1
|
Primavera D, Carta MG, Romano F, Sancassiani F, Chessa E, Floris A, Cossu G, Nardi AE, Piga M, Cauli A. Quality of Life in Systemic Lupus Erythematosus and Other Chronic Diseases: Highlighting the Amplified Impact of Depressive Episodes. Healthcare (Basel) 2024; 12:233. [PMID: 38255120 PMCID: PMC10815265 DOI: 10.3390/healthcare12020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Extensive research has explored SLE's impact on health-related quality of life (H-QoL), especially its connection with mental wellbeing. Recent evidence indicates that depressive syndromes significantly affect H-QoL in SLE. This study aims to quantify SLE's impact on H-QoL, accounting for comorbid depressive episodes through case-control studies. METHODS A case-control study was conducted with SLE patients (meeting the ACR/EULAR 2019 criteria of age ≥ 18). The control group was chosen from a community database. H-QoL was measured with the SF-12 questionnaire, and PHQ-9 was used to assess depressive episodes. RESULTS SLE significantly worsened H-QoL with an attributable burden of 5.37 ± 4.46. When compared to other chronic diseases, only multiple sclerosis had a worse impact on H-QoL. Major depressive episodes had a significant impact on SLE patients' H-QoL, with an attributable burden of 9.43 ± 5.10, similar to its impact on solid cancers but greater than its impact on other diseases. CONCLUSIONS SLE has a comparable impact on QoL to serious chronic disorders. Concomitant depressive episodes notably worsened SLE patients' QoL, exceeding other conditions, similar to solid tumors. This underscores the significance of addressing mood disorders in SLE patients. Given the influence of mood disorders on SLE outcomes, early identification and treatment are crucial.
Collapse
Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00100 Rome, Italy;
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Elisabetta Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Alberto Floris
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Antonio Egidio Nardi
- Panic and Respiration Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro 22725, Brazil;
| | - Matteo Piga
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Alberto Cauli
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
2
|
Bete T, Misgana T, Nigussie K, Aliye K, Abdeta T, Wedaje D, Hunduma G, Assefa A, Tesfaye D, Asfaw H, Amano A, Tariku M, Dereje J, Ali T, Mohammed F, Demissie M, Mohammed A, Hayru N, Assefa B, Wilfong T, Alemu D. Depressive disorder, bipolar disorder, and associated factors among adults, in the Eastern part of Ethiopia. BMC Psychiatry 2024; 24:17. [PMID: 38172755 PMCID: PMC10763018 DOI: 10.1186/s12888-023-05466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Depressive disorder is one of the severe and common mental illnesses in the general population. Bipolar disorder is a severe, persistent mental illness associated with significant morbidity and mortality. However, there is a paucity of data on the prevalence of depressive disorder, and bipolar disorder in our study area. OBJECTIVE This study aimed to assess the prevalence of depressive and bipolar disorders among adults in Kersa, Haramaya, and Harar Health and Demographic Surveillance Sites in Eastern Ethiopia. METHODS A community-based cross-sectional study was conducted among 1,416 participants. A multi-stage sampling was employed to select the participants. DSM-5 diagnostic criteria was used to assess depressive disorder and bipolar disorder. Data was collected using a standard questionnaire. Data were entered into Epi-Data 3.1 and analyzed using SPSS version 26. Both binary and multivariate logistic regression analyses were done. Those with a p-value < 0.05 in the final model were considered statistically significant. RESULTS The overall prevalence of depressive and bipolar disorders among our study participants was 6.7% (95% CI: 5.40, 8.20) and 2.1% (95% CI: (1.40, 3.00), respectively. The independent predictors of depressive disorder included a family history of mental illness, chronic medical illnesses, unemployment, low educational status, divorced or widowed, poor social support, and current alcohol use or khat chewing. Single, males, divorced or widowed, and current consumers of alcohol were independent predictors for bipolar disorder. CONCLUSIONS AND RECOMMENDATION The results of our investigation showed that bipolar illness and depression were significant public health issues. It was shown that although bipolar disorder is highly prevalent in the society, depression is a widespread concern. As a result, it is imperative that the relevant body grow and enhance the provision of mental health services. Furthermore, research on the effects and burdens of bipolar disorder in the community is required.
Collapse
Affiliation(s)
- Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Tadesse Misgana
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kemal Aliye
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Abdeta
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawud Wedaje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gari Hunduma
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abduselam Assefa
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henock Asfaw
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulkarim Amano
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mandaras Tariku
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fethia Mohammed
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekdes Demissie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ahmed Mohammed
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nejiba Hayru
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Birhanu Assefa
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tara Wilfong
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Daniel Alemu
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
3
|
Giovanni Carta M, Kalcev G, Scano A, Aviles Gonzalez CI, Ouali U, Pinna S, Carrà G, Romano F, Preti A, Orrù G, Minerba L, Cossu G, Nardi AE, Primavera D. The impact of MDQ positivity on quality of life impairment: Does it support the hypothesis of "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)? J Public Health Res 2023; 12:22799036231208356. [PMID: 37927350 PMCID: PMC10625312 DOI: 10.1177/22799036231208356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background DSM-5 separates bipolar (BD) from depressive disorders, but some experts consider BD as part of a spectrum of mood disorders. The interpretation of numerous false positives of BD screened by the Mood Disorders Questionnaire (MDQ) is part of this debate. Recent study results suggest that the worsening of health-related quality of life (H-Qol) associated with MDQ positivity does not depend solely on mood disorders. This study aims to clarify whether the impairment may be due to other concomitant disorders, unrelated to mood disorders, leading to a worsening of H-Qol. Additionally, the study aims to explore if MDQ positivity itself observe clinical significance. Design and methods The study involved pairs of cases (MDQ+) and controls (MDQ-) matched for sex, age, and absence of DSM-IV psychiatric comorbidity. The impact of MDQ positivity on the quality of life in a sample of MDQ+ comorbid with MDD was measured and compared to impact of MDD in other chronic disorders. Results The H-Qol was significantly worse in MDQ+ than in controls (both groups without any psychiatric co-morbidity). The worsening was similar to severe chronic disorders The burden of worsening quality of life due to MDD was mild in another sample of MDQ positives with comorbid MDD. Conclusion The study hypothesizes that MDQ positivity may be related to hyperactivation and dysregulation of rhythms typical of stress disorders. In fact, MDQ+ was found strongly related to sleep disturbances. Future studies could verify if a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), causes worsening the H-Qol in MDQ+.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Science, Molecular Biology Service Lab, University of Cagliari, Cagliari, Italy
| | - Cesar Ivan Aviles Gonzalez
- Faculty of Health Sciences, Nursing Program, Univesidad Popular del Cesar, Sede Sabanas, Valledupar, Colombia
| | - Uta Ouali
- Razi Hospital, La Manouba 2010, Faculty of Medicine of Tunisia, University of Tunis, El Manar, Tunisia
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Germano Orrù
- Department of Surgical Science, Molecular Biology Service Lab, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| |
Collapse
|
4
|
