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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Dolenc B, Dernovšek MZ, Sprah L, Tavcar R, Perugi G, Akiskal HS. Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder. J Affect Disord 2015; 174:13-8. [PMID: 25474481 DOI: 10.1016/j.jad.2014.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/09/2014] [Accepted: 11/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression. METHODS 100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A). RESULTS The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile. LIMITATIONS We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers. CONCLUSION Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour.
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Affiliation(s)
- B Dolenc
- Sociomedical Institute, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana, Slovenia.
| | | | - L Sprah
- Sociomedical Institute, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana, Slovenia
| | - R Tavcar
- University Psychiatric Clinic, Ljubljana, Slovenia
| | - G Perugi
- Institute of Behavioural Sciences, "G. De Lisio", Department of Psychiatry, University of Pisa, Pisa, Italy
| | - H S Akiskal
- International Mood Disorder Centre, Department of Psychiatry at the University of California, San Diego, La Jolla, USA
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Shim IH, Woo YS, Bahk WM. Prevalence rates and clinical implications of bipolar disorder "with mixed features" as defined by DSM-5. J Affect Disord 2015; 173:120-5. [PMID: 25462405 DOI: 10.1016/j.jad.2014.10.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the increase in the prevalence of bipolar disorder with mixed features following the replacement of DSM-IV-TR criteria with DSM-5 criteria. Additionally, we examined the clinical implications of the use of "with mixed features" as a specifier with bipolar disorder. METHOD We retrospectively reviewed medical charts from 2003 to 2013. A total of 331 patients diagnosed with bipolar disorder using the DSM-IV TR were enrolled and categorized into four groups: manic/hypomanic with mixed features, manic/hypomanic without mixed features, depressed with mixed features, and depressed without mixed features. These classifications were made in accordance with the DSM-5 definition of bipolar disorder "with mixed features." Changes in the prevalence, demographic and clinical characteristics were compared among the groups. RESULTS The prevalence rates of mixed features were significantly different when using the DSM-5 criteria vs. the DSM-IV-TR criteria. Patients with mixed features had a younger age of onset, younger age at hospitalization, more frequent hospitalizations for mixed episodes, and greater suicide risk compared with patients without mixed features. LIMITATIONS Retrospective study may have resulted in under diagnosis of mixed states. CONCLUSIONS An approximately three-fold greater risk for mixed features was observed in patients with bipolar disorder when using the DSM-5 criteria than when using the DSM-IV-TR criteria. The additional patients may represent patients with sub-syndromal mixed features and could indicate that patients with mixed features are underdiagnosed.
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Affiliation(s)
- In Hee Shim
- Department of Psychiatry, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Young Sup Woo
- Department of Psychiatry, Yeouido St. Mary׳s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, Yeouido St. Mary׳s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Daff E, Thomas SDM. Bipolar disorder and criminal offending: a data linkage study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1985-91. [PMID: 24791923 DOI: 10.1007/s00127-014-0882-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The current study explored criminal offending among people diagnosed with bipolar disorder with and without comorbid substance use and compared this with a community sample with no history of bipolar disorder. METHODS A case-linkage design was used to compare patterns of officially recorded criminal offending between 1,076 people with bipolar disorder drawn from a state-wide psychiatric case register with a community comparison group. RESULTS Those with bipolar disorder were significantly more likely than community members to be charged with, convicted of, and be found guilty of, violent, non-violent and intermediate level criminal offences. Those with a comorbid substance use disorder were two times more likely than those without a substance use disorder to offend; both groups had a significantly higher chance of offending than the community sample. Females with bipolar disorder were significantly more likely to have been convicted of violent offences, irrespective of substance use. Significant interactions were found between bipolar disorder and substance use for males and females with respect to violent offending and for males with respect to non-violent offending. CONCLUSIONS There is a statistically significant association between bipolar disorder and the likelihood of having a criminal history. Co-occurring substance use differentially impacts on the likelihood of criminal offending for males and females.
