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Huang H, Nissen N, Lim CT, Gören JL, Spottswood M, Huang H. Treating Bipolar Disorder in Primary Care: Diagnosis, Pharmacology, and Management. Int J Gen Med 2022; 15:8299-8314. [PMID: 36447648 PMCID: PMC9701507 DOI: 10.2147/ijgm.s386875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 09/10/2023] Open
Abstract
Bipolar disorder is a chronic mental illness associated with early mortality, elevated risk of comorbid cardiovascular disease, enormous burden of disability, and large societal costs. Patients often seek treatment for symptoms of bipolar disorder in the primary care setting but are frequently misdiagnosed. This article provides primary care providers with an evidence-based approach to the screening, diagnosis, and pharmacological management of bipolar disorder. Guidance is also provided for helping patients connect with higher levels of specialty psychiatric care when clinically indicated.
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Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicholas Nissen
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Christopher T Lim
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jessica L Gören
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- Department of Pharmacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, USA
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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Rong H, Xie XH, Zhao J, Lai WT, Wang MB, Xu D, Liu YH, Guo YY, Xu SX, Deng WF, Yang QF, Xiao L, Zhang YL, He FS, Wang S, Liu TB. Similarly in depression, nuances of gut microbiota: Evidences from a shotgun metagenomics sequencing study on major depressive disorder versus bipolar disorder with current major depressive episode patients. J Psychiatr Res 2019; 113:90-99. [PMID: 30927646 DOI: 10.1016/j.jpsychires.2019.03.017] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND To probe the differences of gut microbiota among major depressive disorder (MDD), bipolar disorder with current major depressive episode (BPD) and health participants. METHODS Thirty one MDD patients, thirty BPD patients, and thirty healthy controls (HCs) were recruited. All the faecal samples were analyzed by shotgun metagenomics sequencing. Except for routine analyses of alpha diversity, we specially designed a new indicator, the Gm coefficient, to evaluate the inequality of relative abundances of microbiota for each participant. RESULTS The Gm coefficients are significant decreased in both MDD and BPD groups. The relative abundances of increased phyla Firmicutes and Actinobacteria and decreased Bacteroidetes were significantly in the MDD and BPD groups. At genus level, four of top five enriched genera (Bacteroides, Clostridium, Bifidobacterium, Oscillibacter and Streptococcus) were found increased significantly in the MDD and BPD groups compared with HCs. The genera Escherichia and Klebsiella showed significant changes in abundances only between the BPD and HC groups. At the species level, compared with BPD patients, MDD patients had a higher abundance of Prevotellaceae including Prevotella denticola F0289, Prevotella intermedia 17, Prevotella ruminicola, and Prevotella intermedia. Furthermore, the abundance of Fusobacteriaceae, Escherichia blattae DSM 4481 and Klebsiella oxytoca were significantly increased, whereas the Bifidobacterium longum subsp. infantis ATCC 15697 = JCM 1222 was significantly reduced in BPD group compared with MDD group. CONCLUSIONS Our study suggested that gut microbiota may be involved in the pathogenesis of both MDD and BPD patients, and the nuances of bacteria may have the potentiality of being the biomarkers of MDD and BPD.
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Affiliation(s)
- Han Rong
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China; Affiliated Shenzhen Clinical College of Psychiatry, Jining Medical University, Jining, Shandong, China
| | - Xin-Hui Xie
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China; Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China; Laboratory of Brain Stimulation and Biological Psychiatry, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Jie Zhao
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Wen-Tao Lai
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Ming-Bang Wang
- Xiamen Branch, Shanghai Key Laboratory of Birth Defects, Division of Neonatology, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, 201102, China
| | - Dan Xu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yang-Hui Liu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yuan-Yuan Guo
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Shu-Xian Xu
- Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Wen-Feng Deng
- Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Qi-Fan Yang
- Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Li Xiao
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Ying-Li Zhang
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | | | - Sheng Wang
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Tie-Bang Liu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.
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Paterniti S, Bisserbe JC. Factors associated with false positives in MDQ screening for bipolar disorder: Insight into the construct validity of the scale. J Affect Disord 2018; 238:79-86. [PMID: 29864713 DOI: 10.1016/j.jad.2018.05.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/29/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Identifying bipolar patients in the first phases of the illness is essential to establish adequate treatment. The goal of this study was to examine the discriminant ability of the Mood Disorders Questionnaire (MDQ) in recognizing bipolar patients referred to a tertiary care structure. METHODS Between 2006 and 2012, we assessed 843 individuals referred to the Mood Disorders Program by family physicians in the community. The Structured Clinical Interview for DSM-IV-TR (SCID) was used to assess diagnoses. A nurse collected the information about lifetime symptoms of (hypo)mania in 759 individuals using the MDQ. Univariate chi-square test and logistic regression were used for the statistical analysis. RESULTS Overall, 86% of the sample had a current anxiety or depressive disorder. When compared to the diagnoses formulated through the SCID, the sensitivity of the MDQ was 75.0%, the specificity was 74%, the positive predictive value was 55%, and the negative predictive value was 88%. Among non-bipolar patients, current post-traumatic stress disorder, borderline personality disorder, current or early remission substance use disorder, and the history of childhood abuse were independently associated with false positive screening using the MDQ. LIMITATIONS Individuals with current substance use disorders were under-represented, whether or not the patients were aware of their diagnosis of bipolar disorder was not recorded, and the history of childhood abuse was collected based on an open interview. CONCLUSIONS The self-rated measure of the symptoms listed by the MDQ seems to measure a dimension shared by both bipolar disorder and other conditions characterized by affective instability and impulsivity.
