1
|
Kriner P, Brieger P, Pogarell O, Schüle C, Mußmann L, Korbmacher J, Seemüller F. Treatment of bipolar depression: clinical practice vs. adherence to guidelines-data from a Bavarian drug surveillance project. Front Psychiatry 2024; 15:1425549. [PMID: 39015883 PMCID: PMC11250482 DOI: 10.3389/fpsyt.2024.1425549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/07/2024] [Indexed: 07/18/2024] Open
Abstract
Objectives Pharmacotherapy of bipolar depression (BPD) is confronted with major clinical challenges, like limited evidence-based treatment options, regular cases of treatment resistance, and risk of treatment-emergent affective switches. Medical guidelines can support practitioners to make decisions based on current scientific evidence. The objective of this study is to evaluate to what extent recommendations of the 2019 German S3 guidelines "Diagnosis and Treatment of Bipolar Disorders" are reflected in clinical practice in inpatient treatment. Methods We conducted a descriptive analysis of prescription numbers in 2,627 patients with BPD in a naturalistic inpatient setting analyzing data from the ongoing Bavarian multicenter drug safety project Pharmaco-Epidemiology and Vigilance (Pharmako-EpiVig) from the years 2014-2022. Results Of the patients, 38% were not administered any drug explicitly recommended for treatment of BPD, that is, quetiapine, lamotrigine, carbamazepine, or olanzapine. Only 6% of the patients received monotherapy with one of those drugs. Of the patients, 34% were administered ≥4 psychotropic drugs simultaneously. Patients received 912 different therapy regimens of mono or combination therapy with mood stabilizers (MS), atypical antipsychotics (AAP), and antidepressants. Of the patients, 72% received an antidepressant and 6% without concomitant prescription of an AAP or MS. Prescription rates of venlafaxine (21% to 14%) and tricyclic antidepressants (9% to 6%) decreased significantly from the first (2014-2016) to the last (2020-2022) observed time period. Of the patients, 60% received an MS. Prescription rate of valproate (22% to 14%) decreased significantly, while lithium prescription increased significantly (29% to 35%). Of the patients, 71% were administered an AAP. Quetiapine was the most prescribed drug overall (43%). Only two patients were administered a combination of olanzapine and fluoxetine. Conclusion Our results demonstrate a substantial gap between guideline recommendations and current clinical practice. The remarkable heterogeneity in treatment regimens, with no discernible dominant treatment approach, is in part a reflection of the complexity of bipolar disorder but also substantiates the need of comprehensive recommendations regarding combination therapies. Increase in lithium prescription is an encouraging development due to its unique efficacy in maintenance treatment. To improve the quality of clinical practice guideline implementation, more randomized controlled trials should be conducted in the future to prospectively investigate different implementation strategies.
Collapse
Affiliation(s)
- Paul Kriner
- Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum, Haar, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Cornelius Schüle
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Lisa Mußmann
- Bavarian Institute for Data, Analysis and Quality Assurance, Munich, Germany
| | - Julie Korbmacher
- Bavarian Institute for Data, Analysis and Quality Assurance, Munich, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
2
|
Benacek J, Lawal N, Ong T, Tomasik J, Martin-Key NA, Funnell EL, Barton-Owen G, Olmert T, Cowell D, Bahn S. Identification of Predictors of Mood Disorder Misdiagnosis and Subsequent Help-Seeking Behavior in Individuals With Depressive Symptoms: Gradient-Boosted Tree Machine Learning Approach. JMIR Ment Health 2024; 11:e50738. [PMID: 38206660 PMCID: PMC10811571 DOI: 10.2196/50738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Misdiagnosis and delayed help-seeking cause significant burden for individuals with mood disorders such as major depressive disorder and bipolar disorder. Misdiagnosis can lead to inappropriate treatment, while delayed help-seeking can result in more severe symptoms, functional impairment, and poor treatment response. Such challenges are common in individuals with major depressive disorder and bipolar disorder due to the overlap of symptoms with other mental and physical health conditions, as well as, stigma and insufficient understanding of these disorders. OBJECTIVE In this study, we aimed to identify factors that may contribute to mood disorder misdiagnosis and delayed help-seeking. METHODS Participants with current depressive symptoms were recruited online and data were collected using an extensive digital mental health questionnaire, with the World Health Organization World Mental Health Composite International Diagnostic Interview delivered via telephone. A series of predictive gradient-boosted tree algorithms were trained and validated to identify the most important predictors of misdiagnosis and subsequent help-seeking in misdiagnosed individuals. RESULTS The analysis included data from 924 symptomatic individuals for predicting misdiagnosis and from a subset of 379 misdiagnosed participants who provided follow-up information when predicting help-seeking. Models achieved good predictive power, with area under the receiver operating characteristic curve of 0.75 and 0.71 for misdiagnosis and help-seeking, respectively. The most predictive features with respect to misdiagnosis were high severity of depressed mood, instability of self-image, the involvement of a psychiatrist in diagnosing depression, higher age at depression diagnosis, and reckless spending. Regarding help-seeking behavior, the strongest predictors included shorter time elapsed since last speaking to a general practitioner about mental health, sleep problems disrupting daily tasks, taking antidepressant medication, and being diagnosed with depression at younger ages. CONCLUSIONS This study provides a novel, machine learning-based approach to understand the interplay of factors that may contribute to the misdiagnosis and subsequent help-seeking in patients experiencing low mood. The present findings can inform the development of targeted interventions to improve early detection and appropriate treatment of individuals with mood disorders.
