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Dempsey RC, Dodd AL, Gooding PA, Jones SH. The Types of Psychosocial Factors Associated with Suicidality Outcomes for People Living with Bipolar Disorder: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:525. [PMID: 38791740 PMCID: PMC11120682 DOI: 10.3390/ijerph21050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Bipolar Disorder is associated with high rates of suicidal thoughts, behaviors, and outcomes, yet the lived experience of suicidality and Bipolar Disorder is not particularly well understood. Understanding the role of psychosocial aetiologies in suicidality outcomes for those living with Bipolar Disorder is key for developing appropriately targeted interventions focusing on factors that are amenable to change. In line with PRISMA guidance, we conducted a scoping review to identify the types of psychosocial factors studied in relation to the experience of suicidality for people living with Bipolar Disorder diagnoses. Systematic literature searches identified a sample of 166 articles from which key study data were extracted and charted. A narrative synthesis of the reviewed literature is presented ordered by the factors investigated across studies, a frequency count of the types of psychological/social aetiologies studied, and a brief overview of the key findings for each aetiology. Most of the identified literature took the form of quantitative cross-sectional studies, with only one qualitative study and 18 quantitative prospective studies. The most studied aetiologies were trauma (specifically early adverse experiences and childhood traumas) and stressful life events, impulsivity (primarily subjective self-reported trait impulsivity), social support and functioning, and personality/temperament factors. Only six studies in the final sample reported basing their research questions and/or hypotheses on an explicit theoretical model of suicide. The literature was primarily focused on using self-report measurements of key aetiologies and on factors which lead to worsened suicidality rather than focusing on potentially protective or buffering factors. Future research needs to better justify the aetiologies investigated in relation to suicidality outcomes for people living with Bipolar Disorder, including a firmer basis in theory and hypothesis testing, more prospective designs, and the use of alternative assessments of psychosocial aetiologies in addition to self-report questionnaires.
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Affiliation(s)
- Robert C. Dempsey
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Alyson L. Dodd
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Patricia A. Gooding
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Steven H. Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
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Xiao Z, Obsuth I, Meinck F, Murray AL. Relations between childhood psychological maltreatment and mental health dimensions within a higher-order model. Int J Clin Health Psychol 2024; 24:100416. [PMID: 37822450 PMCID: PMC10563048 DOI: 10.1016/j.ijchp.2023.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Background Experiences of childhood psychological maltreatment have been found to be associated with various mental health outcomes, and this association persists into adulthood. Objective This study investigated whether some types of psychological maltreatment are more harmful than others; whether the harms associated with different types of psychological maltreatment are generalized or specific to particular domains of psychopathology; and whether the associations vary by gender. Method Participants (N = 544, 63.9 % mother as primary caregiver) were Chinese adults from various regions in China. Participants completed measures of childhood psychological maltreatment experiences perpetrated by their primary caregiver and the mental health outcomes of depression, anxiety, anger, physical aggression, and hostility. The data were analyzed in a hierarchical model in which depression and anxiety were defined as indicators of an internalizing factor, while anger, physical aggression, and hostility were defined as indicators of an externalizing factor. Internalizing and externalizing then defined a higher-order general psychopathology factor. The results suggested equivalent harms of psychological abuse and psychological neglect. Further, the associations between psychological maltreatment and mental health were not unique to specific symptom domains but showed broadband associations with general psychopathology. Results These findings suggest that trans-diagnostic interventions may be the most effective approach for addressing the mental health impacts of psychological maltreatment. Conclusion Childhood psychological maltreatment may pose a broadband risk for any and all forms of psychopathology.
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Affiliation(s)
- Zhuoni Xiao
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ingrid Obsuth
- Clinical & Health Psychology, University of Edinburgh, Edinburgh, UK
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Sultan AA, Mio M, Dimick MK, Zou Y, Karthikeyan S, Kolla N, Lanctot K, Zack M, Goldstein BI. Association of cannabis use with neurocognition in adolescents with bipolar disorder. J Psychopharmacol 2023; 37:920-927. [PMID: 37497695 DOI: 10.1177/02698811231187128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Bipolar disorder (BD) and cannabis use are each associated with neurocognitive deficits in adolescents. However, little is known regarding the association of neurocognition with cannabis use among adolescents with BD. Therefore, we examined this topic in a sample of adolescents with BD and healthy control (HC) adolescents. METHODS Participants included 121 adolescents (n = 32 with BD and lifetime cannabis use (BDCB+), n = 31 with BD and no lifetime cannabis use (BDCB-), n = 58 HC with no lifetime cannabis use), aged 14-20 years. Five neurocognitive subtests of the computerized CANTAB battery were assessed. Groups were compared using an analysis of covariance (ANCOVA) covarying for age, sex, and intelligence quotient. RESULTS The three groups differed significantly on tests of visuospatial working memory (F = 4.41, p = 0.014, η p 2 = 0 . 07 ) and sustained attention (F = 5.15, p = 0.007, η p 2 = 0 . 08 ). Post hoc analyses revealed working memory scores were significantly worse in BDCB+ versus HC (p = 0.04, d = 0.59), and sustained attention was significantly worse in BDCB- versus HC (p = 0.006, d = 0.70). CONCLUSION These preliminary findings suggest that cannabis use among adolescents with BD is associated with working memory deficits. Future studies in larger samples are warranted to evaluate causation versus predisposition to cannabis use, and to evaluate duration, quantity, and potency of cannabis on neurocognition among adolescents with BD.
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Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Nathan Kolla
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Krista Lanctot
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Martin Zack
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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Miola A, Fountoulakis KN, Baldessarini RJ, Veldic M, Solmi M, Rasgon N, Ozerdem A, Perugi G, Frye MA, Preti A. Prevalence and outcomes of rapid cycling bipolar disorder: Mixed method systematic meta-review. J Psychiatr Res 2023; 164:404-415. [PMID: 37429185 DOI: 10.1016/j.jpsychires.2023.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
Rapid-cycling in bipolar disorder (RC-BD) is associated with greater illness morbidity and inferior treatment response but many aspects remain unclear, prompting this systematic review of its definitions, prevalence, and clinical characteristics. We searched multiple literature databases through April 2022 for systematic reviews or meta-analyses on RC-BD and extracted associated definitions, prevalence, risk-factors, and clinical outcomes. We assessed study quality (NIH Quality Assessment Tool) and levels of evidence (Oxford criteria). Of 146 identified reviews, 22 fulfilling selection criteria were included, yielding 30 studies involving 13,698 BD patients, of whom 3777 (27.6% [CI: 26.8-28.3]) were considered RC-BD, as defined in 14 reports by ≥4 recurrences/year within the past 12 months or in any year, without considering responsiveness to treatment. Random-effects meta-analytically pooled one-year prevalence was 22.3% [CI: 14.4-32.9] in 12 reports and lifetime prevalence was 35.5% [27.6-44.3] in 18 heterogenous reports. Meta-regression indicated greater lifetime prevalence of RC-BD among women than men (p=0.003). Association of RC-BD with suicide attempts, and unsatisfactory response to mood-stabilizers was supported by strong evidence (Level 1); associations with childhood maltreatment, mixed-features, female sex, and type-II BD had moderate evidence (Level 2). Other factors: genetic predisposition, metabolic disturbances or hypothyroidism, antidepressant exposure, predominant depressive polarity (Level 3), along with greater illness duration and immune-inflammatory dysfunction (Level 4) require further study. RC-BD was consistently recognized as having high prevalence (22.3%-35.5% of BD cases) and inferior treatment response. Identified associated factors can inform clinical practice. Long-term illness-course, metabolic factors, and optimal treatment require further investigation.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience, University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA.
| | - Konstantinos N Fountoulakis
- Department of Psychiatry III, School of Medicine Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Natalie Rasgon
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Giulio Perugi
- Psychiatry Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Antonio Preti
- Department of Neuroscience, University of Turin, via Cherasco 15, 10126, Turin, Italy; Eating Disorders Center, Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Characteristics of rapid cycling in 1261 bipolar disorder patients. Int J Bipolar Disord 2023; 11:21. [PMID: 37271762 DOI: 10.1186/s40345-023-00300-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Rapid-cycling (RC; ≥ 4 episodes/year) in bipolar disorder (BD) has been recognized since the 1970s and associated with inferior treatment response. However, associations of single years of RC with overall cycling rate, long-term morbidity, and diagnostic subtypes are not clear. RESULTS We compared descriptive and clinical characteristics in 1261 BD patients with/without RC, based on history and prospective follow-up for several years. RC in any previous year was identified in 9.36% of BD subjects (3.74% in BD1, 15.2% BD2), and somewhat more among women than men. RC-BD subjects had 3.21-fold greater average prospective annual rates of recurrence but not hospitalizations, had less difference in %-time-ill, received more mood-stabilizing treatments, and had greater suicidal risk, lacked familial psychiatric illnesses, had more cyclothymic temperament, were more likely to be married, had more siblings and children, experienced early sexual abuse, but were less likely to abuse drugs (not alcohol) or smoke. In multivariable regression modeling, older age, mood-switching with antidepressants, and BD2 > BD1 diagnosis, as well as more episodes/year were independently associated with RC. Notably, prospective mean recurrence rates were below 4/year in 79.5% of previously RC patients, and below 2/year in 48.1%. CONCLUSIONS Lifetime risk of RC in BD was 9.36%, more likely in women, with older age, and in BD2 > BD1. With RC, recurrence rates were much higher, especially for depression with less effect on %-time ill, suggesting shorter episodes. Variable associations with unfavorable outcomes and prospective recurrence rates well below 4/year in most previously RC patients indicate that RC was not a sustained characteristic and probably was associated with use of antidepressants.
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Affiliation(s)
- Alessandro Miola
- Department of Psychiatry, University of Padova, Padua, Italy
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA.
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy.
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | - Marco Pinna
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
- Section on Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
- Section on Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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6
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Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:299-311. [PMID: 35711159 PMCID: PMC10192829 DOI: 10.1177/07067437221099769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Given the increasing acceptability and legalization of cannabis in some jurisdictions, clinicians need to improve their understanding of the effect of cannabis use on mood disorders. OBJECTIVE The purpose of this task force report is to examine the association between cannabis use and incidence, presentation, course and treatment of bipolar disorder and major depressive disorder, and the treatment of comorbid cannabis use disorder. METHODS We conducted a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from inception to October 2020 focusing on cannabis use and bipolar disorder or major depressive disorder, and treatment of comorbid cannabis use disorder. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence and clinical considerations were integrated to generate Canadian Network for Mood and Anxiety Treatments recommendations. RESULTS Of 12,691 publications, 56 met the criteria: 23 on bipolar disorder, 21 on major depressive disorder, 11 on both diagnoses and 1 on treatment of comorbid cannabis use disorder and major depressive disorder. Of 2,479,640 participants, 12,502 were comparison participants, 73,891 had bipolar disorder and 408,223 major depressive disorder without cannabis use. Of those with cannabis use, 2,761 had bipolar disorder and 5,044 major depressive disorder. The lifetime prevalence of cannabis use was 52%-71% and 6%-50% in bipolar disorder and major depressive disorder, respectively. Cannabis use was associated with worsening course and symptoms of both mood disorders, with more consistent associations in bipolar disorder than major depressive disorder: increased severity of depressive, manic and psychotic symptoms in bipolar disorder and depressive symptoms in major depressive disorder. Cannabis use was associated with increased suicidality and decreased functioning in both bipolar disorder and major depressive disorder. Treatment of comorbid cannabis use disorder and major depressive disorder did not show significant results. CONCLUSION The data indicate that cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder. Future studies should include more accurate determinations of type, amount and frequency of cannabis use and select comparison groups which allow to control for underlying common factors.
