validated, research into indicated preventive strategies for bipolar I disorder (BD I) has only recently gained momentum. As the first signs of BD I often start before adulthood, such efforts are especially important in the vulnerable pediatric population. Data are summarized regarding the presence and nature of potentially prodromal, that is, subsyndromal, symptoms prior to BD I, defined by first-episode mania, focusing on pediatric patients. Research indicates the possibility of early identification of youth at clinical high risk for BD. Support for this proposition comes from retrospective studies of BD I patients, as well as prospective studies of community samples, offspring of BD I subjects, youth with depressive disorders, and patients at high risk for psychosis or with bipolar spectrum disorders without lifetime history of mania. These data provide essential insight into potential signs and symptoms that may enable presyndromal identification of BD I in youth. However, except for offspring studies, broader prospective approaches that focus on youth at clinical high risk for BD I and on developing specific interviews and (or) rating scales and risk criteria are mostly missing, or in their early stage. More work is needed to determine valid and sufficiently specific clinical high-risk criteria, to distinguish risk factors, endophenotypes, and comorbidities from prodromal symptomatology, and to develop phase-specific interventions that titrate the risk of intervention to the risk of transition to mania and to functional impairment or distress. Moreover, studies are needed that determine potential differences in prodromal symptoms and trajectories between children, adolescents, and adults, and the best phase-specific interventions.
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Affiliation(s)
- Marta Hauser
- Improve Care, Reduce Costs ICRC Project, The Zucker Hillside Hospital, Division of Psychiatry Research, Glen Oaks, New York, USA
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Skjelstad DV, Holte A, Malt UF. Putative early manifestations of bipolar II disorder emerge later in the initial prodrome than manifestations hypothesized to be unrelated: an exploratory study. Early Interv Psychiatry 2012; 6:460-4. [PMID: 22409302 DOI: 10.1111/j.1751-7893.2012.00348.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Symptom instances characterized as episodic or chronic, and as exaggerated responses to life events or inexplicable (e.g. mood swings, irritability/aggressiveness), may be the most likely early manifestations of the first episode of bipolar II disorder (BD-II). Assuming that symptoms that emerge late in the prodrome, to a larger extent, are early manifestations of the disorder itself, we explore the time of onset and the duration of instances classified as 'likely', 'possible' and 'unlikely' early manifestations. METHODS Retrospective interviews of 15 BD-II patients and 22 family members. RESULTS 'Likely' early manifestations do, to a larger extent than other symptom instances, emerge late in the prodrome. The mean time interval between symptom onset and the first episode is shorter for the 'likely' than for the 'unlikely' early manifestations but is similar to the 'possible' ones. CONCLUSIONS Symptom instances classified as 'likely' early manifestations may be the most useful to prospectively predict BD-II.
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The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls. J Neural Transm (Vienna) 2012; 119:1173-84. [DOI: 10.1007/s00702-012-0883-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 07/31/2012] [Indexed: 10/28/2022]
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Salokangas RKR, Ruhrmann S, von Reventlow HG, Heinimaa M, Svirskis T, From T, Luutonen S, Juckel G, Linszen D, Dingemans P, Birchwood M, Patterson P, Schultze-Lutter F, Klosterkötter J. Axis I diagnoses and transition to psychosis in clinical high-risk patients EPOS project: prospective follow-up of 245 clinical high-risk outpatients in four countries. Schizophr Res 2012; 138:192-7. [PMID: 22464922 DOI: 10.1016/j.schres.2012.03.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 03/02/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND In selected samples, a considerable number of patients at clinical high risk of psychosis (CHR) are found to meet criteria for co-morbid clinical psychiatric disorders. It is not known how clinical diagnoses correspond to or even predict transitions to psychosis (TTP). Our aim was to examine distributions of life-time and current Axis I diagnoses, and their association with TTP in CHR patients. METHODS In the EPOS (European Prediction of Psychosis Study) project, six European outpatient centres in four countries examined 245 young help-seeking patients, who fulfilled the inclusion criteria for clinical risk of psychosis according to the Structured Interview for Prodromal Syndromes (SIPS 3.0) or the Bonn Scale for the Assessment of Basic Symptoms - Prediction List basic symptoms (BASBS-P). Patients who had experienced a psychotic episode lasting more than one week were excluded. Baseline and life-time diagnoses were assessed by the Structured Clinical Interview for DSM-IV (SCID-I). TTP was defined by continuation of BLIPS for more than seven days and predicted in Cox-regression analysis. RESULTS Altogether, 71% of the CHR patients had one or more life-time and 62% one or more current SCID-I diagnosis; about a half in each category received a diagnosis of life-time depressive and anxiety disorder. Currently, 34% suffered from depressive and 39% from anxiety disorder. Four percent received a current SCID diagnosis of bipolar, and 6.5% of somatoform disorder. During follow-up, 37 (15.1%) patients had developed full-blown psychosis. In bivariate analyses, current non-psychotic bipolar disorder associated significantly with TTP. In multivariate analyses, current bipolar disorder, somatoform and unipolar depressive disorders associated positively, and anxiety disorders negatively, with TTP. CONCLUSIONS Both life-time and current mood and anxiety disorders are highly prevalent among clinical help-seeking CHR patients and need to be carefully evaluated. Among CHR patients, occurrence of bipolar, somatoform and depressive disorders seems to predict TTP, while occurrence of anxiety disorder may predict non-transition to psychosis.
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Leopold K, Ritter P, Correll CU, Marx C, Özgürdal S, Juckel G, Bauer M, Pfennig A. Risk constellations prior to the development of bipolar disorders: rationale of a new risk assessment tool. J Affect Disord 2012; 136:1000-10. [PMID: 21802741 DOI: 10.1016/j.jad.2011.06.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The precise characterisation of a high risk status for the development of a psychiatric disorder and the question of how well this predicts disease manifestation is of major importance as negative consequences of late diagnosis and treatment have been well demonstrated. In the absence of well defined and disease specific biological markers for bipolar disorder, the recognition of premature stages must rely on combinations of risk factors that have been associated with later disease manifestation. METHODS A review of the literature and our experience from the Early Recognition Centre led us to identify symptom constellations. RESULTS Individual categories defined and grouped included: (I) genetic risk, (II) substance use, misuse or dependence, (III) diagnosis/suspected diagnosis of attention deficit hyperactivity disorder, (IV) pronounced creativity, (V) impairment in psychosocial functioning, (VI) subthreshold affective symptoms, and (VII) early symptomatology including (a) changes in sleep and circadian rhythm, (b) changes in mood, mood swings/affective lability, (c) fearfulness/anxiety, and (d) dissociative symptoms. These risk constellations were operationalised and a new risk assessment instrument, the Early Phase Inventory for Bipolar Disorders (EPIbipolar) was developed. LIMITATIONS Challenges regarding the validity of the data on which the instrument is based, specificity of and correlations between risk categories, and ethical considerations were encountered. CONCLUSIONS Further use of EPIbipolar in research should help to refine prodromal features and narrow these down to a less cumbersome core that can be used to develop a shortened tool for use in clinical care. Prospective longitudinal research is needed to establish the predictive validity of this novel bipolar disorder risk assessment tool.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
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Más allá de la psicosis: el reto de la intervención precoz en los trastornos bipolares. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5:1-4. [DOI: 10.1016/j.rpsm.2011.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/19/2022]
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Early detection and intervention in bipolar affective disorder: targeting the development of the disorder. Curr Psychiatry Rep 2011; 13:493-9. [PMID: 21850462 PMCID: PMC3836252 DOI: 10.1007/s11920-011-0229-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The diagnosis of bipolar affective disorder (BD) is often delayed, and preceded by incorrect diagnoses and potentially harmful treatment, while the development of the disorder is associated with suicidal behavior and help seeking. Several clinical features have been linked to an increased risk of going on to develop BD, in particular attenuated symptoms of BD, personality traits such as cyclothymia, and general psychopathologic symptoms. Several of these show high specificity, indicating that it may be possible to target detection and intervention in individuals at high risk of BD and perhaps moderate the course of the illness and improve treatment outcome. This article summarizes recent evidence on the characteristics of the prodrome to BD and discusses the potential value and challenges of early detection and intervention in BD.
