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McCartan CJ, Yap J, Best P, Breedvelt J, Breslin G, Firth J, Tully MA, Webb P, White C, Gilbody S, Churchill R, Davidson G. Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence. Cochrane Database Syst Rev 2024; 6:CD013557. [PMID: 38837220 PMCID: PMC11152184 DOI: 10.1002/14651858.cd013557.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Mental health problems contribute significantly to the overall disease burden worldwide and are major causes of disability, suicide, and ischaemic heart disease. People with bipolar disorder report lower levels of physical activity than the general population, and are at greater risk of chronic health conditions including cardiovascular disease and obesity. These contribute to poor health outcomes. Physical activity has the potential to improve quality of life and physical and mental well-being. OBJECTIVES To identify the factors that influence participation in physical activity for people diagnosed with bipolar disorder from the perspectives of service users, carers, service providers, and practitioners to help inform the design and implementation of interventions that promote physical activity. SEARCH METHODS We searched MEDLINE, PsycINFO, and eight other databases to March 2021. We also contacted experts in the field, searched the grey literature, and carried out reference checking and citation searching to identify additional studies. There were no language restrictions. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that focused on the experiences and attitudes of service users, carers, service providers, and healthcare professionals towards physical activity for bipolar disorder. DATA COLLECTION AND ANALYSIS We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined questions. We used the "best fit" framework synthesis based on a revised version of the Health Belief Model to analyse and present the evidence. We assessed methodological limitations using the CASP Qualitative Checklist. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) guidance to assess our confidence in each finding. We examined each finding to identify factors to inform the practice of health and care professionals and the design and development of physical activity interventions for people with bipolar disorder. MAIN RESULTS We included 12 studies involving a total of 592 participants (422 participants who contributed qualitative data to an online survey, 170 participants in qualitative research studies). Most studies explored the views and experiences of physical activity of people with experience of bipolar disorder. A number of studies also reported on personal experiences of physical activity components of lifestyle interventions. One study included views from family carers and clinicians. The majority of studies were from high-income countries, with only one study conducted in a middle-income country. Most participants were described as stable and had been living with a diagnosis of bipolar disorder for a number of years. We downgraded our confidence in several of the findings from high confidence to moderate or low confidence, as some findings were based on only small amounts of data, and the findings were based on studies from only a few countries, questioning the relevance of these findings to other settings. We also had very few perspectives of family members, other carers, or health professionals supporting people with bipolar disorder. The studies did not include any findings from service providers about their perspectives on supporting this aspect of care. There were a number of factors that limited people's ability to undertake physical activity. Shame and stigma about one's physical appearance and mental health diagnosis were discussed. Some people felt their sporting skills/competencies had been lost when they left school. Those who had been able to maintain exercise through the transition into adulthood appeared to be more likely to include physical activity in their regular routine. Physical health limits and comorbid health conditions limited activity. This included bipolar medication, being overweight, smoking, alcohol use, poor diet and sleep, and these barriers were linked to negative coping skills. Practical problems included affordability, accessibility, transport links, and the weather. Workplace or health schemes that offered discounts were viewed positively. The lack of opportunity for exercise within inpatient mental health settings was a problem. Facilitating factors included being psychologically stable and ready to adopt new lifestyle behaviours. There were positive benefits of being active outdoors and connecting with nature. Achieving balance, rhythm, and routine helped to support mood management. Fitting physical activity into a regular routine despite fluctuating mood or motivation appeared to be beneficial if practised at the right intensity and pace. Over- or under-exercising could be counterproductive and accelerate depressive or manic moods. Physical activity also helped to provide a structure to people's daily routines and could lead to other positive lifestyle benefits. Monitoring physical or other activities could be an effective way to identify potential triggers or early warning signs. Technology was helpful for some. People who had researched bipolar disorder and had developed a better understanding of the condition showed greater confidence in managing their care or providing care to others. Social support from friends/family or health professionals was an enabling factor, as was finding the right type of exercise, which for many people was walking. Other benefits included making social connections, weight loss, improved quality of life, and better mood regulation. Few people had been told of the benefits of physical activity. Better education and training of health professionals could support a more holistic approach to physical and mental well-being. Involving mental health professionals in the multidisciplinary delivery of physical activity interventions could be beneficial and improve care. Clear guidelines could help people to initiate and incorporate lifestyle changes. AUTHORS' CONCLUSIONS There is very little research focusing on factors that influence participation in physical activity in bipolar disorder. The studies we identified suggest that men and women with bipolar disorder face a range of obstacles and challenges to being active. The evidence also suggests that there are effective ways to promote managed physical activity. The research highlighted the important role that health and care settings, and professionals, can play in assessing individuals' physical health needs and how healthy lifestyles may be promoted. Based on these findings, we have provided a summary of key elements to consider for developing physical activity interventions for bipolar disorder.
