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Tondo L, Miola A, Pinna M, Contu M, Baldessarini RJ. Antidepressant-associated diagnostic change from major depressive to bipolar disorder. Acta Psychiatr Scand 2024. [PMID: 38922810 DOI: 10.1111/acps.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Anticipating diagnostic change from major depressive (MDD) to bipolar disorder (BD) can support better prognosis and treatment, especially of depression but is challenging and reported research results are inconsistent. We therefore assessed clinical characteristics associated with diagnostic change from MDD to BD with antidepressant treatments. METHODS We compared characteristics of 3212 initially MDD patients who became (hypo)manic during antidepressant treatment to those with stable MDD diagnoses as well as with cases of stable, spontaneous BD, using standard bivariate and multivariate statistics. RESULTS Among MDD patients, 6.69% [CI: 5.85-7.61] changed to BD, mostly type II (BD2, 76.7%). BD-converters had higher rates of familial mood disorders (74.1% vs. 57.1%) or BD (33.7% vs. 21.0%) and 2.8-years younger onset than stable MDD patients. They also had more prior depressive recurrences/year, years-of-illness, mood-stabilizer treatment, divorces, fewer children, more suicide attempts and drug-abuse, and higher intake cyclothymia, YMRS and MDQ scores. Predictors independently associated with diagnostic conversion were: more familial BD, depressions/year, unemployment, cyclothymic temperament, suicidal ideation or acts, and fewer children. BD-converters vs. spontaneous BD cases had significantly more suicide attempts, BD2 diagnoses, and affected relatives. Converting to vs. spontaneous BD1 was associated with more ADHD, more suicidal ideation or behavior, MDI course, and younger onset; converting to vs. spontaneous BD2 had more episodes/year, unemployment, ADHD, substance abuse, suicidal ideation or attempts, and more relatives with BD. CONCLUSIONS Few (6.69%) initially MDD subjects converted to BD, most (76.7%) to BD2. Independent predictive associations with diagnostic change included: familial BD, more depressions/year, unemployment, cyclothymic temperament, suicidal behavior and fewer children. Notably, several characteristics were stronger among those changing to BD during antidepressant treatment vs. others with spontaneous BD.
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Affiliation(s)
- Leonardo Tondo
- International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
- Lucio Bini Mood Disorder Center, Cagliari, Italy
- Lucio Bini Mood Disorder Center, Rome, Italy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Miola
- International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy
- Section on Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Center, Cagliari, Italy
- Section on Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Otsuka N, Takaesu Y, Zamami Y, Ota K, Kurihara K, Shinzato H, Kondo T. Elevated Brain-Derived Neurotrophic Factor Levels During Depressive Mixed States. Psychiatry Investig 2023; 20:1027-1033. [PMID: 37997330 PMCID: PMC10678153 DOI: 10.30773/pi.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/23/2023] [Accepted: 08/06/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Neurotrophin-like brain-derived neurotrophic factor (BDNF) and pro-inflammatory cytokines may modulate the pathophysiology of mood disorders. Although several studies show alterations in these biomarkers during the depressive, manic, and euthymic states of mood disorders, evidence is lacking for those in a mixed state. Therefore, this study aimed to investigate the relationship between the depressive mixed state (DMX) and peripheral neurobiological factors. METHODS We enrolled 136 patients with major depressive episodes. Depressive symptoms were assessed using the Quick Inventory of Depressive Symptomatology Self-Report Japanese version (QIDS-SR-J). The severity of DMX was assessed using the self-administered 12-item questionnaire (DMX-12). Categorical screening as DMX-positive (n=54) was determined by a cutoff score of 13 or more in the specific eight symptoms from the DMX-12; the remaining were DMX-negative (n=82). Serum BDNF, tumor necrosis factor-α, highsensitivity C-reactive protein, and interleukin-6 levels were measured. RESULTS When comparing biomarkers between the DMX-positive and DMX-negative groups, higher serum BDNF concentration in the DMX-positive group than in the DMX-negative group was the only significant finding (p=0.009). A positive correlation existed between the total score of the eight specific symptoms of DMX-12 and the BDNF concentration (r=0.190, p=0.027). After adjustment for confounders, logistic regression analysis revealed that BDNF (odds ratio [OR]=1.07, 95% confidence interval [CI]=1.00-1.14, p=0.045), bipolar diagnosis (OR=3.43, 95% CI=1.36-8.66, p=0.009), and total QIDS-SR-J score (OR=1.29, 95% CI=1.15-1.43, p<0.001) were significantly associated with DMX positivity. CONCLUSION BDNF was positively associated with DMX severity, suggesting that higher BDNF concentrations may be involved in the pathophysiology of DMX.