Collapse
Affiliation(s)
- Jiri Benacek
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Nimotalai Lawal
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Tommy Ong
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | - Erin L Funnell
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
| | | | - Tony Olmert
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
| |
Collapse
|
3
|
Almeida OP, Etherton-Beer C, Sanfilippo F, Page A. Health morbidities associated with the dispensing of lithium to males and females: Cross-sectional analysis of the 10 % Pharmaceutical Benefits Scheme sample for 2022. J Affect Disord 2024; 344:503-509. [PMID: 37852583 DOI: 10.1016/j.jad.2023.10.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This study examined the association of gender on the physical morbidity of individuals likely living with bipolar disorder (BD) using a comprehensive health-related database. It investigated the association between lithium dispensing (a surrogate marker for BD) and other health morbidities, considering age and sex. METHODS The cross-sectional study design used the 10 % Schedule of Pharmaceutical Benefits Scheme (PBS) database in Australia for 2022. Medication dispensing, age, and sex were available. A validated algorithm inferred 45 health morbidities from dispensed medicines. Statistical analyses, including logistic regression, assessed the relationship between lithium dispensing, sex, and age with inferred health morbidities. RESULTS The sample consisted of 1,594,112 individuals aged 10 to over 95 years. A higher proportion of women than men were dispensed lithium (0.33 % vs 0.30 %). Lithium dispensing and age were associated with higher prevalence of inferred morbidities. Women dispensed lithium had a greater physical health burden compared to men, with higher odds of chronic airways diseases, diabetes, ischaemic heart disease/hypertension, inflammation, pain, psychosis, and steroid-responsive diseases. Conversely, women dispensed lithium had lower odds of cardiac arrhythmias and hypothyroidism compared to men. CONCLUSIONS This study provides evidence that individuals with BD, indicated by the dispensing of lithium, experience a relatively higher frequency of physical health morbidities, with women being disproportionally affected compared to men. The findings highlight the need for comprehensive care for people living with BD, particularly women.
Collapse
Affiliation(s)
| | | | - Frank Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, Australia
| |
Collapse
|
4
|
Warner A, Holland C, Lobban F, Tyler E, Harvey D, Newens C, Palmier-Claus J. Physical health comorbidities in older adults with bipolar disorder: A systematic review. J Affect Disord 2023; 326:232-242. [PMID: 36709829 DOI: 10.1016/j.jad.2023.01.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To ascertain the prevalence and predictors of physical health comorbidities in older adults with bipolar disorder. METHODS The authors conducted a systematic review and narrative synthesis of peer-reviewed journal articles reporting on physical health comorbidities in older adults (aged ≥50) with a diagnosis of bipolar disorder. The Mixed Methods Appraisal Tool (MMAT) assessed study quality. RESULTS 23 papers reporting on 19 studies met the inclusion criteria. The literature on diabetes, obesity and renal disease was inconclusive. There was some tentative evidence to higher rates of cardiovascular disease and some forms of cancer in older adults with bipolar disorder in comparison to the general population, but this requires further investigation. We identified no studies looking at oral health. LIMITATIONS The quality ratings of the identified research were generally low. Very few studies included a comparison sample from the general population or controlled for key covariates in their analysis. CONCLUSION Existing literature provides tentative evidence that some physical health comorbidities are elevated in older adults with bipolar disorder. Clinicians should consider interventions that improve the physical health of this group, alongside the chronic mental health difficulties they experience.
Collapse
Affiliation(s)
- Aaron Warner
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK; Centre for Ageing Research, Division of Health Research, Lancaster, UK.
