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Yocum AK, Anderau S, Bertram H, Burgess HJ, Cochran AL, Deldin PJ, Evans SJ, Han P, Jenkins PM, Kaur R, Langenecker SA, Marshall DF, Mower Provost E, Sue O’Shea K, Ryan KA, Sperry SH, Smith SN, Tso IF, Versha KM, Wright BM, Zöllner S, McInnis MG. Cohort Profile Update: The Heinz C. Prechter Longitudinal Study of Bipolar Disorder. Int J Epidemiol 2023; 52:e324-e331. [PMID: 37541830 PMCID: PMC10749747 DOI: 10.1093/ije/dyad109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Steve Anderau
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Holli Bertram
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amy L Cochran
- Department of Mathematics and Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | - Patricia J Deldin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | | | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Jenkins
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Ravleen Kaur
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - David F Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Emily Mower Provost
- Department of Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | - K Sue O’Shea
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kritika M Versha
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Brittany M Wright
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sebastian Zöllner
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Dalloul N, Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning. Schizophr Bull 2023; 49:1281-1293. [PMID: 37382553 PMCID: PMC10483466 DOI: 10.1093/schbul/sbad095] [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: 06/30/2023]
Abstract
BACKGROUND AND HYPOTHESIS Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships. STUDY DESIGN Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA). RESULTS Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function. CONCLUSIONS These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.
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Affiliation(s)
- Nada Dalloul
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, CA, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, CA, USA
| | | | - Steven J Luck
- Department of Psychology, University of California, Davis, CA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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3
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Söderholm JJ, Socada JL, Rosenström T, Ekelund J, Isometsä E. Bipolar disorder predicted shorter and borderline personality disorder symptoms longer time to remission - A prospective cohort study of major depressive patients. J Affect Disord 2022; 316:161-168. [PMID: 35985516 DOI: 10.1016/j.jad.2022.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major depressive episodes (MDEs) of major depressive (MDD) or bipolar disorders (BD) are frequently complicated by features of borderline personality disorder (BPD). Mixed features are a hallmark of BD and affective lability of BPD, and both may markedly influence illness course. However, direct comparisons of outcome of depression in MDD, BD, and BPD are scarce. METHODS In a cohort study based on stratified sampling, we diagnosed psychiatric MDE patients with SCID-I/P and SCID-II interviews and examined mixed symptoms using the Mix-MDE scale and borderline symptoms using the Borderline Personality Disorder Severity Index. During a six-month prospective follow-up, the MDE patients with MDD (n = 39), BD (n = 33), or BPD (n = 23) completed biweekly online assessments. Using life chart methodology, we divided the follow-up period into qualitatively different mood state periods. We investigated durations of mood episodes, times to first full symptomatic remission, and their predictors. RESULTS Remission rates were similar in MDD, MDE/BD, and MDE/BPD patients. MDE/BD patients experienced more numerous and shorter distinct mood state periods during follow-up than the others. MDE/BD was associated with shorter (HR = 2.44, 95 % CI = 1.27-4.67) and dimensionally assessed BPD severity with longer time to first remission (HR = 0.95, 95 % CI = 0.91-1.00). LIMITATIONS Moderate sample size and follow-up duration. CONCLUSIONS Course of illness over six months differs between the three depressive groups. Bipolar depressive patients have the most alternating course and the shortest time to first period of remission. Dimensionally assessed severity of BPD may predict longer time to remission from depression.
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Affiliation(s)
- John J Söderholm
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital Brain Center, Helsinki, Finland
| | - J Lumikukka Socada
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital Brain Center, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jesper Ekelund
- Helsinki University Hospital Brain Center, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital Brain Center, Helsinki, Finland.
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4
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Mosolov S, Born C, Grunze H. Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57060624. [PMID: 34203943 PMCID: PMC8232811 DOI: 10.3390/medicina57060624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a "mirror image" design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5-10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.
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Affiliation(s)
- Sergey Mosolov
- Moscow Research Institute of Psychiatry, 107076 Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
- Correspondence:
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Paracelsus Medical University, 90419 Nuremberg, Germany
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5
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Antolín-Concha D, Lähteenvuo M, Vattulainen P, Tanskanen A, Taipale H, Vieta E, Tiihonen J. Suicide mortality and use of psychotropic drugs in patients hospitalized due to bipolar disorder: A Finnish nationwide cohort study. J Affect Disord 2020; 277:885-892. [PMID: 33065830 DOI: 10.1016/j.jad.2020.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Knowledge on the comparative effectiveness of pharmacological treatments to prevent suicide mortality in bipolar disorder is still lacking. METHODS We studied the risk of suicide mortality during 1996-2012 among all patients who had been hospitalized due to bipolar disorder in Finland (n = 18,018; mean follow-up time 7.2 years) using nation-wide databases. We used a Cox proportional hazards model. Analyses were adjusted for the effects of time since diagnosis, order of treatments, current use of other treatments, polypharmacy, number of suicidal hospitalizations within 2 year (indicator of inherent risk of relapse), age at index date, sex, and calendar year of index date. In secondary analysis, the first 30 days were omitted from analysis after initiation of a psychopharmacological treatment to control for protopathic bias. RESULTS In comparison between use and no use among specific agents, only lithium (HR 0.33, 95%CI 0.24-0.47, p<0.0001) and valproic acid (HR 0.61, 95%CI 0.48-0.79, p=0.0002) were associated with a significantly decreased risk of suicide in bipolar disorder. Lithium showed a 42% lower risk for suicide mortality compared to valproic acid (HR 0.58, 95% CI 0.39-0.86, p = 0.007). Hypnotics were associated with a significantly (HR 1.52, 95%CI 1.22-1.90, p=0.0002) higher risk of suicide. LIMITATIONS Only hospitalized patients were included. CONCLUSIONS Lithium should be considered as treatment of choice for patients with bipolar disorder who are at high risk for suicide. Hypnotic use among suicidal patients indicates need for close monitoring of these patients.
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Affiliation(s)
- Diego Antolín-Concha
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen)
| | - Markku Lähteenvuo
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen).
| | | | - Antti Tanskanen
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Taipale, Tiihonen); National Institute for Health and Welfare, Impact Assessment Unit, Helsinki, Finland (Tanskanen)
| | - Heidi Taipale
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Taipale, Tiihonen); School of Pharmacy, University of Eastern Finland, Kuopio, Finland (Taipale)
| | - Eduard Vieta
- Institute of Neurosience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Vieta)
| | - Jari Tiihonen
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Finland (Antolín-Concha, Lähteenvuo, Tanskanen, Taipale, Tiihonen); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Taipale, Tiihonen); Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
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6
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Castillo MFR, Murata S, Schwarz M, Schütze G, Moll N, Martin B, Burger B, Weidinger E, Mueller N, Halaris A. Celecoxib augmentation of escitalopram in treatment-resistant bipolar depression and the effects on Quinolinic Acid. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.npbr.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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7
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Post RM, Leverich GS, McElroy S, Kupka R, Suppes T, Altshuler L, Nolen W, Frye M, Keck P, Grunze H, Hellemann G. Prevalence of axis II comorbidities in bipolar disorder: relationship to mood state. Bipolar Disord 2018; 20:303-312. [PMID: 29369448 DOI: 10.1111/bdi.12596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/09/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES A high incidence of Axis II personality disorders is described in patients with bipolar disorder; however, their relationship to mood state remains uncertain. METHODS A total of 966 outpatients with bipolar disorder gave informed consent and filled out the Personality Disorder Questionnaire, 4th edition (PDQ4) and a questionnaire on demographics and course of illness prior to Bipolar Treatment Outcome Network entry at average age 41 years. Patients were rated at each visit for depression on the Inventory of Depressive Symptoms-Clinician version (IDS-C) and for mania on the Young Mania Rating Scale (YMRS). In a subgroup, the PDQ4 was retaken during periods of depression and euthymia. RESULTS Patients met criteria for most personality disorders at a much higher rate when they took the PDQ4 while depressed compared to while euthymic, and scores were significantly related to the severity of depression (IDS) and of mania (YMRS) assessed within 2 weeks of taking the PDQ. Even when euthymic, more than quarter to half of the patients met criteria for a cluster A, B or C personality disorder. CONCLUSIONS A wide range of personality disorders occur in bipolar patients, but are highly dependent on filling out the form while depressed compared to while euthymic. How this relates to having a personality disorder assessed using a structured clinical interview remains to be tested. However, higher PDQ4 scores are related to an earlier age of onset of bipolar disorder and other factors portending a more difficult course of bipolar disorder, and the optimal treatment of these patients remains to be illuminated.