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Affiliation(s)
- Claire J McCartan
- IMPACT Research Centre, Northern Health & Social Care Trust, Antrim, UK
| | - Jade Yap
- Mental Health Foundation, London, UK
| | - Paul Best
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - Josefien Breedvelt
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gavin Breslin
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Joseph Firth
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | | | | | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Gavin Davidson
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
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Rogliani P, Laitano R, Ora J, Beasley R, Calzetta L. Strength of association between comorbidities and asthma: a meta-analysis. Eur Respir Rev 2023; 32:32/167/220202. [PMID: 36889783 PMCID: PMC10032614 DOI: 10.1183/16000617.0202-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The strength of association between comorbidities and asthma has never been ranked in relation to the prevalence of the comorbidity in the nonasthma population. We investigated the strength of association between comorbidities and asthma. METHODS A comprehensive literature search was performed for observational studies reporting data on comorbidities in asthma and nonasthma populations. A pairwise meta-analysis was performed and the strength of association calculated by anchoring odds ratios and 95% confidence intervals with the rate of comorbidities in nonasthma populations via Cohen's d method. Cohen's d=0.2, 0.5 and 0.8 were cut-off values for small, medium and large effect sizes, respectively; very large effect size resulted for Cohen's d >0.8. The review was registered in the PROSPERO database; identifier number CRD42022295657. RESULTS Data from 5 493 776 subjects were analysed. Allergic rhinitis (OR 4.24, 95% CI 3.82-4.71), allergic conjunctivitis (OR 2.63, 95% CI 2.22-3.11), bronchiectasis (OR 4.89, 95% CI 4.48-5.34), hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06-8.90) and nasal congestion (OR 3.30, 95% CI 2.96-3.67) were strongly associated with asthma (Cohen's d >0.5 and ≤0.8); COPD (OR 6.23, 95% CI 4.43-8.77) and other chronic respiratory diseases (OR 12.85, 95% CI 10.14-16.29) were very strongly associated with asthma (Cohen's d >0.8). Stronger associations were detected between comorbidities and severe asthma. No bias resulted according to funnel plots and Egger's test. CONCLUSION This meta-analysis supports the relevance of individualised strategies for disease management that look beyond asthma. A multidimensional approach should be used to assess whether poor symptom control is related to uncontrolled asthma or to uncontrolled underlying comorbidities.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Rossella Laitano
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Josuel Ora
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
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Revisiting the bipolar disorder with migraine phenotype: Clinical features and comorbidity. J Affect Disord 2021; 295:156-162. [PMID: 34464877 DOI: 10.1016/j.jad.2021.08.026] [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: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION To evaluate the prevalence and clinical correlates of lifetime migraine among patients with bipolar disorder (BD). METHODS In a cross-sectional study, we evaluated 721 adults with BD from the Mayo Clinic Bipolar Disorder Biobank and compared clinical correlates