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de Girolamo G, Andreassen OA, Bauer M, Brambilla P, Calza S, Citerà N, Corcoy R, Fagiolini A, Garcia-Argibay M, Godin O, Klingler F, Kobayashi NF, Larsson H, Leboyer M, Matura S, Martinelli A, De la Peña-Arteaga V, Poli R, Reif A, Ritter P, Rødevand LN, Magno M, Caselani E. Medical comorbidities in bipolar disorder (BIPCOM): clinical validation of risk factors and biomarkers to improve prevention and treatment. Study protocol. Int J Bipolar Disord 2024; 12:15. [PMID: 38703295 PMCID: PMC11069492 DOI: 10.1186/s40345-024-00337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND BIPCOM aims to (1) identify medical comorbidities in people with bipolar disorder (BD); (2) examine risk factors and clinical profiles of Medical Comorbidities (MC) in this clinical group, with a special focus on Metabolic Syndrome (MetS); (3) develop a Clinical Support Tool (CST) for the personalized management of BD and medical comorbidities. METHODS The BIPCOM project aims to investigate MC, specifically MetS, in individuals with BD using various approaches. Initially, prevalence rates, characteristics, genetic and non-genetic risk factors, and the natural progression of MetS among individuals with BD will be assessed by analysing Nordic registers, biobanks, and existing patient datasets from 11 European recruiting centres across 5 countries. Subsequently, a clinical study involving 400 participants from these sites will be conducted to examine the clinical profiles and incidence of specific MetS risk factors over 1 year. Baseline assessments, 1-year follow-ups, biomarker analyses, and physical activity measurements with wearable biosensors, and focus groups will be performed. Using this comprehensive data, a CST will be developed to enhance the prevention, early detection, and personalized treatment of MC in BD, by incorporating clinical, biological, sex and genetic information. This protocol will highlight the study's methodology. DISCUSSION BIPCOM's data collection will pave the way for tailored treatment and prevention approaches for individuals with BD. This approach has the potential to generate significant healthcare savings by preventing complications, hospitalizations, and emergency visits related to comorbidities and cardiovascular risks in BD. BIPCOM's data collection will enhance BD patient care through personalized strategies, resulting in improved quality of life and reduced costly interventions. The findings of the study will contribute to a better understanding of the relationship between medical comorbidities and BD, enabling accurate prediction and effective management of MetS and cardiovascular diseases. TRIAL REGISTRATION ISRCTN68010602 at https://www.isrctn.com/ISRCTN68010602 . Registration date: 18/04/2023.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Ole A Andreassen
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Nicholas Citerà
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Corcoy
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, Division of Psychiatry, University of Siena School of Medicine, Siena, Italy
| | - Miguel Garcia-Argibay
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France
| | - Florian Klingler
- Deutsche Gesellschaft Für Bipolare Störungen (DGBS) E.V, Hamburg, Germany
| | - Nene F Kobayashi
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France
- Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Alessandra Martinelli
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Víctor De la Peña-Arteaga
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Roberto Poli
- Department of Mental Health, Psychiatric Unit of Cremona General Hospital, Azienda Ospedaliera di Cremona, Cremona, Italy
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Linn N Rødevand
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Marta Magno
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elisa Caselani
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Kozicky JM, Schaffer A, Beaulieu S, McIntosh D, Yatham LN. Use of a point-of-care web-based application to enhance adherence to the CANMAT and ISBD 2018 guidelines for the management of bipolar disorder. Bipolar Disord 2022; 24:392-399. [PMID: 34599641 DOI: 10.1111/bdi.13136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES While clinical guidelines exist for the management of bipolar disorder (BD), there are significant challenges to their widespread dissemination and implementation in clinical practice. The Canadian Network of Mood and Anxiety Treatment Improving Patient Care and Outcomes in the Treatment of Bipolar Disorder (C-IMPACT BD) web-based application was developed for use at the point-of-care to improve adherence to guidelines for evidence-based pharmacological management of BD. METHODS C-IMPACT BD uses a point-of-care practice assessment which, via adaptive questioning of patient-specific information, text/video descriptions of the guidelines, and pop-up prompts delivers personalized, evidence-based treatment recommendations for patients with BD. In order to inform quality improvement of the newly developed tool, a sample of Canadian physicians were invited to use the application and record its influence on their prescribing behavior. RESULTS Of 375 patients with bipolar I (BD-I) or bipolar II (BD-II) disorder for whom a point-of-care practice assessment was completed, a change in therapy was considered for 225 (60.0%). Prior to completing the assessment, 59.6% of these patients were receiving first-line therapy recommended for their phase of illness. Following the assessment, the overall number of patients for whom a first-line recommended therapy was being considered increased significantly to 76.9% (p = 0.0001). CONCLUSIONS Outcomes suggest that the C-IMPACT BD web-based application has the potential to improve physician adherence to clinical treatment guidelines. Formal research investigations are warranted to explore the impact of this tool on physician prescribing behavior and patient outcomes.
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Affiliation(s)
- Jan-Marie Kozicky
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Doney E, Cadoret A, Dion‐Albert L, Lebel M, Menard C. Inflammation-driven brain and gut barrier dysfunction in stress and mood disorders. Eur J Neurosci 2022; 55:2851-2894. [PMID: 33876886 PMCID: PMC9290537 DOI: 10.1111/ejn.15239] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
Abstract
Regulation of emotions is generally associated exclusively with the brain. However, there is evidence that peripheral systems are also involved in mood, stress vulnerability vs. resilience, and emotion-related memory encoding. Prevalence of stress and mood disorders such as major depression, bipolar disorder, and post-traumatic stress disorder is increasing in our modern societies. Unfortunately, 30%-50% of individuals respond poorly to currently available treatments highlighting the need to further investigate emotion-related biology to gain mechanistic insights that could lead to innovative therapies. Here, we provide an overview of inflammation-related mechanisms involved in mood regulation and stress responses discovered using animal models. If clinical studies are available, we discuss translational value of these findings including limitations. Neuroimmune mechanisms of depression and maladaptive stress responses have been receiving increasing attention, and thus, the first part is centered on inflammation and dysregulation of brain and circulating cytokines in stress and mood disorders. Next, recent studies supporting a role for inflammation-driven leakiness of the blood-brain and gut barriers in emotion regulation and mood are highlighted. Stress-induced exacerbated inflammation fragilizes these barriers which become hyperpermeable through loss of integrity and altered biology. At the gut level, this could be associated with dysbiosis, an imbalance in microbial communities, and alteration of the gut-brain axis which is central to production of mood-related neurotransmitter serotonin. Novel therapeutic approaches such as anti-inflammatory drugs, the fast-acting antidepressant ketamine, and probiotics could directly act on the mechanisms described here improving mood disorder-associated symptomatology. Discovery of biomarkers has been a challenging quest in psychiatry, and we end by listing promising targets worth further investigation.
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Affiliation(s)
- Ellen Doney
- Department of Psychiatry and NeuroscienceFaculty of Medicine and CERVO Brain Research CenterUniversité LavalQCCanada
| | - Alice Cadoret
- Department of Psychiatry and NeuroscienceFaculty of Medicine and CERVO Brain Research CenterUniversité LavalQCCanada
| | - Laurence Dion‐Albert
- Department of Psychiatry and NeuroscienceFaculty of Medicine and CERVO Brain Research CenterUniversité LavalQCCanada
| | - Manon Lebel
- Department of Psychiatry and NeuroscienceFaculty of Medicine and CERVO Brain Research CenterUniversité LavalQCCanada
| | - Caroline Menard
- Department of Psychiatry and NeuroscienceFaculty of Medicine and CERVO Brain Research CenterUniversité LavalQCCanada
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Menon V, Ransing R, Praharaj SK. Management of Psychiatric Disorders in Patients with Hepatic and Gastrointestinal Diseases. Indian J Psychiatry 2022; 64:S379-S393. [PMID: 35602369 PMCID: PMC9122174 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walalwalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India E-mail:
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Dalkner N, Wagner-Skacel J, Ratzenhofer M, Fellendorf F, Lenger M, Maget A, Tmava-Berisha A, Pilz R, Queissner R, Hamm C, Bengesser S, Platzer M, Birner A, Reininghaus E. Psychological symptoms during and after Austrian first lockdown in individuals with bipolar disorder? A follow-up control-group investigation. Int J Bipolar Disord 2021; 9:16. [PMID: 34059980 PMCID: PMC8166528 DOI: 10.1186/s40345-021-00222-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group. METHODS An online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2). RESULTS At T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients. CONCLUSIONS There was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.
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Affiliation(s)
- Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria.
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, Graz, 8036, Austria
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A Case of Lung Cancer with Brain Metastasis following Late-Onset Bipolar Disorder. Behav Neurol 2021; 2021:8880539. [PMID: 33868511 PMCID: PMC8034995 DOI: 10.1155/2021/8880539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/29/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To describe a case of lung cancer with brain metastasis in a patient who developed new late-onset bipolar disorder 2 years previously. Background The typical onset age of bipolar disorder is approximately 20, and the first episode is usually a depressive episode. It is still not clear which age-specific factors contribute to the underlying risk. Materials and Methods A 65-year-old male patient presented with a new-onset manic episode characterized by labile mood, impulsivity, decreased need for sleep, and grandiosity. He was diagnosed with late-onset bipolar disorder after excluding other possible physiological conditions. He was hospitalized in the acute psychiatric ward, and a combination of mood stabilizers and antipsychotics was prescribed. His mental condition improved, and he remained stable for 2 years. However, he experienced abrupt cognitive decline for 2 months and was referred to the emergency room for physiological examination. Results The patient was diagnosed with lung cancer with brain metastasis by brain magnetic resonance imaging and whole-body positron emission tomography. Conclusion In geriatric patients, who are at high risk of multiple medical conditions, excluding secondary causes of bipolar disorder is important.
