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Léda-Rêgo G, Studart-Bottó P, Abbade P, Rabelo-Da-Ponte FD, Casqueiro JS, Sarmento S, Dallalana C, Troesch M, Prates S, Miranda-Scippa Â. Lifetime prevalence of psychiatric comorbidities in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Res 2024; 337:115953. [PMID: 38763079 DOI: 10.1016/j.psychres.2024.115953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disease and part of its burden is related to the high rates of lifetime psychiatric comorbidity (PC), with diagnostic, therapeutic, and prognostic implications. METHODS Registered in PROSPERO (CRD42021282356). Meta-analyses were performed, searching for relevant papers published from 1993 to 2022 in Medline/PubMed (including E-Pub Ahead of Print), Embase, Cochrane Library (Central), PsycINFO, Scopus, Web of Science and via hand-searching, without language restrictions. 12.698 studies were initially identified, 114 of which were ultimately chosen based on the eligibility criteria. We performed two meta-analyses (prevalence and risk ratio) of mental health conditions among subjects with BD and then conducted a comprehensive examination of moderator effects using multivariable meta-regression models for moderators identified as significant in the univariable analysis. FINDINGS Overall PC prevalence of at least one disorder was 38.91 % (95 % CI 35.24-42.70) and the most frequent disorders were: anxiety (40.4 % [34.97-46.06]), SUD (30.7 % [23.73-38.73]), ADHD (18.6 % [10.66-30.33]) and Disruptive, impulse-control and conduct disorder (15 % [6.21-31.84). The moderators with higher association with individual prevalences were UN's Human Development Index (HDI), female gender, age, suicide attempt, and age at onset (AAO). INTERPRETATION It becomes evident that the prevalence of PC among individuals with BD is notably high, surpassing rates observed in the general population. This heightened prevalence persists despite significant heterogeneity across studies. Consequently, it is imperative to redirect clinical focus towards comprehensive mental health assessments, emphasizing personalized and routine screening. Additionally, there is a pressing need for the enhancement of public policies to create a supportive environment for individuals with BD, ensuring better therapeutic conditions and sustained assistance. By addressing these aspects, we can collectively strive towards fostering improved mental health outcomes for individuals with BD.
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Affiliation(s)
- Gabriela Léda-Rêgo
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil.
| | - Paula Studart-Bottó
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Pedro Abbade
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - F Diego Rabelo-Da-Ponte
- Institute of Psychiatry, Psychology, and Neurosciences, King's College London, United Kingdom
| | - Juliana Socorro Casqueiro
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brasil
| | - Stella Sarmento
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Caroline Dallalana
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Mariana Troesch
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Sarah Prates
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Ângela Miranda-Scippa
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brasil
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Dell'Osso B, Cremaschi L, Macellaro M, Cafaro R, Girone N. Bipolar disorder staging and the impact it has on its management: an update. Expert Rev Neurother 2024; 24:565-574. [PMID: 38753491 DOI: 10.1080/14737175.2024.2355264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The longitudinal course of bipolar disorder (BD) is associated with an active process of neuroprogression, characterized by structural brain alterations and progressive functional impairment. In the last decades, a growing need of a standardized staging model for BD arose, with the aim of a more appropriate definition of stage-specific clinical manifestations and the identification of more customized therapeutic tools. AREAS COVERED The authors review the literature on clinical aspects, neurobiological correlates and treatment issues related to BD progression. Thereafter, they address the definition, constructs, and evolution of the staging concept, focusing on the clinical applications of BD staging models available in literature. EXPERT OPINION Although several staging models for BD have been proposed to date, their application in clinical practice is still relatively scant. This may have a detrimental impact on the clinical and therapeutic management of BD, in terms of early and proper diagnosis as well as tailored treatment interventions according to the different stages of illness. Future research efforts should tend to the integration of recent insights on neuroimaging and epigenetic markers, toward a standardized and multidimensional staging model.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Laura Cremaschi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Nicolaja Girone
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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Jarque P, Carmona M, Roca A, Barcelo B, Pichini S, Elorza MÁ, Sanchis P, Rendal Y, Gomila I. Evaluation of three-year neurodevelopmental outcomes in infants prenatally exposed to substance use. Drug Alcohol Depend 2024; 259:111284. [PMID: 38640866 DOI: 10.1016/j.drugalcdep.2024.111284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Prenatal exposure to substance use is associated with long-term deficits in the neurodevelopment of children. The objective was to investigate the association between cognitive, motor, and language neurodevelopment at three years of age in infants prenatally exposed to substance use. MATERIAL AND METHODS A prospective matched case-control study was conducted. Biomarkers of fetal exposure were measured in meconium samples. The Bayley Scales of Infant and Toddler Development (BSID-III) were used to calculate neurodevelopment scores. RESULTS 32 non-exposed and 32 exposed infants were evaluated, of which 16 were exposed to cannabis, 8 to ethanol, 2 to cocaine and 6 to more than one substance. Normal BSID-III scores ≥85 in all domains, were detected in 23 exposed infants to any substance and 29 infants non-exposed. Neurodevelopmental delay was detected in the language domain, specifically in male infants exposed to cannabis. Two infants exposed to cannabis had a severe developmental delay (score<70). Infants exposed to any substance obtained significantly lower total scores than control infants in all domains. Infants exposed to cannabis obtained significantly lower composite scores in the cognitive and motor domains. Infants exposed to more than one substance had lower scores in motor skills. By gender, only males exposed obtained significantly lower composite scores than non-exposed males in the cognitive domain. CONCLUSIONS The most common and severe neurodevelopmental delay at 36 months was detected in the domain of language in male infants prenatally exposed to cannabis. Neurodevelopmental disorders detected can enable an early intervention and plan therapeutic strategies.
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Affiliation(s)
- Pilar Jarque
- Division of Neonatology, Department of Pediatrics, Son Espases University Hospital, Valldemossa Road, 79, Palma de Mallorca 07120, Spain; Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Miguel Carmona
- Division of Neuropediatrics, Department of Pediatrics, Son Espases University Hospital, Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Antonia Roca
- Division of Neonatology, Department of Pediatrics, Son Espases University Hospital, Valldemossa Road, 79, Palma de Mallorca 07120, Spain; Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Bernardino Barcelo
- Clinical Analysis Service, Clinical Toxicology Unit, Son Espases University Hospital, Valldemossa Road, 79, Palma de Mallorca 07120, Spain; Clinical Toxicology Research Group of Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome 00161, Italy.
| | - Miguel Ángel Elorza
- Clinical Analysis Service, Clinical Toxicology Unit, Son Espases University Hospital, Valldemossa Road, 79, Palma de Mallorca 07120, Spain; Clinical Toxicology Research Group of Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Pilar Sanchis
- Department of Chemistry, University of the Balearic Islands, Valldemossa Road, km 7.5, Palma de Mallorca 07122, Spain; Research Group in Vascular and Metabolic Pathologies of Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Yolanda Rendal
- Division of Child and Youth Psychiatry, Son Espases University Hospital, Valldemossa Road, 79, Palma de Mallorca 07120, Spain.
| | - Isabel Gomila
- Clinical Toxicology Research Group of Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, Palma de Mallorca 07120, Spain; Clinical Analysis Service, Son Llàtzer University Hospital, Manacor Road, Palma de Mallorca 07198, Spain.
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Straszek SPV, Straarup KMN, Hjerrild S, Vinberg M. Adults with both bipolar disorder and ADHD. Ugeskr Laeger 2024; 186:V10230620. [PMID: 38708700 DOI: 10.61409/v10230620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
ADHD and bipolar disorder (BP) commonly coexist, and both share key symptoms, depending on affective state and emotional dysregulation. The overlap poses diagnostic challenges and may lead to underdiagnoses. Comorbid cases exhibit worsened symptom burden, increased psychiatric morbidity, admissions, and suicide attempts. Treating BP before ADHD is recommended. Stimulant use combined with mood stabilisers may be effective and relatively safe; however, this review finds that well-designed randomised controlled studies in the area is warranted.
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Yuan W, Chen M, Wang DW, Li QH, Yin YY, Li B, Wang HR, Hu J, Gong YD, Yuan TF, Yu TG. Computational markers of risky decision-making predict for relapse to alcohol. Eur Arch Psychiatry Clin Neurosci 2024; 274:353-362. [PMID: 37148307 DOI: 10.1007/s00406-023-01602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Relapse remains the major challenge in treatment of alcohol use disorder (AUD). Aberrant decision-making has been found as important cognitive mechanism underlying relapse, but factors associated with relapse vulnerability are unclear. Here, we aim to identify potential computational markers of relapse vulnerability by investigating risky decision-making in individuals with AUD. METHODS Forty-six healthy controls and fifty-two individuals with AUD were recruited for this study. The risk-taking propensity of these subjects was investigated using the balloon analog risk task (BART). After completion of clinical treatment, all individuals with AUD were followed up and divided into a non-relapse AUD group and a relapse AUD group according to their drinking status. RESULTS The risk-taking propensity differed significantly among healthy controls, the non-relapse AUD group, and the relapse AUD group, and was negatively associated with the duration of abstinence in individuals with AUD. Logistic regression models showed that risk-taking propensity, as measured by the computational model, was a valid predictor of alcohol relapse, and higher risk-taking propensity was associated with greater risk of relapse to drink. CONCLUSION Our study presents new insights into risk-taking measurement and identifies computational markers that provide prospective information for relapse to drink in individuals with AUD.
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Affiliation(s)
- Wei Yuan
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Meng Chen
- Brain and Cognitive Neuroscience Research Center, Liaoning Normal University, Dalian, 116029, China
| | - Duan-Wei Wang
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Qian-Hui Li
- Division of Gastroenterology, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518107, China
| | - Yuan-Yuan Yin
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Bin Li
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Hai-Rong Wang
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Ji Hu
- School of Life Science and Technology, ShanghaiTech University, Shanghai, 201210, China
| | - Yuan-Dong Gong
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
| | - Tian-Gui Yu
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China.
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Mirza S, Lima CNC, Del Favero-Campbell A, Rubinstein A, Topolski N, Cabrera-Mendoza B, Kovács EHC, Blumberg HP, Richards JG, Williams AJ, Wemmie JA, Magnotta VA, Fiedorowicz JG, Gaine ME, Walss-Bass C, Quevedo J, Soares JC, Fries GR. Blood epigenome-wide association studies of suicide attempt in adults with bipolar disorder. Transl Psychiatry 2024; 14:70. [PMID: 38296944 PMCID: PMC10831084 DOI: 10.1038/s41398-024-02760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Suicide attempt (SA) risk is elevated in individuals with bipolar disorder (BD), and DNA methylation patterns may serve as possible biomarkers of SA. We conducted epigenome-wide association studies (EWAS) of blood DNA methylation associated with BD and SA. DNA methylation was measured at >700,000 positions in a discovery cohort of n = 84 adults with BD with a history of SA (BD/SA), n = 79 adults with BD without history of SA (BD/non-SA), and n = 76 non-psychiatric controls (CON). EWAS revealed six differentially methylated positions (DMPs) and seven differentially methylated regions (DMRs) between BD/SA and BD/non-SA, with multiple immune-related genes implicated. There were no epigenome-wide significant differences when BD/SA and BD/non-SA were each compared to CON, and patterns suggested that epigenetics differentiating BD/SA from BD/non-SA do not differentiate BD/non-SA from CON. Weighted gene co-methylation network analysis and trait enrichment analysis of the BD/SA vs. BD/non-SA contrast further corroborated immune system involvement, while gene ontology analysis implicated calcium signalling. In an independent replication cohort of n = 48 BD/SA and n = 47 BD/non-SA, fold changes at the discovery cohort's significant sites showed moderate correlation across cohorts and agreement on direction. In both cohorts, classification accuracy for SA history among individuals with BD was highest when methylation at the significant CpG sites as well as information from clinical interviews were combined, with an AUC of 88.8% (CI = 83.8-93.8%) and 82.1% (CI = 73.6-90.5%) for the combined epigenetic-clinical classifier in the discovery and replication cohorts, respectively. Our results provide novel insight to the role of immune system functioning in SA and BD and also suggest that integrating information from multiple levels of analysis holds promise to improve risk assessment for SA in adults with BD.