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Affiliation(s)
| | | | - Susan McElroy
- Linder Center of Hope, Mason, OH, USA
- Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam,, The Netherlands
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and V.A. Palo Alto Health Care System Palo Alto, Palo Alto, CA, USA
| | - Lori Altshuler
- UCLA Mood Disorders Research Program and West LA VA Medical Center, Los Angeles, CA, USA
| | - Willem Nolen
- Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands
| | - Mark Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | - Paul Keck
- Department of Psychiatry and Neuroscience, University of Cincinnati College of Medicine Cincinnati, Mason, OH, USA
- President-CEO Lindner Center of HOPE Mason, Mason, OH, USA
| | - Heinz Grunze
- Paracelsius Medical University, Salzburg, Austria
| | - Gerhard Hellemann
- Biostatistician UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, USA
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Post RM, McElroy S, Kupka R, Suppes T, Hellemann G, Nolen W, Frye M, Keck P, Grunze H, Rowe M. Axis II Personality Disorders Are Linked to an Adverse Course of Bipolar Disorder. J Nerv Ment Dis 2018; 206:469-472. [PMID: 29781886 DOI: 10.1097/nmd.0000000000000819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The relationship of personality disorder (PD) psychopathology to the course of bipolar disorder remains inadequately described. After giving informed consent, more than 782 outpatients with bipolar disorder rated themselves on the 99-item Personality Disorder Questionnaire, Version 4 (PDQ4) when depressed or euthymic. They also rated six poor prognosis factors (PPFs). The relationships of the PPFs to the total PDQ4 score were examined by a linear regression. Even after correcting for the higher PDQ4 scores observed when patients were suffering depression, the PDQ4 was significantly related to a history of child abuse, early age of onset, an anxiety disorder comorbidity, rapid cycling, and 20 or more previous episodes, but not substance abuse. The data suggest close relationships between the total burden of PD psychopathology and correlates of an adverse outcome of bipolar disorder. The nature of this of association and approaches to treatment of comorbid PD remain to be further explored.
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Affiliation(s)
| | | | - Ralph Kupka
- VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Trisha Suppes
- Stanford University School of Medicine and V.A. Palo Alto Health Care System, California
| | - Gerhard Hellemann
- UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA
| | - Willem Nolen
- Universitair Medisch Centrum Groningen (UMCG), the Netherlands
| | | | | | - Heinz Grunze
- Department of Psychiatry and Psychotherapy, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Austria
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McInnis MG, Assari S, Kamali M, Ryan K, Langenecker SA, Saunders EFH, Versha K, Evans S, O’Shea KS, Mower Provost E, Marshall D, Forger D, Deldin P, Zoellner S. Cohort Profile: The Heinz C. Prechter Longitudinal Study of Bipolar Disorder. Int J Epidemiol 2018; 47:28-28n. [PMID: 29211851 PMCID: PMC5837550 DOI: 10.1093/ije/dyx229] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kelly Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Erika FH Saunders
- Department of Psychiatry, Penn State Hershey Medical Group, Hershey, PA, USA
| | - Kritika Versha
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Simon Evans
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - K Sue O’Shea
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Cell and Developmental Biology
| | | | - David Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Sebastian Zoellner
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
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Driscoll KE, Sit DKY, Moses-Kolko EL, Pinheiro E, Yang A, Ciolino JD, Eng HF, Luther JF, Clark CT, Wisniewski SR, Wisner KL. Mood symptoms in pregnant and postpartum women with bipolar disorder: a naturalistic study. Bipolar Disord 2017; 19:295-304. [PMID: 28665044 PMCID: PMC6594856 DOI: 10.1111/bdi.12500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/08/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We conducted a prospective naturalistic study of pregnant women with bipolar disorder (BD) to evaluate symptoms of BD across childbearing and assess whether pharmacotherapy reduced their severity. METHODS Assessments were scheduled at 20, 30, and 36 weeks' gestation and 2, 12, 26, and 52 weeks postpartum. Symptoms were assessed using the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Supplement (SIGH-ADS) and Mania Rating Scale (MRS). RESULTS Pregnant women (N=152) with BD were evaluated; 88 women (58%) were treated and 64 untreated (42%) with psychotropic drugs during pregnancy. Among the 88 women treated, 23 (26%) discontinued their medication in the first trimester and the remaining 65 (74%) were exposed throughout pregnancy or in the second and third trimesters. More than two-thirds (73%) of the women who remained in the study took psychotropic agents postpartum. The mean scores on the SIGH-ADS were in the mild range of depressive symptoms in both the psychotropic-treated and untreated groups in both pregnancy and postpartum. The majority of women had no or few symptoms of mania. Of the pregnant women treated with psychotropic agents, 66% received a guideline-concordant drug, and 34% received either antidepressant monotherapy (for BD I) or mono- or polypharmacy with a variety of other agents. CONCLUSIONS This sample of perinatal women with BD was characterized by mild residual symptoms of depression independent of pharmacotherapy, which poses a risk for recurrence and impaired parenting. The treatment of childbearing women with BD deserves urgent clinical and research attention to improve psychiatric outcomes.
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Affiliation(s)
| | - Dorothy K Y Sit
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Emily Pinheiro
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Yang
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jody D Ciolino
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Heather F Eng
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - James F Luther
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Crystal T Clark
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen R Wisniewski
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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11
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Machado-Vieira R, Luckenbaugh DA, Ballard ED, Henter ID, Tohen M, Suppes T, Zarate CA. Increased Activity or Energy as a Primary Criterion for the Diagnosis of Bipolar Mania in DSM-5: Findings From the STEP-BD Study. Am J Psychiatry 2017; 174:70-76. [PMID: 27523498 PMCID: PMC5205570 DOI: 10.1176/appi.ajp.2016.15091132] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE DSM-5 describes "a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy" as a primary criterion for mania. Thus, increased energy or activity is now considered a core symptom of manic and hypomanic episodes. Using data from the Systematic Treatment Enhancement Program for Bipolar Disorder study, the authors analyzed point prevalence data obtained at the initial visit to assess the diagnostic validity of this new DSM-5 criterion. The study hypothesis was that the DSM-5 criterion would alter the prevalence of mania and/or hypomania. METHOD The authors compared prevalence, clinical characteristics, validators, and outcome in patients meeting the DSM-5 criteria (i.e., DSM-IV criteria plus the DSM-5 criterion of increased activity or energy) and those who did not meet the new DSM-5 criterion (i.e., who only met DSM-IV criteria). RESULTS All 4,360 participants met DSM-IV criteria for bipolar disorder, and 310 met DSM-IV criteria for a manic or hypomanic episode. When the new DSM-5 criterion of increased activity or energy was added as a coprimary symptom, the prevalence of mania and hypomania was reduced. Although minor differences were noted in clinical and concurrent validators, no changes were observed in longitudinal outcomes. CONCLUSIONS The findings confirm that including increased activity or energy as part of DSM-5 criterion A decreases the prevalence of manic and hypomanic episodes but does not affect longitudinal clinical outcomes.
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Kvitland LR, Ringen PA, Aminoff SR, Demmo C, Hellvin T, Lagerberg TV, Andreassen OA, Melle I. Duration of untreated illness in first-treatment bipolar I disorder in relation to clinical outcome and cannabis use. Psychiatry Res 2016; 246:762-768. [PMID: 27814886 DOI: 10.1016/j.psychres.2016.07.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022]
Abstract
There is little knowledge about the role of the duration of untreated bipolar (DUB) illness in first-treatment bipolar disorder I (BD I), its association with symptoms at start of first treatment, and development over the first year, and limited knowledge about factors that influence the length of DUB. Substance use has shown to delay identification of primary psychiatric disorders, and while cannabis use is common in BD the role of cannabis in relationship to DUB is unclear. The aim of the present study is to examine the associations between DUB and key clinical outcomes at baseline in BD I, and at one year follow-up, and to evaluate the influence of cannabis use. Patients with first-treatment BD I (N=62) completed comprehensive clinical evaluations, which included both DUB and the number of previous episodes. There were no significant associations between DUB and key clinical outcomes. Longer duration from first manic episode to treatment was associated with risk of starting excessive cannabis use after onset of the bipolar disorder. The main finding is the lack of significant associations between features of previous illness episodes and clinical outcomes. Long duration of untreated mania seems to increase the risk for later cannabis use.
