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Hypomanic symptoms in early pregnancy: prevalence and associated factors. Arch Womens Ment Health 2021; 24:463-471. [PMID: 33094351 DOI: 10.1007/s00737-020-01078-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.
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Mucci F, Avella MT, Marazziti D. ADHD with Comorbid Bipolar Disorders: A Systematic Review of Neurobiological, Clinical and Pharmacological Aspects Across the Lifespan. Curr Med Chem 2020; 26:6942-6969. [PMID: 31385763 DOI: 10.2174/0929867326666190805153610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/05/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Attention deficit hyperactivity (ADHD) disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, disruptive behaviour, and impulsivity. Despite considered typical of children for a long time, the persistence of ADHD symptoms in adulthood gained increasing interest during the last decades. Indeed, its diagnosis, albeit controversial, is rarely carried out even because ADHD is often comorbid with several other psychiatric diosrders, in particular with bipolar disorders (BDs), a condition that complicates the clinical picture, assessment and treatment. AIMS The aim of this paper was to systematically review the scientific literature on the neurobiological, clinical features and current pharmacological management of ADHD comorbid with BDs across the entire lifespan, with a major focus on the adulthood. DISCUSSION The pharmacology of ADHD-BD in adults is still empirical and influenced by the individual experience of the clinicians. Stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants are useful when a substance abuse history is detected, although they require some weeks in order to be fully effective. In any case, an in-depth diagnostic and clinical evaluation of the single individual is mandatory. CONCLUSION The comorbidity of ADHD with BD is still a controversial matter, as it is the notion of adult ADHD as a distinct nosological category. Indeed, some findings highlighted the presence of common neurobiological mechanisms and overlapping clinical features, although disagreement does exist. In any case, while expecting to disentangle this crucial question, a correct management of this comorbidity is essential, which requires the co-administration of mood stabilizers. Further controlled clinical studies in large samples of adult ADHD-BD patients appear extremely urgent in order to better define possible therapeutic guidelines, as well as alternative approaches for this potentially invalidating condition.
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Affiliation(s)
- Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy
| | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy
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Cheniaux E, Silva RDAD, Santana CMT, Nardi AE, Filgueiras A. Mood versus energy/activity symptoms in bipolar disorder: which cluster of Hamilton Depression Rating Scale better distinguishes between mania, depression, and euthymia? TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 41:401-408. [PMID: 31967199 DOI: 10.1590/2237-6089-2018-0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/22/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although bipolar disorder (BD) is traditionally included among mood disorders, some authors believe that changes in energy and motor activity, rather than mood changes, represent the true cardinal symptoms in mania and depression. The aim of the current study was to identify which cluster of the Hamilton Depression Rating Scale (HAM-D) better distinguishes between mania, depression and euthymia. METHOD A group of 106 patients with BD were followed for 13 years and repeatedly assessed with the HAM-D as well as with other clinical scales. To perform a comparison, HAM-D items were classified according to clinical criteria into three clusters: energy/activity symptoms, mood symptoms, and other symptoms. Item response theory (IRT) analyses were performed to provide a test information curve for those three clusters. We measured the prevalence of one cluster of symptoms over the other two throughout the latent trait. RESULTS Considering HAM-D items individually, the IRT analysis revealed that there was a mixture of mood and energy/activity symptoms among the most discriminative items, both in depression and in euthymia. However, in mania, only energy/activity symptoms - i.e., general somatic symptoms and retardation - were among the most informative items. Considering the classification of items, both in depression as in mania, the energy/activity cluster was more informative than the mood cluster according to the IRT analysis. CONCLUSION Our data reinforce the view of hyperactivity and motor retardation as cardinal changes of mania and depression, respectively.
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Affiliation(s)
- Elie Cheniaux
- Instituto de Psiquiatria - Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil.,Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Rafael de Assis da Silva
- Instituto de Psiquiatria - Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil.,Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Cristina M T Santana
- Instituto de Psiquiatria - Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antonio Egidio Nardi
- Instituto de Psiquiatria - Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil
| | - Alberto Filgueiras
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Glaus J, Van Meter A, Cui L, Marangoni C, Merikangas KR. Factorial structure and familial aggregation of the Hypomania Checklist-32 (HCL-32): Results of the NIMH Family Study of Affective Spectrum Disorders. Compr Psychiatry 2018; 84:7-14. [PMID: 29655654 PMCID: PMC6002901 DOI: 10.1016/j.comppsych.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is substantial evidence that bipolar disorder (BD) manifests on a spectrum rather than as a categorical condition. Detection of people with subthreshold manifestations of BD is therefore important. The Hypomania Checklist-32 (HCL-32) was developed as a tool to identify such people. PURPOSE The aims of this paper were to: (1) investigate the factor structure of HCL-32; (2) determine whether the HCL-32 can discriminate between mood disorder subtypes; and (3) assess the familial aggregation and cross-aggregation of hypomanic symptoms assessed on the HCL with BD. PROCEDURES Ninety-six probands recruited from the community and 154 of their adult first-degree relatives completed the HCL-32. Diagnosis was based on semi-structured interviews and family history reports. Explanatory factor analysis and mixed effects linear regression models were used. FINDINGS A four-factor ("Activity/Increased energy," "Distractibility/Irritability", "Novelty seeking/Disinhibition, "Substance use") solution fit the HCL-32, explaining 11.1% of the total variance. The Distractibility/Irritability score was elevated among those with BP-I and BP-II, compared to those with depression and no mood disorders. Higher HCL-32 scores were associated with increased risk of BD-I (OR = 1.22, 95%CI 1.14-1.30). The "Distractibility/Irritability" score was transmitted within families (β = 0.15, p = 0.040). However, there was no familial cross-aggregation between mood disorders and the 4 HCL factors. CONCLUSIONS Our findings suggest that the HCL-32 discriminates the mood disorder subtypes, is familial and may provide a dimensional index of propensity to BD. Future studies should explore the heritability of symptoms, rather than focusing on diagnoses.