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Affiliation(s)
- Salahudeen Mirza
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Institute of Child Development, University of Minnesota, 55455, Minneapolis, MN, USA
- Department of Psychiatry, Yale School of Medicine, 06510, New Haven, CT, USA
| | - Camila N C Lima
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
| | - Alexandra Del Favero-Campbell
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
| | - Alexandre Rubinstein
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
| | - Natasha Topolski
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | | | - Emese H C Kovács
- Department of Neuroscience and Pharmacology, The University of Iowa, 51 Newton Rd, 52242, Iowa City, IA, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 06510, New Haven, CT, USA
| | - Jenny Gringer Richards
- Department of Radiology, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Aislinn J Williams
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
| | - John A Wemmie
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
- Department of Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Vincent A Magnotta
- Department of Radiology, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Jess G Fiedorowicz
- University of Ottawa Brain and Mind Research Institute, Ottawa Hospital Research Institute, 501 Smyth, K1H 8L6, Ottawa, ON, Canada
| | - Marie E Gaine
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
- Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, 180 South Grand Ave, 52242, Iowa City, IA, USA
| | - Consuelo Walss-Bass
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
- Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, 1941 East Rd, 77054, Houston, TX, USA
| | - Jair C Soares
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
| | - Gabriel R Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA.
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA.
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA.
- Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, 1941 East Rd, 77054, Houston, TX, USA.
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Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M. Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA 2023; 330:1370-1380. [PMID: 37815563 DOI: 10.1001/jama.2023.18588] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Importance Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide. Observations Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide. Conclusions and Relevance Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.
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Affiliation(s)
- Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Bruno Agustini
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ole Köhler-Forsberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Department for Affective Disorder, Aarhus University Hospital, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cristina Cusin
- Harvard Medical School, Boston, Massachusetts
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Douglas Katz
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Louisa G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Amy Peters
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Simjanoski M, de Azevedo Cardoso T, Frey BN, Minuzzi L, De Boni RB, Balanzá-Martínez V, Kapczinski F. Lifestyle in bipolar disorder: A cross-sectional study. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:244-250. [PMID: 37839960 DOI: 10.1016/j.rpsm.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Modifiable lifestyle behaviors are important factors for improving mental health, yet there has been a lack of research studying lifestyle as a multidimensional construct in bipolar disorder (BD). The aim of this cross-sectional study was to compare the lifestyle patterns of individuals with BD in a current mood episode with healthy controls (HCs) using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE). MATERIALS AND METHODS The sample consisted of 46 individuals with BD currently experiencing a depressive or manic episode and 50 HC, assessed using the MINI International Neuropsychiatric Interview, Montgomery-Åsberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). The SMILE scale assesses lifestyle across seven domains: diet and nutrition, substance abuse, physical activity, stress management, restorative sleep, social support, and environmental exposures. Between-groups comparisons were performed based on the presence of a psychiatric diagnosis and the type of BD episode. RESULTS We found significant differences in the total SMILE score (r=0.75, p<0.001) and in scores from each domain of the scale between BD and HC (p<0.05), where individuals with BD in a depressive or manic episode with or without mixed features reported worse lifestyle across all domains. Differences between individuals with BD in different mood episodes across domains on the SMILE scale were non-significant. CONCLUSION Findings from this study highlight the presence of unhealthy lifestyle patterns in people with BD regardless of the polarity of their mood episode. Implementation of multidimensional lifestyle assessments is an essential step toward detecting the clustering of unhealthy lifestyle patterns in BD.
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Affiliation(s)
- Mario Simjanoski
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada.
| | - Taiane de Azevedo Cardoso
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Women's Health Concerns Clinic and Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Women's Health Concerns Clinic and Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, Canada
| | - Raquel B De Boni
- Institute of Scientific and Technological Communication and Information in Health (ICICT), Oswaldo Cruz Foundation (FIOCRUZ), 4365 Manguinhos, Rio de Janeiro, Brazil
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Av. de Blasco Ibáñez, 13, Valencia, Spain
| | - Flavio Kapczinski
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Paulo Gama, 110, Porto Alegre, Brazil
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9
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Li W, Lei D, Tallman MJ, Welge JA, Blom TJ, Fleck DE, Klein CC, Adler CM, Patino LR, Strawn JR, Gong Q, Sweeney JA, DelBello MP. Morphological abnormalities in youth with bipolar disorder and their relationship to clinical characteristics. J Affect Disord 2023; 338:312-320. [PMID: 37301295 PMCID: PMC10527418 DOI: 10.1016/j.jad.2023.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/24/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To characterize the neuroanatomy of BD in youth and its correlation to clinical characteristics. METHODS The current study includes a sample of 105 unmedicated youth with first-episode BD, aged between 10.1 and 17.9 years, and 61 healthy comparison adolescents, aged between 10.1 and 17.7 years, who were matched for age, race, sex, socioeconomic status, intelligence quotient (IQ), and education level. T1-weighted magnetic resonance imaging (MRI) images were obtained using a 4 T MRI scanner. Freesurfer (V6.0) was used to preprocess and parcellate the structural data, and 68 cortical and 12 subcortical regions were considered for statistical comparisons. The relationship between morphological deficits and clinical and demographic characteristics were evaluated using linear models. RESULTS Compared with healthy youth, youth with BD had decreased cortical thickness in frontal, parietal, and anterior cingulate regions. These youth also showed decreased gray matter volumes in 6 of the 12 subcortical regions examined including thalamus, putamen, amygdala and caudate. In further subgroup analyses, we found that youth with BD with comorbid attention-deficit hyperactivity disorder (ADHD) or with psychotic symptoms had more significant deficits in subcortical gray matter volume. LIMITATIONS We cannot provide information about the course of structural changes and impact of treatment and illness progression. CONCLUSIONS Our findings indicate that youth with BD have significant neurostructural deficits in both cortical and subcortical regions mainly located in the regions related to emotion processing and regulation. Variability in clinical characteristics and comorbidities may contribute to the severity of anatomic alterations in this disorder.
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Affiliation(s)
- Wenbin Li
- Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu 610000, Sichuan, PR China; Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, PR China
| | - Du Lei
- College of Medical Informatics, Chongqing Medical University, Chongqing 400016, PR China.
| | - Maxwell J Tallman
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Jeffrey A Welge
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Thomas J Blom
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Christina C Klein
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Caleb M Adler
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - L Rodrigo Patino
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Qiyong Gong
- Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu 610000, Sichuan, PR China.
| | - John A Sweeney
- Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu 610000, Sichuan, PR China; Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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10
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Pozzolo Pedro MO, Pozzolo Pedro M, Martins SS, Castaldelli-Maia JM. Alcohol use disorders in patients with bipolar disorder: a systematic review and meta-analysis. Int Rev Psychiatry 2023; 35:450-460. [PMID: 38299650 DOI: 10.1080/09540261.2023.2249548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/14/2023] [Indexed: 02/02/2024]
Abstract
Alcohol consumption has a key role in more than 200 diseases and health injuries, being an important factor for social and public health costs. Studies with clinical populations show an association between alcohol use disorders (AUD) and bipolar disorder. In this meta-analysis we included studies, reports, or summaries identified in Google Scholar, Lilacs, Medline, and MedCaribe that reported original data published up to 31 January 2023. We included cross-sectional and longitudinal observational studies that investigated the prevalence of AUD in patients with bipolar disorder. We calculated the prevalence rates and conducted a meta-analysis using a random effects model. The meta-analysis included 20 unique studies conducted in 12 countries, with a total sample of 32,886 individuals with bipolar disorder, comprising 17,923 women and 13,963 men, all aged 18 years or older. The prevalence of AUD in individuals with bipolar disorder was found to be 29.12%, while the prevalence of Alcohol Dependence (AD) was 15.87% and the prevalence of Alcohol Abuse (AA) was 18.74%. The high prevalence of AUD individuals with bipolar disorder is important because it highlights the need for targeted interventions to prevent and address comorbid conditions, which may improve treatment outcomes, reduce harm, and promote public health.
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Affiliation(s)
| | | | - Silvia S Martins
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - João Maurício Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
- Department of Neuroscience, Medical School, ABC Health University Center, Santo André, Brazil
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11
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Mirza S, de Carvalho Lima CN, Del Favero-Campbell A, Rubinstein A, Topolski N, Cabrera-Mendoza B, Kovács EH, Blumberg HP, Richards JG, Williams AJ, Wemmie JA, Magnotta VA, Fiedorowicz JG, Gaine ME, Walss-Bass C, Quevedo J, Soares JC, Fries GR. Blood epigenome-wide association studies of suicide attempt in adults with bipolar disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.20.23292968. [PMID: 37546994 PMCID: PMC10402220 DOI: 10.1101/2023.07.20.23292968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Suicide attempt (SA) risk is elevated in individuals with bipolar disorder (BD), and DNA methylation patterns may serve as possible biomarkers of SA. We conducted epigenome-wide association studies (EWAS) of blood DNA methylation associated with BD and SA. DNA methylation was measured at > 700,000 positions in a discovery cohort of n = 84 adults with BD with a history of SA (BD/SA), n = 79 adults with BD without history of SA (BD/non-SA), and n = 76 non-psychiatric controls (CON). EWAS revealed six differentially methylated positions (DMPs) and seven differentially methylated regions (DMRs) between BD/SA and BD/non-SA, with multiple immune-related genes implicated. There were no epigenome-wide significant differences when BD/SA and BD/non-SA were each compared to CON, and patterns suggested that epigenetics differentiating BD/SA from BD/non-SA do not differentiate BD/non-SA from CON. Weighted gene co-methylation network analysis and trait enrichment analysis of the BD/SA vs. BD/non-SA contrast further corroborated immune system involvement, while gene ontology analysis implicated calcium signalling. In an independent replication cohort of n = 48 BD/SA and n = 47 BD/non-SA, fold-changes at the discovery cohort's significant sites showed moderate correlation across cohorts and agreement on direction. In both cohorts, classification accuracy for SA history among individuals with BD was highest when methylation at the significant CpG sites as well as information from clinical interviews were combined, with an AUC of 88.8% (CI = 83.8-93.8%) and 82.1% (CI = 73.6-90.5%) for the combined epigenetic-clinical predictor in the discovery and replication cohorts, respectively. Our results provide novel insight to the role of immune system functioning in SA and BD and also suggest that integrating information from multiple levels of analysis holds promise to improve risk assessment for SA in adults with BD.