Carta MG, Kalcev G, Fornaro M, Pinna S, Gonzalez CIA, Nardi AE, Primavera D. Does Screening for Bipolar Disorders Identify a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)? A Heuristic Working Hypothesis. J Clin Med 2023; 12:5162. [PMID: 37568562 PMCID: PMC10419483 DOI: 10.3390/jcm12155162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this paper is to verify if people with a positive score on the Mood Disorder Questionnaire (MDQ) without comorbidity of mood disorders showed a worse level of Health-related Quality of life (HRQol) compared to a control-matched sample of MDQ negatives, identifying a specific syndrome. This is a case-control study based on a database from a community survey. Cases: MDQ-positive without mood disorders; Controls: MDQ negatives matched by sex, age, and psychiatric diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Tools: MDQ, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) semi-structured interview for psychiatric diagnosis, and the Health Survey Short Form (SF-12) for measuring HRQol. People scoring positive on the MDQ without a diagnosis of mood disorders showed significantly lower scores on the SF-12 compared to people of the same age and of the same sex with an equal diagnosis of psychiatric disorders not related to mood disorders (35.21 ± 6.30 vs. 41.48 ± 3.39, p < 0.0001). In the debate whether a positive score on the MDQ selects an area of "malaise" due to the presence of disorders differing from Bipolar Disorders, or if a positive score on the MDQ may be considered a "subthreshold" form of bipolar disorder in people who may later develop bipolar disorder, a third hypothesis can be advanced, i.e., that a positive score on the MDQ identifies a specific "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), characterized by a considerable amount of suffering and not attributable to other disorders, and which might represent a trigger for the previously mentioned disorders with which a positive score on the MDQ is associated, probably including, in severe conditions, bipolar disorder.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Michele Fornaro
- Department of Psychiatry, Federico II University of Naples, 80126 Naples, Italy;
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Cesar Ivan Aviles Gonzalez
- Nursing Program, Faculty of Health Sciences, Universidad Popular del Cesar, Sede Sabanas, Valledupar 20002, Colombia;
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 22725, Brazil;
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| |
Collapse
|
5
|
Carta MG, Kalcev G, Scano A, Pinna S, Gonzalez CIA, Nardi AE, Orrù G, Primavera D. Screening, Genetic Variants, and Bipolar Disorders: Can Useful Hypotheses Arise from the Sum of Partial Failures? Clin Pract 2023; 13:853-862. [PMID: 37623258 PMCID: PMC10453758 DOI: 10.3390/clinpract13040077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Bipolar disorder (BD) is a relevant public health issue, therefore accurate screening tools could be useful. The objective of this study is to verify the accuracy of the Mood Disorder Questionnaire (MDQ) and genetic risk as screeners, and their comparison in terms of reliability. Older adults (N = 61, ≥60 years) received a clinical psychiatric evaluation, the MDQ, and were evaluated according to the presence of the genetic variant RS1006737 of CACNA1C. MDQ+ versus the diagnosis of BD as a gold standard shows a sensitivity of 0.286 (Cl 95% 0.14-0.39); a specificity of 0.925 (Cl 95% 0.85-0.08); a predictive positive value (PPV) of 0.667 (Cl 95% 0.33-0.91); and a predictive negative value (PNV) of 0.702 (Cl 95% 0.65-0.75). The positivity for the variant RS1006737 of the CACNA1C against the diagnosis of BD as a gold standard shows a sensitivity of 0.750 (Cl 95% 0.55-0.90); a specificity of 0.375 (Cl 95% 0.28-0.45); a PPV of 0.375 (Cl 95% 0.28-0.45); and a PNV of 0.750 (Cl 95% 0.55-0.90). The reliability between the MDQ+ and positivity for the variant RS1006737 of the CACNA1C was very low (K = -0.048, Cl 95% -0.20-0.09). The study found that both the genetic and the paper and pencil test were quite accurate, but were not reliable in case finding. In fact, despite some validity, albeit specular (in the case of a positive genetic test, the probability of having the disorder is very high, whereas in the case of a negative score on the paper and pencil test, the probability of not having the disorder is very high), the unreliability of the two tests (i.e., they certainly do not measure the same underlying dimension) opens the door to the need for an interpretation and the possibility of a synergistic use for screening. From a heuristic perspective, which obviously requires all of the necessary verifications, this study seems to suggest the hypothesis that a condition of hyperactivation common to disorders and stress conditions, and identified by a positive score on the MDQ (which is common to BD, post-traumatic stress disorder (PTSD), and anxiety disorders and whose genetic basis has not yet been clarified) can trigger BD in people with a predisposition to hyperactivity (i.e., in people with the condition identified by the analyzed genetic variant).
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Alessandra Scano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, Blocco I, Asse Didattico Medicina P2, Monserrato (CA), 09042 Cagliari, Italy; (A.S.); (G.O.)
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Cesar Ivan Aviles Gonzalez
- Faculty of Health Sciences, Nursing Program, Univesidad Popular del Cesar, Sede Sabanas, Valledupar 20002, Colombia;
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (Ipub), Federal University of Rio De Janeiro (Ufrj), Rio De Janeiro 22725, Brazil;
| | - Germano Orrù
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, Blocco I, Asse Didattico Medicina P2, Monserrato (CA), 09042 Cagliari, Italy; (A.S.); (G.O.)
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| |
Collapse
|
6
|
Which patients with bipolar depression receive antidepressant augmentation? Results from an observational multicenter study. CNS Spectr 2022; 27:731-739. [PMID: 34505564 DOI: 10.1017/s109285292100078x] [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: 01/29/2023]
Abstract
BACKGROUND To identify demographic and clinical characteristics of bipolar depressed patients who require antidepressant (AD) augmentation, and to evaluate the short- and long-term effectiveness and safety of this therapeutic strategy. METHODS One hundred twenty-two bipolar depressed patients were consecutively recruited, 71.7% of them received mood stabilizers (MS)/second-generation antipsychotics (SGA) with AD-augmentation and 28.3% did not. Patients were evaluated at baseline, and after 12 weeks and 15 months of treatment. RESULTS The AD-augmentation was significantly higher in patients with bipolar II compared with bipolar I diagnosis. Patients with MS/SGA + AD had often a seasonal pattern, depressive polarity onset, depressive index episode with anxious features, a low number of previous psychotic and (hypo)manic episodes and of switch. They had a low irritable premorbid temperament, a low risk of suicide attempts, and a low number of manic symptoms at baseline. After 12 weeks of treatment, 82% of patients receiving ADs improved, 58% responded and 51% remitted, 3.8% had suicidal thoughts or projects, 6.1% had (hypo)manic switch, and 4.1% needed hospitalization. During the following 12 months, 92% of them remitted from index episode, 25.5% did not relapse, and 11% needed hospitalization. Although at the start advantaged, patients with AD-augmentation, compared with those without AD-augmentation, did not significantly differ on any outcome as well on adverse events in the short- and long-term treatment. CONCLUSION Our findings indicate that ADs, combined with MS and/or SGA, are short and long term effective and safe in a specific subgroup for bipolar depressed patients.
Collapse
|
7
|
Aviles Gonzalez CI, Angermeyer M, Deiana L, Loi C, Murgia E, Holzinger A, Cossu G, Massa E, Romano F, Scartozzi M, Carta MG. The Quality of Life of People with Solid Cancer is Less Worse than Other Diseases with better Prognosis, Except in the Presence of Depression. Clin Pract Epidemiol Ment Health 2021; 17:315-323. [PMID: 35444707 PMCID: PMC8985466 DOI: 10.2174/1745017902117010315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/17/2023]
Abstract
Background: Suffering from Solid Cancer (SC) may adversely impact the Health-related Quality of Life (H-QoL). The aims of this study are to measure the H-QoL in a sample of people suffering from SC and to clarify the role of the co-occurrence of depressive episodes. Results were compared with a healthy control group and with groups of other disorders. Methods: In 151 patients with SC (mean±sd age 63.1±11.5; female 54.3%), H-QoL was assessed by SF-12, depressive episodes were identified by PHQ-9. The attributable burden of SC in impairing H-QoL was calculated as the difference between SF-12 score of a community sex and age ¼ matched healthy control group and that of the study sample. The attributable burden of SC was compared with other chronic diseases using specific diagnostic groups drawn from case-control studies that used the same database for selecting control samples. Results: H-QoL in people with SC was significantly worse than in the healthy control group (p<0.0001). The attributable burden in worsening the H-QoL due to SC was similar to those of severe chronic diseases, but lower than Multiple Sclerosis (p<0.0001) or Fibromyalgia (p<0.00001). Having a depressive episode was a strong determinant of decreasing H-QoL, regardless of the severity of cancer. Conclusion: The findings confirm a strong impact of SC but showed that H-QoL in SC was higher than in chronic diseases with better “quoad vitam” outcome. Since depression was a strong determinant, its prevention, early detection and therapy are the main objectives that must be reached in cancer patients.