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Affiliation(s)
- Levi Røstad Kvitland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | | | - Sofie Ragnhild Aminoff
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway; Division of Mental Health Services, Department of Specialized Inpatient Treatment, Akershus University Hospital, Akershus, Norway.
| | - Christine Demmo
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Tone Hellvin
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ole Andreas Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
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Bobo WV, Vande Voort JL, Croarkin PE, Leung JG, Tye SJ, Frye MA. KETAMINE FOR TREATMENT-RESISTANT UNIPOLAR AND BIPOLAR MAJOR DEPRESSION: CRITICAL REVIEW AND IMPLICATIONS FOR CLINICAL PRACTICE. Depress Anxiety 2016; 33:698-710. [PMID: 27062450 DOI: 10.1002/da.22505] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 12/21/2022] Open
Abstract
There is an urgent need for more rapidly effective pharmacotherapies for major depressive disorder and bipolar disorder (BP) that are efficacious and tolerable for depressed patients who respond poorly to conventional treatments. Multiple controlled trials have now demonstrated a rapid, nonsustained antidepressive response to a single intravenous infusion of ketamine. Early controlled studies of intranasal or serial infusion therapy appear promising. The effective dose for depression is lower than the typical anesthetic doses, and side-effects are generally mild and transient. The data investigating the adjunctive use of concurrent ketamine in the course of electroconvulsive therapy (ECT) for depression do not suggest efficacy or tolerability. The therapeutic potential of ketamine has stimulated considerable excitement among clinicians, patients, and industry, and has led to the increasing use of ketamine as an off-label substitute for ECT and other antidepressive treatments. This clinical review of ketamine will assess the evidence-based use of ketamine and initial clinical implications of further development of a potentially novel treatment for rapid reduction of symptoms in depressed patients.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Paul E Croarkin
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Jonathan G Leung
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Susannah J Tye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
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Shakeri J, Khanegi M, Golshani S, Farnia V, Tatari F, Alikhani M, Nooripour R, Ghezelbash MS. Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder. Int J Prev Med 2016; 7:77. [PMID: 27280013 PMCID: PMC4882968 DOI: 10.4103/2008-7802.182734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 04/05/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fatty acids play various physiological roles in the organism; they are crucial for the structure of cell membranes, metabolic processes, transmission of nerve impulses and brain functions. In recent years, particular attention has been paid to the rich sources of omega-3 for the treatment of many diseases, especially mental illnesses. The present study aimed to investigate the effects of omega-3 supplement in the treatment of patients with bipolar I disorder (BID). METHODS In this double-blind clinical trial, 100 patients suffering from BIDs were randomly divided into two, i.e. control (n = 50) and experimental (n = 50) groups. In addition to the other standard treatments, 1000 mg of omega-3 supplement was given to the experimental group on daily basis for 3 months and placebo was given to the control group. The Young Mania Rating Scale was completed for both groups before and after the intervention. Afterward, data were analyzed using paired t-test, independent t-test, and Chi-square test. RESULTS Before intervention, mean severity of mania in the experimental group (23.50 ± 7.02) and control group (23.70 ± 8.09) was not significant (P ≤ 0.89). The difference after the intervention in the experimental group (10.64 ± 3.3) and control group (20.12 ± 6.78) was significant (P < 0.01). The mean intensity of mania before (23.50 ± 7.02) and after (10.64 ± 3.3) intervention reported to be significant at P < 0.05. CONCLUSIONS Since omega-3 supplement was effective for the treatment of BID, it is suggested to use omega-3 supplements as an adjuvant therapy along with the other pharmacotherapies.
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Affiliation(s)
- Jalal Shakeri
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Khanegi
- Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sanobar Golshani
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faeze Tatari
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roghih Nooripour
- Department of Counseling, Faculty of Education and Psychology, AL Zahra University, Tehran, Iran
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Jeon HJ, Baek JH, Ahn YM, Kim SJ, Ha TH, Cha B, Moon E, Kang HJ, Ryu V, Cho CH, Heo JY, Kim K, Lee HJ. Review of Cohort Studies for Mood Disorders. Psychiatry Investig 2016; 13:265-76. [PMID: 27247592 PMCID: PMC4878960 DOI: 10.4306/pi.2016.13.3.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 12/28/2022] Open
Abstract
This paper aimed to review currently available cohort studies of subjects with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD). Using the PubMed and KoreaMed databases, we reviewed eight major cohort studies. Most studies recruited participants with MDD and BD separately, so direct comparison of factors associated with diagnostic changes was difficult. Regular and frequent follow-up evaluations utilizing objective mood ratings and standardized evaluation methods in a naturalistic fashion are necessary to determine detailed clinical courses of mood disorders. Further, biological samples should also be collected to incorporate clinical findings in the development of new diagnostic and therapeutic approaches. An innovative cohort study that can serve as a platform for translational research for treatment and prevention of mood disorders is critical in determining clinical, psychosocial, neurobiological and genetic factors associated with long-term courses and consequences of mood disorders in Korean patients.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences & Technology, Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Ha
- Department of Psychiatry, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University College of Medicine, Gwangju, Republic of Korea
| | - Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Antioxidant Interventions in Neuropsychiatric Disorders. OXIDATIVE STRESS IN APPLIED BASIC RESEARCH AND CLINICAL PRACTICE 2015. [DOI: 10.1007/978-1-4939-0440-2_25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Daglas R, Conus P, Cotton SM, Macneil CA, Hasty MK, Kader L, Berk M, Hallam KT. The impact of past direct-personal traumatic events on 12-month outcome in first episode psychotic mania: trauma and early psychotic mania. Aust N Z J Psychiatry 2014; 48:1017-24. [PMID: 25122448 DOI: 10.1177/0004867414545672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Past traumatic events have been associated with poorer clinical outcomes in people with bipolar disorder. However, the impact of these events in the early stages of the illness remains unclear. The aim of this study was to investigate whether prior traumatic events were related to poorer outcomes 12 months following a first episode of psychotic mania. METHODS Traumatic events were retrospectively evaluated from patient files in a sample of 65 participants who had experienced first episode psychotic mania. Participants were aged between 15 and 28 years and were treated at a specialised early psychosis service. Clinical outcomes were measured by a variety of symptomatic and functioning scales at the 12-month time-point. RESULTS Direct-personal traumatic experiences prior to the onset of psychotic mania were reported by 48% of the sample. Participants with past direct-personal trauma had significantly higher symptoms of mania (p=0.02), depression (p=0.03) and psychopathology (p=0.01) 12 months following their first episode compared to participants without past direct-personal trauma, with medium to large effects observed. After adjusting for baseline scores, differences in global functioning (as measured by the Global Assessment of Functioning scale) were non-significant (p=0.05); however, participants with past direct-personal trauma had significantly poorer social and occupational functioning (p=0.04) at the 12-month assessment with medium effect. CONCLUSIONS Past direct-personal trauma may predict poorer symptomatic and functional outcomes after first episode psychotic mania. Limitations include that the findings represent individuals treated at a specialist early intervention centre for youth and the retrospective assessment of traumatic events may have been underestimated.
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Affiliation(s)
- Rothanthi Daglas
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland
| | - Sue M Cotton
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | | | - Linda Kader
- Orygen Youth Health Clinical Program, Parkville, Australia
| | - Michael Berk
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia Barwon Health and the Geelong Clinic, Swanston Centre, Geelong, Australia
| | - Karen T Hallam
- Department of Psychology, Victoria University, Melbourne, Australia
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18
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Sala R, Goldstein BI, Wang S, Blanco C. Childhood maltreatment and the course of bipolar disorders among adults: epidemiologic evidence of dose-response effects. J Affect Disord 2014; 165:74-80. [PMID: 24882181 PMCID: PMC4083555 DOI: 10.1016/j.jad.2014.04.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) is highly prevalent among individuals with bipolar disorders (BP); however few studies have examined its potential role in the course and outcome of individuals with BP. We aim to examine the dose response relationship between the number of types of CM and the course of individuals with BP. METHODS As part of the National Epidemiologic Survey on Alcohol and Related Conditions, 1600 adults who met lifetime DSM-IV criteria for BP-I (n=1172) and BP-II (n=428) were included. Individuals were evaluated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DMS-IV Version and data was analyzed lifetime and from Waves 1 and 2, approximately 3 years apart. RESULTS Around half of individuals with BP had a history of at least one type of CM. Overall, there was a clear dose-response relationship between number of CM and severity of BP across several domains, including clinical characteristics, probability of treatment, lifetime prevalence of psychiatric comorbidity, incidence of anxiety disorders, substance use disorder, and nicotine dependence, and level of psychosocial functioning. LIMITATIONS The interviews were conducted by lay professional interviewers rather than clinicians, use of retrospective report to determine CM in individuals with BP, and not all respondents from Wave 1 were able to be interviewed in Wave 2. CONCLUSIONS The number of types of CM confers developmental differences in the course of BP with a worse course and outcome of BP. Early identification and treatment of CM are warranted to improve the course and outcome of individuals with BP.
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Affiliation(s)
- Regina Sala
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King׳s College London, London, UK.
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Shuai Wang
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Conus P, Macneil C, McGorry PD. Public health significance of bipolar disorder: implications for early intervention and prevention. Bipolar Disord 2014; 16:548-56. [PMID: 24127825 DOI: 10.1111/bdi.12137] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 05/27/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder (BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder. METHODS The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression. RESULTS BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD. CONCLUSIONS Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder.