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Affiliation(s)
- Salahudeen Mirza
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Institute of Child Development, University of Minnesota, 55455 Minneapolis, Minnesota, USA
| | - Camila N. de Carvalho Lima
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
| | - Alexandra Del Favero-Campbell
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
| | - Alexandre Rubinstein
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
| | - Natasha Topolski
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
| | | | - Emese H.C. Kovács
- Department of Neuroscience and Pharmacology, The University of Iowa, 51 Newton Rd, 52242 Iowa City, Iowa, USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, 06510 New Haven, Connecticut, USA
| | - Jenny Gringer Richards
- Department of Radiology, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
| | - Aislinn J. Williams
- Department of Psychiatry, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
- Iowa Neuroscience Institute, The University of Iowa. 169 Newton Rd, 52242 Iowa City, Iowa USA
| | - John A. Wemmie
- Department of Psychiatry, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
- Iowa Neuroscience Institute, The University of Iowa. 169 Newton Rd, 52242 Iowa City, Iowa USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - Vincent A. Magnotta
- Department of Radiology, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
- Department of Psychiatry, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
| | - Jess G. Fiedorowicz
- University of Ottawa Brain and Mind Research Institute, Ottawa Hospital Research Institute. 501 Smyth, K1H 8L6, Ottawa, Ontario, Canada
| | - Marie E. Gaine
- Iowa Neuroscience Institute, The University of Iowa. 169 Newton Rd, 52242 Iowa City, Iowa USA
- Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, 180 South Grand Ave, 52242, Iowa City, Iowa, USA
| | - Consuelo Walss-Bass
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, Texas, USA
| | - Jair C. Soares
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, Texas, USA
| | - Gabriel R. Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, Texas, USA
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12
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Muhammad N, Talpur S, Sangroula N, Washdave F. Independent Predictors of 30-Day Readmission to Acute Psychiatric Wards in Patients With Mental Disorders: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e42490. [PMID: 37637588 PMCID: PMC10453981 DOI: 10.7759/cureus.42490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Psychiatric readmissions have long been considered significant indicators for healthcare planning. The aim of this study was to identify factors influencing early (30-day) readmissions to acute psychiatric wards. A meta-analysis and systematic review were conducted according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Comprehensive database searching was conducted using online databases, including PubMed and Google Scholar, to search for articles identifying factors associated with early (30-day) readmissions to acute psychiatric wards. Keywords used to search for relevant articles included "Mental illness," "readmission," and factors along with their synonyms and Medical Subject Headings (MeSH) terms. The search included studies published between 2011 and June 2023. A total of 13 studies were included in this meta-analysis. The pooled rate of the 30-day readmission was 16% (95% confidence interval: 13%-20%). A pooled analysis showed that factors significantly associated with an unplanned hospital readmission included gender, length of stay, and insurance status as predictors of the unplanned hospital readmission among individuals with psychiatric illness. Additionally, we also found that the rate of 30-day unplanned admissions was greater in patients with schizophrenia, followed by personality disorder, bipolar disorder, depression, and substance use. This study highlights the importance of providing targeted interventions and support for individuals with these conditions to reduce the risk of readmissions.
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Affiliation(s)
- Nazar Muhammad
- Psychiatry, Cornerstone Family Healthcare, Binghamton, USA
| | - Saifullah Talpur
- Psychiatry, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Fnu Washdave
- Psychiatry, Children's Home of Wyoming Conference, Binghamton, USA
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13
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Forthmann B, Kaczykowski K, Benedek M, Holling H. The Manic Idea Creator? A Review and Meta-Analysis of the Relationship between Bipolar Disorder and Creative Cognitive Potential. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6264. [PMID: 37444111 PMCID: PMC10341485 DOI: 10.3390/ijerph20136264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Even though a relationship between psychopathology and creativity has been postulated since the time of ancient Greece, systematic meta-analyses on this topic are still scarce. Thus, the meta-analysis described here can be considered the first to date that specifically focuses on the relationship between creative potential, as measured by divergent thinking, and bipolar disorder, as opposed to psychopathology in general. An extensive literature search of 4670 screened hits identified 13 suitable studies, including a total of 42 effect sizes and 1857 participants. The random-effects model showed an overall significant, positive, yet diminutively small effect (d = 0.11, 95% CI: [0.002, 0.209], p = 0.045) between divergent thinking and bipolar disorder. A handful of moderators were examined, which revealed a significant moderating effect for bipolar status, as either euthymic (d = 0.14, p = 0.043), subclinical (d = 0.17, p = 0.001), manic (d = 0.25, p = 0.097), or depressed (d = -0.51, p < 0.001). However, moderator analyses should be treated with caution because of the observed confounding of moderators. Finally, none of the employed methods for publication-bias detection revealed any evidence for publication bias. We discuss further results, especially regarding the differences between subclinical and clinical samples.
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Affiliation(s)
- Boris Forthmann
- Institute of Psychology, University of Münster, 48149 Münster, Germany
| | - Karin Kaczykowski
- Institute of Psychology, University of Münster, 48149 Münster, Germany
| | - Mathias Benedek
- Institute of Psychology, University of Graz, 8010 Graz, Austria
| | - Heinz Holling
- Institute of Psychology, University of Münster, 48149 Münster, Germany
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14
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Flaudias V, Samalin L, Godin O, Gard S, Brousse G, Loftus J, Aubin V, Belzeaux R, Dubertret C, Le Strat Y, Mazer N, de Prémorel A, Roux P, Polosan M, Schwitzer T, Aouizerate B, Llorca PM, Biseul I, Etain B, Moirand R, Olié E, Haffen E, Leboyer M, Courtet P, Icick R, Guillaume S. Crossed clinical features between eating disorders and types of bipolar disorder: Results from the FondaMental Advanced Centers of Expertise - Bipolar Disorder cohort. J Affect Disord 2023; 335:177-185. [PMID: 37178826 DOI: 10.1016/j.jad.2023.05.017] [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: 10/19/2022] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Eating disorders (EDs) are liable to alter the disease course of bipolar disorder (BD). We explored the crossed clinical features between EDs and BD, particularly as a function of BD type (BD1 vs. BD2). METHODS 2929 outpatients attending FondaMental Advanced Centers of Expertise were assessed for BD and lifetime EDs with a semi-structured interview, and their sociodemographic, dimensional and clinical data were collected according to a standardized procedure. For each ED type, bivariate analyses were used to investigate associations between these variables and the type of BD type followed by multinomial regressions with the variables associated with EDs and BDs after Bonferroni correction. RESULTS Comorbid EDs were diagnosed in 478 (16.4 %) cases, and were more prevalent in patients with BD2 than in those with BD1 (20.6 % vs. 12.4 %, p < 0.001). Regression models showed no difference according to the subtype of bipolar disorder on the characteristics of patients with anorexia nervosa (AN), bulimia nervosa (BN) or binge eating disorder (BED). After multiple adjustments, the factors differentiating BD patients with versus without ED were primarily age, gender, body mass index, more affective lability and comorbidity with anxiety disorders. BD patients with BED also scored higher regarding childhood trauma. BD patients with AN also showed higher risk of past suicide attempts than those with BED. CONCLUSIONS In a large sample of patients with BD, we found a high prevalence of lifetime EDs, especially for the BD2 type. EDs were associated with several severity indicators, but not with BD type-specific characteristics. This should prompt clinicians to carefully screen patients with BD for EDs, regardless of BD and ED types.
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Affiliation(s)
- Valentin Flaudias
- Nantes Université, Univ Angers, Laboratoire de psychologie des Pays de la Loire, LPPL, UR 4638, Nantes, France; CHU Clermont-Ferrand, Department of Psychiatry, Clermont-Ferrand, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France.
| | - Ludovic Samalin
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | | | - Sébastien Gard
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie Générale et Universitaire, Center Hospitalier Charles Perrens, France NutriNeuro, INRAE UMR 1286, University of Bordeaux, Bordeaux F-33076, France
| | - Georges Brousse
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Joséphine Loftus
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Center Hospitalier Princesse Grace, Monaco
| | - Valérie Aubin
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Center Hospitalier Princesse Grace, Monaco
| | - Raoul Belzeaux
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Caroline Dubertret
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Yann Le Strat
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Nicolas Mazer
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Alix de Prémorel
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Paul Roux
- FondaMental Foundation, Créteil F-94000, France; Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - Mircea Polosan
- FondaMental Foundation, Créteil F-94000, France; Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France
| | - Thomas Schwitzer
- FondaMental Foundation, Créteil F-94000, France; Université de Lorraine, Inserm U 1254, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie CPN, Laxou, France
| | - Bruno Aouizerate
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie Générale et Universitaire, Center Hospitalier Charles Perrens, France NutriNeuro, INRAE UMR 1286, University of Bordeaux, Bordeaux F-33076, France
| | - Pierre-Michel Llorca
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Isabelle Biseul
- FondaMental Foundation, Créteil F-94000, France; AP-HP.Nord, Groupe Hospitalo-universitaire Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris F-75010, France
| | - Bruno Etain
- FondaMental Foundation, Créteil F-94000, France; AP-HP.Nord, Groupe Hospitalo-universitaire Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris F-75010, France; INSERM UMRS 1144, Université de Paris Cité, Paris F-75006, France
| | - Remi Moirand
- FondaMental Foundation, Créteil F-94000, France; INSERM U1028, CNRS UMR5292, University Lyon 1, Villeurbanne F-69000, France; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, F-69678, France
| | - Emilie Olié
- FondaMental Foundation, Créteil F-94000, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France; Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Emmanuel Haffen
- Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Recherche Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, Besançon, France
| | - Marion Leboyer
- FondaMental Foundation, Créteil F-94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Université Paris Est Créteil, INSERM U955, F-94010, France
| | - Philippe Courtet
- FondaMental Foundation, Créteil F-94000, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France
| | - Romain Icick
- FondaMental Foundation, Créteil F-94000, France; AP-HP.Nord, Groupe Hospitalo-universitaire Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris F-75010, France; INSERM UMRS 1144, Université de Paris Cité, Paris F-75006, France
| | - Sébastien Guillaume
- FondaMental Foundation, Créteil F-94000, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France; Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
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Miola A, Alvarez-Villalobos NA, Ruiz-Hernandez FG, De Filippis E, Veldic M, Prieto ML, Singh B, Sanchez Ruiz JA, Nunez NA, Resendez MG, Romo-Nava F, McElroy SL, Ozerdem A, Biernacka JM, Frye MA, Cuellar-Barboza AB. Insulin resistance in bipolar disorder: A systematic review of illness course and clinical correlates. J Affect Disord 2023; 334:1-11. [PMID: 37086806 DOI: 10.1016/j.jad.2023.04.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Although insulin resistance (IR) and cardiometabolic syndrome are prevalent in patients with bipolar disorder (BD), only a few studies have attempted to precisely assess the degree and clinical impact of IR in BD. METHODS A comprehensive search was conducted from multiple research databases through May 2022, following a pre-defined protocol (PROSPERO: CRD42022359259). We extracted neuroimaging, cognition, illness course, and treatment response findings from individuals with BD with evidence of IR compared with euglycemic BD individuals. RESULTS Of 1436 identified articles, 10 reports fulfilling inclusion criteria were included (n = 1183). BD patients with IR displayed worse composite verbal memory scores and worse executive function and exhibited smaller hippocampal volumes along with prefrontal neurochemical alterations compared to euglycemic BD patients. Fixed-effect meta-analysis revealed that BD patients with impaired glucose metabolism (IGM) were more likely to develop a chronic and rapid cycling course when compared with euglycemic BD patients (k = 2, OR = 2.96, 95 % CI 1.69-5.17, OR = 2.88, 95 % CI 1.59-5.21, p < 0.001, respectively), with a trend for significantly lower Global Assessment of Functioning scores (k = 5, MD = -4, 95 % CI -8.23-0.23, p = 0.06). BD patients with IGM displayed a higher rate of poor response to mood stabilizers when compared with euglycemic BD patients (k = 2, OR = 6.74, 95 % CI 1.04-43.54, p = 0.04). LIMITATIONS Cross-sectional design and small sample sizes of studies included limit the generalizability of results. CONCLUSION IR is associated with worse clinical outcomes of BD and inadequate treatment response. Implementing strategies to prevent and treat IR in BD is crucial to improve the prognosis of such a difficult-to-treat population.