of those with and without a lifetime history of migraine. A structured clinical interview (DSM-IV) and a clinician-assessed questionnaire were utilized to establish a BD diagnosis, lifetime history of migraine, and clinical correlates. RESULTS Two hundred and seven (29%) BD patients had a lifetime history of migraine. BD patients with migraine were younger and more likely to be female as compared to those without migraine (p values <0.01). In a multivariate logistic regression model, younger age (OR=0.98, p<0.01), female sex (OR=2.02, p<0.01), higher shape/weight concern (OR=1.04, p=0.02), greater anxiety disorder comorbidities (OR=1.24, p<0.01), and evening chronotype (OR=1.65, p=0.03) were associated with migraine. In separate regression models for each general medical comorbidity (controlled for age, sex, and site), migraines were significantly associated with fibromyalgia (OR=3.17, p<0.01), psoriasis (OR=2.65, p=0.03), and asthma (OR=2.0, p<0.01). Participants with migraine were receiving ADHD medication (OR=1.53, p=0.05) or compounds associated with weight loss (OR=1.53, p=0.02) at higher rates compared to those without migraine. LIMITATIONS Study design precludes determination of causality. Migraine subtypes and features were not assessed. CONCLUSIONS Migraine prevalence is high in BD and is associated with a more severe clinical burden that includes increased comorbidity with pain and inflammatory conditions. Further study of the BD-migraine phenotype may provide insight into common underlying neurobiological mechanisms.
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Jeyagurunathan A, Abdin E, Shafie S, Sambasivam R, Yunjue Z, Chua BY, Vaingankar JA, Verma S, Ee TW, Chong SA, Subramaniam M. Asthma Prevalence and its Risk Factors Among a Multi-Ethnic Adult Population. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:417-427. [PMID: 34602881 PMCID: PMC8461573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Asthma is a substantial global health problem characterized by chronic airway inflammation, leading to intermittent symptoms. This study aims to establish the prevalence and risk factors of asthma in a multi-ethnic adult population. Data for the study were extracted from the Singapore Mental Health Study 2016, a population-based, cross-sectional, epidemiological study of Singapore residents aged 18 years and above. The data relating to asthma prevalence was captured using the modified World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0 chronic conditions checklist. The prevalence of lifetime asthma in this population was 11.9% (95% CI, 10.83-13.12). Those of Malay and Indian ethnicity (versus Chinese), ex-smokers (versus never smoked) and those who were overweight and obese (versus normal weight) were more likely to be associated with asthma. Participants belonging to the age group of 35 years and above (versus 18-34 years of age), male gender (versus female) were less likely to be associated with lifetime asthma. Asthma was also more likely to be associated with bipolar disorder. Those with current asthma (ie, those who had received treatment during the past 12 months) were significantly associated with lower health-related quality of life in the physical component score (PCS) than those without asthma. The high prevalence and association with lowered health-related quality of life makes asthma a significant public health concern. Our study's findings can help create awareness and encourage integrated approaches for managing asthma in the health sector.