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Skjelstad DV, Holte A, Malt UF. Genuine clinical predictors of bipolar II disorder: an exploration of temporal and contextual characteristics. J Affect Disord 2011; 135:419-23. [PMID: 21925738 DOI: 10.1016/j.jad.2011.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Symptoms of the initial prodrome of bipolar disorder (BD) are too nonspecific to reliably prospectively predict BD. An assessment of symptoms' temporal and contextual characteristics may help identify clinical indicators with enhanced predictive power. METHODS Fifteen bipolar II disorder (BD-II) patients and 22 family members were interviewed about characteristics of symptoms that emerged before the first major affective episode (FMAE). The textual data of transcribed interviews were analyzed utilizing qualitative methodology. To identify genuine clinical predictors (GCPs), we outlined three alternative definitions and investigated the extent to which the reported symptoms in different symptom categories survived successively narrower inclusion criteria. RESULTS Most of the reported symptom instances met the broadest GCP criteria as episodic or chronic. "Mood swings" and "irritability/aggressiveness" were the only symptom categories in which most of the reported symptom instances met our intermediate strict criteria as episodic/chronic, and exaggerated/inexplicable. The mood swings were mainly characterized as episodic and occurred for no apparent reason; conversely, irritability and aggressiveness were typically characterized as episodic and exaggerated responses to life events. LIMITATIONS This is a retrospective and hypothesis-generating study. CONCLUSIONS Recurrent mood swings and irritability/aggressiveness are characterized as inexplicable and exaggerated responses, respectively, and may be the most prominent genuine clinical predictors of the FMAE of BD-II. Future studies need to investigate the extent to which the presence of different characteristics of the same symptoms discriminate between individuals who later develop BD and those who do not.
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Affiliation(s)
- Dag V Skjelstad
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, P.O. Box 135, NO 3401-Lier, Norway.
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Howes OD, Lim S, Theologos G, Yung AR, Goodwin GM, McGuire P. A comprehensive review and model of putative prodromal features of bipolar affective disorder. Psychol Med 2011; 41:1567-1577. [PMID: 20836910 PMCID: PMC3687203 DOI: 10.1017/s0033291710001790] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identifying prodromal features that predate the onset of bipolar disorder (BD) may enable the prevention of BD and aid early intervention. This review addresses two key questions: Is there a bipolar prodrome? And, if there is, what are its characteristic features? METHOD A comprehensive search of databases (PubMed, Medline, EMBASE and PsycINFO) supplemented by hand searches was used to identify studies of symptoms preceding the onset of BD. RESULTS Fifty-nine studies were identified, of which 14 met inclusion criteria. Symptoms can predate the onset of BD by months to years and can be categorized as attenuated forms of BD symptoms, general symptoms common to a range of mental disorders, and personality traits, particularly cyclothymia. Two studies provided sufficient data to enable sensitivity and specificity to be calculated. Specificity of several of the features was high (>90%) but sensitivity was generally low (all <60%). We propose a model based on the findings in the studies reviewed to illustrate the potential trajectory to BD and the points at which it may be possible to intervene. CONCLUSIONS Clinical features preceding the onset of BD can be identified. However, conclusions about whether there is a distinct prodrome to BD are restricted by the limitations of current evidence. The high specificity of some features suggests they may be useful in clinical practice. Large-scale longitudinal studies are needed to validate these features and characterize their specificity and sensitivity in independent samples.
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Affiliation(s)
- O D Howes
- Psychiatric Imaging Group, MRC Clinical Sciences Centre, Imperial College Hammersmith Campus, London, UK.