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Affiliation(s)
- Smadar V. Tourjman
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Gabriella Buck
- Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | - Atul Khullar
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Shane McInerney
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jairo V. Pinto
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephane Potvin
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | | | - Benicio N. Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Arun Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Bassir Nia A, Weleff J, Fogelman N, Nourbakhsh S, Sinha R. Regular cannabis use is associated with history of childhood and lifetime trauma in a non-clinical community sample. J Psychiatr Res 2023; 159:159-164. [PMID: 36736285 PMCID: PMC10024801 DOI: 10.1016/j.jpsychires.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
Higher rate of substance use, including cannabis, has been reported in individuals with a history of childhood trauma, but less is known about the association between cannabis use with lifetime history of trauma and chronic stress, and potential gender differences in this association. This study systematically examined this association in a cross-sectional study of 841 individuals recruited between 2007 and 2012 from the community in New Haven, Connecticut. The Cumulative Adversity Index (CAI) was used to measure cumulative lifetime major life events, life trauma, and recent life events and chronic stress. Childhood Trauma Questionnaire (CTQ) was used to measure childhood trauma. Current and regular use of drugs were assessed using self-report questionnaires and objectively verified with urine drug testing. Higher rates of childhood trauma as well as lifetime trauma, and major life events were found in cannabis users, compared to non-users. The association between cannabis use with childhood trauma (total CTQ scores) was significant after controlling for age, gender, ethnicity and regular use of alcohol or cocaine. In logistic regression analysis, cannabis use had a significant positive association with major life events and lifetime trauma, but not with chronic stress, controlling for confounding factors including age, gender, ethnicity, and regular use of alcohol and cocaine. When analyzed separately, only in women the association between cannabis use and childhood trauma was significant. These associations point to further assessment of the impact of these gender differences on neurobiology of stress and cannabis misuse risk.
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Affiliation(s)
- Anahita Bassir Nia
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychiatry and Psychology, Cleveland Clinic, United States.
| | - Nia Fogelman
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Sormeh Nourbakhsh
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, United States
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8
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Yamagishi M, Satomura Y, Sakurada H, Kanehara A, Sakakibara E, Okada N, Koike S, Yagishita S, Ichihashi K, Kondo S, Jinde S, Fukuda M, Kasai K. Retrospective chart review-based assessment scale for adverse childhood events and experiences. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e58. [PMID: 38868652 PMCID: PMC11114386 DOI: 10.1002/pcn5.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 06/14/2024]
Abstract
Aim Adverse childhood experiences (ACEs) are highly prevalent in the general population, and their lifelong impact on physical and mental health is profound. In assessing ACEs, it is vital to consider the pathways and modalities by which an individual internalizes events as an adverse experience and its effects on their biological, psychological, and social function. However, conventional assessments of ACEs are inadequate in that they do not comprehensively assess the source of the adverse event and the pathway and mode of its impact on the individual. Methods This study developed an original scale for ACEs that classifies the source of the event and the pathway and mode of its impact on the individual from a retrospective review of medical charts. We also used this scale to investigate the ACEs in 536 patients with psychiatric disorders (depression, bipolar disorder, and schizophrenia). Results This scale consisted of 28 items, and its reliability and validity were sufficient. We also found that 45.9% of the patients studied had at least one ACE, ranging from 43.5% to 51.5% for all disorders. Psychological trauma (bullying) from peers was the most common cause at 27.2%. Conclusion We developed a retrospective chart review-based assessment tool for ACEs which enables the examination of the source of the events of ACEs and the pathways and modalities of their impact on the individual. The frequency of ACEs is high regardless of the type of psychiatric disorder, and horizontal trauma (bullying victimization) is as frequent as vertical trauma (parental maltreatment).
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Affiliation(s)
- Mika Yamagishi
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshihiro Satomura
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
- Center for Diversity in Medical Education & Research, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hanako Sakurada
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Eisuke Sakakibara
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Naohiro Okada
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
- The International Research Center for NeurointelligenceThe University of Tokyo Institutes for Advanced StudyTokyoJapan
| | - Shinsuke Koike
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
- The International Research Center for NeurointelligenceThe University of Tokyo Institutes for Advanced StudyTokyoJapan
- University of Tokyo Institute for Diversity and Adaptation of Human MindThe University of TokyoTokyoJapan
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and SciencesThe University of TokyoTokyoJapan
| | - Sho Yagishita
- Department of Structural Physiology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shinsuke Kondo
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Seiichiro Jinde
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masato Fukuda
- Department of Psychiatry and NeuroscienceGunma University Graduate School of MedicineMaebashiJapan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
- Center for Diversity in Medical Education & Research, Graduate School of MedicineThe University of TokyoTokyoJapan
- The International Research Center for NeurointelligenceThe University of Tokyo Institutes for Advanced StudyTokyoJapan
- University of Tokyo Institute for Diversity and Adaptation of Human MindThe University of TokyoTokyoJapan
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9
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Bolton S, Joyce DW, Gordon-Smith K, Jones L, Jones I, Geddes J, Saunders KEA. Psychosocial markers of age at onset in bipolar disorder: a machine learning approach. BJPsych Open 2022; 8:e133. [PMID: 35844202 PMCID: PMC9344222 DOI: 10.1192/bjo.2022.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown. AIMS We aim to identify psychosocial factors associated with bipolar disorder AAO. METHOD Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure. RESULTS We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = -0.2855), regular cannabis use in the year before onset (β = -0.2765), death of a close family friend or relative in the 6 months before onset (β = -0.2435), family history of suicide (β = -0.1385), schizotypal personality traits (β = -0.1055) and irritable temperament (β = -0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575). CONCLUSIONS The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.
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Affiliation(s)
- Sorcha Bolton
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK
| | - Dan W Joyce
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | | | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
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10
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Hjelseng IV, Vaskinn A, Ueland T, Lunding SH, Reponen EJ, Steen NE, Andreassen OA, Aas M. Childhood trauma is associated with poorer social functioning in severe mental disorders both during an active illness phase and in remission. Schizophr Res 2022; 243:241-246. [PMID: 32222348 DOI: 10.1016/j.schres.2020.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired social functioning is a core feature of schizophrenia spectrum (SZS) and bipolar spectrum disorders (BDS). Childhood traumatic events are more frequent in SZS and BDS than in healthy individuals (HC), and could represent a cumulative risk for reduced social functioning beyond experiencing ongoing clinical symptoms. METHODS The study comprised 1039 individuals (SZS [n = 348]; BDS [n = 262], and HC [n = 429]). Childhood trauma and level of social functioning was assessed by the Childhood Trauma Questionnaire (CTQ) and the Social Functioning Scale (SFS), respectively. Diagnosis was obtained by the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). RESULTS Patients had poorer social functioning (F = 819.18, p ˂ 0.001, Cohen's d = 0.44) and reported more childhood trauma experiences than HC (X2 = 289.0, p < .001) than HC. Patients with at least one moderate to severe trauma had poorer social functioning than patients without childhood trauma (F = 8.16, p = .004, Cohen's d = 0.17). Within the patients, a cumulative relationship was observed in that more severe childhood trauma was associated with lower social functioning (F = 2.65, p = .02, Cohen's d = 0.20). No significant associations were observed for having at least one moderate to severe trauma or cumulative traumas on social functioning in the HC. Follow-up analysis showed that patients in remission childhood trauma also had poorer social functioning. CONCLUSION Patients who reported childhood trauma experiences had poorer social functioning both during an active illness phase and in remission.
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Affiliation(s)
- Ingrid Varvin Hjelseng
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Copenhagen, Denmark
| | - Anja Vaskinn
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Copenhagen, Denmark; Department of Psychology, University of Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elina J Reponen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Monica Aas
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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11
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Congio AC, Rossaneis AC, Verri WA, Urbano MR, Nunes SOV. Childhood trauma, interleukin-17, C-reactive protein, metabolism, and psychosocial functioning in bipolar depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Grillault Laroche D, Godin O, Belzeaux R, M'Bailara K, Loftus J, Courtet P, Dubertret C, Haffen E, Llorca PM, Olie E, Passerieux C, Polosan M, Schwan R, Leboyer M, Bellivier F, Marie-Claire C, Etain B. Association between childhood maltreatment and the clinical course of bipolar disorders: A survival analysis of mood recurrences. Acta Psychiatr Scand 2022; 145:373-383. [PMID: 35080248 DOI: 10.1111/acps.13401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Childhood maltreatment, also referred as childhood trauma, increases the severity of bipolar disorders (BD). Childhood maltreatment has been associated with more frequent mood recurrences, however, mostly in retrospective studies. Since scarce, further prospective studies are required to identify whether childhood maltreatment may be associated with the time to recurrence in BD. METHODS Individuals with BD (N = 2008) were assessed clinically and for childhood maltreatment at baseline, and followed up for two years. The cumulative probability of mood recurrence over time was estimated with the Turnbull's extension of the Kaplan-Meier analysis for interval-censored data, including childhood maltreatment as a whole, and then maltreatment subtypes as predictors. Analyses were adjusted for potential confounding factors. RESULTS The median duration of follow-up was 22.3 months (IQR:12.0-24.8). Univariable analyses showed associations between childhood maltreatment, in particular all types of abuses (emotional, physical, and sexual) or emotional neglect, and a shorter time to recurrence (all p < 0.001). When including potential confounders into the multivariable models, the time to mood recurrence was associated with multiple/severe childhood maltreatment (i.e., total score above the 75th percentile) (HR = 1.32 95%CI (1.11-1.57), p = 0.002), and more specifically with moderate/severe physical abuse (HR = 1.44 95%CI(1.21-1.73), p < 0.0001). Living alone, lifetime anxiety disorders, lifetime number of mood episodes, baseline depressive and (hypo)manic symptoms, and baseline use of atypical antipsychotics were also associated with the time to recurrence. CONCLUSIONS In addition to typical predictors of mood recurrences, an exposure to multiple/severe forms of childhood maltreatment, and more specifically to moderate to severe physical abuse, may increase the risk for a mood recurrence in BD. This leads to the recommendations of more scrutiny and denser follow-up of the individuals having been exposed to such early-life stressors.