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Affiliation(s)
- Anitha Jeyagurunathan
- Research Division, Institute of Mental Health (IMH),
Singapore,To whom all correspondence should be addressed:
Anitha Jeyagurunathan, MSW, Mphil, Principal Research Officer, Research
Division, Institute of Mental Health, Buangkok Green Medical Park, Singapore;
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health (IMH),
Singapore
| | | | - Zhang Yunjue
- Research Division, Institute of Mental Health (IMH),
Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health (IMH),
Singapore
| | | | - Swapna Verma
- Department of Psychosis and East Region, IMH,
Singapore
| | - Tang Wern Ee
- National Healthcare Group Polyclinics, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health (IMH),
Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health (IMH),
Singapore,Saw Swee Hock School of Public Health, Singapore
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Hossain SF, Huang M, Ono N, Morita A, Kanaya S, Altaf-Ul-Amin M. Development of a biomarker database toward performing disease classification and finding disease interrelations. DATABASE-THE JOURNAL OF BIOLOGICAL DATABASES AND CURATION 2021; 2021:6168336. [PMID: 33705530 PMCID: PMC7951048 DOI: 10.1093/database/baab011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022]
Abstract
A biomarker is a measurable indicator of a disease or abnormal state of a body that plays an important role in disease diagnosis, prognosis and treatment. The biomarker has become a significant topic due to its versatile usage in the medical field and in rapid detection of the presence or severity of some diseases. The volume of biomarker data is rapidly increasing and the identified data are scattered. To provide comprehensive information, the explosively growing data need to be recorded in a single platform. There is no open-source freely available comprehensive online biomarker database. To fulfill this purpose, we have developed a human biomarker database as part of the KNApSAcK family databases which contain a vast quantity of information on the relationships between biomarkers and diseases. We have classified the diseases into 18 disease classes, mostly according to the National Center for Biotechnology Information definitions. Apart from this database development, we also have performed disease classification by separately using protein and metabolite biomarkers based on the network clustering algorithm DPClusO and hierarchical clustering. Finally, we reached a conclusion about the relationships among the disease classes. The human biomarker database can be accessed online and the inter-disease relationships may be helpful in understanding the molecular mechanisms of diseases. To our knowledge, this is one of the first approaches to classify diseases based on biomarkers. Database URL: http://www.knapsackfamily.com/Biomarker/top.php.
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Affiliation(s)
- Shaikh Farhad Hossain
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Ming Huang
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Naoaki Ono
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Aki Morita
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Shigehiko Kanaya
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Md Altaf-Ul-Amin
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
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McCartan CJ, Yap J, Firth J, Stubbs B, Tully MA, Best P, Webb P, White C, Gilbody S, Churchill R, Breedvelt JJF, Davidson G. Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence. Hippokratia 2020. [DOI: 10.1002/14651858.cd013557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Claire J McCartan
- Queen's University Belfast; Centre for Evidence & Social Innovation, School of Social Sciences, Education & Social Work; 6 College Park Belfast Northern Ireland UK BT7 1LP
| | - Jade Yap
- Mental Health Foundation; London UK
| | - Joseph Firth
- University of Manchester; Division of Psychology & Mental Health; Manchester UK
| | - Brendon Stubbs
- Kings College London; Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Mark A Tully
- Ulster University; Institute of Mental Health Sciences, School of Health Sciences; Shore Road Newtownabbey Northern Ireland UK BT37 0QB
| | - Paul Best
- Queen's University Belfast; Centre for Evidence & Social Innovation, School of Social Sciences, Education & Social Work; 6 College Park Belfast Northern Ireland UK BT7 1LP
| | | | | | - Simon Gilbody
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; Seebohm Rowntree Building York UK YO10 5DD
| | - Rachel Churchill
- University of York; Centre for Reviews and Dissemination; Heslington York UK YO10 5DD
- University of York; Cochrane Common Mental Disorders; York - None - UK Y010 5DD
| | | | - Gavin Davidson
- Queen's University Belfast; Centre for Evidence & Social Innovation, School of Social Sciences, Education & Social Work; 6 College Park Belfast Northern Ireland UK BT7 1LP