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Affiliation(s)
- Sabrina Paterniti
- Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Jean-Claude Bisserbe
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Université Paris Est Créteil, Paris, France
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Chang HH, Wang TY, Lee IH, Lee SY, Chen KC, Huang SY, Yang YK, Lu RB, Chen PS. C-reactive protein: A differential biomarker for major depressive disorder and bipolar II disorder. World J Biol Psychiatry 2017; 18:63-70. [PMID: 26895280 DOI: 10.3109/15622975.2016.1155746] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives We aimed to examine whether the C-reactive protein (CRP) level could be used to differentiate between major depressive disorder (MDD) and bipolar II disorder (BD II). Methods Ninety-six healthy controls, 88 BD II and 72 MDD drug-naïve patients in their major depressive episodes were enrolled. The fasting plasma level of high-sensitivity CRP was assessed at baseline and after treatment. Results The BD II patients presented significantly higher 17-item Hamilton Depression Rating Scale (HDRS) scores and CRP levels at baseline when adjustment for age, gender, and body mass index (P < 0.001 and P < 0.001, respectively). After treatment the CRP levels remained significantly different (P < 0.001), although the HDRS score was not significantly different between the BD II and MDD patients. A receiver-operating characteristic analysis showed that a baseline CRP level of 621.6 ng/mL could discriminate between BD II and MDD, with an area under the curve of 0.816 and a sensitivity and specificity of 0.699 and 0.882, respectively. Furthermore, the baseline CRP level greater than 621.6 ng/ml had 28.2 higher odds of a diagnosis of BD II (P < 0.001, 95% confidence interval: 10.96-72.35). Conclusions The level of CRP plays a role of biomarker to differentiate between MDD and BD II depression in both their depressed and euthymic state.
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Affiliation(s)
- Hui Hua Chang
- a Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,b School of Pharmacy, College of Medicine , National Cheng Kung University , Tainan , Taiwan
| | - Tzu-Yun Wang
- c Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - I Hui Lee
- c Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,d Addiction Research Center, National Cheng Kung University , Tainan , Taiwan.,e Department of Psychiatry , National Cheng Kung University Hospital , Dou-Liou Branch , Yunlin, Taiwan
| | - Sheng-Yu Lee
- f Department of Psychiatry , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Kao Chin Chen
- c Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,d Addiction Research Center, National Cheng Kung University , Tainan , Taiwan
| | - San-Yuan Huang
- g Department of Psychiatry , Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
| | - Yen Kuang Yang
- c Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,d Addiction Research Center, National Cheng Kung University , Tainan , Taiwan.,e Department of Psychiatry , National Cheng Kung University Hospital , Dou-Liou Branch , Yunlin, Taiwan.,h Institute of Behavioral Medicine, College of Medicine , National Cheng Kung University , Tainan , Taiwan
| | - Ru-Band Lu
- c Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,d Addiction Research Center, National Cheng Kung University , Tainan , Taiwan
| | - Po See Chen
- c Department of Psychiatry , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,d Addiction Research Center, National Cheng Kung University , Tainan , Taiwan
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Qiu F, Akiskal HS, Kelsoe JR, Greenwood TA. Factor analysis of temperament and personality traits in bipolar patients: Correlates with comorbidity and disorder severity. J Affect Disord 2017; 207:282-290. [PMID: 27741464 PMCID: PMC5107122 DOI: 10.1016/j.jad.2016.08.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/07/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Temperament and personality traits have been suggested as endophenotypes for bipolar disorder based on several lines of evidence, including heritability. Previous work suggested an anxious-reactive factor identified across temperament and personality inventories that produced significant group discrimination and could potentially be useful in genetic analyses. We have attempted to further characterize this factor structure in a sample of bipolar patients. METHODS A sample of 1195 subjects with bipolar I disorder was evaluated, all with complete data available. Dimension reduction across two inventories identified 18 factors explaining 39% of the variance. RESULTS The two largest factors reflected affective instability and general anxiety/worry, respectively. Subsequent analyses of the clinical features associated with bipolar disorder revealed specificity for the factors in a predictable pattern. Cluster analysis of the factors identified a subgroup defined by a strong lack of general anxiety and low affective instability represented by the first two factors. The remaining subjects could be distinguished into two clusters by the presence of either more positive characteristics, including persistence/drive, spirituality, expressivity, and humor, or more negative characteristics of depression and anxiety. LIMITATIONS These analyses involved bipolar I subjects only and must be extended to other bipolar spectrum diagnoses, unaffected relatives, and individuals at risk. CONCLUSIONS These results suggest that temperament and personality measures access latent traits associated with important clinical features of bipolar disorder. By translating clinical variables into quantitative traits, we may identify subgroups of bipolar patients with distinct clinical profiles, thereby facilitating both individual treatment strategies and genetic analyses.