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Fürtjes AE, Coleman JRI, Tyrrell J, Lewis CM, Hagenaars SP. Associations and limited shared genetic aetiology between bipolar disorder and cardiometabolic traits in the UK Biobank. Psychol Med 2021; 52:1-10. [PMID: 33766158 PMCID: PMC9811277 DOI: 10.1017/s0033291721000945] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with bipolar disorder (BPD) are more likely to die prematurely, which is partly attributed to comorbid cardiometabolic traits. Previous studies report cardiometabolic abnormalities in BPD, but their shared aetiology remains poorly understood. This study examined the phenotypic associations and shared genetic aetiology between BPD and various cardiometabolic traits. METHODS In a subset of the UK Biobank sample (N = 61 508) we investigated phenotypic associations between BPD (ncases = 4186) and cardiometabolic traits, represented by biomarkers, anthropometric traits and cardiometabolic diseases. To determine shared genetic aetiology in European ancestry, polygenic risk scores (PRS) and genetic correlations were calculated between BPD and cardiometabolic traits. RESULTS Several traits were significantly associated with increased risk for BPD, namely low total cholesterol, low high-density lipoprotein cholesterol, high triglycerides, high glycated haemoglobin, low systolic blood pressure, high body mass index, high waist-to-hip ratio; and stroke, coronary artery disease and type 2 diabetes diagnosis. BPD was associated with higher polygenic risk for triglycerides, waist-to-hip ratio, coronary artery disease and type 2 diabetes. Shared genetic aetiology persisted for coronary artery disease, when correcting PRS associations for cardiometabolic base phenotypes. Associations were not replicated using genetic correlations. CONCLUSIONS This large study identified increased phenotypic cardiometabolic abnormalities in BPD participants. It is found that the comorbidity of coronary artery disease may be based on shared genetic aetiology. These results motivate hypothesis-driven research to consider individual cardiometabolic traits rather than a composite metabolic syndrome when attempting to disentangle driving mechanisms of cardiometabolic abnormalities in BPD.
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Affiliation(s)
- Anna E. Fürtjes
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan R. I. Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Jess Tyrrell
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, EX2 5DW, UK
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Saskia P. Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Holgerson AA, Clark MM, Frye MA, Kellogg TA, Mundi MS, Veldic M, Grothe K. Symptoms of bipolar disorder are associated with lower bariatric surgery completion rates and higher food addiction. Eat Behav 2021; 40:101462. [PMID: 33307467 DOI: 10.1016/j.eatbeh.2020.101462] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Bipolar disorder (BP) is highly comorbid with obesity, however, little is known about how BP might be associated with bariatric surgery outcomes. METHODS In this retrospective clinical cohort study, 1034 patients completed a psychological evaluation, and screening positive for possible BP was defined as a score ≥7 and moderate disability on the Mood Disorders Questionnaire. Food addiction (FA), subthreshold binge eating disorder (BED), and illegal drug use were also assessed using standardized questionnaires. RESULTS The 54 (5.2%) patients screening positive for BP were less likely to have bariatric surgery compared to 980 (94.8%) patients who screened negative for BP (5 patients or 9.3% vs 273 patients, or 27.9%). Patients with possible BP also had significantly higher prevalence of FA (37% vs 13.2%), subthreshold BED (29.6% vs 8.3%) and illegal drug use (7.4% vs 2.1%). CONCLUSIONS In this retrospective clinical cohort study, patients who screened positive for BP had a higher prevalence of food addiction, subthreshold binge eating disorder and recent illegal drug use. They also demonstrated lower completion rates for having bariatric surgery. Clearly, more needs to be learned about how to help patients with symptoms of bipolar disorder manage their obesity and behavioral challenges.
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Affiliation(s)
- Allison A Holgerson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Todd A Kellogg
- Department of Subspecialty General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Marin Veldic
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Karen Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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Gao N, Eissenstat SJ, Giacobbe G. Poor physical health: A major barrier to employment among individuals with serious mental illness. JOURNAL OF VOCATIONAL REHABILITATION 2020. [DOI: 10.3233/jvr-191063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ni Gao
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - SunHee J. Eissenstat
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Giovanna Giacobbe
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Baldessarini RJ, Vázquez GH, Tondo L. Bipolar depression: a major unsolved challenge. Int J Bipolar Disord 2020; 8:1. [PMID: 31903509 PMCID: PMC6943098 DOI: 10.1186/s40345-019-0160-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
| | - Gustavo H Vázquez
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
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Abstract
Objective: We reviewed important clinical aspects of bipolar depression, a progressive psychiatric condition that is commonly treated in primary care. Bipolar depression is associated with considerable burden of illness, high suicide risk, and greater morbidity and mortality than bipolar mania. Methods: We identified articles relevant to our narrative review using a multistep search of the literature and applying terms that were relevant to bipolar depression or bipolar disorder. Results: Bipolar depression accounts for the majority of time spent unwell for patients with bipolar disorder; high rates of morbidity and mortality arise from full symptomatic episodes and interepisode subsyndromal symptoms. Bipolar depression is an important contributor to long-term dysfunction for patients with bipolar disorder due to psychosocial impairment, loss of work productivity and high rates of substance abuse. Missed and delayed diagnosis is prevalent due to overlapping symptoms with unipolar depression and other diagnoses. Medical comorbidities (i.e. cardiovascular disease, hypertension, obesity, metabolic syndrome) and psychiatric comorbidities (i.e. anxiety disorder, personality disorder, eating disorder, attention-deficit/hyperactivity disorder) are common. Currently, only three treatments are FDA-approved for bipolar depression; monotherapy antidepressants are not a recommended treatment option. Conclusions: Bipolar disorder is common among primary care patients presenting with depression; it is often treated exclusively in primary care. Clinicians should be alert for symptoms of bipolar disorder in undiagnosed patients, know what symptoms probabilistically suggest bipolar versus unipolar depression, have expertise in providing ongoing treatment to diagnosed patients, and be knowledgeable about managing common medication-related side effects and comorbidities. Prompt and accurate diagnosis is critical.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network , Toronto , Canada
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12
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Reininghaus B, Riedrich K, Dalkner N, Lehner LA, Rieger A, Hamm C, Dorn M, Gradauer L, Hufnagl A, Mayr-Mauhart M, Miniberger G, Schachner A, Wagger K, Birner A, Platzer M, Fellendorf F, Queissner R, Bengesser S, Reininghaus E. Physical health in individuals with psychiatric disorders in Austria. J Affect Disord 2019; 257:38-44. [PMID: 31299403 DOI: 10.1016/j.jad.2019.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The association between severe psychiatric disorders and metabolic syndrome is well documented and goes along with a reduced life expectancy. The prevalence of medical comorbidities in individuals suffering from psychiatric disorders in Austria has not yet been examined; aim of this study was to analyze the prevalence of comorbid somatic disorder in individuals diagnosed with psychiatric disorders in Austria. METHODS Patients (n = 600) with a life-time diagnosis of mood and anxiety disorders undergoing a six-week course of intensive treatment in a psychiatric rehabilitation center were recruited. Prevalent somatic and psychological conditions, anamnestic data, medical history, blood samples, clinical and psychological tests as well as medication were examined to determine somatic and psychiatric diagnoses. RESULTS Metabolic disorders were highly prevalent especially in individuals diagnosed with affective disorders, respectively in bipolar disorder. Furthermore, obesity and thyroid dysfunction were found in about 40% of individuals diagnosed with bipolar disorder in the present study. Significant gender differences were found in CVD and hypertension with higher prevalence in men, while thyroid dysfunction occurred more often in women also compared to the general female population. CONCLUSIONS Characterizing somatic comorbidity in individuals with psychiatric disorders can stimulate research to better understand possible shared etiologic factors and has public health implications for improving models of care. This could have a positive effect on the course of mental disorders, and additionally improve social integration and life expectancy. Knowledge about sex differences should be used to further improve individualized treatment of individuals with psychiatric disorders.
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Affiliation(s)
- Bernd Reininghaus
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Karin Riedrich
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria.
| | | | - Alexandra Rieger
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Carlo Hamm
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | | | | | | | | | | | | | | | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
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13
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Onyeka IN, Collier Høegh M, Nåheim Eien EM, Nwaru BI, Melle I. Comorbidity of Physical Disorders Among Patients With Severe Mental Illness With and Without Substance Use Disorders: A Systematic Review and Meta-Analysis. J Dual Diagn 2019; 15:192-206. [PMID: 31164045 DOI: 10.1080/15504263.2019.1619007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Physical disorders in patients with severe mental illness (SMI) are common and they tend to be underdiagnosed by clinicians, which might lead to negative treatment outcomes. The presence of substance use disorders could further aggravate the situation. There are existing systematic reviews on physical disorders among individuals with SMI in general but none of these previous reviews stratified their findings by substance use disorder status. This study aimed to synthesize the evidence on the frequency of comorbid physical disorders among patients with SMI with or without substance use disorders. Methods: We searched for studies published in English between 1988 and 2017 in MEDLINE, Embase, CINAHL, PsycINFO, Global Health, Web of Science, Scopus, WHO Global Health Library (Global Index Medicus), Google Scholar, OpenGrey, the Grey Literature Report, Cochrane Library, International Standardized Randomized Controlled Trial Number Registry, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Australian and New Zealand Clinical Trials Registry, and PROSPERO. There was no geographical restriction and the target population was adults (≥18 years) with diagnosed SMI including schizophrenia, bipolar disorder, and other psychotic illnesses. The outcome of interest was physical disorder. Results: A total of 6,994 records were retrieved. Only 30 papers (representing 24 studies) met our inclusion criteria and 13 studies were included in the meta-analysis. The prevalence of most of the reported physical disorders was higher in SMI patients with substance use disorders than in those without substance use disorders. When ranked according to pooled prevalence level, hypertension (35.6%), tardive dyskinesia (35.4%), and hepatitis C (26.9%) were the most prevalent physical disorders among SMI patients with substance use disorders. For SMI patients without substance use disorders, hypertension (32.5%), tardive dyskinesia (25.1%), and endocrine disease (19.0%) were more common. Estimates for diabetes (7.5% vs. 7.5%) and cardiovascular diseases (11.8% vs. 11.3%) were similar across groups. Conclusions: Physical disorders among SMI patients vary by substance use disorder status. Clinicians managing SMI in patients should screen for physical disorders and substance use disorders and provide treatment or referral. Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42017072286.