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Affiliation(s)
- Diane Grillault Laroche
- AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France
| | - Ophélia Godin
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry laboratory, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France.,Fondation FondaMental, Créteil, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Katia M'Bailara
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, Bordeaux, France.,Université de Bordeaux, Centre Hospitalier Charles Perrens, Laboratoire NutriNeuro (UMR INRA 1286), Université de Bordeaux, Bordeaux, France
| | - Joséphine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,Université de Paris, Paris, France.,AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France.,Université de Paris, Inserm UMR1266, Sorbonne Paris Cité, Faculté de Médecine, France
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie Clinique, CIC-1431 INSERM, CHU de Besançon, Besançon, France.,EA481 Neurosciences, Université Bourgogne Franche-Comté, Besançon, France
| | - Pierre Michel Llorca
- Fondation FondaMental, Créteil, France.,Centre Hospitalier et Universitaire, Département de Psychiatrie, Clermont-Ferrand, France.,Université d'Auvergne, Clermont-Ferrand, France
| | - Emilie Olie
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'adulte et d'addictologie, Le Chesnay, France.,Equipe « PsyDev », CESP, Université Versailles Saint-Quentin-en-Yvelines - Paris-Saclay, Inserm, Villejuif, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France
| | - Raymund Schwan
- Fondation FondaMental, Créteil, France.,Université de Lorraine, Centre Psychothérapique de Nancy, Inserm U1114, Nancy, France
| | | | - Marion Leboyer
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry laboratory, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France.,Fondation FondaMental, Créteil, France
| | - Frank Bellivier
- AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France.,Fondation FondaMental, Créteil, France.,Université de Paris, Paris, France
| | - Cynthia Marie-Claire
- Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France
| | - Bruno Etain
- AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France.,Fondation FondaMental, Créteil, France.,Université de Paris, Paris, France
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13
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Grillault Laroche D, Godin O, Dansou Y, Belzeaux R, Aouizerate B, Burté T, Courtet P, Dubertret C, Haffen E, Llorca P, Olie E, Roux P, Polosan M, Schwan R, Leboyer M, Bellivier F, Marie-Claire C, Etain B. Influence of childhood maltreatment on prevalence, onset and persistence of psychiatric comorbidities and suicide attempts in bipolar disorders. Eur Psychiatry 2022; 65:e15. [PMID: 35060460 PMCID: PMC8853858 DOI: 10.1192/j.eurpsy.2022.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusions
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14
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Gerhardt S, Eidenmueller K, Hoffmann S, Bekier NK, Bach P, Hermann D, Koopmann A, Sommer WH, Kiefer F, Vollstädt-Klein S. A History of Childhood Maltreatment Has Substance- and Sex-Specific Effects on Craving During Treatment for Substance Use Disorders. Front Psychiatry 2022; 13:866019. [PMID: 35492729 PMCID: PMC9046680 DOI: 10.3389/fpsyt.2022.866019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
RATIONALE Childhood maltreatment (CM) leads to detrimental mental health outcomes, such as substance use disorders (SUD). This study examined prevalence and severity of all five types of CM with respect to specific substances and sex in treatment-seeking individuals with SUD. The influences of type of CM and symptoms of depressiveness, anxiety, and perceived stress on substance craving at admission as well as craving reduction during SUD treatment were examined. METHODS N = 546 patients in treatment for SUD and N = 109 individuals in opioid maintenance treatment filled out questionnaires regarding CM (Childhood Trauma Questionnaire) and psychopathologies. Substance craving was assessed throughout treatment using the Mannheim Craving Scale. Group differences in CM, type of substance and sex were examined. General linear models were applied to examine influences on substance craving. RESULTS Higher prevalence and severity of all five subtypes of CM were observed in individuals with SUD compared to the general population. Women were more severely affected by emotional and sexual abuse than men. Patients with cannabis use disorder reported more severe experiences of emotional abuse compared to all other substances. Craving at admission to treatment was influenced by emotional abuse, however, symptoms of depressiveness, anxiety, and perceived stress contributed to craving at admission or craving reduction during treatment. CONCLUSION CM relates to SUD and should be incorporated in prevention and treatment of SUD. Underlying mechanisms of the association might relate to impairments in processing and regulation of stress, emotions, and interpersonal relations following a history of CM.
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Eidenmueller
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina K Bekier
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Derik Hermann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Therapieverbund Ludwigsmühle gGmbH, Landau, Germany
| | - Anne Koopmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang H Sommer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Institute for Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Bethania Hospital for Psychiatry, Psychosomatics, and Psychotherapy, Greifswald, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center of Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center of Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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15
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Olgiati P, Serretti A. Post-traumatic stress disorder and childhood emotional abuse are markers of subthreshold bipolarity and worse treatment outcome in major depressive disorder. Int Clin Psychopharmacol 2022; 37:1-8. [PMID: 34686642 PMCID: PMC9648980 DOI: 10.1097/yic.0000000000000380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
Post-traumatic stress disorder (PTSD) and childhood maltreatment (CMT: parental neglect; emotional, physical and sexual abuse) have been linked to bipolar disorder but they are also common in major depressive disorder (MDD). Our objective was to investigate their association with the bipolar spectrum and antidepressant treatment outcome in 482 outpatients with DSM-IV MDD treated in the Combining Medications to Enhance Depression Outcomes trial for 28 weeks Bipolar spectrum score included age of onset <21 years, subthreshold hypomania (a period of elated or irritable mood with at least two concurrent hypomanic symptoms, which did not fulfill DSM criteria for hypomanic/manic episode) and depressive mixed state (DMX). PTSD subjects (n = 107; 22%) had more severe depression (P < 0.0001), work and social impairment (P = 0.0031), comorbid anxiety disorders (P < 0.0001) and increased suicidality (P = 0.0003). Bipolar spectrum score was higher with PTSD comorbidity (P = 0.0063) and childhood emotional abuse (P = 0.0001). PTSD comorbidity was associated with residual suicidality (P = 0.0218) after 6 weeks of antidepressant use whereas childhood emotional abuse [odds ratio (OR), 1.01-2.22], subthreshold hypomania (OR, 1.04-4.09) and DMX (OR, 1.00-4.19) were predictors of mood switch. These results corroborate the role of PTSD and childhood emotional abuse as markers of bipolar spectrum and prognostic factors during antidepressant treatment.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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16
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Abstract
In this chapter, we will focus on childhood maltreatment and its role in the vulnerability to BD.We will review how childhood maltreatment and trauma not only predispose to the development of BD but also to a more unstable, pernicious, and severe clinical expression of the disorder. This environmental risk factor is suggested to be part of a multiple hit model of vulnerability, involving not only early stressors (prenatal and postnatal ones) but also interactions with the genetic background of individuals and with other stressors occurring later in life. We will also review how childhood maltreatment and trauma may modify the brain functioning and circuits and alter some biological pathways in BD, hence leading to psychopathology. Finally, we will briefly discuss the implications for clinical practice and treatment.
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Affiliation(s)
- Bruno Etain
- Université de Paris, Paris, France.
- INSERM U1144, Faculté de Pharmacie de Paris, Université de Paris, Paris, France.
- Assistance Publique des Hôpitaux de Paris P-HP, GHU Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.
| | - Monica Aas
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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17
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Immature defense mechanisms mediate the relationship between childhood trauma and onset of bipolar disorder. J Affect Disord 2021; 278:672-677. [PMID: 33125910 DOI: 10.1016/j.jad.2020.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accumulating evidence has converged to suggest that childhood trauma may contribute to bipolar disorder (BD). This study aimed to investigate the patterns of childhood trauma among patients with bipolar I (BD-I) and bipolar II (BD-II) disorders, according to DSM-IV and in contrast with healthy volunteers. We also explored whether the relationship between childhood trauma and onset of bipolar disorder is mediated by immature defense mechanisms. METHODS Participants were patients with BD-I (n=44) and BD-II (n = 42), and healthy controls (HCs, n = 43). Childhood traumatic experiences and defense mechanisms were assessed by the Childhood Trauma Questionnaire (CTQ) and the Defense Style Questionnaire (DSQ), respectively. RESULTS BD patients experienced more severe childhood trauma than HCs. Physical neglect sub-score and total score of the CTQ had both direct and indirect effects on the diagnosis of BD-I, and an immature defense style mediated the indirect effects. The diagnosis of BD-II was mainly related to the physical neglect and emotional abuse subs-core and total score of the CTQ, as mediated by the immature defense mechanisms. BD-I and BD-II significantly differed in the emotional abuse sub-score of the CTQ. CONCLUSIONS Physical neglect sub-score and total score of the CTQ were associated with the diagnosis of BD (both BD-I and BD-II), as mediated by an immature defense style. Furthermore, emotional abuse might be an important risk factor for BD-II compared to BD-I. These findings may inform risk reduction and psychosocial intervention strategies to prevent and treat patients with bipolar disorders.
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18
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Lagerberg TV, Icick R, Aminoff SR, Nerhus M, Barrett EA, Bjella TD, Olsen SH, Høegh MC, Melle I. Substance Misuse Trajectories and Risk of Relapse in the Early Course of Bipolar Disorder. Front Psychiatry 2021; 12:656912. [PMID: 34017275 PMCID: PMC8129526 DOI: 10.3389/fpsyt.2021.656912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/07/2021] [Indexed: 01/14/2023] Open
Abstract
Substance misuse is highly prevalent in bipolar disorder even in the early illness phases. However, the trajectories of misuse of different substances after treatment initiation is not well-studied. Also, knowledge on how substance misuse trajectories influence the early course of bipolar disorder is limited. We recruited 220 individuals in first treatment of bipolar disorder of which 112 participated in a 1-year follow-up study at the NORMENT center in Oslo, Norway. Misuse was defined as having scores above cut-off for harmful use on the Alcohol or Drug Use Disorders Identification Tests (AUDIT or DUDIT). We investigated rates of stopping and continuing misuse of alcohol, cannabis and other illicit substances and daily nicotine use over the follow-up period, and whether such misuse trajectories predicted the risk for affective relapse. The prevalence of cannabis misuse was reduced from 29 to 15% and alcohol misuse was reduced from 39 to 21% during follow-up. Continuing alcohol misuse significantly and independently predicted affective relapse, whereas there was no difference in relapse risk between individuals stopping alcohol misuse and never misusing alcohol. Cannabis misuse trajectories did not significantly predict relapse risk although we cannot exclude interactions with alcohol misuse. In conclusion, substance misuse decreased in the early phase of bipolar disorder treatment but should be further reduced with interventions specifically addressing substance misuse. Stopping alcohol misuse is likely to yield substantial benefit on the clinical course of bipolar disorder.
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Affiliation(s)
- Trine Vik Lagerberg
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Romain Icick
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,INSERM UMR_S1144, Paris University, Paris, France.,FondaMental Foundation, Créteil, France
| | - Sofie Ragnhild Aminoff
- Early Intervention in Psychosis Advisory Unit for South East Norway (TIPS Sør-Øst), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Norwegian Center for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mari Nerhus
- Norwegian Center for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departement for Specialized Psychiatry, Division of Mental Health, Akershus University Hospital, Lorenskog, Norway
| | - Elizabeth Ann Barrett
- Early Intervention in Psychosis Advisory Unit for South East Norway (TIPS Sør-Øst), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Thomas Doug Bjella
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,Norwegian Center for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stine Holmstul Olsen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Margrethe Collier Høegh
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,Norwegian Center for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Zhang S, Lin X, Yang T, Zhang S, Pan Y, Lu J, Liu J. Prevalence of childhood trauma among adults with affective disorder using the Childhood Trauma Questionnaire: A meta-analysis. J Affect Disord 2020; 276:546-554. [PMID: 32871685 DOI: 10.1016/j.jad.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Childhood trauma is associated with major depressive disorder (MDD) and bipolar disorder (BD) in adults. However, no meta-analysis was performed on the prevalence of different types of childhood trauma in adults with affective disorders, using the Childhood Trauma Questionnaire (CTQ). METHODS Four databases were used to search articles regarding the prevalence of childhood emotional abuse (CEA), childhood physical abuse (CPA), childhood sexual abuse (CSA), childhood physical neglect (CPN), and childhood emotional neglect (CEN) in patients with MDD and BD using the CTQ. RESULTS A total of 17 and 11 articles were found analyzing patients with MDD and BD, respectively. A pooled prevalence rate of 33.0% and 30.0% for CEA, 17.0% and 18.0% for CPA, 19.0% and 22.0% for CSA, 37.0% and 31.0% for CEN, and 31% and 30.0% for CPN was found in patients with MDD and BD respectively. A difference in 95% confidence interval in the CSA rate between men and women was found in patients with MDD in the gender subgroup and in the rate of some types of childhood trauma in the continent subgroup in both patient types. LIMITATIONS A limited number of articles were included in some continents, thus, the heterogeneity in the meta-analysis was generally high. CONCLUSION The prevalence of CEA, CEN, and CPN in patients with affective disorders was relatively high, whereas that of CPA and CSA was relatively low. These childhood traumas might be affected by continent and gender.