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Affiliation(s)
- Naoaki Otsuka
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yu Zamami
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuki Ota
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuhiro Kurihara
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hotaka Shinzato
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Faurholt-Jepsen M, Busk J, Tønning ML, Bardram JE, Frost M, Vinberg M, Kessing LV. Irritability in bipolar disorder and unipolar disorder measured daily using smartphone-based data: An exploratory post hoc study. Acta Psychiatr Scand 2023; 147:593-602. [PMID: 37094823 DOI: 10.1111/acps.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate (i) the proportions of time with irritability and (ii) the association between irritability and affective symptoms and functioning, stress, and quality of life in patients with bipolar disorder (BD) and unipolar depressive disorder (UD). METHODS A total of 316 patients with BD and 58 patients with UD provided self-reported once-a-day data on irritability and other affective symptoms using smartphones for a total of 64,129 days with observations. Questionnaires on perceived stress and quality of life and clinical evaluations of functioning were collected multiple times during the study. RESULTS During a depressive state, patients with UD spent a significantly higher proportion of time with presence of irritability (83.10%) as compared with patients with BD (70.27%) (p = 0.045). Irritability was associated with lower mood, activity level and sleep duration and with increased stress and anxiety level, in both patient groups (p-values<0.008). Increased irritability was associated with impaired functioning and increased perceived stress (p-values<0.024). In addition, in patients with UD, increased irritability was associated with decreased quality of life (p = 0.002). The results were not altered when adjusting for psychopharmacological treatments. CONCLUSIONS Irritability is an important part of the symptomatology in affective disorders. Clinicians could have focus on symptoms of irritability in both patients with BD and UD during their course of illness. Future studies investigating treatment effects on irritability would be interesting.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Morten Lindberg Tønning
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg hospital, Frederiksberg, Denmark
| | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | | | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Northern Zealand, Hilleroed, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Mills J. Antidepressants and Activation Syndrome: Decades Without Definition. Issues Ment Health Nurs 2021; 42:976-979. [PMID: 34524934 DOI: 10.1080/01612840.2021.1972662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, a Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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Tokumitsu K, Yasui-Furukori N, Adachi N, Kubota Y, Watanabe Y, Miki K, Azekawa T, Edagawa K, Katsumoto E, Hongo S, Goto E, Ueda H, Kato M, Yoshimura R, Nakagawa A, Kikuchi T, Tsuboi T, Shimoda K, Watanabe K. Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder. BMC Psychiatry 2020; 20:555. [PMID: 33228573 PMCID: PMC7686705 DOI: 10.1186/s12888-020-02967-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/17/2020] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were not sufficiently based on real-world clinical practice. METHODS The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder by performing a retrospective medical record survey. The questionnaire included patient characteristics (age, gender, height, weight, academic background, and occupational status), comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. RESULTS Data on 2705 patients were included in this study. The proportion of patients receiving antidepressant prescriptions was 40.9%. The most commonly used antidepressant was duloxetine, and the most frequently used antidepressant class was selective serotonin reuptake inhibitors (SSRIs). Binomial logistic regression analysis and bivariate analysis revealed that the usage of antidepressants was correlated with low prescription rates for mood stabilizers, high prescription rates for anxiolytics and hypnotics, and low GAF scores. In addition, patients in a depressive state had a significantly higher rate of antidepressant prescriptions than patients with other mental states. CONCLUSIONS Approximately 40% of patients in Japan with a diagnosis of bipolar disorder have received antidepressants. Antidepressants were most often prescribed in combination with mood stabilizers, antipsychotics or both. Patients who were prescribed antidepressants received fewer mood stabilizers, more anxiolytics, and more hypnotics than those who did not receive antidepressant prescriptions.
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Affiliation(s)
- Keita Tokumitsu
- grid.255137.70000 0001 0702 8004Department of Psychiatry, Dokkyo Medical University, School of Medicine, Mibu, Shimotsuga, Tochigi 321-0293 Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. .,The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | | | - Kazuhira Miki
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Koji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Masaki Kato
- grid.469781.50000 0004 5897 9100The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,grid.410783.90000 0001 2172 5041Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Reiji Yoshimura
- grid.469781.50000 0004 5897 9100The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,grid.271052.30000 0004 0374 5913Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Atsuo Nakagawa
- grid.469781.50000 0004 5897 9100The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,grid.26091.3c0000 0004 1936 9959Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshiaki Kikuchi
- grid.469781.50000 0004 5897 9100The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,grid.26091.3c0000 0004 1936 9959Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- grid.469781.50000 0004 5897 9100The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,grid.411205.30000 0000 9340 2869Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazutaka Shimoda
- grid.255137.70000 0001 0702 8004Department of Psychiatry, Dokkyo Medical University, School of Medicine, Mibu, Shimotsuga, Tochigi 321-0293 Japan
| | - Koichiro Watanabe
- grid.469781.50000 0004 5897 9100The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,grid.411205.30000 0000 9340 2869Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
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Tondo L, Vazquez GH, Baldessarini RJ. Suicidal Behavior Associated with Mixed Features in Major Mood Disorders. Psychiatr Clin North Am 2020; 43:83-93. [PMID: 32008690 DOI: 10.1016/j.psc.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Mixed features of the opposite nominal mood-polarity are increasingly recognized in both depressive and [hypo]manic phases of major affective disorders. They are associated with major increases of risk of suicidal behaviors. The authors reviewed the association of suicidal behavior with mixed features in both major depressive and bipolar disorders, as well as potentially relevant adverse effects of antidepressant treatment and use of alternative treatments aimed at minimizing agitation and suicidal risk.
