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Goldstein BI. Editorial: The Challenge of Psychopharmacological Treatment of Anxiety Among Youth Offspring of Parents With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2024; 63:396-398. [PMID: 37992856 DOI: 10.1016/j.jaac.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
Mood disorders, including bipolar disorder (BD) and major depressive disorder (MDD), are leading causes of disability worldwide. MDD is the leading cause of disability beginning at age 10 years and thereafter, and BD is the fourth leading cause of disability in adolescents.1 Although one might expect that at a young age, and with a short duration of illness, mood disorders in youth are less complex than in adults, this is far from the reality. Even in epidemiologic, representative samples that do not have the same sample selection biases as clinical studies, mood disorders in youth are characterized by high rates of psychiatric comorbidity and suicidality.2-4 The perniciousness of mood disorders in youth necessitates strategies to enhance prediction of future mood disorders among those at risk, to guide prevention and early intervention strategies.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Kennedy KG, Ghugre NR, Roifman I, Qi X, Saul K, McCrindle BW, Macgowan CK, MacIntosh BJ, Goldstein BI. Impaired coronary microvascular reactivity in youth with bipolar disorder. Psychol Med 2024; 54:1196-1206. [PMID: 37905407 DOI: 10.1017/s0033291723003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD. METHODS Participants were 86 youth, ages 13-20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12-15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction). RESULTS The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = -0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups. CONCLUSION Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.
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Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Idan Roifman
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Xiuling Qi
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kayla Saul
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology & Artificial Intelligence (CRAI) unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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Dutta SS, Dasgupta S, Banerjee AK, Nath I, Biswas U, Bera N, Ruram A. Exploring the Role of Serum Hydrogen Sulphide (H2S) Levels in Manic Depressive Psychosis in Terms of Its Association, Diagnostic Ability, and Severity Prediction: Findings From a Tertiary Care Center in North Bengal. Cureus 2024; 16:e56857. [PMID: 38659549 PMCID: PMC11040162 DOI: 10.7759/cureus.56857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Manic depressive psychosis (MDP) or bipolar disorder, a prevalent psychiatric condition globally and in the Indian population, has been attributed to various pathological mechanisms. Hydrogen sulphide (H2S), a member of the gasotransmitter family, may be linked to the development of bipolar disorder because it plays a crucial role in maintaining proper neuronal function in terms of excitability, plasticity, and homeostatic functions. There is very little data regarding the role of the gasotransmitter H2S in MDP in terms of its association, diagnostic ability, and severity prediction, which led us to conduct this study among MDP patients in the Sub-Himalayan region of West Bengal. METHODS This was an observational case-control study performed in the Department of Biochemistry, North Bengal Medical College and Hospital, Siliguri, West Bengal, India, from January 2022 to December 2022. Fifty diagnosed MDP patients and 50 healthy age- and sex-matched control subjects satisfying the inclusion and exclusion criteria were studied. The H2S level in the blood was assayed using the standardised spectrophotometric methylene blue method. The severity of depression was assessed by Hamilton Depression Rating Scale (HAM-D) scoring. RESULTS Of the 50 MDP patients, 45 (90%) were in the depressive phase, and five (10%) were in the manic phase. Of the 45 depressive patients, eight (17.8%) had mild depression, 12 (26.7%) had moderate depression, 19 (42.2%) had severe depression, and six (13.3%) had very severe depression. The mean H2S level in MDP patients (41.98±18.88 μmol/l) was significantly (P<0.05) lower than that in control subjects (99.20± 15.20 μmol/l). It was also observed that the mean H2S level in MDP patients decreased with the duration of the disease but was not statistically significant. The mean H2S levels in the different depression severity groups were found to be significantly different (P<0.001). Receiver operating characteristic (ROC) curve analysis revealed that a cut-off value of H2S <78.5 μmol/l was associated with MDP, with a sensitivity of 96% and a specificity of 88%, and a cut-off value of H2S < 53 μmol/l predicted the severity of depression with a sensitivity of 89.3% and a specificity of 76.5%. CONCLUSION The significant association of the gasotransmitter H2S in MDP patients and its role as a diagnostic and severity predictive marker can help us to employ proper measures for better management of MDP and improving quality of life.
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Affiliation(s)
| | - Sayantan Dasgupta
- Biochemistry, North Bengal Medical College and Hospital, Siliguri, IND
| | - Arup K Banerjee
- Biochemistry, Prafulla Chandra Sen Government Medical College and Hospital, Arambag, IND
| | - Indrajit Nath
- Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Utpal Biswas
- Biochemistry, North Bengal Medical College and Hospital, Siliguri, IND
| | - Nirmal Bera
- Psychiatry, North Bengal Medical College and Hospital, Siliguri, IND
| | - Alice Ruram
- Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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Zhong Y, Chen Y, Su X, Wang M, Li Q, Shao Z, Sun L. Global, regional and national burdens of bipolar disorders in adolescents and young adults: a trend analysis from 1990 to 2019. Gen Psychiatr 2024; 37:e101255. [PMID: 38390238 PMCID: PMC10882284 DOI: 10.1136/gpsych-2023-101255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/14/2023] [Indexed: 02/24/2024] Open
Abstract
Background Bipolar disorder is identified as a cause of severe damage to the physical, psychological and social functioning of adolescents and young adults. Aims The aim of this study is to ascertain the trends in the burden of bipolar disorder among individuals aged 10-24 years at global, regional and national levels from 1990 to 2019. Methods The data analysed in this study were from the Global Burden of Diseases 2019. The numbers, rates per 100 000 population, average annual percentage changes (AAPCs) of incidence, prevalence and years lived with disability (YLDs) of bipolar disorder are reported at the global, regional and national levels among individuals aged 10-24 years. Global trends by age, sex and Social Development Index (SDI) were further analysed. Results Globally, the incidence of bipolar disorder among adolescents and young adults increased from 79.21 per 100 000 population (95% uncertainty interval (UI): 58.13 to 105.15) in 1990 to 84.97 per 100 000 population (95% UI: 61.73 to 113.46) in 2019, AAPC 0.24 (95% confidence interval (CI): 0.22 to 0.26). In the past three decades, there has been an increase in incidence, prevalence and YLDs in both males and females. The largest increase in incidence between 1990 and 2019 was observed in those aged 20-24 years old (from 51.76 per 100 000 population (95% UI: 26.81 to 87.20) in 1990 to 58.37 per 100 000 population (95% UI: 30.39 to 98.55) in 2019; AAPC 0.42 (95% CI: 0.38 to 0.47)). By the SDI quintile, the largest increase in incidence was observed in the middle SDI; however, the high SDI countries had the highest incidence. Regionally, the largest increase in incidence was observed in southern Latin America. At the national level, the most pronounced increase in the incidence was in Greenland. Conclusions The global increase in incidence among adolescents and young adults between 1990 and 2019 indicates that strategies to improve their mental health still need to be emphasised.
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Affiliation(s)
- Yunxi Zhong
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Yifan Chen
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Xiaoying Su
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Meiqi Wang
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Qixiu Li
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Ziming Shao
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Long Sun
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
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Mitchell RHB, Grigorian A, Robertson A, Toma S, Luciw NJ, Karthikeyan S, Mutsaerts HJMM, Fiksenbaum L, Metcalfe AWS, MacIntosh BJ, Goldstein BI. Sex differences in cerebral blood flow among adolescents with bipolar disorder. Bipolar Disord 2024; 26:33-43. [PMID: 37217255 DOI: 10.1111/bdi.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Abnormalities in cerebral blood flow (CBF) are common in bipolar disorder (BD). Despite known differences in CBF between healthy adolescent males and females, sex differences in CBF among adolescents with BD have never been studied. OBJECTIVE To examine sex differences in CBF among adolescents with BD versus healthy controls (HC). METHODS CBF images were acquired using arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in 123 adolescents (72 BD: 30M, 42F; 51 HC: 22M, 29F) matched for age (13-20 years). Whole brain voxel-wise analysis was performed in a general linear model with sex and diagnosis as fixed factors, sex-diagnosis interaction effect, and age as a covariate. We tested for main effects of sex, diagnosis, and their interaction. Results were thresholded at cluster forming p = 0.0125, with posthoc Bonferroni correction (p = 0.05/4 groups). RESULTS A main effect of diagnosis (BD > HC) was observed in the superior longitudinal fasciculus (SLF), underlying the left precentral gyrus (F =10.24 (3), p < 0.0001). A main effect of sex (F > M) on CBF was detected in the precuneus/posterior cingulate cortex (PCC), left frontal and occipital poles, left thalamus, left SLF, and right inferior longitudinal fasciculus (ILF). No regions demonstrated a significant sex-by-diagnosis interaction. Exploratory pairwise testing in regions with a main effect of sex revealed greater CBF in females with BD versus HC in the precuneus/PCC (F = 7.1 (3), p < 0.01). CONCLUSION Greater CBF in female adolescents with BD versus HC in the precuneus/PCC may reflect the role of this region in the neurobiological sex differences of adolescent-onset BD. Larger studies targeting underlying mechanisms, such as mitochondrial dysfunction or oxidative stress, are warranted.
