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Mosheva M, Serretti A, Stukalin Y, Fabbri C, Hagin M, Horev S, Mantovani V, Bin S, Mattiaccio A, Nivoli A, Vieta E, Popovic D. Association between CANCA1C gene rs1034936 polymorphism and alcohol dependence in bipolar disorder. J Affect Disord 2020; 261:181-186. [PMID: 31634677 DOI: 10.1016/j.jad.2019.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a highly heritable and disabling mental illness, commonly associated with substance abuse, being alcohol abuse the most frequent. Comorbid BD and substance abuse disorders are often associated with high levels of health service utilization and destabilization of the course of illness resulting in poor treatment outcomes. Although recent genome-wide association studies have detected a number of risk genes for BD, the data is still sparse and inconclusive for those genes that may contribute to the increased risk of comorbid alcohol abuse (AA) in BD. The primary aim of the present study was to investigate the effects of 46 single-nucleotide polymorphisms (SNPs) within eight genes on different phenotypes of BD patients, such as comorbid alcohol abuse. We further assessed clinical variables associated with AA. METHODS One-hundred fifty-eight BD I and II patients were enrolled in a naturalistic cohort study. Genomic DNA of 92 patients was extracted from whole blood using standard procedures and 46 tag SNPs in eight genes of interest (ANK, CACNA1C, CACNB2, FKBP5, GRM7, ITIH3, SYNE1 and TCF4) were genotyped. RESULTS Seventy-one patients out of 158 (45%) satisfied diagnostic criteria for comorbid AA. Among 46 SNPs analyzed, the only SNP associated with comorbid AA was rs1034936 polymorphism in the CANCA1C gene. This polymorphism was also associated with lifetime cocaine abuse, manic switch and current atypical antipsychotics. CONCLUSIONS Our findings suggest a role of rs1034936 CACNA1C gene variant in BD-AA group. Despite their preliminary nature, the present results may provide new insight on mechanisms underlying AA in BD.
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Affiliation(s)
- Mariela Mosheva
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Yelena Stukalin
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michal Hagin
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel
| | - Sagi Horev
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel; Semmelewis University, Budapest, Hungary
| | - Vilma Mantovani
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Sofia Bin
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Alessandro Mattiaccio
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Alessandra Nivoli
- Clinica Psichiatrica, Dipartimento di Medicina Clinica e Sperimentale, University of Sassari, Italy
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Spain
| | - Dina Popovic
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel.
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Yapici Eser H, Kacar AS, Kilciksiz CM, Yalçinay-Inan M, Ongur D. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry 2018; 9:229. [PMID: 29997527 PMCID: PMC6030835 DOI: 10.3389/fpsyt.2018.00229] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/11/2018] [Indexed: 12/23/2022] Open
Abstract
Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence. Method: We searched PubMed to access relevant articles published until September 2015, using the keywords "Bipolar disorder" or "Affective Psychosis" or "manic depressive" separately with "generalized anxiety," "panic disorder," "social phobia," "obsessive compulsive," and "anxiety." Variables for associated features and prevalence of anxiety disorders were carefully extracted. Results: Lifetime any anxiety disorder comorbidity in BD was 40.5%; panic disorder (PD) 18.1%, generalized anxiety disorder (GAD) 13.3%, social anxiety disorder (SAD) 13.5% and obsessive compulsive disorder (OCD) 9.7%. Current any anxiety disorder comorbidity in BD is 38.2%; GAD is 15.2%, PD 13.3%, SAD 11.7%, and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38% and 34%, PD was 15% and 15%, GAD was 14% and 16.6%, SAD was 8% and 13%, OCD was 8% and 10%, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31% and 37%, PD was 9% and 13%, GAD was 8% and 12%, SAD was 7% and 11%, and OCD was 8% and 7%, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD-SAD comorbidity. History of psychotic features significantly affected current PD and GAD. Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.