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Affiliation(s)
- Elizabeth Daff
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
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Abolghasemi A, Sadeghi H, Kiamarsi A, Abbasi M. Role of behavioral addictions in predicting reactivity in bipolar mood disorder patients. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e13909. [PMID: 24971298 PMCID: PMC4070189 DOI: 10.5812/ijhrba.13909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 12/03/2013] [Accepted: 01/21/2014] [Indexed: 11/16/2022]
Abstract
Background: Behavioral addictions (BAs) can be understood as disorders characterized by repetitive occurrence of reactivity and uncontrolled behaviors. Very few studies have investigated their association with bipolar mood disorders. Objectives: The present study aimed to determine the role of behavioral addictions in predicting interpersonal behavioral addictions in bipolar mood disorder patients. Materials and Methods: This study had a cross-sectional correlation design. The statistical population was composed of all outpatients with bipolar mood disorders referring to clinical centers in Ardabil. The sample included 60 bipolar mood patients selected from patients referring to clinical centers using the available sampling method. A researcher-made behavioral addiction checklist, Interpersonal Behavioral Addictions Index, and exercise, sexual, and work addiction questionnaires, were used for data collection. The data were analyzed with a Pearson’s correlation coefficient and multivariate regression analysis. Results: The results showed a significant negative relationship between behavioral addictions and interpersonal behavioral addictions (P ≥ 0.01). Multivariate regression analysis results also showed that behavioral addictions are significant and can explain 61% of the variance of interpersonal behavioral addictions in bipolar mood patients. Conclusions: These results suggest that addictive behaviors can affect behavioral addictions in bipolar mood patients. Behavioral addictions lead to negative emotional regulation strategies and result in increased behavioral addictions in these patients. People with high levels of arousal or those who cannot control their behavioral addictions are probably more prone to addictive behaviors.
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Affiliation(s)
- Abbas Abolghasemi
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, IR Iran
- Corresponding authors: Abbas Abolghasemi, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail: ; Hasan Sadeghi, Young Researchers Club and Elites, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail:
| | - Hasan Sadeghi
- Young Researchers Club and Elites, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran
- Corresponding authors: Abbas Abolghasemi, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail: ; Hasan Sadeghi, Young Researchers Club and Elites, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail:
| | - Azar Kiamarsi
- Department of Psychology, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran
| | - Moslem Abbasi
- Department of Psychology, Faculty of Literature and Human Sciences, Salman Farsi University of Kazerun, Kazerun, IR Iran
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Abstract
Schizophrenia without any comorbidity confers a modest, but statistically significant elevation of the risk for violence. That risk is considerably increased by comorbid antisocial personality disorder or psychopathy as well as by comorbid substance use disorders. These comorbidities are frequent. Conduct disorder and conduct disorder symptoms elevate the risk for aggressive behavior in patients with schizophrenia. Violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Aggressive behavior in bipolar disorder occurs mainly during manic episodes, but it remains elevated in euthymic patients in comparison with controls. The risk of violent behavior is increased by comorbidity with borderline personality disorder, antisocial personality disorder, and substance use disorders. These comorbidities are frequent. Borderline personality disorder and bipolar disorder are related in their phenomenology and response to medication. These two disorders share a tendency to impulsiveness, and impulsive behavior, including impulsive aggression, is particularly expressed when they co-occur.
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Affiliation(s)
- Jan Volavka
- Emeritus of Psychiatry, New York University School of Medicine, PO Box 160663, Big Sky, MT, 59716, USA,
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Chou YH, Lin CL, Wang SJ, Lirng JF, Yang KC, Chien Chang A, Liao MH. Aggression in bipolar II disorder and its relation to the serotonin transporter. J Affect Disord 2013; 147:59-63. [PMID: 23123132 DOI: 10.1016/j.jad.2012.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aggression is frequently observed in patients diagnosed with bipolar disorder (BD). Previous studies found a negative association between aggression and serotoninergic function in patients with BD, as well as in healthy subjects. The objective of this study was to determine whether there is an association between aggression and the availability of the serotonin transporter (SERT) in euthymic BD II patients. METHODS Thirty-eight age-matched healthy controls (HCs) and 24 BD II patients were recruited. BD II patients were under stable treatment in the euthymic state. The Overt Aggression Scale (OAS) was used for the assessment of aggression. Single photon emission computed tomography with (123)I-ADAM was used for SERT imaging. A specific uptake ratio, which represents availability, was the primary measured outcome. RESULTS The total OAS scores, as well as the scores on all of the sub-items, were significantly higher in BD II patients than in the HCs group. There was no significant difference in SERT availability between BD II and HCs subjects in different brain regions. The Pearson's correlation between the total OAS scores and the sub-item aggression and SERT availability was significant. LIMITATION The OAS was used for the assessment of the past week of the patients' condition and thus did not reflect their trait status. CONCLUSIONS The higher total scores of OAS in euthymic BD II patients than in HCs support the idea that aggression might be a trait marker for BD. Although SERT availability in euthymic BD II patients and in HCs did not differ significantly, the correlation of SERT availability and total OAS provides the possible explanation of aggression in BD II.