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Affiliation(s)
- Simei Zhang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China
| | - Xiujin Lin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080
| | - Tingyu Yang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shengjie Zhang
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China
| | - Yuli Pan
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China
| | - Jianping Lu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China.
| | - Jianbo Liu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China.
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20
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Child maltreatment and mental health problems in 30-year-old adults: A birth cohort study. J Psychiatr Res 2020; 129:111-117. [PMID: 32653613 DOI: 10.1016/j.jpsychires.2020.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
Abstract
Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer with limited data at 30-year follow-up. This was a prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment was associated with adverse psychological outcomes in early adulthood when participants were 30 years old. We used data from 2861 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exposure to suspected child maltreatment was measured by linkage with state child protection data. The primary outcomes were DSM-IV diagnoses derived from the Composite International Diagnostic Interview-Auto version (CIDI). There were child abuse notifications on 171 participants, of which 103 were substantiated. The most common notifications were for physical abuse (n=96) followed by emotional abuse and neglect (n=80 each). There were 63 notifications of sexual abuse. Of those completing the CIDI at follow-up, 257 participants (9%) reported a depressive disorder, 703 (25%) an anxiety disorder and 138 (5%) PTSD. After adjustment for potential confounders, there were variations in the long-term effects of different types of abuse with physical abuse having a stronger association with depression, and sexual abuse with PTSD. Both emotional abuse and neglect were associated to varying degrees with depression, anxiety and PTSD. Substantiated abuse or multiple forms of abuse had generally the worst outcomes.
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21
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Gawęda Ł, Pionke R, Hartmann J, Nelson B, Cechnicki A, Frydecka D. Toward a Complex Network of Risks for Psychosis: Combining Trauma, Cognitive Biases, Depression, and Psychotic-like Experiences on a Large Sample of Young Adults. Schizophr Bull 2020; 47:395-404. [PMID: 33728467 PMCID: PMC7965064 DOI: 10.1093/schbul/sbaa125] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although the linkage between traumatic life events and psychotic-like experiences (PLEs) is well established, the knowledge of potential mechanisms of this relationship is scarce. The aim of the present study was to better understand the structure of connections between traumatic life events and PLEs by considering at the same time the role of cognitive biases and depressive symptoms in the population of young adults (18-35 years of age, M = 26.52, SD = 4.74, n = 6772). Our study was conducted within a framework of network analysis. PLEs were measured with the Prodromal Questionnaire (PQ-16), cognitive biases were measured with nine items from the Davos Assessment of Cognitive Biases Scale-18 (DACOBS-18), depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CESD-R) and exposure to traumatic life events was measured with a combination of Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and Traumatic Experience Checklist (TEC). The results present a network of all nodes being interconnected within and between domains, with no isolated factors. Exposures to sexual trauma were the most central node in the network. Pathways were identified from trauma to PLEs via cognitive biases and depressive symptoms. However, the shortest pathway between the most central traumatic life event and PLEs was through other traumatic life events, without cognitive biases or depressive symptoms along the way. Our findings suggest the importance of environmental adversities as well as dysfunctional information processing and depression in the network of psychosis risks.
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Affiliation(s)
- Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,To whom correspondence should be addressed; Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378 Warsaw, Poland; tel: +48 (22) 583-13-80, fax: +48 (22) 583-13-81, e-mail:
| | - Renata Pionke
- Psychopathology and Early Interventions Lab, II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Jessica Hartmann
- Orygen, Parkville, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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22
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Abstract
Bipolar spectrum disorders encompass heterogeneous clinical manifestations and comorbidities. A latent class analysis (LCA) was performed in 1846 subjects who experienced an episode of abnormally elevated or irritable mood to identify homogeneous groups of subjects, based on the distribution of 11 manic and 7 psychotic symptoms. LCA identified five classes: 1) two classes with irritability and with low and high level of psychosis (respectively "irritable," 29.1% of the sample, and "irritable-psychotic," 16.2%); 2) a class with expansive mood and hyperactivity ("expansive-hyperactive," 12.7%); and 3) two classes with manic symptoms and high and low level of psychosis ("manic-psychotic," 15.0%, and "manic," 27.2%). "Irritable" displayed lower rates of depressive episode, panic, and substance use disorders. Manic-psychotic displayed higher rates of depressive episode, panic, generalized anxiety, and substance use disorders. Use of mental health treatment more frequent in manic-psychotic and manic classes. Five classes of bipolar spectrum disorders were characterized by different sociodemographic and clinical patterns.
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23
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Lee JY, Pahl K, Kim W. Correlates of Cannabis Use Disorders among urban women of color: childhood abuse, relationship with spouse/partner, and media exposure. JOURNAL OF SUBSTANCE USE 2020; 26:132-137. [DOI: 10.1080/14659891.2020.1784301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jung Yeon Lee
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Kerstin Pahl
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
- Nathan Kline Institute, Research Foundation for Mental Hygiene, Orangeburg, New York, USA
| | - Wonkuk Kim
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
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24
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Duarte D, Belzeaux R, Etain B, Greenway KT, Rancourt E, Correa H, Turecki G, Richard-Devantoy S. Childhood-maltreatment subtypes in bipolar patients with suicidal behavior: systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 42:558-567. [PMID: 32520164 PMCID: PMC7524421 DOI: 10.1590/1516-4446-2019-0592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/23/2020] [Indexed: 03/29/2023]
Abstract
Objective: Patients with bipolar disorders have a high risk of suicidal behavior. Childhood maltreatment is a well-established risk factor for suicidal behavior. The objective of this study was to examine the association between childhood-maltreatment subtypes and vulnerability to suicide attempts in bipolar disorder using the Childhood Trauma Questionnaire (CTQ). Methods: A literature review was performed using the MEDLINE, Embase, and PsycINFO databases. Thirteen studies met the selection criteria. In the meta-analysis, the Childhood Trauma Questionnaire (CTQ) was used to assess a wide range of childhood maltreatment subtypes, which were analyzed by using a random-effects model to account for the likely variations of true effect sizes between the included studies. Results: In the systematic review, 13 studies met the selection criteria. The CTQ was selected for the meta-analysis to increase the homogeneity of assessment and to encompass a wide range of childhood-maltreatment subtypes. The data were analyzed using a random-effects model. Compared to bipolar non-attempters, bipolar suicide attempters had experienced childhood maltreatment with a significantly higher frequency and had higher total CTQ scores (Hedges’ g = -0.38, 95%CI -0.52 to -0.24, z = -5.27, p < 0.001) and CTQ sub-scores (sexual abuse: g = -0.39, 95%CI -0.52 to -0.26, z = -5.97; physical abuse: g = -0.26, 95%CI -0.39 to -0.13, z = -4.00; emotional abuse: g = -0.39, 95%CI -0.65 to -0.13, z = -2.97; physical neglect: g = -0.18, 95%CI -0.31 to -0.05, z = -2.79; emotional neglect: g = -0.27, 95%CI -0.43 to -0.11, z = -3.32). Conclusions: Childhood maltreatment, as assessed by the CTQ, may contribute to an increased risk of suicidal behavior among people with bipolar disorders. Recognizing maltreatment as an etiological risk factor is a crucial step toward furthering science-based preventive psychiatry.
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Affiliation(s)
- Dante Duarte
- Departamento de Saúde Mental, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Raoul Belzeaux
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.,Département de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université (INT-UMR 7289), Marseille, France
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Centres Experts Troubles Bipolaires et Dépressions Résistantes, Faculté de Pharmacie, Groupe Hospitalo-Universitaire (G.H.U.) Saint Louis-Lariboisiere-Fernand-Widal, Université Paris Diderot, Inserm UMRS 1144, Paris, France
| | - Kyle T Greenway
- Département de Psychiatrie et de Médecine Addictologique, Centres Experts Troubles Bipolaires et Dépressions Résistantes, Faculté de Pharmacie, Groupe Hospitalo-Universitaire (G.H.U.) Saint Louis-Lariboisiere-Fernand-Widal, Université Paris Diderot, Inserm UMRS 1144, Paris, France
| | - Emilie Rancourt
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Humberto Correa
- Departamento de Saúde Mental, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Stéphane Richard-Devantoy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.,Centre Intégré de Santé et de Services Sociaux des Laurentides, Saint-Jérôme, Québec, Canada
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25
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Aas M, Bellivier F, Bettella F, Henry C, Gard S, Kahn JP, Lagerberg TV, Aminoff SR, Melle I, Leboyer M, Jamain S, Andreassen OA, Etain B. Childhood maltreatment and polygenic risk in bipolar disorders. Bipolar Disord 2020; 22:174-181. [PMID: 31628696 DOI: 10.1111/bdi.12851] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Childhood maltreatment is a well-known risk factor for developing a more severe and complex form of bipolar disorders (BD). However, knowledge is scarce about the interactions between childhood maltreatment and underlying genetic vulnerability on the clinical expression of BD. METHOD We assigned a BD-polygenic risk score (BD-PRS), calculated from the Psychiatric Genomics Consortium, to each individual in a sample of 402 cases with BD. The lifetime clinical expression of BD was characterized using structured interviews and patients completed the Childhood Trauma Questionnaire (CTQ) to assess the severity of childhood maltreatment. RESULTS Cases who reported more severe childhood maltreatment had a lower BD-PRS (rho = -0.12, P = .01), especially when considering emotional abuse (rho = -0.16, P = .001). An interaction between BD-PRS and childhood maltreatment was observed for the risk of rapid cycling (P = .01). No further interactions between BD-PRS and childhood maltreatment were observed for other clinical characteristics (age at onset, suicide attempts, number of mood episodes, mixed features, substance use disorders and psychotic symptoms). CONCLUSION Our study is the first to show that less genetic risk may be needed to develop a more unstable form of BD when exposed to childhood maltreatment. Our study supports childhood trauma as an independent risk factor for BD.
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Affiliation(s)
- Monica Aas
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Frank Bellivier
- Université Paris Diderot, Paris, France.,INSERM U1144, Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Université Sorbonne Paris Cité, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation Fondamental, Créteil, France
| | - Francesco Bettella
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Chantal Henry
- AP-HP, Pôle de Psychiatry, DHU Pepsy, Hôpitaux Universitaires Henri Monody, Créteil, France.,Université Paris-Est-Creteil-Val de Marne, Créteil, France.,Institut Pasteur, Unité Perception et Mémoire, Centre National de la Recherche Scientifique, Paris, France.,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
| | - Sebastien Gard
- Fondation Fondamental, Créteil, France.,Centre Expert Trouble Bipolaire, Service de psychiatrie adulte, Hôpital Charles Perrens, Bordeaux, France
| | - Jean-Pierre Kahn
- Fondation Fondamental, Créteil, France.,Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy - Université de Lorraine, Nancy, France
| | - Trine V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sofie R Aminoff
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marion Leboyer
- Fondation Fondamental, Créteil, France.,AP-HP, Pôle de Psychiatry, DHU Pepsy, Hôpitaux Universitaires Henri Monody, Créteil, France.,Université Paris-Est-Creteil-Val de Marne, Créteil, France.,Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - Stéphane Jamain
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
| | - Bruno Etain
- Université Paris Diderot, Paris, France.,INSERM U1144, Faculté de Pharmacie de Paris, Université Paris Descartes, Université Paris Diderot, Université Sorbonne Paris Cité, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation Fondamental, Créteil, France.,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
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26
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Abstract
Objective: This review discusses the relationship between cannabis use and psychotic, bipolar, depressive, and anxiety disorders, as well as suicide. It summarizes epidemiological evidence from cross-sectional and long-term prospective studies and considers possible etiological mechanisms. Methods: Systematic reviews and methodologically robust studies in the field (from inception to February 2019) were identified using a comprehensive search of Medline, PsychINFO, and Embase and summarized using a narrative synthesis. Results: Consistent evidence, both from observational and experimental studies, has confirmed the important role of cannabis use in the initiation and persistence of psychotic disorders. The size of the effect is related to the extent of cannabis use, with greater risk for early cannabis use and use of high-potency varieties and synthetic cannabinoids. Accumulating evidence suggests that frequent cannabis use also increases the risk for mania as well as for suicide. However, the effect on depression is less clear and findings on anxiety are contradictory with only a few methodologically robust studies. Furthermore, the relationship with common mental disorders may involve reverse causality, as depression and anxiety are reported to lead to greater cannabis consumption in some studies. Pathogenetic mechanisms focus on the effect of tetrahydrocannabinol (THC, the main psychoactive ingredient of cannabis) interacting with genetic predisposition and perhaps other environmental risk factors. Cannabidiol (CBD), the other important ingredient of traditional cannabis, ameliorates the psychotogenic effects of THC but is absent from the high-potency varieties that are increasingly available. Conclusions: The evidence that heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis is sufficiently strong to merit public health education. Evidence of similar but smaller effects in mania and suicide is growing, but is not convincing for depression and anxiety. There is much current interest in the possibility that CBD may be therapeutically useful.