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Affiliation(s)
- Leonardo Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Lucio Bini Mood Disorders Center, Cagliari, Italy.
| | - Gustavo H Vazquez
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Ross J Baldessarini
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Sampogna G, Del Vecchio V, Giallonardo V, Luciano M, Fiorillo A. Diagnosis, Clinical Features, and Therapeutic Implications of Agitated Depression. Psychiatr Clin North Am 2020; 43:47-57. [PMID: 32008687 DOI: 10.1016/j.psc.2019.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Agitated "unipolar" depression is a clinical entity characterized by excitement together with depressed mood during the same episode. The clinical picture of agitated "unipolar" depression is characterized by a depressed and anxious mood with inner, psychic agitation, whereas motor agitation may or may not be present. Some investigators have conceptualized this disorder as a mixed affective state, laying on the bipolar disorder spectrum, but controversies still persist. The diagnosis of agitated "unipolar" depression has important prognostic and therapeutic implications, with many clinicians reporting difficulties to adequately diagnose and treat it.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy.
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
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Takeshima M. Early recognition and appropriate pharmacotherapy for mixed depression: the key to resolving complex or treatment-refractory clinical cases. ACTA ACUST UNITED AC 2019. [DOI: 10.5234/cnpt.10.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Minoru Takeshima
- Meishinkai Shibata Hospital, Takaoka City, Japan
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
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9
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Serra F, Gordon-Smith K, Perry A, Fraser C, Di Florio A, Craddock N, Jones I, Jones L. Agitated depression in bipolar disorder. Bipolar Disord 2019; 21:547-555. [PMID: 31004555 DOI: 10.1111/bdi.12778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES It has been suggested that agitated depression (AD) is a common, severe feature in bipolar disorder. We aimed to estimate the prevalence of AD and investigate whether presence of AD was associated with episodic and lifetime clinical features in a large well-characterized bipolar disorder sample. METHOD The prevalence of agitation, based on semi-structured interview and medical case-notes, in the most severe depressive episode was estimated in 2925 individuals with DSM-IV bipolar disorder recruited into the UK Bipolar Disorder Research Network. Predictors of agitation were ascertained using symptoms within the same episode and lifetime clinical features using multivariate models. RESULTS 32.3% (n = 946) experienced agitation during the worst depressive episode. Within the same episode, significant predictors of presence of agitation were: insomnia (OR 2.119, P < 0.001), poor concentration (OR 1.966, P = 0.027), decreased libido (OR 1.960, P < 0.001), suicidal ideation (OR 1.861, P < 0.001), slowed activity (OR 1.504, P = 0.001), and poor appetite (OR 1.297, P = 0.029). Over the lifetime illness course, co-morbid panic disorder (OR 2.000, P < 0.001), suicide attempt (OR 1.399, P = 0.007), and dysphoric mania (OR 1.354, P = 0.017) were significantly associated with AD. CONCLUSIONS Agitation accompanied bipolar depression in at least one-third of cases in our sample and was associated with concurrent somatic depressive symptoms, which are also common features of mixed manic states. Furthermore, AD in our sample was associated with lifetime experience of mixed mania, in addition to severe lifetime illness course including comorbid panic disorder and suicidal behavior. Our results have implications for the diagnosis and treatment of agitated features in bipolar depression.