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Affiliation(s)
- Alessandro Miola
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Neri A Alvarez-Villalobos
- Department of Human Anatomy, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | | | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Miguel L Prieto
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Facultad de Medicina, Universidad de los Andes, Santiago, Chile; Mental Health Service,, Clínica Universidad de los Andes, Santiago, Chile; Center for Biomedical Research and Innovation, Universidad de los Andes, Santiago, Chile
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Manuel Gardea Resendez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Joanna M Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Alfredo B Cuellar-Barboza
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
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16
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Johnson DE, McIntyre RS, Mansur RB, Rosenblat JD. An update on potential pharmacotherapies for cognitive impairment in bipolar disorder. Expert Opin Pharmacother 2023; 24:641-654. [PMID: 36946229 DOI: 10.1080/14656566.2023.2194488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cognitive impairment is a core feature of bipolar disorder (BD) that impedes recovery by preventing the return to optimal socio-occupational functioning and reducing quality of life. Presently, there are no efficacious treatments for cognitive impairment in BD, but many pharmacological interventions are being considered as they have the potential to target the underlying pathophysiology of the disorder. AREAS COVERED This review summarizes the available evidence for pharmacological interventions for cognitive impairment in bipolar disorder. We searched PubMed, MedLine, and PsycInfo from inception to December 1st, 2022. Traditional treatments, such as lithium, anticonvulsants (lamotrigine), antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, and olanzapine), antidepressants (vortioxetine, fluoxetine, and tianeptine) and psychostimulants (modafinil), and emerging interventions, such as acetylcholinesterase inhibitors (galantamine and donepezil), dopamine agonists (pramipexole), erythropoietin, glucocorticoid receptor antagonists (mifepristone), immune modulators (infliximab, minocycline and doxycycline), ketamine, metabolic agents (insulin, metformin, and liraglutide), probiotic supplements, and Withania somnifera are discussed. EXPERT OPINION The investigation of interventions for cognitive impairment in BD is a relatively under-researched area. In the past, methodological pitfalls in BD cognition trials have also been a critical limiting factor. Expanding on the existing literature and identifying novel pharmacological and non-pharmacological treatments for cognitive impairment in BD should be a priority.
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Affiliation(s)
- Danica E Johnson
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Institute of Medical Science, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry and Pharmacology, University of Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
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17
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El Sayed S, Gomaa S, Al Hazmi A, Sonbol H, ElKalla I. Role of DSM5 anxious distress specifier interview in acute manic episode: sociodemographic characteristics, clinical presentation and quality of life. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Abstract
Background
DSM 5 anxious distress specifier is one of the newly added specifiers for bipolar and related disorders. It may have impacts on the symptoms severity, insight, impulsivity, and different domains of quality of life of acute manic episodes of bipolar disorders. The current study aimed to study the effects of DSM 5 anxious distress specifier in acute manic episodes and its relation to sociodemographic data, clinical characteristics, and quality of life. 380 patients with the diagnosis of acute manic episode were recruited in the study, sociodemographic data, clinical features, DSM 5 anxious distress specifier interview, attitude and insight of the disorder, impulsivity and different aspects of quality of life were also evaluated in those patients.
Results
The studied patients were divided into 2 subgroups according to the presence of high DSM5 anxious distress specifier interview score. The duration of a manic episode (P < 0.001), the severity of the manic episode (P < 0.001), and the presence of psychotic features (P = 0.002) were more common in the subgroup with high DSM 5 anxious distress. DSM 5 anxious distress specifier was severe (P < 0.001) and more frequent (P < 0.001) in the 1st subgroup than the 2nd one. There was a statistically significant difference regarding the attentional facet of the Barratt impulsiveness scale between the studied groups (P = 0.002). In addition, there was a statistically significant difference regarding the mean score (P < 0.001) and severe impairment (P < 0.001) domains of work and social adjustment scale between the 2 subgroups.
Conclusions
DSM 5 anxious distress specifier interview is a very crucial parameter of evaluation the patients with acute manic episodes which may have implications on the clinical presentations, symptoms severity, impulsivity, and variable aspects of quality of life in those patients. All these implications might change the course, prognosis, and outcomes of an acute manic episode of bipolar disorder.
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18
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Grewal S, McKinlay S, Kapczinski F, Pfaffenseller B, Wollenhaupt-Aguiar B. Biomarkers of neuroprogression and late staging in bipolar disorder:
A systematic review. Aust N Z J Psychiatry 2023; 57:328-343. [PMID: 35403455 PMCID: PMC9950598 DOI: 10.1177/00048674221091731] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bipolar disorder may undertake a progressive course in a subset of patients, and research efforts have been made to understand the biological basis underlying this process. This systematic review examined the literature available on biological markers associated with illness progression in bipolar disorder. METHODS Peer-reviewed articles were assessed using Embase, PsycINFO and PubMed, as well as from external sources. After initial screening, a total of 871 citations from databases and other sources were identified. Participants with a diagnosis of bipolar disorder were included in our systematic review; however, studies with participants younger than 15 or older than 65 were excluded. All studies were assessed using the Newcastle-Ottawa Scale assessment tool, and data pertaining to the results were extracted into tabular form using Google Sheets and Google Documents. The systematic review was registered on PROSPERO international prospective register of systematic reviews (ID Number: CRD42020154305). RESULTS A total of 35 studies were included in the systematic review. Increased ventricular size and reduction of grey matter volume were the most common brain changes associated with illness progression in bipolar disorder. Among the several biomarkers evaluated in this systematic review, findings also indicate a role of peripheral inflammatory markers in this process. DISCUSSION The studies evaluating the biological basis of the illness progression in bipolar disorder are still scarce and heterogeneous. However, current evidence supports the notion of neuroprogression, the pathophysiological process related to progressive brain changes associated with clinical progression in patients with bipolar disorder. The increase in peripheral inflammatory biomarkers and the neuroanatomical changes in bipolar disorder suggest progressive systemic and structural brain alterations, respectively.
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Affiliation(s)
- Sonya Grewal
- Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stuart McKinlay
- Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Flávio Kapczinski
- Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,Mood Disorders Program, St. Joseph’s
Healthcare Hamilton, Hamilton, ON, Canada,Instituto Nacional de Ciência e
Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil,Department of Psychiatry, Universidade
Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Bianca Pfaffenseller
- Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,Mood Disorders Program, St. Joseph’s
Healthcare Hamilton, Hamilton, ON, Canada
| | - Bianca Wollenhaupt-Aguiar
- Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,Mood Disorders Program, St. Joseph’s
Healthcare Hamilton, Hamilton, ON, Canada,Bianca Wollenhaupt de Aguiar, Department of
Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th
Street, Suite G116, Hamilton, ON L8N 3K7, Canada.
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19
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Cardiometabolic and endocrine comorbidities in women with bipolar disorder: A systematic review. J Affect Disord 2023; 323:841-859. [PMID: 36538952 DOI: 10.1016/j.jad.2022.12.023] [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: 09/09/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bipolar Disorder (BD) is known to be equally distributed among males and females. The well-documented increased risk of medical comorbidities in patients with BD, in comparison to BD patients without medical comorbidities, shows a negative impact on the course of illness. There is some evidence suggesting that women with BD have higher psychiatric and medical comorbidities in comparison to men with BD, however there is no evidence in comparison to women without BD or other major psychiatric illness. These comorbidities, along with various psychosocial factors, are known to affect the course of BD. METHODS We aimed to systematically review the literature on cardiovascular, metabolic and endocrine comorbidities in women with BD in comparison to men with BD and control women. A comprehensive search of electronic databases including PubMed, PsycINFO, Embase, and SCOPUS was conducted, and a total of 61 identified studies were included in this review. RESULTS Women with BD had higher rates of cardiovascular risk factors/mortality, diabetes mellitus II and thyroid disorders compared to women in the general population. In comparison to men with BD, women with BD had comparable cardiovascular risk but higher prevalence of metabolic and thyroid disorders. LIMITATIONS Gender specific data was limited in multiple studies. CONCLUSIONS Results present a need for gender-specific screening and interventions for various medical comorbidities in patients with BD.
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20
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Impact of Preexisting Alcohol Use Disorder, Bipolar Disorder, and Schizophrenia on Ischemic Stroke Risk and Severity: A Lebanese Case-Control Study. Healthcare (Basel) 2023; 11:healthcare11040538. [PMID: 36833072 PMCID: PMC9957385 DOI: 10.3390/healthcare11040538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Stroke remains a major leading cause of morbidity and death globally. For ischemic stroke, the most frequent type of stroke, there are numerous risk models and risk assessments offered. Further research into potential risk factors or triggers is being sought to improve stroke risk models. Schizophrenia, bipolar disorder, and alcohol use disorder are all common causes of serious mental illnesses in the general population. Due to the tangled relationship between stroke and many chronic illnesses, lifestyle factors, and diet that may be present in a patient with a mental disease, the relationship between mental diseases and stroke requires further validation. Consequently, the purpose of this study is to assess the potential influence of bipolar disorder, schizophrenia, and alcohol use disorder on stroke patients as compared to non-stroke participants, after controlling for demographic, physical, and medical conditions. We aimed, as a secondary objective, to evaluate the impact of these pre-existing disorders on stroke severity levels. METHODS This research is a case-control survey study involving 113 Lebanese patients with a clinical diagnosis of ischemic stroke and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from several hospitals in Lebanon (April 2020-April 2021). Based on the participant's consent, data was collected by filling out an anonymous paper-based questionnaire. RESULTS All of the odds ratios (ORs) generated by our regression model were greater than 1, indicating that the factors studied were associated with an increased risk of ischemic stroke. As such having schizophrenia (adjusted OR [aOR]: 6.162, 95% confidence interval [CI]: 1.136-33.423), bipolar disorder (aOR: 4.653, 95% CI: 1.214-17.834), alcohol use disorder (aOR: 3.918, 95% CI: 1.584-9.689), atrial fibrillation (aOR: 2.415, 95% CI: 1.235-4.721), diabetes (aOR: 1.865, 95% CI: 1.117-3.115), heart diseases (aOR: 9.890, 95% CI: 5.099-19.184), and asthma-COPD (aOR: 1.971, 95% CI: 1.190-3.263) were all involved with a high risk of developing an ischemic stroke. Moreover, obesity (aOR: 1.732, 95% CI: 1.049-2.861) and vigorous physical activity (aOR: 4.614, 95% CI: 2.669-7.978) were also linked to an increased risk of stroke. Moreover, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke alcohol use disorder (aOR: 1.719, 95% CI: 1.385-2.133), bipolar disorder (aOR: 1.656, 95% CI: 1.281-2.141), and schizophrenia (aOR: 6.884, 95% CI: 3.294-11.492) compared to people who had never had a stroke. CONCLUSION The findings in our study suggest that individuals with schizophrenia, bipolar disorder, and alcohol use disorder may be at a higher risk for ischemic stroke and exhibit more severe symptoms. We believe that the first step toward creating beneficial preventative and treatment interventions is determining individuals with schizophrenia, bipolar disorder, or alcohol use disorder, assessing their risk of ischemic stroke, developing more integrated treatments, and closely monitoring the long-term outcome in the event of an ischemic stroke.
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21
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Léda-Rêgo G, Studart-Bottó P, Sarmento S, Cerqueira-Silva T, Bezerra-Filho S, Miranda-Scippa Â. Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01562-5. [PMID: 36725737 DOI: 10.1007/s00406-023-01562-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
The aim was to assess the lifetime prevalence of psychiatric comorbidity (PC) in Brazilian euthymic individuals with bipolar disorder type I, and investigate its effects on clinical outcomes and functioning. A group of 179 outpatients with BD-I in the recuperation phase were assessed, of whom 75 (41.9%) had PC and 104 (58.1%) had not. Both groups were compared using sociodemographic/clinical questionnaire, Structured Clinical Interview for DSM-IV axis I and II, Sheehan Disability and Barratt Impulsiveness Scales. Patients with PC presented less religious affiliation, more history of lifetime psychotic symptoms, rapid cycling, suicide attempts, worse scores of functioning, and higher prevalence of personality disorders. Ordinal logistic regression indicated that PC was associated with increased odds of worse levels of disability. Therefore, it could be observed that patients with BD evaluated only in euthymia presented a high mental disorders comorbidity. Considering their burdensome impact, appropriate management is a challenging reality and a crucial factor in reducing morbidity and mortality associated with BD. Further longitudinal studies on their relationship may broaden interventions to reduce patient's suffering.