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Affiliation(s)
- Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Robertson
- Department of Kinesiology, Research Institute for Aging, University of Waterloo, Ontario, Canada
| | - Simina Toma
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Henri J M M Mutsaerts
- Radiology and Nuclear Medicine Vrje Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
| | - Lisa Fiksenbaum
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Arron W S Metcalfe
- Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program , Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program , Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
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6
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Mio M, Kennedy KG, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes PJ, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. White matter microstructural integrity is associated with retinal vascular caliber in adolescents with bipolar disorder. J Psychosom Res 2023; 175:111529. [PMID: 37856933 DOI: 10.1016/j.jpsychores.2023.111529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Reduced white matter integrity is observed in bipolar disorder (BD), and is associated with cardiovascular risk in adults. This topic is underexplored in youth, and in BD, where novel microvascular measures may help to inform understanding of the vascular-brain connection. We therefore examined the association of retinal vascular caliber with white matter integrity in a cross-sectional sample of adolescents with and without BD. METHODS Eighty-four adolescents (n = 42 BD, n = 42 controls) completed retinal imaging, yielding arteriolar and venular caliber. Diffusion tensor imaging measured white matter fractional anisotropy (FA). Multiple linear regression tested associations between retinal vascular caliber and FA in regions-of-interest; corpus callosum, anterior thalamic radiation, uncinate fasciculus, and superior longitudinal fasciculus. Complementary voxel-wise analyses were performed. RESULTS Arteriolar caliber was elevated in adolescents with BD relative to controls (F(1,79) = 6.15, p = 0.02, η2p = 0.07). In the overall sample, higher venular caliber was significantly associated with lower corpus callosum FA (β = -0.24, puncorrected = 0.04). In voxel-wise analyses, higher arteriolar caliber was significantly associated with lower corpus callosum and forceps minor FA in the overall sample (β = -0.46, p = 0.03). A significant diagnosis-by-venular caliber interaction on FA was noted in 5 clusters including the right retrolenticular internal capsule (β = 0.72, p = 0.03), corticospinal tract (β = 0.72, p = 0.04), and anterior corona radiata (β = 0.63, p = 0.04). In each instance, venular caliber was more positively associated with FA in BD vs. controls. CONCLUSION Retinal microvascular measures are associated with white matter integrity in BD, particularly in the corpus callosum. This study was proof-of-concept, designed to guide future studies focused on the vascular-brain interface in BD.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter J Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Sultan AA, Mio M, Dimick MK, Zou Y, Karthikeyan S, Kolla N, Lanctot K, Zack M, Goldstein BI. Association of cannabis use with neurocognition in adolescents with bipolar disorder. J Psychopharmacol 2023; 37:920-927. [PMID: 37497695 DOI: 10.1177/02698811231187128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Bipolar disorder (BD) and cannabis use are each associated with neurocognitive deficits in adolescents. However, little is known regarding the association of neurocognition with cannabis use among adolescents with BD. Therefore, we examined this topic in a sample of adolescents with BD and healthy control (HC) adolescents. METHODS Participants included 121 adolescents (n = 32 with BD and lifetime cannabis use (BDCB+), n = 31 with BD and no lifetime cannabis use (BDCB-), n = 58 HC with no lifetime cannabis use), aged 14-20 years. Five neurocognitive subtests of the computerized CANTAB battery were assessed. Groups were compared using an analysis of covariance (ANCOVA) covarying for age, sex, and intelligence quotient. RESULTS The three groups differed significantly on tests of visuospatial working memory (F = 4.41, p = 0.014, η p 2 = 0 . 07 ) and sustained attention (F = 5.15, p = 0.007, η p 2 = 0 . 08 ). Post hoc analyses revealed working memory scores were significantly worse in BDCB+ versus HC (p = 0.04, d = 0.59), and sustained attention was significantly worse in BDCB- versus HC (p = 0.006, d = 0.70). CONCLUSION These preliminary findings suggest that cannabis use among adolescents with BD is associated with working memory deficits. Future studies in larger samples are warranted to evaluate causation versus predisposition to cannabis use, and to evaluate duration, quantity, and potency of cannabis on neurocognition among adolescents with BD.
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Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Nathan Kolla
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Krista Lanctot
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Martin Zack
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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Goldstein BI. Comorbidity in pediatric bipolar disorder: An unmet challenge in need of treatment studies. Acta Psychiatr Scand 2023; 148:107-109. [PMID: 37439358 PMCID: PMC10471138 DOI: 10.1111/acps.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Psychiatry and Pharmacology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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9
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Sultan AA, Dimick MK, Zai CC, Kennedy JL, MacIntosh BJ, Goldstein BI. The association of CNR1 genetic variants with resting-state functional connectivity in youth bipolar disorder. Eur Neuropsychopharmacol 2023; 71:41-54. [PMID: 36972648 DOI: 10.1016/j.euroneuro.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
Cannabinoid 1 receptors coded by the CNR1 gene are implicated in mood disorders and addiction. Given the prevalence and negative correlates of cannabis use in bipolar disorder (BD), we examined CNR1 polymorphism rs1324072 in relation to resting-state functional connectivity (rsFC) in youth BD. Participants included 124 youth, ages 13-20 years: 17 BD G-carriers, 48 BD non-carriers, 16 healthy controls (HC) G-carriers, and 43 HC non-carriers. rsFC was obtained using 3T-MRI. General linear models examined main effects of diagnosis, gene, and diagnosis-by-gene interaction, controlling for age, sex, and race. Regions-of-interests in seed-to-voxel analyses included: bilateral amygdala, hippocampus, nucleus accumbens (NAc), and orbitofrontal cortex (OFC). Main effects of diagnosis were observed for rsFC between the right amygdala seed and right occipital pole, and between the left NAc seed and left superior parietal lobe. Interaction analyses identified 6 significant clusters. G-allele was associated with negative connectivity in BD and positive connectivity in HC for: left amygdala seed with right intracalcarine cortex; right NAc seed with left inferior frontal gyrus; and right hippocampal seed with bilateral cuneal cortex (all p<0.001). G-allele was associated with positive connectivity in BD and negative connectivity in HC for: right hippocampal seed with left central opercular cortex (p = 0.001), and left NAc seed with left middle temporal cortex (p = 0.002). In conclusion, CNR1 rs1324072 was differentially associated with rsFC in youth with BD in regions relevant to reward and emotion. Future studies powered to integrate CNR1 alongside cannabis use are warranted to examine the inter-relationship between rs1324072 G-allele, cannabis use, and BD.
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Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement C Zai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James L Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Computational Radiology and Artificial Intelligence unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Program, Sandra E Black Centre for Brain Resilience & Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Khoubaeva D, Dimick M, Timmins VH, Fiksenbaum LM, Mitchell RHB, Schaffer A, Sinyor M, Goldstein BI. Clinical correlates of suicidality and self-injurious behaviour among Canadian adolescents with bipolar disorder. Eur Child Adolesc Psychiatry 2023; 32:41-51. [PMID: 34028609 DOI: 10.1007/s00787-021-01803-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
There is high risk of suicidality in bipolar disorder (BD), particularly in early onset cases. The literature regarding correlates and putative predictors of suicide attempts (SA), non-suicidal self-injury (NSSI) and suicidal ideation (SI) among youth with BD remains sparse. Participants included 197 adolescents with BD, divided into 4 groups: SA (with or without NSSI), NSSI (with or without SI), SI only, and comparison group (CG; no SA/NSSI/SI). Diagnoses, treatment, and suicidality measures were determined via semi-structured interviews, conducted between 2009 and 2017. Univariate analyses were followed by multinomial regression. Overall, 73.6% of participants had history of SA, NSSI, and/or SI. In comparison to CG, SA and NSSI were each associated with BD-II/-NOS (odds ratio [OR] = 15.99, p = 0.002; OR = 16.76, p = 0.003), female sex (OR = 6.89, p = 0.006; OR = 3.76, p = 0.02), and emotion dysregulation (OR = 1.10, p < 0.001; OR = 1.07, p = 0.004). NSSI and SI were each associated with most severe lifetime depression (OR = 1.10, p = 0.01; OR = 1.10, p = 0.01). SA and SI were associated with psychiatric hospitalization (OR = 19.45, p = 0.001; OR = 6.09, p = 0.03). SA was associated with poorer global functioning at most severe episode (OR = 0.88, p = 0.008). NSSI was associated with not living with both natural parents (OR = 0.22, p = 0.009). Study limitations include cross-sectional and retrospective design, stringent cut-offs for SA and NSSI, and recruitment from a tertiary clinical setting. Three quarters of adolescents with BD have had suicidality and/or self-injury. SA and NSSI were most similar to one another, and most different from CG, supporting the broader construct of self-harm. Future research should address the gap in knowledge regarding how sex differences and neurobiology are associated with the observed clinical differences.
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Affiliation(s)
- Diana Khoubaeva
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Mikaela Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Vanessa H Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | | | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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11
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Mio M, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes P, McCrindle BW, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. Neurovascular correlates of retinal microvascular caliber in adolescent bipolar disorder. J Affect Disord 2023; 320:81-90. [PMID: 36162693 DOI: 10.1016/j.jad.2022.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The connection between vascular and brain metrics is well-studied in older adults, but neglected in youth and in psychiatric populations at increased cardiovascular risk. We therefore examined the association of retinal vascular caliber with cerebral blood flow (CBF) in adolescents with and without bipolar disorder (BD). METHODS Ninety-four adolescents (n = 48 BD, n = 46 controls) completed retinal fundus imaging, yielding estimates of arteriolar and venular diameter. Arterial spin labelling MRI was performed to measure CBF. We tested for associations between retinal vascular caliber and CBF in regions of interest; anterior cingulate cortex (ACC), middle frontal gyrus, and hippocampus in BD and controls separately. Complementary voxel-wise analyses were also performed. RESULTS In the BD group, higher arteriovenous ratio (AVR) was associated with greater ACC CBF (β = 0.34, puncorrected = 0.02), after controlling for age, sex, and BMI, however this finding did not survive correction for multiple comparisons. The control group did not show any associations (β = 0.13, puncorrected = 0.40). Voxel-wise analyses within the BD group detected a significant positive association between AVR and regional CBF in two distinct clusters: i) left hippocampus (p < 0.0001); ii) right middle temporal gyrus (p = 0.04). LIMITATIONS Limited sample size; young, medically healthy sample limits signal detection; cross-sectional design. CONCLUSION This study reveals that higher AVR is associated with higher regional CBF in adolescents with BD. Present findings advance understanding of potential neurofunctional mechanisms linking retinal vascular caliber with psychiatric diagnoses. This proof-of-concept study was designed to generate initial insights to guide future studies focusing on the vascular-brain connection in youth and in psychiatry.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Dimick MK, Toma S, MacIntosh BJ, Grigorian A, Fiksenbaum L, Youngstrom EA, Robertson AD, Goldstein BI. Cerebral Blood Flow and Core Mood Symptoms in Youth Bipolar Disorder: Evidence for Region-Symptom Specificity. J Am Acad Child Adolesc Psychiatry 2022; 61:1455-1465. [PMID: 35487335 DOI: 10.1016/j.jaac.2022.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/03/2022] [Accepted: 04/19/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Building on prior findings in adults, this study investigated regional cerebral blood flow (CBF) in relation to DSM-5 criterion A symptoms of depression and mania in youth with bipolar disorder (BD). METHOD The study recruited 81 youths with BD and 75 healthy controls 13-20 years old. CBF was ascertained using pseudocontinuous arterial spin labeling magnetic resonance imaging. Region-of-interest analyses examined the amygdala, anterior cingulate cortex (ACC), middle frontal gyrus, and global gray matter CBF. The association of criterion A depression and mania symptoms with CBF was examined dimensionally in youth with BD in regression analyses with continuous symptom severity scores. Age and sex were included as covariates. False discovery rate (FDR) was used to correct for 28 tests (4 regions by 7 symptoms; α < .0017). CBF for BD and healthy control groups was compared to give context for findings. RESULTS In youth with BD, depressed mood inversely correlated with ACC (β = -0.31, puncorrected = .004, pFDR = .056) and global (β = -0.27, puncorrected = .013, pFDR = .09) CBF. The same pattern was observed for anhedonia (ACC CBF: β = -0.33, puncorrected = .004, pFDR = .056; global CBF: β = -0.29, puncorrected = .008, pFDR = .07). There were no significant findings for manic symptoms or in BD vs healthy control contrasts. CONCLUSION The present findings, while not significant after correction for multiple testing, highlight the potential value of focusing on ACC in relation to depressed mood and anhedonia, and demonstrate that CBF is sensitive to depression symptom severity in youth. Lack of findings regarding manic symptoms may relate to the exclusion of fully manic participants in this outpatient sample.