Collapse
|
8
|
Carta MG, Moro MF, Piras M, Ledda V, Prina E, Stocchino S, Orrù G, Romano F, Brasesco MV, Freire RC, Nardi AE, Tondo L. Megacities, migration and an evolutionary approach to bipolar disorder: a study of Sardinian immigrants in Latin America. ACTA ACUST UNITED AC 2020; 42:63-67. [PMID: 31269095 PMCID: PMC6986479 DOI: 10.1590/1516-4446-2018-0338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
Objective: To determine whether people with a Sardinian genetic background who live in the megacities of South America have a higher frequency of hypomania than residents of Sardinia. Methods: A community survey of Sardinian immigrants was carried out in four Brazilian metropoles (n=218) and Buenos Aires (n=306). The results were compared with those of a study involving a similar methodology (Mood Disorder Questionnaire [MDQ] as a screening tool) conducted in seven Italian regions, including a sub-sample from Sardinia. Results: There was a higher prevalence of lifetime hypomania among Sardinians living in the Brazilian metropoles than among those living in Sardinia. This result was also consistent with Sardinian immigrants in Buenos Aires. After stratification by sex and age, the lifetime prevalence of MDQ scores ≥ 8 among Sardinians in South-American megacities and Sardinia was 8.6% vs. 2.9%, respectively (p < 0.0001). Conclusions: The higher frequency of hypomania in migrant populations appears to favor an evolutionary view in which mood disorders may be a maladaptive aspect of a genetic background with adaptive characteristics.
Collapse
Affiliation(s)
- Mauro G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Maria F Moro
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martina Piras
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Vanessa Ledda
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Eleonora Prina
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Serena Stocchino
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Germano Orrù
- Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | | | - Maria V Brasesco
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Rafael C Freire
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antonio E Nardi
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Leonardo Tondo
- Centro Lucio Bini Cagliari, Cagliari/Rome, Italy.,McLean Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Cybulski M, Cybulski Ł, Cwalina U, Kowalczuk K, Krajewska-Kułak E. Mental Health of the Participants of the Third Age University Program: A Cross-Sectional Study. Front Psychiatry 2020; 11:656. [PMID: 32754065 PMCID: PMC7365889 DOI: 10.3389/fpsyt.2020.00656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Population aging is a progressive demographic phenomenon observed in all countries worldwide. The progressive global process of population aging poses many threats, especially in the context of the mental health of the elderly. Third Age Universities are an essential preventive measure shown to improve the quality of life and psychological wellbeing of the elderly. OBJECTIVES The aim of this study was to analyze the mental status of older persons attending Third Age Universities in Poland, with particular emphasis on sociodemographic sources of variance in psychological indices. METHODS The study included a group of the Third Age University program participants from Poland. A total of 247 persons were enrolled, among them 215 women and 32 men. The study was carried out as a diagnostic survey, using the following validated psychometric scales: The Mood Disorder Questionnaire (MDQ), Geriatric Depression Scale (GDS), General Health Questionnaire-28 (GHQ-28), The Athens Insomnia Scale (AIS), Courtauld Emotional Control Scale (CECS), State-Trait Anxiety Inventory (STAI) and SMAST-G-Short Michigan Alcoholism Screening Test-Geriatric Version. RESULTS The vast majority of the respondents did not screen positively for possible bipolar disorder. However, more than 90% of the participants presented with the symptoms of mild depression, and more than one-third had manifestations of non-psychotic mental morbidity. Nearly half of the respondents had complaints associated with insomnia, and in more than one-fourth, SMAST-G score raised suspicion of problem alcohol drinking. Retired participants were shown to present with significantly higher levels of anger control than the occupationally active respondents. Respondents with poor economic status had significantly higher levels of symptoms for non-psychotic mental disorders. Men significantly more often than women showed symptoms raising suspicion of alcohol-related problems. DISCUSSION In conclusion, the study group was characterized primarily by the mild depressive and anxiety symptoms. The mental health of the Polish participants of the Third Age University program was significantly modulated by their socio-occupational and marital status, and financial condition. The study showed that persons with likely problem alcohol drinking differed from other respondents in terms of the occurrence of possible bipolar disorder, depression, and non-psychotic symptoms of mental disorders, state and trait anxiety levels and anger control. There is a need for further research in the field of mental health status in the Third Age Universities seniors to determine the prevalence of these phenomena on a national scale.
Collapse
Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Łukasz Cybulski
- Faculty of Social Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Urszula Cwalina
- Department of Statistics and Medical Informatics, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Krystyna Kowalczuk
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
10
|
Correlates of current rapid-cycling bipolar disorder: Results from the Italian multicentric RENDiBi study. Eur Psychiatry 2019; 62:82-89. [PMID: 31550582 DOI: 10.1016/j.eurpsy.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/23/2019] [Accepted: 09/05/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND we aimed to compare socio-demographic and clinical differences between patients with versus without current RC in order to detect clinical factors that may favor early diagnosis and personalized treatment. METHODS A total of 1675 patients (males: n = 714 and females: n = 961; bipolar 1: n = 1042 and bipolar 2: n = 633) from different psychiatric clinics were grouped and compared according to the current presence of RC in terms of socio-demographic and clinical variables. Chi-squared tests for qualitative variables and Student's t tests for quantitative variables were executed for group comparison, and multivariable logistic regressions were performed, considering the current presence of RC as dependent variable, and socio-demographic/clinical factors as independent variables. RESULTS Female gender (male versus female: OR = 0.64, p = 0.04), unidentifiable prevalent polarity (versus depressive polarity: OR = 1.76, p = 0.02; versus manic polarity: OR: 2.86, p < 0.01) and hospitalization in the last year (no versus yes: OR = 0.63, p = 0.02) were found to be associated with RC in the final multivariable regression analysis. CONCLUSIONS RC in BD seems to be more prevalent in female gender and associated with some unfavorable clinical features, such as an increased risk of hospitalization. These aspects should be taken into account in the management and monitoring of RC versus non-RC patients.
Collapse
|
11
|
Sancassiani F, Carmassi C, Romano F, Balestrieri M, Caraci F, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Moro MF, Roncone R, Preti A, Dell'Osso L. Impairment of Quality of Life Associated With Lifetime Diagnosis of Post-traumatic Stress Disorder in Women - A National Survey in Italy. Clin Pract Epidemiol Ment Health 2019; 15:38-43. [PMID: 30972141 PMCID: PMC6416466 DOI: 10.2174/1745017901915010038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/28/2019] [Accepted: 02/02/2019] [Indexed: 12/16/2022]
Abstract
Introduction The aim of the study was to measure the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among women of an Italian community sample, the comorbidity of PTSD with mood and anxiety disorders and the burden attributable to PTSD in worsening the Quality of Life (QoL). Methods Community survey on a sample of 1961 adult women randomly selected. Tools: psychiatric clinical interview ANTAS partially derived from the SCID-DSM-IV, administered by psychologists or medical doctors; Short Form Health Survey (SF-12); Mood Disorder Questionnaire (MDQ). Results Lifetime prevalence of PTSD in women was 1.3%, (1.4% in<45 years aged, 1.3% in >44 years aged; p=0.8). In order of risk of comorbidity, PTSD was associated with: Bipolar Spectrum Disorders (MDQ+), Panic Disorders (PD) and Major Depressive Disorder (MDD). People with PTSD showed an SF-12 mean score lower than women of the same sample without PTSD (standardized by gender and age), with a mean difference (attributable burden) of 3.9±0.9 similarly to MDD and Eating Disorders and higher than PD. Among the analyzed nonpsychiatric diseases, Multiple Sclerosis and Carotid Atherosclerosis showed a higher burden in impairing QoL than PTSD; Wilson's Disease showed a similar burden and Celiac Disease was found less impairing on QoL than PTSD. Conclusion The attributable burden in worsening women' perceived QoL due to a lifetime diagnosis of PTSD was found comparable to those caused by MDD, Eating Disorders or by neurological condition such as Wilson's Disease. The comorbidity of PTSD with Bipolar Spectrum Disorders was remarkable, even further studies are needed to clarify the direction of causality.