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Affiliation(s)
- Jennifer Glaus
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
| | - Anna Van Meter
- Ferkauf Graduate School, Yeshiva University, University in New York, 1165 Morris Park Ave, Bronx, New York 10461, United States.
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
| | - Ciro Marangoni
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
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Barton J, Kyle SD, Varese F, Jones SH, Haddock G. Are sleep disturbances causally linked to the presence and severity of psychotic-like, dissociative and hypomanic experiences in non-clinical populations? A systematic review. Neurosci Biobehav Rev 2018; 89:119-131. [DOI: 10.1016/j.neubiorev.2018.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 12/15/2022]
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Sensory profiles as potential mediators of the association between hypomania and hopelessness in 488 major affective outpatients. J Affect Disord 2018; 225:466-473. [PMID: 28863299 DOI: 10.1016/j.jad.2017.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Extreme sensory processing patterns may contribute to the pathophysiology of major affective disorders. We aimed to examine whether significant correlations exist between sensory profiles, hypomania, self-reported depression, and hopelessness and whether sensory profiles may be potential mediators of the association between hypomania and depression/hopelessness. METHODS The sample consisted of 488 euthymic affective disorder patients of which 283 diagnosed with unipolar and 162 with bipolar disorder with an age ranging from 18 to 65 years (mean = 47.82 ± 11.67). RESULTS Lower registration of sensory input and sensory sensitivity significantly correlated with elevated self-reported depression, hopelessness, and irritable/risk-taking hypomania while sensation seeking and avoiding significantly correlated with elevated depression and hopelessness but not with irritable/risk-taking hypomania. Moreover, individuals with lower ability to register sensory input and higher hypomania showed higher self-reported depression than those with good registration of sensory information. According to SEM analyses, there was both a direct/indirect effect of irritable/risk-taking on depression-hopelessness with the mediation model explaining 48% of the variance in depression-hopelessness. LIMITATIONS The relatively small sample size and the cross-sectional nature of the study design do not allow the generalization of the main findings. CONCLUSION Low registration was associated with enhanced depressed mood and hopelessness while sensory seeking may be considered a resilient factor.
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Raucher-Chéné D, Terrien S, Gierski F, Obert A, Caillies S, Besche-Richard C, Kaladjian A. Neural Correlates of Semantic Inhibition in Relation to Hypomanic Traits: An fMRI Study. Front Psychiatry 2018; 9:108. [PMID: 29670548 PMCID: PMC5893717 DOI: 10.3389/fpsyt.2018.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/19/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Language modifications are a core feature of mania, but little is known about the semantic mechanisms behind these disturbances. The aim of the present study was thus to identify deficits in semantic inhibition and their respective neural activation patterns in a sample of individuals assessed for hypomanic personality traits. METHODS Thirty-six young adults with no neurological or psychiatric diagnoses were assessed for hypomanic personality traits with the Hypomanic Personality Scale (HPS) and underwent an fMRI task of semantic ambiguity resolution. RESULTS Regression analyses revealed a positive association between the HPS score and activity in the left superior frontal gyrus, left inferior parietal lobule, and anterior cingulate gyrus during semantic ambiguity resolution. CONCLUSION We found a link between HPS scores and brain areas that are part of the cognitive control loop and semantic memory network during language processing in a nonclinical sample of individuals. The hyperactivation of these regions may reflect a compensatory neural response in a population with greater vulnerability to BD.