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Affiliation(s)
| | | | - Amy Perry
- Psychological Medicine, University of Worcester, UK
| | | | | | - Nick Craddock
- National Centre of Mental Health, Cardiff University, UK
| | - Ian Jones
- National Centre of Mental Health, Cardiff University, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, UK
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Perugi G, Pacchiarotti I, Mainardi C, Verdolini N, Menculini G, Barbuti M, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Vieta E. Patterns of response to antidepressants in major depressive disorder: Drug resistance or worsening of depression are associated with a bipolar diathesis. Eur Neuropsychopharmacol 2019; 29:825-834. [PMID: 31227264 DOI: 10.1016/j.euroneuro.2019.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
Abstract
Resistance and worsening of depression in response to antidepressants (ADs) are major clinical challenges. In a large international sample of patients with major depressive disorder (MDD), we aim to explore the possible associations between different patterns of response to ADs and bipolarity. A total of 2811 individuals with a major depressive episode (MDE) were enrolled in the BRIDGE-II-MIX study. This post-hoc analysis included only 1329 (47%) patients suffering from MDD. Patients with (TRD-MDD, n = 404) and without (NTRD-MDD, n = 925) history of resistance to AD treatment and with (n = 184) and without (n = 1145) previous AD-induced irritability and mood lability (AIM) were compared using Chi-square, t-Student's test and logistic regression models. TRD-MDD patients resulted significantly associated with higher rates of AIM, psychotic features, history of suicide attempts, emotional lability and impulsivity, comorbid borderline personality disorder and polipharmacological treatment, compared to NTRD-MDD group. In comparison to NAIM-MDD patients, subjects in the AIM-MDD group showed significantly higher rates of first-degree family history for BD, previous TRD, atypical features, mixed features, psychiatric comorbidities, lifetime suicide attempts and lower age at first psychiatric symptoms. In addition, patients with AIM presented more often almost all the hypomanic symptoms evaluated in this study. Among these latter symptoms, logistic regressions showed that distractibility, impulsivity and hypersexuality were significantly associated with AIM-MDD. In conclusion, in MDD patients, a lifetime history of resistance and/or irritability/mood lability in response to ADs was associated with the presence of mixed features and a possible underlying bipolar diathesis.
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Affiliation(s)
- Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Isabella Pacchiarotti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Cecilia Mainardi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy; Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy; FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Giulia Menculini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Margherita Barbuti
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Jules Angst
- Psychiatric Hospital, University of Zurich, Switzerland
| | | | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London SE5 8AZ, United Kingdom
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
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11
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Fornaro M, Anastasia A, Novello S, Fusco A, Solmi M, Monaco F, Veronese N, De Berardis D, de Bartolomeis A. Incidence, prevalence and clinical correlates of antidepressant-emergent mania in bipolar depression: a systematic review and meta-analysis. Bipolar Disord 2018; 20:195-227. [PMID: 29441650 DOI: 10.1111/bdi.12612] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment-emergent mania (TEM) represents a common phenomenon inconsistently reported across primary studies, warranting further assessment. METHODS A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were conducted. Major electronic databases were searched from inception to May 2017 to assess the incidence and prevalence rates and clinical features associated with manic switch among bipolar depressed patients receiving antidepressants, using meta-regression and subgroup analysis. RESULTS Overall, 10 098 depressed patients with bipolar disorder (BD) across 51 studies/arms were included in the quantitative analysis. The cumulative incidence of cases (TEM+ ) among 4767 patients with BD over 15 retrospective studies was 30.9% (95% confidence interval [CI] 19.6-45.0%, I2 = 97.9%). The cumulative incidence of TEM+ among 1929 patients with BD over 12 prospective open studies was 14.4% (95% CI 7.4-26.1%, I2 = 93.7%). The cumulative incidence of TEM+ among 1316 patients with BD over 20 randomized controlled trials (RCTs) was 11.8% (95% CI 8.4-16.34%, I2 = 73.46%). The pooled prevalence of TEM+ among 2086 patients with BD over four cross-sectional studies was 30.9% (95% CI 18.1-47.4%, I2 = 95.6%). Overall, concurrent lithium therapy predicted the lowest TEM rates. Inconsistent operational definitions of TEM were recorded, and the lack of information about age, sex, co-occurring anxiety, and other clinically relevant moderators precluded further stratification of the results. CONCLUSIONS Rates of TEM vary primarily depending on study setting, which is concordant with the high degree of heterogeneity of the included records. Forthcoming RCT studies should adopt consistent operational definitions of TEM and broaden the number of moderators, in order to contribute most effectively to the identification of clear-cut sub-phenotypes of BD and patient-tailored pharmacotherapy.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Annalisa Anastasia
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Stefano Novello
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Andrea Fusco
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Marco Solmi
- Neuroscience Department, University of Padua, Padua, Italy.,Azienda Ospedaliera di Padova, Padua Hospital, Psychiatry Unit, Padua, Italy
| | - Francesco Monaco
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Nicola Veronese
- Azienda Ospedaliera di Padova, Padua Hospital, Psychiatry Unit, Padua, Italy.,National Research Council, Aging Branch, Padua, Italy
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Teramo, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
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Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Azorin JM, Yatham L, Mosolov S, Möller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder. World J Biol Psychiatry 2018; 19:2-58. [PMID: 29098925 DOI: 10.1080/15622975.2017.1384850] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults. METHODS Material used for these guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A-F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode. RESULTS Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention. LIMITATIONS The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands. CONCLUSIONS Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.
