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Pelizza L, Leuci E, Leucci AC, Quattrone E, Azzali S, Pupo S, Plazzi E, Paulillo G, Pellegrini P, Menchetti M. Diagnostic shift in first episode psychosis: Results from the 2-year follow-up of the "Parma Early Psychosis" program. Schizophr Res 2024; 267:99-106. [PMID: 38531162 DOI: 10.1016/j.schres.2024.03.010] [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: 06/27/2023] [Revised: 01/17/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Although the stability of current diagnostic criteria for people with First Episode Psychosis (FEP) is essential for treatment, it still remains poorly investigated. As its examination necessarily requires a prospective evaluation of diagnostic trajectories, the aims of the current longitudinal investigation were: (a) to assess diagnostic changes in an Italian FEP population treated within an "Early Intervention in Psychosis" service during a 2-year follow-up period, and (b) to identify potential sociodemographic and clinical moderators of diagnostic instability at entry. METHODS All participants were FEP individuals, aged 12-35 years. Their primary diagnosis was formulated both at baseline and at the end of the follow-up. At entry, they also completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. As measure of diagnostic stability, the Kappa statistic was first calculated. The associations of diagnostic shift with baseline sociodemographic and clinical characteristics were then analyzed using a logistic model with the diagnostic change as dependent variable. Finally, a propensity score was calculated, based on logistic analysis results. RESULTS 221 (50.1 %) FEP participants changed their initial diagnosis. The highest prospective diagnostic stability was found for initial diagnosis of schizophrenia (93.9 %) and affective spectrum psychoses (92.4 %). Diagnostic instability was high for initial diagnosis of brief psychotic disorder (100 %), schizophreniform disorder (100 %) and psychotic disorder not otherwise specified (92.1 %). The best predictors of diagnostic change were previous contact with neuropsychiatry services, shorter duration of untreated psychosis and higher baseline levels of disorganization. CONCLUSIONS Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses and detecting its moderators at entry are important challenges for future diagnostic development of early psychosis.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy; Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Anna Caterina Leucci
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Enrico Plazzi
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy
| | - Giuseppina Paulillo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università di Bologna, Bologna, BO, Italy
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Grover S, Kathiravan S. Acute and transient psychotic disorders: A review of Indian research. Indian J Psychiatry 2023; 65:895-913. [PMID: 37841545 PMCID: PMC10569331 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_254_23] [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: 04/09/2023] [Revised: 06/26/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023] Open
Abstract
Background Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. Aim This paper aims to review the literature on ATPD emerging from India. Methodology A combination of search terms "Acute and Transient Psychosis," "acute psychosis," "non-affective psychosis," "non-affective psychotic disorder," "reactive psychosis," "first-episode psychosis," and "India" were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. Results The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. Conclusion There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Relationship of Family Genetic Risk Score With Diagnostic Trajectory in a Swedish National Sample of Incident Cases of Major Depression, Bipolar Disorder, Other Nonaffective Psychosis, and Schizophrenia. JAMA Psychiatry 2023; 80:241-249. [PMID: 36696095 PMCID: PMC9878431 DOI: 10.1001/jamapsychiatry.2022.4676] [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: 09/10/2022] [Accepted: 11/11/2022] [Indexed: 01/26/2023]
Abstract
Importance Since its inception under Kraepelin in the modern era, diagnostic stability and familial/genetic risk have been among the most important psychiatric nosologic validators. Objective To assess the interrelationships of family genetic risk score (FGRS) with diagnostic stability or diagnostic change in major depression (MD), bipolar disorder (BD), other nonaffective psychosis (ONAP), and schizophrenia. Design, Setting, and Participants This longitudinal population-based cohort (N = 4 171 120) included individuals with incident cases of MD (n = 235 095), BD (n = 11 681), ONAP (n = 16 009), and schizophrenia (n = 6312) who had at least 1 further diagnosis of the 4 disorders during follow-up, as assessed from Swedish national medical registries, observed over a mean (SD) of 13.1 (5.9) years until a mean (SD) age of 48.4 (12.3) years. Data were collected from January 1973 to December 2018, and data were analyzed from August to September 2022. Exposures FGRS for MD, BD, ONAP, and schizophrenia, calculated from morbidity risks for disorders in first-degree through fifth-degree relatives, controlling for cohabitation effects. Main Outcomes and Measures Final