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Affiliation(s)
- Hale Yapici Eser
- School of Medicine, Koç University, Sariyer, Turkey.,Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Anil S Kacar
- Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Can M Kilciksiz
- School of Medicine, Koç University, Sariyer, Turkey.,Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Pavlova B, Perlis RH, Mantere O, Sellgren CM, Isometsä E, Mitchell PB, Alda M, Uher R. Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: a meta-analysis. Psychol Med 2017; 47:1107-1115. [PMID: 27995827 DOI: 10.1017/s0033291716003135] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent in people with bipolar disorder, but it is not clear how many have anxiety disorders even at times when they are free of major mood episodes. We aimed to establish what proportion of euthymic individuals with bipolar disorder meet diagnostic criteria for anxiety disorders. METHOD We performed a random-effects meta-analysis of prevalence rates of current DSM-III- and DSM-IV-defined anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, specific phobia, obsessive-compulsive disorder, post-traumatic stress disorder, and anxiety disorder not otherwise specified) in euthymic adults with bipolar disorder in studies published by 31 December 2015. RESULTS Across 10 samples with 2120 individuals with bipolar disorder, 34.7% met diagnostic criteria for one or more anxiety disorders during euthymia [95% confidence interval (CI) 23.9-45.5%]. Direct comparison of 189 euthymic individuals with bipolar disorder and 17 109 population controls across three studies showed a 4.6-fold increase (risk ratio 4.60, 95% CI 2.37-8.92, p < 0.001) in prevalence of anxiety disorders in those with bipolar disorder. CONCLUSIONS These findings suggest that anxiety disorders are common in people with bipolar disorder even when their mood is adequately controlled. Euthymic people with bipolar disorder should be routinely assessed for anxiety disorders and anxiety-focused treatment should be initiated if indicated.
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Affiliation(s)
- B Pavlova
- Nova Scotia Health Authority,Halifax, Nova Scotia,Canada
| | - R H Perlis
- Department of Psychiatry,Harvard Medical School,Boston, MA,USA
| | - O Mantere
- Douglas Mental Health University Institute,Montréal, Québec,Canada
| | - C M Sellgren
- Department of Psychiatry,Harvard Medical School,Boston, MA,USA
| | - E Isometsä
- Department of Psychiatry,University of Helsinki and Helsinki University Hospital,Helsinki,Finland
| | - P B Mitchell
- University of New South Wales, School of Psychiatry,Sydney,Australia
| | - M Alda
- Nova Scotia Health Authority,Halifax, Nova Scotia,Canada
| | - R Uher
- Nova Scotia Health Authority,Halifax, Nova Scotia,Canada
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Bezerra S, Galvão-de-Almeida A, Studart P, Martins DF, Caribé AC, Schwingel PA, Miranda-Scippa Â. Suicide attempts in bipolar I patients: impact of comorbid personality disorders. ACTA ACUST UNITED AC 2017; 39:133-139. [PMID: 28076649 PMCID: PMC7111445 DOI: 10.1590/1516-4446-2016-1982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/27/2016] [Indexed: 11/22/2022]
Abstract
Objective To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD). Methods One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics. Results History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis. Conclusions Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.