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Affiliation(s)
- Yuan-Hwa Chou
- Department of Psychiatry Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
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van Enkhuizen J, Geyer MA, Young JW. Differential effects of dopamine transporter inhibitors in the rodent Iowa gambling task: relevance to mania. Psychopharmacology (Berl) 2013; 225:661-74. [PMID: 22945515 PMCID: PMC3537839 DOI: 10.1007/s00213-012-2854-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 08/17/2012] [Indexed: 01/05/2023]
Abstract
RATIONALE The Iowa Gambling Task (IGT) can be used to quantify impulsive and risky choice behaviors in psychiatric patients, e.g., bipolar disorder (BD) sufferers. Although developing treatments for these behaviors is important, few predictive animal models exist. Inhibition of the dopamine transporter (DAT) can model profiles of altered motor activity and exploration seen in patients with BD. The effect of DAT inhibition on impulsive choices related to BD has received limited study however. We used a rodent IGT to elucidate the effects of similarly acting drugs on risky choice behavior. OBJECTIVES We hypothesized that (1) C57BL/6 mice could adopt the "safe" choice options in the IGT and (2) DAT inhibition would alter risk preference. METHODS Mice were trained in the IGT to a stable risk-preference and then administered the norepinephrine/DAT inhibitor amphetamine, or the more selective DAT inhibitors modafinil or GBR12909. RESULTS Mice developed a preference for the "safe" option, which was potentiated by amphetamine administration. GBR12909 or modafinil administration increased motor impulsivity, motivation significantly, and risk preference subtly. CONCLUSIONS The rodent IGT can measure different impulse-related behaviors and differentiate similarly acting BD-related drugs. The contrasting effects of amphetamine and modafinil in mice are similar to effects in rats and humans in corresponding IGT tasks, supporting the translational validity of the task. GBR12909 and modafinil elicited similar behaviors in the IGT, likely through a shared mechanism. Future studies using a within-session IGT are warranted to confirm the suitability of DAT inhibitors to model risk-preference in BD.
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Affiliation(s)
- Jordy van Enkhuizen
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Mark A. Geyer
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804
- Research Service, VA San Diego Healthcare System, San Diego, CA
| | - Jared W. Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804
- Research Service, VA San Diego Healthcare System, San Diego, CA
- Correspondence: Jared W. Young, Ph.D., Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, California, 92093-0804, Tel: +1 619 543 3582, Fax: +1 619 735 9205,
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Mazza M, Mandelli L, Zaninotto L, Di Nicola M, Martinotti G, Harnic D, Bruschi A, Catalano V, Tedeschi D, Colombo R, Bria P, Serretti A, Janiri L. Bipolar disorder: "pure" versus mixed depression over a 1-year follow-up. Int J Psychiatry Clin Pract 2012; 16:113-20. [PMID: 22296514 DOI: 10.3109/13651501.2011.633171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare two samples of Bipolar (BD) patients presenting "pure" (D) and mixed (Mx) depression to assess any difference in terms of clinical outcome, social functioning and quality of life during a 1-year follow-up. METHODS A total of 114 depressed outpatients (HDRS > 13) were included. "Pure" depressed (D, n = 76) were divided from "mixed" depressed (Mx, n = 38) by the number of concomitant manic symptoms. All patients were evaluated by the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Young Mania Rating Scale (YMRS), the Global Assessment of Functioning (GAF), the Social Adjustment Self-reported Scale (SASS) and the Quality of Life Scale (QoL), at baseline and after 1, 3, 6 and 12 months of treatment. RESULTS Mx patients were significantly younger at the onset of BD. Manic features persisted significantly higher in Mx than in D patients all over the follow-up period. Axis I comorbidities had a negative impact on the course of social functioning over the medium term period, while Mx patients showed a faster improvement in social adjustment than "pure" depressed patients. CONCLUSIONS Mixed features may persist relatively stable throughout a depressive episode, having a negative impact over clinical and functional outcome, but not on social adjustment.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Institute of Psychiatry and Psychology, Bipolar Disorders Unit, Catholic University of Sacred Heart, Rome, Italy