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Affiliation(s)
- Gabriela Léda-Rêgo
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil. .,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil.
| | - Paula Studart-Bottó
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil
| | - Stella Sarmento
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil
| | | | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, BA, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil.,Department of Neurosciences and Mental Health, Medical School, UFBA, Salvador, BA, Brazil
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22
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Barksdale BR, Fonzo GA. Repetitive Transcranial Magnetic Stimulation in Bipolar Depression: Current Evidence and Future Perspectives. Psychiatr Ann 2023. [DOI: 10.3928/00485713-20230119-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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23
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Couillard Larocque M, Fortin-Vidah G, Angers M, Garceau L, Gros L, Fournel I, Provencher MD. Anxiety in bipolar disorder: A review of publication trends. J Affect Disord 2023; 320:340-347. [PMID: 36174785 DOI: 10.1016/j.jad.2022.09.057] [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: 04/11/2022] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although anxiety is highly prevalent in people with bipolar disorders and has deleterious impact on the course of the illness, past reviews have shown that many aspects of the topic remain under-researched. This scoping review aims to provide a comprehensive overview of the literature addressing anxiety in bipolar disorder (A-BD) between 2011 and 2020, assess if the interest in the topic has increased over the period and map the publication trends. METHODS Three databases were systematically searched, and all articles were screened at the title/abstract and full text level based on inclusion and exclusion criteria. Of these, 1099 articles were included in the study. The annual number of articles on A-BD published between 2011 and 2020 was calculated and articles addressing it as a primary topic (n = 310) were classified into 4 categories and 11 subcategories to identify gaps in the knowledge. RESULTS The results show no clear increase in the number of annual publications during the period and much of the available literature is of a descriptive nature. Less is known about the processes underlying the comorbidity and about treatment approaches. LIMITATIONS Given the large scope of the research question, no quality assessment of the evidence was made. Only articles in English or French were considered. CONCLUSIONS These results highlight the need to change the focus of research efforts to better understand and address this unique set of conditions in clinical settings.
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Sex-specific associations between lifetime diagnosis of bipolar disorder and cardiovascular disease: A cross-sectional analysis of 257,673 participants from the UK Biobank. J Affect Disord 2022; 319:663-669. [PMID: 36162675 DOI: 10.1016/j.jad.2022.09.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/10/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sex is seldom considered as a potential moderator of the impact of bipolar disorder (BD) on cardiovascular disease (CVD) risk. We aimed to characterize the sex-specific association of CVD and BD using data from the UK Biobank. METHODS In a cross-sectional analysis, we compared the odds ratio between women and men with BD for seven CVD diagnoses (coronary artery disease, myocardial infarction, angina, atrial fibrillation, heart failure, stroke, and essential hypertension) and four cardiovascular biomarkers (arterial stiffness index, low-density lipoprotein, C-reactive protein, and HbA1c) in 293 participants with BD and 257,380 psychiatrically healthy controls in the UK Biobank. RESULTS After adjusting for age, we found a two- to three-fold stronger association among women than among men between BD and rates of coronary artery disease, heart failure, and essential hypertension, with a significant sex-by-diagnosis interactions. The association remained significant after controlling for self-reported race, education, income, and smoking status. After controlling for potential confounders, there was no significant association between sex and any cardiovascular biomarkers. LIMITATIONS These analyses could not disentangle effects of BD from its treatment. CONCLUSIONS Our results underscore the importance of incorporating sex and mental illness in risk estimation tools for CVD, and improving screening for, and timely treatment of, CVD in those with BD. Future research is needed to better understand the contributors and mechanisms of sex differences related to CVD risk in BD.
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Everett J, Druyor K, Krasinski C, Obaid M, Li Y. Predictors of behavioral health unit readmission within 30 days of discharge: A retrospective study. Heliyon 2022; 8:e10784. [PMID: 36217492 PMCID: PMC9547231 DOI: 10.1016/j.heliyon.2022.e10784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/14/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Several studies have aimed to describe associated demographic and psychiatric risk factors that would lead to readmission to a behavioral health unit within 30 days of discharge. Here we considered 1,095 patients that were discharged from Millcreek Community Hospital (MCH) in Erie, Pennsylvania between June 2018 and June 2019. We extracted electronic medical data and analyzed various risk factors using a SPSS software and performed Chi square analysis to determine significance. We determined that patients between the age 30–39 that were diagnosed with major depressive disorder or bipolar disorder, and patients that had 12 or more previous behavioral health admissions were significantly more likely to be readmitted within 30 days of discharge. By analyzing risk factors that lead to a higher percentage of readmission rates, physicians can be more readily equipped and prepared while treating inpatient psychiatric patients. These physicians can take more precautionary measures when discharging patients with specific characteristic profiles to prevent the risk of being readmitted within 30 days of discharge.
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26
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Stuart AL, Pasco JA, Berk M, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Mohebbi M, Williams LJ. Falls in community-dwelling women with bipolar disorder: a case-control study. BMC Psychiatry 2022; 22:620. [PMID: 36127652 PMCID: PMC9487100 DOI: 10.1186/s12888-022-04258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common occurrence in psychiatric hospital settings, however population-based research among individuals with psychiatric disorders, in particular bipolar disorder (BD) is scant. Thus, we aimed to investigate falls risk in community-dwelling women diagnosed with BD. METHODS Women with BD (cases, n = 119) were recruited from health care settings located in southeast Victoria, Australia. Age-matched controls (n = 357, ratio 3:1) without BD were participants in the Geelong Osteoporosis Study drawn from the same geographical region. Lifetime history of BD was identified by semi-structured clinical interview (SCID-IV/NP). Previous 12-month falls data were obtained via questionnaire. Information on mobility, alcohol use, general health, medication use, blood pressure, body mass index, socioeconomic status and use of a walking aid was collected. Generalised Estimating Equations, binary and ordinal logistic regression were used to determine the odds ratio (OR) and 95% confidence interval (CI) for falls following adjustment for confounders. RESULTS During the 12-month period, 34 (28.6%, median age 48.4 yr) cases and 70 (19.6%, median age 49.1 yr) controls reported one fall; 22 (18.5%) cases and 18 (5.0%) controls reported ≥ two falls (p < 0.001). Cases had 2.5-fold increased odds of at least one fall and 2.9-fold increased likelihood of increasing falls categories (0 vs. 1 vs. 2 +), compared to controls [adjOR 2.5, 95%CI (1.8, 3.4), adjOR OR 2.9, 95%CI (2.0, 4.1)]. CONCLUSION Risk of falls was greater among women with BD. Balance training could be a research and clinical focus for falls prevention programs among women with bipolar disorder to prevent the detrimental outcomes associated with falling.
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Affiliation(s)
- Amanda L. Stuart
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia
| | - Julie A. Pasco
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.414257.10000 0004 0540 0062Barwon Health University Hospital, Geelong, Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine-Western Health, The University of Melbourne, St Albans, Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Berk
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Psychiatry, The University of Melbourne, Parkville, Australia ,grid.418025.a0000 0004 0606 5526Florey Institute of Neuroscience and Mental Health, Parkville, Australia ,grid.488501.00000 0004 8032 6923Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Shae E. Quirk
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XMental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Mohammadreza Mohebbi
- grid.1021.20000 0001 0526 7079Faculty of Health, Deakin University, Burwood, Australia
| | - Lana J. Williams
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia
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Qi X, Jia Y, Pan C, Li C, Wen Y, Hao J, Liu L, Cheng B, Cheng S, Yao Y, Zhang F. Index of multiple deprivation contributed to common psychiatric disorders: A systematic review and comprehensive analysis. Neurosci Biobehav Rev 2022; 140:104806. [PMID: 35926729 DOI: 10.1016/j.neubiorev.2022.104806] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/08/2022] [Accepted: 07/31/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Limited studies have been conducted to explore the interaction effects of social environmental and genetic factors on the risks of common psychiatric disorders. METHODS 56,613-106,695 individuals were collected from the UK Biobank cohort. Logistic or liner regression models were first used to evaluate the associations of index of multiple deprivation (IMD) with bipolar disorder (BD), depression and anxiety in UK Biobank cohort. Then, for the significant IMD associated with BD, depression and anxiety, genome-wide gene-environment interaction study (GWEIS) was performed by PLINK 2.0. RESULT Totally, the higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. For BD, GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167 for income and rs111841503 for education. For depression and anxiety, GWEIS found significant SNPs interacting with income and education, such as rs147013419 for income and rs142366753 for education. CONCLUSION Social environmental deprivations contributed to the risks of psychiatric disorders. Besides, we reported multiple candidate genetic loci interacting with IMD, providing novel insights into the biological mechanism.
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Affiliation(s)
- Xin Qi
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chuyu Pan
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chune Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jingcan Hao
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yao Yao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
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McInnis MG, Andreassen OA, Andreazza AC, Alon U, Berk M, Brister T, Burdick KE, Cui D, Frye M, Leboyer M, Mitchell PB, Merikangas K, Nierenberg AA, Nurnberger JI, Pham D, Vieta E, Yatham LN, Young AH. Strategies and foundations for scientific discovery in longitudinal studies of bipolar disorder. Bipolar Disord 2022; 24:499-508. [PMID: 35244317 PMCID: PMC9440950 DOI: 10.1111/bdi.13198] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Bipolar disorder (BD) is a complex and dynamic condition with a typical onset in late adolescence or early adulthood followed by an episodic course with intervening periods of subthreshold symptoms or euthymia. It is complicated by the accumulation of comorbid medical and psychiatric disorders. The etiology of BD remains unknown and no reliable biological markers have yet been identified. This is likely due to lack of comprehensive ontological framework and, most importantly, the fact that most studies have been based on small nonrepresentative clinical samples with cross-sectional designs. We propose to establish large, global longitudinal cohorts of BD studied consistently in a multidimensional and multidisciplinary manner to determine etiology and help improve treatment. Herein we propose collection of a broad range of data that reflect the heterogenic phenotypic manifestations of BD that include dimensional and categorical measures of mood, neurocognitive, personality, behavior, sleep and circadian, life-story, and outcomes domains. In combination with genetic and biological information such an approach promotes the integrating and harmonizing of data within and across current ontology systems while supporting a paradigm shift that will facilitate discovery and become the basis for novel hypotheses.
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Affiliation(s)
| | - Ole A. Andreassen
- NORMENT CentreUniversity of Oslo and Oslo University HospitalOsloNorway
| | - Ana C. Andreazza
- Department of Pharmacology & ToxicologyTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | | | - Michael Berk
- Deakin UniversityIMPACT – the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthGeelongAustralia
- OrygenThe National Centre of Excellence in Youth Mental HealthCentre for Youth Mental HealthFlorey Institute for Neuroscience and Mental Health and the Department of PsychiatryThe University of MelbourneMelbourneAustralia
| | - Teri Brister
- National Alliance on Mental IllnessArlingtonVirginiaUSA
| | | | - Donghong Cui
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghai Mental Health CenterShangaiChina
| | | | - Marion Leboyer
- Département de psychiatrieUniversité Paris Est Creteil (UPEC)AP‐HPHôpitaux Universitaires H. MondorDMU IMPACTINSERM, translational NeuropsychiatryFondation FondaMentalCreteilFrance
| | | | - Kathleen Merikangas
- Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | | | | | - Daniel Pham
- Milken InstituteCenter for Strategic PhilanthopyWashingtonDistrict of ColumbiaUSA
| | - Eduard Vieta
- Bipolar and Depressive disorders UnitHospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaCataloniaSpain
| | | | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College London & South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamKentUK
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Arvilommi P, Pallaskorpi S, Linnaranta O, Suominen K, Leppämäki S, Valtonen H, Isometsä E. Long-term work disability due to type I and II bipolar disorder: findings of a six-year prospective study. Int J Bipolar Disord 2022; 10:19. [PMID: 35811322 PMCID: PMC9271449 DOI: 10.1186/s40345-022-00264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/10/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, the prevalence and predictors of long-term work disability among patients with type I and II BD have scarcely been studied. We investigated the clinical predictors of long-term work disability among patients with BD. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (n = 191) of adult psychiatric in- and out-patients with DSM-IV type I and II BD in three Finnish cities. Within JoBS we examined the prevalence and predictors of disability pension being granted during a six-year follow-up of the 152 patients in the labor force at baseline and collected information on granted pensions from national registers. We determined the predictors of disability pension using logistic regression models. Results Over the 6 years, 44% of the patients belonging to the labor force at baseline were granted a disability pension. Older age; type I BD; comorbidity with generalized anxiety disorder, post-traumatic stress disorder or avoidant personality disorder; and duration of time with depressive or mixed symptoms predicted disability pensions. Including disability pensions granted before baseline increased their total prevalence to 55.5%. The observed predictors were similar. Conclusion This regionally representative long-term prospective study found that about half of patients with type I or II bipolar disorder suffer from persistent work disability that leads to disability pension. In addition to the severity of the clinical course and type I bipolar disorder, the longitudinal accumulation of time depressed, psychiatric comorbidity, and older age predicted pensioning. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00264-6.