diagnostic outcome of MD, BD, ONAP, or schizophrenia. Results Of 269 097 included individuals, 173 061 (64.3%) were female, and the mean (SD) age at first registration was 35.1 (11.9) years. Diagnostic stability was highest for MD (214 794 [91.4%]), followed by schizophrenia (4621 [73.2%]), BD (7428 [63.6%]), and ONAP (6738 [42.1%]). The second most common final diagnosis for each of these MD, schizophrenia, BD, and ONAP were BD (15 506 [6.6%]), ONAP (1110 [17.6%]), MD (2681 [23.0%]), and schizophrenia (4401 [27.5%]), respectively. A high FGRS for the incident diagnosis was consistently associated with diagnostic stability, while a high FGRS for the final diagnosis and a low FGRS for the incident diagnosis was associated with diagnostic change. In multivariate models, those in the upper 5% of genetic risk had an odds ratio (OR) of 1.75 or greater for the following diagnostic transition: for MD FGRS, ONAP to MD (OR, 1.91; 95% CI, 1.59-2.29) and schizophrenia to MD (OR, 2.45; 95% CI, 1.64-3.68); for BD FGRS, MD to BD (OR, 2.60; 95% CI, 2.47-2.73), ONAP to BD (OR, 2.16; 95% CI, 1.85-2.52), and schizophrenia to BD (OR, 2.20; 95% CI, 1.39-3.49); for ONAP FGRS, MD to ONAP (OR, 1.80; 95% CI, 1.62-2.02), MD to schizophrenia (OR, 1.95; 95% CI, 1.58-2.41), and BD to schizophrenia (OR, 1.89; 95% CI, 1.39-2.56); and for schizophrenia FGRS, MD to schizophrenia (OR, 1.80; 95% CI, 1.46-2.23), and BD to schizophrenia (OR, 1.75; 95% CI, 1.25-2.45). FGRS profiles for incident cases confirmed at final diagnosis were more homogenous than genetic profiles for those who changed diagnoses. Conclusions and Relevance In a large population-based longitudinal cohort, the genetic risk factors for MD, BD, ONAP, and schizophrenia were meaningfully and systematically associated with the diagnostic trajectories of these 4 disorders. Over time, clinical diagnosis and genetic risk profiles became increasingly consilient, thereby providing genetic validation of these diagnostic constructs. Diagnostically unstable incident cases were more genetically heterogeneous than those who were diagnostically stable over time.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York City, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York City, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York
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Høj Jørgensen TS, Osler M, Jorgensen MB, Jorgensen A. Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish nationwide cohort study using sequence analysis. Lancet Psychiatry 2023; 10:12-20. [PMID: 36450298 DOI: 10.1016/s2215-0366(22)00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A key clinical problem in psychiatry is predicting the diagnostic future of patients presenting with psychopathology for the first time. The objective of this study was to establish a comprehensive map of subsequent diagnoses after a first psychiatric hospital diagnosis. METHODS Through the Danish National Patient Registry, we identified patients aged 18 years or older with an inpatient or outpatient psychiatric hospital contact and who had received one of the 20 most common first-time psychiatric diagnoses (defined at the ICD-10 two-cipher level, F00-F99) between Jan 1, 1995, and Dec 31, 2008. For each first-time diagnosis, the 20 most frequent subsequent psychiatric diagnoses (F00-F99), and death, occurring during 10 years of follow-up were identified as outcomes. To assess diagnostic stability, we used social sequence analyses, assigning a subsequent diagnosis to each state with a length of 6 months following each first-time diagnosis. The subsequent diagnosis was defined as the last diagnosis given within each 6-month period. We calculated the normalised entropy of each sequence to show the uncertainty of predicting the states in a given sequence. Cox proportional hazards models were used to assess the risk of receiving a subsequent diagnosis (at the one-cipher level, F0-F9) after each first-time diagnosis. FINDINGS The cohort consisted of 184 949 adult patients (77 129 [41·7%] men and 107 820 [58·3%] women, mean age 42·5 years [SD 18·5; range 18 to >100). Ethnicity data were not recorded. Over 10 years of follow-up, 86 804 (46·9%) patients had at least one subsequent diagnosis that differed from their first-time diagnosis. Measured by mean normalised entropy values, persistent delusional disorders (ICD-10 code F22), mental and behavioural disorders due to multiple drug use and use of other psychoactive substances (F19), and acute and transient psychotic disorders (F23) had the highest diagnostic variability, whereas eating disorders (F50) and non-organic sexual dysfunction (F52) had the lowest. The risk of receiving a subsequent diagnosis with a psychiatric disorder from an ICD-10 group different from that of the first-time diagnosis varied substantially among first-time diagnoses. INTERPRETATION These data provide detailed information on possible diagnostic outcomes after a first-time presentation in a psychiatric hospital. This information could help clinicians to plan relevant follow-up and inform patients and families on the degree of diagnostic uncertainty associated with receiving a first psychiatric hospital diagnosis, as well as likely and unlikely trajectories of diagnostic progression. FUNDING Mental Health Services, Capital region of Denmark. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.