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Affiliation(s)
- Delphine Raucher-Chéné
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Sarah Terrien
- Speech and Language Laboratory (UMR 7309), CNRS, Aix-en-Provence, France
| | - Fabien Gierski
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Alexandre Obert
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Stéphanie Caillies
- Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Chrystel Besche-Richard
- Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Arthur Kaladjian
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
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Jahangard L, Rahmani A, Haghighi M, Ahmadpanah M, Sadeghi Bahmani D, Soltanian AR, Shirzadi S, Bajoghli H, Gerber M, Holsboer-Trachsler E, Brand S. "Always Look on the Bright Side of Life!" - Higher Hypomania Scores Are Associated with Higher Mental Toughness, Increased Physical Activity, and Lower Symptoms of Depression and Lower Sleep Complaints. Front Psychol 2017; 8:2130. [PMID: 29312026 PMCID: PMC5733035 DOI: 10.3389/fpsyg.2017.02130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022] Open
Abstract
Background: In the present study, we explored the associations between hypomania, symptoms of depression, sleep complaints, physical activity and mental toughness. The latter construct has gained interest for its association with a broad variety of favorable behavior in both clinical and non-clinical samples. Subjects and Methods: The non-clinical sample consisted of 206 young adults (M = 21.3 years; age range: 18–24 years; 57.3% males). They completed questionnaires covering hypomania, mental toughness, symptoms of depression, physical activity, and sleep quality. Results: Higher hypomania scores were associated with higher mental toughness, increased physical activity, lower symptoms of depression and lower sleep complaints. No gender differences were observed. Higher hypomania scores were predicted by higher scores of mental toughness subscales of control and challenge, and physical activity. Conclusion: The pattern of results suggests that among a non-clinical sample of young adults, self-rated hypomania scores were associated with higher scores on mental toughness and physical activity, along with lower depression and sleep complaints. The pattern of results further suggests that hypomania traits are associated with a broad range of favorable psychological, behavioral and sleep-related traits, at least among a non-clinical sample of young adults.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Anahita Rahmani
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Dena Sadeghi Bahmani
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Ali R Soltanian
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahriar Shirzadi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hafez Bajoghli
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Serge Brand
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Substance Abuse Prevention Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorder Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mistry S, Zammit S, Price VE, Jones HJ, Smith DJ. Borderline personality and attention-deficit hyperactivity traits in childhood are associated with hypomanic features in early adulthood. J Affect Disord 2017; 221:246-253. [PMID: 28662455 DOI: 10.1016/j.jad.2017.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/08/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is limited understanding of the symptomatic development of bipolar disorder from childhood to early adulthood. AIMS We assessed whether borderline personality disorder traits, ADHD, and emotional, behavioural and social difficulties during childhood were associated with hypomania assessed in young adulthood. METHOD We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), to examine associations between measures of childhood psychopathology and lifetime hypomanic features assessed at age 22-23 years using the Hypomania Checklist-32 (HCL-32; n = 3372). We also conducted a factor analysis of the HCL to identify latent constructs underlying hypomania, and the extent to which childhood psychopathology was associated with these. RESULTS We identified two factors of the HCL corresponding to energy/mood and risk-taking/irritability. There was evidence of association between childhood borderline personality disorder traits and both hypomania factors, with evidence that the association was stronger with the risk-taking/irritability factor. All individual borderline traits, with the exception of fear of abandonment, were associated with hypomania. There was also evidence of association between most other measures of childhood psychopathology (ADHD, hyperactivity, conduct problems, peer relationship problems and reduced prosocial behaviour) and the risk-taking/irritability factor, but much less consistent evidence of association with the energy/mood factor. LIMITATIONS The HCL cannot diagnose bipolar disorder and may be subject to reporting bias. CONCLUSIONS A broad range of childhood psychopathologies may represent early markers of risk for hypomania. Further studies are required to understand the mechanisms underlying these associations, and to inform earlier detection of bipolar disorder.
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Affiliation(s)
- Sumit Mistry
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK.
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, UK
| | - Valentina-Escott Price
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Hannah J Jones
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, I Lilybank Gardens, University of Glasgow, UK
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10
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Positive affect and sleep: A systematic review. Sleep Med Rev 2017; 35:21-32. [DOI: 10.1016/j.smrv.2016.07.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
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Berk L, Hallam KT, Venugopal K, Lewis AJ, Austin DW, Kulkarni J, Dodd S, de Castella A, Fitzgerald PB, Berk M. Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder. Bipolar Disord 2017; 19:184-197. [PMID: 28470892 DOI: 10.1111/bdi.12486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/12/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. METHODS We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. RESULTS At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. CONCLUSIONS Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
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Affiliation(s)
- Lesley Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Melbourne School of Global and Population Health, University of Melbourne, Parkville, Vic., Australia
| | - Karen T Hallam
- Department of Psychology, The University of Melbourne, Parkville, Vic., Australia.,Department of Psychology, Victoria University, Melbourne, Vic., Australia
| | - Kamalesh Venugopal
- South Australian Department for Health and Ageing, Adelaide, SA, Australia
| | - Andrew James Lewis
- School of Psychology & Exercise Science, Murdoch University, Murdoch, WA, Australia.,Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - David W Austin
- School of Psychology, Faculty of Health, Deakin University, Burwood, Vic., Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Seetal Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, Vic., Australia
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Hosang GM, Cardno AG, Freeman D, Ronald A. Characterization and structure of hypomania in a British nonclinical adolescent sample. J Affect Disord 2017; 207:228-235. [PMID: 27728870 PMCID: PMC5113133 DOI: 10.1016/j.jad.2016.08.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study aimed to test the validity of using the Hypomania Checklist-16 [HCL-16] to measure hypomania in a British adolescent community sample. Limited research is available concerning the characterization of hypomania among community adolescent samples, particularly in the UK, despite its potential importance for early intervention policy development. METHOD To explore the structure and characterization of hypomania in a British adolescent nonclinical cohort, over 1400 17 year olds (Mean=17.05 years; SD=0.88) completed the HCL-16 along with measures of different psychological and psychopathological dimensions. RESULTS Principal components analysis revealed a 2-component solution for the HCL-16, described as active-elated and irritable/risk-taking. Hypomanic symptoms were significantly correlated with many psychopathological dimensions. There were distinct correlation patterns for the two HCL-16 subscales, with the irritability/risk-taking subscale showing significantly stronger associations with psychotic-like experiences, internalizing and externalizing problems, and reduced life satisfaction relative to the active-elated dimension. Adolescents at 'high-risk' for bipolar disorder reported more psychopathology relative to the comparison group. LIMITATIONS Absence of the clinical diagnosis of bipolar disorder in the sample means that the classification of the 'high-risk' group cannot be confirmed. CONCLUSIONS The structure of the HCL-16 in this UK adolescent sample mirrored that observed in adult and clinical cohorts. The observed links between the HCL-16 and psychopathological dimensions that have been previously associated with both hypomania and bipolar disorder lend support to the HCL-16's validity as a hypomania instrument for adolescents. Better understanding of hypomania prior to adulthood has considerable potential for informing early intervention approaches.