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Affiliation(s)
- Lucia Sideli
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Harriet Quigley
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
| | - Caterina La Cascia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
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27
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Icick R, Melle I, Etain B, Ringen PA, Aminoff SR, Leboyer M, Aas M, Henry C, Bjella TD, Andreassen OA, Bellivier F, Lagerberg TV. Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. J Affect Disord 2019; 256:348-357. [PMID: 31202989 DOI: 10.1016/j.jad.2019.05.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. METHODS 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. RESULTS 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. LIMITATIONS Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. CONCLUSION Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
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Affiliation(s)
- R Icick
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France.
| | - I Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Etain
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - P A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - S R Aminoff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Leboyer
- FondaMental Foundation, Créteil F-94000, France; Inserm U955, Psychiatric Genetics Team, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Henri Mondor, DHU PePsy, Psychiatry Center, Créteil F-94000, France
| | - M Aas
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France
| | - T D Bjella
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - T V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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28
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Cannabis use disorder and suicide attempts in bipolar disorder: A meta-analysis. Neurosci Biobehav Rev 2019; 103:14-20. [DOI: 10.1016/j.neubiorev.2019.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 12/28/2022]
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29
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Nascimento C, Nunes VP, Diehl Rodriguez R, Takada L, Suemoto CK, Grinberg LT, Nitrini R, Lafer B. A review on shared clinical and molecular mechanisms between bipolar disorder and frontotemporal dementia. Prog Neuropsychopharmacol Biol Psychiatry 2019; 93:269-283. [PMID: 31014945 PMCID: PMC6994228 DOI: 10.1016/j.pnpbp.2019.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022]
Abstract
Mental disorders are highly prevalent and important causes of medical burden worldwide. Co-occurrence of neurological and psychiatric symptoms are observed among mental disorders, representing a challenge for their differential diagnosis. Psychiatrists and neurologists have faced challenges in diagnosing old adults presenting behavioral changes. This is the case for early frontotemporal dementia (FTD) and bipolar disorder. In its initial stages, FTD is characterized by behavioral or language disturbances in the absence of cognitive symptoms. Consequently, patients with the behavioral subtype of FTD (bv-FTD) can be initially misdiagnosed as having a psychiatric disorder, typically major depression disorder (MDD) or bipolar disorder (BD). Bipolar disorder is associated with a higher risk of dementia in older adults and with cognitive impairment, with a subset of patients presents a neuroprogressive pattern during the disease course. No mendelian mutations were identified in BD, whereas three major genetic causes of FTD have been identified. Clinical similarities between BD and bv-FTD raise the question whether common molecular pathways might explain shared clinical symptoms. Here, we reviewed existing data on clinical and molecular similarities between BD and FTD to propose biological pathways that can be further investigated as common or specific markers of BD and FTD.
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Affiliation(s)
- Camila Nascimento
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Villela Paula Nunes
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Roberta Diehl Rodriguez
- Behavioral and Cognitive Neurology Unit, Department of Neurology and LIM 22, University of São Paulo, São Paulo 05403-900, Brazil
| | - Leonel Takada
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo, São Paulo 05403-900, Brazil
| | - Cláudia Kimie Suemoto
- Division of Geriatrics, LIM-22, University of São Paulo Medical School, São Paulo 01246-90, Brazil
| | - Lea Tenenholz Grinberg
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo 01246-90, Brazil; Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143-120, USA.
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo, São Paulo 05403-900, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Fleiss B, Rivkees SA, Gressens P. Early origins of neuropsychiatric disorders. Pediatr Res 2019; 85:113-114. [PMID: 30367161 DOI: 10.1038/s41390-018-0225-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Bobbi Fleiss
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Scott A Rivkees
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
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Kisely S, Abajobir AA, Mills R, Strathearn L, Clavarino A, Najman JM. Child maltreatment and mental health problems in adulthood: birth cohort study. Br J Psychiatry 2018; 213:698-703. [PMID: 30475193 DOI: 10.1192/bjp.2018.207] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer.AimsTo examine, using a prospective record-linkage analysis, whether substantiated child maltreatment is associated with adverse psychological outcomes in early adulthood. METHOD The participants were 3778 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D) at approximately 21 years of age. A subset completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto). RESULTS In total, 171 (4.5%) participants had a history of substantiated child maltreatment, most commonly emotional abuse (n = 91), followed by physical abuse (n = 78), neglect (n = 73) and sexual abuse (n = 54). After adjustment for potential confounders, depressive symptoms on the CES-D, as well as internalising and externalising behaviours were strongly associated with substantiated abuse in all forms, except sexual abuse. The results for the subset of the sample who completed the CIDI-Auto were less clear. Anxiety, especially post-traumatic stress disorder, showed the strongest association whereas the findings for depressive disorder were equivocal. However, across all diagnostic categories, emotional abuse and neglect, as well as multiple forms of abuse, showed a consistent association. CONCLUSIONS Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health. These two warrant the attention given to other forms of child maltreatment. Children experiencing more than one type of maltreatment are at particular risk.Declaration of interestNone.
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Affiliation(s)
- Steve Kisely
- Professor,School of Medicine,University of Queensland, Princess Alexandra Hospital,AustraliaandDepartments of Psychiatry, Community Health and Epidemiology,Dalhousie University,Canada
| | | | - Ryan Mills
- Senior Lecturer,School of Medicine,University of Queensland, Princess Alexandra Hospital,Australia
| | - Lane Strathearn
- Professor,Department of Paediatrics, Developmental and Behavioural Paediatrics,University of Iowa,USA
| | - Alexandra Clavarino
- Associate Professor,The School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland,Australia
| | - Jake Moses Najman
- Professor,School of Medicine, Princess Alexandra Hospital, School of Social Sciences, The University of Queensland and Queensland Alcohol and Drug Research and Education Centre, The University of Queensland,Australia
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Abstract
BACKGROUND Cannabis use in young people is common and associated with psychiatric disorders. However, the prospective link between cannabis use and bipolar disorder symptoms has rarely been investigated. The study hypothesis was that adolescent cannabis use is associated with hypomania in early adulthood via several potential etiological pathways. METHODS Data were used from the Avon Longitudinal Study of Parents and Children, a UK birth cohort study. The prospective link between cannabis use at age 17 and hypomania at age 22-23 years was tested using regression analysis, adjusted for gender, early environmental risk factors, alcohol and drug use, and depression and psychotic symptoms at age 18 years. Path analysis examined direct and indirect effects of the link and whether gender, childhood family adversity, or childhood abuse are associated with hypomania via an increased risk of cannabis use. RESULTS Data were available on 3370 participants. Cannabis use at least 2-3 times weekly was associated with later hypomania (OR = 2.21, 95% CI = 1.49-3.28) after adjustment. There was a dose-response relationship (any use vs weekly). Cannabis use mediated the association of both childhood sexual abuse and hypomania, and male gender and hypomania. The cannabis use-hypomania link was not mediated by depression or psychotic symptoms. CONCLUSIONS Adolescent cannabis use may be an independent risk factor for future hypomania, and the nature of the association suggests a potential causal link. Cannabis use mediates the link between childhood abuse and future hypomania. As such it might be a useful target for indicated prevention of hypomania.
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Affiliation(s)
- Steven Marwaha
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Affective Disorders Service, Caludon Centre, Coventry, UK
- To whom correspondence should be addressed; Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK; tel: +44-2476-151046, fax: +44-24-7646-1606, e-mail:
| | - Catherine Winsper
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Daniel Smith
- University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Ng QX, Yong BZJ, Ho CYX, Lim DY, Yeo WS. Early life sexual abuse is associated with increased suicide attempts: An update meta-analysis. J Psychiatr Res 2018; 99:129-141. [PMID: 29454220 DOI: 10.1016/j.jpsychires.2018.02.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
Abstract
Suicide is an emerging, yet preventable global health issue associated with significant mortality. Identification of underlying risk factors and antecedents may inform preventive strategies and interventions. This study serves to provide an updated meta-analysis examining the extent of association of early life sexual abuse with suicide attempts. Using the keywords [early abuse OR childhood abuse OR sexual OR rape OR molest* OR violence OR trauma OR PTSD] AND [suicid* OR premature OR unnatural OR deceased OR died OR mortality], a preliminary search on the PubMed, Ovid, PsychINFO, Web of Science and Google Scholar databases yielded 12,874 papers published in English between 1-Jan-1988 and 1-June-2017. Of these, only 47 studies were included in the final meta-analysis. The 47 studies (25 cross-sectional, 14 cohort, 6 case-control and 2 twin studies) contained a total of 151,476 subjects. Random-effects meta-analysis found early life sexual abuse to be a significant risk factor for suicide attempts, compared to baseline population (pooled OR 1.89, 95% CI: 1.66 to 2.12, p < 0.001). Subgroup analyses of cross-sectional and longitudinal studies showed similar findings of increased risk as they yielded ORs of 1.98 (95% CI: 1.70 to 2.25, p < 0.001) and 1.65 (95% CI: 1.37 to 1.93, p < 0.001), respectively. In both cross-sectional and longitudinal studies, childhood sexual abuse was consistently associated with increased risk of suicide attempts. The findings of the present study provide strong grounds for funding public policy planning and interventions to prevent sexual abuse and support its victims. Areas for future research should include preventive and treatment strategies and factors promoting resilience following childhood sexual abuse. Future research on the subject should have more robust controls and explore the differential effects of gender and intra-versus extra-familial sexual abuse.
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Affiliation(s)
- Qin Xiang Ng
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore; MOH Holdings Pte Ltd, 1 Maritime Square, Singapore, 099253, Singapore.
| | | | | | - Donovan Yutong Lim
- Department of Child and Adolescent Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Wee-Song Yeo
- National University Hospital, National University Health System, Singapore, 119074, Singapore
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Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder. Psychiatry Res 2018; 260:391-399. [PMID: 29253803 DOI: 10.1016/j.psychres.2017.12.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/10/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
Child maltreatment is a public health issue that is a well-established risk factor for many psychological conditions, including bipolar disorder. The current study is one of the first to investigate associations among child maltreatment, dissociative symptomatology, alexithymia, anxiety, depression, and attachment insecurities. 40 patients with bipolar disorder-I and 40 healthy subjects matched for age, gender, and education participated in the study. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Childhood Trauma Questionnaire (CTQ-28), Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Experiences in Close Relationships-Revised (ECR-R) were completed by participants. In comparison to control participants, patients with bipolar disorder-I reported significantly more frequent abusive experiences in childhood, higher levels of attachment insecurities, more severe pathological and somatoform dissociation, as well as higher scores on measures of alexithymia, anxiety, depression and psychological stress. Reports of psychopathology among first-degree relatives (OR = 102.169, 95%IC = 4.596-2271.255; P < 0.01) and childhood emotional trauma (OR = 1.032; 95%CI = 0.782-1.363, P = 0.05) significantly contributed to bipolar disorder-I diagnosis. In contrast, absorption was negatively associated with bipolar illness (OR = 0.852; 95% CI = 0.747-0.973, P < 0.05). Our results showed significant associations between childhood trauma exposure and risk of bipolar disorder. Moreover, the results demonstrate that emotional abuse exposure predicts bipolar illness.