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Affiliation(s)
- Philippe Conus
- Service de Psychiatrie Générale, Département Universitaire de Psychiatrie CHUV, Lausanne University, Clinique de Cery, Prilly, Switzerland
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Rocha-Rego V, Jogia J, Marquand AF, Mourao-Miranda J, Simmons A, Frangou S. Examination of the predictive value of structural magnetic resonance scans in bipolar disorder: a pattern classification approach. Psychol Med 2014; 44:519-532. [PMID: 23734914 PMCID: PMC3880067 DOI: 10.1017/s0033291713001013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 10/03/2012] [Accepted: 04/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is one of the leading causes of disability worldwide. Patients are further disadvantaged by delays in accurate diagnosis ranging between 5 and 10 years. We applied Gaussian process classifiers (GPCs) to structural magnetic resonance imaging (sMRI) data to evaluate the feasibility of using pattern recognition techniques for the diagnostic classification of patients with BD. METHOD GPCs were applied to gray (GM) and white matter (WM) sMRI data derived from two independent samples of patients with BD (cohort 1: n = 26; cohort 2: n = 14). Within each cohort patients were matched on age, sex and IQ to an equal number of healthy controls. RESULTS The diagnostic accuracy of the GPC for GM was 73% in cohort 1 and 72% in cohort 2; the sensitivity and specificity of the GM classification were respectively 69% and 77% in cohort 1 and 64% and 99% in cohort 2. The diagnostic accuracy of the GPC for WM was 69% in cohort 1 and 78% in cohort 2; the sensitivity and specificity of the WM classification were both 69% in cohort 1 and 71% and 86% respectively in cohort 2. In both samples, GM and WM clusters discriminating between patients and controls were localized within cortical and subcortical structures implicated in BD. CONCLUSIONS Our results demonstrate the predictive value of neuroanatomical data in discriminating patients with BD from healthy individuals. The overlap between discriminative networks and regions implicated in the pathophysiology of BD supports the biological plausibility of the classifiers.
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Affiliation(s)
- V. Rocha-Rego
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - J. Jogia
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
| | - A. F. Marquand
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
| | - J. Mourao-Miranda
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
- Computer Science Department, Centre for Computational Statistics and Machine Learning, University College London, UK
| | - A. Simmons
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
- MRC Centre for Neurodegeneration Research, Institute of Psychiatry, King's College London, UK
| | - S. Frangou
- Psychosis Research Program, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, NY, USA
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Abstract
Valproate is principally effective in manic aspects of bipolar disorder. Tolerability has been somewhat more favorable for valproate than comparators, with the frequent adverse effects being gastrointestinal disturbances and weight gain. Total cholesterol and low-density lipoproteins are reduced by valproate. Valproate is effective and well tolerated when combined with lithium or antipsychotic drugs. Valproate is efficacious in mixed and euphoric mania. In studies of maintenance versus placebo and active comparators, patients initially treated with divalproex for mania had more robust long-term benefits than in the full sample analyses. In maintenance treatment, patients whose valproate serum levels were between 75 and 99 microg/ml had longer time to discontinuation for any reason or a new mood episode than did patients receiving placebo. The profile of utility in bipolar disorders is principally for core features of manic symptomatology (e.g., impulsivity, hyperactivity and irritability), with little evidence of benefit for anxiety or psychosis. Valproate appears useful in other disorders that have behavioral dimensions inclusive of the domains that valproate benefits in bipolar disorders, such as schizophrenia.
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Affiliation(s)
- Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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22
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Do young adults with bipolar disorder benefit from early intervention? J Affect Disord 2014; 152-154:403-8. [PMID: 24268595 DOI: 10.1016/j.jad.2013.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment and group psychoeducation. The aim of the present report was to compare the effects of early intervention among patients with bipolar disorder aged 18-25 years to that of patients aged 26 years or older. METHODS Patients were randomised to early treatment in a specialised outpatient mood disorder clinic versus standard care. The primary outcome was risk of psychiatric re-hospitalisation. RESULTS A total of 158 patients with mania/bipolar disorder were included among whom 29 (18.4%) were between 18 and 25 years and 129 patients were 26 years or older. For both age groups, the point estimate of the hazard ratio of re-hospitalisation was insignificantly decreased for patients treated in the mood disorder clinic versus standard treatment but more so for patients between 18 and 25 years (HR 0.33, 95% CI 0.10-1.07; p=0.064) than for patients 26 years or older (HR 0.68, 95% CI 0.40-1.14, p=0.14). Younger adults treated in the mood disorder clinic used mood stabilisers and antipsychotics more in contrast to those treated in standard care. The differences between the estimates of effects did not reach significance in tests of interactions (p>0.2). LIMITATIONS The study was based on a post hoc subgroup analysis and due to the small number of patients aged 18-25 years, type II errors cannot be excluded. CONCLUSIONS Although not statistically different, the observed differences of the point estimates was surprisingly larger for young adults suggesting that young adults with bipolar disorder may benefit even more than older adults from early intervention combining pharmacological treatment and group psychoeducation.
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Saunders KEA, Hawton K. Clinical assessment and crisis intervention for the suicidal bipolar disorder patient. Bipolar Disord 2013; 15:575-83. [PMID: 23565916 DOI: 10.1111/bdi.12065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Suicidal behaviour is common in people suffering with bipolar disorder, and suicide is a leading cause of death in this group. Our aim in this review is to provide an overview of key assessment and management strategies, highlight research findings relevant to suicide prevention, and identify important areas for future research. METHODS We reviewed the published literature regarding the risk factors for and management of suicida\l behaviour in individuals with bipolar disorder using the Pubmed and PsychINFO databases. Where available, we focused our search on systematic reviews. RESULTS Suicide is usually associated with a depressive phase, although mixed affective states also convey increased risk. All individuals with bipolar disorder should have an up-to-date crisis management plan which outlines the action to be taken should suicidal behaviour emerge. Timely clinical assessment is essential in ensuring that those at high risk are identified. This should include mental state examination, consideration of risk factors, and evaluation of issues such as access to means, preparatory acts before suicide, and also protective factors. While pharmacological approaches are the mainstay of management, less specific measures, such as the removal of access to means, are also important in ensuring safety in the acute situation. Intensifying the clinical support of both patients and relatives, and the sharing of risk information with other health agencies are essential in management. Specific psychological treatments are likely to be helpful in preventing crises, although the evidence base is limited. CONCLUSIONS The aetiology of suicidal behaviour in bipolar disorder is multifactorial and requires proactive crisis planning and management. A range of issues need to be addressed in the assessment of at-risk patients. Determining the efficacy of interventions specific to reducing suicidality in bipolar disorder should be a research priority.
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Affiliation(s)
- Kate E A Saunders
- Centre for Suicide Research, Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK
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Young AH, Hale A. Patients with bipolar disorder in a bipolar clinic setting: practical steps. Acta Psychiatr Scand Suppl 2013:19-24. [PMID: 23581789 DOI: 10.1111/acps.12120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - A. Hale
- University of Kent; Canterbury; UK
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McMurrich S, Sylvia LG, Dupuy JM, Peckham AD, Peters AT, Deckersbach T, Perlis RH. Course, outcomes, and psychosocial interventions for first-episode mania. Bipolar Disord 2012; 14:797-808. [PMID: 22963164 DOI: 10.1111/bdi.12001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The course of bipolar disorder tends to worsen over time, highlighting the importance of early intervention. Despite the recognized need for adjunctive psychosocial treatments in first-episode mania, very few studies have evaluated psychological interventions for this period of significant risk. In this empirical review, we evaluate existing research on first-episode bipolar disorder, compare this body of research to parallel studies of first-episode schizophrenia, and identify strategies for future research. METHODS A comprehensive literature search of the MEDLINE and PsychINFO databases was conducted to identify studies of first-episode mania, as well as first-episode schizophrenia. Recovery and relapse rates were compared across studies. RESULTS In contrast to a number of studies of first-episode schizophrenia, the authors identified only seven independent programs assessing first-episode mania. Findings from these studies suggest that, while pharmacological treatment helps patients achieve recovery from acute episodes, it fails to bring patients to sustained remission. Early psychosocial intervention may be imperative in reducing residual symptoms, preventing recurrence of mood episodes, and improving psychosocial functioning. However, very few studies of psychosocial interventions for first-episode mania have been systematically studied. CONCLUSIONS Studies of first-episode mania indicate a gap between syndromal/symptomatic and functional recovery. Novel psychosocial interventions for first-episode mania may help bridge this gap, but require controlled study.