| | - Carol Holland
- Centre for Ageing Research, Division of Health Research, Lancaster, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK; Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Elizabeth Tyler
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Daisy Harvey
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK
| | - Connie Newens
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK; Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| |
Collapse
|
5
|
Gunasekaran S, Teh WL, Liu J, Cetty L, Mok YM, Subramaniam M. The Relationship between Predominant Polarity, Lifetime Comorbid Anxiety Disorders and Subjective Quality of Life among Individuals with Bipolar Disorder in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1155. [PMID: 36673910 PMCID: PMC9859592 DOI: 10.3390/ijerph20021155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Depressive features and comorbid anxiety disorders are two discrete but interconnected clinical features that have been reported to be associated with a poorer quality of life (QoL) among individuals with bipolar disorders. However, the relationship between manic features and quality of life is less conclusive. The present study aimed to assess differences in QoL among bipolar outpatients who present with either depressive predominant polarity (DPP), manic predominant polarity (MPP) and/or a lifetime diagnosis of comorbid anxiety disorders in Singapore. METHODS Data from 74 outpatients in Singapore diagnosed with bipolar disorder were collected. Sociodemographic information, the polarity of most episodes (2 out of 3), the diagnosis of anxiety disorders and QoL were obtained from a self-reported interview and/or through clinical records. QoL was measured using the abbreviated version of the World Health Organization questionnaire. We used multivariate regression models to determine the relationships between predominant polarity, lifetime comorbid anxiety disorders and QoL in physical health, psychological health, social relationships and environment domains. RESULTS After adjusting for covariates, individuals with DPP scored poorer for WHOQOL-BREF for all four domains as compared with individuals with indeterminate polarity. As compared to individuals with indeterminate polarity, individuals with MPP scored poorer for WHOQOL-BREF social relationships. Lastly, individuals with lifetime comorbid anxiety disorders scored poorer for WHOQOL-BREF physical health, social relationships and environment. DISCUSSION AND CONCLUSIONS The present study provides preliminary support for the relationship between DPP, lifetime comorbid anxiety disorders and poorer QoL, paving the pathway for future research with larger samples to utilise our study design to verify our results.
Collapse
Affiliation(s)
- Savita Gunasekaran
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Jianlin Liu
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Yee Ming Mok
- Department of Mood & Anxiety, Institute of Mental Health, Singapore 539747, Singapore
| | | |
Collapse
|
6
|
McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
Collapse
Affiliation(s)
- Roger S. McIntyre
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada,Department of PharmacologyUniversity of TorontoTorontoONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Ross J. Baldessarini
- Harvard Medical SchoolBostonMAUSA,International Consortium for Bipolar & Psychotic Disorders ResearchMcLean HospitalBelmontMAUSA,Mailman Research CenterMcLean HospitalBelmontMAUSA
| | - Michael Bauer
- University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of MedicineDeakin UniversityGeelongVICAustralia,Orygen, National Centre of Excellence in Youth Mental HealthCentre for Youth Mental Health, University of MelbourneMelbourneVICAustralia
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | | | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Heinz Grunze
- Allgemeinpsychiatrie OstKlinikum am WeissenhofWeinsbergGermany,Paracelsus Medical Private University NurembergNurembergGermany
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research CenterPsychiatric Center CopenhagenCopenhagenDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - David J. Miklowitz
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los Angeles (UCLA) Semel InstituteLos AngelesCAUSA
| | - Gordon Parker
- School of PsychiatryUniversity of New South WalesSydneyNSWAustralia
| | - Robert M. Post
- School of Medicine & Health SciencesGeorge Washington UniversityWashingtonDCUSA,Bipolar Collaborative NetworkBethesdaMDUSA
| | - Alan C. Swann
- Department of PsychiatryBaylor College of MedicineHoustonTXUSA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural SciencesStanford School of Medicine and VA Palo Alto Health Care SystemPalo AltoCAUSA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamUK
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| |
Collapse
|
7
|
Physical Health Burden Among Older Men and Women With Bipolar Disorder: Results From the Gage-Bd Collaboration. Am J Geriatr Psychiatry 2022; 30:727-732. [PMID: 34980553 DOI: 10.1016/j.jagp.2021.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the prevalence of physical morbidities among men and women with older adult bipolar disorder (OABD), and men with and without OABD. METHODS Cross-sectional analysis of the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) database and non-OABD data from the Health in Men Study. OABD defined as bipolar disorder among adults aged greater than or equal to 50 years. Outcomes of interest were diseases affecting the cardiovascular, respiratory, gastrointestinal, renal, musculoskeletal and endocrinological systems. RESULTS We examined 1407 participants with OABD aged 50-95 years, of whom 787 were women. More women than men showed evidence of morbidities affecting the respiratory, gastrointestinal, musculoskeletal and endocrinological systems. More men with than without OABD showed evidence of cardiovascular, renal and endocrinological diseases. CONCLUSION GAGE-BD data showed that physical morbidities affect more women than men with OABD, and more men with than without OABD. The underlying reasons for these differences require clarification.
Collapse
|
8
|
Rate of polycystic ovary syndrome in mental health disorders: a systematic review. Arch Womens Ment Health 2022; 25:9-19. [PMID: 34499230 DOI: 10.1007/s00737-021-01179-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is associated with increased risk of many mental health conditions, including mood and anxiety disorders. Whether PCOS is more common in mental health conditions than in the general population is less clear. A systematic review investigating this question may provide clarity regarding whether increased prevalence of PCOS is seen in particular mental health disorders, and thus, whether screening female mental health patients for PCOS is warranted. AIMS To systematically synthesise and review research examining rates of PCOS in mental health disorders. METHODS Peer-reviewed articles assessing the prevalence of PCOS within a sample of reproductive-aged females with a diagnosis of Axis I or II mental health disorder were included. Key studies were identified through a comprehensive search of PubMed and Web of Science. RESULTS Eleven studies met inclusion criteria, assessing rate of diagnosed PCOS in samples with bipolar disorder (n = 7), autism spectrum disorders (ASD; n = 2), bulimia nervosa (n = 1), and post-traumatic stress disorder (PTSD; n = 1). Overall, there was limited evidence of elevated rates of PCOS in bipolar disorder, compared with population estimates or healthy control group rates. In ASD, bulimia nervosa, and PTSD samples, significantly increased rates of PCOS were reported compared with healthy control samples, although studies were relatively small. CONCLUSIONS This review highlights complexities and methodological considerations in this area of research. There are a limited number of studies assessing PCOS in mental health samples, and thus, important areas of future research have been identified. TRIAL REGISTRATION This systematic review was registered on PROSPERO (ID: CRD42020151420; https://www.crd.york.ac.uk/prospero/ ) on 28 April 2020.