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Johansson AGM, Nikamo P, Schalling M, Landén M. AKR1C4 gene variant associated with low euthymic serum progesterone and a history of mood irritability in males with bipolar disorder. J Affect Disord 2011; 133:346-51. [PMID: 21570127 DOI: 10.1016/j.jad.2011.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/08/2011] [Accepted: 04/08/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Irritable mood during mood elevation is common in bipolar disorder. The progesterone metabolite allopregnanolone (ALLO) has been implicated in other disorders presenting with irritability. This study aimed to test whether a history of manic/hypomanic irritability is associated with low serum progesterone levels; and whether single nucleotide polymorphisms (SNPs) in gene coding for steroidogenetic enzymes (HSD3B2, SRD5A1 and AKR1C4 were coupled to previous manic irritability and/or with serum progesterone concentrations. METHODS Morning serum progesterone concentrations during euthymic phase of bipolar illness types 1 and 2 were assessed in 71 males and 107 females. Previous manic/hypomanic irritability was assessed using the Affective Disorders Evaluation. Selected SNPs were analyzed: i) aldoketoreductase-type-4 (AKR1C4 - rs17306779, rs3829125, rs10904440, rs12762017, and rs11253048), ii) 3-β-hydroxysteroid-dehydrogenase (HSD3B2 - rs4659174, rs2854964, and rs3765948), iii) steroid-5-α-reductase (SRD5A1 - rs8192139, rs181807, rs3822430, and rs3736316). RESULTS In males, progesterone concentrations were lower in those who had shown manic/hypomanic irritability compared with nonirritable (F=7.05, p=0.0099). SNPs rs17306779, rs3829125, and rs10904440 were associated with manic/hypomanic irritability. A cystine to serine change at position 145 in AKR1C4 (rs3829125) was associated with lower serum progesterone (F=6.34, p=0.014). There were no associations in females. LIMITATIONS Relatively small sample sizes. CONCLUSION Low progesterone levels and a cystine to serine change at position 145 in AKR1C4 gene are associated with manic/hypomanic irritability in males. Given that the enzyme AKR1C4 has both dehydrogenating and reductive activities in the steroidogenetic pathway, a missense variation in the gene may predispose to manic/hypomanic irritability by altering the relationship between progesterone and ALLO concentrations in the brain.
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Affiliation(s)
- Anette G M Johansson
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Young JW, van Enkhuizen J, Winstanley CA, Geyer MA. Increased risk-taking behavior in dopamine transporter knockdown mice: further support for a mouse model of mania. J Psychopharmacol 2011; 25:934-43. [PMID: 21421642 PMCID: PMC3568506 DOI: 10.1177/0269881111400646] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reduced functioning of the dopamine transporter (DAT) has been linked to bipolar disorder (BD). Mice with reduced DAT functioning (knockdown, KD) exhibit a behavioral profile in the mouse Behavioral Pattern Monitor (BPM) consistent with patients with BD mania in the human BPM. Patients with BD also exhibit increased risk taking, which can be quantified using the Iowa Gambling Task (IGT). We hypothesized that DAT KD mice would exhibit increased risk-taking behavior in a novel mouse version of the IGT. DAT KD and wildtype (WT) littermates were trained in the mouse IGT. In session 1, KD mice initially made riskier choices, but later performed comparably to WT mice. Once trained to stable choice performance, DAT KD mice continued to exhibit a trend to choose the riskier options more than WT mice. Finally, we confirmed that these DAT KD mice also exhibited an exploratory profile in the BPM consistent with patients with BD mania, where risky choice behavior modestly correlated with specific exploration. These data demonstrate that DAT KD mice chose the riskier options more than WT mice, providing further support for the use of DAT KD mice as a model of BD mania.
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Affiliation(s)
- Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA CA 92093-0804, USA.
| | | | | | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Carpiniello B, Lai L, Pirarba S, Sardu C, Pinna F. Impulsivity and aggressiveness in bipolar disorder with co-morbid borderline personality disorder. Psychiatry Res 2011; 188:40-4. [PMID: 21131058 DOI: 10.1016/j.psychres.2010.10.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 10/26/2010] [Accepted: 10/27/2010] [Indexed: 11/16/2022]
Abstract
Few studies to date have been performed to investigate impulsivity and aggressivity in patients with bipolar disorder (BD) and borderline personality disorder (BPD); the primary aim of the present study was to evaluate the impact of co-morbidity of BPD on impulsivity and aggressivity in patients affected by BD. A total of 57 patients (male=20, female=37) affected by BD (BD-I 51%; BD-II 49%) in clinical stable remission were recruited; 28 patients were affected by BD (49.1%), 18 by BD and BPD (31.6%) and 11 (19.3%) by BD plus other personality disorders (OPD) (19.3%). They were assessed with the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, and were evaluated by means of the Clinical Global Impression (CGI)-severity and Global Assessment Functioning (GAF) scales, the Barratt Impulsivity Scale (BIS-11) and the Aggression Questionnaire (AQ). Mean total scores were significantly higher among BD/BPD patients with respect to BD and to BD/OPD, both on the BIS-11 and the AQ; the rate of attempted suicides was approximately three times higher in BD/BPD patients with respect to BD and 7.6 times higher than in BD/OPD patients. The results of our study suggest that patients with co-morbid BD and BPD are more impulsive and aggressive. Furthermore, this co-morbid condition may be a risk factor for suicidality.