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Affiliation(s)
- Frank Qiu
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | | | - Hagop S. Akiskal
- Department of Psychiatry, University of California San Diego, La Jolla, CA,San Diego Veterans Affairs Healthcare System, San Diego, CA,International Mood Center, La Jolla, CA
| | - John R. Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA,San Diego Veterans Affairs Healthcare System, San Diego, CA,Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA
| | - Tiffany A. Greenwood
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Address correspondence to: Tiffany A. Greenwood, Ph.D. Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC 0689, La Jolla, CA 92093, Phone: 858-246-1897,
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Stubbs B, Vancampfort D, Solmi M, Veronese N, Fornaro M. How common is bipolar disorder in general primary care attendees? A systematic review and meta-analysis investigating prevalence determined according to structured clinical assessments. Aust N Z J Psychiatry 2016; 50:631-9. [PMID: 26764372 DOI: 10.1177/0004867415623857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There are mounting calls for bipolar disorder to be managed in primary care, yet the exact prevalence remains unclear. We conducted a meta-analysis to investigate the prevalence of bipolar disorder in general primary care attendees without other comorbid psychiatric diagnosis. METHOD We systematically searched major electronic databases from inception till 03/2015. Articles were included that reported the prevalence of bipolar disorder determined in line with structured clinical assessment in primary care settings. Two independent authors conducted searches, completed methodological appraisal and extracted data. A random effects meta-analysis and meta-regression were performed. RESULTS Sixteen studies were included accounting for 425,691 participants (mean age = 41.1 years [standard deviation = 7.2 years] 33.3% males). Overall, the global prevalence of bipolar disorder was 1.9% (95% confidence interval = [0.6, 5.4]). The prevalence of bipolar disorder in studies recording a current diagnosis was 3.7% (95% confidence interval = [1.9, 6.0]) and 0.7% (95% confidence interval = [0.2, 1.5]) in studies considering a 12-month period. A diagnosis of bipolar disorder appeared higher in North America (3.7%, 95% confidence interval = [0.9, 8.1]) compared to Europe (0.8%, 95% confidence interval = [0.3, 1.5]). Meta-regression suggests that a more recent publication date (co-efficient = 0.089, 95% confidence interval = [0.0173, 0.1654], z = 2.19, p = 0.01, R(2) = 0.21) and younger age of participants (co-efficient -0.0851, 95% confidence interval = [-0.1696, 0.005], z = -1.97, p = 0.04, R(2) = 0.24) moderated a higher prevalence of bipolar disorder. CONCLUSION The global prevalence of bipolar disorder in primary care is 1.9%, with potentially higher prevalence rates in North America compared to Europe. A more recent study publication date is a significant predictor of higher prevalence of bipolar disorder. Potential reasons/drivers of this are considered within the text.
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Affiliation(s)
- Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK Physiotherapy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Davy Vancampfort
- UPC KU Leuven, Department of Neurosciences, KU Leuven, Kortenberg, Belgium Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Padova, Padova, Italy
| | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
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Loebel A, Xu J, Hsu J, Cucchiaro J, Pikalov A. The development of lurasidone for bipolar depression. Ann N Y Acad Sci 2016; 1358:95-104. [PMID: 26771990 DOI: 10.1111/nyas.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Bipolar disorder is a chronic, recurrent illness that ranks among the top 10 causes of disability in the developed world. As the illness progresses, major depressive episodes increasingly predominate. However, few treatment options are available that have demonstrated efficacy in the treatment of bipolar depression, either as monotherapy or adjunctive therapy in combination with mood stabilizers. Lurasidone is an atypical antipsychotic drug that was initially developed for the treatment of schizophrenia. Since no previous atypical antipsychotic development program had proceeded directly from work on schizophrenia to bipolar depression, the decision to focus on this indication represented an innovation in central nervous system drug development and was designed to address a clinically significant unmet need. The current review summarizes key results of a clinical development program undertaken to characterize the efficacy and safety of lurasidone in patients diagnosed with bipolar depression. Lurasidone is currently the only treatment for bipolar depression approved in the United States as both a monotherapy and an adjunctive therapy with lithium or valproate. The approval of lurasidone expands available treatment options for patients with bipolar depression and provides a therapy with an overall favorable risk-benefit profile.
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Affiliation(s)
- Antony Loebel
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Jane Xu
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Jay Hsu
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Josephine Cucchiaro
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
| | - Andrei Pikalov
- Sunovion Pharmaceuticals Inc., Fort Lee, New Jersey, and Marlborough, Massachusetts
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