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Affiliation(s)
- Georgina M. Hosang
- Psychology Department, Goldsmiths, University of London, London SE14 6NW, UK
| | - Alastair G. Cardno
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Angelica Ronald
- Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK.
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Lee K, Oh H, Lee EH, Kim JH, Kim JH, Hong KS. Investigation of the clinical utility of the hypomania checklist 32 (HCL-32) for the screening of bipolar disorders in the non-clinical adult population. BMC Psychiatry 2016; 16:124. [PMID: 27146281 PMCID: PMC4855804 DOI: 10.1186/s12888-016-0831-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The hypomania checklist-32 (HCL-32) is a widely used questionnaire developed for identifying hypomanic components in patients with a depressive episode. Measuring and screening previous hypomanic symptoms in individuals without any definite history of depressive episode would also be needed for early detection of bipolar disorders (BDs). This study aimed at testing the clinical utility of the HCL-32 for screening of BDs in the non-clinical population. METHODS Lifetime history of hypomanic symptoms was evaluated by using the HCL-32 in 220 patients with BDs and 313 non-clinical individuals. Sensitivity, specificity, and the area under the curve (AUC) of the Receiver Operating Characteristic (ROC) were evaluated for assessing the discriminatory power of the scale and its two sub-domains in screening BDs. RESULTS The mean HCL-32 total score was significantly higher in the Bipolar II disorder group compared to the non-clinical group (P < 0.001). Most of the items (10/12) of the irritable/risk-taking factor showed higher positive responses in patient groups. Items of active/elated factor showed mixed results. The HCL-32 total score and the active/elated factor score were not adequate for both BDs and its subgroups with AUC values of less than 0.7. The irritable/risk-taking factor score showed higher discrimination power, i.e. AUC for BDs, Bipolar I disorder, and Bipolar II disorder was 0.71, 0.67, and 0.75, respectively. CONCLUSIONS The HCL-32 could not adequately distinguish BD patients from the non-clinical adult population. However, the current study identified items of irritable/risk-taking factor of the scale that could be useful in screening BDs in the general population.
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Affiliation(s)
- Kounseok Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Republic of Korea ,Present address: Department of Psychiatry, St. Andrew’s Hospital, Icheon, Republic of Korea
| | - Hyeji Oh
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Eun-Ho Lee
- Depression Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Joo Hyun Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Republic of Korea
| | - Ji-Hae Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Republic of Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea. .,Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea.
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Benarous X, Mikita N, Goodman R, Stringaris A. Distinct relationships between social aptitude and dimensions of manic-like symptoms in youth. Eur Child Adolesc Psychiatry 2016; 25:831-42. [PMID: 26650482 PMCID: PMC4967092 DOI: 10.1007/s00787-015-0800-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 11/17/2015] [Indexed: 01/28/2023]
Abstract
Difficulties with interpersonal relationships have been reported in children and adolescents with manic symptoms, even if they do not fulfil criteria for a manic episode. The role of social aptitude (SA) in youths with manic symptoms has never been examined in the general population. Moreover, no study has examined whether SA is differentially associated with dimensions of manic symptoms. We hypothesised that youth with predominantly undercontrol manic symptoms (characterised by irritability) would show lower levels of SA; conversely, youth with predominantly exuberant symptoms would show better than average social skills. Our sample comprised 5325 participants from the 2004 British Child and Adolescent Mental Health Survey (B-CAMHS04), mean age 10.3 years, SD = 3.3, 48 % girls. Manic symptoms were assessed with the Development and Wellbeing Assessment by interviewing parents and young people. Children and adolescents with manic symptoms had a lower SA score, compared to the general population by parent report, but not by self-report. SA score was higher in youths with predominantly exuberant manic symptoms compared to the general population; whereas the youths with predominantly undercontrol manic symptoms had lower SA scores by parent and self-report. Our results provide further evidence for the distinction between exuberant and undercontrol manic symptoms and highlight the need to focus on SA in future research.
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Affiliation(s)
- Xavier Benarous
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. .,Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013, Paris, France. .,, 19 rue de Turenne, 75004, Paris, France.
| | - Nina Mikita
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Robert Goodman
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Argyris Stringaris
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Box P085, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
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15
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Jung S, Wollmer MA, Kruger THC. The Hamburg-Hannover Agitation Scale (H2A): Development and validation of a self-assessment tool for symptoms of agitation. J Psychiatr Res 2015; 69:158-65. [PMID: 26343608 DOI: 10.1016/j.jpsychires.2015.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Agitation has long been underestimated as a symptom occurring across psychiatric disorders. While several instruments exist for highly specific clinical target groups (e.g., dementia, traumatic brain injury), no tool captures agitation in a broader range of psychiatric patients. The Hamburg-Hannover Agitation Scale (H2A) has been designed to satisfy this demand. This study concentrated on the development and validation of the scale in a psychiatric and a healthy control sample. METHODS The H2A was developed, tested in an expert sample, and revised. The German version was validated in a study involving two clinical institutions. Patients (n = 180) completed the H2A and several other questionnaires in order to test for congruent and discriminant validity. Healthy subjects (n = 685) completed the H2A only. The H2A was translated into English. RESULTS The H2A showed very satisfying quality criteria (reliability, selectivity, item difficulty) and regression analysis demonstrated the H2A's ability to distinguish between subjects with a psychiatric diagnosis and healthy subjects with or without psychiatric record. Factor analysis revealed a three-factorial structure representing a physiological/somatic, a mental and a mixed ('psychophysiological') dimension of agitation. LIMITATIONS Although validation showed promising quality criteria and predictive value of the H2A, calibration tests with bigger and more balanced sample sizes are necessary. CONCLUSIONS Agitation has become more clinically relevant as a symptom occurring in various affective disorders, yet its assessment is limited. The H2A was developed in order to meet this need. Validation of the H2A revealed very satisfactory item and scale quality criteria promoting its utility.