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Matson JL, Horovitz M, Kozlowski AM, Sipes M, Worley JA, Shoemaker ME. Person characteristics of individuals in functional assessment research. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:621-624. [PMID: 21211941 DOI: 10.1016/j.ridd.2010.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper is a review of person characteristics that were present in 173 studies that were reviewed on functional assessment. The purpose was to give the reader an idea about the types of individuals for which functional assessment is appropriate and to outline persons and their characteristics which have the best research support. The majority of participants were diagnosed with intellectual disability and/or autism. Additionally more males that females were included and children were frequently studied versus adolescents and older adults. Finally, while the majority of studies employed experimental functional analysis, the number of participants per study was small. Conversely, functional analysis scales were used in far fewer studies, but with much larger sample sizes. Thus, relatively equal numbers of individuals have been studied with both methods.
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Affiliation(s)
- Johnny L Matson
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, United States.
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Abstract
BACKGROUND The study of insight in bipolar disorder has received limited attention, despite its potential impact on treatment compliance and prognosis. In the current study we compare insight levels during different phases of bipolar disorder, and consider its relationship to symptoms dimensions and epidemiologic variables. METHODS Insight ratings obtained from 156 bipolar subjects in any phase of bipolar disorder were compared. A regression analysis was also conducted to identify symptom dimensions predictive of insight levels. RESULTS Greater impairments in insight were observed during pure manic episodes than during mixed or depressed episodes, or during euthymia. Depressive symptoms were associated with better insight. Improvements in insight with treatment were neither complete nor universal. Lack of insight was unrelated to age, years of illness, age of first psychiatric illness, or lifetime number of hospitalizations. CONCLUSIONS Although psychosis may be associated with impaired insight, other variables also impact on degree of impaired insight. Specifically, depressed mood appears to be associated with preservation of insight. That relationship may transcend strict syndromal diagnosis.
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Principal domains of behavioral psychopathology identified by the Bipolar Inventory of Signs and Symptoms Scale (BISS). Psychiatry Res 2010; 175:221-6. [PMID: 20022384 DOI: 10.1016/j.psychres.2009.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 02/20/2009] [Accepted: 04/23/2009] [Indexed: 11/21/2022]
Abstract
Current symptom rating scales and diagnostic categories for bipolar disorder (BD) do not provide dimensional profiles of the types of behavior disturbed in this complex disorder. To overcome these limitations we identified the principal domains of behavioral symptomatology in bipolar individuals, including all mood states, and used a more comprehensive rating scale for BD: the Bipolar Inventory of Signs and Symptoms Scale (BISS). A total of 246 patients with BD (196 with BD type I, and 50 with BD type II) were interviewed using the BISS. Exploratory factor analysis was performed on the BISS results using the maximum likelihood factor extraction method, followed by oblique rotation of the extracted factor loadings. We determined the strength of relationships between factor scores using the Pearson correlation coefficient. The following five factors were extracted: mania, depression, irritability, anxiety and psychosis. Anxiety was significantly correlated with depression and irritability. The mania factor score was only weakly associated with the other four factors. The domains of the BISS capture both the historical categories of depression and mania, plus irritability, psychosis, and an additional principal domain, anxiety. Despite the common occurrence of anxiety in BD, it has not been identified in most prior factor analyses, in part due to limited coverage of anxiety symptoms in the source scales.
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SWANN ALANC, STEINBERG JOELL, LIJFFIJT MARIJN, MOELLER GERARDF. Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features. World Psychiatry 2009; 8:166-72. [PMID: 19812754 PMCID: PMC2758583 DOI: 10.1002/j.2051-5545.2009.tb00245.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to produce a continuum of mixed states. In 88 subjects with bipolar disorder (DSM-IV), we evaluated symptoms and clinical characteristics, and compared depression-based, mania-based, and other published definitions of mixed states. We developed an index of the extent to which symptoms were mixed (Mixed State Index, MSI) and characterized its relationship to clinical state. Predominately manic and depressive mixed states using criteria from recent literature, as well as Kraepelinian mixed states, had similar symptoms and MSI scores. Anxiety correlated significantly with depression scores in manic subjects and with mania scores in depressed subjects. Discriminant function analysis associated mixed states with symptoms of hyperactivity and negative cognitions, but not subjective depressive or elevated mood. High MSI scores were associated with severe course of illness. For depressive or manic episodes, characteristics of mixed states emerged with two symptoms of the opposite polarity. This was a cross-sectional study. Mixed states appear to be a continuum. An index of the degree to which depressive and manic symptoms combine appears useful in identifying and characterizing mixed states. We propose a depressive or manic episode with three or more symptoms of the opposite polarity as a parsimonious definition of a mixed state.