Collapse
Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | | | | | | | | | | | - Maria Carolina Hardoy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Francesca Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Mailman School of Public Health Columbia University, New York, NY 10027, USA
| | | | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | |
Collapse
|
12
|
Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS). J Affect Disord 2018; 241:319-324. [PMID: 30142591 DOI: 10.1016/j.jad.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. METHODS Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15-64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. RESULTS Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6-24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00-2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81-3.81) persisted in multivariable models. LIMITATION Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. CONCLUSION The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
Collapse
|
13
|
Differential prevalence and demographic and clinical correlates of antidepressant use in American bipolar I versus bipolar II disorder patients. J Affect Disord 2018. [PMID: 29524749 DOI: 10.1016/j.jad.2018.02.091] [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] [Indexed: 11/21/2022]
Abstract
AIMS Antidepressant use is controversial in bipolar disorder (BD) due to questionable efficacy/psychiatric tolerability. We assessed demographic/clinical characteristics of baseline antidepressant use in BD patients. METHODS Prevalence and correlates of baseline antidepressant use in 503 BD I and BD II outpatients referred to the Stanford Bipolar Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. RESULTS Antidepressant use was 39.0%, overall, and was higher in BD II versus BD I (46.9% versus 30.5%, p = 0.0002). Both BD I and BD II antidepressant compared to non-antidepressant users had higher rates of complex pharmacotherapy (≥ 4 mood stabilizers, antipsychotics, and/or antidepressants) and use of other psychotropics. Antidepressant use in BD II versus BD I was higher during euthymia (44.0% vs. 28.0%) and subsyndromal symptoms (56.1% vs. 28.6%), but not depression or mood elevation. LIMITATIONS American tertiary BD clinic referral sample receiving open naturalistic treatment. CONCLUSIONS In our sample, antidepressant use was higher in BD II versus BD I patients, and was associated with markers of heightened illness severity in both BD I and BD II patients. Additional research is warranted to investigate these complex relationships.
Collapse
|
14
|
Cossu G, Carta MG, Contu F, Mela Q, Demelia L, Elli L, Dell'Osso B. Coeliac disease and psychiatric comorbidity: epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects. Int Rev Psychiatry 2017; 29:489-503. [PMID: 28681625 DOI: 10.1080/09540261.2017.1314952] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coeliac Disease (CD) is an autoimmune disease in which an environmental factor, gluten, triggers a pathological reaction. It results in intra- and entra-intestinal manifestations of disease, including, most frequently, diarrhoea, weight loss, and anaemia. CD occurs in ∼1% of the western population, being one of the most common autoimmune lifelong disorders, and may present with a variety of psychiatric comorbidities. Psychiatric comorbidity in CD often complicates the diagnosis, reduces the quality-of-life, and worsens the prognosis of affected patients. This review summarizes the epidemiological studies that underline this connection, and focuses on the potential mechanisms related to this comorbility, such as nutritional deficiencies, immune responses, interference in brain processes, and dysfunctions in the gut-brain axis. Factors that play a central role on patients' quality of life, psychological well-being and adherence are presented. Finally, evidence of regression in psychiatric symptoms following the introduction of a gluten-free diet is underlined as well.
Collapse
Affiliation(s)
- Giulia Cossu
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Mauro Giovanni Carta
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Federico Contu
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Quirico Mela
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Luigi Demelia
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Luca Elli
- b Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Bernardo Dell'Osso
- c Department of Pathophysiology and Transplantation , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.,d Department of Psychiatry and Behavioral Sciences , Bipolar Disorders Clinic, Stanford University , CA , USA
| |
Collapse
|
15
|
Jaeschke RR, Dudek D, Topór-Mądry R, Drozdowicz K, Datka W, Siwek M, Rybakowski J. Postpartum depression: bipolar or unipolar? Analysis of 434 Polish postpartum women. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2017; 39:154-159. [PMID: 27982293 PMCID: PMC7111438 DOI: 10.1590/1516-4446-2016-1983] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/22/2016] [Indexed: 11/22/2022]
Abstract
Objective To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology. Methods Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features. Results Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics. Conclusion Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.
Collapse
Affiliation(s)
- Rafał R. Jaeschke
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Dominika Dudek
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Roman Topór-Mądry
- Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Drozdowicz
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Datka
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Siwek
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Janusz Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland
| |
Collapse
|
16
|
Carta MG, Perra A, Atzeni M, D'Oca S, Moro MF, Kurotschka PK, Moro D, Sancassiani F, Minerba L, Brasesco MV, Mausel G, Nardi AE, Tondo L. An evolutionary approach to mania studying Sardinian immigrants to Argentina. ACTA ACUST UNITED AC 2017; 39:147-153. [PMID: 28300934 PMCID: PMC7111436 DOI: 10.1590/1516-4446-2016-2005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
Objective: To ascertain lifetime prevalence of positivity to a screening questionnaire for bipolar disorders (BD) in Sardinian immigrants to Argentina and residents of Sardinia and assess whether such positivity affects quality of life (QoL) in either group. Our hypothesis is that screen positivity for BD may be more frequent in immigrants. Methods: Observational study. Subjects were randomly selected from the membership lists of associations of Sardinian immigrants in Argentina. A study carried out in Sardinia using the same methodology was used for comparison. The Mood Disorder Questionnaire was used to screen for mania/hypomania and the Short-Form Health Survey-12 to measure QoL. Results: A higher prevalence of manic/hypomanic episodes was found in Sardinian immigrants to Argentina (p < 0.0001; odds ratio = 3.0, 95% confidence interval 1.87-4.77). Positivity at screening was associated with a lower QoL both in Sardinian immigrants to Argentina and in residents of Sardinia. Conclusions: To the best of our knowledge, this is the first study to show a higher lifetime prevalence of manic/hypomanic episodes in a general-population sample of individuals who migrated to a foreign country. Our results are in agreement with the hypothesis that hyperactive/novelty-seeking features may represent an adaptive substrate in certain conditions of social change.
Collapse
Affiliation(s)
- Mauro G Carta
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Alessandra Perra
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Michela Atzeni
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Silvia D'Oca
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Maria F Moro
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter K Kurotschka
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Daniela Moro
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Maria V Brasesco
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Gustavo Mausel
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Antonio E Nardi
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Leonardo Tondo
- Centro Lucio Bini Cagliari and Centro Lucio Bini Roma, Italy.,Harvard Medical School, McLean Hospital, Boston, MA, USA
| |
Collapse
|
17
|
Carta MG, Angst J. Screening for bipolar disorders: A public health issue. J Affect Disord 2016; 205:139-143. [PMID: 27442457 DOI: 10.1016/j.jad.2016.03.072] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 02/16/2016] [Accepted: 03/12/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a public health issue; it is one of the leading causes of disability and its late diagnosis heightens the impact of the condition. Screening tools for early detection could be extremely useful. METHODS Narrative review on screening of BD. RESULTS Screening questionnaires have high sensitivity but relatively low specificity if DSM diagnoses are taken as the "gold standard". Critics maintain that an excess of false positives makes such tools unnecessary for identifying cases and of little use in screening studies consisting of two phases. However, "positive" screening was frequently homogeneous with BD in terms of gender, age, level of distress, low social functioning and employment rate, comorbidity with alcohol and substance abuse, heavy recourse to health care, use of mood stabilizers and antidepressants, risk of suicide attempts, and high recurrence of depressive episodes. While none of these components is pathognomonic of BD, their co-occurrence could identify subthreshold "cases". The studies reviewed found positivity at screening to be associated with impaired quality of life, even without BD and independently of comorbidity. Patients with a neurological disease and positive at screening show homogenous brain lesions, different from those of patients screening negative. CONCLUSIONS The results are coherent with the hypothesis that positivity identifies a bipolar spectrum of clinical and public health interest, including sub-threshold bipolar cases, which do not fulfil the diagnostic criteria for BD.