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Affiliation(s)
- Stefanie Jung
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany; Asklepios Clinic North - Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Germany.
| | - M Axel Wollmer
- Asklepios Clinic North - Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Germany.
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
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16
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Fornaro M, De Berardis D, Mazza M, Pino M, Favaretto E, Bedani F, Wieser C, Indelicato L, Paternò VF, Lo Monaco F, Dugo F, Ventriglio A, Mungo S, Selle V, Valchera A, Elassy M, Martinotti G, De Bartolomeis A, Iasevoli F, Tomasetti C, Avvisati L, Tartaglione S, Perna G, Cattaneo CI, Consoli G, Romano A, Del Debbio A, Martino M, D' Angelo E, De Pasquale C, Koshy AS, Angst J. Factor structure and reliability of the Italian adaptation of the Hypomania Check List-32, second revision (HCL-32-R2). J Affect Disord 2015; 178:112-20. [PMID: 25805403 DOI: 10.1016/j.jad.2015.03.001] [Citation(s) in RCA: 13] [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: 12/16/2014] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients. METHODS A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS In our sample (n=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2. LIMITATIONS No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE. CONCLUSIONS Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy; Polyedra Research Group, Italy.
| | - Domenico De Berardis
- Polyedra Research Group, Italy; National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | - Monica Mazza
- Polyedra Research Group, Italy; Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy.
| | - Mariachiara Pino
- Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy.
| | - Ettore Favaretto
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Fulvio Bedani
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Christian Wieser
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Luisa Indelicato
- Department of Education Science, University of Catania, Catania, Italy.
| | - Vito Fabio Paternò
- Centro siciliano per la cura di Depressione e Ansia (CESIDEA), Catania, Italy; Ospedale San Raffaele, Milano, Italy.
| | | | - Febronia Dugo
- Department of Education Science, University of Catania, Catania, Italy.
| | - Antonio Ventriglio
- Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy.
| | - Sergio Mungo
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | - Alessandro Valchera
- Polyedra Research Group, Italy; Casa di Cura Villa San Giuseppe, Via dei Girasoli, n.6, 63100 Ascoli Piceno, Italy.
| | - Mai Elassy
- Department of Psychiatry, Mansoura Faculty of Medicine, Mansoura City, Egypt.
| | - Giovanni Martinotti
- Polyedra Research Group, Italy; Department of Neuroscience and Imaging, University "G. d׳Annunzio", Chieti, Italy.
| | - Andrea De Bartolomeis
- Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Felice Iasevoli
- Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Carmine Tomasetti
- Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy; National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy.
| | - Livia Avvisati
- Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Sergio Tartaglione
- National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy.
| | - Giampaolo Perna
- Polyedra Research Group, Italy; Department of Clinical Neuroscience, San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy.
| | | | | | - Anna Romano
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | | | - Matteo Martino
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | | | - Ann Sarah Koshy
- St. John׳s National Academy of Health Sciences, Bangalore, India.
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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17
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Fornaro M, Elassy M, Mounir M, Abd-Elmoneim N, Ashour H, Hamed R, Al-Shehri A, Bedir S, Rashed I, Amer N, Mohammed TA, De Berardis D, Mazza M, Pino M, Koshy AS, De Pasquale C, Okasha T, Angst J. Factor structure and reliability of the Arabic adaptation of the Hypomania Check List-32, second revision (HCL-32-R2). Compr Psychiatry 2015; 59:141-50. [PMID: 25770763 DOI: 10.1016/j.comppsych.2015.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/12/2015] [Accepted: 02/22/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the psychometric properties of the Arabic adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) inpatients suffering a current major depressive episode (MDE). METHOD The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" Arabic module of the HCL-32-R2 was administered to mother-tongue Arabic MDE inpatients between March 2013 and October 2014. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS In our sample (n=500, of whom, BD-I=329; BD-II=70; MDD=101), using a cut-off of 17 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=82% and specificity=77%. Area under the curve was .883; positive and negative predictive values were 93.44% and 73.23% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factors analyses. Item n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the HCL-32 loaded onto F1, though very slightly. Cronbach's alphas were F1=.86 and F2=.60. LIMITATIONS No cross-validation with any additional validated screening tool. Inpatients only sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, or record of severity of current MDE. CONCLUSIONS In our sample, the HCL-32 fairly discriminated between MDD and BD-I but not BD-II, therefore soliciting for replication studies for use in Arabic-speaking depressed inpatients.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy.
| | - Mai Elassy
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | - Mina Mounir
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | | | - Hala Ashour
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | | | | | - Samir Bedir
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | - Ibrahem Rashed
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | - Noha Amer
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | | | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | - Monica Mazza
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Mariachiara Pino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Ann Sarah Koshy
- St. John's National Academy of Health Sciences, Bangalore, India.
| | | | - Tarek Okasha
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt.