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Abajobir AA, Najman JM, Williams G, Strathearn L, Clavarino A, Kisely S. Substantiated childhood maltreatment and young adulthood cannabis use disorders: A pre-birth cohort study. Psychiatry Res 2017; 256:21-31. [PMID: 28622571 PMCID: PMC5603409 DOI: 10.1016/j.psychres.2017.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
This study investigates the association between exposure to prospectively-substantiated childhood maltreatment between 0 and 14 years of age and lifetime cannabis use, abuse and dependence reported at 21 years. Data were taken from 2526 (51.6% female) participants in the Mater Hospital-University of Queensland Study of Pregnancy, a pre-birth, prospective, cohort study. Prospectively-substantiated cases of childhood maltreatment, reported to the government child protection agencies between 0 and 14 years of age, were linked to CIDI DSM-IV self-report data from the 21-year follow-up. Exposure to any childhood maltreatment, and childhood neglect in particular, predicted subsequent cannabis abuse with adjusted odds ratios (AORs) of 1.79 and 2.62, respectively. Any childhood maltreatment, physical abuse, emotional abuse and neglect predicted cannabis dependence with AORs of 2.47, 2.81, 2.44 and 2.68, respectively. The associations for an early age of onset of cannabis abuse and dependence were significant and consistent for maltreated children. In addition, frequency of maltreatment substantiations predicted cannabis abuse, dependence and an early age of onset of these disorders. The AORs for cannabis ever use without any DSM-IV cannabis disorder were 1.78 for any maltreatment and 2.15 for emotional abuse. Any childhood maltreatment and neglect predicted lifetime ever cannabis use, as well as cannabis use disorder. There was little evidence for any interaction between gender and different forms of childhood maltreatment and its association with cannabis use disorders. Physical abuse, emotional abuse and neglect, as well as multiple episodes of maltreatment independently predicted cannabis use disorders.
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Affiliation(s)
- Amanuel Alemu Abajobir
- Faculty of Medicine, School of Public Health, The University of Queensland, Public Health Building, Herston 4006, Queensland, Australia.
| | - Jake Moses Najman
- Faculty of Medicine, School of Public Health, The University of Queensland, Public Health Building, Herston 4006, Queensland, Australia; Queensland Alcohol and Drug Research and Education Center, The University of Queensland, Herston 4006, Queensland, Australia; Faculty of Humanities and Social Sciences, School of Social Sciences, The University of Queensland, St Lucia 4072, Queensland, Australia
| | - Gail Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Public Health Building, Herston 4006, Queensland, Australia
| | - Lane Strathearn
- Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa, Iowa City, IA, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Alexandra Clavarino
- Faculty of Health and Behavioral Sciences, School of Pharmacy, The University of Queensland, Woolloongabba 4102, Queensland, Australia
| | - Steve Kisely
- Faculty of Medicine, School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba 4102, Queensland, Australia; Faculty of Medicine, Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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Aas M, Dieset I, Hope S, Hoseth E, Mørch R, Reponen E, Steen NE, Laskemoen JF, Ueland T, Aukrust P, Agartz I, Andreassen OA, Melle I. Childhood maltreatment severity is associated with elevated C-reactive protein and body mass index in adults with schizophrenia and bipolar diagnoses. Brain Behav Immun 2017; 65:342-349. [PMID: 28619247 DOI: 10.1016/j.bbi.2017.06.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/27/2017] [Accepted: 06/12/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Several studies have described an association between childhood maltreatment and inflammatory markers in the psychotic disorders (schizophrenia [SZ] and bipolar disorder [BD]). Previous studies have been relatively small (<50 participants), and the severity of abuse and the putative influence of body mass index (BMI) have not been properly investigated. METHODS The combined effects of childhood abuse severity and clinical diagnosis on inflammatory markers were investigated in a large sample (n=483) of patients with a disorder on the psychosis spectrum and in healthy controls (HCs). Plasma levels of inflammatory markers (high-sensitivity C-reactive protein [hs-CRP], soluble tumor necrosis factor receptor type 1 [TNFR-R1], glycoprotein 130 [gp130]) were analyzed, and BMI and data on childhood trauma events, on the basis of the Childhood Trauma Questionnaire (CTQ), were obtained from all participants. RESULTS Patients had increased levels of hs-CRP (P<0.001, Cohens d=0.4), lower levels of gp130 (P<0.001, Cohens d=0.5), higher BMI (P<0.001, Cohens d=0.5) and reported more childhood maltreatment experiences (P<0.001, Cohens d=1.2) than the HC group. The severity of childhood abuse (up to three types of abuse: sexual abuse, physical abuse, and emotional abuse) was associated with elevated BMI (f=8.46, P<0.001, Cohen's d=0.5) and hs-CRP (f=5.47, P=0.001, Cohen's d=0.3). Combined effects of patient status and severity of childhood abuse were found for elevated hs-CRP (f=4.76, P<0.001, Cohen's d=0.4). Differences among the groups disappeared when BMI was added to the model. DISCUSSION Trauma-altered immune activation via elevated hs-CRP in patients with SZ and BD may be mediated by higher BMI; however, the direction of this association needs further clarification.
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Affiliation(s)
- Monica Aas
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway.
| | - Ingrid Dieset
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
| | - Sigrun Hope
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
| | - Eva Hoseth
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
| | - Ragni Mørch
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
| | - Elina Reponen
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
| | - Nils Eiel Steen
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway; Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ole A Andreassen
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
| | - Ingrid Melle
- NORMENT K.G Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Norway
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37
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Aas M, Henry C, Bellivier F, Lajnef M, Gard S, Kahn JP, Lagerberg TV, Aminoff SR, Bjella T, Leboyer M, Andreassen OA, Melle I, Etain B. Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders. Psychol Med 2017; 47:902-912. [PMID: 27894372 DOI: 10.1017/s0033291716003081] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many studies have shown associations between a history of childhood trauma and more severe or complex clinical features of bipolar disorders (BD), including suicide attempts and earlier illness onset. However, the psychopathological mechanisms underlying these associations are still unknown. Here, we investigated whether affective lability mediates the relationship between childhood trauma and the severe clinical features of BD. METHOD A total of 342 participants with BD were recruited from France and Norway. Diagnosis and clinical characteristics were assessed using the Diagnostic Interview for Genetic Studies (DIGS) or the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Affective lability was measured using the short form of the Affective Lability Scale (ALS-SF). A history of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Mediation analyses were performed using the SPSS process macro. RESULTS Using the mediation model and covariation for the lifetime number of major mood episodes, affective lability was found to statistically mediate the relationship between childhood trauma experiences and several clinical variables, including suicide attempts, mixed episodes and anxiety disorders. No significant mediation effects were found for rapid cycling or age at onset. CONCLUSIONS Our data suggest that affective lability may represent a psychological dimension that mediates the association between childhood traumatic experiences and the risk of a more severe or complex clinical expression of BD.
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Affiliation(s)
- M Aas
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - C Henry
- AP-HP,Hôpitaux Universitaires Henri Mondor,Pôle de Psychiatry,DHU Pepsy,Créteil,France
| | | | - M Lajnef
- Inserm,U955,Equipe Psychiatrie Translationnelle,Créteil,France
| | - S Gard
- Fondation Fondamental,Créteil,France
| | - J-P Kahn
- Fondation Fondamental,Créteil,France
| | - T V Lagerberg
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - S R Aminoff
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - T Bjella
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - M Leboyer
- AP-HP,Hôpitaux Universitaires Henri Mondor,Pôle de Psychiatry,DHU Pepsy,Créteil,France
| | - O A Andreassen
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - I Melle
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - B Etain
- Fondation Fondamental,Créteil,France
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Mills R, Kisely S, Alati R, Strathearn L, Najman JM. Child maltreatment and cannabis use in young adulthood: a birth cohort study. Addiction 2017; 112:494-501. [PMID: 27741369 DOI: 10.1111/add.13634] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/19/2016] [Accepted: 10/10/2016] [Indexed: 12/01/2022]
Abstract
AIMS To investigate whether: (1) child maltreatment is associated with life-time cannabis use, early-onset cannabis use, daily cannabis use and DSM-IV cannabis abuse in young adulthood; and (2) behaviour problems, tobacco use and alcohol use at age 14 are associated with cannabis use. DESIGN Birth cohort using linked government agency child protection data to define exposure to child maltreatment. SETTING The Mater-University of Queensland Study of Pregnancy in Brisbane, Australia. PARTICIPANTS Of the original cohort of 7223 mother and child pairs, obtained from consecutive presentations for prenatal care at a hospital serving a cross-section of the community, 3778 (52.3%) of the young people participated at age 21 years. MEASUREMENTS Exposure to child maltreatment was established by substantiated government agency reports. Cannabis outcomes were by self-report questionnaire and Composite International Diagnostic Interview (CIDI)-Auto at age 21. Associations were adjusted for a range of potential confounders. Additional adjustment was carried out for variables measured at age 14-youth behaviour problems [Achenbach Child Behavior Checklist (CBCL)], tobacco use and alcohol use. FINDINGS After adjustment, substantiated child maltreatment was associated with any life-time cannabis use [odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.08-2.39], cannabis use prior to age 17 (OR = 2.47, 95 % CI = 1.67-3.65), daily cannabis use (OR = 2.68, 95% CI = 1.49-4.81) and DSM-IV cannabis abuse/dependence (OR = 1.72, 95% CI = 1.07-2.77). Externalizing behaviour and tobacco and alcohol use at age 14 were associated significantly with almost all cannabis outcomes (P < 0.05), with internalizing behaviour associated inversely (P < 0.05). CONCLUSIONS Children in Australia who are documented as having been maltreated are more likely to go on to use cannabis before the age of 17, use cannabis as an adult, use cannabis daily and meet DSM-IV criteria for cannabis dependence. Externalizing behaviour in adolescence appears partly to mediate the association with adult cannabis use.