Collapse
Affiliation(s)
- M G Carta
- Chair of Quality of Care and Applied Medical Technologies, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.
| | - J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Barbato A, Vallarino M, Rapisarda F, Lora A, Parabiaghi A, D'Avanzo B, Lesage A. Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy. Int J Soc Psychiatry 2016; 62:334-44. [PMID: 26896028 DOI: 10.1177/0020764016631368] [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] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. AIMS This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system. METHOD Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression. RESULTS A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation. CONCLUSION Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
Collapse
Affiliation(s)
- Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy IRIS Postgraduate School of Psychotherapy, Milan, Italy
| | - Martine Vallarino
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- Mental Health Department, Lecco Hospital, Lecco, Italy
| | - Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| |
Collapse
|
20
|
Carta MG, Conti A, Lecca F, Sancassiani F, Cossu G, Carruxi R, Boccone A, Cadoni M, Pisanu A, Francesca Moro M, Demelia L. The Burden of Depressive and Bipolar Disorders in Celiac Disease. Clin Pract Epidemiol Ment Health 2015; 11:180-5. [PMID: 26962323 PMCID: PMC4763959 DOI: 10.2174/1745017901511010180] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 01/09/2023]
Abstract
Introduction: Aims: to measure the
association between Celiac Disease (CD) and affective disorders, particularly
Bipolar Disorder (BD), since it has not been studied yet, and to measure how
much the quality of life (QoL) of a person with CD is affected by comorbidity
with these disorders. Methods: Design: Case-control study. Cases:
60 consecutive patients with CD. Controls: 240 subjects without CD, randomly
selected after sex- and age-matching from a database of an epidemiological
study. Psychiatric diagnoses according to DSM-IV carried out by physicians using
structured interview tools (ANTAS-SCID). QoL was measured by means of SF-12. Results: The lifetime prevalence of Major Depressive Disorder (MDD)
was higher in CD than in controls (30.0% vs 8.3%, P<0.0001) as well as
Panic Disorder (PD) (18.3% vs 5.4%, P<0.001) and BD (4.3% vs 0.4%,
P<0.005). Patients with CD show a lower mean score than controls on SF12
(35.8±5.7 vs.
38.2±6.4; p=0.010), but those without comorbidity with MDD, PD and BD do
not. The attributable burden of CD in worsening QoL - when comorbid with these
disorders - was found comparable to that of serious chronic diseases like
Wilson’s Disease, and lower than Multiple Sclerosis only. Conclusion: MDD, PD and BD are strictly associated with CD. The comorbidity with these
disorders is the key determinant of impaired quality of life in CD. Thus a
preventive action on mood and anxiety disorders in patients suffering from CD is
required. Moreover a screening for CD in people with affective disorders and
showing key symptoms or family history of CD is recommended.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Alessandra Conti
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Federica Lecca
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Federica Sancassiani
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Giulia Cossu
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Rossana Carruxi
- Department of Medicine "Mario Aresu", University of Cagliari, Italy
| | | | - Michela Cadoni
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Anna Pisanu
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Maria Francesca Moro
- Department of Public Health Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Luigi Demelia
- Department of Medicine "Mario Aresu", University of Cagliari, Italy
| |
Collapse
|
21
|
Carta MG, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Hardoy MC, D'Aloja E, Machado S, Roncone R, Faravelli C. The attributable burden of panic disorder in the impairment of quality of life in a national survey in Italy. Int J Soc Psychiatry 2015; 61:693-9. [PMID: 25770204 DOI: 10.1177/0020764015573848] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION/OBJECTIVE The aim was to measure the lifetime prevalence of panic disorder (PD) in an Italian community sample, and to estimate the burden attributable to PD in compromising the quality of life (QoL) of people diagnosed with it. METHODS Community survey was conducted on a sample of 4,999 randomly selected adult subjects. Instruments used were semi-structured clinical interview Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians and allowing diagnosis according to Diagnostic and Statistical Manual of Mental Disorder (4th ed.; DSM-IV); Short Form Health Survey (SF-12). RESULTS The lifetime prevalence of PD was 3.6% (4.4% in females, 2.5% in males; p = .002). People with PD had a lower SF-12 score than the standardized community sample (35.5 ± 6.5 vs. 38.4 ± 5.9; p < .0001) with a mean difference (attributable burden) of 2.9 ± 0.7, that is, lower than PD with agoraphobia (AP; 4.2 ± 2.4). Wilson Disease (WD), Multiple Sclerosis, Major Depressive Disorder and Eating Disorders (ED) show a higher attributable burden in impaired QoL than PD, while the attributable burden of PD with AP is not lower than in ED and WD. CONCLUSIONS The burden attributable to the impairment of QoL following a lifetime diagnosis of PD was found to be not so great compared to the impairment caused by Major Depressive Disorder (MDD) or neurological conditions. The comorbidity of PD with AP worsens QoL significantly.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sergio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | |
Collapse
|
22
|
Carta MG, Norcini-Pala A, Moro MF, Balestrieri M, Caraci F, Dell'Osso L, Sciascio GD, Faravelli C, Hardoy MC, Aguglia E, Roncone R, Nardi AE, Drago F. Does Mood Disorder Questionnaire identify sub-threshold bipolarity? Evidence studying worsening of quality of life. J Affect Disord 2015; 183:173-8. [PMID: 26021966 DOI: 10.1016/j.jad.2015.04.058] [Citation(s) in RCA: 11] [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: 02/28/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It is debated whether the Mood Disorder Questionnaire (MDQ) can generate false positives by screening other disorders as bipolar, or identify sub-threshold bipolarity. The aim is to verify if Quality of Life (QoL) impairment in MQD positives in the community is due to MDQ positivity itself, or to psychiatric diagnosis associated with MDQ positivity (supporting the former hypothesis). METHOD Community survey. Sample randomized after stratification of the adult population in the records of seven Italian regions. TOOLS MDQ; Short Form Health Survey (SF-12); semi-structured clinical interview carried out by clinicians. RESULTS Positives at MDQ show worsening QoL with an attributable burden of 2.8 ± 1.8 lower than in MDD (5.6 ± 3.6, p < 0.001) or Eating Disorders (4.4 ± 6.6, p < 0.03) and similar to Panic Disorder (2.9 ± 0.9, p = 0.44). The burden is lower in the middle-aged (25-59 years) than in the young (18-24) (4.65 ± 4.5 vs 2.58 ± 2.0, p=0.007) or in the elderly (≥60) (4.12 ± 3.2; p = 0.024). In the elderly the burden is independent from comorbid psychiatric disorders. LIMITATIONS This is a preliminary study based on one survey not designed to test this specific hypothesis, thus its results have a heuristic value only. CONCLUSIONS The worsening of QoL due to positivity at MDQ is largely independent from comorbid conditions, supporting the hypothesis that MDQ positivity identifies a specific area of suffering that is "subthreshold" to the psychiatric diagnosis, and relevant for public health.