Collapse
|
9
|
Grunze A, Mosolov S, Grunze H, Born C. The detrimental effects of smoking on the course and outcome in adults with bipolar disorder-A narrative review. Front Psychiatry 2022; 13:1114432. [PMID: 36699491 PMCID: PMC9870053 DOI: 10.3389/fpsyt.2022.1114432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Smoking is a substantial and avoidable risk for physical disability and premature death. Despite a declining tobacco use in the community of developed countries, smoking remains abundant in people with mental disorders. This narrative review highlights the epidemiology, consequences and treatment options of tobacco use disorder (TUD) and nicotine dependence (ND) in people with bipolar disorder (BD). METHODS The authors conducted a Medline literature search from 1970 to November 2022 using MeSH terms "bipolar disorder" x "smoking" or "nicotine" or "tobacco" that retrieved 770 results. Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Finally, 92 references were considered as essential and selected for the educational purpose of this review. SUMMARY OF FINDINGS Lifetime and point prevalence of smoking in people with BD is in the range of 45-70% and thus about 2-3 times more frequent in BD than in community samples. Smoking, TUD and ND have a detrimental impact both on mental and physical health as well as mortality in people with BD. In the absence of large controlled studies in comorbid BD and TUD or ND, pharmacological treatment follows the individual guidance for each disorder. Community-based psychosocial interventions for TUD and ND appear to be suitable in people with BD, too, as well as Cognitive Behavioral (CBT) or Acceptance and Commitment (ACT) based psychotherapies. CONCLUSIONS Smoking is a modifiable risk factor causing increased risks both for mental and physical health in BD, and deserves more attention in treatment. More treatment research into pharmacological and psychosocial interventions in comorbid BD and TUD or ND are still needed to deliver evidence-based recommendations to physicians.
Collapse
Affiliation(s)
- Anna Grunze
- Psychiatrisches Zentrum Nordbaden, Wiesloch, Germany
| | - Sergey Mosolov
- Moscow Research Institute of Psychiatry, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
10
|
Arnold I, Dehning J, Grunze A, Hausmann A. Old Age Bipolar Disorder-Epidemiology, Aetiology and Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57060587. [PMID: 34201098 PMCID: PMC8226928 DOI: 10.3390/medicina57060587] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023]
Abstract
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.
Collapse
Affiliation(s)
- Ivan Arnold
- Helios Klinik Berlin-Buch, 13125 Berlin, Germany;
| | - Julia Dehning
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, 6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-83802
| | - Anna Grunze
- Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany;
| | - Armand Hausmann
- Private Practice, Wilhelm-Greil-Straße 5, 6020 Innsbruck, Austria;
| |
Collapse
|
11
|
Humpston CS, Bebbington P, Marwaha S. Bipolar disorder: Prevalence, help-seeking and use of mental health care in England. Findings from the 2014 Adult Psychiatric Morbidity Survey. J Affect Disord 2021; 282:426-433. [PMID: 33422818 DOI: 10.1016/j.jad.2020.12.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, the lifetime prevalence of Bipolar Disorder (BD) and BD patients' access to mental health care in England has not been systematically studied. METHODS We used data from the Adult Psychiatric Morbidity Survey 2014 (N = 7546). The Mood Disorders Questionnaire (MDQ) was used to screen for BD. Associations between sociodemographic and clinical variables and use of mental health services were investigated. Weighted regression modelling established factors associated with being in receipt of care for mental health problems over the last year. RESULTS The lifetime prevalence of BD in the community in England was 1.7%. Approximately 40% had not received mental health care in the last year, and only 16.9% had received BD specific treatment. 14.6% had asked for a specific form of help but not received it. Psychopathology differed between individuals who successfully sought care and those who didn't. Obtaining care was independently associated with female sex (p<0.0001, odds ratio(OR):4.65 (Confidence Interval (CI):2.18-10.30), unemployment (p = 0.02, OR: 2.65 (C.I: 1.23-5.88) and suicidal ideation (p = 0.04, OR: 3.36, (C.I: 1.04-10.89). LIMITATIONS The MDQ is less sensitive than some of the longer measures, especially in the general population. Some between-group comparisons may have suffered from limited power. CONCLUSIONS The lifetime prevalence of BD in England was similar to rates worldwide. Most people with BD had not received any specific treatment for the condition in the last year, while 1 in 7 had requested specific help but did not receive it. Secondary mental health services in England for BD appear suboptimal.