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Affiliation(s)
- Heinz Grunze
- a Institute of Neuroscience , Newcastle University , Newcastle upon Tyne , UK
- b Paracelsus Medical University , Nuremberg , Germany
- c Zentrum für Psychiatrie Weinsberg , Klinikum am Weissenhof , Weinsberg , Germany
| | - Eduard Vieta
- d Bipolar Disorders Programme, Institute of Neuroscience , Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Guy M Goodwin
- e Department of Psychiatry , University of Oxford, Warneford Hospital , Oxford , UK
| | - Charles Bowden
- f Dept. of Psychiatry , University of Texas Health Science Center , San Antonio , TX , USA
| | - Rasmus W Licht
- g Psychiatric Research Unit, Psychiatry , Aalborg University Hospital , Aalborg , Denmark
- h Clinical Department of Medicine , Aalborg University , Aalborg , Denmark
| | - Jean-Michel Azorin
- i Department of Psychiatry , Hospital Ste. Marguerite , Marseille , France
| | - Lakshmi Yatham
- j Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Sergey Mosolov
- k Department for Therapy of Mental Disorders , Moscow Research Institute of Psychiatry , Moscow , Russia
| | - Hans-Jürgen Möller
- l Department of Psychiatry and Psychotherapy , Ludwigs-Maximilian University , Munich , Germany
| | - Siegfried Kasper
- m Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
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Ogasawara K, Nakamura Y, Kimura H, Aleksic B, Ozaki N. Issues on the diagnosis and etiopathogenesis of mood disorders: reconsidering DSM-5. J Neural Transm (Vienna) 2017; 125:211-222. [PMID: 29275445 DOI: 10.1007/s00702-017-1828-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
The authors present a narrative review from the diagnostic and nosologic viewpoints of mood disorders (bipolar and depressive ones) by revisiting the revision from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision to DSM-5, including the following: the separation of the bipolar and depressive sections; the addition of increased energy and continuation of symptoms to the hypo/manic criteria; the elimination of mixed episodes; the creation of new categories and specifiers ("other specified bipolar and related disorder", "disruptive mood dysregulation disorder", "with anxious distress", "with mixed features", "with peripartum onset"); the categorization of hypo/manic episodes during antidepressant treatment into bipolar disorder; the elimination of the "bereavement exclusion"; the ambiguous separation between bipolar I and II; the insufficient distinction between "other specified bipolar and related disorders" and major depressive disorder; the differentiation regarding borderline personality disorder; agitation; premenstrual dysphoric disorder; and society and psychiatry. Through this analysis, we point out both the achievements and limitations of DSM-5. In addition, to examine the future direction of psychiatry, we introduce our cohort study regarding maternal depression and an outline of the National Institute of Mental Health's Research Domain Criteria project in the US. Finally, we advocate the importance of elucidating etiopathogeneses by starting from or going beyond the DSM operational diagnostic system, which has shown great efficacy.
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Affiliation(s)
- Kazuyoshi Ogasawara
- Bioethics Research Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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14
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Barbuti M, Pacchiarotti I, Vieta E, Azorin JM, Angst J, Bowden CL, Mosolov S, Young AH, Perugi G. Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study. J Affect Disord 2017; 219:187-192. [PMID: 28558366 DOI: 10.1016/j.jad.2017.05.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/12/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The issue of antidepressant-induced mood switches to hypomania, mania, or mixed states within the course of mayor depressive disorder (MDD) has been a controversial topic. The present post-hoc analysis of the BRIDGE-II-MIX study focuses on the clinical features of patients with history of antidepressant-induced hypomania/mania (AIHM) in a large international sample of patients with major depressive episode (MDE). METHODS 2811 subjects with major depression were enrolled in this multicentre cross-sectional study. Current mixed symptoms, socio-demographic and other clinical variables were collected and compared among MDD-AIHM, MDD and BD patients. RESULTS 475 patients out of 2811 had history of AIHM (16.90%). In the MDD-AIHM group, familiarity for BD and rates of atypical features and comorbid anxiety, eating and borderline personality disorders were similar to BD and significantly more frequent compared to MDD group. MDD-AIHM patients had more frequently more than 3 episodes and reported higher rates of treatment resistance, mood lability and irritability following treatment with antidepressants. Frequencies of depression with mixed features and (hypo)manic symptoms were similar in patients of MDD-AIHM and BD groups and significantly higher in both groups than in MDD. LIMITATIONS there were widely varying rates of hospitalized patients across countries and the participating centres were not randomly selected. CONCLUSIONS Our results strongly support the DSM-5 inclusion of MDD patients with AIHM within the rubric of bipolar disorder. Differences with other MDD and BD were also observed suggesting the possibility that MDD-AIHM may represent a specific sub-population, particularly sensitive to exogenous input from antidepressants.