| | - Merete Osler
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - Martin Balslev Jorgensen
- Department of Public Health, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Anders Jorgensen
- Department of Public Health, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Frahm Laursen M, Correll CU, Licht RW, Rodrigo-Domingo M, Pagsberg AK, Nielsen RE. Characteristics prior to and at time of diagnosis in pediatric bipolar disorder. Nord J Psychiatry 2022; 77:282-292. [PMID: 35816446 DOI: 10.1080/08039488.2022.2096112] [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] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Describe symptoms before and at time of register-diagnosis in children and adolescents. METHODS A random sample was selected for chart-review from a Danish nationwide cohort of patients <18 years registered with an incident ICD-10 register-diagnosis of single hypomanic/manic episode or bipolar disorder between 1995 and 2014. Patients with symptoms which adequately documented a BD diagnosis in the chart were included for analysis. RESULTS 521 were diagnosed in the study period. A random sample of 25% were selected, and 106 charts were possible to retrieve, with 48 chart reviews resulting in confirmation of diagnosis. Time from first reported affective symptoms to diagnosis was 2.6 ± 2.7 years for depressive symptoms, 2.5 ± 2.9 years for mixed symptoms, 1.4 ± 1.6 years for hypomanic symptoms, and 0.4 ± 0.5 years for manic symptoms. A hierarchical clustering analysis revealed three patient-profiles: primarily hypomanic/manic, primarily depressive, and more rare, primarily mixed profile. Frequently reported symptoms prior to diagnosis include anhedonia (79%), irritability (71%), hyperactivity (62.5%), decreased energy (62.5%), and psychotic symptoms (52%).Symptoms of ADHD (19%), comorbid ADHD (15%), symptoms of anxiety (52%), comorbid anxiety (4%), suicidal thoughts (50%), suicide attempts (8%), cutting (23%), substance misuse (21%), and criminal activity (10%) were reported before incident BD diagnosis. CONCLUSION The observed patient-profiles leading to diagnosis were primarily manic or depressive, resembling presentations in adults. The presence of ADHD, anxiety, suicide attempts, cutting, and criminal activity prior to diagnosis emphasizes the need for treatment of children and adolescents with affective symptoms. The gap from appearance of the symptoms to diagnosis suggests a window for earlier treatment.
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Affiliation(s)
- Mathilde Frahm Laursen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christoph U Correll
- Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, New York, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine, Hempstead, NY, USA.,Center for Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Rasmus W Licht
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - María Rodrigo-Domingo
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Ernst Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
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Mylona I, Floros GD. Blue Light Blocking Treatment for the Treatment of Bipolar Disorder: Directions for Research and Practice. J Clin Med 2022; 11:jcm11051380. [PMID: 35268469 PMCID: PMC8911317 DOI: 10.3390/jcm11051380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023] Open
Abstract
Recent results from a small number of clinical studies have resulted in the suggestion that the process of blocking the transmission of shorter-wavelength light (‘blue light’ with a wave length of 450 nm to 470 nm) may have a beneficial role in the treatment of bipolar disorder. This critical review will appraise the quality of evidence so far as to these claims, assess the neurobiology that could be implicated in the underlying processes while introducing a common set of research criteria for the field.