Collapse
Affiliation(s)
| | | | - Maria Francesca Moro
- Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Filippo Caraci
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Institute of Psychiatry, University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carlo Faravelli
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Firenze, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Rita Roncone
- Department of Health, Life and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Antonio Egidio Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Drago
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| |
Collapse
|
23
|
Carta MG, Moro MF, Lorefice L, Picardi A, Trincas G, Fenu G, Cocco E, Floris F, Bessonov D, Akiskal HS, Marrosu MG. Multiple sclerosis and bipolar disorders: the burden of comorbidity and its consequences on quality of life. J Affect Disord 2015; 167:192-7. [PMID: 24995886 DOI: 10.1016/j.jad.2014.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose is to measure the worsening of the Quality of Life (QoL) in people with Multiple Sclerosis (MS) and the concomitant role of co-morbid Major Depressive Disorder (MDD) and Bipolar Disorder (BD), the latter not yet studied even though it was found strictly associated with MS. CASES 201 consecutive-MS-patients. CONTROLS 804 sex-and-age-matched subjects without MS, randomly selected from an epidemiological database study. Psychiatric diagnoses according to DSM-IV were determined by physicians using structured interview tools (ANTAS-SCID). Bipolar Spectrum Disorders were identified by Mood Disorders Questionnaire (MDQ). QoL was measured by SF-12. RESULTS MS was the strongest determinant in worsening the QoL in the overall sample. Both MDD and BD type-II lifetime diagnoses were significantly associated with a poorer quality of life in the total sample as in cases of MS. In MS the impairment of the QoL attributable to BD type-II was even greater than that in MDD. LIMITATIONS The MS diagnosis was made differently in cases and controls. Although this may have produced false negatives in controls, it would have reinforced the null hypothesis (no role of MS in worsening the QoL); therefore, it does not invalidate the study. CONCLUSIONS MDD as well BD type-II are co-determinants in worsening QoL in MS. Clinicians should consider depressive symptoms as well as the hypomanic and mixed components in MS. Additional research is required to confirm our results and further clarify the manner in which BD and the mixed symptoms of BD type-II may affect awareness of both the underlying disease and psychiatric component and finally to what extent they impact treatment adherence with the available therapies for MS.
Collapse
Affiliation(s)
- M G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - M F Moro
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - L Lorefice
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - A Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | - G Trincas
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - G Fenu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - E Cocco
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - F Floris
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - D Bessonov
- International Mood Center, University of California, San Diego, La Jolla, CA, United States.
| | - H S Akiskal
- International Mood Center, University of California, San Diego, La Jolla, CA, United States.
| | - M G Marrosu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| |
Collapse
|
24
|
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.
Collapse
Affiliation(s)
| | - Lissia Ana Basso
- WP Centro de Psicoterapia Cognitivo-Comportamental, Santa Maria, RS, Brazil
| | | | | |
Collapse
|
25
|
Carta MG, Saba L, Moro MF, Demelia E, Sorbello O, Pintus M, Pintus E, Simavorian T, Akiskal H, Demelia L. Homogeneous magnetic resonance imaging of brain abnormalities in bipolar spectrum disorders comorbid with Wilson's disease. Gen Hosp Psychiatry 2015; 37:134-8. [PMID: 25772945 DOI: 10.1016/j.genhosppsych.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose was to determine if brain damage in Wilson's disease (WD) is different in comorbid bipolar spectrum disorders (BDs), comorbid major depressive disorder (MDD) or without any mood disorders. METHODS An observational study was conducted on consecutive patients from a center for WD care. The study sample was divided by psychiatric assessment into WD without any mood disorders, WD with BDs and WD with MDD negative at Mood Disorder Questionnaire (MDQ). RESULTS Thirty-eight WD patients were recruited (53.2% females): 21 without mood disorders (55.2%), 9 with comorbid BDs (26.7%) and 8 with MDD without MDQ+ (21.1%). The BDs showed a higher frequency of brain damage, reaching statistically significant differences in the basal ganglia (P<.001), in the overall brain (P<.003) and at the limit in the white matter (P<.05). CONCLUSIONS In WD, comorbidity with BDs is associated with earlier evidence of brain damage, especially in the basal ganglia. The results confirm the importance of screening and early diagnosis of BDs in WD. Future follow-up studies on large samples are required to confirm if detection of BDs may be an early marker of brain damage and if a good therapeutic response in BDs may improve the prognosis of WD.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato, Cagliari, 09045, Italy.
| | - Maria Francesca Moro
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | - Enrico Demelia
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato, Cagliari, 09045, Italy.
| | - Orazio Sorbello
- UOC of Gastroenterology, Azienda Ospedaliero - Universitaria, Cagliari, Italy.
| | - Mirra Pintus
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | - Elisa Pintus
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | | | - Hagop Akiskal
- International Mood Center, University of CA, San Diego, USA.
| | - Luigi Demelia
- UOC of Gastroenterology, Azienda Ospedaliero - Universitaria, Cagliari, Italy.
| |
Collapse
|
26
|
Atypical features and treatment choices in bipolar disorders: a result of the National Bipolar Mania Pathway Survey in China. Neurosci Bull 2015; 31:22-30. [PMID: 25564191 DOI: 10.1007/s12264-014-1487-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022] Open
Abstract
In this study, we examined the point prevalence rate of atypical features in bipolar disorder, and estimated the potential impact of these features on treatment practices in China. Using the atypical features criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV), we documented the atypical symptoms in 3 906 consecutive participants with bipolar disorder enrolled at 26 psychiatric services across China. We further assessed the association between atypical features and the treatment approaches, including the prescription of antidepressants. The overall point prevalence rate of atypical features was 9.1% among patients with various bipolar disorder subtypes. When the definition was broadened to include atypical features B, the overall rate increased to 11.8%. Interestingly, among patients with the mixed state and remission subtypes, there was a significant difference in the rates of antidepressant medication usage between patients who met and those who did not meet the criteria for atypical features B. These findings indicate a trend of using antidepressants for these two types of patients with atypical features. Further, for both mixed state and remission patients, treatment approaches were related to atypical features B. Our findings provide evidence to assist clinicians to readily recognize atypical features in bipolar subtypes and can propose treatments based on these diagnoses.
Collapse
|
27
|
Bragazzi NL, Pezzoni F, Del Puente G. Investigating Aggressive Styles and Defense Mechanisms in Bipolar Patients and in their Parents. Health Psychol Res 2014; 2:1546. [PMID: 26973942 PMCID: PMC4768587 DOI: 10.4081/hpr.2014.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/15/2014] [Accepted: 06/15/2014] [Indexed: 11/23/2022] Open
Abstract
Bipolar disorder (BD) is a very common mental health disorder, whose etiology concerning aggressive styles and defense mechanisms is still poorly known despite the efforts dedicated to develop psychological and biological theories. After obtaining written signed informed consent, this study will recruit inpatients with a clinical diagnosis of BD, based on Structured Clinical Interview and the Diagnostic and Statistical Manual of Mental Disorders criteria, and their parents. The Bus-Perry Aggression Questionnaire, the Defense Style Questionnaire 40, the Symptom check list SCL-90-R, developed by DeRogatis will be administered to the participants, together with a semi-structured questionnaire concerning demographic data (age, gender, employment, education) and only for the patients clinical information (onset year of the disorder, presence of co-morbidities, alcohol and drug use, suicide tendencies, kind of treatment). All the questionnaires are in the Italian validated version. The successful completion of this study will shed light on the relationship between aggressive styles and defensive mechanisms in bipolar inpatients and in their parents, helping the clinicians to develop ad hoc psychological interventions.