Collapse
Affiliation(s)
- Clara S Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London W1T 7NF, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, B15 2TT, United Kingdom; Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, B1 3RB, United Kingdom.
| |
Collapse
|
12
|
Grunze H, Schaefer M, Scherk H, Born C, Preuss UW. Comorbid Bipolar and Alcohol Use Disorder-A Therapeutic Challenge. Front Psychiatry 2021; 12:660432. [PMID: 33833701 PMCID: PMC8021702 DOI: 10.3389/fpsyt.2021.660432] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40-70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.
Collapse
Affiliation(s)
- Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
- *Correspondence: Heinz Grunze
| | - Martin Schaefer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik, und Suchtmedizin, Evang. Kliniken Essen-Mitte, Essen, Germany
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christoph Born
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ulrich W. Preuss
- Vitos Klinik Psychiatrie und Psychotherapie, Herborn, Germany
- Klinik für Psychiatrie, Psychotherapie, und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| |
Collapse
|
13
|
Xue S, Husain MI, Ortiz A, Husain MO, Daskalakis ZJ, Mulsant BH. COVID-19: Implications for bipolar disorder clinical care and research. SAGE Open Med 2020; 8:2050312120981178. [PMID: 33403113 PMCID: PMC7739076 DOI: 10.1177/2050312120981178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023] Open
Abstract
The COVID-19 pandemic has posed significant challenges to health care globally, and individuals with bipolar disorder are likely disproportionally affected. Based on review of literature and collective clinical experience, we discuss that without special intervention, individuals with bipolar disorder will experience poorer physical and mental health outcomes due to interplay of patient, provider and societal factors. Some risk factors associated with bipolar disorder, including irregular social rhythms, risk-taking behaviours, substantial medical comorbidities, and prevalent substance use, may be compounded by lockdowns, social isolation and decrease in preventive and maintenance care. We further discuss implications for clinical research of bipolar disorders during the pandemic. Finally, we propose mitigation strategies on working with individuals with bipolar disorder in a clinical and research context, focusing on digital medicine strategies to improve quality of and accessibility to service.
Collapse
Affiliation(s)
- Siqi Xue
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
14
|
Colomer L, Anmella G, Vieta E, Grande I. Physical health in affective disorders: a narrative review of the literature. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:621-630. [PMID: 33146344 PMCID: PMC8639004 DOI: 10.1590/1516-4446-2020-1246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
This article reviews the most common non-psychiatric comorbidities associated with affective disorders, examining the implications of their possible bidirectional link. A narrative review was conducted on the association among the three most common non-psychiatric diseases in major depressive disorder and bipolar disorder (obesity, metabolic syndrome, and cardiovascular diseases) in articles published from January 1994 to April 2020. The evidence suggests that obesity, metabolic syndrome, and cardiovascular diseases are highly prevalent in patients diagnosed with affective disorders. The presence of non-psychiatric comorbidities significantly worsens the therapeutic management and prognosis of affective disorders and vice versa. In many cases, these comorbidities may precede the onset of affective disorders, although in most cases they appear after it. The presence of these concurrent non-psychiatric diseases in an individual diagnosed with an affective disorder is associated with a more complex disease presentation and management. For professionals, the evidence unequivocally supports routine surveillance of comorbidities from a multidisciplinary approach.
Collapse
Affiliation(s)
- Lluc Colomer
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Gerard Anmella
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eduard Vieta
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Iria Grande
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| |
Collapse
|
15
|
Trastornos afectivos y salud física, implicaciones de la comorbilidad con enfermedades médicas: una revisión de la literatura. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
16
|
Gurok MG, Korkmaz H, Yıldız S, Bakış D, Atmaca M. QT and P-wave dispersion during the manic phase of bipolar disorder. Neuropsychiatr Dis Treat 2019; 15:1805-1811. [PMID: 31308673 PMCID: PMC6613347 DOI: 10.2147/ndt.s208253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Patients with bipolar disorder (BD) are at increased risk for cardiovascular diseases and complications. This increased risk is considered to be associated with the autonomic nervous system (ANS) abnormalities. However, there is little or no documentation of the relationship between this increased risk and the phases of BD. In this study, we aimed to compare the changes in the QT dispersion (QTd) and P-wave dispersion (Pd), which are predictors of sudden cardiac death and atrial fibrillation, between the patients with manic BD and healthy controls. PARTICIPANTS AND METHODS The study included a patient group of 44 patients (26 female and 18 male) that were hospitalized due to a diagnosis of manic BD and met the inclusion criteria, and a control group of 34 age- and gender-matched healthy individuals (21 female and 13 male) with no history of psychiatric and neurological disorders. The QTd and Pd values were determined in each participant by performing the standard 12-lead body surface electrocardiography (ECG). RESULTS The principal electrocardiographic indicators including corrected maximum QT interval, corrected QT dispersion, and minimum P-wave duration significantly increased in the patient group compared to the control group (t=2.815, p<0.01; t=4.935, p<0.001; t=3.337, p<0.001, respectively). CONCLUSION The results indicated that patients with manic BD are at increased risk for cardiovascular autonomic dysfunction. Therefore, clinicians should be more careful about ECG changes and related possible cardiac conduction problems such as cardiac arrthythmias in patients with manic BD. Further longitudinal studies are needed to investigate BD and its phases (depression, mania, and hypomania) with regard to ANS and cardiac abnormalities.
