1
|
Watson M, Filia K, Stevens A, Cotton S, Nelson B, Ratheesh A. A systematic review and meta-analysis of global and social functioning among people at risk of bipolar disorder. J Affect Disord 2023; 321:290-303. [PMID: 36306929 DOI: 10.1016/j.jad.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD. METHODS We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible. RESULTS 7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples. LIMITATIONS Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms. CONCLUSIONS Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.
Collapse
Affiliation(s)
- M Watson
- The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia; The University of Melbourne, Melbourne Medical School, Parkville 3052, Australia
| | - K Filia
- Orygen, Parkville 3052, Australia
| | | | - S Cotton
- Orygen, Parkville 3052, Australia
| | - B Nelson
- Orygen, Parkville 3052, Australia
| | - A Ratheesh
- Orygen, Parkville 3052, Australia; The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia.
| |
Collapse
|
2
|
Aguglia A, Natale A, Fusar-Poli L, Amerio A, Costanza A, Fesce F, Gnecco GB, Marino M, Placenti V, Serafini G, Aguglia E, Amore M. Complex polypharmacy in bipolar disorder: Results from a real-world inpatient psychiatric unit. Psychiatry Res 2022; 318:114927. [PMID: 36332508 DOI: 10.1016/j.psychres.2022.114927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple medications are frequently prescribed to patients with bipolar disorder (BD). The aim of the present study was to identify sociodemographic and clinical characteristics associated with complex polypharmacy in patients affected by BD. METHODS 556 patients with BD were included. A semi-structured interview was used to collect sociodemographic and clinical characteristics, as well as pharmacological treatment. Participants were divided in two groups, abased on the use of complex polypharmacy (i.e., a combination of 4 or more psychotropic medications). Differences between the two groups were evaluated with t-test and chi-squared test. A stepwise logistic regression was then applied to identify factors significantly associated with complex polypharmacy. RESULTS Patients with BD and complex polypharmacy were more likely to be single and unemployed. Moreover, earlier age at onset, longer duration of illness, higher number of hospitalizations, higher prevalence of medical and psychiatric comorbidity, and the use of illicit substances (except heroin) were associated with complex polypharmacy. In the logistic regression model, single status, older age, number of hospitalizations, and the presence of psychiatric comorbidities were regarded as factors significantly associated with complex polypharmacy. CONCLUSIONS Our findings reflect the need to develop clear guidelines for the long-term management of BD, especially when pharmacological discontinuation is needed.
Collapse
Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Fabio Fesce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Margherita Marino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valeria Placenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
3
|
Lalli M, Brouillette K, Kapczinski F, de Azevedo Cardoso T. Substance use as a risk factor for bipolar disorder: A systematic review. J Psychiatr Res 2021; 144:285-295. [PMID: 34710665 DOI: 10.1016/j.jpsychires.2021.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Detecting substance use as a predictor of bipolar disorder (BD) is important for clinicians to perform accurate and early diagnosis, as well as better manage the treatment of individuals with BD. The aim of this systematic review was to describe whether substance use is a predictor of BD. A literature search was conducted using the following databases: PubMed, PsycINFO, and Embase. All eligible studies published up to February 9, 2021 were included. This systematic review included 22 studies. We found that 66.7% of the studies assessing overall substance use found that overall substance use was a risk factor for BD. Regarding the specific substances assessed, cannabis use was described as a risk factor for BD in 55.6% of the studies, nonmedical use of prescription medications was a risk factor for BD in 50% of the studies, nicotine was found as a risk factor for BD in 50% of the studies, and alcohol use was described as a risk factor for BD in 42.9% of the studies assessing it. Only one study assessed whether cocaine use was a risk factor for BD and found a significant association. Interestingly, some studies suggested that the greater frequency of cannabis use was associated with greater risk to develop BD or hypomanic/manic symptoms. In conclusion, there is evidence supporting that substance use is a risk factor for BD. Importantly, when assessing the risk factors for BD related to psychoactive substance use, special attention should be given for the frequency of cannabis use.