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Affiliation(s)
- Stephanie McMurrich
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
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Antipsychotiques de seconde génération dans la dépression bipolaire : une nouvelle option thérapeutique ? Encephale 2011; 37 Suppl 3:S209-13. [DOI: 10.1016/s0013-7006(11)70055-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lloyd LC, Giaroli G, Taylor D, Tracy DK. Bipolar depression: clinically missed, pharmacologically mismanaged. Ther Adv Psychopharmacol 2011; 1:153-62. [PMID: 23983940 PMCID: PMC3736904 DOI: 10.1177/2045125311420752] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bipolar affective disorders are common and frequently debilitating mental illnesses. Diagnostic criteria mean they are defined by the presence of pathological mood elevation, but research shows greater disease burden is inflicted by depressive phases (bipolar depression) both in terms of duration and impact of symptoms. Despite this there is consistent evidence for the underdiagnosis of bipolar depression and its misdiagnosis as a unipolar disorder, with significant subsequent impact on medication management. There is currently less robust evidence for the appropriate pharmacological approach in such individuals than in unipolar depression, and fewer guidelines for clinicians. Despite this there is clear and growing evidence that 'treatment as usual' of depressive symptomatology is ineffective at best, harmful at worst, and that there is little role for the use of antidepressants. Both mood stabilizers and antipsychotics demonstrate efficacy, and whilst there are emerging data on intraclass differences, more research is needed, particularly concerning bipolar II disorder. Present treatment strategies are limited by insufficient large randomized control trials, an inadequate understanding of the neuropathology of bipolar illnesses and a lack of tailored medications. Better clinical training, understanding and recognition of this common condition are essential.
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Affiliation(s)
- Lisa C Lloyd
- CSI Lab, Psychological Medicine, The Institute of Psychiatry, King's College London, DeCrespigny Park, London, UK
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Brietzke E, Moreira CLR, Toniolo RA, Lafer B. Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I. J Affect Disord 2011; 130:162-5. [PMID: 21071093 DOI: 10.1016/j.jad.2010.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 09/22/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report on the presence of current and lifetime eating disorders (ED) in a well-defined sample of 137 female individuals with bipolar disorder type I. METHODS Trained psychiatrists interviewed the patients, and the diagnoses of BD and comorbidities were confirmed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Axis I Disorders. Clinical and demographic characteristics of both groups (group with ED vs. group without ED) were compared. RESULTS Female patients with ED had an earlier onset of BD and an increased number of mood episodes, predominantly depressive. Women in the ED group also had higher rates of comorbidity with substance use disorders and anxiety disorders and reported a history of suicide attempts more frequently than women without ED. CONCLUSION The presence of ED is a correlate of severity of BD type I, and interventions should be developed to minimize distress and suicide risk and to improve treatment outcome.
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Affiliation(s)
- Elisa Brietzke
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Kessing LV, Hansen HV, Christensen EM, Dam H, Gluud C, Wetterslev J. The effects of centralised and specialised combined pharmacological and psychological intervention compared with decentralised and non-specialised treatment in the early course of severe unipolar and bipolar affective disorders--design of two randomised clinical trials. Trials 2011; 12:32. [PMID: 21291564 PMCID: PMC3045900 DOI: 10.1186/1745-6215-12-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/03/2011] [Indexed: 12/26/2022] Open
Abstract
Background In unipolar, and bipolar affective disorders, there is a high risk of relapse that increases as the number of episodes increases. Naturalistic follow-up studies suggest that the progressive development of the diseases is not prevented with the present treatment modalities. It is not known whether centralised and specialised secondary care intervention initiated early after the onset of the diseases can prevent the progression and thereby improve the prognosis. Methods Two randomised clinical multi-centre trials comparing a centralised and specialised outpatient intervention program consisting of combined pharmacological and psychological intervention with standard decentralised psychiatric treatment. Patients discharged from their first, second, or third hospitalisation due to a manic episode or bipolar disorder (trial 1) or to a single depressive episode or recurrent depressive disorder (trial 2) were randomised. Central randomisations for both trials were stratified for the number of hospitalisations and treatment centre. The primary outcome measure for the two trials is time to re-hospitalisation with an affective episode. Discussion These trials are the first to evaluate the effect of a centralised and specialised intervention in patients with early severe affective disorders. The trials used a pragmatic design comparing a specialised mood disorder clinic intervention with decentralised, non-specialised standard psychiatric treatment. Trial Registration ClinicalTrials.gov: NCT00253071
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Affiliation(s)
- Lars Vedel Kessing
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Yatham LN. A clinical review of aripiprazole in bipolar depression and maintenance therapy of bipolar disorder. J Affect Disord 2011; 128 Suppl 1:S21-8. [PMID: 21220077 DOI: 10.1016/s0165-0327(11)70005-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bipolar disorder is a chronic, recurrent disorder with a significant negative impact on quality of life. Effective treatments are available for acute mania. In contrast, there is a lack of consensus on the treatment of acute bipolar depression and long treatment options for bipolar disorder require more study. Aripiprazole is FDA approved for the treatment of acute mania. This paper reviews current data on the efficacy of aripiprazole in the treatment of acute bipolar depression and in maintenance therapy of bipolar disorder. METHODS PubMed and abstracts of recent conferences were searched for randomized, double-blind studies that investigated the efficacy of aripiprazole in acute bipolar depression or maintenance therapy of bipolar disorder. RESULTS Two studies assessed the efficacy of aripiprazole monotherapy in the treatment of acute bipolar depression. These showed that although aripiprazole significantly reduced depressive symptoms early in treatment, the results were not significantly different from placebo at the primary end point of week 8. As to long-term treatment, aripiprazole was superior to placebo in delaying time to relapse for manic episodes, but not for depressive episodes after 26 and 100 weeks of maintenance therapy. Aripiprazole was as effective as lithium, and adjunctive aripiprazole with lithium or valproate was more effective than placebo plus lithium or valproate, in preventing a manic relapse. Reductions in manic and mixed relapse rates compared to placebo were achieved in a study combining aripiprazole with lamotrigine; however, the results were not statistically significant. Similar to other maintenance studies, depressive relapse rates were not significantly reduced compared to placebo. LIMITATIONS Negative findings for aripiprazole in the treatment of acute bipolar depression have been attributed to high study doses, rapid titration, and high placebo rates. A recent post-hoc analysis demonstrated that aripiprazole was more effective in patients with severe depressive symptoms, particularly for patients on a lower dose. Further research is needed to confirm this finding. The inability of aripiprazole to reduce the time to depressive relapse during maintenance therapy may be due to the recruitment of patients with an index manic episode and a consequent lower incidence of depressive relapses. Therefore, studies using a depression index episode are needed to appropriately evaluate relapse prevention. CONCLUSIONS Although aripiprazole has proven efficacy for acute mania and the prevention of mania, the evidence available thus far does not support the efficacy of aripiprazole for the treatment of acute bipolar depression and prevention of depressive relapse. Further studies with appropriate doses and a depressive index episode are needed to clarify the role of aripiprazole in bipolar disorder.
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Affiliation(s)
- Lakshmi N Yatham
- UBC Department of Psychiatry, The University of British Columbia, UBC Hospital, Vancouver, BC, Canada.
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Depp CA, Mausbach BT, Harvey PD, Bowie CR, Wolyniec PS, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Patterson TL. Social competence and observer-rated social functioning in bipolar disorder. Bipolar Disord 2010; 12:843-50. [PMID: 21176031 PMCID: PMC3639014 DOI: 10.1111/j.1399-5618.2010.00880.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Impairment in social functioning appears to be common in bipolar disorder, although estimates have been derived largely from self-report measures. We examined performance-based and observer-based ratings of social competence and functioning and assessed the contribution of symptoms and neurocognitive ability to social functioning in bipolar disorder. METHODS In this cross-sectional study, 164 subjects with bipolar disorder were administered the performance-based Social Skills Performance Assessment (SSPA), rated by an informant on the Specific Level of Functioning (SLOF)-Interpersonal subscale, received clinical ratings of depression and manic symptoms, and performed neurocognitive tests. We assessed the proportion of patients exhibiting social deficits and examined the associations between composite measures of neurocognitive ability, depression and manic symptoms, and SSPA scores with informant-rated, real-world social functioning. RESULTS Mean age of the sample was 47.6 years (SD = 14.1). Subjects were experiencing, on average, mild levels of depression and minimal manic symptoms. A total of 29% exhibited norm-referenced impairment on the SSPA, and 64% registered at least one impairment on SLOF items; unemployed subjects had lower SSPA and SLOF ratings. Neurocognitive performance correlated with both performance-based and observer-rated social functioning, whereas depressive and manic symptoms correlated only with observer-rated social impairments. In multivariate models, depression was the most potent association with social functioning, and impairment in social competence (i.e., capacity) increased the strength of the relationships between depression and neurocognitive impairment and social functioning (i.e., real-world functioning). CONCLUSIONS Our study confirmed the negative relationship of bipolar depression with social functioning. A subgroup of outpatients with bipolar disorder has impaired social competence, which, when present, worsened the impact of depression and cognitive impairment on social functioning.