Collapse
Affiliation(s)
- Mehmet Gurkan Gurok
- Fırat University, School of Medicine, Department of Psychiatry, Elazig, Turkey
| | - Hasan Korkmaz
- Fırat University, School of Medicine, Department of Cardiology, Elazig, Turkey
| | - Sevler Yıldız
- Fırat University, School of Medicine, Department of Psychiatry, Elazig, Turkey
| | - Dilek Bakış
- Fırat University, School of Medicine, Department of Psychiatry, Elazig, Turkey
| | - Murad Atmaca
- Fırat University, School of Medicine, Department of Psychiatry, Elazig, Turkey
| |
Collapse
|
17
|
Bipolar Disorder and Immune Dysfunction: Epidemiological Findings, Proposed Pathophysiology and Clinical Implications. Brain Sci 2017; 7:brainsci7110144. [PMID: 29084144 PMCID: PMC5704151 DOI: 10.3390/brainsci7110144] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022] Open
Abstract
Bipolar disorder (BD) is strongly associated with immune dysfunction. Replicated epidemiological studies have demonstrated that BD has high rates of inflammatory medical comorbidities, including autoimmune disorders, chronic infections, cardiovascular disease and metabolic disorders. Cytokine studies have demonstrated that BD is associated with chronic low-grade inflammation with further increases in pro-inflammatory cytokine levels during mood episodes. Several mechanisms have been identified to explain the bidirectional relationship between BD and immune dysfunction. Key mechanisms include cytokine-induced monoamine changes, increased oxidative stress, pathological microglial over-activation, hypothalamic-pituitary-adrenal (HPA) axis over-activation, alterations of the microbiome-gut-brain axis and sleep-related immune changes. The inflammatory-mood pathway presents several potential novel targets in the treatment of BD. Several proof-of-concept clinical trials have shown a positive effect of anti-inflammatory agents in the treatment of BD; however, further research is needed to determine the clinical utility of these treatments. Immune dysfunction is likely to only play a role in a subset of BD patients and as such, future clinical trials should also strive to identify which specific group(s) of BD patients may benefit from anti-inflammatory treatments.
Collapse
|
18
|
Strassnig M, Kotov R, Cornaccio D, Fochtmann L, Harvey PD, Bromet EJ. Twenty-year progression of body mass index in a county-wide cohort of people with schizophrenia and bipolar disorder identified at their first episode of psychosis. Bipolar Disord 2017; 19:336-343. [PMID: 28574189 PMCID: PMC5568920 DOI: 10.1111/bdi.12505] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is an increased prevalence of obesity in schizophrenia and bipolar disorder, leading to a disproportionate risk of adverse health conditions. Prospective, long-term weight gain data, however, are scarce. METHODS We analyzed data from the Suffolk County Mental Health Project cohort of consecutive first admissions with psychosis recruited from September 1989 to December 1995 and subsequently followed for 20 years, focusing on people with schizophrenia (n=146) and bipolar disorder (n=87). The time course of weight gain was examined using a 2 (group)×5 (time) mixed-model repeated measures ANOVA, and body mass index (BMI) scores at the first (6 months) and second (2 years) assessments were compared to examine whether early overweight predicted later obesity. RESULTS There was a statistically significant effect of time (F(1,210)=68.06, P<.001) and diagnosis (F(1,210)=29.18, P<.001) on BMI, but not the interaction of time×diagnosis (F(1,210)=0.88, P=.48). Most participants had normal BMIs at the first two assessments. Early overweight was a predictor of eventual obesity for both groups. At the 20-year follow-ups, approximately 50% of the bipolar and 62% of the schizophrenia sample were obese, with a greater prevalence of obesity in schizophrenia at each assessment (all P<.02), except for years 4 (P=.12) and 20 (P=.27). CONCLUSIONS Nearly two-thirds of the participants with schizophrenia and over half of those with bipolar disorder were obese 20 years after first hospitalization for psychosis, considerably higher than the rate for adults in New York State (27%). Early intervention may be required to prevent long-term consequences of obesity-related morbidity and mortality.
Collapse
Affiliation(s)
- M Strassnig
- Department of Integrated Medical Science, Charles Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - R Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Danielle Cornaccio
- School of Integrated Science and Humanity, Florida International University
| | - L Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - PD Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine
| | - EJ Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| |
Collapse
|
19
|
Levin JB, Krivenko A, Howland M, Schlachet R, Sajatovic M. Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review. CNS Drugs 2016; 30:819-35. [PMID: 27435356 DOI: 10.1007/s40263-016-0368-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical.