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Affiliation(s)
- Margherita Barbuti
- University of Pisa, Pisa, Italy; Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Jules Angst
- Psychiatric Hospital, University of Zurich, Switzerland
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15
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) mixed features specifier provides a less restrictive definition of mixed mood states, compared to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), including mood episodes that manifest with subthreshold symptoms of the opposite mood state. A limited number of studies have assessed the efficacy of treatments specifically for DSM-5-defined mixed features in mood disorders. As such, there is currently an inadequate amount of data to appropriately inform evidence-based treatment guidelines of DSM-5 defined mixed features. However, given the high prevalence and morbidity of mixed features, treatment recommendations based on the currently available evidence along with expert opinion may be of benefit. This article serves to provide these interim treatment recommendations while humbly acknowledging the limited amount of evidence currently available. Second-generation antipsychotics (SGAs) appear to have the greatest promise in the treatment of bipolar disorder (BD) with mixed features. Conventional mood stabilizing agents (ie, lithium and divalproex) may also be of benefit; however, they have been inadequately studied. In the treatment of major depressive disorder (MDD) with mixed features, the comparable efficacy of antidepressants versus other treatments, such as SGAs, remains unknown. As such, antidepressants remain first-line treatment of MDD with or without mixed features; however, there are significant safety concerns associated with antidepressant monotherapy when mixed features are present, which merits increased monitoring. Lurasidone is the only SGA monotherapy that has been shown to be efficacious specifically in the treatment of MDD with mixed features. Further research is needed to accurately determine the efficacy, safety, and tolerability of treatments specifically for mood episodes with mixed features to adequately inform future treatment guidelines.
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16
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Kuroki T, Ishitobi M, Kamio Y, Sugihara G, Murai T, Motomura K, Ogasawara K, Kimura H, Aleksic B, Ozaki N, Nakao T, Yamada K, Yoshiuchi K, Kiriike N, Ishikawa T, Kubo C, Matsunaga C, Miyata H, Asada T, Kanba S. Current viewpoints on DSM-5 in Japan. Psychiatry Clin Neurosci 2016; 70:371-93. [PMID: 27414748 DOI: 10.1111/pcn.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 01/10/2023]
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, and its official Japanese version was published in 2014. The Japanese Government uses classifications from the 10th revision of the I nternational C lassification of D iseases (ICD-10) to categorize disorders and determine treatment fees. However, since the publication of the DSM-III, the use of the DSM system has become prevalent in research and educational settings in Japan. In addition to traditional psychiatry, both the ICD and the DSM are taught by many Japanese medical schools, and virtually all clinical research and trials refer to the DSM to define targeted disorders. Amid the current backdrop in which the reputation of the DSM-5 is being established, the editorial board of P sychiatry and C linical N eurosciences has asked Japanese experts across 12 specialties to examine the structure of the DSM-5, including the following categories: Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders, Major Depression, Bipolar Disorders, Obsessive-Compulsive Disorders, Somatic Symptom Disorder, Eating Disorders, Substance-Related and Addictive Disorders, Gender Dysphoria, and Neurocognitive Disorders. Although opinions were only obtained from these selected experts, we believe that we have succeeded, to a certain extent, in presenting views that are representative of each specialty.