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Affiliation(s)
- Petri Arvilommi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Pallaskorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Kirsi Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Valtonen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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30
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Sengupta G, Jena S. Psychiatric comorbidity and quality of life in patients with bipolar disorder. Ind Psychiatry J 2022; 31:318-324. [PMID: 36419713 PMCID: PMC9678181 DOI: 10.4103/ipj.ipj_24_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity in patients with bipolar disorder (BD) has been associated with an earlier onset, rapid cycling, worsening severity and outcome, and increased suicidality. Patients with BD have been reported to have poor quality of life (QOL) even during remission. AIMS AND OBJECTIVES Estimate the prevalence of psychiatric comorbidity and assess the QOL in patients with BD, and find the associated sociodemographic and clinical variables. MATERIALS AND METHODS This cross-sectional study was done in a general hospital psychiatric unit on 100 patients (both inpatients and outpatients) with DSM-IV-TR BD in partial or complete remission. Patients were assessed using a semi-structured pro forma, Mini International Neuropsychiatric Interview 6.0 - Hindi version, Hamilton Rating Scale for Depression or Young Mania Rating Scale and World Health Organization QOL instrument, short-form (WHOQOL-BREF), Hindi Version. RESULTS Sixty-one percent of the sample had at least one psychiatric comorbidity, and the commonest comorbid disorders were substance use disorders (SUD) (30%) and anxiety disorders (AD) (28%). Male gender was identified as a predictor for comorbidity in BD. The mean QOL-BREF score was 85.96 ± 14.35. Poor QOL was associated with older age at onset of comorbidity, multiple comorbidities, mixed episodes, rapid cycling, partial remission, and increased severity of depression while patients with current hypomanic symptoms were found to have better QOL. BD with comorbidity had worse QOL than those without comorbidity. CONCLUSION The majority of patients with BD had at least one comorbidity. SUD were the most common comorbid disorders. QOL, already poor in BD patients, was poorer in cases with comorbidity.
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Affiliation(s)
- Gunja Sengupta
- Department of Psychiatry, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Shivananda Jena
- Department of Psychiatry, Maulana Azad Medical College and GIPMER, New Delhi, India
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31
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van der Markt A, Klumpers UMH, Dols A, Boks MP, Vreeker A, Beekman ATF, Kupka RW. Clinical profiles of subsequent stages in bipolar disorder: Results from the Dutch Bipolar Cohort. Bipolar Disord 2022; 24:424-433. [PMID: 34821429 PMCID: PMC9542330 DOI: 10.1111/bdi.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The manifestation of bipolar disorder (BD) is hypothesized to be determined by clinical characteristics such as familial loading, childhood abuse, age at onset, illness duration, comorbid psychiatric disorders, addiction, treatment resistance, and premorbid cognitive functioning. Which of these are associated with a more severe course and worse outcome is currently unknown. Our objective is to find a combination of clinical characteristics associated with advancement to subsequent stages in two clinical staging models for BD. METHODS Using cross-sectional data from the Dutch Bipolar Cohort, staging was applied to determine the progression of bipolar-I-disorder (BD-I; N = 1396). Model A is primarily defined by recurrence of mood episodes, ranging from prodromal to chronicity. Model B is defined by level of inter-episodic functioning, ranging from prodromal to inability to function autonomously. For both models, ordinal logistic regression was conducted to test which clinical characteristics are associated with subsequent stages. RESULTS For model A, familial loading, childhood abuse, earlier onset, longer illness duration, psychiatric comorbidity, and treatment resistance were all predictors for a higher stage in contrast to addiction and cognitive functioning. For model B, childhood abuse, psychiatric comorbidity, cognitive functioning, and treatment resistance were predictors for a more severe stage, whereas age at onset, illness duration, and addiction were not. DISCUSSION/CONCLUSIONS Differences in clinical characteristics across stages support the construct validity of both staging models. Characteristics associated with a higher stage largely overlapped across both models. This study is a first step toward determining different clinical profiles, with a corresponding course and outcome.
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Affiliation(s)
- Afra van der Markt
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Ursula M. H. Klumpers
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands,Amsterdam UMCVrije Universiteit AmsterdamAmsterdam NeurosciencePsychiatryThe Netherlands
| | - Annemiek Dols
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands,Amsterdam UMCVrije Universiteit AmsterdamAmsterdam NeurosciencePsychiatryThe Netherlands
| | - Marco P. Boks
- Department of PsychiatryUniversity Medical Center UtrechtUtrechtThe Netherlands,Brain Center University Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Annabel Vreeker
- Department of Child and Adolescent Psychiatry and PsychologyErasmus MCRotterdamThe Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Ralph W. Kupka
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
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Yilmaz S, Huguet A, Kisely S, Rao S, Wang J, Baur K, Price M, O'Mahen H, Wright K. Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis. J Affect Disord 2022; 301:193-204. [PMID: 35007645 DOI: 10.1016/j.jad.2021.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment. OBJECTIVES This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression? DATA SOURCES A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html). ELIGIBILITY CRITERIA Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score. RESULTS The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size. CONCLUSIONS Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome.
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Affiliation(s)
- Sakir Yilmaz
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK.
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Canada; Departament de Psicologia, Universitat Rovira I Virgili, Spain; IWK Health Center, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Canada; University of Queensland, Psychiatry, Australia; Metro South Addiction and Mental Health Epidemiology Service, Australia
| | - Sanjay Rao
- Faculty of Medicine, Psychiatry, University of Ottawa, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | | | - Heather O'Mahen
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
| | - Kim Wright
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
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Gundugurti PR, Bhattacharyya R, Koneru A. Management of Psychiatric Disorders in Patients with Cardiovascular Diseases. Indian J Psychiatry 2022; 64:S355-S365. [PMID: 35602356 PMCID: PMC9122167 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Prasad Rao Gundugurti
- Division of Schizophrenia and Psychopharmacology, Asha Hospital, Hyderabad, Telangana, India
| | - Ranjan Bhattacharyya
- Department of Psychiatry, Murshidabad Medical College and Hospital & Charak Square Diagnostic and Research Center, Berhampore, West Bengal, India
| | - Amulya Koneru
- Department of Reproductive Psychiatry, Asha Hospital, Hyderabad, Telangana, India E-mail:
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Girela-Serrano BM, Guerrero-Jiménez M, Spiers ADV, Gutiérrez-Rojas L. Obesity and overweight among children and adolescents with bipolar disorder from the general population: A review of the scientific literature and a meta-analysis. Early Interv Psychiatry 2022; 16:113-125. [PMID: 33735937 DOI: 10.1111/eip.13137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/05/2021] [Accepted: 03/06/2021] [Indexed: 11/27/2022]
Abstract
There is substantial evidence of the high prevalence of obesity (OB) and overweight (OW) and their association with increased medical and psychiatric burden among adults with bipolar disorder (BD). However, little is known regarding its prevalence among young people with BD, other than the risk from psychotropic medication, which has been the focus of research in this population. We present a systematic review and meta-analysis of the literature on prevalence and correlates of OB and OW children and adolescents with BD using a different perspective than impact of medication. Four studies met inclusion criteria. The prevalence of OB in children and adolescents with BD was 15% (95% CI 11-20%). We observed a higher prevalence of OB in comparison to the general population. Different studies found significant associations between OB, OW, and BD in young populations including non-Caucasian race, physical abuse, suicide attempts, self-injurious behaviours, psychotropic medication, and psychiatric hospitalizations.
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Affiliation(s)
| | - Margarita Guerrero-Jiménez
- Department of Psychiatry, University of Granada, Granada, Spain.,Virgen de las Nieves University Hospital, Granada, Spain
| | - Alexander D V Spiers
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,San Cecilio University Hospital, Granada, Spain
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35
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Liu G, Kong L, Baweja R, Ba D, Saunders EFH. Gender disparity in bipolar disorder diagnosis in the United States: A retrospective analysis of the 2005-2017 MarketScan Commercial Claims database. Bipolar Disord 2022; 24:48-58. [PMID: 33872456 DOI: 10.1111/bdi.13082] [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: 10/05/2020] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine gender disparities in the diagnosis of bipolar disorder (BD) within a privately insured population in the United States and investigate potential contributing factors for these gender differences. METHODS This retrospective cohort study utilized 2005-2017 claims data from the MarketScan® Commercial Claims and Encounters database. The study cohort included subjects, aged 10-64 years, who had a minimum of 1-year continuous insurance coverage and no record of a BD diagnosis before cohort entry. We examined the gender difference in BD diagnosis rate, overall and by subgroups. We then used Cox regression models to evaluate the gender effect on time to first BD diagnosis, and the potential moderators of gender effect. RESULTS The study cohort consisted of 97,193,443 subjects; 0.45% of subjects were diagnosed with BDs after cohort entry with males having a lower diagnosis rate than females (0.36% vs. 0.54%). The Cox regression analysis indicated that males were less likely to be diagnosed with BDs (unadjusted Hazard Ratio, HR [95% CI]: 0.69 [0.68-0.69]) and gender difference remained significant after adjusting for demographics, comorbidity and healthcare utilizations (adjusted HR [95% CI]: 0.77 [0.76-0.77]). Gender disparity was consistently strong among most age groups, but varied in other demographic subgroups. CONCLUSIONS Even though the prevalence of BDs is approximately equal between genders in the general population, our study found a much lower diagnosis rate in men compared to women for a privately insured U.S. POPULATION Future studies aimed at identifying and understanding the barriers to diagnosis of BDs in men are warranted.