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Affiliation(s)
- Colin A Depp
- Stein Institute for Research on Aging, Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0664, USA.
| | - Brent T Mausbach
- Department of Psychiatry, University of California at San Diego, San Diego, CA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | | | - Paula S Wolyniec
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary H Thornquist
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R Luke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John A McGrath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann E Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California at San Diego, San Diego, CA
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McNamara RK, Nandagopal JJ, Strakowski SM, DelBello MP. Preventative strategies for early-onset bipolar disorder: towards a clinical staging model. CNS Drugs 2010; 24:983-96. [PMID: 21090835 DOI: 10.2165/11539700-000000000-00000] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bipolar disorder is a chronic and typically recurring illness with significant psychosocial morbidity. Although the aetiological factors that contribute to the onset of mania, and by definition bipolar I disorder, are poorly understood, it most commonly occurs during the adolescent period. Putative risk factors for developing bipolar disorder include having a first-degree relative with a mood disorder, physical/sexual abuse and other psychosocial stressors, substance use disorders, psychostimulant and antidepressant medication exposure and omega-3 fatty acid deficiency. Prominent prodromal clinical features include episodic symptoms of depression, anxiety, hypomania, anger/irritability and disturbances in sleep and attention. Because prodromal mood symptoms precede the onset of mania by an average of 10 years, and there is low specificity of risk factors and prodromal features for mania, interventions initiated prior to onset of the disorder (primary prevention) or early in the course of the disorder (early or secondary prevention) must be safe and well tolerated upon long-term exposure. Indeed, antidepressant and psychostimulant medications may precipitate the onset of mania. Although mood stabilizers and atypical antipsychotic medications exhibit efficacy in youth with bipolar I disorder, their efficacy for the treatment of prodromal mood symptoms is largely unknown. Moreover, mood stabilizers and atypical antipsychotics are associated with prohibitive treatment-emergent adverse effects. In contrast, omega-3 fatty acids have neurotrophic and neuroprotective properties and have been found to be efficacious, safe and well tolerated in the treatment of manic and depressive symptoms in children and adolescents. Together, extant evidence endorses a clinical staging model in which subjects at elevated risk for developing mania are treated with safer interventions (i.e. omega-3 fatty acids, family-focused therapy) in the prodromal phase, followed by pharmacological agents with potential adverse effects for nonresponsive cases and secondary prevention. This approach warrants evaluation in prospective longitudinal trials in youth determined to be at ultra-high risk for bipolar I disorder.
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Affiliation(s)
- Robert K McNamara
- Department of Psychiatry, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Bowie CR, Depp C, McGrath JA, Wolyniec P, Mausbach BT, Thornquist MH, Luke J, Patterson TL, Harvey PD, Pulver AE. Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. Am J Psychiatry 2010; 167:1116-24. [PMID: 20478878 PMCID: PMC3694770 DOI: 10.1176/appi.ajp.2010.09101406] [Citation(s) in RCA: 324] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Schizophrenia and bipolar disorder are associated with multidimensional disability. This study examined differential predictors of functional deficits in the two disorders. METHOD Community-dwelling individuals with schizophrenia (N=161) or bipolar disorder (N=130) were assessed with neuropsychological tests, symptom measures, and performance-based social and adaptive (i.e., everyday living skills) functional competence measures as well as three domains of real-world functioning: community and household activities; work skills; and interpersonal relationships. The authors used confirmatory path analysis to find the best-fitting models to examine the direct and indirect (as mediated by competence) prediction of the three domains of real-world functioning. RESULTS In all models for both groups, neurocognition's relationship with outcomes was largely mediated by competence. Symptoms were negatively associated with outcomes but unassociated with competence, with the exception of depression, which was a direct and mediated (through social competence) predictor in bipolar disorder. In both groups, neurocognition was related to activities directly and through a mediated relationship with adaptive competence. Work skills were directly and indirectly (through mediation with social competence) predicted by neurocognition in schizophrenia and entirely mediated by adaptive and social competence in bipolar disorder. Neurocognition was associated with interpersonal relationships directly in the schizophrenia group and mediated by social competence in both groups. CONCLUSIONS Although there was greater disability in schizophrenia, neurocognition predicted worse functioning in all outcome domains in both disorders. These results support the shared role of neurocognition in bipolar disorder and schizophrenia in producing disability, with predictive differences between disorders in domain-specific effects of symptoms and social and adaptive competence.
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Affiliation(s)
| | - Colin Depp
- Department of Psychiatry, University of California San Diego
| | - John A. McGrath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Paula Wolyniec
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Mary H. Thornquist
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - James Luke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Ann E. Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Abstract
The aim of the present study was to investigate the relationship between treatment delay and excessive substance use. A total of 151 bipolar disorder (BD) I and II patients were consecutively recruited from in- and outpatient psychiatric units, and categorized as primary or secondary BD (without or with antecedent excessive substance use). Predictors of treatment delay among all patients, and predictors of subsequent excessive substance use among primary BD patients, were investigated with logistic regression analyses. The median treatment delay was 2.0 years (IQR 14.0). The risk of long treatment delays was increased in patients with BD II disorder, no lifetime psychosis, a higher age at first contact with specialized psychiatric services, primary BD, and excessive substance use. In primary BD, the risk for developing excessive substance use was increased in males, in patients with shorter education and longer treatment delays. Patients with antecedent excessive substance use had reduced risk of long treatment delays. The risk of developing excessive substance use after BD onset increased with longer treatment delays.
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Amsterdam JD, Shults J. Efficacy and safety of long-term fluoxetine versus lithium monotherapy of bipolar II disorder: a randomized, double-blind, placebo-substitution study. Am J Psychiatry 2010; 167:792-800. [PMID: 20360317 PMCID: PMC2896440 DOI: 10.1176/appi.ajp.2009.09020284] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the safety and efficacy of long-term fluoxetine monotherapy, lithium monotherapy, and placebo therapy in preventing relapse and recurrence of bipolar type II major depressive episode. The authors hypothesized that fluoxetine monotherapy would be superior to lithium monotherapy with a similar hypomanic mood conversion rate. METHOD Patients at least 18 years old who recovered from their major depressive episode during initial open-label fluoxetine monotherapy were randomly assigned to receive 50 weeks of double-blind monotherapy with fluoxetine at 10-40 mg/day, lithium at 300-1200 mg/day, or placebo. The primary outcome measure was time to relapse or recurrence. Secondary outcome measures included the proportion of patients remaining well and the frequency of hypomanic symptoms. RESULTS There were no significant differences in clinical or demographic characteristics among the fluoxetine (N=28), lithium (N=26), and placebo (N=27) groups. The mean time to relapse was 249.9 days for the fluoxetine group, 156.4 days for the lithium group, and 186.9 days for the placebo group. The hazard of relapse was significantly lower with fluoxetine compared with lithium, and the estimated hazard of relapse with lithium was 2.5 times greater than with fluoxetine. There were no statistically significant or clinically meaningful differences in hypomanic symptoms among treatment groups over time. One patient taking fluoxetine and one patient taking placebo discontinued treatment because of hypomania. CONCLUSIONS These findings suggest that long-term fluoxetine monotherapy may provide superior relapse-prevention benefit relative to lithium monotherapy after recovery from bipolar II major depressive episode without an increase in hypomanic mood conversion episodes.
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Efficacy and mood conversion rate of short-term fluoxetine monotherapy of bipolar II major depressive episode. J Clin Psychopharmacol 2010; 30:306-11. [PMID: 20473068 PMCID: PMC2894607 DOI: 10.1097/jcp.0b013e3181da5300] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As part of a long-term, relapse-prevention study of antidepressant versus mood stabilizer monotherapy of bipolar II major depressive episode, we prospectively examined the efficacy and mood conversion rate of initial fluoxetine monotherapy. We hypothesized that there would be a statistically significant reduction in depressive symptoms without a clinically meaningful increase in mood conversion symptoms. METHODS Patients received open-label fluoxetine monotherapy 10 to 80 mg daily for up to 14 weeks. Primary outcome was change over time in Hamilton Depression Rating score, with secondary outcomes including the proportion of treatment responders and remitters, change over time in Young Mania Rating Scale (YMRS) score, and frequency of mood conversion episodes. RESULTS One hundred forty-eight patients had at least 1 post-baseline measurement. Mean Hamilton Depression Rating score decreased by 9.0 points (P < 0.0005). There were 88 responder patients (59.5%; 95% confidence interval [CI], 51.1%-67.4%) (P < 0.0005) and 86 remitter patients (58.1%; 95% CI, 49.7%-66.2%) (P < 0.0005). Mean time to remission was 64.4 days (95% CI, 59.1-69.7 days). Six patients (4.1%; 95% CI, 1.5%-8.6%) (P < 0.0005) had hypomania, and 29 patients (19.6%; 95% CI, 13.5%-26.9%) (P < 0.0005) had subsyndromal hypomania, which did not result in treatment discontinuation. Six patients (4.1%; 95% CI, 1.5%-8.6%) had a YMRS score of 8 or greater (P < 0.0005), and 4 patients (2.7%; 95% CI, 0.7%-6.8%) (P < 0.0005) had a YMRS score of 12 or greater at any study visit. CONCLUSIONS Although design limitations constrain the interpretation of the current findings, fluoxetine monotherapy may be an effective short-term treatment of bipolar II major depressive episode with a relatively low rate of syndromal hypomanic episodes.