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Affiliation(s)
- ALAN C. SWANN
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
| | - JOEL L. STEINBERG
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
| | - MARIJN LIJFFIJT
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
| | - GERARD F. MOELLER
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
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Abstract
AIMS In clinical practice, overt aggressive behaviour is frequently observed in patients diagnosed with bipolar disorder. It can be dangerous and complicates patient care. Nevertheless, it has not been adequately studied as a phenomenon that is separate from other symptoms such as agitation. The aim of this review is to provide information on the prevalence, clinical context, and clinical management of aggression in patients with bipolar disorder. METHODS MEDLINE and PsycInfo data bases were searched for articles published between 1966 and November 2008 using the combination of key words 'aggression' or 'violence' with 'bipolar disorder'. For the treatment searches, generic names of mood stabilisers and antipsychotics were used in combination with key words 'bipolar disorder' and 'aggression'. No language constraint was applied. Articles dealing with children and adolescents were not included. RESULTS Acutely ill hospitalised bipolar patients have a higher risk for aggression than other inpatients. In a population survey, the prevalence of aggressive behaviour after age 15 years was 0.66% in persons without lifetime psychiatric disorder, but 25.34% in bipolar I disorder. Comorbidity with personality disorders and substance use disorders is frequent, and it elevates the risk of aggression in bipolar patients. Impulsive aggression appears to be the most frequent subtype observed in bipolar patients. Clinical management of aggression combines pharmacological and non-pharmacological approaches. DISCUSSION A major problem with the evidence is that aggression is frequently reported only as one of the items contributing to the total score on a scale or a subscale. This makes it impossible to ascertain specifically aggressive behaviour. Large controlled head-to-head randomised controlled studies comparing treatments for aggressive behaviour in bipolar disorder are not yet available. There is some evidence favouring divalproex, but it is not particularly strong .We do not know if there are any efficacy differences among antipsychotics for this indication.
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Affiliation(s)
- K Látalová
- Psychiatric Department, Palacký University, Olomouc, Czech Republic.
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Cassano G, Benvenuti A, Miniati M, Calugi S, Mula M, Maggi L, Rucci P, Fagiolini A, Perris F, Frank E. The factor structure of lifetime depressive spectrum in patients with unipolar depression. J Affect Disord 2009; 115:87-99. [PMID: 18947882 PMCID: PMC3387569 DOI: 10.1016/j.jad.2008.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/07/2008] [Accepted: 09/09/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND While previous attempts to elucidate the factor structure of depression tended to agree on a central focus on depressed mood, other factors were not replicated across studies. By examining data from a large number of items covering the range of depressive symptoms, the aim of the present study is to contribute to the identification of the structure of depression on a lifetime perspective. METHODS The study sample consisted of 598 patients with unipolar depression who were administered the Mood Spectrum Self-Report (lifetime version) in Italian (N=415) or English (N=183). In addition to classical exploratory factor analysis using tetrachoric correlation coefficients, an IRT-based factor analysis approach was adopted to analyze the data on 74 items of the instrument that explore cognitive, mood and energy/activity features associated with depression. RESULTS Six factors were identified, including 'Depressive Mood', 'Psychomotor Retardation', 'Suicidality', 'Drug/Illness related depression', 'Psychotic Features' and 'Neurovegetative Symptoms', accounting overall for 48.3% of the variance of items. LIMITATIONS Clinical information on onset of depression and duration of illness is available only for 350 subjects. Therefore, differences between sites can only be partially accounted using available data. CONCLUSIONS Our study confirms the central role of depressed mood, psychomotor retardation and suicidality and identifies the factors 'Drug/Illness related depression', 'Psychotic features' and the neurovegetative dysregulation not captured by the instruments most frequently used in previous studies. The identification of patients with specific profiles on multiple factors may be useful in achieving greater precision in neuroimaging studies and in informing treatment selection.