Collapse
Affiliation(s)
| | - Franca Pezzoni
- Department of Mental Health, Genoa Health Local Unit, University of Genoa , Italy
| | - Giovanni Del Puente
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa , Italy
| |
Collapse
|
28
|
Carta MG, Preti A, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, D'Aloja E, Cossu G, Calò S, Palumbo G, Bhugra D. Eating disorders as a public health issue: prevalence and attributable impairment of quality of life in an Italian community sample. Int Rev Psychiatry 2014; 26:486-92. [PMID: 25137115 DOI: 10.3109/09540261.2014.927753] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence of eating disorders (ED) in the community is still under debate, as well as the measure of their impact on the well-being of individuals. It was decided to evaluate the prevalence of eating disorders in an Italian community sample as well as to measure the burden of the quality of life of people and to compare it to those attributable to other chronic illnesses. A community survey of 4,999 people using a questionnaire on health services utilization, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), a semi-structured clinical interview derived from the non-patient version of the DSM-IV (SCID/NP) and Short Form Health Survey (SF-12) was conducted. A total of 3,398 individuals were interviewed (68% of those recruited). Lifetime prevalence for overall ED was 1.7%; for anorexia 0.7%; for bulimia 0.6% and for binge eating disorder 0.5%. ED was more frequent in women than in men. No cases of anorexia in men were identified. ED showed an attributable burden in impairing quality of life with no statistically significant differences with those due to major depressive disorder, bipolar spectrum disorders and Wilson's disease. Of the pathological conditions considered, only multiple sclerosis showed a worsening attributable burden. ED thus has a non-negligible frequency in Italy, with severe impact on quality of life comparable to that produced by severe chronic psychiatric and general medical conditions. These elements emphasize that ED is a serious public health issue.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari , Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Wang Z, Gao K, Hong W, Xing M, Wu Z, Chen J, Zhang C, Yuan C, Huang J, Peng D, Wang Y, Lu W, Yi Z, Yu X, Zhao J, Fang Y. Guidelines disconcordance in acute bipolar depression: data from the national Bipolar Mania Pathway Survey (BIPAS) in mainland China. PLoS One 2014; 9:e96096. [PMID: 24763748 PMCID: PMC3999095 DOI: 10.1371/journal.pone.0096096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 04/03/2014] [Indexed: 12/14/2022] Open
Abstract
With the recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have been published. This survey investigated prescribing pattern and predictors for guideline disconcordance in the acute treatment of bipolar depression across mainland China. Pharmacological treatments of 1078 patients with bipolar depression were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments. Predictors for guidelines discordance were analyzed with logistic regression. Of the 1078 patients, 50.2% patients were treated against treatment guidelines recommendations. The patients who were treated in general hospitals (OR = 1.53, 95% CI 1.18-1.97), with a depressive episode (OR = 1.67, 95% CI 1.27-2.19) and an older age at first onset (OR = 1.62, 95% CI 1.15-2.28) were more likely to receive guideline-disconcordant treatment than their counterparts. In contrast, the patients with current mental comorbidity, an older age at study entry, a longer duration of disease, and more frequent episodes in past year were less likely to receive guideline-disconcordant treatments than their counterparts with an OR of 0.43 (95% CI 0.24-0.77), 0.52 (95CI% 0.36-0.75), 0.48 (95% CI 0.36-0.65), and 0.50 (95% CI 0.38-0.64), respectively. Our finding suggested the disconcordance with treatment guidelines in patients with an acute bipolar depression is common under naturalistic conditions in mainland China, and the predicting factors correlated with guidelines disconcordance include both psychiatrist-specific (clinicians from general hospitals) and patient-specific features (a depressive episode at first onset, no current co-morbidity with mental disorders, a younger age at study entry, an older age at first onset, shorter duration of disease, and non-frequent episodes in past year).
Collapse
Affiliation(s)
- Zuowei Wang
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai, China
| | - Keming Gao
- Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Wu Hong
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengjuan Xing
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiguo Wu
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Zhang
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengmei Yuan
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Huang
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wang
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weihong Lu
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenghui Yi
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Yu
- Institute of Mental Health, Peking University, Beijing, China
| | - Jingping Zhao
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yiru Fang
- Division of Mood Disorders, Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
30
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Audrey Fortezzo
- International Mood Center, University of California, San Diego, USA
| | - Hagop Akiskal
- International Mood Center, University of California, San Diego, USA
| |
Collapse
|
31
|
Carta MG, Moro MF, Lorefice L, Trincas G, Cocco E, Del Giudice E, Fenu G, Colom F, Marrosu MG. The risk of Bipolar Disorders in Multiple Sclerosis. J Affect Disord 2014; 155:255-60. [PMID: 24295600 DOI: 10.1016/j.jad.2013.11.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/10/2013] [Accepted: 11/12/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim was to determine the risk of Mood Disorders (MD), particularly Bipolar Disorders (BD), in Multiple Sclerosis (MS) using standardized psychiatric diagnostic tools. METHODS Case-control study. CASES 201 consecutive-patients with MS. CONTROLS 804 sex- and age-matched subjects without MS, randomly selected from a database concurrently used for an epidemiological study on the MD prevalence in the community. Psychiatric diagnoses according to DSM-IV were determined by physicians using structured interview tools (ANTAS-SCID). RESULTS Compared to controls, MS patients had a higher lifetime prevalence of DSM-IV Major Depressive Disorders (MDD; P<0.0001), BD I (P=0.05), BD II (P<0.0001) and Cyclothymia (P=0.0001). As people with MS had a higher risk of depressive and bipolar spectrum disorders, ratio MDD/bipolar spectrum disorders was lower among cases (P<0.005) indicating a higher association with Bipolar Spectrum Disorders and MS. LIMITATIONS MS diagnosis was differently collected in cases and controls. Even if this might have produced false negatives in controls, it would have reinforced the null hypothesis of no increased risk for MD in MS; therefore, it does not invalidate the results of the study. CONCLUSIONS This study was the first to show an association between BD and MS using standardized diagnostic tools and a case-control design. The results suggest a risk of under-diagnosis of BD (particularly type II) in MS and caution in prescribing ADs to people with depressive episodes in MS without prior excluding BD. The association between auto-immune degenerative diseases (like MS) and BD may be an interesting field for the study of the pathogenic hypothesis.
Collapse
Affiliation(s)
- M G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - M F Moro
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - L Lorefice
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - G Trincas
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - E Cocco
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - E Del Giudice
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - G Fenu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - F Colom
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain.
| | - M G Marrosu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| |
Collapse
|
32
|
Abstract
Depressive symptoms and episodes dominate the long-term course of bipolar disorder and are associated with high levels of disability and an increased risk of suicide. However, the treatment of bipolar depression has been poorly investigated in comparison with that of manic episodes and unipolar major depressive disorder. The goal of treatment in bipolar depression is not only to achieve full remission of acute symptoms, but also to avoid long-term mood destabilization and to prevent relapses. A depressive presentation of bipolar disorder may often delay the appropriate management and, thus, worsen the long-term outcome. In these cases, an accurate screening for diagnostic indicators of a possible bipolar course of the illness should guide the therapeutic choices, and lead to prognostic improvement. Antidepressant use is still the most controversial issue in the treatment of bipolar depression. Despite inconclusive evidence of efficacy and tolerability, this class of agents is commonly prescribed in acute and long-term treatment, often in combination with mood stabilizers. In this article, we review available treatment options for bipolar depression, and we shall provide some suggestions for the management of the different presentations of depression in the course of bipolar disorder.