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Affiliation(s)
- Severino Bezerra
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil
| | - Amanda Galvão-de-Almeida
- Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.,Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
| | - Paula Studart
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil
| | - Davi F Martins
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil
| | - André C Caribé
- Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Paulo A Schwingel
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.,Departamento de Nutrição, Universidade de Pernambuco (UPE), Petrolina, PE, Brazil
| | - Ângela Miranda-Scippa
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.,Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
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Preti A, Vrublevska J, Veroniki AA, Huedo-Medina TB, Fountoulakis KN. Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2016; 19:73-81. [PMID: 27405742 PMCID: PMC10699460 DOI: 10.1136/eb-2016-102412] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 01/04/2023]
Abstract
QUESTION Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression; however, less attention has been paid to comorbidity of anxiety disorders with BD. Generalised anxiety disorder (GAD) is one of the most prevalent anxiety disorders that is highly comorbid with other mental disorders. We carried out a systematic review and meta-analysis to assess the degree of comorbidity between GAD and BD. STUDY SELECTION AND ANALYSIS We searched for all studies, which included primary data concerning the existence of GAD in patients with BD. The literature search strategy, selection of publications and the reporting of results have been conducted with PRISMA guidelines. The meta-analysis calculated prevalence estimates using the variance-stabilising Freeman-Tukey double arcsine transformation. We applied the inverse variance method using both fixed-effects and random-effects models to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I(2) statistics, respectively. FINDINGS The current meta-analysis analysed data from 28 independent studies and a total of 2975 patients from point prevalence studies and 4919 patients from lifetime studies. The overall random-effects point prevalence of GAD in patients with BD was 12.2% (95% CI 10.9% to 13.5%) and the overall random-effects lifetime estimate was 15.1% (95% CI 9.7% to 21.5%). Both estimates reported significant heterogeneity (94.0% and 94.7%, respectively). CONCLUSIONS Published studies report prevalence rates with high heterogeneity and consistently higher than those typically reported in the general population. It is believed that comorbid GAD might be associated with a more severe BD course and increased suicidality, and it is unknown how best to treat such conditions. The current meta-analysis confirms that GAD is highly prevalent in BD and the rate is higher in comparison to those in the general population.
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Affiliation(s)
- Antonio Preti
- Genneruxi Medical Center, Cagliari, Italy
- Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | | | - Tania B Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Nabavi B, Mitchell AJ, Nutt D. A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population. EBioMedicine 2015; 2:1405-19. [PMID: 26629535 PMCID: PMC4634892 DOI: 10.1016/j.ebiom.2015.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. AIMS To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. METHOD Random effects meta-analyses were used to calculate the lifetime prevalence of comorbid generalised anxiety disorder, panic disorder, social anxiety disorder, specific phobia, agoraphobia, obsessive compulsive disorder and posttraumatic stress disorder in bipolar affective disorder. RESULTS 52 studies were included in the meta-analysis. The rate of lifetime comorbidity was as follows: panic disorder 16.8% (95% CI 13.7-20.1), generalised anxiety disorder 14.4% (95% CI 10.8-18.3), social anxiety disorder13.3% (95% CI 10.1-16.9), post-traumatic stress disorder 10.8% (95% CI 7.3-14.9), specific phobia 10.8% (95% CI 8.2-13.7), obsessive compulsive disorder 10.7% (95% CI 8.7-13.0) and agoraphobia 7.8% (95% CI 5.2-11.0). The lifetime prevalence of any anxiety disorders in bipolar disorder was 42.7%. CONCLUSIONS Our results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder. The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap. The treatment of co-existing conditions has clinically remained challenging.
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Affiliation(s)
- Behrouz Nabavi
- The Oleaster Centre, Birmingham and Solihull Mental Health NHS Foundation Trust, West Midlands, UK
| | - Alex J Mitchell
- Department of Psycho-oncology, University of Leicester and Leicester Partnership NHS Trust, Leicester, UK
| | - David Nutt
- Centre of Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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Normal Metabolic Levels in Prefrontal Cortex in Euthymic Bipolar I Patients with and without Suicide Attempts. Neural Plast 2015; 2015:165180. [PMID: 26075096 PMCID: PMC4444600 DOI: 10.1155/2015/165180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction/Objective. Evidence suggests that the prefrontal cortex has been implicated in the pathophysiology of bipolar disorder (BD), but few neurochemical studies have evaluated this region in bipolar patients and there is no information from BD suicide attempters using Proton Magnetic Resonance Spectroscopy (H+MRS). The objective was to evaluate the metabolic function of the medial orbital frontal cortex in euthymic BD type I suicide and nonsuicide attempters compared to healthy subjects by H+MRS. Methods. 40 euthymic bipolar I outpatients, 19 without and 21 with history of suicide attempt, and 22 healthy subjects were interviewed using the Structured Clinical Interview with the DSM-IV axis I, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Barratt Impulsiveness Scale-11 and underwent H+MRS. Results. We did not find any metabolic abnormality in medial orbital frontal regions of suicide and nonsuicide BD patients and BD patients as a group compared to healthy subjects. Conclusions. The combined chronic use of psychotropic drugs with neuroprotective or neurotrophic effects leading to a euthymic state for longer periods of time may improve neurometabolic function, at least measured by H+MRS, even in suicide attempters. Besides, these results may implicate mood dependent alterations in brain metabolic activity. However, more studies with larger sample sizes of this heterogeneous disorder are warranted to clarify these data.