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Affiliation(s)
- Ifeoma N Onyeka
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital , Belfast , UK
| | - Margrethe Collier Høegh
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway
| | | | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.,Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg , Gothenburg , Sweden
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway
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Abstract
PURPOSE OF REVIEW Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption. RECENT FINDINGS Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.
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15
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Penninx BWJH, Lange SMM. Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29946213 PMCID: PMC6016046 DOI: 10.31887/dcns.2018.20.1/bpenninx] [Citation(s) in RCA: 280] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychiatric patients have a greater risk of premature mortality, predominantly due to cardiovascular diseases (CVDs). Convincing evidence shows that psychiatric conditions are characterized by an increased risk of metabolic syndrome (MetS), a clustering of cardiovascular risk factors including dyslipidemia, abdominal obesity, hypertension, and hyperglycemia. This increased risk is present for a range of psychiatric conditions, including major depressive disorder (MDD), bipolar disorder (BD), schizophrenia, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD). There is some evidence for a dose-response association with the severity and duration of symptoms and for a bidirectional longitudinal impact between psychiatric disorders and MetS. Associations generally seem stronger with abdominal obesity and dyslipidemia dysregulations than with hypertension. Contributing mechanisms are an unhealthy lifestyle and a poor adherence to medical regimen, which are prevalent among psychiatric patients. Specific psychotropic medications have also shown a profound impact in increasing MetS dysregulations. Finally, pleiotropy in genetic vulnerability and pathophysiological mechanisms, such as those leading to the increased central and peripheral activation of immunometabolic or endocrine systems, plays a role in both MetS and psychiatric disorder development. The excess risk of MetS and its unfavorable somatic health consequences justifies a high priority for future research, prevention, close monitoring, and treatment to reduce MetS in the vulnerable psychiatric patient.
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Affiliation(s)
- Brenda W J H Penninx
- Department of Psychiatry, VU University Medical Center & GGZ InGeest, Amsterdam, The Netherlands
| | - Sjors M M Lange
- Department of Psychiatry, VU University Medical Center & GGZ InGeest, Amsterdam, The Netherlands
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16
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Damegunta SR, Gundugurti PR. A Cross-sectional Study to Estimate Cardiovascular Risk Factors in Patients with Bipolar Disorder. Indian J Psychol Med 2017; 39:634-640. [PMID: 29200560 PMCID: PMC5688891 DOI: 10.4103/ijpsym.ijpsym_369_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is increasing recognition of cardiovascular mortality and comorbidity in bipolar disorder (BD) in the recent times. Framingham 10 years risk of coronary heart disease (CHD) has been a widely accepted as a reliable estimate of cardiovascular risk in the general population. A few studies have estimated the relative risk of developing CHD in BDs, in India. We attempt to present a cross-sectional data from a prospective study to estimate the 10 years cardiovascular risk in BD population. SUBJECTS AND METHODS A total of 50 patients with BD aged between 20 and 60 years fulfilling the inclusion and exclusion criteria were enrolled into this study. Demographic variables and clinical evaluations including smoking history, medical and pharmacologic treatment history, physical examination, anthropometric measurements, and clinical laboratories for metabolic profiles were assessed. Using the Framingham 10-year risk questionnaire, the risk for each patient was calculated and compared with that of normal healthy control group. RESULTS The risk of developing a future cardiovascular event was 3.26% in BD and 2.02% in controls. We identified that a higher age at onset of illness, waist-hip ratio, total cholesterol, and unemployment showed a strong positive correlation with future CHD risk whereas administration of valproate, lithium for management of BD, higher socioeconomic status and educational status, and nonsmokers was associated negatively with the future CHD risk. CONCLUSIONS It appears that there is a significant association between BD and metabolic factors, CHD, sociodemographic variables, and underscores the predictive ability of Framingham risk score in detecting cardiovascular diseases.
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17
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Simon J, Budge K, Price J, Goodwin GM, Geddes JR. Remote mood monitoring for adults with bipolar disorder: An explorative study of compliance and impact on mental health service use and costs. Eur Psychiatry 2017; 45:14-19. [PMID: 28728090 DOI: 10.1016/j.eurpsy.2017.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Remote monitoring of mood disorders may be an effective and low resource option for patient follow-up, but relevant evidence remains very limited. This study explores real-life compliance and health services impacts of mood monitoring among patients with bipolar disorder in the UK. METHODS Patients with a diagnosis of bipolar disorder who were registered users of the True Colours monitoring system for at least 12months at study assessment were included in this retrospective cohort study (n=79). Compliance was measured as the proportion of valid depression and mania scale messages received in comparison to their expected numbers over the first 12months of monitoring. Mental health service use data were extracted from case notes, costed using national unit costs, and compared 12months before (pre-TC period) and 12months after (TC period) patients' engagement with monitoring. Associations with relevant patient factors were investigated in a multiple regression model. RESULTS Average compliance with monitoring was 82%. Significant increases in the annual use and costs of psychiatrist contacts and total mental health services were shown for patients newly referred to the clinic during the pre-TC period but not for long-term patients of the clinic. Psychiatric medication costs increased significantly between the pre-TC and TC periods (£235, P=0.005) unrelated to patients' referral status. CONCLUSIONS Remote mood monitoring has good compliance among consenting patients with bipolar disorder. We found no associations between observed changes in mental health service costs and the introduction of monitoring except for the increase in psychiatric medication costs.
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Affiliation(s)
- J Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; Department of Psychiatry, University of Oxford and Oxford Health NHS Trust, OX3 7JX Oxford, UK; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, OX3 7LF Oxford, UK.
| | - K Budge
- Department of Psychiatry, University of Oxford and Oxford Health NHS Trust, OX3 7JX Oxford, UK; North Essex Partnership NHS Foundation Trust, CO4 5HG Colchester, UK
| | - J Price
- Department of Psychiatry, University of Oxford and Oxford Health NHS Trust, OX3 7JX Oxford, UK
| | - G M Goodwin
- Department of Psychiatry, University of Oxford and Oxford Health NHS Trust, OX3 7JX Oxford, UK
| | - J R Geddes
- Department of Psychiatry, University of Oxford and Oxford Health NHS Trust, OX3 7JX Oxford, UK
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18
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Dickinson CM, Karlin DR, Nunez HR, Cao SA, Heffernan DS, Monaghan SF, Kheirbek T, Adams CA, Stephen AH. Do Patients with Pre-Existing Psychiatric Illness Have an Increased Risk of Infection after Injury? Surg Infect (Larchmt) 2017; 18:545-549. [PMID: 28353417 DOI: 10.1089/sur.2016.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Trauma remains a leading cause of death and long term-morbidity. We have shown that patients who sustain traumatic injuries are at increased risk for the development of infectious complications. Psychiatric illnesses (PIs) are also noted to occur frequently among the general population. The presence of a PI has been shown to be a risk factor for the development of infections. Despite the prevalence of both traumatic injuries and psychiatric diseases, there are little data relating the impact of PI on the outcome of patients with trauma. We hypothesize that the presence of a PI will be associated with an increased risk of an infection developing after injury. PATIENTS AND METHODS This is a five year retrospective chart review of all admitted patients with trauma age 18 years and older. Patients with and without a major psychiatric illness were compared. Demographic data, mechanism of injury and Injury Severity Score (ISS) were reviewed. Co-morbidities included diabetes mellitus, obesity, pre-injury steroid use, and International Classification of Diseases, 9th edition, based psychiatric illness. All infections were diagnosed by microbiologic criteria (urinary tract infection [UTI], ventilator-associated pneumonia) or Centers for Disease Control and Prevention criteria for clinically evident infections (surgical site infection). RESULTS Of the 11,147 admitted trauma patients, 14.5% had a pre-injury PI diagnosis. The PI patients were older (61.5 ± 0.5 vs. 54.3; p < 0.001), more often female (56% vs. 39.1%; p < 0.001), and had no difference in blunt mechanism rates (88.4% vs. 89.9%; p = 0.06) or median ISS (9 vs. 9; p = 0.06). There was no difference between PI and non-PI patients in pre-injury diabetes mellitus (13.4% vs. 12.7%; p = 0.4), steroid use (2.5% vs. 1.9%; p = 0.1), but patients with PI were more likely to be obese (15.7% vs. 13.6%; p = 0.03). Patients with PI were more likely to have an infection develop (10.4% vs. 7.5%; p < 0.001). The most common infection in both groups was UTI (6.9% vs. 4.2%; p < 0.001). Compared with non-PI patients, adjusting for age, gender, ISS, diabetes mellitus, and obesity, patients with PI were more likely to have an infection develop (odds ratio 1.3, 95% confidence interval = 1.1-1.5) Conclusions: Patients with an underlying PI are at increased risk of having a UTI after traumatic injury. This study identifies a previously unknown independent risk factor for UTIs in patients with trauma. This stresses the need for increased awareness and attention to this vulnerable population.