Collapse
Affiliation(s)
- Jennifer B Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA. .,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA.
| | - Anna Krivenko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Psychology, Cleveland State University, 2300 Chester Avenue, Cleveland, OH, 44115, USA
| | - Molly Howland
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rebecca Schlachet
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA.,Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| |
Collapse
|
20
|
Abstract
The pathophysiology of bipolar disorder (BD) remains poorly understood. Current psychopharmacologic treatments are often poorly tolerated and carry high rates of treatment resistance. Mounting evidence has suggested that innate immune system dysfunction may play a role in the pathophysiology of BD. Elevated proinflammatory cytokine levels have been identified. The innate immune system is a novel therapeutic target in BD. Lithium has been shown to have antiinflammatory properties. Further research is needed to establish the role of antiinflammatory agents in the treatment of BD; however, evidence from several clinical trials indicates that antiinflammatory agents may be incorporated into clinical practice soon.
Collapse
Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario M5T 2S8, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario M5T 2S8, Canada.
| |
Collapse
|
21
|
Happell B, Stanton R, Hodgetts D, Scott D. Quality of Life Outcomes in Community-based Mental Health Consumers: Comparisons with Population Norms and Changes over Time. Issues Ment Health Nurs 2016; 37:146-52. [PMID: 26962895 DOI: 10.3109/01612840.2015.1119223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Quality of life is shown to be lower in people diagnosed with mental illness in comparison to the general population. The aim of this study is to examine the Quality of life in a subset of people accessing mental health services in a regional Queensland Centre. Thirty-seven people accessing mental health services completed the SF36 Health Survey on three occasions. Differences and relationships between Physical Composite Scores and Mental Composite Scores, comparisons with Australian population norms, and temporal change in Quality of Life were examined. Physical Composite Scores were significantly different to, but significantly correlated with, Mental Composite Scores on each occasion. Physical Composite Scores and Mental Composite Scores were significantly different to population norms, and did not vary significantly across time. The poor Quality of life of people with mental illness remains a significant challenge for the mental health workforce.
Collapse
Affiliation(s)
- Brenda Happell
- a SYNERGY: Nursing and Midwifery Research Centre , University of Canberra and ACT Health , Australia
| | - Robert Stanton
- b School of Medical and Applied Sciences , Central Queensland University , Australia
| | - Danya Hodgetts
- b School of Medical and Applied Sciences , Central Queensland University , Australia
| | - David Scott
- c School of Clinical Studies , Monash University , Australia
| |
Collapse
|
22
|
Quintana DS, Westlye LT, Kaufmann T, Rustan ØG, Brandt CL, Haatveit B, Steen NE, Andreassen OA. Reduced heart rate variability in schizophrenia and bipolar disorder compared to healthy controls. Acta Psychiatr Scand 2016; 133:44-52. [PMID: 26371411 DOI: 10.1111/acps.12498] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite current diagnostic systems distinguishing schizophrenia (SZ) and bipolar disorder (BD) as separate diseases, emerging evidence suggests they share a number of clinical and epidemiological features, such as increased cardiovascular disease (CVD) risk. It is not well understood if poor cardiac autonomic nervous system regulation, which can be indexed non-invasively by the calculation of heart rate variability (HRV), contributes to these common CVD risk factors in both diseases. METHOD We calculated HRV in 47 patients with SZ, 33 patients with BD and 212 healthy controls. Measures of symptom severity were also collected from the patient groups. RESULTS Heart rate variability was significantly reduced in both these disorders in comparison with the healthy participants; however, there were no HRV differences between disorders. Importantly, these reductions were independent of the medication, age or body mass index effects. There was also preliminary evidence that patients with reduced HRV had increased overall and negative psychosis symptom severity regardless of SZ or BD diagnosis. CONCLUSION We suggest that HRV may provide a possible biomarker of CVD risk and symptom severity in severe mental illness. Thus, our results highlight the importance of cardiometabolic screening across SZ and bipolar spectrum disorders.
Collapse
Affiliation(s)
- D S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - L T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - T Kaufmann
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Ø G Rustan
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - C L Brandt
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - B Haatveit
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - N E Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway.,Drammen Outpatient Clinic, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| |
Collapse
|
23
|
Rosenblat JD, McIntyre RS. Are medical comorbid conditions of bipolar disorder due to immune dysfunction? Acta Psychiatr Scand 2015; 132:180-91. [PMID: 25772638 DOI: 10.1111/acps.12414] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Epidemiological data have shown a clear association between bipolar disorder (BD) and medical comorbidities. The aim of this article was to assess the evidence of immune dysfunction as a key mediator of this observed association. METHOD For this narrative clinical overview, the MEDLINE/PubMed, EMBASE, Google Scholar, and ClinicalTrials.gov databases were searched for relevant articles. RESULTS Bipolar disorder has been shown to have an increased prevalence in patients with autoimmune disorders, cardiovascular disease, and metabolic dysfunction. Further, an elevation in proinflammatory cytokines in BD has been repeatedly demonstrated. Several mechanisms have been proposed to explain the effect of immune dysfunction on mood and cognition. Anti-inflammatory agents including TNF-α inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), minocycline and omega-3 polyunsaturated fatty acids (O3PUFA) are being investigated for their use as novel treatment of BD in patients with immune dysfunction. CONCLUSION Immune dysfunction appears to be an important mediator of the association observed between BD and medical comorbidities. It therefore serves as a potential novel target for treatment of BD. Further, the observed bidirectional interaction merits screening for psychiatric disorders in patients with immune dysfunction and vice versa to allow for early detection and treatment of this at risk population.