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Affiliation(s)
- G.B. Cassano
- Corresponding author. Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, via Roma 67 - 56100 Pisa, Italy. Tel.: +39 050 835419; fax: +39 050 21581. (G.B. Cassano)
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Cassano G, Mula M, Rucci P, Miniati M, Frank E, Kupfer D, Oppo A, Calugi S, Maggi L, Gibbons R, Fagiolini A. The structure of lifetime manic-hypomanic spectrum. J Affect Disord 2009; 112:59-70. [PMID: 18541309 PMCID: PMC3387675 DOI: 10.1016/j.jad.2008.04.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND The observation that bipolar disorders frequently go unrecognized has prompted the development of screening instruments designed to improve the identification of bipolarity in clinical and non-clinical samples. Starting from a lifetime approach, researchers of the Spectrum Project developed the Mood Spectrum Self-Report (MOODS-SR) that assesses threshold-level manifestations of unipolar and bipolar mood psychopathology, but also atypical symptoms, behavioral traits and temperamental features. The aim of the present study is to examine the structure of mania/hypomania using 68 items of the MOODS-SR that explore cognitive, mood and energy/activity features associated with mania/hypomania. METHODS A data pool of 617 patients with bipolar disorders, recruited at Pittsburgh and Pisa, Italy was used for this purpose. Classical exploratory factor analysis, based on a tetrachoric matrix, was carried out on the 68 items, followed by an Item Response Theory (IRT)-based factor analytic approach. RESULTS Nine factors were initially identified, that include Psychomotor Activation, Creativity, Mixed Instability, Sociability/Extraversion, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Inflated Self-esteem, Euphoria, Wastefulness/Recklessness, and account overall for 56.4% of the variance of items. In a subsequent IRT-based bi-factor analysis, only five of them (Psychomotor Activation, Mixed Instability, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Euphoria) were retained. CONCLUSIONS Our data confirm the central role of Psychomotor Activation in mania/hypomania and support the definitions of pure manic (Psychomotor Activation and Euphoria) and mixed manic (Mixed Instability and Mixed Irritability) components, bearing the opportunity to identify patients with specific profiles for a better clinical and neurobiological definition.
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Affiliation(s)
- G.B. Cassano
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy,Corresponding author. Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, via Roma 67-56100 Pisa, Italy. Tel.: +39 050 835419; fax: +39 050 21581. (G.B. Cassano)
| | - M Mula
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy
| | - P Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - M Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy
| | - E Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - D.J. Kupfer
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - A Oppo
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy
| | - S Calugi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy
| | - L Maggi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy
| | - R Gibbons
- Center for Health Statistics, University of Illinois at Chicago, United States
| | - A Fagiolini
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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20
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Abstract
OBJECTIVES Although aggressive behavior has been associated with bipolar disorder (BD), it has also been linked with developmental factors and disorders frequently found to be comorbid with BD, making it unclear whether or not it represents an underlying biological disturbance intrinsic to bipolar illness. We therefore sought to identify predictors of trait aggression in a sample of adults with BD. METHODS Subjects were 100 bipolar I (n = 73) or II (n = 27) patients consecutively evaluated in the Bipolar Disorders Research Program of the New York Presbyterian Hospital-Payne Whitney Clinic. Diagnoses were established using the Structured Clinical Interview for the DSM-IV (SCID-I) and Cluster B sections of the SCID-II. Mood severity was rated by the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Histories of childhood maltreatment were assessed via the Childhood Trauma Questionnaire (CTQ), while trait aggression was measured by the Brown-Goodwin Aggression Scale (BGA). RESULTS In univariate analyses, significant relationships were observed between total BGA scores and CTQ total (r = 0.326, p = 0.001), childhood emotional abuse (r = 0.417, p < 0.001), childhood physical abuse (r = 0.231, p = 0.024), childhood emotional neglect (r = 0.293, p = 0.004), post-traumatic stress disorder (t = -2.843, p = 0.005), substance abuse/dependence (t = -2.914, p = 0.004), antisocial personality disorder (t = -2.722, p = 0.008) and borderline personality disorder (t = -5.680, p < 0.001) as well as current HDRS (r = 0.397, p < 0.001) and YMRS scores (r = 0.371, p < 0.001). Stepwise multiple regression revealed that trait aggression was significantly associated with: (i) diagnoses of comorbid borderline personality disorder (p < 0.001); (ii) depressive symptoms (p = 0.001); and (iii) manic symptoms (p < 0.001). CONCLUSIONS Comorbid borderline personality disorder and current manic and depressive symptoms each significantly predicted trait aggression in BD, while controlling for confounding factors. The findings have implications for nosologic distinctions between bipolar and borderline personality disorders, and the developmental pathogenesis of comorbid personality disorders as predisposing to aggression in patients with BD.
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Affiliation(s)
- Jessica L Garno
- Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, NY 11004, USA.