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Win-Shwe TT, Yanagisawa R, Koike E, Takano H. Memory Function, Neurological, and Immunological Biomarkers in Allergic Asthmatic Mice Intratracheally Exposed to Bisphenol A. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193770. [PMID: 31597243 PMCID: PMC6801617 DOI: 10.3390/ijerph16193770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/29/2019] [Accepted: 10/04/2019] [Indexed: 01/07/2023]
Abstract
Bisphenol A (BPA) is a major constituent of plastic products, including epoxy resin containers, mobile phones, dental sealants, as well as electronic and medical equipment. BPA is recognized as an endocrine system-disrupting chemical which has toxic effects on the brain and reproductive system. However, little is known about the effects of co-exposure of BPA with allergens on the memory function and neurological as well as immunological biomarker levels. In this study, we examined the effects of intratracheal instillation of BPA on the memory function and neuroimmune biomarker levels using a mouse model of allergic asthma. Male C3H/HeJ Jcl mice were given three doses of BPA (0.0625 pmol, 1.25 pmol, and 25 pmol BPA/animal) intratracheally once a week, and ovalbumin (OVA) intratracheally every other week from 5 to 11 weeks old. At 11 weeks of age, a novel object recognition test was conducted after the final administration of OVA, and the hippocampi and hypothalami of the animals were collected after 24 h. The expression levels of the memory function-related genes N-methyl-D-aspartate (NMDA) receptor subunits, inflammatory cytokines, microglia markers, estrogen receptor-alpha, and oxytocin receptor were examined by real-time RT-PCR (real-time reverse transcription polymerase chain reaction) and immunohistochemical methods. Impairment of the novel object recognition ability was observed in the high-dose BPA-exposed mice with allergic asthma. In addition, the allergic asthmatic mice also showed downregulation of neurological biomarkers, such as NMDA receptor subunit NR2B in the hippocampus but no significant effect on immunological biomarkers in the hypothalamus. These findings suggest that exposure to high-dose BPA triggered impairment of memory function in the allergic asthmatic mice. This is the first study to show that, in the presence of allergens, exposure to high-dose BPA may affect memory by modulating the memory function-related genes in the hippocampus.
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Affiliation(s)
- Tin-Tin Win-Shwe
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Rie Yanagisawa
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Eiko Koike
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Hirohisa Takano
- Environmental Health Sciences, Graduate School of Global Environmental Studies, Kyoto University, Kyoto 615-8540, Japan.
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Akula M, Kulikova A, Khan DA, Brown ES. The relationship between asthma and depression in a community-based sample. J Asthma 2018; 55:1271-1277. [PMID: 29336633 PMCID: PMC6212321 DOI: 10.1080/02770903.2017.1418885] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Asthma is an increasingly prevalent disease that is associated with substantial physical and financial burdens. Additionally, asthma is linked to psychiatric disorders. This study examines the relationship between asthma diagnosis, current depressive symptoms, and lifetime psychiatric disorder history in a large, community-based sample. METHODS We analyzed data from 2168 participants in the Dallas Heart Study, a large, diverse, community-based sample of people designed to be representative of the Dallas County population. Logistic regressions analyzing the relationship between asthma diagnosis and history of a psychiatric disorder, as well as between asthma diagnosis and the Quick Inventory of Depressive Symptomatology (QIDS) scores were performed, controlling for demographic data. RESULTS 13.4% of the sample had an asthma diagnosis. Asthma diagnosis was significantly associated with a history of nervous, emotional, or mental health disorder diagnosis [OR 1.810 (95% CI 1.280-2.559) p = 0.001], and with QIDS scores consistent with moderate or greater current depressive symptom severity [OR 1.586 (95%CI 1.106-2.274) p = 0.012]. The relationships were not moderated by age, gender, race, smoking status, or Body Mass Index. CONCLUSIONS A diagnosis of asthma may be associated with current clinically significant levels of depressive symptoms and a lifetime psychiatric disorder. The current report adds to the existing literature in this area by assessing both current and lifetime symptoms and by using a large and diverse population. The findings highlight the clinical importance of considering the possibility of psychiatric illness in asthma patients and suggest further research in this area is needed.