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Affiliation(s)
- Catherine M Dickinson
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Daniel R Karlin
- 2 Department of Psychiatry, Tufts University School of Medicine , Boston, Massachusetts
| | - Hector R Nunez
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Shiliang A Cao
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Daithi S Heffernan
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Sean F Monaghan
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Tareq Kheirbek
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Charles A Adams
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Andrew H Stephen
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
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19
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Fountoulakis KN, Vieta E, Young A, Yatham L, Grunze H, Blier P, Moeller HJ, Kasper S. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 4: Unmet Needs in the Treatment of Bipolar Disorder and Recommendations for Future Research. Int J Neuropsychopharmacol 2017; 20:196-205. [PMID: 27677983 PMCID: PMC5408978 DOI: 10.1093/ijnp/pyw072] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The current fourth paper on the International College of Neuropsychopharmacology guidelines for the treatment of bipolar disorder reports on the unmet needs that became apparent after an extensive review of the literature and also serves as a conclusion to the project of the International College of Neuropsychopharmacology workgroup. MATERIALS AND METHODS The systematic review of the literature that was performed to develop the International College of Neuropsychopharmacology guidelines for bipolar disorder identified and classified a number of potential shortcomings. RESULTS Problems identified concerned the reliability and validity of the diagnosis of bipolar disorder and especially of bipolar depression. This, in turn, has profound consequences for early detection and correct treatment of the disorder. Another area that needs improvement is the unsatisfactory efficacy and effectiveness of therapeutic options, especially in special populations such as those with mixed features and rapid cycling course. Gender issues and adherence problems constitute an additional challenge. The literature suggests that while treatment providers are concerned more with treatment-related issues, patients and their caregivers worry more about issues pertaining to the availability of services and care, quality of life, and various types of burden. The workgroup identified additional unmet needs related to the current standard of research in bipolar disorder. These include the fragmentation of bipolar disorder into phases that are handled as being almost absolutely independent from each other, and thus the development of an overall therapeutic strategy on the basis of the existing evidence is very difficult. Trials are not always designed in a way that outcomes cover the most important aspects of bipolar disorder, and often the reporting of the results is biased and unsatisfactory. The data on combination treatments and high dosages are sparse, whereas they are common in real world practice. CONCLUSIONS The workgroup endorses the full release of raw study data to the scientific community, and the development of uniform clinical trial standards (also including more realistic outcomes) and the reporting of results. The 2 large appendices summarize the results of this systematic review with regard to the areas of lack of knowledge where further focused research is necessary.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
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Lackner N, Bengesser SA, Birner A, Painold A, Fellendorf FT, Platzer M, Reininghaus B, Weiss EM, Mangge H, McIntyre RS, Fuchs D, Kapfhammer HP, Wallner-Liebmann SJ, Reininghaus EZ. Abdominal obesity is associated with impaired cognitive function in euthymic bipolar individuals. World J Biol Psychiatry 2016; 17:535-46. [PMID: 26068130 DOI: 10.3109/15622975.2015.1046917] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Overweight/obesity has been implicated to play a role in cognitive deficits in bipolar disorder (BD). This study aims to identify the relationship between body fat distribution and different domains of cognition in BD during euthymia. METHODS A sample of 100 euthymic individuals with BD was measured with a cognitive test battery (i.e., Trail Making Test-A-B/TM-A/B, d2 Test of Attention, Stroop test, California Verbal Learning Test/CVLT) and an anthropometric measures set (body mass index, waist circumference, hip circumference, waist-to-hip-ratio, waist-to-height-ratio, and lipometry). Patient data were compared with a healthy control group (n = 64). RESULTS Results show that overweight patients with BD exhibit lower performance in the TMT-A/B as well as in the free recall performance of the CVLT compared to normal-weight patients with BD and controls. In bipolar individuals, (abdominal) obesity was significantly associated with a poor cognitive performance. In bipolar females, associations with measures of verbal learning and memory were found; in bipolar males, associations with poor performance in the TMT-A/B and in the Stroop interference task were demonstrated. In controls, no associations were found. CONCLUSIONS There are several possible pathways moderating the association between obesity and cognition in BD. Anthropometric and lipometry data underline the substantial mediating impact of body fat distribution on cognition in BD.
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Affiliation(s)
- N Lackner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S A Bengesser
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Birner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Painold
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - F T Fellendorf
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - M Platzer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - B Reininghaus
- b Therapiezentrum Justuspark, Versicherungsanstalt öffentlich Bediensteter , Austria
| | - E M Weiss
- c Department of Biological Psychology , Karl-Franzens University Graz , Graz , Austria
| | - H Mangge
- d Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria.,e BioTechMed-Graz , Graz , Austria
| | - R S McIntyre
- f Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , Canada
| | - D Fuchs
- g Division of Biological Chemistry, Medical University of Innsbruck , Innsbruck , Austria
| | - H P Kapfhammer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S J Wallner-Liebmann
- h Department of Pathophysiology and Immunology , Medical University Graz , Graz , Austria
| | - E Z Reininghaus
- a Department of Psychiatry , Medical University Graz , Graz , Austria
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Kao MJ, Nunez H, Monaghan SF, Heffernan DS, Adams CA, Lueckel SN, Stephen AH. Trauma patients who present in a delayed fashion: a unique and challenging population. J Surg Res 2016; 208:204-210. [PMID: 27993211 DOI: 10.1016/j.jss.2016.09.037] [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: 04/08/2016] [Revised: 09/13/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A proportion of trauma patients present for evaluation in a delayed fashion after injury, likely due to a variety of medical and nonmedical reasons. There has been little investigation into the characteristics and outcomes of trauma patients who present delayed. We hypothesize that trauma patients who present in a delayed fashion are a unique population at risk of increased trauma-related complications. MATERIALS AND METHODS This was a retrospective review from 2010-2015 at a Level I trauma center. Patients were termed delayed if they presented >24 hours after injury. Patients admitted within 24 hours of their injury were the comparison group. Charts were reviewed for demographics, mechanism, comorbidities, complications and outcomes. A subgroup analysis was done on patients who suffered falls. RESULTS During the 5-y period, 11,705 patients were admitted. A total of 588 patients (5%) presented >24 h after their injury. Patients in the delayed group were older (65 versus 55 y, P < 0.001) and more likely to have psychiatric comorbidities (33% vs. 24%, P = 0.0001) than the control group. They were also more likely to suffer substance withdrawal (8.9% vs. 4.1%, P < 0.001) but had toxicology testing for drugs and alcohol done at significantly lower rates. Patients that presented delayed after falls were similar in age and injury severity score (ISS) but more likely to suffer substance withdrawal when compared to those with falls that presented within 24 hours. Patients with falls that presented delayed had toxicology testing at significantly lower rates than the comparison group. CONCLUSIONS Trauma patients that present to the hospital in a delayed fashion have unique characteristics and are more likely to suffer negative outcomes including substance withdrawal. Future goals will include exploring strategies for early intervention, such as automatic withdrawal monitoring and social work referral for all patients who present in a delayed fashion.
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Affiliation(s)
- Mary J Kao
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Hector Nunez
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sean F Monaghan
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Daithi S Heffernan
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Charles A Adams
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Stephanie N Lueckel
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Andrew H Stephen
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
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Hsu JH, Chien IC, Lin CH. Increased risk of chronic liver disease in patients with bipolar disorder: A population-based study. Gen Hosp Psychiatry 2016; 42:54-9. [PMID: 27638973 DOI: 10.1016/j.genhosppsych.2016.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the prevalence and incidence of chronic liver disease in patients with bipolar disorder. METHODS We used a random sample of 766,427 subjects aged ≥18 years from the National Health Research Institute database in the year 2005. Subjects with at least one primary diagnosis of bipolar disorder in 2005 were identified. Patients with a primary or secondary diagnosis of chronic liver disease were also defined. We compared the prevalence and associated factors of chronic liver disease between patients with bipolar disorder and the general population in 2005. We also compared the incidence of chronic liver disease in patients with bipolar disorder and the general population from 2006 to 2010. RESULTS The prevalence of chronic liver disease in patients with bipolar disorder (13.9%) was 2.68 times higher than that of the general population (5.8%) in 2005. The average annual incidence of chronic liver disease in patients with bipolar disorder from 2006 to 2010 was also higher than that of the general population (2.95% vs. 1.73%; risk ratio: 1.71; 95% confidence interval: 1.46-2.01). CONCLUSIONS Patients with bipolar disorder had a significantly higher prevalence and incidence of chronic liver disease than those in the general population, and younger patients with bipolar disorder have a much higher prevalence and incidence than those in the general population. Male sex, second-generation antipsychotic or antidepressant use, and hyperlipidemia were associated factors for chronic liver disease in patients with bipolar disorder.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Ministry of Health and Welfare, Chiayi City, Taiwan
| | - I-Chia Chien
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan; Department of Public Health & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Heng Lin
- Taichung Veteran General Hospital, Taichung, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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23
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Leo RJ, Singh J. Migraine headache and bipolar disorder comorbidity: A systematic review of the literature and clinical implications. Scand J Pain 2016; 11:136-145. [PMID: 28850455 DOI: 10.1016/j.sjpain.2015.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/21/2015] [Accepted: 12/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Psychiatric disorders, e.g., depression, are often comorbid with, and can complicate the treatment of, patients with migraine headache. Although empirical work has increasingly focused on the association between migraine and bipolar disorder, this topic has received little attention in the pain literature. Bipolar disorder is a chronic and recurrent mood disorder characterized by cyclic occurrence of elevated (i.e., manic or hypomanic) and depressed mood states. Bipolar I disorder is diagnosed when patients present with at least one abnormally and persistently elevated manic episode; bipolar II disorder is characterized by the presence of hypomanic episodes. Bipolar disorder warrants attention as depressive phases of the disorder can prevail and are often misconstrued by the unwary clinician as unipolar depression. However, treatment for bipolar disorder is distinct from that of unipolar depression and use of antidepressants, which are often invoked in migraine prophylaxis as well as the treatment of depression, may precipitate significant mood changes among bipolar disorder patients. A systematic review of the literature addressing the co-occurrence of bipolar disorder and migraine was conducted. The treatment of dually affected patients is also discussed. METHODS In order to review the literature to date on migraine and bipolar disorder co-occurrence, a comprehensive search of MEDLINE, EMBASE, PubMed, PsycINFO, Web of Science, and CINAHL for clinic-based and epidemiological studies was conducted using terms related to migraine and bipolar disorder. Studies were selected for review if they included subjects meeting validated diagnostic criteria for bipolar disorder as well as migraine headache and if a quantitative description of prevalence rates of comorbid bipolar disorder and migraine were reported. Weighted means of the prevalence rates were calculated to compare with general epidemiological prevalence trends for migraine and bipolar disorder, respectively. RESULTS Eleven studies met inclusion criteria. Although findings were constrained by methodological limitations and several low quality studies, clinic- and epidemiological cross-sectional investigations demonstrated a high rate of comorbidity between bipolar disorder and migraine. The weighted mean prevalence rate for migraine headache among bipolar disorder patients was 30.7%; for bipolar disorder among migraineurs, the weighted mean prevalence rates were 9% and 5.9% in clinic-based and epidemiological studies, respectively. The association between bipolar disorder and migraine was most notable among women and patients with the bipolar II disorder subtype. CONCLUSIONS High rates of comorbidity exist between migraine and bipolar disorder, exceeding estimated prevalence rates for those conditions in the general population. Comorbidity may portend a more serious clinical course for dually afflicted individuals. IMPLICATIONS Clinicians need to structure treatment approaches to address concurrent migraine and bipolar disorder in dually afflicted individuals. Although further evidence-based investigation is warranted to inform optimal treatment approaches for both conditions concurrently, anticonvulsants (e.g., valproate, lamotrigine and topiramate); atypical antipsychotics (e.g., olanzapine or quetiapine); and calcium channel blockers (e.g., verapamil) may be considered.