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Richardson T, Garavan H. Relationships between substance use and hypomanic symptoms in a non-clinical sample. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/17523281.2010.509845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Skjelstad DV, Malt UF, Holte A. Symptoms and behaviors prior to the first major affective episode of bipolar II disorder. An exploratory study. J Affect Disord 2011; 132:333-43. [PMID: 21435726 DOI: 10.1016/j.jad.2011.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND Few studies have investigated the initial prodrome of bipolar disorders, and none has explicitly addressed bipolar II disorder (BD-II). We explored symptoms and behaviors preceding the first major affective episode (FMAE) of BD-II to generate hypotheses concerning possible clinical targets for early intervention. METHODS In-depth interviews of 15 BD-II patients and 22 family informants were carried out. Clinical diagnoses were reassessed. The textual data of transcribed interviews were analyzed utilizing qualitative methodology supplemented by quantitative analyses. RESULTS All patients experienced clinically significant symptoms and behaviors at an average of more than a decade before the FMAE. Anxiety and depression-type symptoms were the most common. Two distinct subgroups were identified based on prominent and enduring personal characteristics prior to the FMAE. The individuals in one of the subgroups were described as very well-functioning, whereas the individuals in the other subgroup were characterized by neurocognitive deficits, relatively low academic and social functioning, and pronounced irritability and aggressiveness. Furthermore, it is possible that these individuals experience earlier prodromal symptom onset, earlier FMAEs, and more symptoms than individuals without these characteristics. LIMITATIONS This is a retrospective and hypothesis-generating qualitative study. The hypotheses generated need to be tested in future studies. CONCLUSIONS Prodromal clinical phenomenology is too nonspecific to predict the occurrence of the FMAE of BD-II. However, identifiable subgroups may exist. We hypothesize that neurocognitive deficits together with pronounced irritability and aggressiveness may constitute a vulnerability marker for a subgroup of individuals who subsequently develop BD-II. This subgroup may be of potential interest for early identification.
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Morse M, Procter N. Review: exploring the role of mental health nurse-practitioner in the treatment of early psychosis. J Clin Nurs 2011; 20:2702-11. [DOI: 10.1111/j.1365-2702.2010.03574.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Azorin JM, Kaladjian A, Adida M, Fakra E, Hantouche E, Lancrenon S. Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients. Eur Psychiatry 2011; 27:557-62. [PMID: 21292450 DOI: 10.1016/j.eurpsy.2010.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition. METHODS One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics. RESULTS Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year. CONCLUSION In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.
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Affiliation(s)
- J M Azorin
- SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique-Hôpitaux de Marseille, 13274 Marseille cedex 9, France.
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Excessive cannabis use is associated with earlier age at onset in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2011; 261:397-405. [PMID: 21267743 PMCID: PMC3159738 DOI: 10.1007/s00406-011-0188-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 01/05/2011] [Indexed: 01/17/2023]
Abstract
The aim of the study was to investigate which factors are associated with age at onset in bipolar disorder with a specific focus on excessive alcohol and cannabis use, and the sequence of the onsets of excessive substance use and bipolar disorder. We investigated a naturalistic sample of 151 patients with bipolar I and II disorder receiving psychiatric treatment. Whether the presence of excessive substance use prior to bipolar disorder onset or the type of substance used (alcohol or cannabis) was associated with differences in age at onset was investigated using hierarchical and multiple linear regression analyses, adjusting for potential confounders. Patients with excessive alcohol use had a significantly later onset compared with patients with excessive cannabis use. Excessive general substance use prior to bipolar disorder onset was associated with a later onset. However, excessive cannabis use was associated with an earlier onset whether it preceded or followed bipolar disorder onset, also after adjusting for possible confounders. Excessive use of alcohol or other substances was not independently associated with age at onset in multivariate analyses. Alcohol use was associated with a later onset compared with cannabis use, suggesting different relationships to the onset of bipolar disorder. Lifetime use of cannabis predicted an earlier onset, independent of the sequence of onsets. This indicates that an early onset may increase the risk of cannabis use and that cannabis use may trigger bipolar disorder in vulnerable individuals.