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Affiliation(s)
- Mahima Akula
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - Alexandra Kulikova
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - David A. Khan
- Internal Medicine, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - E. Sherwood Brown
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
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Gender Differences and Comorbidities in U.S. Adults with Bipolar Disorder. Brain Sci 2018; 8:brainsci8090168. [PMID: 30200460 PMCID: PMC6162692 DOI: 10.3390/brainsci8090168] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Past studies have evaluated the association of various comorbidities with bipolar disorder. This study analyzes differences in the prevalence and association of medical and psychiatric comorbidities in bipolar patients by gender. Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (2010–2014). Using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes, we narrowed the study population to comprise those with a primary diagnosis of bipolar disorder and then obtained information about comorbidities. The differences in comorbidities by gender were quantified using chi-square tests and the logistic regression model (odds ratio (OR)). Results: Hypertension (20.5%), asthma (12.5%) and hypothyroidism (8.1%) were the top medical comorbidities found in bipolar patients. Migraine and hypothyroidism were seen three times higher in females (OR = 3.074 and OR = 3.001; respectively). Females with bipolar disorder had higher odds of comorbid inflammatory disorders like asthma (OR = 1.755), Crohn’s disease (OR = 1.197) and multiple sclerosis (OR = 2.440) compared to males. Females had a two-fold higher likelihood of comorbid post-traumatic stress disorder (PTSD) (OR = 2.253) followed by personality disorders (OR = 1.692) and anxiety disorders (OR = 1.663) compared to males. Conclusion: Women with bipolar disorder have a much higher medical comorbidity burden than men and may highly benefit from an integrated team of physicians to manage their condition and improve their health-related quality of life.
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Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol 2018; 8:251-269. [PMID: 30181867 PMCID: PMC6116765 DOI: 10.1177/2045125318769235] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/13/2018] [Indexed: 12/20/2022] Open
Abstract
Bipolar disorder is a multifactorial illness with uncertain aetiology. Knowledge of potential risk factors enables clinicians to identify patients who are more likely to develop bipolar disorder, which directs further investigation, follow up and caution when prescribing. Ideally, identifying directly causative factors for bipolar disorder would enable intervention on an individual or population level to prevent the development of the illness, and improve outcomes through earlier treatment. This article reviews the epidemiology of bipolar disorder, along with putative demographic, genetic and environmental risk factors, while assessing the strength of these associations and to what extent they might be said to be 'causative'. While numerous genetic and environmental risk factors have been identified, the attributable risk of individual factors is often small, and most are not specific to bipolar disorder but are associated with several mental illnesses. Therefore, while some genetic and environmental factors have strong evidence supporting their association with bipolar disorder, fewer have sufficient evidence to establish causality. There is increasing interest in the role of specific gene-environment interactions, as well as the mechanisms by which risk factors interact to lead to bipolar disorder.
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Affiliation(s)
- Tobias A Rowland
- Unit of Mental Health and Wellbeing, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Steven Marwaha
- Division of Health Sciences, University of Warwick, Coventry, UK
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ITGB4 deficiency in bronchial epithelial cells directs airway inflammation and bipolar disorder-related behavior. J Neuroinflammation 2018; 15:246. [PMID: 30170608 PMCID: PMC6117971 DOI: 10.1186/s12974-018-1283-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic persistent airway inflammation has been associated with the comorbidity of asthma and bipolar disorder (BD). However, the direct relevance between airway inflammation and BD-like psychiatric comorbidity is almost unknown. Integrin β4 (ITGB4) is downregulated on the airway epithelial of asthma patients, which might play a critical role in the parthenogenesis of airway inflammation. So this study aimed to examine the role of ITGB4 deficiency in mediating airway inflammation and further leading to the BD-like behaviors. METHODS ITGB4-/- mice were generated by mating ITGB4fl/fl mice with CCSP-rtTAtg/-/TetO-Cretg/tg mice. Mania-like behavior tests were performed, including hyperlocomotion, D-amphetamine-induced hyperactivity, open-field test, and elevated plus-maze test. Depressive-like behavior tests were carried out, including sucrose preference, forced swimming, and learned helplessness. Inflammatory cells (Th17, Th1, Th2) in the lung were examined by flow cytometry. Futhermore, inflammatory cytokines (IL-4, IL-13) in bronchoalveolar lavage fluid and sera were detected by ELISA. Protein expression of the IL-4Rα on choroid plexus, microglial marker (IBA1), and synapse-associated proteins (synaptophysin, SYP) in the hippocampus and prefrontal cortex were examined by western blotting. Additionally, proinflammatory cytokines (IL-1β, IL-6, and TNF-α) in the