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Affiliation(s)
- Raphael J Leo
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Joshna Singh
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Grothe KB, Mundi MS, Himes SM, Sarr MG, Clark MM, Geske JR, Kalsy SA, Frye MA. Bipolar disorder symptoms in patients seeking bariatric surgery. Obes Surg 2015; 24:1909-14. [PMID: 24752620 DOI: 10.1007/s11695-014-1262-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
BACKGROUND Mood disorders are common among patients seeking bariatric surgery although little data exist regarding the prevalence of bipolar symptoms in this population and how they influence surgical outcomes. Our aim was to describe baseline rates of bipolar symptoms and their relationship to psychological factors and completing surgery in a sample of adults seeking bariatric surgery at an academic medical center. METHODS We retrospectively reviewed the relationship of bipolar symptoms to demographic characteristics, baseline weight, psychological factors, and bariatric surgery completion. RESULTS Nine hundred thirty-five patients completed the preoperative psychological evaluation. Six percent of the preoperative sample screened positive for symptoms of bipolar disorder. Patients with bipolar symptoms endorsed more robust psychopathology, trauma history, and problematic eating behaviors than patients without bipolar symptoms. Twenty-two percent of the patients with bipolar symptoms underwent bariatric surgery (n = 12), yet only 13 % were denied bariatric surgery for psychiatric reasons, suggesting that other variables may influence the completion of bariatric surgery for these patients. CONCLUSION Prevalence rates of bipolar symptoms may be greater in patients seeking bariatric surgery compared with the general population, and few patients with bipolar symptoms actually undergo bariatric surgery. Psychological factors differentiate patients with bipolar symptoms who undergo bariatric surgery vs those who do not.
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Affiliation(s)
- Karen B Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA,
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25
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Hayes JF. Reply: To PMID 25735195. Acta Psychiatr Scand 2015; 132:315-6. [PMID: 25943709 DOI: 10.1111/acps.12438] [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: 11/30/2022]
Affiliation(s)
- J F Hayes
- Division of Psychiatry, UCL, London, UK.
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Cumulative stress pathophysiology in schizophrenia as indexed by allostatic load. Psychoneuroendocrinology 2015; 60:120-9. [PMID: 26142568 PMCID: PMC4526449 DOI: 10.1016/j.psyneuen.2015.06.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The etiopathophysiology of schizophrenia has long been linked to stress and the influence of stress is important in all stages of the illness. Previous examinations of perceived stress and acute stress responses may not capture this longitudinal stress pathophysiology. We hypothesized that the cumulative negative effects of stress, indexed by allostatic load (AL), would be elevated in schizophrenia, and that the AL paradigm would be relevant to our understanding of pathophysiology in schizophrenia. METHODS We assessed allostatic load in 30 patients with schizophrenia (SZ; mean age = 33; 17 males) and 20 healthy controls (HC; mean age = 35; 12 males) using 13 cardiovascular, metabolic, neuroendocrine and immune biomarkers. Participants' perceived stress over the past month, functional capacity and psychiatric symptoms were also measured. RESULTS Controlling for age, SZ had significantly higher AL as compared to HC (p = 0.007). Greater AL was present in both early course and chronic SZ, and was associated with reduced functional capacity (p = 0.006) and more psychotic symptoms (p = 0.048) in SZ. Current level of perceived stress was not significantly elevated in SZ or associated with AL in either group. CONCLUSIONS The higher AL found in SZ may reflect increased bodily "wear and tear", possibly caused by more chronic stress exposure or maladaptive responses to stress over time, although additional research is required to differentiate these causes. The higher AL is similarly present in early and chronic SZ, suggesting primary maladaptive stress physiology rather than secondary effects from medications or chronic illness.
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Hayes JF, Miles J, Walters K, King M, Osborn DPJ. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 2015; 131:417-25. [PMID: 25735195 PMCID: PMC4939858 DOI: 10.1111/acps.12408] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review and complete meta-analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all-cause and cause-specific mortalities. METHOD Cause-specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random-effects meta-analysis. Heterogeneity was examined via subgroup analysis and meta-regression. RESULTS Systematic searching found 31 studies meeting inclusion criteria. Summary SMR for all-cause mortality = 2.05 (95% CI 1.89-2.23), but heterogeneity was high (I(2) = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid-decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43-8.55) and natural death = 1.64 (95% CI 1.47-1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43-16.78), other violent death SMR = 3.68 (95% CI 2.77-4.90), deaths from circulatory disease = 1.73 (95% CI 1.54-1.94), respiratory disease = 2.92 (95% CI 2.00-4.23), infection = 2.25 (95% CI 1.70-3.00) and neoplasm = 1.14 (95% CI 1.10-1.21). CONCLUSION Despite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.
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Affiliation(s)
- J. F. Hayes
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
| | - J. Miles
- Camden & Islington NHS Foundation TrustNHSLondonUK
| | - K. Walters
- Department of Primary Care and Population HealthUCLLondonUK
| | - M. King
- Division of PsychiatryUCLLondonUK
| | - D. P. J. Osborn
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
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Yamanishi K, Doe N, Sumida M, Watanabe Y, Yoshida M, Yamamoto H, Xu Y, Li W, Yamanishi H, Okamura H, Matsunaga H. Hepatocyte nuclear factor 4 alpha is a key factor related to depression and physiological homeostasis in the mouse brain. PLoS One 2015; 10:e0119021. [PMID: 25774879 PMCID: PMC4361552 DOI: 10.1371/journal.pone.0119021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 01/26/2015] [Indexed: 12/20/2022] Open
Abstract
Major depressive disorder (MDD) is a common psychiatric disorder that involves marked disabilities in global functioning, anorexia, and severe medical comorbidities. MDD is associated with not only psychological and sociocultural problems, but also pervasive physical dysfunctions such as metabolic, neurobiological and immunological abnormalities. Nevertheless, the mechanisms underlying the interactions between these factors have yet to be determined in detail. The aim of the present study was to identify the molecular mechanisms responsible for the interactions between MDD and dysregulation of physiological homeostasis, including immunological function as well as lipid metabolism, coagulation, and hormonal activity in the brain. We generated depression-like behavior in mice using chronic mild stress (CMS) as a model of depression. We compared the gene expression profiles in the prefrontal cortex (PFC) of CMS and control mice using microarrays. We subsequently categorized genes using two web-based bioinformatics applications: Ingenuity Pathway Analysis and The Database for Annotation, Visualization, and Integrated Discovery. We then confirmed significant group-differences by analyzing mRNA and protein expression levels not only in the PFC, but also in the thalamus and hippocampus. These web tools revealed that hepatocyte nuclear factor 4 alpha (Hnf4a) may exert direct effects on various genes specifically associated with amine synthesis, such as genes involved in serotonin metabolism and related immunological functions. Moreover, these genes may influence lipid metabolism, coagulation, and hormonal activity. We also confirmed the significant effects of Hnf4a on both mRNA and protein expression levels in the brain. These results suggest that Hnf4a may have a critical influence on physiological homeostasis under depressive states, and may be associated with the mechanisms responsible for the interactions between MDD and the dysregulation of physiological homeostasis in humans.
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Affiliation(s)
- Kyosuke Yamanishi
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Hirakata General Hospital for Developmental Disorders, Hirakata, Osaka, Japan
| | - Nobutaka Doe
- Laboratory of Neurogenesis and CNS Repair, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Section of Behavioral Science, Kouiken Co., Ltd., Akashi, Hyogo, Japan
| | - Miho Sumida
- Section of Behavioral Science, Kouiken Co., Ltd., Akashi, Hyogo, Japan
| | - Yuko Watanabe
- Hirakata General Hospital for Developmental Disorders, Hirakata, Osaka, Japan
| | - Momoko Yoshida
- Hirakata General Hospital for Developmental Disorders, Hirakata, Osaka, Japan
| | - Hideyuki Yamamoto
- Laboratory of Tumor Immunology and Cell Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yunfeng Xu
- Laboratory of Tumor Immunology and Cell Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Wen Li
- Laboratory of Tumor Immunology and Cell Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiromichi Yamanishi
- Hirakata General Hospital for Developmental Disorders, Hirakata, Osaka, Japan
| | - Haruki Okamura
- Laboratory of Tumor Immunology and Cell Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Kardiale und metabolische Risikofaktoren bei schweren psychischen Erkrankungen. DER NERVENARZT 2015; 86:866-71. [DOI: 10.1007/s00115-014-4232-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Reininghaus EZ, Lackner N, Fellendorf FT, Bengesser S, Birner A, Reininghaus B, Unterweger R, Platzer M, Wallner-Liebmann SJ, Zelzer S, Mangge H, Fuchs D, Kapfhammer HP, McIntyre RS. Weight cycling in bipolar disorder. J Affect Disord 2015; 171:33-8. [PMID: 25443762 DOI: 10.1016/j.jad.2014.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND An association between excess weight and/or weight fluctuations and cardiovascular morbidity and mortality is amply documented. Individuals with bipolar disorder (BD) are differentially affected by overweight/obesity, chaotic eating patterns (e.g., binge eating), as well as cardiovascular morbidity and mortality. Weight cycling (WCYC) is defined as a pattern of repetitive weight loss and gain. METHODS We sought to determine the relationship between course of illness and BD and WCYC retrospectively as well whether these co-occurring phenotypes identify a biologically distinct subpopulation on the basis of having a unique inflammatory biomarker/biosignature profile. Sociodemographic, clinical, and inflammatory markers were gathered from a well-characterized cohort of actual euthymic adults with BD (n=101) and a healthy control group (n=48). RESULTS Individuals with BD with a history of WCYC were provided evidence of a greater frequency of prior episodes (i.e., both manic and depressed), as well as of significantly higher levels of circulating IL-6 concentrations when compared to non-WCYC individuals with BD. The association persisted after adjusting for relevant covariates (e.g., BMI, age, number of prior episodes). LIMITATIONS Include the small control group, differing medication status and that all data relies on personal information. Nevertheless we tried to verify all data as far as clinical disclosure was available. CONCLUSION The results of this study indicate that adults with BD excessive in weight are not only more susceptible to a relapse-prone course of illness, but also are more likely to present with WCYC. The finding of elevated pro-inflammatory cytokines in this subpopulation may identify a separate subpopulation with greater susceptibility to cardiovascular disease. The overarching aim of personalized treatment and preventive strategies in BD begins with appropriate, empirically supported patient stratification. Our results provide preliminary support for stratifying BD cardiovascular risk on the basis of anthropometrics and WCYC.