Collapse
Affiliation(s)
- Mikayla Lalli
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Khadija Brouillette
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Graduate Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Taiane de Azevedo Cardoso
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
4
|
Psychosocial and biological risk factors of anxiety disorders in adolescents: a TRAILS report. Eur Child Adolesc Psychiatry 2021; 30:1969-1982. [PMID: 33113027 PMCID: PMC8563629 DOI: 10.1007/s00787-020-01669-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/19/2020] [Indexed: 01/04/2023]
Abstract
Anxiety disorders are a common problem in adolescent mental health. Previous studies have investigated only a limited number of risk factors for the development of anxiety disorders concurrently. By investigating multiple factors simultaneously, a more complete understanding of the etiology of anxiety disorders can be reached. Therefore, we assessed preadolescent socio-demographic, familial, psychosocial, and biological factors and their association with the onset of anxiety disorders in adolescence. This study was conducted among 1584 Dutch participants of the TRacking Adolescents' Individual Lives Survey (TRAILS). Potential risk factors were assessed at baseline (age 10-12), and included socio-demographic (sex, socioeconomic status), familial (parental anxiety and depression), psychosocial (childhood adversity, temperament), and biological (body mass index, heart rate, blood pressure, cortisol) variables. Anxiety disorders were assessed at about age 19 years through the Composite International Diagnostic Interview (CIDI). Univariate and multivariate logistic regression analyses were performed with onset of anxiety disorder as a dependent variable and the above-mentioned putative risk factors as predictors. Of the total sample, 25.7% had a lifetime diagnosis of anxiety disorder at age 19 years. Anxiety disorders were twice as prevalent in girls as in boys. Multivariate logistic regression analysis showed that being female (OR = 2.38, p < .01), parental depression and anxiety (OR = 1.34, p = .04), temperamental frustration (OR = 1.31, p = .02) and low effortful control (OR = 0.76, p = .01) independently predicted anxiety disorders. We found no associations between biological factors and anxiety disorder. After exclusion of adolescents with an onset of anxiety disorder before age 12 years, being female was the only significant predictor of anxiety disorder. Being female was the strongest predictor for the onset of anxiety disorder. Psychological and parental psychopathology factors increased the risk of diagnosis of anxiety, but to a lesser extent. Biological factors (heart rate, blood pressure, cortisol, and BMI), at least as measured in the present study, are unlikely to be useful tools for anxiety prevention and intervention strategies.
Collapse
|
5
|
Anxiety disorders anticipate the diagnosis of bipolar disorder in comorbid patients: Findings from an Italian tertiary clinic. J Affect Disord 2019; 257:376-381. [PMID: 31302527 DOI: 10.1016/j.jad.2019.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies indicate bipolar disorder (BD) syndromal symptoms are commonly preceded by sub-syndromal BD symptoms, dysregulated sleep, irritability, and anxiety. We aimed to evaluate prevalence and clinical correlates of anxiety disorders (ADs) at BD onset in outpatients with versus without at least one AD at BD onset. METHODS 246 bipolar spectrum outpatients, according to the text revision of the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM- IV-TR), attending Sacco University Hospital in Milan, were recruited and their onset and clinical features assessed retrospectively. Patients were stratified into those with versus without an AD at BD onset (w/A and wo/A), according to a semi-structured clinical interview to provide diagnoses according to (DSM- IV-TR). RESULTS 29% of patients reported being w/A, among whom Panic Disorder (PD, in 55.6%) was the most frequent AD, and first AD occurred approximately 4 years before BD diagnosis. Patients w/A versus wo/A had higher (p < 0.05) rates of BDII and first mood episode being depression versus elevation (mania/hypomania), and lifetime rates of separation anxiety disorder, substance poly-abuse and benzodiazepine abuse. In contrast, patients wo/A had higher lifetime rates of alcohol and illicit drug use. CONCLUSION In this naturalistic sample, ADs, in particular PD, preceded BD in almost 1/3 of BD outpatients, and had distinctive clinical correlates. Further investigation into relationships between BD and AD at onset may enhance early BD diagnosis and treatment.
Collapse
|