hippocampus and prefrontal cortex were detected by immunohistochemistry. Inflammatory disorder in the lung, hippocampus, and prefrontal cortex was tested by hematoxylin and eosin (H&E) staining. And cell apoptosis in the hippocampus and prefrontal cortex was measured by TUNEL test. RESULTS ITGB4-/- mice exhibited mania-like behavior, including hyperlocomotion, D-amphetamine-induced hyperactivity, and reduced anxiety-like behavior. While under stressful conditions, ITGB4-/- mice manifested depressive-like behavior, including anhedonia, behavioral despair, and enhanced learned helplessness. At the same time, ITGB4-/- mice mainly exerted Th2-type inflammation in periphery, like the number and major cytokines IL-4 and IL-13 of Th2-type inflammation. ITGB4-/- mice also showed a significant increase of microglia and pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α in the hippocampus and prefrontal cortex. Additionally, neuron damage, increased neuron apoptosis, and the decrease of SYP were found in ITGB4-/- mice. CONCLUSIONS These findings confirmed that airway inflammatory induced by ITGB4 deficiency is the important incentive for the BD-like behavior during asthma pathogenesis. The ITGB4-deficient mice provide a validated animal model for us to study the possible mechanism of BD-like psychiatric comorbidity of asthma patients.
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Abstract
PURPOSE OF REVIEW Bipolar disorder (BD) medical comorbidity presents significant clinical and public health concerns with serious impact on health. The aim of this article is to present an updated narrative review of original research articles (case control, longitudinal cohort, and cross-sectional studies) and meta-analyses published in English language journals from January 2013 to May 2017 focusing on general medical comorbidity in BD, including the added risks of iatrogenic factors relevant to the treatment of BD. RECENT FINDINGS We found numerous patterns of association between BD and various medical disorders involving multiple organ systems. One pattern indicated reciprocal increase in the rate of each comorbid condition, such as an increased rate of BD in asthma or migraine, and likewise an increase in the rate of asthma or migraine in patients with BD. A second pattern was a predominantly unidirectional increase in the rate of BD in patients with certain medical disorders, such as multiple sclerosis or cerebellar diseases. A third pattern was a predominantly unidirectional increased rate of medical disorders in patients with BD. One study suggested the potential involvement of genetic mechanisms for the association between BD and migraine. Most of the studies had cross-sectional or retrospective designs, and many relied on analysis of large administrative databases inviting multiple potential biases. Our review highlights the association between BD and a variety of medical disorders. Further research is needed to elucidate the potential underlying etiopathological mechanisms that contribute to observed comorbidities. The results of this review also emphasize the need for comprehensive screening for medical disorders in BD and for adoption of an integrated model of care to address these complex comorbidities.
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Affiliation(s)
- Aktriti Sinha
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Anam Shariq
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Khaled Said
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Abhinav Sharma
- Homewood Health Center, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
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Hiyoshi A, Sabet JA, Sjöqvist H, Melinder C, Brummer RJ, Montgomery S. Precursors in adolescence of adult-onset bipolar disorder. J Affect Disord 2017; 218:353-358. [PMID: 28499209 DOI: 10.1016/j.jad.2017.04.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/28/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although the estimated contribution of genetic factors is high in bipolar disorder, environmental factors may also play a role. This Swedish register-based cohort study of men examined if physical and psychological characteristics in late adolescence, including factors previously linked with bipolar disorder (body mass index, asthma and allergy), are associated with subsequent bipolar disorder in adulthood. Unipolar depression and anxiety are analysed as additional outcomes to identify bipolar disorder-specific associations. METHODS A total of 213,693 men born between 1952 and 1956, who participated in compulsory military conscription assessments in late adolescence were followed up to 2009, excluding men with any psychiatric diagnoses at baseline. Cox regression estimated risk of bipolar disorder, depression and anxiety in adulthood associated with body mass index, asthma, allergy, muscular strength stress resilience and cognitive function in adolescence. RESULTS BMI, asthma and allergy were not associated with bipolar disorder. Higher grip strength, cognitive function and stress resilience were associated with a reduced risk of bipolar disorder and the other disease outcomes. LIMITATIONS The sample consisted only of men; even though the characteristics in adolescence pre-dated disease onset, they may have been the consequence of prodromal disease. CONCLUSIONS Associations with body mass index and asthma found by previous studies may be consequences of bipolar disorder or its treatment rather than risk factors. Inverse associations with all the outcome diagnoses for stress resilience, muscular strength and cognitive function may reflect general risks for these psychiatric disorders or intermediary factors.