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Affiliation(s)
- Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; University of Toronto, Canada
| | - Simina Toma
- University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Eric A Youngstrom
- University of North Carolina at Chapel Hill and Helping Give Away Psychological Science, Inc., Chapel Hill, North Carolina
| | | | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; University of Toronto, Canada.
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Positive moods are all alike? Differential affect amplification effects of 'elated' versus 'calm' mental imagery in young adults reporting hypomanic-like experiences. Transl Psychiatry 2022; 12:453. [PMID: 36261422 PMCID: PMC9581908 DOI: 10.1038/s41398-022-02213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/08/2022] Open
Abstract
Positive mood amplification is a hallmark of the bipolar disorder spectrum (BPDS). We need better understanding of cognitive mechanisms contributing to such elevated mood. Generation of vivid, emotionally compelling mental imagery is proposed to act as an 'emotional amplifier' in BPDS. We used a positive mental imagery generation paradigm to manipulate affect in a subclinical BPDS-relevant sample reporting high (n = 31) vs. low (n = 30) hypomanic-like experiences on the Mood Disorder Questionnaire (MDQ). Participants were randomized to an 'elated' or 'calm' mental imagery condition, rating their momentary affect four times across the experimental session. We hypothesized greater affect increase in the high (vs. low) MDQ group assigned to the elated (vs. calm) imagery generation condition. We further hypothesized that affect increase in the high MDQ group would be particularly apparent in the types of affect typically associated with (hypo)mania, i.e., suggestive of high activity levels. Mixed model and time-series analysis showed that for the high MDQ group, affect increased steeply and in a sustained manner over time in the 'elated' imagery condition, and more shallowly in 'calm'. The low-MDQ group did not show this amplification effect. Analysis of affect clusters showed high-MDQ mood amplification in the 'elated' imagery condition was most pronounced for active affective states. This experimental model of BPDS-relevant mood amplification shows evidence that positive mental imagery drives changes in affect in the high MDQ group in a targeted manner. Findings inform cognitive mechanisms of mood amplification, and spotlight prevention strategies targeting elated imagery, while potentially retaining calm imagery to preserve adaptive positive emotionality.
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14
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Goldstein TR, Saul M, Nagy D, Sylvester R, Rode N, Donohue J. One-Year Treatment Utilization Among Adolescents With Bipolar Spectrum Disorder. Psychiatr Serv 2022; 73:1123-1131. [PMID: 35414190 DOI: 10.1176/appi.ps.202100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early-onset bipolar disorder is among the costliest psychiatric disorders; yet inpatient and outpatient service use patterns in this group are largely unknown. One-year behavioral and medical health service use was examined among adolescents diagnosed as having bipolar disorder, and rates were compared between adolescents with threshold versus subthreshold bipolar disorder. METHODS Participants included 100 adolescents (ages 12–18 years, 85% had been assigned female sex at birth) diagnosed as having bipolar disorder (type I, N=14; type II, N=28; not otherwise specified [NOS], N=58) via semistructured interviews and who consented to electronic health record (EHR) data review for enrollment in a psychosocial treatment study. Service use data were extracted in the year preceding study entry from a data repository containing all clinical and financial records (including outpatient and inpatient behavioral and medical visits) from a large western Pennsylvania health system. RESULTS EHRs indicated that 99% of adolescents used some behavioral health service, most commonly outpatient psychotherapy (60%) and medication management (43%). Use of intensive behavioral health services was common (49%), and 48% had at least one psychotropic medication noted in their EHR. General medical health services were used by 78%, most commonly outpatient (67%) and emergency department (39%) visits. No differences in service use were observed for adolescents with bipolar disorder type I or II compared with NOS for any services or medications examined. CONCLUSIONS High use of behavioral and medical health services among adolescents with bipolar spectrum disorders has important implications for health care systems, insurers, providers, and consumers. Greater coordination of health care for this high-risk, high-use population may improve outcomes.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Melissa Saul
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Dylan Nagy
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Raeanne Sylvester
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Noelle Rode
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Julie Donohue
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
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15
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Banach E, Jaworski T, Urban-Ciećko J. Early synaptic deficits in GSK-3β overexpressing mice. Neurosci Lett 2022; 784:136744. [PMID: 35718239 DOI: 10.1016/j.neulet.2022.136744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Synaptic dysfunction is the prominent feature of many neuropsychiatric and neurological diseases, in which glycogen synthase kinase 3β (GSK-3β) has been shown to play a role. Overexpression of constitutively active form of GSK-3β (GSK-3β[S9A]) in mice recapitulates the cognitive and structural brain deficits characteristic for manic phase of bipolar disorder (BD). Yet, the mechanisms underlying GSK-3β-induced synaptic dysfunction have not been fully elucidated. The aim of the present study was to dissect the effect of GSK-3β overactivity on synaptic function in adolescent (3-week-old) mice. We found that overactivity of GSK-3β in adolescent transgenic mice leads to an alteration in dendritic spines morphology of granule cells in dentate gyrus (DG) without changes in overall spine density. There was an increase in the number of thin, presumably immature dendritic spines in GSK-3β[S9A] mice. Subsequent electrophysiological analysis showed changes in excitatory synaptic transmission manifested by an increase of inter-event intervals of miniature excitatory postsynaptic currents (mEPSCs) in DG granule cells and an increase in the number of silent (unfunctional) synapses at the perforant path-DG pathway in GSK-3β[S9A] mice. Altogether, our data indicate that GSK-3β overactivity leads to synaptic deficits in adolescent, GSK-3β[S9A] mice. These data might provide potential mechanisms underlying GSK-3β-induced synaptic dysfunction in psychiatric disorders.
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Affiliation(s)
- Ewa Banach
- Laboratory of Electrophysiology, Nencki Institute of Experimental Biology, PAS, Warsaw, Poland; Laboratory of Animal Models, Nencki Institute of Experimental Biology PAS, Warsaw, Poland; Laboratory of Neurobiology, BRAINCITY, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093, Warsaw, Poland.
| | - Tomasz Jaworski
- Laboratory of Animal Models, Nencki Institute of Experimental Biology PAS, Warsaw, Poland; Laboratory of Neurobiology, BRAINCITY, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093, Warsaw, Poland; Research and Development Centre, Celon Pharma SA, Kazun Nowy, Poland
| | - Joanna Urban-Ciećko
- Laboratory of Electrophysiology, Nencki Institute of Experimental Biology, PAS, Warsaw, Poland; Laboratory of Neurobiology, BRAINCITY, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093, Warsaw, Poland
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16
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Sultan AA, Hird MA, Dimick MK, MacIntosh BJ, Goldstein BI. Cannabis use and resting state functional connectivity in adolescent bipolar disorder. J Psychiatry Neurosci 2021; 46:E559-E567. [PMID: 34625488 PMCID: PMC8526158 DOI: 10.1503/jpn.200228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/21/2021] [Accepted: 07/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adolescents with bipolar disorder have high rates of cannabis use, and cannabis use is associated with increased symptom severity and treatment resistance in bipolar disorder. Studies have identified anomalous resting-state functional connectivity among reward networks in bipolar disorder and cannabis use independently, but have yet to examine their convergence. METHODS Participants included 134 adolescents, aged 13 to 20 years: 40 with bipolar disorder and lifetime cannabis use, 31 with bipolar disorder and no history of cannabis use, and 63 healthy controls without lifetime cannabis use. We used a seed-to-voxel analysis to assess the restingstate functional connectivity of the amygdala, the nucleus accumbens and the orbitofrontal cortex, regions implicated in bipolar disorder and cannabis use. We used a generalized linear model to explore bivariate correlations for each seed, controlling for age and sex. RESULTS We found 3 significant clusters. Resting-state functional connectivity between the left nucleus accumbens seed and the left superior parietal lobe was negative in adolescents with bipolar disorder and no history of cannabis use, and positive in healthy controls. Resting-state functional connectivity between the right orbitofrontal cortex seed and the right lateral occipital cortex was positive in adolescents with bipolar disorder and lifetime cannabis use, and negative in healthy controls and adolescents with bipolar disorder and no history of cannabis use. Resting-state functional connectivity between the right orbitofrontal cortex seed and right occipital pole was positive in adolescents with bipolar disorder and lifetime cannabis use, and negative in adolescents with bipolar disorder and no history of cannabis use. LIMITATIONS The study did not include a cannabis-using control group. CONCLUSION This study provides preliminary evidence of cannabis-related differences in functional reward circuits in adolescents with bipolar disorder. Further studies are necessary to evaluate whether the present findings reflect consequences of or predisposition to cannabis use.
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Affiliation(s)
- Alysha A Sultan
- From the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, (Sultan, Hird, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, (Sultan, Dimick, Goldstein); the Faculty of Medicine, University of Toronto, (Sultan, Hird, Dimick, Goldstein); the Department of Psychiatry, University of Toronto, (Goldstein); the Department of Medical Biophysics, University of Toronto, (MacIntosh); and the Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, (MacIntosh, Goldstein) Toronto, Ont. Canada
| | - Megan A Hird
- From the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, (Sultan, Hird, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, (Sultan, Dimick, Goldstein); the Faculty of Medicine, University of Toronto, (Sultan, Hird, Dimick, Goldstein); the Department of Psychiatry, University of Toronto, (Goldstein); the Department of Medical Biophysics, University of Toronto, (MacIntosh); and the Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, (MacIntosh, Goldstein) Toronto, Ont. Canada
| | - Mikaela K Dimick
- From the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, (Sultan, Hird, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, (Sultan, Dimick, Goldstein); the Faculty of Medicine, University of Toronto, (Sultan, Hird, Dimick, Goldstein); the Department of Psychiatry, University of Toronto, (Goldstein); the Department of Medical Biophysics, University of Toronto, (MacIntosh); and the Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, (MacIntosh, Goldstein) Toronto, Ont. Canada
| | - Bradley J MacIntosh
- From the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, (Sultan, Hird, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, (Sultan, Dimick, Goldstein); the Faculty of Medicine, University of Toronto, (Sultan, Hird, Dimick, Goldstein); the Department of Psychiatry, University of Toronto, (Goldstein); the Department of Medical Biophysics, University of Toronto, (MacIntosh); and the Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, (MacIntosh, Goldstein) Toronto, Ont. Canada
| | - Benjamin I Goldstein
- From the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, (Sultan, Hird, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, (Sultan, Dimick, Goldstein); the Faculty of Medicine, University of Toronto, (Sultan, Hird, Dimick, Goldstein); the Department of Psychiatry, University of Toronto, (Goldstein); the Department of Medical Biophysics, University of Toronto, (MacIntosh); and the Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, (MacIntosh, Goldstein) Toronto, Ont. Canada.