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Affiliation(s)
| | - Nina Lackner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | | | - Armin Birner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | | | - Martina Platzer
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Sieglinde Zelzer
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8043 Graz, Austria
| | - Harald Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8043 Graz, Austria; BioTechMed-Graz, Austria.
| | - Dietmar Fuchs
- Division of Biological Chemistry, Innsbruck Medical University, Innsbruck, Austria
| | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto, Canada; Department of Psychiatry and Pharmacology at the University of Toronto, Toronto, Canada
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Cermolacce M, Belzeaux R, Adida M, Azorin JM. [Affective disorders: endocrine and metabolic comorbidities]. Encephale 2015; 40 Suppl 3:S33-9. [PMID: 25550238 DOI: 10.1016/s0013-7006(14)70129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Links between affective and endocrine-metabolic disorders are numerous and complex. In this review, we explore most frequent endocrine-metabolic comorbidities. On the one hand, these comorbidities imply numerous iatrogenic effects from antipsychotics (metabolic side-effects) or from lithium (endocrine side-effects). On the other hand, these comorbidities are also associated with affective disorders independently from medication. We will successively examine metabolic syndrome, glycemic disturbances, obesity and thyroid disorders among patients with affective disorders. Endocrinemetabolic comorbidities can be individually encountered, but can also be associated. Therefore, they substantially impact morbidity and mortality by increasing cardiovascular risk factors. Two distinct approaches give an account of processes involved in these comorbidities: common environmental factors (iatrogenic effects, lifestyle), and/or shared physiological vulnerabilities. In conclusion, we provide a synthesis of important results and recommendations related to endocrine-metabolic comorbidities in affective disorders : heavy influence on morbidity and mortality, undertreatment of somatic diseases, importance of endocrine and metabolic side effects from main mood stabilizers, impact from sex and age on the prevalence of comorbidities, influence from previous depressive episodes in bipolar disorders, and relevance of systematic screening for subclinical (biological) disturbances.
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Affiliation(s)
- M Cermolacce
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France; Laboratoire de Neurosciences Cognitives, UMR CNRS 6155 & Aix-Marseille Université, Fédération 3C, Marseille, France.
| | - R Belzeaux
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - J-M Azorin
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
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Barbosa IG, Rocha NP, Assis F, Vieira ÉLM, Soares JC, Bauer ME, Teixeira, AL. Monocyte and lymphocyte activation in bipolar disorder: a new piece in the puzzle of immune dysfunction in mood disorders. Int J Neuropsychopharmacol 2014; 18:pyu021. [PMID: 25539506 PMCID: PMC4368866 DOI: 10.1093/ijnp/pyu021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study tested the hypothesis that the low-grade inflammation presented in patients with bipolar disorder (BD) is associated with expansion of activated T cells, and this activated state may be due to a lack of peripheral regulatory cells. METHODS Specifically, we investigated the distribution of monocytes and lymphocyte subsets, and investigated Th1/Th2/Th17 cytokines in plasma by flow cytometry. Twenty-one BD type I patients and 21 age- and sex-matched controls were recruited for this study. RESULTS BD patients had increased proportions of monocytes (CD14+). Regarding lymphocyte populations, BD patients presented reduced proportions of T cells (CD3+) and cytotoxic T cells (CD3+CD8+). BD patients also exhibited a higher percentage of activated T CD4+CD25+ cells, and a lower percentage of IL-10 expressing Treg cells. CONCLUSIONS Our data shed some light into the underlying mechanisms involved with the chronic low-grade inflammatory profile described in BD patients.
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Affiliation(s)
- Izabela Guimarães Barbosa
- Laboratório Interdisciplinar de Investigação Médica (LIIM), Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (Drs Barbosa, Rocha, Assis, Vieira, and Teixeira); D epartment of Psychiatry and Behavioral Sciences, UT Health School of Medicine, Houston, Texas (Dr Soares); Laboratório de Imunologia do Envelhecimento, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Brazil (Dr Bauer).
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Trevizol F, Dias VT, Roversi K, Barcelos RC, Kuhn FT, Roversi K, Pase CS, Golombieski R, Veit JC, Piccolo J, Emanuelli T, Rocha JB, Bürger ME. Cross-generationaltransfat intake modifies BDNF mRNA in the hippocampus: Impact on memory loss in a mania animal model. Hippocampus 2014; 25:556-65. [DOI: 10.1002/hipo.22391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Fabíola Trevizol
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
| | | | | | - Raquel C.S. Barcelos
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
| | - Fábio T. Kuhn
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
| | - Karine Roversi
- Departamento de Fisiologia e Farmacologia- UFSM-RS; Brasil
| | - Camila S. Pase
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
| | | | - Juliana C. Veit
- Programa de Pós-Graduação em Ciência e Tecnologia dos Alimentos-UFSM-RS; Brasil
| | - Jaqueline Piccolo
- Programa de Pós-Graduação em Ciência e Tecnologia dos Alimentos-UFSM-RS; Brasil
| | - Tatiana Emanuelli
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
- Programa de Pós-Graduação em Ciência e Tecnologia dos Alimentos-UFSM-RS; Brasil
| | - João B.T. Rocha
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
| | - Marilise E. Bürger
- Programa de Pós-Graduação em Farmacologia-Universidade Federal de Santa Maria(UFSM)-RS; Brasil
- Programa de Pós-Graduação em Bioquímica Toxicológica-UFSM-RS; Brasil
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Galvez JF, Bauer IE, Sanches M, Wu HE, Hamilton JE, Mwangi B, Kapczinski FP, Zunta-Soares G, Soares JC. Shared clinical associations between obesity and impulsivity in rapid cycling bipolar disorder: a systematic review. J Affect Disord 2014; 168:306-13. [PMID: 25086289 DOI: 10.1016/j.jad.2014.05.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/23/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity seems to show a two-way relationship with bipolar disorder (BD), representing not only a possible vulnerability factor but also a consequence of chronic mood dysregulation associated with an overall poor prognosis. Increased impulsivity has been described across all stages and phases of BD as being also associated with a worse prognosis. Although obesity and impulsivity are common features among rapid cycling bipolar disorder (RC-BD) patients, there is a lack of understanding about the clinical implications of these conditions combined in BD. METHODS To explore and integrate available evidence on shared clinical associations between obesity and impulsivity in RC-BD a systematic search of the literature in the electronic database of the National Library of Medicine (PubMed) has been conducted. RESULTS One hundred and fourteen articles were included in our systematic review. Among RC-BD patients, substance abuse disorders (SUDs), anxiety disorders (ADs), predominantly depressive polarity, chronic exposure to antidepressants, psychotic symptoms, suicidality, and comorbid medical conditions are strongly associated with both obesity and impulsivity. LIMITATIONS Heterogeneity of published data, inconsistent measurements of both obesity and impulsivity in RC-BD and an absence of control for RC-BD in epidemiological surveys. Consequently, their combined impact on the severity of RC-BD is yet to be recognized and remains to be poorly understood. CONCLUSION In RC-BD patients the co-occurrence of obesity and impulsivity is associated with an unfavorable course of illness, specific shared clinical correlates, negative psychosocial impact, and overall worse prognosis. There is a need to examine obesity and impulsivity as modulating factors and markers of severity in RC-BD.
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Affiliation(s)
- Juan F Galvez
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Department of Psychiatry, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia.
| | - Isabelle E Bauer
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Hanjing E Wu
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Jane E Hamilton
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Flavio P Kapczinski
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Molecular Psychiatry Laboratory, UT Center of Excellence on Mood Disorders, Houston, TX, USA; Harris County Psychiatric Center (HCPC), University of Texas Health Science Center, Houston, TX, USA.
| | - Giovana Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Harris County Psychiatric Center (HCPC), University of Texas Health Science Center, Houston, TX, USA.
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Carvalho AF, Nunes-Neto PR, Castelo MS, Macêdo DS, Dimellis D, Soeiro-de-Souza MG, Soczynska JK, McIntyre RS, Hyphantis TN, Fountoulakis KN. Screening for bipolar depression in family medicine practices: prevalence and clinical correlates. J Affect Disord 2014; 162:120-7. [PMID: 24767016 DOI: 10.1016/j.jad.2014.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/15/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning. METHODS In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire. RESULTS The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression. LIMITATIONS The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed. CONCLUSIONS Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
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Affiliation(s)
- André F Carvalho
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil.
| | - Paulo R Nunes-Neto
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Milena S Castelo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil
| | - Danielle S Macêdo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Dimos Dimellis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Márcio G Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of Sao Paulo (IPq-HC-FMUSP), Brazil
| | - Joanna K Soczynska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Thomas N Hyphantis
- Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Vázquez GH, Baldessarini RJ, Tondo L. Co-occurrence of anxiety and bipolar disorders: clinical and therapeutic overview. Depress Anxiety 2014; 31:196-206. [PMID: 24610817 DOI: 10.1002/da.22248] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/12/2014] [Accepted: 01/18/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Anxiety commonly co-occurs with bipolar disorders (BDs), but the significance of such "co-morbidity" remains to be clarified and its optimal treatment adequately defined. METHODS We reviewed epidemiological, clinical, and treatment studies of the co-occurrence of BD and anxiety disorder through electronic searching of Pubmed/MEDLINE and EMBASE databases. RESULTS Nearly half of BD patients meet diagnostic criteria for an anxiety disorder at some time, and anxiety is associated with poor treatment responses, substance abuse, and disability. Reported rates of specific anxiety disorders with BD rank: panic ≥ phobias ≥ generalized anxiety ≥ posttraumatic stress ≥ obsessive-compulsive disorders. Their prevalence appears to be greater among women than men, but similar in types I and II BD. Anxiety may be more likely in depressive phases of BD, but relationships of anxiety phenomena to particular phases of BD, and their temporal distributions require clarification. Adequate treatment trials for anxiety syndromes in BD patients remain rare, and the impact on anxiety of treatments aimed at mood stabilization is not clear. Benzodiazepines are sometimes given empirically; antidepressants are employed cautiously to limit risks of mood switching and emotional destabilization; lamotrigine, valproate, and second-generation antipsychotics may be useful and relatively safe. CONCLUSIONS Anxiety symptoms and syndromes co-occur commonly in patients with BD, but "co-morbid" phenomena may be part of the BD phenotype rather than separate illnesses.