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
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18
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Brand S, Foell S, Bajoghli H, Keshavarzi Z, Kalak N, Gerber M, Schmidt NB, Norton PJ, Holsboer-Trachsler E. "Tell me, how bright your hypomania is, and I tell you, if you are happily in love!"--among young adults in love, bright side hypomania is related to reduced depression and anxiety, and better sleep quality. Int J Psychiatry Clin Pract 2015; 19:24-31. [PMID: 25273225 DOI: 10.3109/13651501.2014.968588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies on adolescents and adults show that romantic love (RL) is associated with favorable emotional states. However, data on these associations are scarce for adults. The aim of the present study was, therefore, to explore the associations between RL, symptoms of depression, anxiety, hypomania (bright side and dark side), and sleep in a sample of adults. METHOD A total of 844 participants currently in love (M = 24.79 years, 75.8% females) took part in the study. They completed a series of questionnaires related to RL, symptoms of depression, anxiety, hypomania (bright side and dark side), and sleep. RESULTS An increased state of RL was associated both with the bright and the dark side of hypomania (BRHYP and DAHYP). Relative to participants with BRHYP, participants with DAHYP reported stronger symptoms of depression and state anxiety, and poor sleep quality. CONCLUSIONS The pattern of results adds to our knowledge that in adults RL is not entirely a joyful and happy period of life. Rather, data suggest that for young adults in love, bright versus dark side of hypomania was associated with a different quality of psychological functioning and sleep. We conclude that experiencing RL might be a critical life event associated with symptoms of depression and anxiety, and poor sleep.
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Affiliation(s)
- Serge Brand
- Center for Affective, Stress, and Sleep Disorders, Psychiatric Clinics of the University of Basel , Basel , Switzerland
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19
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Carvalho AF, Takwoingi Y, Sales PMG, Soczynska JK, Köhler CA, Freitas TH, Quevedo J, Hyphantis TN, McIntyre RS, Vieta E. Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies. J Affect Disord 2015; 172:337-46. [PMID: 25451435 DOI: 10.1016/j.jad.2014.10.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bipolar spectrum disorders are frequently under-recognized and/or misdiagnosed in various settings. Several influential publications recommend the routine screening of bipolar disorder. A systematic review and meta-analysis of accuracy studies for the bipolar spectrum diagnostic scale (BSDS), the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ) were performed. METHODS The Pubmed, EMBASE, Cochrane, PsycINFO and SCOPUS databases were searched. Studies were included if the accuracy properties of the screening measures were determined against a DSM or ICD-10 structured diagnostic interview. The QUADAS-2 tool was used to rate bias. RESULTS Fifty three original studies met inclusion criteria (N=21,542). At recommended cutoffs, summary sensitivities were 81%, 66% and 69%, while specificities were 67%, 79% and 86% for the HCL-32, MDQ, and BSDS in psychiatric services, respectively. The HCL-32 was more accurate than the MDQ for the detection of type II bipolar disorder in mental health care centers (P=0.018). At a cutoff of 7, the MDQ had a summary sensitivity of 43% and a summary specificity of 95% for detection of bipolar disorder in primary care or general population settings. LIMITATIONS Most studies were performed in mental health care settings. Several included studies had a high risk of bias. CONCLUSIONS Although accuracy properties of the three screening instruments did not consistently differ in mental health care services, the HCL-32 was more accurate than the MDQ for the detection of type II BD. More studies in other settings (for example, in primary care) are necessary.
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Affiliation(s)
- André F Carvalho
- (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
| | - Yemisi Takwoingi
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Paulo Marcelo G Sales
- (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Joanna K Soczynska
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada
| | - Cristiano A Köhler
- Memory Research Laboratory, Brain Institute (ICe), Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Thiago H Freitas
- (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - João Quevedo
- Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil; Center for Experimental Models in Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Eduard Vieta
- Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain
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20
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Koenders MA, Spijker AT, Hoencamp E, Haffmans JPM, Zitman FG, Giltay EJ. Effects of mood state on divided attention in patients with bipolar disorder: evidence for beneficial effects of subclinical manic symptoms. Psychiatry Res 2014; 220:302-8. [PMID: 25129563 DOI: 10.1016/j.psychres.2014.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/19/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
A relatively small number of studies have been dedicated to the differential effects of the current mood state on cognition in patients with a bipolar disorder (BD). The aim of the current study was to investigate the effect of current mood state on divided attention (DA) performance, and specifically examine possible beneficial effects of the (hypo-) manic state. Over a maximum period of 24 months, medication use, divided attention test (a subtest of the Test for Attentional Performance (TAP)) was assessed every 6 months in 189 outpatients with BD. Data were analyzed with multilevel regression analysis (i.e. linear mixed models). DA performance varied considerable over time within patients. Corrected for psychotropic medication a significant quadratic relationship between manic symptoms and DA performance was found, with mild hypomanic symptoms having a positive influence on divided attention scores and moderate to severe manic symptoms having a negative influence. No association between depressive symptoms and DA performance was found. In future research on mania and cognition as well as in the clinical practice both the beneficial and negative effects of mania should be taken into account.