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Affiliation(s)
- Ioanna Mylona
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Georgios D. Floros
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-69-4432-4565
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Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Family Genetic Risk Scores and the Genetic Architecture of Major Affective and Psychotic Disorders in a Swedish National Sample. JAMA Psychiatry 2021; 78:735-743. [PMID: 33881469 PMCID: PMC8060884 DOI: 10.1001/jamapsychiatry.2021.0336] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/11/2021] [Indexed: 11/14/2022]
Abstract
Importance Family and genetic approaches have traditionally been used to evaluate our diagnostic concepts. Using a novel method, the family genetic risk score (FGRS), can we validate the genetic architecture of major affective and psychotic disorders in a national Swedish sample? Objective To determine whether FGRSs, calculated for the entire Swedish population, can elucidate the genetic relationship between major affective and psychotic disorders and clarify the association of genetic risk with important clinical features of disease. Design, Setting, and Participants This cohort study included the native Swedish population born from January 1, 1950, through December 31, 1995, and followed up through December 31, 2017. Data were collected from Swedish population-based primary care, specialist, and hospital registers, including age at first registration for a psychiatric diagnosis and number of registrations for major depression, bipolar disorder, and schizophrenia. Data were analyzed from October 15, 2020, to February 2, 2021. Exposures FGRSs for major depression, bipolar disorder, and schizophrenia calculated from morbidity risks for disorders in first- through fifth-degree relatives, controlling for cohabitation. Main Outcomes and Measures Diagnoses of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, and other nonaffective psychoses (ONAPs), age at registration, and number of registrations for major depression, bipolar disorder, and schizophrenia. Diagnostic conversion of major depression to bipolar disorder and ONAPs to schizophrenia was assessed by Cox proportional hazards regression models. Results The cohort included 4 129 002 individuals (51.4% male) with a mean (SD) age at follow-up of 45.5 (13.4) years. Mean FGRSs for major depression, bipolar disorder, and schizophrenia produced distinct patterns for major depression, bipolar disorder, schizophrenia, schizoaffective disorder, and ONAPs with large separations between disorders. In major depression, bipolar disorder, and schizophrenia, high FGRSs were associated with early age at onset and high rates of recurrence: a high mean FGRS for bipolar disorder was associated with early age at onset (younger than 25 years, 0.11; 95% CI, 0.11-0.12) and higher recurrence (8 or more registrations, 0.11; 95% CI, 0.11-0.12) in major depression. The schizophrenia FGRS was separately associated with psychotic and nonpsychotic forms of major depression (0.10; 95% CI, 0.06-0.14 vs 0.03; 95% CI, 0.02-0.03) and bipolar disorder (0.22; 95% CI, 0.16-0.28 vs 0.11; 95% CI, 0.09-0.12). The bipolar disorder and schizophrenia FGRSs were associated with conversion from major depression to bipolar disorder (eg, hazard ratio, 1.70 [95% CI, 1.63-1.78] for high vs low bipolar FGRS) and ONAP to schizophrenia (eg, hazard ratio, 1.38 [95% CI, 1.27-1.51] for high vs low schizophrenia FGRS). Conclusions and Relevance In this Swedish cohort study, the FGRSs for major depression, bipolar disorder, and schizophrenia for the Swedish population clearly separated major affective and psychotic disorders from each other in a larger and more representative patient sample than previously possible. These findings provide possible validation, from a genetic perspective, for these major diagnostic categories. These results replicated and extended prior observations on more limited samples of the association of FGRS with age at onset, recurrence, psychotic subtypes, and diagnostic conversions.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Barata PC, Godinho F, Guedes R, Silva L, Oliveira P, Serrano R, Oliveira CF, Pereira ME, Martins B, Araújo R, Borja-Santos JN, Maia T. Bipolar disorder diagnostic stability: a Portuguese multicentric study. Psychiatry Res 2020; 291:113255. [PMID: 32603931 DOI: 10.1016/j.psychres.2020.113255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Pedro Cabral Barata
- Departmento de Psiquiatria, Hospital Prof. Dr. Fernando Fonseca, EPE, Lisboa, Portugal.
| | - Filipe Godinho
- Departmento de Psiquiatria e Saúde Mental, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Renato Guedes
- Serviço de Psiquiatria, Centro Hospitalar São João, Porto, Portugal
| | - Luís Silva
- Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Pedro Oliveira
- Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Serrano
- Departmento de Psiquiatria, Hospital Prof. Dr. Fernando Fonseca, EPE, Lisboa, Portugal
| | | | - Maria Emília Pereira
- Serviço de Psiquiatria de Adultos, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal
| | - Beatriz Martins
- Departmento de Psiquiatria e Saúde Mental, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Rafael Araújo
- Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Teresa Maia
- Departmento de Psiquiatria, Hospital Prof. Dr. Fernando Fonseca, EPE, Lisboa, Portugal
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