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Affiliation(s)
- Gustavo H Vázquez
- International Consortium for Bipolar and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts; Department of Neuroscience, Palermo University, Buenos Aires, Argentina
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Zendjidjian XY, Lodovighi MA, Richieri R, Guedj E, Boyer L, Dassa D, Lançon C. Resistant bipolar depressive disorder: case analysis of adjunctive transcranial magnetic stimulation efficiency in medical comorbid conditions. Bipolar Disord 2014; 16:211-3. [PMID: 24350675 DOI: 10.1111/bdi.12170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/17/2013] [Indexed: 01/19/2023]
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Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. J Psychiatr Res 2014; 48:102-10. [PMID: 24139811 DOI: 10.1016/j.jpsychires.2013.09.014] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/16/2013] [Accepted: 09/19/2013] [Indexed: 11/22/2022]
Abstract
Even though individuals with psychiatric conditions have a prevalence of smoking approximately 2-4 times greater than the general population, surprisingly little evidence exists to inform an assessment of the full range of tobacco-related mortality in such populations. The current study aims to provide mortality estimates for conditions causally related to tobacco use among individuals hospitalized with a primary psychiatric diagnosis in California from 1990 to 2005. Restricting cases to those of individuals aged 35 or older at the mid-point of their follow-up period, we assembled cohorts of individuals with ICD-9 diagnoses of schizophrenia and related disorders ("schizophrenia"; n = 174,277), depressive disorders (n = 338,250), or bipolar disorder (n = 78,739). Inpatient records were linked to death-certificate data. We generated age-, sex-, and race-adjusted standardized mortality ratios (SMRs) for the 19 diseases identified by the Centers for Disease Control and Prevention as being causally linked to tobacco use. The SMRs for all tobacco-linked diseases combined were: schizophrenia, 2.45 (95% CI = 2.41-2.48); bipolar, 1.57 (95% CI = 1.53-1.62); and depression, 1.95 (95% CI = 1.93-1.98). Tobacco-related conditions comprised approximately 53% (23,620/44,469) of total deaths in the schizophrenia, 48% (6004/12,564) in the bipolar, and 50% (35,729/71,058) in the depression cohorts. Addressing tobacco use in psychiatric populations is a critical clinical and public-health concern, especially in light of the currently limited clinical attention devoted to tobacco use in these groups.
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Liu CS, Carvalho AF, Mansur RB, McIntyre RS. Obesity and bipolar disorder: synergistic neurotoxic effects? Adv Ther 2013; 30:987-1006. [PMID: 24194362 DOI: 10.1007/s12325-013-0067-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Indexed: 12/11/2022]
Abstract
Bipolar disorder (BD) is a disabling and chronic neuropsychiatric disorder that is typified by a complex illness presentation, episode recurrence and by its frequent association with psychiatric and medical comorbidities. Over the past decade, obesity has emerged as one of many comorbidities generating substantial concern in the BD population due to important prognostic implications. This comprehensive review details the bidirectional relationship between obesity and BD as evidenced by alterations in the structure and function of the central nervous system, in addition to greater depressive recurrence, cognitive dysfunction and risk of suicidality. Drawing on current research results, this article presents several putative mechanisms underlying the synergistic toxic effects and provides a framework for future treatment options for the obesity-BD comorbidity. There is a need for more large-scale prospective studies to investigate the bidirectional relationships between obesity and BD.
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Affiliation(s)
- Celina S Liu
- Department of Human Biology, University of Toronto, Toronto, ON, Canada
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Atkins J, Naismith SL, Luscombe GM, Hickie IB. Psychological distress and quality of life in older persons: relative contributions of fixed and modifiable risk factors. BMC Psychiatry 2013; 13:249. [PMID: 24103220 PMCID: PMC3852717 DOI: 10.1186/1471-244x-13-249] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With a rapidly ageing population and increasing life expectancy, programs directed at improving the mental health and quality of life (QOL) of older persons are extremely important. This issue may be particularly relevant in the aged-care residential sector, where very high rates of depression and poor QOL are evident. This study aims to investigate the fixed and modifiable risk factors of psychological distress and QOL in a cohort of Australians aged 60 and over living in residential and community settings. METHODS The study examined the relationship between demographic, health and lifestyle factors and the outcome variables of self-reported QOL and psychological distress (K10 scores) based on data from 626 Australians aged 60 and over from the 45 and Up Study dataset. Univariate and multivariate regression analyses (performed on a subset of 496) examined risk factors related to psychological distress and QOL adjusting for age and residential status. RESULTS Significant psychological distress was experienced by 15% of the residential sample and 7% of the community sample and in multivariate analyses was predicted by older age, more functional limitations, more time spent sleeping and lower levels of social support (accounting for 18% of the variance). Poorer QOL was predicted by more functional limitations and greater levels of psychological distress. Together these variables accounted for 35% of the variance in QOL ratings. CONCLUSIONS While psychological distress was more common in residential settings, programs targeting modifiable risk factors have the potential to improve QOL and reduce psychological distress in older persons living in both residential and community settings. In particular, promoting health and mobility, optimising sleep-wake cycles and increasing social support may reduce levels of psychological distress and improve QOL.
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Affiliation(s)
- Joanna Atkins
- Brain & Mind Research Institute, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Sharon L Naismith
- Brain & Mind Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Georgina M Luscombe
- School of Rural Health, Sydney Medical School, University of Sydney, Orange, Australia
| | - Ian B Hickie
- Brain & Mind Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
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McIntyre RS, Alsuwaidan M, Soczynska JK, Szpindel I, Bilkey TS, Almagor D, Woldeyohannes HO, Powell AM, Cha DS, Gallaugher LA, Kennedy SH. The effect of lisdexamfetamine dimesylate on body weight, metabolic parameters, and attention deficit hyperactivity disorder symptomatology in adults with bipolar I/II disorder. Hum Psychopharmacol 2013; 28:421-7. [PMID: 24014142 DOI: 10.1002/hup.2325] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 04/25/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We primarily sought to determine the effect of adjunctive lisdexamfetamine dimesylate (LDX) on anthropometric and metabolic parameters. Our secondary aim was to evaluate the effect of LDX on attention deficit hyperactivity disorder (ADHD) symptom severity in adults with bipolar I/II disorder. METHODS Forty-five stable adults (i.e., non-rapid cycling, absence of clinically significant hypo/manic symptoms) with bipolar I/II disorder and comorbid ADHD were enrolled in a phase IV, 4-week, flexible dose, open-label study of adjunctive LDX. All subjects were initiated at 30 mg/day of adjunctive LDX for the first week with flexible dosing (i.e., 30-70 mg/day) between weeks 2 and 4. RESULTS Of the 45 subjects enrolled, 40 received adjunctive LDX (mean dose = 60 ± 10 mg/day). A statistically significant decrease from baseline to endpoint was evident in weight (p < 0.001), body mass index (p < 0.001), fasting total cholesterol (p = 0.011), low density lipoprotein cholesterol (p = 0.044), high density lipoprotein cholesterol (p = 0.015) but not triglycerides, or blood glucose. Significant reductions were also observed in leptin (p = 0.047), but not in ghrelin, adiponectin, or resistin levels. Diastolic blood pressure and pulse increased significantly over time but on average remained within the normal range (p < 0.001). There was a significant reduction from baseline to endpoint in the total score of the ADHD Self-Report Scale. Significant improvement from baseline to endpoint was also observed in the Montgomery-Åsberg Depression Rating Scale total score as well as the Clinical Global Impression Severity and Improvement score. CONCLUSIONS Short-term adjunctive LDX treatment was well tolerated by this sample of adults with stable bipolar I/II disorder. Lisdexamfetamine dimesylate offered beneficial effects on body weight, body mass index and several metabolic parameters. In addition to demonstrating short-term (i.e., 4 weeks) safety and tolerability, beneficial effects of LDX were also observed in mitigating depressive and ADHD symptom severity.
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Affiliation(s)
- Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada
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Gomes FA, Almeida KM, Magalhães PV, Caetano SC, Kauer-Sant'Anna M, Lafer B, Kapczinski F. Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:126-30. [DOI: 10.1590/1516-4446-2011-0768] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/16/2012] [Indexed: 11/22/2022]
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Castelo MS, Hyphantis TN, Macêdo DS, Lemos GO, Machado YO, Kapczinski F, McIntyre RS, Carvalho AF. Screening for bipolar disorder in the primary care: a Brazilian survey. J Affect Disord 2012; 143:118-24. [PMID: 22959680 DOI: 10.1016/j.jad.2012.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Two recent studies conducted in the US and in France found an unexpectedly high prevalence of a positive screen for bipolar disorder (BD) in primary care (PC). There are few studies of the prevalence of BD in PC and no information exists on the epidemiology of BD in Brazilian PC services. This study investigated the prevalence and correlates of a positive screen for BD among patients attending three Brazilian PC centers. METHODS This cross-sectional survey recruited a systematic sample of 720 patients between 18 and 70 years of age who were seeking primary care treatment. Study measures included the Mood Disorder Questionnaire, the Center for Epidemiologic Studies Depression Scale, the World Health Organization Quality of Life instrument-Abbreviated version, the Functional Comorbidity Index, the Functioning Assessment Short Test, data on past mental health care, service utilization and a review of medical records for coded diagnosis. RESULTS The prevalence of receiving positive screen for BD was 7.6% (n=55; 95% CI: 5.6-9.5%), but only 2 (3.6%) were recognized by general practitioners. A positive screen for BD was associated with significant depressive symptoms (CES-D score ≥16; 70.9%) and more general medical conditions, along with higher primary care utilization. Patients who screened positive for BD reported worse health-related quality of life as well as impaired functioning, compared to those who screened negative. LIMITATIONS Co-morbid mental disorders were not assessed. The cross-sectional design prevents firm cause-effect inferences. CONCLUSIONS The prevalence of a positive screening for BD is high, clinically significant and under-recognized in Brazilian PC settings.