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Affiliation(s)
- Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden.
| | - Julia A Sabet
- Nutrition Gut Brain Interactions Research Centre, School of Medical Sciences, Örebro University, Sweden
| | - Hugo Sjöqvist
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden; Department of Statistics, Örebro University, Sweden
| | - Carren Melinder
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden
| | - Robert J Brummer
- Nutrition Gut Brain Interactions Research Centre, School of Medical Sciences, Örebro University, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden; Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK
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Bortolato B, Köhler CA, Evangelou E, León-Caballero J, Solmi M, Stubbs B, Belbasis L, Pacchiarotti I, Kessing LV, Berk M, Vieta E, Carvalho AF. Systematic assessment of environmental risk factors for bipolar disorder: an umbrella review of systematic reviews and meta-analyses. Bipolar Disord 2017; 19:84-96. [PMID: 28470927 DOI: 10.1111/bdi.12490] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The pathophysiology of bipolar disorder is likely to involve both genetic and environmental risk factors. In our study, we aimed to perform a systematic search of environmental risk factors for BD. In addition, we assessed possible hints of bias in this literature, and identified risk factors supported by high epidemiological credibility. METHODS We searched the Pubmed/MEDLINE, EMBASE and PsycInfo databases up to 7 October 2016 to identify systematic reviews and meta-analyses of observational studies that assessed associations between putative environmental risk factors and BD. For each meta-analysis, we estimated its summary effect size by means of both random- and fixed-effects models, 95% confidence intervals (CIs), the 95% prediction interval, and heterogeneity. Evidence of small-study effects and excess of significance bias was also assessed. RESULTS Sixteen publications met the inclusion criteria (seven meta-analyses and nine qualitative systematic reviews). Fifty-one unique environmental risk factors for BD were evaluated. Six meta-analyses investigated associations with a risk factor for BD. Only irritable bowel syndrome (IBS) emerged as a risk factor for BD supported by convincing evidence (k=6; odds ratio [OR]=2.48; 95% CI=2.35-2.61; P<.001), and childhood adversity was supported by highly suggestive evidence. Asthma and obesity were risk factors for BD supported by suggestive evidence, and seropositivity to Toxoplasma gondii and a history of head injury were supported by weak evidence. CONCLUSIONS Notwithstanding that several environmental risk factors for BD were identified, few meta-analyses of observational studies were available. Therefore, further well-designed and adequately powered studies are necessary to map the environmental risk factors for BD.
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Affiliation(s)
- Beatrice Bortolato
- Institute for clinical Research and Education in Medicine, I.R.E.M., Padova, Italy
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jordi León-Caballero
- Bipolar Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Universidad Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Marco Solmi
- Institute for clinical Research and Education in Medicine, I.R.E.M., Padova, Italy.,Department of Neurosciences, University of Padova, Padova, Italy.,Local Health Unit 17 ULSS 17, Mental Health Department, Padova, Italy.,Department of Medicine, DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Lazaros Belbasis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Isabella Pacchiarotti
- Bipolar Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lars V Kessing
- Psychiatric Centre Copenhagen, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Berk
- IMPACT Strategic Research Centre (Barwon Health), School of Medicine, Deakin University, Geelong, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Eduard Vieta
- Bipolar Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - André F Carvalho
- Institute for clinical Research and Education in Medicine, I.R.E.M., Padova, Italy.,Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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