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Treuer T, Tohen M. Predicting the course and outcome of bipolar disorder: a review. Eur Psychiatry 2010; 25:328-33. [PMID: 20444581 DOI: 10.1016/j.eurpsy.2009.11.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 11/02/2009] [Accepted: 11/09/2009] [Indexed: 11/28/2022] Open
Abstract
Despite of advances in pharmacological and non-pharmacological treatments, bipolar disorder often entails multiple relapses and impaired psychological functioning. The extent to which modern treatments have influenced the natural course of a mental disorder is uncertain. Prediction of the course and outcome of bipolar disorders continues to be challenging, despite the multiple research efforts worldwide. Due to a lack of laboratory diagnostic tests and biomarkers, psychiatric interview and examination provide the basis for outcome prediction. While considered to have more favorable prognosis than schizophrenia, it is not uncommon for bipolar disorder to include persisting alterations of psychosocial functioning. Although long-term symptomatic remission does not guarantee functional recovery, it may have a favorable impact on long-term overall prognosis. The high degree of treatment resistance in patients with bipolar disorder highlights the need to develop better identification of outcome predictors, prognosis and treatment intervention, designed to reverse or prevent this illness burden. This review summarizes the main factors involved in predicting the course and outcome of bipolar disorder.
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Affiliation(s)
- T Treuer
- Area Medical Center Vienna, Eli Lilly & Company, 1075 Budapest, Madach u 13-14, Hungary
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Conus P, Cotton S, Schimmelmann BG, Berk M, Daglas R, McGorry PD, Lambert M. Pretreatment and outcome correlates of past sexual and physical trauma in 118 bipolar I disorder patients with a first episode of psychotic mania. Bipolar Disord 2010; 12:244-52. [PMID: 20565431 DOI: 10.1111/j.1399-5618.2010.00813.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the prevalence and correlates of childhood and adolescent sexual and/or physical abuse (SPA) in bipolar I disorder (BDI) patients treated for a first episode of psychotic mania. METHODS The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. A total of 704 files were available; 43 were excluded because of a nonpsychotic diagnosis at endpoint and 3 due to missing data regarding past stressful events. Among 658 patients with available data, 118 received a final diagnosis of BDI and were entered in this study. RESULTS A total of 80% of patients had been exposed to stressful life events during childhood and adolescence and 24.9% to SPA; in particular, 29.8% of female patients had been exposed to sexual abuse. Patients who were exposed to SPA had poorer premorbid functioning, higher rates of forensic history, were less likely to live with family during treatment period, and were more likely to disengage from treatment. CONCLUSIONS SPA is highly prevalent in BDI patients presenting with a first episode of psychotic mania; exposed patients have lower premorbid functional levels and poorer engagement with treatment. The context in which such traumas occur must be explored in order to determine whether early intervention strategies may contribute to diminish their prevalence. Specific psychological interventions must also be developed.
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Affiliation(s)
- Philippe Conus
- Treatment and Early Intervention in Psychosis Program, Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland.
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Gau CS, Chang CJ, Tsai FJ, Chao PF, Gau SSF. Association between mood stabilizers and hypothyroidism in patients with bipolar disorders: a nested, matched case-control study. Bipolar Disord 2010; 12:253-63. [PMID: 20565432 DOI: 10.1111/j.1399-5618.2010.00814.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study investigated whether lithium, carbamazepine, and valproate increased the risk for hypothyroidism using Taiwan's National Health Insurance Dataset. METHODS The sample included 557 bipolar disorder patients with incident hypothyroidism first diagnosed between 1998 and 2004, and 2,228 sex-, age-, and index date-matched bipolar disorder patients without hypothyroidism from 1996-2004. We compared the use of lithium, carbamazepine, and valproate before the onset of hypothyroidism between the two groups using a conditional logistical regression model. RESULTS Compared with patients who had never used any of the three mood stabilizers, patients were more likely to have hypothyroidism if they only used carbamazepine [odds ratio (OR) = 1.68; 95% confidence interval (CI): 1.07-2.65]; or comedication of lithium and valproate (OR = 2.40; 95% CI: 1.70-3.40), lithium and carbamazepine (OR = 1.52; 95% CI: 1.10-2.08), and three mood stabilizers (OR = 2.34; 95% CI: 1.68-3.25). There was a dose-response relationship between the number of mood stabilizers and risk for hypothyroidism (OR = 1.34, 95% CI: 1.21-1.49) and a significant interaction between lithium and valproate on the risk for hypothyroidism (p = 0.020). CONCLUSIONS Our findings indicate that lithium, carbamazepine, and valproate may increase the risk for hypothyroidism, particularly if combined, and suggest regular monitoring of thyroid function and monotherapy of mood stabilizers for treating patients with bipolar disorders.
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Affiliation(s)
- Churn-Shiouh Gau
- Graduate Institute of Clinical Pharmacy, School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Berk M, Hallam K, Malhi GS, Henry L, Hasty M, Macneil C, Yucel M, Pantelis C, Murphy B, Vieta E, Dodd S, McGorry PD. Evidence and implications for early intervention in bipolar disorder. J Ment Health 2010; 19:113-26. [DOI: 10.3109/09638230903469111] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
We review three studies of omega-3 fatty acids in the treatment of depression that were carried out by our research group at the Beer Sheva Mental Health Center. The first study examined eicosapentaenoic acid (EPA) versus placebo as an adjunct to antidepressant treatment in 20 unipolar patients with recurrent major depression. The second study used omega-3 fatty acids in childhood major depression; 28 children aged 6-12 were randomized to omega-3 fatty acids or placebo as pharmacologic monotherapy. The third study was an open-label add-on trial of EPA in bipolar depression. Twelve bipolar outpatients with depressive symptoms were treated with 1.5-2.0 g/day of EPA for up to 6 months. In the adult unipolar depression study, highly significant benefits were found by week 3 of EPA treatment compared with placebo. In the child study, an analysis of variance (ANOVA) showed highly significant effects of omega-3 on each of the three rating scales. In the bipolar depression study, 8 of the 10 patients who completed at least 1 month of follow-up achieved a 50% or greater reduction in Hamilton depression (Ham-D) scores within 1 month. No significant side effects were reported in any of the studies. Omega-3 fatty acids were shown to be more effective than placebo for depression in both adults and children in small controlled studies and in an open study of bipolar depression. (This review discusses three studies, all from our group, completed before the clinical trial registry was initiated.)
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Affiliation(s)
- Yamima Osher
- Ministry of Health Beer Sheva Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry 2010; 11:81-109. [PMID: 20148751 DOI: 10.3109/15622970903555881] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES These guidelines are based on a first edition that was published in 2002, and have been edited and updated with the available scientific evidence until September 2009. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute bipolar depression in adults. METHODS The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (A-F). As these guidelines are intended for clinical use, the scientific evidence was finally assigned different grades of recommendation to ensure practicability. RESULTS We identified 10 pharmacological monotherapies or combination treatments with at least limited positive evidence for efficacy in bipolar depression, several of them still experimental and backed up only by a single study. Only one medication was considered to be sufficiently studied to merit full positive evidence. CONCLUSIONS Although major advances have been made since the first edition of this guideline in 2002, there are many areas which still need more intense research to optimize treatment. The majority of treatment recommendations is still based on limited data and leaves considerable areas of uncertainty.
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Affiliation(s)
- Heinz Grunze
- Newcastle University, RVI, Division of Psychiatry, Institute of Neuroscience, Newcastle upon Tyne, UK.