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Rahmani N, Hatch J, Dimick M, Naiberg MR, Fiksenbaum L, Andreazza AC, Bowie CR, Dickstein DP, Goldstein BI. Lower pro- to anti-inflammatory ratios associated with reduced neurocognitive flexibility in symptomatic adolescents with bipolar disorder. J Affect Disord 2021; 292:430-438. [PMID: 34144368 DOI: 10.1016/j.jad.2021.05.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Peripheral inflammatory markers, such as C-reactive protein (CRP), are elevated among adolescents and adults with bipolar disorder (BD), particularly during symptomatic episodes. Neurocognition, predominantly in the domain of executive function, is also impaired among adults and youth with BD. In adults with BD, CRP is negatively associated with neurocognitive functioning. We aim to investigate this relationship in BD adolescents. METHODS Serum levels of CRP and five other inflammatory markers (interleukin (IL)-1β, IL-6, IL-10, IL-4 and tumor necrosis factor α (TNF)) were examined in 60 adolescents with BD (34 symptomatic, 26 asymptomatic) age- and sex-matched to 51 healthy controls (HC). Diagnoses were confirmed using semi-structured interviews. Pro- to anti-inflammatory marker ratios were also examined. Neurocognitive flexibility was assessed via the intra/extradimensional shift (IED) task from the CANTAB battery. Multivariate linear regression controlled for age, sex and race. RESULTS Within symptomatic BD adolescents, but not asymptomatic BD or HC adolescents, lower IL-6/IL-10 and lower CRP/IL-10 ratios were significantly associated with worse performance on the neurocognitive flexibility task (p = 0.03 and p = 0.04, respectively). Both models accounted for 13.3% of variance in neurocognitive flexibility. No significant CRP by diagnosis interaction effects were observed on neurocognitive flexibility. LIMITATIONS Limited sample-size restricted ability to separate the symptomatic BD adolescents into varying mood states. CONCLUSION More balanced pro- to anti-inflammatory ratios were associated with better neurocognitive flexibility in symptomatic BD adolescents. Prospective studies are warranted to assess the direction of these findings.
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Affiliation(s)
- Noreen Rahmani
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada.
| | - Jessica Hatch
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada
| | - Mikaela Dimick
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada; Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Melanie R Naiberg
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada
| | - Lisa Fiksenbaum
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada; Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Christopher R Bowie
- Centre for Neuroscience Studies, Department of Psychology & Department of Psychiatry, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Daniel P Dickstein
- PediMIND Program, Department of Psychiatry and Human Behaviour, Bradley Hospital and Alpert Medical School of Brown University, Rhode Island, East Providence 02915, USA
| | - Benjamin I Goldstein
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5R 0A3, Canada; Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
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18
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Neurostructural correlates of retinal microvascular caliber in adolescent bipolar disorder. JCPP ADVANCES 2021. [DOI: 10.1002/jcv2.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Parry P, Allison S, Bastiampillai T. 'Pediatric Bipolar Disorder' rates are still lower than claimed: a re-examination of eight epidemiological surveys used by an updated meta-analysis. Int J Bipolar Disord 2021; 9:21. [PMID: 34170440 PMCID: PMC8233426 DOI: 10.1186/s40345-021-00225-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 01/20/2023] Open
Abstract
Background ‘Pediatric bipolar disorder’ (PBD) is a controversial diagnosis with varying rates of clinical diagnosis. A highly cited meta-analysis (Van Meter et al. 2011) of a dozen epidemiological surveys suggested a global community prevalence of PBD of 1.8%. This was updated to 3.9% with eight additional surveys (Van Meter et al. 2019a). In terms of the Cochrane Handbook for Systematic Reviews of Interventions, the heterogenous community surveys were arguably unsuitable for statistical meta-analysis and warranted a narrative analysis. A narrative analysis (Parry et al. 2018) of the original 12 surveys concluded rates of PBD were substantially lower than 1.8% and led to a nine-article debate on the validity, arguable overdiagnosis and iatrogenic aspects of the PBD diagnosis (e.g. Carlson and Dubicka Child Adolesc Mental Health 21:86–87, 2019). This article extends the narrative analysis to include the eight newer community surveys. Methods A narrative analysis of the methodologies and the prevalence rates reported by the epidemiological surveys. Results Across all twenty surveys there was significant variation in methodologies and reported prevalence rates. Of the eight newer surveys, five (two Brazilian, one English, one Turkish, one United States) provided information of pre-adolescent prevalence rates of bipolar spectrum disorder. These pre-adolescent rates were zero or close to zero. Rates of adolescent hypomania and mania were higher, but follow-up data in two studies suggested hypomania might sometimes achieve prolonged remission or not lead to adult bipolar disorder. Limitations Methods in the original surveys vary and criteria used for various bipolar diagnoses were not always fully described. This limitation applies to a narrative analysis but also to a statistical meta-analysis. Conclusion Bipolar disorder is very rare in childhood and rare in adolescence. PBD as a diagnostic construct fails to correlate with adult bipolar disorder and the term should be abandoned. Hypomanic syndromes in adolescence may not always progress to adult bipolar disorder. Early diagnosis of bipolar disorder is important, but over-diagnosis risks adverse iatrogenic consequences.
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Affiliation(s)
- Peter Parry
- College of Medicine and Public Health, Flinders University, Adelaide, Australia. .,Children's Health Queensland Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Australia.
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Sultan AA, Kennedy KG, Fiksenbaum L, MacIntosh BJ, Goldstein BI. Neurostructural Correlates of Cannabis Use in Adolescent Bipolar Disorder. Int J Neuropsychopharmacol 2021; 24:181-190. [PMID: 33103721 PMCID: PMC7968618 DOI: 10.1093/ijnp/pyaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Little is known regarding the association of cannabis use with brain structure in adolescents with bipolar disorder (BD). This subject is timely, given expanded availability of cannabis contemporaneously with increased social acceptance and diminished societal constraints to access. Therefore, we set out to examine this topic in a sample of adolescents with BD and healthy control (HC) adolescents. METHODS Participants included 144 adolescents (47 BD with cannabis use [BDCB+; including 13 with cannabis use disorder], 34 BD without cannabis use [BDCB-], 63 HC without cannabis use) ages 13-20 years. FreeSurfer-processed 3T MRI with T1-weighted contrast yielded measures of cortical thickness, surface area (SA), and volume. Region of interest (amygdala, hippocampus, ventrolateral prefrontal cortex, ventromedial prefrontal cortex, and anterior cingulate cortex) analyses and exploratory vertex-wise analysis were undertaken. A general linear model tested for between-group differences, accounting for age, sex, and intracranial volume. RESULTS Vertex-wise analysis revealed significant group effects in frontal and parietal regions. In post-hoc analyses, BDCB+ exhibited larger volume and SA in parietal regions, and smaller thickness in frontal regions, relative to HC and BDCB-. BDCB- had smaller volume, SA, and thickness in parietal and frontal regions relative to HC. There were no significant region of interest findings after correcting for multiple comparisons. CONCLUSION This study found that cannabis use is associated with differences in regional brain structure among adolescents with BD. Future prospective studies are necessary to determine the direction of the observed association and to assess for dose effects.
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Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences & Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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21
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Humpston CS, Bebbington P, Marwaha S. Bipolar disorder: Prevalence, help-seeking and use of mental health care in England. Findings from the 2014 Adult Psychiatric Morbidity Survey. J Affect Disord 2021; 282:426-433. [PMID: 33422818 DOI: 10.1016/j.jad.2020.12.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, the lifetime prevalence of Bipolar Disorder (BD) and BD patients' access to mental health care in England has not been systematically studied. METHODS We used data from the Adult Psychiatric Morbidity Survey 2014 (N = 7546). The Mood Disorders Questionnaire (MDQ) was used to screen for BD. Associations between sociodemographic and clinical variables and use of mental health services were investigated. Weighted regression modelling established factors associated with being in receipt of care for mental health problems over the last year. RESULTS The lifetime prevalence of BD in the community in England was 1.7%. Approximately 40% had not received mental health care in the last year, and only 16.9% had received BD specific treatment. 14.6% had asked for a specific form of help but not received it. Psychopathology differed between individuals who successfully sought care and those who didn't. Obtaining care was independently associated with female sex (p<0.0001, odds ratio(OR):4.65 (Confidence Interval (CI):2.18-10.30), unemployment (p = 0.02, OR: 2.65 (C.I: 1.23-5.88) and suicidal ideation (p = 0.04, OR: 3.36, (C.I: 1.04-10.89). LIMITATIONS The MDQ is less sensitive than some of the longer measures, especially in the general population. Some between-group comparisons may have suffered from limited power. CONCLUSIONS The lifetime prevalence of BD in England was similar to rates worldwide. Most people with BD had not received any specific treatment for the condition in the last year, while 1 in 7 had requested specific help but did not receive it. Secondary mental health services in England for BD appear suboptimal.
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Affiliation(s)
- Clara S Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London W1T 7NF, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom; Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, B1 3RB, United Kingdom.
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Lu W, Kennedy KG, Sultan A, Fiksenbaum LM, Dimick MK, Toma S, Goldstein BI. Clinical and neurostructural characteristics among youth with familial and non-familial bipolar disorder: Family history and youth bipolar disorder. J Affect Disord 2021; 282:1315-1322. [PMID: 33601710 DOI: 10.1016/j.jad.2020.12.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is highly heritable and often severe, particularly when illness onset occurs early in life. There is limited knowledge regarding the clinical and neurostructural correlates of family history of BD among youth with BD. METHODS Clinical characteristics were evaluated in 197 youth with BD, ages 13-20 years, including 87 with familial BD and 110 with non-familial BD. Structural neuroimaging was examined in a subsample of familial BD (n=39), non-familial BD (n=42), and healthy control (HC, n=58) youth. Region of interest (ROI) analyses of anterior cingulate cortex (ACC), inferior frontal gyrus (IFG), and amygdala were complemented by whole-brain vertex-wise analyses. RESULTS Youth with familial BD had more family history of other psychiatric disorders, less severe worst manic episode, and less treatment with lithium, selective serotonin reuptake inhibitor (SSRI) antidepressants, and any lifetime psychiatric medications. None of these findings survived after correction for multiple comparisons. There were no significant between-group differences in ROI analyses. In whole-brain analyses, significant differences in cortical thickness were as follows: familial and non-familial BD < HC in left precentral gyrus and right inferior parietal lobe; familial BD < HC in left superior frontal gyrus; non-familial BD < HC in right precentral gyrus. LIMITATIONS Relatives did not complete full diagnostic interviews. CONCLUSIONS There were relatively few differences in clinical and neurostructural correlates related to family history of BD in youth with BD. Current findings suggest that family history of BD is not a strong contributor to the clinical or neuroimaging phenotypes in youth with BD.