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Affiliation(s)
- Guodong Liu
- Department of Public Health Sciences, Penn State University College of Medicine, Hersey, PA, USA.,Department of Psychiatry and Behavioral Health Hershey, Penn State University College of Medicine, Hersey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State University College of Medicine, Hersey, PA, USA
| | - Ritika Baweja
- Department of Psychiatry and Behavioral Health Hershey, Penn State University College of Medicine, Hersey, PA, USA
| | - Djibril Ba
- Department of Public Health Sciences, Penn State University College of Medicine, Hersey, PA, USA
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health Hershey, Penn State University College of Medicine, Hersey, PA, USA
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Koul A, Shetty AS. Frequency of psychiatric comorbid symptoms in bipolar disorder patients in remission. Ind Psychiatry J 2022; 31:126-134. [PMID: 35800862 PMCID: PMC9255627 DOI: 10.4103/ipj.ipj_233_20] [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: 12/24/2020] [Revised: 03/16/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Psychiatric comorbidity has been detected in one-third of bipolar patients. The illness itself may be a precipitating factor for developing substance use and anxiety disorders. Comorbid anxiety disorders with bipolar disorder (BD) are associated with decreased chances of recovery, poorer role functioning, and quality of life, and greater likelihood of suicide attempts. Hence, identifying comorbid symptoms in remitting patients has important preventive and therapeutic implications. AIMS The aim of the study was to estimate the frequency of psychiatric comorbid symptoms in patients of bipolar affective disorder in remission and to identify its relationship with sociodemographic variables. METHODOLOGY This is a cross-sectional study conducted in Father Muller Medical College and Hospital, Mangalore (April 2019-July 2019), which included 90 patients aged 18-50 years with BD, manic, or depressive episodes in remission for 8 weeks who were evaluated using mini international neuropsychiatric interview plus, Hamilton rating scale for depression, and young mania rating scale. Sociodemographic details were assessed by a semi-structured pro forma. The data were analyzed using frequency, Chi-square test, and t-test. RESULTS Most common psychiatry comorbid symptoms seen in BD were found to be drug dependence/abuse (n = 31), second most common being alcohol dependence/abuse (n = 21), followed by suicidality (n = 8), antisocial personality, social phobia, panic disorder, and agoraphobia. Significance was found for suicidality, agoraphobia, and social phobia if the last episode was depressive and for suicidality if index episode was depressive and if age of onset was >40 years. CONCLUSION Psychiatric comorbidities in BD may worsen the course and prognosis of the disorder and hence, clinicians must maintain a high index of suspicion for them. Furthermore, comorbidities may need to be identified and appropriate interventions employed to prevent iatrogenic complications.
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Affiliation(s)
- Aarshie Koul
- Department of Psychiatry, Father Muller Medical College Hospital, Mangalore, Karnataka, India
| | - A Siddharth Shetty
- Department of Psychiatry, Father Muller Medical College Hospital, Mangalore, Karnataka, India
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Tokumitsu K, Norio YF, Adachi N, Kubota Y, Watanabe Y, Miki K, Azekawa T, Edagawa K, Katsumoto E, Hongo S, Goto E, Ueda H, Kato M, Nakagawa A, Kikuchi T, Tsuboi T, Watanabe K, Shimoda K, Yoshimura R. Real-world clinical predictors of manic/hypomanic episodes among outpatients with bipolar disorder. PLoS One 2022; 16:e0262129. [PMID: 34972188 PMCID: PMC8719757 DOI: 10.1371/journal.pone.0262129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/16/2021] [Indexed: 01/21/2023] Open
Abstract
Background Bipolar disorder is a mental illness in which manic and depressive states are repeated, causing psychosocial dysfunction. Manic/hypomanic episodes cause problems with interpersonal, social and financial activities, but there is limited evidence regarding the predictors of manic/hypomanic episodes in real-world clinical practice. Methods The multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was administered in an observational study that was conducted to accumulate evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics by conducting a retrospective medical record survey. Our study extracted baseline patient characteristics from September to October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. We investigated the presence or absence of manic/hypomanic episodes over the course of one year from baseline to September-October 2017. Results In total, 2231 participants were included in our study, 29.1% of whom had manic/hypomanic episodes over the course of one year from baseline. Binomial logistic regression analysis revealed that the presence of manic/hypomanic episodes was correlated with lower baseline GAF scores, rapid cycling, personality disorder, bipolar I disorder, and a mood state with manic or mixed features. Substance abuse was also a risk factor for manic episodes. There was no significant association between a baseline antidepressant prescription and manic/hypomanic episodes. Conclusions In Japan, 29.1% of outpatients with bipolar disorder had manic/hypomanic episodes over the course of one year. Our study suggested that a low GAF score, rapid cycling, personality disorder, bipolar I disorder, substance abuse, and baseline mood state could be predictors of manic/hypomanic episodes. Based on our findings, an antidepressant prescription is not a predictor of manic/hypomanic episodes.
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Affiliation(s)
- Keita Tokumitsu
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasui-Furukori Norio
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- * E-mail:
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | | | - Kazuhira Miki
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Koji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Masaki Kato
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Atsuo Nakagawa
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshiaki Kikuchi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Reiji Yoshimura
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
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Symptom profiles of women at risk of mood disorders: A latent class analysis. J Affect Disord 2021; 295:139-147. [PMID: 34450523 DOI: 10.1016/j.jad.2021.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Depression is the leading cause of disease burden among women worldwide. However, an understanding of symptom profiles among women at risk of mood disorders is limited. We determined distinct profiles of affective symptoms among high risk women, along with their distinguishing characteristics. METHODS Women were recruited from 17 clinical sites affiliated with the National Network of Depression Centers. They completed measures of depression (Patient Health Questionnaire - 9) and anxiety (Generalized Anxiety Disorder - 7) as well as questions regarding demographics, reproductive status, behavioral/mental health history, and life stress/adversity. Latent class analysis and multinomial logistic regression were used to identify and characterize symptom profiles. RESULTS 5792 women participated, ages 18 to 90 (M = 38). Three latent classes were identified: generally asymptomatic (48%), elevated symptoms of comorbid anxiety and depression (16%), and somatic symptoms (36%). Financial security and greater social support were protective factors that distinguished asymptomatic women. The profile of the class with elevated anxiety/depressive symptoms constituted a complex mix of adverse social determinants and potentially heritable clinical features, including a diagnosis of Bipolar Disorder. Women in the 3rd latent class were characterized by menstrual irregularity and a stronger expression of neurovegetative symptoms, especially sleep disturbance and fatigue. LIMITATIONS Limitations included less than optimal racial diversity of our sample and reliance on self-report. CONCLUSIONS Different symptom profiles may reflect distinct subtypes of women at risk of mood disorders. Understanding the etiology and mechanisms underlying clinical and psychosocial features of these profiles can inform more precisely targeted interventions to address women's diverse needs.
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Cha S, Kim SS. Comorbidity Patterns of Mood Disorders in Adult Inpatients: Applying Association Rule Mining. Healthcare (Basel) 2021; 9:1155. [PMID: 34574929 PMCID: PMC8470302 DOI: 10.3390/healthcare9091155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022] Open
Abstract
This study explored physical and psychiatric comorbidities of mood disorders using association rule mining. There were 7709 subjects who were patients (≥19 years old) diagnosed with mood disorders and included in the data collected by the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) between 2006 and 2018. Physical comorbidities (46.17%) were higher than that of psychiatric comorbidities (27.28%). The frequent comorbidities of mood disorders (F30-F39) were hypertensive diseases (I10-I15), neurotic, stress-related and somatoform disorders (F40-F48), diabetes mellitus (E10-E14), and diseases of esophagus, stomach, and duodenum (K20-K31). The bidirectional association path of mood disorders (F30-F39) with hypertensive diseases (I10-I15) and diabetes mellitus (E10-E14) were the strongest. Depressive episodes (F32) and recurrent depressive disorders (F33) revealed strong bidirectional association paths with other degenerative diseases of the nervous system (G30-G32) and organic, including symptomatic and mental disorders (F00-F09). Bipolar affective disorders (F31) revealed strong bidirectional association paths with diabetes mellitus (E10-E14) and hypertensive diseases (I10-I15). It was found that different physical and psychiatric disorders are comorbid according to the sub-classification of mood disorders. Understanding the comorbidity patterns of major comorbidities for each mood disorder can assist mental health providers in treating and managing patients with mood disorders.
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Affiliation(s)
- Sunkyung Cha
- Department of Nursing Science, Sunmoon University, Asan 31460, Korea;
| | - Sung-Soo Kim
- Department of Health Administration & Healthcare, Cheongju University, Cheongju 28503, Korea
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Granger S, Pavlis A, Collett J, Hallam KT. Revisiting the “manic defence hypothesis”: assessing explicit and implicit cognitive biases in euthymic bipolar disorder. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1948303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shara Granger
- Psychology Discipline, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Alexia Pavlis
- Psychology Discipline, College of Health and Biomedicine, Victoria University, Melbourne, Australia
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - James Collett
- Department of Psychology, School of Science and Biomedicine, RMIT, Melbourne, Australia
| | - Karen T. Hallam
- Centre for Youth AOD Research and Practice, Youth Support and Advocacy Service (YSAS), Fitzroy, Australia
- Institute for Innovation in Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Australia
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Amerio A, Giacomini C, Fusar-Poli L, Aguglia A, Costanza A, Serafini G, Aguglia E, Amore M. Efficacy and safety of lurasidone in children and adolescents: Recommendations for clinical management and future research. Curr Pharm Des 2021; 27:4062-4069. [PMID: 34348620 DOI: 10.2174/1381612827666210804110853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
Lurasidone is a novel azapirone derivative, and atypical antipsychotic agent with a high binding affinity for dopaminergic (D2), serotoninergic (5-HT2A), and 5-HT7 receptors (antagonist), a moderate affinity for 5-HT1A receptors (partial agonist), and no appreciable affinity for histaminergic (H1) and muscarinic (M1) receptors. It was recently included by the European Medication Agency among the in-label pharmacological treatments for children and adolescents affected by early onset schizophrenia. As a dopamine and serotonin antagonist, lurasidone acts on a variety of receptors and showed its efficacy both as an antipsychotic and an activating compound. Administered with food or within 30 minutes from a meal, it presents sufficient bioavailability and does not interact ith most of the other drugs during metabolism. With little effects on hormones and weight gain, potential procognitive profile due to its 5-HT7 antagonism, and reduced extrapyramidal side effects, lurasidone could be a good choice in terms of both effectiveness and tolerability, particularly for patients headed towards a long-term treatment. This article aims to summarize the available scientific evidence from the literature on the use of lurasidone in children and adolescents and to provide recommendations for clinical management and future research.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Costanza Giacomini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania. Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva. Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania. Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
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Gomes-da-Costa S, Marx W, Corponi F, Anmella G, Murru A, Pons-Cabrera MT, Giménez-Palomo A, Gutiérrez-Arango F, Llach CD, Fico G, Kotzalidis GD, Verdolini N, Valentí M, Berk M, Vieta E, Pacchiarotti I. Lithium therapy and weight change in people with bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 134:104266. [PMID: 34265322 DOI: 10.1016/j.neubiorev.2021.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023]
Abstract
Lithium remains the gold standard maintenance treatment for Bipolar Disorder (BD). However, weight gain is a side effect of increasing relevance due to its metabolic implications. We conducted a systematic review and meta-analysis aimed at summarizing evidence on the use of lithium and weight change in BD. We followed the PRISMA methodology, searching Pubmed, Scopus and Web of Science. From 1003 screened references, 20 studies were included in the systematic review and 9 included in the meta-analysis. In line with the studies included in the systematic review, the meta-analysis revealed that weight gain with lithium was not significant, noting a weight increase of 0.462 Kg (p = 0158). A shorter duration of treatment was significantly associated with more weight gain. Compared to placebo, there were no significant differences in weight gain. Weight gain was significantly lower with lithium than with active comparators. This work reveals a low impact of lithium on weight change, especially compared to some of the most widely used active comparators. Our results could impact clinical decisions.
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Affiliation(s)
- Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Filippo Corponi
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Maria Teresa Pons-Cabrera
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Felipe Gutiérrez-Arango
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Cristian Daniel Llach
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Georgios D Kotzalidis
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain.