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Affiliation(s)
- Manja A Koenders
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands.
| | - Annet T Spijker
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands
| | - Erik Hoencamp
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Judith P M Haffmans
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Frans G Zitman
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - Erik J Giltay
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
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21
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Stringaris A, Castellanos-Ryan N, Banaschewski T, Barker GJ, Bokde AL, Bromberg U, Büchel C, Fauth-Bühler M, Flor H, Frouin V, Gallinat J, Garavan H, Gowland P, Heinz A, Itterman B, Lawrence C, Nees F, Paillere-Martinot ML, Paus T, Pausova Z, Rietschel M, Smolka MN, Schumann G, Goodman R, Conrod P. Dimensions of manic symptoms in youth: psychosocial impairment and cognitive performance in the IMAGEN sample. J Child Psychol Psychiatry 2014; 55:1380-9. [PMID: 24865127 PMCID: PMC4167034 DOI: 10.1111/jcpp.12255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been reported that mania may be associated with superior cognitive performance. In this study, we test the hypothesis that manic symptoms in youth separate along two correlated dimensions and that a symptom constellation of high energy and cheerfulness is associated with superior cognitive performance. METHOD We studied 1755 participants of the IMAGEN study, of average age 14.4 years (SD = 0.43), 50.7% girls. Manic symptoms were assessed using the Development and Wellbeing Assessment by interviewing parents and young people. Cognition was assessed using the Wechsler Intelligence Scale For Children (WISC-IV) and a response inhibition task. RESULTS Manic symptoms in youth formed two correlated dimensions: one termed exuberance, characterized by high energy and cheerfulness and one of undercontrol with distractibility, irritability and risk-taking behavior. Only the undercontrol, but not the exuberant dimension, was independently associated with measures of psychosocial impairment. In multivariate regression models, the exuberant, but not the undercontrolled, dimension was positively and significantly associated with verbal IQ by both parent- and self-report; conversely, the undercontrolled, but not the exuberant, dimension was associated with poor performance in a response inhibition task. CONCLUSIONS Our findings suggest that manic symptoms in youth may form dimensions with distinct correlates. The results are in keeping with previous findings about superior performance associated with mania. Further research is required to study etiological differences between these symptom dimensions and their implications for clinical practice.
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Affiliation(s)
| | - Natalie Castellanos-Ryan
- Department of Psychiatry, Centre de recherche du CHU Ste-Justine, Montral UniversityMontreal, QC, Canada
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthMannheim, Germany,Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | | | - Arun L Bokde
- Institute of Neuroscience, School of Medicine, Trinity College DublinDublin, Ireland
| | - Uli Bromberg
- University Medical Centre Hamburg-EppendorfHamburg, Germany
| | | | - Mira Fauth-Bühler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthMannheim, Germany
| | - Herta Flor
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthMannheim, Germany,Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | | | - Juergen Gallinat
- Department of Psychiatry and Psychology, Campus Charite Mitte, Charite Universitatsmedizin BerlinBerlin, Germany
| | - Hugh Garavan
- Institute of Neuroscience, School of Medicine, Trinity College DublinDublin, Ireland,Department of Psychiatry and Psychology, University of VermontBurlington, VT, USA
| | - Penny Gowland
- School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - Andreas Heinz
- Department of Psychiatry and Psychology, Campus Charite Mitte, Charite Universitatsmedizin BerlinBerlin, Germany
| | - Bernd Itterman
- Physikalisch-Technische Bundesanstalt (PTB)Berlin, Germany
| | - Claire Lawrence
- School of Psychology, University of NottinghamNottingham, UK
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthMannheim, Germany,Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Marie-Laure Paillere-Martinot
- Institut National de la Sante et de la Recherche Medicale, INSERM CEA Unit 1000 Imaging & Psychiatry, University Paris SudOrsay, France
| | - Tomas Paus
- School of Psychology, University of NottinghamNottingham, UK,Rotman Research Institute, University of TorontoToronto, ON, Canada,Montreal Neurological Institute, McGill UniversityMontreal, QC, Canada
| | - Zdenka Pausova
- The Hospital for Sick Children, University of TorontoToronto, ON, Canada
| | - Marcella Rietschel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthMannheim, Germany,Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany,Department of Genetic Epidemiology, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Michael N Smolka
- Neuroimaging Centre, Department of Psychiatry and Psychotherapy, Dresden University of TechnologyDresden, Germany
| | | | - Robert Goodman
- Institute of Psychiatry, King's College LondonLondon, UK
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Bae M, Lee K, Baek JH, Kim JS, Cho Y, Ryu S, Ha K, Hong KS. Lifetime experiences of hypomanic symptoms are associated with delayed and irregular sleep-wake cycle and seasonality in non-clinical adult samples. Compr Psychiatry 2014; 55:1111-5. [PMID: 24666716 DOI: 10.1016/j.comppsych.2014.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Disturbances of the sleep-wake cycle and seasonality have been reported in patients with bipolar disorder (BD). Considering that BD seems to be a spectrum condition in terms of clinical and biological characteristics, circadian and seasonal rhythm related to BD could be detected in non-clinical individuals with subthreshold bipolarity. The aim of this study was to screen past hypomanic symptoms in non-clinical samples and investigate their association with deviated sleep-wake cycle and seasonality. METHODS Lifetime history of hypomanic symptoms was assessed with the Hypomania Checklist-32 (HCL-32). Circadian preference, variability of sleep-wake time and seasonal changes in mood and behavior were evaluated on a lifetime-basis in non-clinical adult samples (n=313), using the Composite Scale of Morningness (CSM), the Sleep Timing Questionnaire (STQ), and the Seasonal Pattern Assessment Questionnaire (SPAQ). RESULTS Two subdomains of hypomanic symptoms were identified through factor analysis of HCL-32, i.e., "active/elated" factor and "irritable/risk-taking" factor. The HCL-32 total score (p<0.001) and the "active/elated" factor score (p=0.028) were weakly correlated only with seasonality, whereas the "irritable/risk-taking" factor score was associated not only with seasonality (p<0.001), but also with evening preference (p<0.001) and irregularity of sleep-wake times (p=0.001~0.011). CONCLUSION Circadian and seasonal characteristics related to BD are also associated with a past history of hypomanic symptoms in non-clinical samples, especially "irritable/risk-taking" symptoms, suggesting the existence of subclinical presentation of BD and their biological traits.