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Affiliation(s)
- Ryan Mills
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Department of Paediatrics, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Rosa Alati
- Centre for Youth Substance Abuse Research, School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Lane Strathearn
- Division of Developmental and Behavioral Pediatrics, University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, Iowa, IA, USA
| | - Jake M Najman
- Queensland Alcohol and Drug Research and Education Centre, University of Queensland, School of Public Health, Herston, Queensland, Australia
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Pignon B, Geoffroy PA, Thomas P, Roelandt JL, Rolland B, Morgan C, Vaiva G, Amad A. Prevalence and clinical severity of mood disorders among first-, second- and third-generation migrants. J Affect Disord 2017; 210:174-180. [PMID: 28049102 DOI: 10.1016/j.jad.2016.12.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/27/2016] [Accepted: 12/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The role of migration as a risk factor remains unknown for mood disorders because of poor data. We sought to examine the prevalence and severity of mood disorders (bipolar disorder (BD), unipolar depressive disorder (UDD) and dysthymia) in first, second, and third generation migrants in France. METHODS The Mental Health in the General Population survey interviewed 38,694 individuals. The prevalence of lifetime mood disorders, comorbidities, and clinical features was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex and level of education. RESULTS The prevalence of any lifetime mood disorder was higher in migrants compared with non-migrants (OR = 1.36, 95% CI [1.27 - 1.45]). This increased prevalence was significant for UDD (OR = 1.44, 95% CI [1.34 - 1.54]), but not for BD (OR = 1.15, 95% CI [0.96 - 1.36]) or dysthymia (OR = 1.09, 95% CI [0.94 - 1.27]), although the prevalence of BD was increased in the third generation (OR = 1.27, 95% CI [1.01 - 1.60]). Migrants with BD or UDD were more likely to display a comorbid psychotic disorder compared to non-migrants with BD or UDD. Cannabis-use disorders were more common in migrant groups for the 3 mood disorders, whereas alcohol-use disorders were higher in migrants with UDD. Posttraumatic stress disorder was more frequent among migrants with UDD. LIMITATIONS The study used cross-sectional prevalence data and could be biased by differences in the course of disease according to migrant status. Moreover, this design does not allow causality conclusion or generalization of the main findings. CONCLUSION Mood disorders are more common among migrants, especially UDD. Moreover, migrants with mood disorders presented with a more severe profile, with increased rates of psychotic and substance-use disorders.
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Affiliation(s)
- Baptiste Pignon
- Univ. Lille, CNRS, CHU LILLE, UMR9193-PsychiC-SCALab, UMR9193-PsychiC-SCALab, Psychiatry Department, F-59000 Lille, France.
| | - Pierre Alexis Geoffroy
- Inserm, U1144, Paris F-75006, France; Paris Descartes University, UMR-S 1144, Paris F-75006, France; Paris Diderot University, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Psychiatry and Addiction Medicine Department, 75475 Paris Cedex 10, France
| | - Pierre Thomas
- Univ. Lille, CNRS, CHU LILLE, UMR9193-PsychiC-SCALab, UMR9193-PsychiC-SCALab, Psychiatry Department, F-59000 Lille, France; Federation of Mental Health Research, Lille, France; INSERM 1123, Equipe ECEVE, Paris, France
| | - Jean-Luc Roelandt
- World Health Organization Collaborative Centre (WHO-CC), EPSM Lille-Metropole, Lille, France; INSERM 1123, Equipe ECEVE, Paris, France
| | - Benjamin Rolland
- Univ. Lille, CNRS, CHU LILLE, UMR9193-PsychiC-SCALab, UMR9193-PsychiC-SCALab, Psychiatry Department, F-59000 Lille, France; Univ. Lille, INSERM, CHU LILLE, U1171, Department of Addiction Medicine - Addiction Consultation Liaison Unit, Pôle de Psychiatrie, F-59000 Lille, France
| | - Craig Morgan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Guillaume Vaiva
- Univ. Lille, CNRS, CHU LILLE, UMR9193-PsychiC-SCALab, UMR9193-PsychiC-SCALab, Psychiatry Department, F-59000 Lille, France; Federation of Mental Health Research, Lille, France
| | - Ali Amad
- Univ. Lille, CNRS, CHU LILLE, UMR9193-PsychiC-SCALab, UMR9193-PsychiC-SCALab, Psychiatry Department, F-59000 Lille, France; King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Dualibe AL, Osório FL. Bipolar Disorder and Early Emotional Trauma: A Critical Literature Review on Indicators of Prevalence Rates and Clinical Outcomes. Harv Rev Psychiatry 2017; 25:198-208. [PMID: 28759479 DOI: 10.1097/hrp.0000000000000154] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate the prevalence of early emotional trauma in patients with bipolar disorder (BD)• Assess the impact of these traumas on patients and on their development of BD OBJECTIVES: We performed a systematic literature review to (1) evaluate the prevalence of early emotional trauma (EET) in patients with bipolar disorder (BD) and the impact of these traumas on the development of the disorder, and (2) integrate the findings of our review with those previously reported by Fisher and Hosang, Daruy-Filho and colleagues, and Maniglio. METHODS The literature search was performed on PubMed, SciELO, and PsycINFO databases using the keywords bipolar disorder, early trauma, physical abuse, emotional abuse, sexual abuse, maltreatment, adversity, and neglect. RESULTS Twenty-eight articles were selected and analyzed. Taken together, the articles described a high prevalence of EET in BD, consisting mainly of emotional neglect/abuse (approximately 40%), particularly when compared to healthy subjects. The review also identified substantial evidence regarding an association between the presence of EET, early disease onset, rapid cycling, comorbidity with anxiety/stress disorders, and cannabis use. CONCLUSION The integration of the current findings with the identified studies reveals that (1) the methodological limitations noted by Daruy-Filho and colleagues have been largely resolved in more recent studies and (2) the presence of EET in patients with BD is associated with worse clinical outcomes, particularly early disease onset, presence of clinical or psychiatric comorbidities, suicide, and presence of psychotic episodes/symptoms. The review shows that patients with BD experience more traumatic situations than controls and that emotional trauma is the most frequent type of trauma in this group.
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Affiliation(s)
- Aline Limiéri Dualibe
- From the Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo State, Brazil; Brazilian National Institute of Science and Translational Technology in Medicine, Brazil (Dr. Osório)
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Etain B, Lajnef M, Bellivier F, Henry C, M'bailara K, Kahn JP, Leboyer M, Fisher HL. Revisiting the association between childhood trauma and psychosis in bipolar disorder: A quasi-dimensional path-analysis. J Psychiatr Res 2017; 84:73-79. [PMID: 27705819 DOI: 10.1016/j.jpsychires.2016.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/05/2016] [Accepted: 09/23/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood trauma has been associated with a more severe clinical expression of bipolar disorder (BD). However, the results that specifically associated traumatic events and psychotic features in BD have been inconsistent, possibly due to the low resolution of the phenotypes being used. METHODS 270 normothymic patients with BD completed the Childhood Trauma Questionnaire (CTQ) and the Peters Delusion Inventory (PDI) that assessed 21 delusional beliefs. Patients were characterized for the lifetime presence of psychotic features during episodes and cannabis misuse in accordance with DSM-IV. We performed a series of path analyses to investigate the links from three types of childhood abuse (physical, sexual and emotional) directly to delusional beliefs and psychotic features, and indirectly through cannabis misuse. RESULTS A first path analysis showed no link between any of the childhood abuse types and psychotic features when only a categorical definition of psychosis was used. When incorporating the quasi-dimensional measure of delusional beliefs in a second path analysis, we found that emotional and physical abuse and cannabis misuse were each directly associated with PDI score. PDI score and psychotic features were strongly correlated. Childhood abuse did not operate through cannabis misuse to increase delusional beliefs. Including type of BD in the model did not alter the results. CONCLUSION Emotional and physical abuse, but also cannabis misuse, increased delusional beliefs in patients with BD. Using a quasi-dimensional measure of psychotic symptoms in BD provided higher resolution of the psychosis phenotype and helped reconcile ambiguous findings from previous studies.
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Affiliation(s)
- B Etain
- AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S, 1144, Paris, France; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Fondation Fondamental, Créteil, France.
| | - M Lajnef
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - F Bellivier
- AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S, 1144, Paris, France; Fondation Fondamental, Créteil, France
| | - C Henry
- Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, F-75015, Paris, France
| | - K M'bailara
- Fondation Fondamental, Créteil, France; Université de Bordeaux, Laboratoire Psychologie, EA 4139, Bordeaux, France; Hôpital Charles Perrens, Service de psychiatrie adulte, pôle 3-4-7, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Université de Lorraine, CHU de Nancy et Pôle 6 de Psychiatrie et Psychologie Clinique - Centre Psychothérapique de Nancy, 1 rue du Docteur Archambault, Laxou Cedex, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
| | - H L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Hanna RC, Perez JM, Ghose S. Cannabis and development of dual diagnoses: A literature review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:442-455. [PMID: 27612527 DOI: 10.1080/00952990.2016.1213273] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of cannabis has garnered more attention recently with ongoing efforts at marijuana legalization. The consequences of cannabis use are not clearly understood and remain a concern. OBJECTIVES To review the acute and persistent effects of cannabis use and associations with psychiatric disorders. METHODS Using Pubmed and PsychInfo, we conducted a narrative review of the literature on cannabis and psychiatric comorbidity using the keywords cannab*, marijuana, schizo*, psychosis, mood, depression, mania, bipolar, and anxiety. RESULTS There is substantial evidence of cannabis use leading to other illicit drug use and of an association between cannabis use and psychosis. A few reports suggest an association with bipolar disorder while the association with depression and anxiety disorders is mixed. CONCLUSIONS Whenever an association is observed between cannabis use and psychiatric disorders, the relationship is generally an adverse one. Age at the time of cannabis use appears to be an important factor with stronger associations observed between adolescent onset cannabis use and later onset of psychiatric disorders. Additional studies taking into account potential confounds (such as withdrawal symptoms, periods of abstinence, and other substance use) and moderators (such as age of initiation of cannabis use, the amount and frequency of drug use, prior history of childhood maltreatment, and gender) are needed to better understand the psychiatric consequences of cannabis use.
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Affiliation(s)
- Rebecca C Hanna
- a Department of Psychiatry , UT Southwestern , Dallas , TX , USA
| | - Jessica M Perez
- a Department of Psychiatry , UT Southwestern , Dallas , TX , USA
| | - Subroto Ghose
- a Department of Psychiatry , UT Southwestern , Dallas , TX , USA
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Balhara YPS, Lev-Ran S, Martínez-Raga J, Benyamina A, Singh S, Blecha L, Szerman N. State of Training, Clinical Services, and Research on Dual Disorders Across France, India, Israel, and Spain. J Dual Diagn 2016; 12:252-260. [PMID: 27797649 DOI: 10.1080/15504263.2016.1254309] [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] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This article overviews training, clinical services, and research on dual disorders across four countries: France, India, Israel, and Spain. METHODS The current dual disorders systems in each of the four countries were reviewed, with a focus on strengths and limitations of each. RESULTS In France, psychiatric care occurs within the public health care system and involves little training of medical graduates for managing dual disorders. Special courses and forums for specialists have recently started to meet the growing interest of physicians in learning how to manage dual disorders. The Indian health care system grapples with a large treatment gap for mental disorders, and while some treatment services for dual disorders exist, specific research and training efforts on dual disorders are just beginning. Israel has both public- and private sector services for patients with dual disorders, with specialized inpatient and emergency care for the acutely ill as well as day care and therapeutic communities for long-term management. Interest by researchers is growing, but training and education efforts in dual disorders are, however, minimal. Similar to the other countries, addiction and psychiatry disciplines are governed by separate divisions within the National Health System in Spain. There are some dual disorders services available, but they are limited in scope. While medical professionals clearly recognize the importance of dual disorders, there is no such recognition by the national and regional governing bodies. CONCLUSIONS The common thread in various aspects of dual disorder management in each of these four countries is that there is a lower-than-desirable level of attention to dual disorders in terms of care, policy, research, and training. There are growing opportunities for training and continuing education in dual disorders management. We suggest that nations could learn from each other's experiences on how to address the issue of dual disorders.