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Affiliation(s)
- Toshihide Kuroki
- Department of Clinical Psychology Practice, Graduate School of Human Environment Studies, Kyushu University, Fukuoka, Japan
| | - Makoto Ishitobi
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Genichi Sugihara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keisuke Motomura
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuyoshi Ogasawara
- Department of Human Care, Nagoya University of Arts and Sciences, Nagoya, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Yamada
- Department of Psychiatry, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuo Kiriike
- Department of Neuropsychiatry, Osaka City University, Osaka, Japan
| | - Toshio Ishikawa
- Department of Psychosomatic Medicine, Kohnodai Hospital, Tokyo, Japan
| | - Chiharu Kubo
- Department of Psychosomatic Medicine, Kyushu University, Fukuoka, Japan
| | - Chiaki Matsunaga
- Chiaki Clinic, Jikei University School of Medicine, Tokyo, Japan
| | - Hisatsugu Miyata
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Asada
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Takeshima M, Oka T. Comparative analysis of affective temperament in patients with difficult-to-treat and easy-to-treat major depression and bipolar disorder: Possible application in clinical settings. Compr Psychiatry 2016; 66:71-8. [PMID: 26995239 DOI: 10.1016/j.comppsych.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/18/2015] [Accepted: 01/08/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Difficult-to-treat major depressive disorder (MDD-DT), which involves antidepressant refractoriness or antidepressant-related adverse psychiatric effects, is bipolar in nature; therefore, it may share common temperamental features with bipolar disorder. To examine this hypothesis, affective temperament was compared between MDD-DT, easy-to-treat major depressive disorder (MDD-ET), and bipolar disorder. METHODS Affective temperament was measured in 320 patients (69, 56, and 195 with MDD-ET, MDD-DT, and bipolar disorder, respectively) using the self-rated questionnaire version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), with between-group differences examined using multiple logistic regression analysis controlling for confounders. Optimal cut-off points for TEMPS-A scores to discriminate between diagnostic groups were determined using receiver-operating characteristic analysis. RESULTS Of the five temperamental domains, the mode for cyclothymic temperament score was highest, followed by those of bipolar disorder, MDD-DT, and MDD-ET. The cyclothymic temperament score discriminated significantly between bipolar disorder and MDD-DT (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.20, p=0.0022), MDD-DT and MDD-ET (OR: 1.15, 95% CI: 1.01-1.31, p=0.0334), and bipolar and major depressive disorders (OR: 1.17, 95% CI: 1.07-1.28, p=0.0003). Optimal cut-off points for the cyclothymic temperament scores to discriminate between bipolar disorder and major depressive disorder and MDD-DT and MDD-ET were 9 (sensitivity: 64.6%, specificity: 76.0%) and 6 (66.1%, 62.3%), respectively. CONCLUSIONS MDD-DT has a quantitatively stronger bipolar temperamental feature, cyclothymic temperament, relative to that of MDD-ET. Cut-off points determined in this study could be clinically helpful. Because of our study design, longitudinal changes in temperamental scores during treatment cannot be fully excluded.
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Affiliation(s)
- Minoru Takeshima
- J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan; Department of Psychiatry, Kouseiren Takaoka Hospital, 5-10 Eiraku-cyou, Takaoka City, 933-8555, Japan.
| | - Takashi Oka
- J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan.
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Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states. Compr Psychiatry 2015; 63:15-21. [PMID: 26555487 DOI: 10.1016/j.comppsych.2015.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/05/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022] Open
Abstract
Several studies investigating bipolar disorders have shown that polarity of onset can predict differences in symptomatology, course, and prognosis. Frequently, however, research on the topic has examined only bipolar I inpatients and has not included patients with mixed onset. The aim of the present naturalistic study was to evaluate the clinical characteristics and illness course of a consecutive sample (407 outpatients, 58.7% with bipolar I (BD-I) and 41.3% with bipolar II (BD-II) disorder) according to polarity of onset: depressive (DP-o); manic/hypomanic (HM-o); or mixed--broadly defined to include agitated depression for BD-II--onset (MX-o). As compared with patients in the other two groups: a) DP-o patients (67.3%) were more frequently affected by BD-II and had lower ratings for psychotic symptoms; b) HM-o patients (17%) had a higher rate of family history for psychosis and a lower rate of suicide attempts; and c) patients in the MX-o group (15.7%) more frequently showed substance abuse and had a higher number of mixed recurrences per year. In the BD-II group, MX-o patients more frequently attempted suicide. The present study's main limitations are those of retrospective assessment of onset polarity and lack of treatment-impact evaluations over illness course. In conclusion, we confirm clinical expression differences in bipolar disorder in function of polarity of onset and underscore the importance of carefully considering broadly defined mixed state when examining polarity of onset. Further investigations are required to confirm the present study's results.
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Tundo A, Calabrese JR, Proietti L, de Fillippis R. Variation in response to short-term antidepressant treatment between patients with continuous and non-continuous cycling bipolar disorders. J Affect Disord 2015; 174:126-30. [PMID: 25497468 DOI: 10.1016/j.jad.2014.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The study aimed to compare effectiveness and safety of short-term antidepressant treatment between patients with continuous (CCC) and non-continuous (N-CCC) cycling bipolar disorders. METHODS The study sample included 101 patients with bipolar disorder, 22 (21.8%) CCC and 79 (78.2%) N-CCC. Response was defined as a HDRS21 total score <7 at 12 weeks of treatment and remission as a ≥50% reduction of baseline HDRS21 total score sustained for 8 weeks. RESULTS Compared with N-CCC patients, CCC patients achieved a significantly lower percentage of response (respectively 50% vs. 82.3%, χ²=9.6, p=0.002) and remission (respectively 40.9% vs. 69.6%, χ²=6.11, p=0.013). Adjusted logistic regression analysis indicated that CCC patients were 4.3 times more likely to be non-responders and 3.3 times more likely to be non-remitters than N-CCC patients. CONCERNING AD safety, 1 (5.0%) CCC patient committed a suicide attempt and AD-emerging switch was observed in 2 patients with N-CCC (2.5%) and in 1 with CCC (4.5%). LIMITATIONS The observational nature of the study, retrospective assessment of course, and unblinded outcomes assessment. CONCLUSIONS Our findings indicate that the presence or absence of a free interval identifies two different forms of bipolar disorders with different response not only to prophylactic treatment, as previously reported, but also to short-term ADs. We submit that clinicians should take into consideration their patients׳ pattern of cycling when prescribing short-term AD treatment. Moreover, subtypes of bipolar disorders might be used as moderators of treatment response in studies assessing the efficacy or the effectiveness of antidepressant treatment.