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Affiliation(s)
- Weicong Lu
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada; Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, No. 36 MingXin Road, LiWan District, Guangzhou, Guangdong, 510370, China; Postgraduate Medical Education, University of Toronto, ON, 602-500 University Avenue Toronto, ON, M5G 1V7, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Science Building, Rm 4207 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Alysha Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Science Building, Rm 4207 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Lisa M Fiksenbaum
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Science Building, Rm 4207 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Simina Toma
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Science Building, Rm 4207 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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Goldstein BI, Korczak DJ. Links Between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk. Can J Cardiol 2020; 36:1394-1405. [DOI: 10.1016/j.cjca.2020.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022] Open
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Toma S, Islam AH, Metcalfe AWS, Mitchell RHB, Fiksenbaum L, MacIntosh BJ, Goldstein BI. Cortical Volume and Thickness Across Bipolar Disorder Subtypes in Adolescents: A Preliminary Study. J Child Adolesc Psychopharmacol 2019; 29:141-151. [PMID: 30359542 DOI: 10.1089/cap.2017.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Neuroimaging studies of adults with bipolar disorder (BD) have identified several BD subtype distinctions, including greater deficits in prefrontal gray matter volumes in BD-I (bipolar I disorder) compared to BD-II (bipolar II disorder). We sought to investigate BD subtype differences in brain structure among adolescents and young adults. METHODS Forty-four youth with BD (14 BD-I, 16 BD-II, and 14 BD-not otherwise specified [NOS], mean age 17) underwent 3T-MRI and images were analyzed using FreeSurfer software. Cortical volume and thickness were analyzed for region of interest (ROI): ventrolateral prefrontal cortex, ventromedial prefrontal cortex, anterior cingulate cortex (ACC), subgenual cingulate cortex, and amygdala, controlling for age, sex, and total intracranial volume. ROIs were selected as found to be implicated in BD in prior studies. A whole brain vertex-wise exploratory analysis was also performed. Uncorrected results are presented. RESULTS There were group differences in ACC thickness (F = 3.88, p = 0.03, η2 = 0.173 uncorrected), which was reduced in BD-II in comparison to BD-I (p = 0.027 uncorrected) and BD-NOS (p = 0.019 uncorrected). These results did not survive correction for multiple comparisons and no other group differences were observed. The exploratory vertex-wise analysis found a similar pattern of lower cortical thickness in BD-II in the left and right superior frontal gyrus and left caudal middle frontal gyrus. CONCLUSIONS This study found reduced cortical thickness for youth with BD-II, relative to BD-I, in regions associated with cognitive control. Further neurostructural differences between subtypes may emerge later during the course of illness.
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Affiliation(s)
- Simina Toma
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Alvi H Islam
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Arron W S Metcalfe
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,3 Brain Sciences , Sunnybrook Health Sciences Centre, Toronto, Canada .,4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rachel H B Mitchell
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Lisa Fiksenbaum
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- 3 Brain Sciences , Sunnybrook Health Sciences Centre, Toronto, Canada .,4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , Sunnybrook Health Sciences Centre, Toronto, Canada .,5 Department of Medical Biophysics, University of Toronto , Toronto, Canada .,6 Department of Physical Sciences, Sunnybrook Health Sciences Centre , Toronto, Canada
| | - Benjamin I Goldstein
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada .,4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , Sunnybrook Health Sciences Centre, Toronto, Canada .,7 Department of Pharmacology, University of Toronto , Toronto, Canada
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Mitchell RH, Metcalfe AW, Islam AH, Toma S, Patel R, Fiksenbaum L, Korczak D, MacIntosh BJ, Goldstein BI. Sex differences in brain structure among adolescents with bipolar disorder. Bipolar Disord 2018; 20:448-458. [PMID: 29956452 DOI: 10.1111/bdi.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) is twice as prevalent amongst female as amongst male adolescents. Thus far, little is known regarding the neurostructural substrates underlying this disparity. We therefore examined sex differences in neurostructural magnetic resonane imaging (MRI) phenotypes amongst adolescents with BD. METHODS T1-weighted structural MRI was acquired from 44 BD (25 female [F] and 19 male [M]) and 58 (28 F and 30 M) healthy control (HC) adolescents (13-21 years old). Whole-brain and region-of-interest (ROI) analyses examined structural volume and cortical thickness using FreeSurfer. ROIs included the ventrolateral prefrontal cortex (vlPFC), anterior cingulate cortex (ACC), amygdala and hippocampus. General linear models evaluated sex-by-diagnosis interactions, controlling for age and intracranial volume. RESULTS Whole-brain analysis revealed sex-by-diagnosis interactions in the left supramarginal gyrus (SMG) (P = .02, η2 = 0.02) and right inferior parietal lobule (IPL) volumes (P = .04, η2 = 0.01). Sex differences in HCs were found in the SMG (M > F) and IPL (F > M). In BD, sex differences were reversed and of smaller magnitude in the SMG (M < F) and of greater magnitude in the IPL (F > M), driven by trends towards smaller SMG and IPL in BD vs HC male participants (P = .05 and .14). Whole-brain analyses for cortical thickness, and ROI analyses for volume and cortical thickness, were not significant. CONCLUSIONS Normative sex differences may be disrupted in adolescent BD in the SMG and IPL, heteromodal association network hubs responsible for higher order integration of cognitive and emotional processing. Unexpectedly, these findings may inform our understanding of aberrant brain structure in adolescent BD male patients, rather than female patients. Future work should focus on replication, as well as the impact of puberty status and sex hormones on measures of brain structure and function.
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Affiliation(s)
- Rachel Hb Mitchell
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Arron Ws Metcalfe
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alvi H Islam
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Simina Toma
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ronak Patel
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Daphne Korczak
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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Yang F, Barbosa IG, Vieira EL, Bauer ME, Rocha NP, Teixeira AL. Further Evidence of Accelerated Aging in Bipolar Disorder: Focus on GDF-15. Transl Neurosci 2018; 9:17-21. [PMID: 29607212 PMCID: PMC5874508 DOI: 10.1515/tnsci-2018-0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/09/2018] [Indexed: 01/06/2023] Open
Abstract
Background Bipolar disorder (BD) is a mood disorder associated with cardiovascular and metabolic diseases and premature aging. Growth differentiation factor 15 (GDF-15) has emerged as a biomarker for cardiovascular risk and aging. Our aim was to compare plasma levels of GDF-15 between BD patients and controls, and to evaluate whether they were associated with clinical parameters. Methods Forty-six patients with type I BD (23 in euthymia and 23 in mania) and 33 healthy controls were recruited for this study. Plasma levels of GDF-15 were measured by immunoassay. Results The levels of GDF-15 were significantly higher (p < 0.001) in patients with BD in comparison with controls. In patients, GDF-15 levels correlated with age (rho = 0.434; p = 0.003) and illness duration (rho = 0.502; p = 0.001). Conclusion Our findings corroborate the view that BD is an illness associated with accelerated aging.
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Affiliation(s)
- Fang Yang
- Neuropsychiatry Program / Immuno-Psychiatry Lab, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at Houston (UT Health), Houston, USA
| | - Izabela G Barbosa
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Erica L Vieira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Moises E Bauer
- Laboratório de Imunossenescência, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Natalia P Rocha
- Neuropsychiatry Program / Immuno-Psychiatry Lab, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at Houston (UT Health), Houston, USA
| | - Antonio L Teixeira
- Neuropsychiatry Program / Immuno-Psychiatry Lab, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at Houston (UT Health), Houston, USA.,Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 937] [Impact Index Per Article: 156.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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Gene Genie of Bipolar Disorder, We Have a Few More Wishes. J Am Acad Child Adolesc Psychiatry 2017; 56:1006-1007. [PMID: 29173731 DOI: 10.1016/j.jaac.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 11/21/2022]
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Goldstein BI. Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities. Can J Cardiol 2017; 33:1565-1576. [DOI: 10.1016/j.cjca.2017.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
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Goldstein BI, Birmaher B, Carlson GA, DelBello MP, Findling RL, Fristad M, Kowatch RA, Miklowitz DJ, Nery FG, Perez‐Algorta G, Van Meter A, Zeni CP, Correll CU, Kim H, Wozniak J, Chang KD, Hillegers M, Youngstrom EA. The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disord 2017; 19:524-543. [PMID: 28944987 PMCID: PMC5716873 DOI: 10.1111/bdi.12556] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. METHODS An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. RESULTS Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. CONCLUSIONS As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoCanada,Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoCanada
| | - Boris Birmaher
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Gabrielle A Carlson
- Department of PsychiatryStony Brook University School of MedicineStony BrookNYUSA
| | - Melissa P DelBello
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | - Robert L Findling
- Department of Psychiatry & Behavioral SciencesThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Mary Fristad
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | - Robert A Kowatch
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | | | - Fabiano G Nery
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | | | - Anna Van Meter
- Ferkauf Graduate School of PsychologyYeshiva UniversityBronxNYUSA
| | | | - Christoph U Correll
- The Zucker Hillside HospitalDepartment of PsychiatryNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA
| | - Hyo‐Won Kim
- Department of PsychiatryUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea
| | - Janet Wozniak
- Clinical and Research Program in Pediatric PsychopharmacologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Kiki D Chang
- Department of PsychiatryStanford UniversityPalo AltoCAUSA
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry and PsychologyErasmus Medical Center‐SophiaRotterdamThe Netherlands
| | - Eric A Youngstrom
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNCUSA
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Naiberg MR, Hatch JK, Selkirk B, Fiksenbaum L, Yang V, Black S, Kertes PJ, Goldstein BI. Retinal photography: A window into the cardiovascular-brain link in adolescent bipolar disorder. J Affect Disord 2017; 218:227-237. [PMID: 28477501 DOI: 10.1016/j.jad.2017.04.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The burden of cardiovascular disease in bipolar disorder (BD) exceeds what can be explained by traditional cardiovascular risk factors (CVRFs), lifestyle, and/or medications. Moreover, neurocognitive deficits are a core feature of BD, and are also related to CVRFs. We examined retinal vascular photography, a proxy for cerebral microvasculature, in relation to CVRFs, peripheral microvascular function, and neurocognition among BD adolescents. METHODS Subjects were 30 adolescents with BD and 32 healthy controls (HC). Retinal photography was conducted using a Topcon TRC 50 DX, Type IA camera, following pupil dilation. Retinal arteriolar and venular caliber was measured, from which the arterio-venular ratio (AVR) was computed. All measures were conducted masked to participant diagnosis. Peripheral arterial tonometry measured endothelial function. Neurocognition was assessed using the Cambridge Neuropsychological Tests Automated Battery. RESULTS AVR was not significantly different between groups (Cohen's d=0.18, p=0.103). Higher diastolic blood pressure (BP) was associated with lower (worse) AVR in BD (r=-0.441, p=0.015) but not HC (r=-0.192, p=0.293). Similarly, in the BD group only, higher (better) endothelial function was associated with higher AVR (r=0.375, p=0.041). Hierarchical regression models confirmed that, independent of covariates, retinal vascular caliber was significantly associated with diastolic BP and endothelial function in BD. Within the BD group, mood scores were significantly negatively correlated with AVR (β=-0.451, p=0.044). LIMITATIONS This study's limitations include a small sample size, a cross-sectional study design, and a heterogeneous sample. CONCLUSION Retinal photography may offer unique insights regarding the cardiovascular and neurocognitive burden of BD. Larger longitudinal studies are warranted.