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Nery FG, Miranda-Scippa A, Nery-Fernandes F, Kapczinski F, Lafer B. Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: results from the Brazilian Bipolar Research Network. Compr Psychiatry 2014; 55:1116-21. [PMID: 24746528 DOI: 10.1016/j.comppsych.2014.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To investigate prevalence rates and clinical correlates of alcohol use disorders (AUD) among bipolar disorder (BD) patients in a large sample from the Brazilian Bipolar Research Network. METHODS Four hundred and eighty-three DSM-IV BD patients, divided according to the presence or absence of a lifetime AUD diagnosis (BD-AUD vs. BD-nonAUD), were included. Demographic and clinical characteristics of these two groups were compared. Logistic regression was performed to identify which characteristics were most strongly associated with a lifetime AUD diagnosis. RESULTS Nearly 23% presented a lifetime AUD diagnosis. BD-AUD patients were more likely to be male, to present rapid cycling, post-traumatic stress disorder (PTSD), anorexia, other substance use disorders (SUD), family history of SUD, any substance misuse during the first mood episode, history of psychosis, suicide attempts, and younger age at onset of illness than BD-nonAUD patients. Logistic regression showed that the variables most strongly associated with a lifetime AUD diagnosis were SUD (non-alcohol), any substance misuse during the first mood episode, PTSD, male gender, suicide attempt, family history of SUD, and younger age at onset of BD. CONCLUSIONS BD-AUD patients begin their mood disorder earlier and present more suicidal behaviors than BD-nonAUD patients. Personal and family history of SUD may be good predictors of comorbid AUD among BD patients. These variables are easily assessed in the clinical setting and may help to identify a particularly severe subgroup of BD patients.
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Affiliation(s)
- Fabiano G Nery
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Angela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Department of Neurosciences and Mental Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Fabiana Nery-Fernandes
- Mood and Anxiety Disorders Program (CETHA), Department of Neurosciences and Mental Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Flavio Kapczinski
- Bipolar Disorder Program (PROTAHBI), Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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The clinical implications of cognitive impairment and allostatic load in bipolar disorder. Eur Psychiatry 2012; 28:21-9. [PMID: 22534552 DOI: 10.1016/j.eurpsy.2011.11.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/25/2011] [Accepted: 11/11/2011] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Allostatic load (AL) relates to the neural and bodily "wear and tear" that emerge in the context of chronic stress. This paper aims to provide clinicians with a comprehensive overview of the role of AL in patophysiology of bipolar disorder (BD) and its practical implications. METHODS PubMed searches were conducted on English-language articles published from 1970 to June 2011 using the search terms allostatic load, oxidative stress, staging, and bipolar disorder cross-referenced with cognitive impairment, comorbidity, mediators, prevention. RESULTS Progressive neural and physical dysfunction consequent to mood episodes in BD can be construed as a cumulative state of AL. The concept of AL can help to reconcile cognitive impairment and increased rates of clinical comorbidities that occur over the course of cumulative BD episodes. CONCLUSIONS Data on transduction of psychosocial stress into the neurobiology of mood episodes converges to the concept of AL. Mood episodes prevention would not only alleviate emotional suffering, but also arrest the cycle of AL, cognitive decline, physical morbidities and, eventually, related mortality. These objectives can be achieved by focusing on effective prophylaxis from the first stages of the disorder, providing mood-stabilizing agents and standardized psychoeducation and, potentially, addressing cognitive deficits by the means of specific medication and neuropsychological interventions.