Collapse
|
33
|
Carta MG, Zairo F, Saphino D, Sevilla-Dedieu C, Moro MF, Massidda D, Kovess V. MDQ positive people's searching for effective and ineffective treatments for bipolar disorders: a screening study in France. J Affect Disord 2013; 149:84-92. [PMID: 23623740 DOI: 10.1016/j.jad.2013.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The objective was to estimate the rate of subjects who tested positive at a screening for bipolar disorders among the people insured by a French Health Company, and subsequently to measure treatment patterns. METHODS Cross-sectional postal survey on the "Mutuelle Générale de l'Education Nationale" (MGEN) policyholders. A self-rated questionnaire was sent by mail to 20,099 individuals randomly selected among MGEN policyholders. Tools: questionnaire on socio-demographic variables and health-care use; Mood Disorder Questionnaire (MDQ); Composite International Diagnostic Interview Short Form Self-Administered (CIDI-SA). RESULTS Responders were 10,288 (53%). The prevalence of MDQ positivity (MDQ(+)) was 3.6%. The respondents older than 65 showed the lowest frequencies. High frequencies were recorded by the people who had left work because of long term sickness and by people with invalidity. Subjects having a diagnosis of ICD-10 major depression were found to be at risk. Positive subjects had no more contacts with general practitioners than negative subjects; on the contrary they had more contacts with psychiatrists, alternative medicine professionals, psychologists, psychoanalysts, spiritual guides or welfare workers. MDQ+ subjects had a higher risk to use all kinds of psychodrugs, including antidepressants (27.7%, OR=2.7, CI95% 1.9-3.9). DISCUSSION The prevalence of MDQ(+) was similar to the surveys in the USA and Italy. The use of ADs in people with MDQ(+) and MDD diagnosis needs to be taken into account when managing the public health-care system. A large rate of positive subjects reported to have used ineffective treatments for bipolar disorders. LIMITS Relative low response rate and observational design.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| | | | | | | | | | | | | |
Collapse
|
34
|
MG C, MF M, V K, MV B, KM B, MC A, HS A. Could hypomanic traits explain selective migration? Verifying the hypothesis by the surveys on sardinian migrants. Clin Pract Epidemiol Ment Health 2012; 8:175-179. [PMID: 23248679 PMCID: PMC3522090 DOI: 10.2174/1745017901208010175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION A recent survey put forward the hypothesis that the emigration that occurred from Sardinia from the 1960's to the 1980's, selected people with a hypomanic temperament. The paper aims to verify if the people who migrated from Sardinia in that period have shown a high risk of mood disorders in the surveys carried out in their host countries, and if the results are consistent with this hypothesis. METHODS This is systematic review. RESULTS In the 1970's when examining the attitudes towards migration in Sardinian couples waiting to emigrate, Rudas found that the decision to emigrate was principally taken by males. Female showed lower self-esteem than male emigrants. A study on Sardinian immigrants in Argentina carried out in 2001-02, at the peak of the economic crisis, found a high risk of depressive disorders in women only. These results were opposite to the findings recorded ten years earlier in a survey on Sardinian immigrants in Paris, where the risk of Depressive Episode was higher in young men only. DISCUSSION Data point to a bipolar disorder risk for young (probably hypomanic) male migrants in competitive, challenging conditions; and a different kind of depressive episodes for women in trying economic conditions. The results of the survey on Sardinian migrants are partially in agreement with the hypothesis of a selective migration of people with a hypomanic temperament. Early motivations and self-esteem seem related to the ways mood disorders are expressed, and to the vulnerability to specific triggering situations in the host country.
Collapse
Affiliation(s)
- Carta MG
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Moro MF
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Kovess V
- Ecole de Hautes Etudes en Santé Publique, Paris Rennes, France
| | - Brasesco MV
- University of California at San Diego, V.A. Medical Center -- Psychiatry (116A), 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Bhat KM
- Department of Neuroscience And Cell Biology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Angermeyer MC
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
- Centre for Public Mental Health, Gösing am Wagram, Austria
| | - Akiskal HS
- University of California at San Diego, V.A. Medical Center -- Psychiatry (116A), 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| |
Collapse
|
35
|
MG C, E A, F C, L D, G DS, F D, E DG, C F, MC H, ME L, MF M, S C, M C, MC A, M B. Quality of life and urban / rural living: preliminary results of a community survey in Italy. Clin Pract Epidemiol Ment Health 2012; 8:169-74. [PMID: 23248678 PMCID: PMC3522089 DOI: 10.2174/1745017901208010169] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 08/12/2012] [Accepted: 08/20/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of this population-based study is to examine the association between subjective quality of life and rural/urban residence in six Italian regions, including age and gender into the analysis. METHODS STUDY DESIGN community survey. STUDY POPULATION Samples stratified according to sex and age, drawn from municipal records. SAMPLE SIZE 4999 people 18 years and older, from seven communities within six regions of Italy. TOOLS Ad-hoc form to assess basic demographic data; SF-12. Interviewers were trained psychologists or medical doctors. RESULTS 3398 subjects were interviewed (68% of recruited sample). The mean score of SF-12 in the overall sample was 38.4±6.1, SF-12 was higher in men than in in women (38.4±6.1 vs 37.5±5.9 F=99.18, df 1, 3396, 3397, p<0.0001); SF-12 score decreased from the youngest to the oldest age group, with significant differences between all ages groups; men showed higher scores in all age groups. The urban/rural difference of mean scores of SF-12 did not achieve statistical significance in women. Young men with urban residence had higher SF-12 scores than their counterparts with rural residence. Maen aged 65 years and older with rural residence showed, by contrast, higher scores than men from the same age group with urban residence. CONCLUSIONS Men show a higher subjective quality of life than women. Subjective quality of life decreases with age in both genders.Men are more sensitive to urban/rural residence than women.Young men live better in cities, elderly men better in rural areas.
Collapse
Affiliation(s)
| | | | | | | | | | - Drago F
- University of Cagliari, Italy
| | | | | | | | | | - Moro MF
- University of Cagliari, Italy
| | - Calò S
- University of Florence, Italy
| | | | | | | |
Collapse
|
36
|
Carta MG, Tondo L, Balestrieri M, Caraci F, dell'Osso L, Di Sciascio G, Faravelli C, Hardoy MC, Lecca ME, Moro MF, Bhat KM, Casacchia M, Drago F. Sub-threshold depression and antidepressants use in a community sample: searching anxiety and finding bipolar disorder. BMC Psychiatry 2011; 11:164. [PMID: 21985128 PMCID: PMC3206417 DOI: 10.1186/1471-244x-11-164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To determine the use of antidepressants (ADs) in people with sub-threshold depression (SD); the lifetime prevalence of mania and hypomania in SD and the link between ADs use, bipolarity and anxiety disorders in SD. STUDY DESIGN community survey. STUDY POPULATION samples randomly drawn, after stratification from the adult population of municipal records. SAMPLE SIZE 4999 people from seven areas within six Italian regions. Tools: Questionnaire on psychotropic drug consumption, prescription; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Hamilton Depression Rating Scale (HAM-D); Mood Disorder Questionnaire (MDQ); Short Form Health Survey (SF-12). SD definition: HAM-D > 10 without lifetime diagnosis of Depressive Episode (DE). RESULTS SD point prevalence is 5.0%. The lifetime prevalence of mania and hypomania episodes in SD is 7.3%. Benzodiazepines (BDZ) consumption in SD is 24.1%, followed by ADs (19.7%). In SD, positive for MDQ and comorbidity with Panic Disorder (PD) or Generalized Anxiety Disorders (GAD) are associated with ADs use, whereas the association between a positive MDQ and ADs use, without a diagnosis of PD or GAD, is not significant. Only in people with DE the well-being (SF-12) is higher among those using first-line antidepressants compared to those not using any medication. In people with SD no significant differences were found in terms of SF-12 score according to drug use. CONCLUSIONS This study suggests caution in prescribing ADs to people with SD. In people with concomitant anxiety disorders and SD, it should be mandatory to perform a well-designed assessment and evaluate the presence of previous manic or hypomanic symptoms prior to prescribing ADs.
Collapse
Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Cagliari, Italy.
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Matteo Balestrieri
- Inter-University Center for Behavioural Neurosciences, DPMSC, University of Udine, Udine, Italy
| | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Italy
| | - Liliana dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Guido Di Sciascio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Carlo Faravelli
- Department of Neurology and Psychiatry, Florence University, Firenze, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, University of Cagliari, Cagliari, Italy,Department of Psychiatry, Reald University, Vlore, Albania
| | - Maria E Lecca
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | | | - Krishna M Bhat
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Massimo Casacchia
- Department of Science of Health, University of L'Aquila, L'Aquila, Italy
| | - Filippo Drago
- Department of Drug Sciences, University of Catania, Italy
| |
Collapse
|