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Affiliation(s)
- Melanie R Naiberg
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Jessica K Hatch
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Beth Selkirk
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Lisa Fiksenbaum
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Victor Yang
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Sandra Black
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Medicine (Neurology), Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Peter J Kertes
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
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Reyes AN, Cardoso TA, Jansen K, Mondin TC, Souza LDM, Magalhães PVS, Kapczinski F, Silva RA. Functional impairment and cognitive performance in mood disorders: A community sample of young adults. Psychiatry Res 2017; 251:85-89. [PMID: 28189942 DOI: 10.1016/j.psychres.2017.01.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 11/23/2016] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare the global functioning and cognitive performance in a community sample of young adults with mood disorders versus community controls. This was a cross-sectional study nested in a cohort study with a community sample. Data was collected from February 2012 to June 2014; specifically, at a mean of five years after the first phase, all young adults were invited to participate in a re-evaluation. Mini International Neuropsychiatric Interview - PLUS (MINI-PLUS) was used for the diagnosis of mood disorders. The Functional Assessment Short Test (FAST) and the Montreal Cognitive Assessment (MoCA) were used to assess the global functioning, and cognitive performance, respectively. Were included 1258 subjects. Functional impairment was greater in subjects with bipolar disorder when compared to community controls, and there were no differences between major depressive disorder and community controls. There were no significant differences in cognitive performance between young adults with mood disorders when compared to community controls. Functional impairment is a marker for bipolar disorder in young adults; however, gross cognitive impairment assessed by a screening test is not, possibly because cognition is impaired in more advanced stages of the disorder.
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Affiliation(s)
- Amanda N Reyes
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil
| | - Taiane A Cardoso
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Ciências Médicas, Psiquiatria, Brazil
| | - Karen Jansen
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil
| | - Thaíse C Mondin
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil
| | - Luciano D M Souza
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil
| | - Pedro V S Magalhães
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Ciências Médicas, Psiquiatria, Brazil
| | - Flavio Kapczinski
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Ciências Médicas, Psiquiatria, Brazil
| | - Ricardo A Silva
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil.
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Increased cerebral blood flow among adolescents with bipolar disorder at rest is reduced following acute aerobic exercise. J Affect Disord 2017; 208:205-213. [PMID: 27792964 DOI: 10.1016/j.jad.2016.08.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Cerebral blood flow (CBF) is altered in mood disorders but has not been examined among adolescents with bipolar disorder (BD). Similarly, little is known about the acute neurophysiologic effects of aerobic exercise in BD. We therefore compared CBF between adolescents with and without BD at rest and acutely following a single exercise session. METHODS Thirty-one adolescents with BD and 20 age and sex-matched controls participated in this study. CBF magnetic resonance images (MRI) were acquired using arterial spin labeling at a baseline as well as 15 and 45min after a single 20-min session of recumbent cycling. Voxel-based CBF analyses compared groups at baseline and after exercise. Clinical, body mass index (BMI) and exercise-induced feelings inventory (EFI) data were examined for their influence on CBF findings. RESULTS Baseline CBF was increased in medial frontal and middle cingulate regions in BD compared to controls. Analysis of the acute CBF changes revealed pronounced exercise-related decreases in CBF in BD. Exercise-related feelings of exhaustion were associated with CBF changes in frontal but not parietal regions. DISCUSSION A single bout of moderate-intensity aerobic exercise reduced regional CBF to a greater extent in BD compared to controls; these time dependent CBF responses were associated with exercise-induced feelings of exhaustion.
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Naiberg MR, Newton DF, Collins JE, Bowie CR, Goldstein BI. Impulsivity is associated with blood pressure and waist circumference among adolescents with bipolar disorder. J Psychiatr Res 2016; 83:230-239. [PMID: 27665535 DOI: 10.1016/j.jpsychires.2016.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/12/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cardiovascular risk factors (CVRFs) and impulsivity are common in bipolar disorder (BD), and CVRFs are also linked with impulsivity through a number of mechanisms, both behavioral and biological. This study examines the association between CVRFs and impulsivity in adolescents with BD. METHODS Subjects were 34 adolescents with BD and 35 healthy control (HC) adolescents. CVRFs were based on International Diabetes Federation metabolic syndrome criteria (triglycerides, high-density lipoprotein cholesterol, waist circumference, blood pressure (BP) and glucose). Impulsivity was measured using the computerized Cambridge Gambling Task (CGT). Analyses controlled for age, IQ, lifetime attention deficit hyperactivity disorder, and current antipsychotic use. RESULTS Adolescents with BD had higher diastolic BP (73.36 ± 9.57 mmHg vs. 67.91 ± 8.74 mmHg, U = 401.0, p = 0.03), higher triglycerides (1.13 ± 0.60 mmol/L vs. 0.78 ± 0.38 mmol/L, U = 373.5, p = 0.008), and were more likely to meet high-risk criteria for waist circumference (17.6% vs. 2.9%, p = 0.04) vs. HC. Within the BD group, CGT sub-scores were correlated with CVRFs. For example, overall proportion bet was positively correlated with systolic (r = 0.387, p = 0.026) and diastolic (ρ = 0.404, p = 0.020) BP. Quality of decision-making was negatively correlated with systolic BP (ρ = -0.401, p = 0.021) and waist circumference (ρ = -0.534, p = 0.003). Significant interactions were observed, such that BD diagnosis moderates the relationship between both waist circumference and BP with CGT sub-scores. CONCLUSION BP and waist circumference are associated with impulsivity in BD adolescents, but not in HC adolescents. Future studies are warranted to determine temporality and to evaluate whether optimizing CVRFs improves impulsivity among BD adolescents.
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Affiliation(s)
- Melanie R Naiberg
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, ON, M4N 3M5, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, ON, M5R 0A3, Canada
| | - Dwight F Newton
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, ON, M4N 3M5, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, ON, M5R 0A3, Canada
| | - Jordan E Collins
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, ON, M4N 3M5, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Psychiatry, Queen's University, Kingston, ON K7L 3N6, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, ON, M4N 3M5, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, ON, M5R 0A3, Canada.
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Categorical and dimensional psychopathology in Dutch and US offspring of parents with bipolar disorder: A preliminary cross-national comparison. J Affect Disord 2016; 205:95-102. [PMID: 27423424 PMCID: PMC5373647 DOI: 10.1016/j.jad.2016.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Accumulating evidence suggests cross-national differences in adults with bipolar disorder (BD), but also in the susceptibility of their offspring (bipolar offspring). This study aims to explore and clarify cross-national variation in the prevalence of categorical and dimensional psychopathology between bipolar offspring in the US and The Netherlands. METHODS We compared levels of psychopathology in offspring of the Pittsburgh Bipolar Offspring Study (n=224) and the Dutch Bipolar Offspring Study (n=136) (age 10-18). Categorical psychopathology was ascertained through interviews using the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS-PL), dimensional psychopathology by parental reports using the Child Behavior Checklist (CBCL). RESULTS Higher rates of categorical psychopathology were observed in the US versus the Dutch samples (66% versus 44%). We found no differences in the overall prevalence of mood disorders, including BD-I or -II, but more comorbidity in mood disorders in US versus Dutch offspring (80% versus 34%). The strongest predictors of categorical psychopathology were maternal BD (OR: 1.72, p<.05), older age of the offspring (OR: 1.19, p<.05), and country of origin (US; OR: 2.17, p<.001). Regarding comorbidity, only country of origin (OR: 7.84, p<.001) was a significant predictor. In general, we found no differences in dimensional psychopathology based on CBCL reports. LIMITATIONS Preliminary measure of inter-site reliability. CONCLUSIONS We found cross-national differences in prevalence of categorical diagnoses of non-mood disorders in bipolar offspring, but not in mood disorder diagnoses nor in parent-reported dimensional psychopathology. Cross-national variation was only partially explained by between-sample differences. Cultural and methodological explanations for these findings warrant further study.
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Wilens T, Biederman J, Martelon M, Zulauf C, Anderson J, Yule A, Wozniak J, Fried R, Faraone S, Faraone SV. Further Evidence for Smoking and Substance Use Disorders in Youth With Bipolar Disorder and Comorbid Conduct Disorder. J Clin Psychiatry 2016; 77:1420-1427. [PMID: 27574842 PMCID: PMC6410713 DOI: 10.4088/jcp.14m09440] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Bipolar disorder (BPD) is a highly morbid disorder increasingly recognized in adolescents. The aim of this study was to examine the relative risk for substance use disorders (SUDs; alcohol or drug abuse or dependence) and cigarette smoking in adolescents with BPD. METHODS We evaluated the relative risk for SUDs and cigarette smoking in a case-controlled, 5-year prospective follow-up of adolescents with (n = 105, mean ± SD baseline age = 13.6 ± 2.5 years) and without ("controls"; n = 98, baseline age = 13.7 ± 2.1 years) BPD. Seventy-three percent of subjects were retained at follow-up (BPD: n = 68; controls: n = 81; 73% reascertainment). Our main outcomes were assessed by blinded structured interviews for DSM-IV criteria. RESULTS Maturing adolescents with BPD, compared to controls, were more likely to endorse higher rates of SUD (49% vs 26%; hazard ratio [HR] = 2.0; 95% confidence interval (CI), 1.1-3.6; P = .02) and cigarette smoking (49% vs 17%; HR = 2.9; 95% CI, 1.4-6.1; P = .004), as well as earlier onset of SUD (14.9 ± 2.6 [SD] years vs 16.5 ± 1.6 [SD] years; t = 2.6; P = .01). Subjects with conduct disorder (CD) were more likely to have SUD and nicotine dependence than subjects with BPD alone or controls (all P values < .05). When we added conduct disorder to the model with socioeconomic status and parental SUD, all associations lost significance (all P values > .05). Subjects with the persistence of a BPD diagnosis were also more likely to endorse cigarette smoking and SUD in comparison to those who lost a BPD diagnosis or controls at follow-up. CONCLUSIONS The results provide further evidence that adolescents with BPD, particularly those with comorbid CD, are significantly more likely to endorse cigarette smoking and SUDs when compared to their non-mood disordered peers. These findings indicate that youth with BPD should be carefully monitored for comorbid CD and the development of cigarette smoking and SUDs.