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Saunders EH, Scott LJ, McInnis MG, Burmeister M. Familiality and diagnostic patterns of subphenotypes in the National Institutes of Mental Health bipolar sample. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:18-26. [PMID: 17525972 DOI: 10.1002/ajmg.b.30558] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bipolar-related subphenotypes that cluster within families may help identify subsets of patients that are more genetically homogeneous. Environmental or assessment factors that segregate by family may influence estimates of familiality. We aimed to determine familiality of subphenotypes of bipolar disorder (BP), accounting for effects of age, sex, diagnosis, and site/wave of ascertainment. We studied 589 sibships with 1416 siblings affected with bipolar I (BPI), schizoaffective disorder, bipolar type (SAB), bipolar II (BPII), or recurrent unipolar depression (RUDD). Sibships were from families with > or =2 BPI cases collected by the NIMH Bipolar Genetics Initiative (NIMHBGI). Rapid cycling showed the strongest evidence for familiality [odds ratio (OR) (95%CI) = 2.02 (1.43, 2.85), P = 6.0 x 10(-5)] in a model including age, sex, diagnosis, and site/wave of ascertainment. Additional significantly familial traits were comorbid alcohol abuse/dependence (P = 2 x 10(-4)) and comorbid panic disorder (P = 8 x 10(-3)), as well as psychosis, suicidal thoughts, and rapid mood switching (P = 6 x 10(-3) - 0.03). Omission of the effect of site/wave of ascertainment from the model inflated the significance level of the apparent familial association of almost all subphenotypes from one to four orders of magnitude. We have found evidence of familiality for subphenotypes of BP. In multicenter samples, familiality may be overestimated if variability in diagnosis of subphenotypes between site/wave of ascertainment is not considered.
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Affiliation(s)
- Erika H Saunders
- University of Michigan Depression Center, Ann Arbor, Michigan 48109, USA.
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Sato T, Bottlender R, Sievas M, Schröter A, Hecht S, Möller HJ. Long-term inter-episode stability of syndromes underlying mania. Acta Psychiatr Scand 2003; 108:310-3. [PMID: 12956833 DOI: 10.1034/j.1600-0447.2003.00194.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To explore the stability of diverse manic presentations across manic recurrences. METHOD A total of 253 bipolar patients who experienced two or more hospitalizations, because of consecutive manic (or mixed) episodes, during a 20-year period were included. All patients had second hospitalizations with an mean interval of 773 days, while 126 and 91 patients had third and fourth hospitalizations with mean intervals of 1559 and 2237 days from the index hospitalization, respectively. Seven symptom scores, previously factor-validated, were calculated. RESULTS Depressive mood, irritable aggression, psychomotor/thought inhibition, mania, emotional lability/agitation and psychosis were moderately correlated across the index and subsequent hospitalizations. CONCLUSION A majority of diverse manic presentations were stable across manic recurrences. The stability was not restricted to two consecutive recurrences but appeared widespread over the long-term course of bipolar disorder. The finding may serve for the development of more effective long-term treatment strategies and a clinically more reasonable subtyping of mania.
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Affiliation(s)
- T Sato
- Psychiatric Hospital, Ludwig-Maximilian University, Munich, Germany.
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Serretti A, Artioli P, Zanardi R, Rossini D. Clinical features of antidepressant associated manic and hypomanic switches in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:751-7. [PMID: 12921905 DOI: 10.1016/s0278-5846(03)00104-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study investigated possible clinical differences between bipolar patients with and without manic or hypomanic switch during antidepressant (AD) treatment. The authors undertook a retrospective assessment of 169 individuals affected by bipolar disorder type I (BP I: n=96) and II (BP II: n=73) who experienced at least one manic or hypomanic episode following depression without any interposed normothymic period ("manic switch") during AD therapy. They were compared with a sex, age (+/-5 years), and ethnicity-matched group of 247 subjects, randomly selected from our pool of bipolar subjects who have never had manic switches. Only 2 of the 169 patients had had spontaneous switches before the AD-related one. Switched subjects were marginally older (t=-2.65, df=414, P=.008) compared to not switched and less frequently delusional (chi2=13.86, P=.0002). Polarity of the onset episode was more frequently depressive in switched patients (chi2=21.93, P=.00002), which had also less previous manic episodes than not switched (t=3.44, df=332, P=.0006). Those differences were more pronounced in the BP I subsample. Switched patients were more frequently BP I (chi2=29.66; P<.00001). Maintenance with mood stabilizers appears to be a strong protective factor; in fact, of the 124 individuals undertaking a mood stabilizer therapy, 21 had a switch and 103 had no switches (chi2=41.10, P<.000001). In conclusion, some clinical variables, such as the number of manic episodes, the presence of delusions, the polarity of onset episode, and the mood-stabilizing treatment, may be involved in AD-related switches. Further studies are required to investigate the causal relationships between those factors.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, School of Medicine, Vita-Salute University San Raffaele, Via Stamira D'Ancona 20, Milan 20127, Italy.
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