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Premier épisode thymique : cas particulier de l’intervention dans la phase précoce des troubles bipolaires. Encephale 2010; 36 Suppl 3:S71-6. [DOI: 10.1016/s0013-7006(10)70034-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Kapczinski F, Dias VV, Kauer-Sant'Anna M, Brietzke E, Vázquez GH, Vieta E, Berk M. The potential use of biomarkers as an adjunctive tool for staging bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1366-71. [PMID: 19666076 DOI: 10.1016/j.pnpbp.2009.07.027] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/24/2009] [Accepted: 07/24/2009] [Indexed: 02/06/2023]
Abstract
Recent data show that biomarkers differ in early and late-stage bipolar disorder (BD). Here we propose a model of staging for bipolar disorder that emphasizes the potential use of biomarkers for differentiating early and late-stage BD patients in the inter-episodic period. The proposed model includes a Latent phase: patients at "ultra-high-risk" for developing BD, characterized by a family history of BD, temperament traits, mood, and anxiety symptoms as well as genetic vulnerability for developing the disorder; Stage I: patients who return to their baseline level of functioning when mood episodes resolve; Stage II: biomarkers and functioning impairment are related to comorbidities or rapid-cycling presentations; Stage III: persistent cognitive and functioning impairment in the inter-episode period as well as changes in biomarkers; and Stage IV: same findings as in Stage III associated with extreme cognitive and functioning impairment, to the point that patients are unable to live autonomously. Empirical testing will determine the ability of the present model to inform patients and clinicians about both prognosis and response to treatment.
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Affiliation(s)
- Flávio Kapczinski
- Bipolar Disorder Program and Molecular Psychiatry Unit, Hospital de Clínicas, UFRGS, INCT Translational Medicine, Porto Alegre, Brazil.
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Wang G, Tse S, Michalak EE. Self-management techniques for bipolar disorder in a sample of New Zealand Chinese. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.11.44941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grace Wang
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Samson Tse
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; and and
| | - Erin E. Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Kapczinski F, Dias VV, Kauer-Sant'Anna M, Frey BN, Grassi-Oliveira R, Colom F, Berk M. Clinical implications of a staging model for bipolar disorders. Expert Rev Neurother 2009; 9:957-66. [PMID: 19589046 DOI: 10.1586/ern.09.31] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A model of staging in the field of bipolar disorder (BD) should offer a means for clinicians to predict response to treatment and more general outcome measures, such as the level of functioning and autonomy. The present staging model emphasizes the assessment of patients in the interepisodic period and includes: latent phase: individuals who present mood and anxiety symptoms and increased risk for developing threshold BD; Stage I--patients with BD who present well established periods of euthymia and absence of overt psychiatric morbidity between episodes; Stage II--patients who present rapid cycling or current axis I or II comorbidities; Stage III--patients who present a clinically relevant pattern of cognitive and functioning deterioration, as well as altered biomarkers; and Stage IV--patients who are unable to live autonomously and present altered brain scans and biomarkers. Such a model implies a longitudinal appraisal of clinical variables, as well as assessment of neurocognition and biomarkers in the interepisodic period. Staging facilitates understanding of the mechanisms underlying progression of the disorder, assists in treatment planning and prognosis and, finally, underscores the imperative for early intervention.
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Affiliation(s)
- Flávio Kapczinski
- Bipolar Disorders Program, Laboratory of Molecular Psychiatry and INCT Translational Medicine, Hospital de Clinicas de Porto Alegre, Avenida Ramiro Barcelos 2350, 90035-903 PortoAlegre RS, Brazil.
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47
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Amsterdam JD, Shults J. Does tachyphylaxis occur after repeated antidepressant exposure in patients with Bipolar II major depressive episode? J Affect Disord 2009; 115:234-40. [PMID: 18694599 DOI: 10.1016/j.jad.2008.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 07/02/2008] [Accepted: 07/07/2008] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Tachyphylaxis often refers to the loss of antidepressant efficacy during long-term treatment. However, it may also refer to the gradual loss of efficacy after repeated antidepressant exposures over time. The aim of this study was to examine the phenomenon of tachyphylaxis in patients with Bipolar II major depression treated with either venlafaxine or lithium. We hypothesized that a greater number of prior antidepressant exposures would result in a reduced response to venlafaxine, but not lithium, therapy. METHODS 83 patients were randomized to treatment with either venlafaxine (n=43) or lithium (n=40). The primary outcome was a >or= 50% reduction in baseline Hamilton Depression Rating score. A detailed history of prior drug therapy was obtained. Logistic regression was used to test the hypothesis that prior antidepressant exposure was associated with reduced response to venlafaxine therapy. RESULTS The mean number of prior antidepressant and mood stabilizer exposures was significantly higher in venlafaxine non-responders versus responders (p=0.02). There was no significant association between response to lithium and the number of prior antidepressant and mood stabilizer exposures (p=0.38). The odds of responding to venlafaxine or lithium therapy decreased with an increasing number of prior antidepressant exposures (p=0.04). Response was not significantly affected by the number of prior mood stabilizer exposures (p=0.30). Adjustment for clinical and demographic covariates sharpened the estimated impact of prior antidepressant exposure on treatment outcome. LIMITATIONS This study was a post hoc exploratory analysis. The study was not specifically powered to test the hypothesis of an association between number of prior antidepressant drug exposures and response to venlafaxine or lithium therapy. CONCLUSION These observations support earlier findings suggesting the presence of tachyphylaxis occurring after repeated antidepressant drug exposures. Possible mechanisms of tachyphylaxis may include genetic predisposition for non-response, physiological adaptation after repeated antidepressant exposures, and inherent illness and pharmacokinetic heterogeneity.
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Affiliation(s)
- Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, United States.
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Berk M, Malhi GS, Hallam K, Gama CS, Dodd S, Andreazza AC, Frey BN, Kapczinski F. Early intervention in bipolar disorders: clinical, biochemical and neuroimaging imperatives. J Affect Disord 2009; 114:1-13. [PMID: 18819715 DOI: 10.1016/j.jad.2008.08.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 08/18/2008] [Accepted: 08/18/2008] [Indexed: 01/12/2023]
Abstract
In the absence of clear targets for primary prevention of many psychiatric illnesses, secondary prevention becomes the most feasible therapeutic target, and is best encompassed by the concept of early intervention. This construct encompasses the goals of minimising diagnostic delay and the prompt initiation of clinically appropriate therapy. This paper develops the rationale for early intervention in bipolar disorder. Three interrelated themes are discussed; the clinical data supporting the value of prompt diagnosis and treatment in bipolar disorder, the putative biochemical mechanisms underlying the pathophysiological processes, and the parallel concept of neuroprotection, and the developing neuroimaging data that supports early intervention. Early initiation of appropriate therapy may potentially facilitate improved clinical outcomes, and further might allow the secondary prevention of the sequelae of untreated illness, which include the deleterious impact on family relationships, psychosexual and vocational development, identity and self-concept and self-stigma.
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Affiliation(s)
- Michael Berk
- Department of Clinical and Biomedical Sciences, University of Melbourne, PO Box 281, Geelong, Australia
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El-Mallakh RS, Ghaemi SN, Sagduyu K, Thase ME, Wisniewski SR, Nierenberg AA, Zhang HW, Pardo TA, Sachs G. Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients. J Affect Disord 2008; 111:372-7. [PMID: 18565592 DOI: 10.1016/j.jad.2008.03.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 03/25/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been proposed that antidepressants can induce a chronic, dysphoric, irritable state in bipolar patients (called ACID for antidepressant-associated chronic irritable dysphoria). This phenomenon has only been described in case series format, and has not been prospectively validated. METHODS Prospective data from the first 1500 patients (62.7% with bipolar I, 30.1% with bipolar II, and 7.2% with NOS) treated in the STEP-BD database were examined and those who were euthymic for at least one month at study entry, subsequently developed a depressive episode, and were then followed for one year were identified. Outcome of those who received an antidepressant for this depressive episode (n=27) was compared to those who did not (n=56), with particular attention given to the presence of the proposed symptom triad of ACID, namely dysphoria, irritability, and middle insomnia. RESULTS Patients treated with antidepressants were ten times more likely to develop ACID than those who were not (Hazard ratio=9.95, CI=1.103-89.717, P=0.04). However, the hazard ratio dropped to 1.05 (P=0.99) when corrected for significant covariates, notably past antidepressant-related manic switch and sex. DISCUSSION This study does not support the existence of ACID as an independent phenomenon. Rather, ACID appears to be part of a broader spectrum of antidepressant treatment-emergent affective switches.
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Affiliation(s)
- Rif S El-Mallakh
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 501 East Broadway, MedCenter One, Suite 340, Louisville, Kentucky 40202, United States.
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50
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Jones SH, Burrell-Hodgson G. Cognitive-behavioural treatment of first diagnosis bipolar disorder. Clin Psychol Psychother 2008; 15:367-77. [DOI: 10.1002/cpp.584] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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