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Affiliation(s)
- Timothy Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Harvard Medical School, Boston, MA 02115
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Harvard Medical School, Boston, MA 02115
| | - MaryKate Martelon
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Courtney Zulauf
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Jesse Anderson
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Amy Yule
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Stephen Faraone
- Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, 13210
| | - Stephen V Faraone
- Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA
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Kim JH, Chang SM, Hong JP, Bae JN, Cho SJ, Hahm BJ, Lee DW, Park JI, Lee JY, Jeon HJ, Kim BS, Cho MJ. Lifetime prevalence, sociodemographic correlates, and diagnostic overlaps of bipolar spectrum disorder in the general population of South Korea. J Affect Disord 2016; 203:248-255. [PMID: 27314811 DOI: 10.1016/j.jad.2016.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/21/2016] [Accepted: 06/05/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with subthreshold bipolar disorder (Sub-BP) experience severe clinical courses and functional impairments which are comparable to those with bipolar I and II disorders (BP-I and -II). Nevertheless, lifetime prevalence, socioeconomic correlates and diagnostic overlaps of bipolar spectrum disorder (BPS) have not yet been estimated in the general population of South Korean adults. METHODS A total of 3013 adults among the 2011 Korean Epidemiologic Catchment Area survey (KECA-2011) completed face-to-face interviews using the Korean versions of the Composite International Diagnostic Interview 2.1 and Mood Disorder Questionnaire (K-CIDI and K-MDQ). RESULTS The lifetime prevalence of BPS in the South Korean adults was measured to be 4.3% (95% CI 2.6-6.9). Nearly 80% of the subjects with BPS were co-diagnosed with other DSM-IV non-psychotic mental disorders: 35.4% (95% CI 24.2-48.5) for major depression and dysthymic disorder, 35.1% (95% CI 27.7-43.3) for anxiety disorders, and 51.9% (95% CI 40.5-63.1) for alcohol and nicotine use disorders. Younger age (18-34 years) was the only sociodemographic predictor of BPS positivity (P=0.014), and the diagnostic overlap patterns were different between men and women. LIMITATIONS The prevalence of BPS and other mental disorders could have been influenced by recall bias due to the retrospective nature of this study. CONCLUSIONS Positivity for BPS was estimated to be much greater than the prevalence of DSM-IV BP in South Korea. Most of the respondents with BPS were diagnosed with other major mental disorders and this might be related with mis- and/or under-diagnosis of clinically relevant Sub-BP.
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Affiliation(s)
- Ji-Hyun Kim
- Department of Psychiatry, College of Medicine, Inha University, Incheon, South Korea
| | - Sung Man Chang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea.
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Nam Bae
- Department of Psychiatry, College of Medicine, Inha University, Incheon, South Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon Medical School, Gachon University of Medicine and Science, Incheon, South Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, Seoul, South Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Dong-Woo Lee
- Department of Psychiatry, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, South Korea
| | - Jong-Ik Park
- Department of Psychiatry, College of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, Seoul, South Korea; Department of Neuropsychiatry, Seoul Metropolitan Boramae Medical Center, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Samsung Advanced Institute for Health Science & Technology (SAIHST), Seoul, South Korea
| | - Byung-Soo Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Maeng Je Cho
- Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, Seoul, South Korea
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Goodday SM, Horrocks J, Keown-Stoneman C, Grof P, Duffy A. Repeated salivary daytime cortisol and onset of mood episodes in offspring of bipolar parents. Int J Bipolar Disord 2016; 4:12. [PMID: 27230036 PMCID: PMC4882311 DOI: 10.1186/s40345-016-0053-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/12/2016] [Indexed: 12/04/2022] Open
Abstract
Background Differences in cortisol secretion may differentiate individuals at high compared to low genetic risk for bipolar disorder (BD) and predict the onset or recurrence of mood episodes. The objectives of this study were to determine if salivary cortisol measures are: (1) different in high-risk offspring of parents with BD (HR) compared to control offspring of unaffected parents (C), (2) stable over time, (3) associated with the development of mood episode onset/recurrence, and (4) influenced by comorbid complications. Methods Fifty-three HR and 22 C completed salivary cortisol sampling annually for up to 4 years in conjunction with semi-structured clinical interviews. The cortisol awakening response (CAR), daytime cortisol [area under the curve (AUC)], and evening cortisol (8:00 p.m.) were calculated. Results There were no differences in baseline CAR, AUC and evening cortisol between HR and C (p = 0.38, p = 0.30 and p = 0.84), respectively. CAR, AUC and evening cortisol were stable over yearly assessments in HR, while in Cs, evening cortisol increased over time (p = 0.008), and CAR and AUC remained stable. In HR, AUC and evening cortisol increased the hazard of a new onset mood disorder/recurrence by 2.7 times (p = 0.01), and 3.5 times (p = 0.01), respectively, but this was no longer significant after accounting for multiple comparisons. Conclusions Salivary cortisol is stable over time within HR offspring. However, between individuals, basal salivary cortisol is highly variable. More research is needed, with larger samples of prospectively studied HR youth using a more reliable method of cortisol measurement, to determine the potential role of cortisol in the development of mood disorders. Electronic supplementary material The online version of this article (doi:10.1186/s40345-016-0053-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah M Goodday
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Julie Horrocks
- Department of Mathematics & Statistics, University of Guelph, Guelph, ON, Canada
| | | | - Paul Grof
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Mood Disorders Centre of Ottawa, Ottawa University Health Services, Ottawa, ON, Canada
| | - Anne Duffy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Mood Disorders Centre of Ottawa, Ottawa University Health Services, Ottawa, ON, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
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Correlates of Adolescent-reported and Parent-reported Family Conflict Among Canadian Adolescents With Bipolar Disorder. J Psychiatr Pract 2016; 22:31-41. [PMID: 26813486 DOI: 10.1097/pra.0000000000000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Family conflict exacerbates the course of bipolar disorder (BP) among adults. However, few studies have examined family conflict among adolescents with BP, and fewer have looked at adolescent-reported and parent-reported family conflict separately. METHODS Subjects were 89 adolescents, aged 13 to 19 years, with a diagnosis of BP on the basis of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL). Subjects were divided into high-conflict and low-conflict groups using a median split on the Conflict Behavior Questionnaire (child report and parent report). The χ(2) analyses and independent samples t tests were performed for univariate analyses. Multivariable logistic regression analyses were performed on variables with P<0.2. RESULTS Parent-reported and adolescent-reported Conflict Behavior Questionnaire scores were significantly correlated (r=0.50, P<0.001). High parent-reported family conflict was positively associated with recent manic symptoms, externalizing comorbidities, and dimensional scores reflecting emotional dysregulation. High adolescent-reported family conflict was positively associated with recent manic symptoms and emotional dysregulation, and negatively associated with socioeconomic status and lifetime psychiatric hospitalization. Bipolar subtype was significantly associated with high versus low family conflict. LIMITATIONS The limitations of this study included being a cross-sectional study, use of a medium-sized sample, and lack of a control group. CONCLUSIONS Despite substantial agreement between adolescents and parents regarding the amount of family conflict, there were meaningful differences in the factors associated with adolescent-reported and parent-reported conflict. These findings demonstrate the importance of ascertaining family conflict from adolescents as well as from parents. Moreover, these findings can potentially inform family therapy, which is known to be effective for adolescents with BP.
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Cardoso TDA, Mondin TC, Souza LDDM, da Silva RA, Magalhães PVS, Kapczinski F, Jansen K. Functioning in bipolar disorder with substance abuse/dependence in a community sample of young adults. J Affect Disord 2015; 187:179-82. [PMID: 26339928 DOI: 10.1016/j.jad.2015.08.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess the functional impairment of young adults with bipolar disorder with substance abuse/dependence comorbidity. METHOD Cross-sectional study within a community sample. Bipolar Disorder was assessed by qualified psychologists using The Mini International Neuropsychiatric Interview - PLUS (MINI-PLUS). Substance abuse and dependence was assessed using the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST). Functional impairment was assessed using the Functional Assessment Short Test (FAST). RESULTS The sample included 1259 young adults. The prevalence of Bipolar Disorder (BD) without Substance Abuse/Dependence (SAD) comorbidity was 5.9% (n=74), and the prevalence of bipolar disorder with substance abuse/dependence comorbidity was 1.4% (n=17). Both groups showed higher impairment in overall functioning, interpersonal relationship, and leisure time as compared to controls. In addition, BD+SAD showed higher impairment in the cognitive functioning domain of FAST. LIMITATION A battery of neuropsychological tests was not performed. CONCLUSION Functional impairment is associated with BD, independently of substance abuse or dependence. In addition, BD+SAD present a more severe impairment in the cognitive domain of FAST as compared to controls.
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Affiliation(s)
- Taiane de Azevedo Cardoso
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil; University of Texas Health Science Center at Houston - Department of Psychiatry, United States
| | - Thaise Campos Mondin
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil
| | | | | | - Pedro V S Magalhães
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Ciências Médicas: Psiquiatria, Brazil
| | - Flavio Kapczinski
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Ciências Médicas: Psiquiatria, Brazil
| | - Karen Jansen
- Universidade Católica de Pelotas - Programa de Pós-Graduação em Saúde e Comportamento, Brazil; University of Texas Health Science Center at Houston - Department of Psychiatry, United States.
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Khazanov GK, Cui L, Merikangas KR, Angst J. Treatment patterns of youth with bipolar disorder: results from the National Comorbidity Survey-Adolescent Supplement (NCS-A). JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:391-400. [PMID: 24958307 DOI: 10.1007/s10802-014-9885-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite growing evidence that bipolar disorder often emerges in adolescence, there are limited data regarding treatment patterns of youth with bipolar disorder in community samples. Our objective was to present the prevalence and clinical correlates of treatment utilization for a nationally representative sample of US adolescents with bipolar disorder. Analyses are based on data from the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of 10,123 adolescents (ages 13-18) identified in household and school settings. We found that of adolescents meeting DSM-IV criteria for bipolar I or II disorder (N = 250), 49 % were treated for depression or mania, 13 % were treated for conditions other than depression or mania, and 38 % did not report receiving treatment. Treatment for depression or mania was associated with increased rates of suicide attempts, as well as greater role disability and more comorbid alcohol use relative to those who had not received treatment. Treated adolescents had triple the rate of ADHD and double the rates of behavior disorders than those without treatment. Our findings demonstrate that a substantial proportion of youth with bipolar disorder do not receive treatment, and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. Treatment was more common among youth with severe manifestations and consequences of bipolar disorder and those with behavior problems. These trends highlight the need to identify barriers to treatment for adolescents with bipolar disorder and demonstrate that those in treatment are not representative of youth with bipolar disorder in the general population.