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Affiliation(s)
- Yatan Pal Singh Balhara
- a Department of Psychiatry and National Drug Dependence Treatment Centre , WHO Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences , New Delhi , India.,b International Programme in Addiction Studies, Master of Science in Addiction Studies, King's College London , United Kingdom.,c University of Adelaide , Adelaide , South Australia , Australia.,d Virginia Commonwealth University , Richmond , Virginia , USA
| | - Shaul Lev-Ran
- e Addiction Medicine and Dual Disorders Services, Department of Psychiatry , Sheba Medical Center , Tel-Hashomer , Israel.,f Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - José Martínez-Raga
- g Unidad Docente de Psiquiatría y Psicología Medica, Hospital Universitario Dr. Peset y Universidad de Valencia, & Universidad CEU-UCH , Valencia , Spain
| | - Amine Benyamina
- h National Institute for Medical Research, University Paris-Sud, Hôpital Universitaire Paul Brousse , Villejuif , France
| | - Shalini Singh
- a Department of Psychiatry and National Drug Dependence Treatment Centre , WHO Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences , New Delhi , India
| | - Lisa Blecha
- h National Institute for Medical Research, University Paris-Sud, Hôpital Universitaire Paul Brousse , Villejuif , France
| | - Nestor Szerman
- i Departamento de Psiquiatría , Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo , Madrid , Spain
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Stentebjerg-Olesen M, Pagsberg AK, Fink-Jensen A, Correll CU, Jeppesen P. Clinical Characteristics and Predictors of Outcome of Schizophrenia-Spectrum Psychosis in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2016; 26:410-27. [PMID: 27136403 DOI: 10.1089/cap.2015.0097] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treatment of early-onset schizophrenia spectrum psychosis (EOS) is hampered by limited data on clinical presentation and illness course. We aimed to systematically review the clinical characteristics, diagnostic trajectories, and predictors of illness severity and outcomes of EOS. METHODS We conducted a systematic PubMed, PsycINFO, and Embase literature review including studies published from January 1, 1990 to August 8, 2014 of EOS patients with 1) ≥50% nonaffective psychosis cases; 2) mean age of subjects <19 years; 3) clinical samples recruited through mental health services; 4) cross-sectional or prospective design; 5) ≥20 participants at baseline; 6) standardized/validated diagnostic instruments; and 7) quantitative psychotic symptom frequency or severity data. Exploratory analyses assessed associations among relevant clinical variables. RESULTS Across 35 studies covering 28 independent samples (n = 1506, age = 15.6 years, age at illness onset = 14.5 years, males = 62.3%, schizophrenia-spectrum disorders = 89.0%), the most frequent psychotic symptoms were auditory hallucinations (81.9%), delusions (77.5%; mainly persecutory [48.5%], referential [35.1%], and grandiose [25.5%]), thought disorder (65.5%), bizarre/disorganized behavior (52.8%), and flat or blunted affect/negative symptoms (52.3%/50.4%). Mean baseline Positive and Negative Syndrome Scale (PANSS)-total, positive, and negative symptom scores were 84.5 ± 10.9, 19.3 ± 4.4 and 20.8 ± 2.9. Mean baseline Clinical Global Impressions-Severity and Children's Global Assessment Scale/Global Assessment of Functioning (CGAS/GAF) scores were 5.0 ± 0.7 and 35.5 ± 9.1. Comorbidity was frequent, particularly posttraumatic stress disorder (34.3%), attention-deficit/hyperactivity and/or disruptive behavior disorders (33.5%), and substance abuse/dependence (32.0%). Longer duration of untreated psychosis (DUP) predicted less CGAS/GAF improvement (p < 0.0001), and poor premorbid adjustment and a diagnosis of schizophrenia predicted less PANSS negative symptom improvement (p = 0.0048) at follow-up. Five studies directly comparing early-onset with adult-onset psychosis found longer DUP in EOP samples (18.7 ± 6.2 vs. 5.4 ± 3.1 months, p = 0.0027). CONCLUSIONS EOS patients suffer substantial impairment from significant levels of positive and negative symptoms. Although symptoms and functioning improve significantly over time, pre-/and comorbid conditions are frequent, and longer DUP and poorer premorbid adjustment is associated with poorer illness outcome.
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Affiliation(s)
- Marie Stentebjerg-Olesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anne K Pagsberg
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anders Fink-Jensen
- 3 Mental Health Center, Copenhagen University Hospital , Copenhagen, Denmark .,4 Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen , Copenhagen, Denmark
| | - Christoph U Correll
- 5 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish Health System, Glen Oaks, New York.,6 Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine , Hempstead, New York.,7 The Feinstein Institute for Medical Research , Manhasset, New York.,8 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York
| | - Pia Jeppesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
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Sheikh MA, Abelsen B, Olsen JA. Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study. Front Psychol 2016; 7:727. [PMID: 27252668 PMCID: PMC4879780 DOI: 10.3389/fpsyg.2016.00727] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/29/2016] [Indexed: 11/13/2022] Open
Abstract
Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RR Total Effect = 2.75, 95% CI: 2.19-3.10), an 89% increased risk of being unhealthy (RR Total Effect = 1.89, 95% CI: 1.47-1.99), and a 42% increased risk of having a low level of well-being in adulthood (RR Total Effect = 1.42, 95% CI: 1.29-1.52). Social support and behavioral factors mediate 11-18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being.
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Affiliation(s)
- Mashhood A Sheikh
- Department of Community Medicine, University of Tromsø Tromsø, Norway
| | - Birgit Abelsen
- Department of Community Medicine, University of Tromsø Tromsø, Norway
| | - Jan A Olsen
- Department of Community Medicine, University of Tromsø Tromsø, Norway
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Aas M, Henry C, Andreassen OA, Bellivier F, Melle I, Etain B. The role of childhood trauma in bipolar disorders. Int J Bipolar Disord 2016; 4:2. [PMID: 26763504 PMCID: PMC4712184 DOI: 10.1186/s40345-015-0042-0] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/13/2015] [Indexed: 12/22/2022] Open
Abstract
This review will discuss the role of childhood trauma in bipolar disorders. Relevant studies were identified via Medline (PubMed) and PsycINFO databases published up to and including July 2015. This review contributes to a new understanding of the negative consequences of early life stress, as well as setting childhood trauma in a biological context of susceptibility and discussing novel long-term pathophysiological consequences in bipolar disorders. Childhood traumatic events are risk factors for developing bipolar disorders, in addition to a more severe clinical presentation over time (primarily an earlier age at onset and an increased risk of suicide attempt and substance misuse). Childhood trauma leads to alterations of affect regulation, impulse control, and cognitive functioning that might decrease the ability to cope with later stressors. Childhood trauma interacts with several genes belonging to several different biological pathways [Hypothalamic–pituitary–adrenal (HPA) axis, serotonergic transmission, neuroplasticity, immunity, calcium signaling, and circadian rhythms] to decrease the age at the onset of the disorder or increase the risk of suicide. Epigenetic factors may also be involved in the neurobiological consequences of childhood trauma in bipolar disorder. Biological sequelae such as chronic inflammation, sleep disturbance, or telomere shortening are potential mediators of the negative effects of childhood trauma in bipolar disorders, in particular with regard to physical health. The main clinical implication is to systematically assess childhood trauma in patients with bipolar disorders, or at least in those with a severe or instable course. The challenge for the next years will be to fill the gap between clinical and fundamental research and routine practice, since recommendations for managing this specific population are lacking. In particular, little is known on which psychotherapies should be provided or which targets therapists should focus on, as well as how childhood trauma could explain the resistance to mood stabilizers.
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Affiliation(s)
- Monica Aas
- NORMENT, KG Jebsen Centre for Psychosis Research, TOP Study Group, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Bygg 49, Ullevål Sykehus, Nydalen, PO Box 4956, 0424, Oslo, Norway. .,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. .,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France.
| | - Chantal Henry
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie, 94000, Créteil, France. .,Université Paris Est, Faculté de Médecine, 94000, Créteil, France. .,Inserm, U955, 94000, Créteil, France. .,Fondation Fondamental, Créteil, France. .,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France.
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, TOP Study Group, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Bygg 49, Ullevål Sykehus, Nydalen, PO Box 4956, 0424, Oslo, Norway. .,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. .,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France.
| | - Frank Bellivier
- Fondation Fondamental, Créteil, France. .,AP-HP, Hôpital Fernand Widal, Pôle Addictologie-Toxicologie-Psychiatrie and Université Paris-7, Paris, France. .,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, TOP Study Group, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Bygg 49, Ullevål Sykehus, Nydalen, PO Box 4956, 0424, Oslo, Norway. .,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. .,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France.
| | - Bruno Etain
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie, 94000, Créteil, France. .,Inserm, U955, 94000, Créteil, France. .,Fondation Fondamental, Créteil, France. .,ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France.
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Interaction between SLC6A4 promoter variants and childhood trauma on the age at onset of bipolar disorders. Sci Rep 2015; 5:16301. [PMID: 26542422 PMCID: PMC4635347 DOI: 10.1038/srep16301] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022] Open
Abstract
Age at onset (AAO) of bipolar disorders (BD) could be influenced both by a repeat length polymorphism (5HTTLPR) in the promoter region of the serotonin transporter gene (SLC6A4) and exposure to childhood trauma. We assessed 308 euthymic patients with BD for the AAO of their first mood episode and childhood trauma. Patients were genotyped for the 5HTTLPR (long/short variant) and the rs25531. Genotypes were classified on functional significance (LL, LS, SS). A sample of 126 Brazilian euthymic patients with BD was used for replication. In the French sample, the correlation between AAO and trauma score was observed only among 'SS' homozygotes (p = 0.002) but not among 'L' allele carriers. A history of at least one trauma decreased the AAO only in 'SS' homozygotes (p = 0.001). These results remained significant after correction using FDR. Regression models suggested an interaction between emotional neglect and 'SS' genotype on the AAO (p = 0.009) and no further interaction with other trauma subtypes. Partial replication was obtained in the Brazilian sample, showing an interaction between emotional abuse and 'LS' genotype on the AAO (p = 0.02). In conclusion, an effect of childhood trauma on AAO of BD was observed only in patients who carry a specific stress responsiveness-related SLC6A4 promoter genotype.
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Schaffer A, Isometsä ET, Azorin JM, Cassidy F, Goldstein T, Rihmer Z, Sinyor M, Tondo L, Moreno DH, Turecki G, Reis C, Kessing LV, Ha K, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:1006-20. [PMID: 26175498 PMCID: PMC5858693 DOI: 10.1177/0004867415594428] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. METHODS A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. RESULTS We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. CONCLUSION There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology, and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Abstract
PURPOSE OF REVIEW Recent studies on mental health consequences of violence against women and girls were reviewed in a range of situations. RECENT FINDINGS Although several studies continued to show cross-sectional associations between child sexual abuse (CSA) and mental health outcomes, a few prospective studies showed a robust association between CSA and depression. Studies on the impact of dating violence are still at a nascent stage and focus on antecedents of violence rather than its consequences. Women at higher risk, such as adolescents, migrants, the homeless, and women in the perinatal period have been studied and specific vulnerabilities identified. Women reporting bidirectional violence had higher rates of depression and post-traumatic stress disorder (PTSD). Cumulative violence, severity of violence, and recent violence are associated with higher morbidity. Studies among women in conflict zones have emphasized the role of different forms of sexual and physical violence on mental health. SUMMARY Newer emerging areas that need more research include mental health consequences of women in conflict zones and among same sex relationships. There are also few studies on the violence experience of both older women and adolescents. The need to better delineate the psychopathology of complex manifestations of PTSD is underscored.
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Guloksuz S, van Nierop M, Lieb R, van Winkel R, Wittchen HU, van Os J. Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology. Psychol Med 2015; 45:2389-2401. [PMID: 25804288 DOI: 10.1017/s0033291715000380] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity. METHOD In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive-compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology. RESULTS The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose-response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56-68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use. CONCLUSIONS In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.
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Affiliation(s)
- S Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - M van Nierop
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - R Lieb
- Epidemiology and Health Psychology, Institute of Psychology, University of Basel,Basel,Switzerland
| | - R van Winkel
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden,Dresden,Germany
| | - J van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
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