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Nery-Fernandes F, Quarantini LC, Guimarães JL, de Oliveira IR, Koenen KC, Kapczinski F, Miranda-Scippa Â. Is there an association between suicide attempt and delay of initiation of mood stabilizers in bipolar I disorder? J Affect Disord 2012; 136:1082-7. [PMID: 22138284 DOI: 10.1016/j.jad.2011.10.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 10/26/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the extent to which delay of initiation of mood-stabilizing treatment may influence outcomes in bipolar patients (BP). In this study, our aim was to investigate the association between delay of mood stabilizer treatment in bipolar patients and lifetime history of suicide attempts. METHOD A consecutive sample of 268 bipolar I outpatients from two teaching hospitals in Brazil was recruited. The assessment included a socio-demographic history form, a clinical interview regarding clinical variables and the Structured Clinical Interview for DSM-IV. Participants were divided into three groups: BP that initiated the first mood stabilizer in the same year of the first episode of the disease (FMS≤1), between 1 and 5 years after the first episode of the disease (1<FMS≤5), and after 5 years after the first episode of BD (FMS>5). RESULTS The mean time from the first episode until the first mood stabilizer medication was 8.6 years (SD 9.8 years). The FMS>5 group, showed a higher lifetime prevalence of suicide attempts than the other two groups (PR=1.75, 95% CI: 1.24-2.47), p=0.001. These results remained significant after adjusting for potential confounders, (PR=1.82, 95% CI: 1.29-2.60), p=0.001. LIMITATIONS This study evaluated patients retrospectively and does not permit a cause-effect relationship. CONCLUSION The present study supports the importance of early diagnosis and early intervention for BP in order to limit the potentially lethal impact of the disease.
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Affiliation(s)
- Fabiana Nery-Fernandes
- Program of Mood and Anxiety Disorders (CETHA), University Hospital, and Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Brazil.
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Grande I, Kunz M, Potter W, Balanzá-Martínez V, Vieta E, Kapczinski F. Should bipolar disorder be considered a systemic illness? ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.10.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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12
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Barbosa IG, Ferreira RDA, Huguet RB, Rocha FL, Salgado JV, Teixeira AL. Comorbidades clínicas e psiquiátricas em pacientes com transtorno bipolar do tipo I. JORNAL BRASILEIRO DE PSIQUIATRIA 2011. [DOI: 10.1590/s0047-20852011000400007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Contexto: O transtorno bipolar tipo I está comumente associado a comorbidades clínicas e psiquiátricas, mas ainda há poucos dados disponíveis sobre pacientes brasileiros. Objetivos: O objetivo do presente estudo foi avaliar a prevalência de comorbidades clínicas e psiquiátricas em uma amostra brasileira de pacientes bipolares tipo I. O objetivo secundário foi investigar as associações de características clínico-demográficas e comorbidades com tentativas de suicídio. Métodos: Foram incluídos neste estudo 94 pacientes bipolares tipo I. O diagnóstico psiquiátrico foi determinado utilizando-se a avaliação Mini International Neuropsychiatric Interview (MINI-Plus). O diagnóstico de comorbidades clínicas foi baseado na história clínica e no acompanhamento de clínicos gerais. Resultados: As comorbidades mais prevalentes nos pacientes bipolares foram: transtorno de ansiedade generalizada (19,20%), dependência de substâncias (43,60%), hipertensão arterial (29,80%), diabetes mellitus (17,00%), dislipidemia (22,30%) e hipotireoidismo (19,10%). Não foram encontradas diferenças estatísticas em relação às características demográficas ou à prevalência de comorbidades nos grupos com e sem tentativa de suicídio. Conclusão: Pacientes bipolares atendidos em serviço psiquiátrico apresentam elevada prevalência de comorbidades psiquiátricas e clínicas. Nessa população, tentativas de suicídio não se associam com a presença de comorbidades ou características demográficas.
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