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Comparing clinical and neurocognitive features of the schizophrenia prodrome to the bipolar prodrome. Schizophr Res 2010; 123:59-63. [PMID: 20716479 PMCID: PMC2939255 DOI: 10.1016/j.schres.2010.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/05/2010] [Accepted: 07/08/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is an increased interest in early intervention strategies for severe mental disorders with hopes of mitigating the emergence and impact of the illness. Individuals at clinical high-risk (CHR) for schizophrenia have been primarily identified by the presence of attenuated positive symptoms. Although bipolar disorder and schizophrenia may have overlapping etiologies, few studies have investigated the potential prodrome in bipolar disorder. We sought to determine if there is a prodrome to bipolar disorder and if clinical or neurocognitive measures could distinguish between the bipolar and schizophrenia prodromes. METHODS We examined subjects who were initially identified as CHR for schizophrenia during the prodromal phase of the illness and followed them prospectively. Unexpectedly, eight subjects developed bipolar disorder. Baseline data from subjects who eventually developed bipolar disorder (pre-BP; N=8), schizophrenia or a psychotic disorder (pre-SZ; N=24) and a non-converter comparison group (NCC; N=115) were compared. RESULTS The pre-BP and pre-SZ groups did not differ on attenuated positive symptom severity, global measures of functioning or on the global neurocognitive score. Compared to NCC individuals, both pre-BP and pre-SZ patients reported more severe attenuated positive symptoms and were more likely to be on antipsychotic medication at baseline. The pre-SZ group had a significantly lower current IQ and was significantly more impaired than the NCC group on the overall neurocognitive score. CONCLUSIONS This study provides preliminary support for a bipolar prodrome, which may be indistinguishable from the schizophrenia prodrome based on clinical and neurocognitive measures currently used in high-risk schizophrenia programs.
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Correll CU, Hauser M, Auther AM, Cornblatt BA. Research in people with psychosis risk syndrome: a review of the current evidence and future directions. J Child Psychol Psychiatry 2010; 51:390-431. [PMID: 20214698 PMCID: PMC3085111 DOI: 10.1111/j.1469-7610.2010.02235.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
After decades of research, schizophrenia and related psychotic disorders are still among the most debilitating disorders in medicine. The chronic illness course in most individuals, greater treatment responsiveness during the first episode, progressive gray matter decline during early disease stages, and retrospective accounts of 'prodromal' or early illness signs and symptoms formed the basis for research on the psychosis risk syndrome (PRS), known variably as 'clinical high risk' (CHR), or 'ultra-high risk' (UHR), or 'prodromal'. The pioneering era of research on PRS focused on the development and validation of specific assessment tools and the delineation of high risk criteria. This was followed by the examination of conversion rates in psychosis risk cohorts followed naturalistically, identification of predictors of conversion to psychosis, and investigation of interventions able to abort or delay the development of full psychosis. Despite initially encouraging results concerning the predictive validity of PRS criteria, recent findings of declining conversion rates demonstrate the need for further investigations. Results from intervention studies, mostly involving second-generation antipsychotics and cognitive behavioral therapy, are encouraging, but are currently still insufficient to make treatment recommendations for this early, relatively non-specific illness phase. The next phase of research on PRS, just now beginning, has moved to larger, 'multisite' projects to increase generalizability and to ensure that sufficiently large samples at true risk for psychosis are included. Emphasis in these emerging studies is on: 1) identification of biomarkers for conversion to psychosis; 2) examination of non-antipsychotic, neuroprotective and low-risk pharmacologic and non-pharmacologic interventions; 3) testing of potentially phase-specific interventions; 4) examination of the relationship between treatment response during PRS and prognosis for the course of illness; 5) follow-up of patients who developed schizophrenia despite early interventions and comparison of illness trajectories with patients who did not receive early interventions; 6) characterization of individuals with outcomes other than schizophrenia-spectrum disorders, such as bipolar disorder and remission from PRS, including false positive cases; and 7) assessment of meaningful social and role functioning outcomes. While the research conducted to date has already yielded crucial information, the translation of the concept of a clinically identifiable PRS into clinical practice does not seem justified at this point.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, New York 11004, USA.
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Premier épisode thymique : cas particulier de l’intervention dans la phase précoce des troubles bipolaires. Encephale 2010; 36 Suppl 3:S71-6. [DOI: 10.1016/s0013-7006(10)70034-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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