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Affiliation(s)
- Milena S Castelo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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da-Rosa DD, Valvassori SS, Steckert AV, Ornell F, Ferreira CL, Lopes-Borges J, Varela RB, Dal-Pizzol F, Andersen ML, Quevedo J. Effects of lithium and valproate on oxidative stress and behavioral changes induced by administration of m-AMPH. Psychiatry Res 2012; 198:521-6. [PMID: 22429481 DOI: 10.1016/j.psychres.2012.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/12/2012] [Accepted: 01/18/2012] [Indexed: 01/02/2023]
Abstract
In the last years our research group has studied and validated the animal model of mania induced by dextroamphetamine (d-AMPH). Considering the lack of animal models of mania reported in the literature; this study evaluated the possibilities to validate the animal model induced by methamphetamine (m-AMPH). Then, we evaluated the effects of lithium (Li), valproate (VPA) on the behavior and parameters of oxidative damage in rat brain after administration of m-AMPH. In the prevention treatment, Wistar rats were pretreated with Li, VPA or saline (Sal) for 14 days, and then, between days 8 and 14, rats were treated with m-AMPH (1, 0.5 or 0.25 mg/kg) or Sal. In the reversal treatment, rats were first given m-AMPH (0.25 mg/kg) or Sal. Locomotor behavior was assessed using the open-field task and parameters of oxidative damage were measured in brain structures. Our results show that the hyperactivity was prevented and reverted by Li and VPA only when m-AMPH was administered in the dose of 0.25mg/kg. In addition, the m-AMPH in all doses administrated induced oxidative damage in both structures tested in two models. Li and VPA reversed and prevented this impairment, however in a way dependent of cerebral area, the dose of m-AMPH and technique.
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Affiliation(s)
- Dayane D da-Rosa
- Laboratory of Neurosciences and National Institute for Translational Medicine, Postgraduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, 88806-000 Criciúma, SC, Brazil
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Hodgkin D, Volpe-Vartanian J, Merrick EL, Horgan CM, Nierenberg AA, Frank RG, Lee S. Customization in prescribing for bipolar disorder. HEALTH ECONOMICS 2012; 21:653-668. [PMID: 21506194 PMCID: PMC3164906 DOI: 10.1002/hec.1737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/18/2011] [Accepted: 03/14/2011] [Indexed: 05/30/2023]
Abstract
For many disorders, patient heterogeneity requires physicians to customize their treatment to each patient's needs. We test for the existence of customization in physicians' prescribing for bipolar disorder, using data from a naturalistic clinical effectiveness trial of bipolar disorder treatment (STEP-BD), which did not constrain physician prescribing. Multinomial logit is used to model the physician's choice among five combinations of drug classes. We find that our observed measure of the patient's clinical status played only a limited role in the choice among drug class combinations, even for conditions such as mania that are expected to affect class choice. However, treatment of a patient with given characteristics differed widely depending on which physician was seen. The explanatory power of the model was low. There was variation within each physician's prescribing, but the results do not suggest a high degree of customization in physicians' prescribing, based on our measure of clinical status.
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Affiliation(s)
- Dominic Hodgkin
- Institute for Behavioral Health, Heller School of Social Policy & Management, Brandeis University, Waltham, MA 02454, USA.
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Engmann B. Bipolar affective disorder and migraine. Case Rep Med 2012; 2012:389851. [PMID: 22649454 PMCID: PMC3357514 DOI: 10.1155/2012/389851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 03/09/2012] [Accepted: 03/11/2012] [Indexed: 11/17/2022] Open
Abstract
This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.
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Affiliation(s)
- Birk Engmann
- Department of Neurology, Fachklinikum Brandis, Am Wald, 04821 Brandis, Germany
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The clinical implications of cognitive impairment and allostatic load in bipolar disorder. Eur Psychiatry 2012; 28:21-9. [PMID: 22534552 DOI: 10.1016/j.eurpsy.2011.11.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/25/2011] [Accepted: 11/11/2011] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Allostatic load (AL) relates to the neural and bodily "wear and tear" that emerge in the context of chronic stress. This paper aims to provide clinicians with a comprehensive overview of the role of AL in patophysiology of bipolar disorder (BD) and its practical implications. METHODS PubMed searches were conducted on English-language articles published from 1970 to June 2011 using the search terms allostatic load, oxidative stress, staging, and bipolar disorder cross-referenced with cognitive impairment, comorbidity, mediators, prevention. RESULTS Progressive neural and physical dysfunction consequent to mood episodes in BD can be construed as a cumulative state of AL. The concept of AL can help to reconcile cognitive impairment and increased rates of clinical comorbidities that occur over the course of cumulative BD episodes. CONCLUSIONS Data on transduction of psychosocial stress into the neurobiology of mood episodes converges to the concept of AL. Mood episodes prevention would not only alleviate emotional suffering, but also arrest the cycle of AL, cognitive decline, physical morbidities and, eventually, related mortality. These objectives can be achieved by focusing on effective prophylaxis from the first stages of the disorder, providing mood-stabilizing agents and standardized psychoeducation and, potentially, addressing cognitive deficits by the means of specific medication and neuropsychological interventions.
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Eőry A, Gonda X, Torzsa P, Kalabay L, Rihmer Z. Affective temperaments: from neurobiological roots to clinical application. Orv Hetil 2011; 152:1879-86. [DOI: 10.1556/oh.2011.29245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) has grown to be a clinically important outcome measure in the diagnosis and the clinical course of mood disorders. However, temperaments, which represent the biologically stable core of personality, are not just antecedents of major affective disorders, but also serve as a reservoir of genetically advantageous traits for the survival of different cultures. The rapidly growing body of research in psychiatric and non-psychiatric fields even raises the question of temperament as a common root in psychiatric and somatic disorders, providing a new meaning for the construct of psychosomatic disorders. In this review we aim to summarize current knowledge on both the neurobiological background and clinical importance of affective temperaments including implications for future research. Orv. Hetil., 2011, 152, 1879–1886.
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Affiliation(s)
- Ajándék Eőry
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Xénia Gonda
- Semmelweis Egyetem, Általános Orvostudományi Kar Klinikai és Kutatási Mentálhigiénés Osztály Budapest
| | - Péter Torzsa
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - László Kalabay
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Zoltán Rihmer
- Semmelweis Egyetem, Általános Orvostudományi Kar Klinikai és Kutatási Mentálhigiénés Osztály Budapest
- Semmelweis Egyetem, Általános Orvostudományi Kar Pszichiátriai és Pszichoterápiás Klinika Budapest
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Balanzá-Martínez V, Fries GR, Colpo GD, Silveira PP, Portella AK, Tabarés-Seisdedos R, Kapczinski F. Therapeutic use of omega-3 fatty acids in bipolar disorder. Expert Rev Neurother 2011; 11:1029-47. [PMID: 21721919 DOI: 10.1586/ern.11.42] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bipolar disorder (BD) is a severe, chronic affective disorder, associated with significant disability, morbidity and premature mortality. Omega-3 polyunsaturated fatty acids (PUFAs) play several important roles in brain development and functioning. Evidence from animal models of dietary omega-3 (n-3) PUFA deficiency suggest that these fatty acids are relevant to promote brain development and to regulate behavioral and neurochemical aspects related to mood disorders, such as stress responses, depression and aggression, as well as dopaminergic content and function. Preclinical and clinical evidence suggests roles for PUFAs in BD. n-3 PUFAs seem to be an effective adjunctive treatment for unipolar and bipolar depression, but further large-scale, well-controlled trials are needed to examine its clinical utility in BD. The use of n-3 as a mood stabilizer among BD patients is discussed here. This article summarizes the molecular pathways related to the role of n-3 as a neuroprotective and neurogenic agent, with a specific focus on BDNF. It is proposed that the n-3-BDNF association is involved in the pathophysiology of BD and represents a promising target for developing a novel class of rationally devised therapies.
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Affiliation(s)
- Vicent Balanzá-Martínez
- Section of Psychiatry, Department of Medicine, CIBERSAM University of Valencia Medical School, Valencia, Spain.
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Brietzke E, Kapczinski F, Grassi-Oliveira R, Grande I, Vieta E, McIntyre RS. Insulin dysfunction and allostatic load in bipolar disorder. Expert Rev Neurother 2011; 11:1017-28. [PMID: 21721918 DOI: 10.1586/ern.10.185] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is associated with substantial morbidity, as well as premature mortality. Available evidence indicates that 'stress-sensitive' chronic medical disorders, such as cardiovascular disease, obesity and Type 2 diabetes mellitus, are critical mediators and/or moderators of BD. Changes in physiologic systems implicated in allostasis have been proposed to impact brain structures and neurocognition, as well as medical comorbidity in this population. For example, abnormalities in insulin physiology, for example, insulin resistance, hyperinsulinemia and central insulinopenia, are implicated as effectors of allostatic load in BD. Insulin's critical role in CNS physiological (e.g., neurotrophism and synaptic plasticity) and pathophysiological (e.g., neurocognitive deficits, pro-apoptosis and amyloid deposition) processes is amply documented. This article introduces the concept that insulin is a mediator of allostatic load in the BD and possibly a therapeutic target.
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Affiliation(s)
- Elisa Brietzke
- Bipolar Disorder Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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