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Affiliation(s)
- Gabriela Kattan Khazanov
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bldg. 35A, Rm 2E410, 35 Convent Dr. MSC 3720, Bethesda, MD, 20892-0001, USA
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Dell'Aglio JC, Basso LA, Argimon IIDL, Arteche A. Systematic review of the prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015; 35:99-105. [PMID: 25923299 DOI: 10.1590/s2237-60892013000200002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/28/2013] [Indexed: 11/22/2022]
Abstract
This paper describes the findings of a systematic literature review aimed at providing an overview of the lifetime prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. Databases MEDLINE, ProQuest, Psychnet, and Web of Science were browsed for papers published in English between 1999 and May 2012 using the following search string: bipolar disorders OR bipolar spectrum disorders AND prevalence OR cross-sectional OR epidemiology AND population-based OR non-clinical OR community based. The search yielded a total of 434 papers, but only those published in peer-reviewed journals and with samples aged ≥ 18 years were included, resulting in a final sample of 18 papers. Results revealed rather heterogeneous findings concerning the prevalence of bipolar disorders and bipolar spectrum disorders. Lifetime prevalence of bipolar disorder ranged from 0.1 to 7.5%, whereas lifetime prevalence of bipolar spectrum disorders ranged from 2.4 to 15.1%. Differences in the rates of bipolar disorder and bipolar spectrum disorders may be related to the consideration of subthreshold criteria upon diagnosis. Differences in the prevalence of different subtypes of the disorder are discussed in light of diagnostic criteria and instruments applied.
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Affiliation(s)
| | - Lissia Ana Basso
- WP Centro de Psicoterapia Cognitivo-Comportamental, Santa Maria, RS, Brazil
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Non-invasive vascular imaging is associated with cardiovascular risk factors among adolescents with bipolar disorder. Pediatr Cardiol 2015; 36:158-64. [PMID: 25096903 DOI: 10.1007/s00246-014-0980-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
Cardiovascular disease (CVD) is exceedingly prevalent among adults with bipolar disorder (BD), implicating BD adolescents as a high-risk group for CVD. Non-invasive ultrasound measures of vascular structure (via carotid intima media thickness [cIMT]) and function (via flow-mediated dilation [FMD]) predict future CVD, and are associated with traditional CVD risk factors among adolescents without mood disorders. This study examined, for the first time, the association of cIMT and FMD with CVD risk factors among adolescents with BD. The presence of multiple potential confounds among adolescents with BD, including various medications and mood states, informs the need to demonstrate whether cIMT and FMD are associated with CVD risk factors in this population specifically. Participants were 30 adolescents, 13-19 years old, with BD, without CVD. High-resolution ultrasonography was used to evaluate vascular structure (cIMT) and function (FMD). Analyses examined associations of cIMT and FMD with traditional CVD risk factors. cIMT was significantly positively associated with systolic blood pressure and waist circumference. FMD was significantly negatively associated with waist circumference, body mass index, triglycerides, and glucose, and positively associated with high-density lipoprotein. cIMT and FMD are associated with traditional CVD risk factors among adolescents with BD. Irrespective of numerous potential confounds, non-invasive vascular ultrasound approaches may be used as CVD risk proxies among adolescents with BD as they are for other adolescents.
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Straub J, Keller F, Sproeber N, Koelch MG, Plener PL. Suicidal behavior in german adolescents. Prevalence and association with depressive and manic symptoms. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 43:39-45. [PMID: 25536895 DOI: 10.1024/1422-4917/a000331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. METHODS 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. RESULTS In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. CONCLUSIONS Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.
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Affiliation(s)
- Joana Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Nina Sproeber
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Michael G Koelch
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
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Cardoso TDA, Farias CDA, Mondin TC, da Silva GDG, Souza LDDM, da Silva RA, Pinheiro KT, do Amaral RG, Jansen K. Brief psychoeducation for bipolar disorder: impact on quality of life in young adults in a 6-month follow-up of a randomized controlled trial. Psychiatry Res 2014; 220:896-902. [PMID: 25300245 DOI: 10.1016/j.psychres.2014.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 09/09/2014] [Accepted: 09/21/2014] [Indexed: 12/18/2022]
Abstract
There are scarce follow-up studies evaluating the role of psychoeducation in the treatment of bipolar disorder, especially in a young sample, with a recent diagnosis and that probably received a few previous interventions. This was a randomized clinical trial with young adults aged 18-29 years, who had been diagnosed with bipolar disorder through the Structured Clinical Interview for DSM (SCID). The evaluation of quality of life was carried out using the Medical Outcomes Survey 36-Item Short-Form Health Survey (MOS SF-36). All participants were randomized into two groups: combined intervention (psychoeducation plus medication) and treatment-as-usual (medication). The sample consisted of 61 patients divided in two groups (29 usual treatment; 32 combined intervention). The quality of life domains did not reveal statistically significant differences when comparing baseline, post-intervention and 6-month follow-up evaluations, which indicates that there is no difference between combined intervention and usual intervention regarding quality of life improvement. Both groups presented improvements in quality of life domains, except General Health and Bodily Pain, at post-intervention. Moreover, this improvement persisted at 6-month follow-up, except for the Role Physical Health domain, which remained reduced. Combined Psychoeducation plus pharmacological intervention is so effective in improving quality of life perception as it is pharmacological only intervention.
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Affiliation(s)
| | | | - Thaíse Campos Mondin
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Brazil
| | | | | | | | - Karen Tavares Pinheiro
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Brazil
| | | | - Karen Jansen
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Brazil.
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Waugh MJ, Meyer TD, Youngstrom EA, Scott J. A review of self-rating instruments to identify young people at risk of bipolar spectrum disorders. J Affect Disord 2014; 160:113-21. [PMID: 24461633 DOI: 10.1016/j.jad.2013.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite 15-25 years being the peak age at onset for bipolar disorder (BD), recognition and introduction of appropriate treatment are typically delayed by 6 or more years. A major reason for these delays is the failure to identify prior mood episodes or risk factors for bipolarity, suggesting that there may be a particular benefit in using screening tools in this age group. METHODS We identified papers published between 1980 and 2012 that assessed the validity of measures specifically used to screen for BD, risk factors for bipolarity, or a prior history of depressive, hypomanic or manic episodes. From these, we identified those studies that included sufficient information about participants aged 15-25 years. RESULTS Searches yielded only eleven independent studies with available data on the target age group. The studies employed seven separate scales that demonstrated quite different screening properties. The cut-off scores for optimal sensitivity and specificity often differed from those reported for adult samples and varied according to sample characteristics. LIMITATIONS Our findings may be undermined by the small sample sizes and low number of individuals in the specified age range included in the studies identified. Although we explored all available methods for detecting studies and data sets, we cannot exclude the likelihood that other relevant studies on this age range exist. CONCLUSIONS Available screening tools for BD have mainly been validated in middle-aged adult samples with established mood disorders, and the instruments reviewed show sub-optimal screening properties when applied to adolescents and young adults. Overall, those measures that examine personality traits or temperament appear to perform better than those assessing discrete symptoms or episodes. However, all the measures need further testing and/or modification. In the interim, to improve screening for BD in those in the peak age range for onset of this disorder, it may be appropriate to combine a measure with high sensitivity with one that demonstrates high specificity for a given sampling frame.
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Affiliation(s)
- Meghan J Waugh
- Northumberland, Tyne & Wear NHS Foundations Trust, Newcastle upon Tyne, UK
| | | | | | - Jan Scott
- Institute of Neuroscience, Newcastle University, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
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Abstract
BACKGROUND The existence of bipolar disorder (BP) in youth is controversial. METHODS The current evidence regarding the diagnosis of BP in youth was reviewed. RESULTS BP is a recurrent familial disorder that occurs in 1-3% of youth, particularly in adolescents. Except for subsyndromal BP, the prevalence of BP-I is similar across most countries. Due to the child's immaturity, the presence of comorbid disorders, and divergent interpretations of manic symptomatology it is difficult to diagnose BP in youth. Youth with subsyndromal mania and family history of BP, are at high risk to develop BP-I and BP-II. Both the full and subsyndromal syndromal BP are associated with significant psychosocial difficulties and increased risk for use of substances, suicidality, legal problems, and services utilization. CONCLUSION BP disorder exists in youth, but it is difficult to diagnose. The recurrent nature and psychosocial morbidity associated with this illness during critical developmental stages calls for comprehensive longitudinal evaluation and accurate recognition and treatment because delays in treatment are associated with poor outcome.
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Affiliation(s)
- Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Bellefield Towers Room 612, Pittsburgh, PA, 15213, USA
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1-44. [PMID: 23237061 DOI: 10.1111/bdi.12025] [Citation(s) in RCA: 540] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Petermann F, Jaščenoka J, Koglin U, Karpinski N, Petermann U, Kullik A. Zur Lebenszeitprävalenz Affektiver Störungen im Jugendalter. KINDHEIT UND ENTWICKLUNG 2012. [DOI: 10.1026/0942-5403/a000087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Schon vor einigen Jahren konnte die Bremer Jugendstudie zeigen, dass Affektive Störungen im Jugendalter ein häufiges psychisches Störungsbild darstellen ( Essau, Karpinski, Petermann & Conradt, 1998 ). Aktuell fehlen Studien, die den kategorialen Ansatz zur Messung psychischer Störungen heranziehen und aktuelle Daten für die Verbreitung Affektiver Störungen bei Jugendlichen liefern. Die vorliegende Studie führte mit 333 Jugendlichen zwischen 12 und 17 Jahren vollstandardisierte, klinische Interviews zur Messung von Lebenszeitprävalenzen psychischer Störungen in der Stadt Bremen durch und erhob darüber hinaus mithilfe eines Fragebogenkatalogs umfassende Angaben zum psychischen Funktionsniveau der Jugendlichen. Die ersten Ergebnisse zeigen, dass insgesamt 14.4 % der Jugendlichen von Affektiven Störungen betroffen waren (7.5 % Major Depression, 5.4 % Dysthyme Störung, 1.5 % Bipolare und Hypomane Störungen). Diese Ergebnisse entsprechen Prävalenzschätzungen früherer Studien und betonen die Notwendigkeit einer frühzeitigen Prävention und Behandlung.
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Affiliation(s)
- Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Julia Jaščenoka
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Ute Koglin
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Norbert Karpinski
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Ulrike Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Angelika Kullik
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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Tsiami A, Sookhoo D, Tingle A, Loveday H, Golsorkhi M. A systematic review of the effectiveness of polyunsaturated fatty acids in reducing the clinical symptoms of paediatric bipolar disorder in children and adolescents. JBI LIBRARY OF SYSTEMATIC REVIEWS 2012; 10:1-18. [PMID: 27820454 DOI: 10.11124/jbisrir-2012-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Amalia Tsiami
- 1.JBI Collaborating Centre, School of Psychology, Social Work and Human Sciences, University of West London, London, UK 2. JBI Collaborating Centre, College of Nursing, Midwifery and Healthcare, University of West London, London, UK
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