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Affiliation(s)
| | - Joseph R Calabrese
- Department of Psychiatry, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Tundo A, Calabrese JR, Proietti L, de Filippis R. Short-term antidepressant treatment of bipolar depression: are ISBD recommendations useful in clinical practice? J Affect Disord 2015; 171:155-60. [PMID: 25305430 DOI: 10.1016/j.jad.2014.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/13/2014] [Accepted: 09/18/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed to test the effectiveness of the ISBD Guidelines for short-term AD treatment of BP depression. METHODS The study sample included 255 patients with mood disorders (154 UP, 49 BP-I, 52 BP-II). Response was defined as a HDRS21 total score<7 at 12 weeks of treatment and remission as a ≥50% reduction of baseline HDRS21 total score sustained for 8 weeks. RESULTS Response was achieved by 64.9% of patients with UP disorder, 75.5% of patients with BP-I disorder and 75.0% with BP-II disorder without significant differences (χ²=3.0, p=0.219). The remission rate did not differ significantly among groups (χ²=3.8, p=0.151). The dropout rate was significantly higher for patients with UP (18.2%) than for patients with BP-I (2%) and BP-II (7.7%) disorder (χ²=10.1, p=0.006). Concerning AD safety, one patient with BP-I depression committed a suicide attempt and AD-emerging switch was observed in 2.9% of patients, 2 with BP-I and 1 with BP-II disorder. LIMITATIONS The observational nature of the study and unblinded outcomes assessment. CONCLUSIONS Our findings confirm the usefulness of ISBD Guidelines for short-term AD treatment of BP depression. These patients appear to have similar response and remission rate to those observed in UP depression and do not exhibit significant switch rates or risk of suicide. Our results are limited to patients with pure bipolar depression (excluding those with broadly defined mixed states), treated with ADs-mood stabilizers combination. We suggest to partially modify ISBD Recommendations 1 and 4, to include potential responders and to improve safety.
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Affiliation(s)
| | - Joseph R Calabrese
- Department of Psychiatry, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Harada T, Inada K, Yamada K, Sakamoto K, Ishigooka J. A prospective naturalistic study of antidepressant-induced jitteriness/anxiety syndrome. Neuropsychiatr Dis Treat 2014; 10:2115-21. [PMID: 25419134 PMCID: PMC4235204 DOI: 10.2147/ndt.s70637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients often develop neuropsychiatric symptoms such as anxiety and agitation after they have started taking an antidepressant, and this is thought to be associated with a potentially increased risk of suicide. However, the incidence of antidepressant-induced jitteriness/anxiety syndrome has not been fully investigated, and little has been reported on its predictors. The aim of this study was to survey the incidence of antidepressant-induced jitteriness/anxiety syndrome and clarify its predictors in a natural clinical setting. MATERIALS AND METHODS Between January 2009 and July 2012, we prospectively surveyed 301 patients who had not taken any antidepressants for 1 month before presentation, and who were prescribed antidepressants for 1 month after their initial visit. Patients were classified as developing antidepressant-induced jitteriness/anxiety syndrome if they experienced any symptoms of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, or mania during the first month. RESULTS Among the 301 patients, 21 (7.0%) developed antidepressant-induced jitteriness/anxiety syndrome. Major depressive disorder and a diagnosis of mood disorder in first-degree relatives of patients were significantly associated with induction of antidepressant-induced jitteriness/anxiety syndrome (odds ratio 10.2, P=0.001; odds ratio 4.65, P=0.02; respectively). However, there was no such relationship for sex, age, class of antidepressant, combined use of benzodiazepines, or diagnosis of anxiety disorder. CONCLUSION The findings of this study suggest that major depressive disorder and a diagnosis of mood disorder in first-degree relatives may be clinical predictors of antidepressant-induced jitteriness/anxiety syndrome.
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Affiliation(s)
- Tsuyoto Harada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kazuo Yamada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kaoru Sakamoto
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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