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
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Martini J, Leopold K, Pfeiffer S, Berndt C, Boehme A, Roessner V, Fusar-Poli P, Young AH, Correll CU, Bauer M, Pfennig A. Early detection of bipolar disorders and treatment recommendations for help-seeking adolescents and young adults: Findings of the Early Detection and Intervention Center Dresden. Int J Bipolar Disord 2021; 9:23. [PMID: 34215910 PMCID: PMC8253866 DOI: 10.1186/s40345-021-00227-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early identification and intervention of individuals with risk factors for or subtle prodromal symptoms of bipolar disorders (BD) may improve the illness course and prevent adverse long-term consequences. Methods We examined sociodemographic, clinical and psychopathological characteristics of help-seeking adolescents and young adults who consulted the Early Detection and Intervention Center Dresden at the University of Dresden (Germany) and presented with or without pre-defined at-risk criteria for BD. The standardized diagnostic procedure for all help-seeking youth included a comprehensive psychiatric history and a structured clinical interview. When BD at-risk state was suspected, early detection instruments (EPIbipolar, BPSS-FP) were applied. Treatment recommendations were formulated in multi-professional case conferences. Results Out of 890 help-seeking persons between 05/2009 and 04/2018, 582 (65%) completed the diagnostic process. Of these, 24 (4%) had manifest BD and 125 (21%) fulfilled at-risk BD criteria (age = 23.9 ± 0.6 years, female = 62%). Of the pre-defined main risk factors, family history for BD was reported in 22% of the at-risk persons, (hypo-)mania risk state in 44%, and increasing cyclothymic mood swings with increased activity in 48%. The most common secondary risk factors were decreased psychosocial functioning (78%), lifetime diagnosis of depressive disorder (67%) and specific sleep/circadian rhythm disturbances (59%). Substance use was very common in subjects at-risk for BD (cannabis = 50%, alcohol = 33%) and highest in patients with BD (cannabis = 75%, alcohol = 40%). Psychiatric treatment history, including psychopharmacological therapy, was similar between the groups, while treatment recommendations differed, with more advice for psychotherapy and antidepressants in the at-risk group with a lifetime diagnosis of depression and more advice for specialized BD treatment including mood stabilizers in patients with BD. Conclusion This analysis on the phenomenology of different BD at-risk stages suggests that early detection of individuals presenting with suggested risk factors for the development of BD is feasible in help-seeking young people. Future research should further develop/test stage-specific prevention and early targeted intervention approaches that were described in a naturalistic setting.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Boehme
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Veit Roessner
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Paolo Fusar-Poli
- Early Psychosis: Intervention and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Christoph U Correll
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Abstract
Further understanding of older age bipolar disorder (OABD) may lead to more specific recommendations for treatment adjusted to the specific characteristics and needs caused by age-related somatic and cognitive changes. Late-onset mania has a broad differential diagnosis and requires full psychiatric and somatic work-up, including brain imaging. Research on pharmacotherapy in OABD is limited. First-line treatment of OABD is similar to that for adult bipolar disorder (BD), with specific attention to vulnerability to side effects and somatic comorbidity. Because findings in younger adults with BD cannot be extrapolated to OABD, more research in OABD is warranted.
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Affiliation(s)
- Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health Research Institute, Van der Boechorstsstraat 7, 1081 BT, Amsterdam, The Netherlands; Mood, Anxiety and Psychosis Program, Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Aartjan Beekman
- Department of Old Age Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health Research Institute, Van der Boechorstsstraat 7, 1081 BT, Amsterdam, The Netherlands; Mood, Anxiety and Psychosis Program, Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Department of Psychiatry, GGZinGeest and VUmc University Medical Center, Amstelveenseweg 589, 1081 JC, Amsterdam, The Netherlands
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45
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Yuan M, Xiao ZL, Zhou HY, Rao W, Huang G, Nie HB, Cao WF, Xu RS. Bipolar disorder and the risk for stroke incidence and mortality: a meta-analysis. Neurol Sci 2021; 43:467-476. [PMID: 34052937 DOI: 10.1007/s10072-021-05348-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) may be associated with an increased risk of stroke, but to date, the results of the studies are still controversial. This study aimed to assess the association of BD with stroke incidence and mortality by a meta-analysis. METHOD PubMed, EMBASE, the Cochrane library databases, and Web of Science databases were searched from inception to July 2020. We regarded stroke as a composite endpoint. The pooled hazard ratio (HRs) of 95% confidence interval (Cls) was calculated. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity of the pooled estimation. RESULTS A total of 7 studies involving a total of 13,305,007 participants were included in this meta-analysis. Pooled analysis showed participants with BD experienced a significantly increased risk of both stroke incidence (combined HR, 1.43; 95% CI, 1.24-1.66; p = 0.000) and stroke mortality (combined HR, 1.54; 95% CI, 1.09-2.18; p = 0.013) compared to participants without BD. In addition, the pooled estimate of multivariate HRs of stroke incidence and mortality were 1.35 (95% CI: 1.26-1.45); 2.30 ( 95% CI: 1.37-3.85) among men and 1.43 (95% CI:1.27-1.60); 2.08 (95% CI:1.60-2.71) among women respectively. CONCLUSIONS This meta-analysis suggests that BD may modestly increase the risk of both stroke incidence and mortality. Extensive clinical observational studies should be conducted in the future to explore whether BD is a potentially modifiable risk factor for stroke.
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Affiliation(s)
- Min Yuan
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China.
| | - Zhi-Long Xiao
- Department of Neurology, The Third Hospital of Nanchang, Nanchang, 330009, Jiangxi, China
| | - Huang-Yan Zhou
- Department of Blood Transfusion, Jiangxi Cancer Hospital, Nanchang, 330029, Jiangxi, China
| | - Wei Rao
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Gang Huang
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Hong-Bing Nie
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China.
| | - Wen-Feng Cao
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China.
| | - Ren-Shi Xu
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China
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46
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Ozcan H, Takim U. 50 Useful Sociodemographic and Clinical Tips to Overcome the Challenge Differentiating Bipolar Depression from Unipolar Depression. Eurasian J Med 2021; 53:64-66. [PMID: 33716534 PMCID: PMC7929576 DOI: 10.5152/eurasianjmed.2021.20064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Halil Ozcan
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ugur Takim
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
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47
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Shonibare DO, Patel RR, Islam AH, Metcalfe AWS, Fiksenbaum L, Freeman N, MacIntosh BJ, Kennedy JL, Goldstein BI. Neurostructural phenotypes of CACNA1C rs1006737 in adolescents with bipolar disorder and healthy controls. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110071. [PMID: 32800865 DOI: 10.1016/j.pnpbp.2020.110071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/05/2020] [Accepted: 08/09/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Investigate the effects of CACNA1C rs1006737 on cortical and subcortical neurostructural phenotypes in Caucasian bipolar disorder (BD) and healthy control (HC) adolescents. METHODS Seventy-one adolescents (14-20 years; 38BD, 33HC) underwent 3-Tesla Magnetic Resonance Imaging (MRI). Region of interest (ROI) and vertex-wise analyses examined cortical volume, surface area (SA), and thickness, as well as subcortical volume. ROIs included the ventromedial prefrontal cortex (vmPFC), ventrolateral prefrontal cortex (vlPFC), anterior cingulate cortex (ACC), putamen, and amygdala. General linear models included main effects of diagnosis and rs1006737, and an interaction term, controlling for age, sex, and total intracranial volume. RESULTS Vertex-wise analysis found significant BD-by-rs1006737 interactions for prefrontal and occipital regions such that BD A-carriers were found to have greater SA relative to BD non-carriers, while HC A-carriers had reduced SA relative to HC non-carriers. ROI analysis found an interaction in the ACC such that BD A-carriers were found to have greater SA relative to BD non-carriers, while no significant difference was found in HCs. Main effects of rs1006737 were also found on ACC SA from ROI analysis, and occipital SA from vertex-wise analysis, such that A-carriers had larger SA relative to non-carriers in both of these regions. CONCLUSIONS The current study identified neurostructural intermediate phenotypes relevant to the impact of CACNA1C rs1006737 on adolescent BD. Further investigation is warranted into the neurofunctional and neurocognitive relevance of rs1006737 associations with BD-specific elevations in regional SA.
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Affiliation(s)
- Daniel O Shonibare
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Ronak R Patel
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Alvi H Islam
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Arron W S Metcalfe
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
| | - Lisa Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natalie Freeman
- Tanenbaum Centre for Pharmacogenetics, Centre for Addiction and Mental Health, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - James L Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Canada; Tanenbaum Centre for Pharmacogenetics, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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48
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Sperling JD, Dalkner N, Berndt C, Fleischmann E, Ratzenhofer M, Martini J, Pfennig A, Bauer M, Reininghaus E, Vinberg M. Physical Health Profile and Associated Behavior During the COVID-19 Pandemic in Patients With Bipolar Disorder. Front Psychiatry 2021; 12:759694. [PMID: 34938211 PMCID: PMC8685329 DOI: 10.3389/fpsyt.2021.759694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background: The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioral, mental, and physical health, presumably with effects on patients with severe mental disorders. This study examines pandemic-related physical and mental health and (compensatory) behavioral changes, in patients with BD as compared to healthy control individuals. Method: Physical and mental health and self-reported changes in daily structure and behavior due to the pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) in Germany, Austria, and Denmark in individuals with BD and a healthy control group. Results: The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rates of COVID-19 testing, had more worries concerning health, and experienced more anxiety but less social distancing. Conclusion: The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behavior due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimizing and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as the COVID-19 pandemic. Limitations: Sampling issues and self-report forms, selectivity (missing elderly, and those lacking access or knowledge of technology).
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Affiliation(s)
- Jon Dyg Sperling
- Mental Health Center, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Christina Berndt
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Julia Martini
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Maj Vinberg
- Mental Health Center, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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49
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Brown A, Alas H, Bortz C, Pierce KE, Vasquez-Montes D, Ihejirika RC, Segreto FA, Haskel J, Kaplan DJ, Segar AH, Diebo BG, Hockley A, Gerling MC, Passias PG. Patients with psychiatric diagnoses have increased odds of morbidity and mortality in elective orthopedic surgery. J Clin Neurosci 2020; 84:42-45. [PMID: 33485597 DOI: 10.1016/j.jocn.2020.11.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/28/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p < 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p < 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p < 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p < 0.001).
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Affiliation(s)
- Avery Brown
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Haddy Alas
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Cole Bortz
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Rivka C Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Jonathan Haskel
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Daniel James Kaplan
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Anand H Segar
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Aaron Hockley
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Michael C Gerling
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.
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50
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Hasin D, Walsh C. Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review. J Clin Med 2020; 10:E15. [PMID: 33374666 PMCID: PMC7793504 DOI: 10.3390/jcm10010015] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The landscape of attitudes, legal status and patterns of use of cannabis is rapidly changing in the United States and elsewhere. Therefore, the primary aim of this narrative review is to provide a concise overview of the literature on the comorbidity of cannabis use and cannabis use disorder (CUD) with other substance use and psychiatric disorders, and to use this information to accurately guide future directions for the field. METHODS A literature review of PubMed was conducted for studies relating to cannabis use, CUD, and a co-occurring psychiatric disorder. To provide an overview of representative data, the literature review focused on national-level, population-based work from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and National Survey on Drug Use and Health (NSDUH) surveys. Considering rapidly changing cannabis laws, recent (past five-year) studies were addressed. RESULTS A strong body of literature shows associations between cannabis use and CUD with other drug use, psychosis, mood disorders, anxiety disorders, and personality disorders. The strongest evidence of a potential causal relationship exists between cannabis use and psychotic disorders. While some evidence shows potential directionality between cannabis use and mood and anxiety disorders, results are inconsistent. Studies have established higher rates of CUD among those with personality disorders, but little about the specifics of this relationship is understood. CONCLUSIONS Although the general population in the United States increasingly perceives cannabis to be a harmless substance, empirical evidence shows that cannabis use is associated both with CUD and comorbid psychiatric illness. However, there is mixed evidence regarding the role of cannabis in the etiology, course, and prognosis of a co-occurring disorder across all categories of psychiatric disorders. Future research should expand on the existing body of literature with representative, longitudinal data, in order to better understand the acute and long-term effects of cannabis on comorbid psychiatric illness.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, New York, NY 10032, USA;
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY 10032, USA;
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