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Affiliation(s)
- Moonoh Bae
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Sun Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Korea
| | - Youngah Cho
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Korea; Seoul National Hospital, Seoul, Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea; Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
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24
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Carta MG, Massidda D, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Calò S, Pollice R, Fortezzo A, Akiskal H. Comparing factor structure of the Mood Disorder Questionnaire (MDQ): In Italy sexual behavior is euphoric but in Asia mysterious and forbidden. J Affect Disord 2014; 155:96-103. [PMID: 24238869 DOI: 10.1016/j.jad.2013.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders. In this work, we studied the item response pattern of the MDQ in the Italian population and compared the results with those of the validation of the MDQ in Asian studies (Chinese and Korean), analyzing similarities and differences among the populations studied. METHODS The sample was made up of 2278 participants, distributed as follows: 56.6% females, 50.8% living in the north-central Italy, and 33.7% living in rural areas. The factor analysis was run on the matrix of tetrachoric correlations. The psychometric properties of the MDQ were also studied using the Rasch logistic model. RESULTS The parallel analysis found two significant components. The first includes symptoms referring to acceleration, danger and irritability as risky behaviors, social interaction problems and mental flow. The second includes symptoms referring to self-confidence and energy. With respect to the Korean/Chinese results, the Italian sample, item 11 ("much more sex"), appears related to self-confidence and energy, while in Asia it is connected with items expressing risky behaviors and irritability. LIMITATIONS Differences in the frequency of comorbid disorders in Asian and Italian populations should be considered. The results should be confirmed and compared with those of other populations. CONCLUSIONS Cultural differences appear to be associated with a different symptomatic expression of bipolar spectrum disorders. Future research will investigate the role of gene-environment interaction in the genesis of these differences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Audrey Fortezzo
- International Mood Center, University of California, San Diego, USA
| | - Hagop Akiskal
- International Mood Center, University of California, San Diego, USA
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Bajoghli H, Joshaghani N, Gerber M, Mohammadi MR, Holsboer-Trachsler E, Brand S. In Iranian female and male adolescents, romantic love is related to hypomania and low depressive symptoms, but also to higher state anxiety. Int J Psychiatry Clin Pract 2013; 17:98-109. [PMID: 22876738 DOI: 10.3109/13651501.2012.697564] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Experiencing romantic love is important in individual development. Little is known about romantic love among adolescents in non-Western countries. The aim of the present study was to explore romantic love among Iranian male and female adolescents. METHOD A total of 201 adolescents (mean age: 17.73 years) took part in the study; of these, 81 indicated they were experiencing romantic love at the time of survey, and 120 indicated they were not in love. Participants answered questionnaires related to affective states (hypomania, depressive symptoms, state and trait anxiety) and exercise, and completed a sleep log for seven consecutive nights. RESULTS Compared to controls, participants in love displayed favourable hypomania scores, fewer depressive symptoms and increased concentration during the day. However, participants in love also had higher state anxiety scores. Moreover, hypomanic-like stages increased with duration of relationship in female, but not in male participants. CONCLUSIONS The pattern of results suggests a favourable association between being currently in love and emotional and cognitive processes. Sleep, however, seemed unrelated to this specific state.
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Affiliation(s)
- Hafez Bajoghli
- Psychiatry & Psychology Research Center (PPRC), Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Haghighi M, Bajoghli H, Angst J, Holsboer-Trachsler E, Brand S. The Farsi version of the Hypomania Check-List 32 (HCL-32): applicability and indication of a four-factorial solution. BMC Psychiatry 2011; 11:14. [PMID: 21251272 PMCID: PMC3036591 DOI: 10.1186/1471-244x-11-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/20/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Data from the Iranian population for hypomania core symptom clusters are lacking. The aim of the present study was therefore to apply the Farsi version of the Hypomania-Check-List 32 (HCL-32), and to explore its factorial structure. METHODS A total of 163 Iranian out-patients took part in the study; 61 suffered from Major Depressive Disorder (MDD), and 102 suffered from Bipolar Disorders (BP). Participants completed the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist (HCL-32). Exploratory factor analyses were used to examine the properties of the HCL-32. A ROC-curve analysis was performed to calculate sensitivity and specificity. RESULTS The HCL-32 differentiated between patients with MDD and with BP. Psychometric properties were satisfactory: sensitivity: 73%; specificity: 91%. MDQ and HCL-32 did correlate highly. No differences were found between patients suffering from BP I and BP II. DISCUSSION Instead of the two-factorial structure of the HCL-32 reported previously, the present pattern of factorial results suggest a distinction between four factors: two broadly positive dimensions of hypomania ("physically and mentally active"; "positive social interactions") and two rather negative dimensions ("risky behavior and substance use"; "difficulties in social interaction and impatience"). CONCLUSION The Farsi version of the HCL-32 proved to be applicable, and therefore easy to introduce within a clinical context. The pattern of results suggests a four factorial solution.
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Affiliation(s)
- Mohammad Haghighi
- Research Center for Behavioural Disorders and Substance Abuse of Hamadan University of medical sciences, Hamadan, Islamic Republic of Iran
| | - Hafez Bajoghli
- Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Jules Angst
- Zurich University Psychiatric Hospital, Zurich, Switzerland
| | | | - Serge Brand
- Psychiatric Hospital of the University of Basel, Basel, Switzerland
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