Collapse
Affiliation(s)
- J D Rosenblat
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada.,Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - R S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
24
|
Stanton R, Reaburn P, Happell B. Barriers to exercise prescription and participation in people with mental illness: the perspectives of nurses working in mental health. J Psychiatr Ment Health Nurs 2015; 22:440-8. [PMID: 25855247 DOI: 10.1111/jpm.12205] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 12/11/2022]
Abstract
ACCESSIBLE SUMMARY Exercise is valuable in the treatment of mental illness, yet personal and organizational barriers limit widespread implementation by nurses in mental health settings. Using a self-report questionnaire, we sought to identify how often nurses prescribe exercise and their level of agreement with previously identified barriers to exercise prescription and participation for mental health consumers. Nurses disagree that many of the previously identified barriers should impede exercise prescription for people with mental illness. Nurses agree that many of the barriers expressed by mental health consumers might prevent exercise participation. Our study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness; however, it is limited to a small sample. Confirmation of these findings in larger, geographically and professionally diverse groups is needed. ABSTRACT Evidence is mounting for the efficacy of exercise in the treatment of people with mental illness. Nurses working in mental health settings are well placed to provide exercise advice for people with mental illness. However, quantitative examinations of the barriers to exercise prescription experienced by nurses, or their views regarding the barriers to exercise participation experienced by people with mental illness, are lacking. In this study, 34 nurses completed the Exercise in Mental Illness Questionnaire-Health Professionals Version (EMIQ-HP). This survey examined the frequency of exercise prescription and the level of agreement with statements regarding barriers to exercise prescription for, and exercise participation by, people with mental illness. The level of agreement scores for statements for each section was summed, with a higher score indicating a higher level of agreement. Nurses disagree with many of the barriers to exercise prescription presented in the literature. The level of agreement scores did not differ between nurses who prescribe exercise 'Always', 'Most of the time', 'Occasionally' or 'Never'. We found a non-significant negative relationship between frequency of exercise prescription and summed level of agreement scores for barriers to exercise prescription. Consensus regarding barriers to exercise participation by mental health consumers is less clear. This study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness. Confirmation in larger samples is needed before translation of research to practice.
Collapse
Affiliation(s)
- R Stanton
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - P Reaburn
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - B Happell
- Research Centre for Nursing and Midwifery Practice, University of Canberra, Canberra, ACT, Australia.,Research Centre for Nursing and Midwifery Practice, ACT Health, Canberra, ACT, Australia
| |
Collapse
|
25
|
Murru A, Popovic D, Pacchiarotti I, Hidalgo D, León-Caballero J, Vieta E. Management of adverse effects of mood stabilizers. Curr Psychiatry Rep 2015; 17:603. [PMID: 26084665 DOI: 10.1007/s11920-015-0603-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.
Collapse
Affiliation(s)
- Andrea Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,
| | | | | | | | | | | |
Collapse
|
26
|
Safari R, Tunca Z, Ozerdem A, Ceylan D, Yazicioglu CE, Sakizli M. New alterations at potentially regulated regions of the Glial Derived Neurotrophic Factor gene in bipolar disorder. J Affect Disord 2015; 167:244-50. [PMID: 24997227 DOI: 10.1016/j.jad.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/02/2014] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Glial Derived Neurotrophic Factor (GDNF) plays an important role in the survival and differentiation of neurons. We examined 5'upstream and 3' untranslated region of the GDNF gene by PCR amplification and direct sequencing to explore the effect of alteration in the potentially regulated part of GDNF in bipolar disorder. MATERIALS AND METHODS Sixty-six patients with bipolar disorder, 27 first degree relatives of these patients and 56 healthy volunteers were screened for mutations and polymorphisms in GDNF gene. RESULTS Seven previously reported polymorphisms and additional three novel allele variants of GDNF were detected. Association test of rs2075680 C>A SNP showed significant difference between patients and healthy subjects with higher allele frequency in healthy subjects performing Chi-square test. However, there was no significant difference after multiple test corrections between groups. There were no significant differences in association test of rs2075680 C>A SNP between first degree relatives and healthy volunteers/patients. rs142426358 T>C SNP was seen only in one patient with an early age of illness onset. New T>A alterations were found in chromosome locations 5:37812784 and 5:37812782 in two male bipolar disorder patients with age of illness onset 12 and 24 years. LIMITATIONS The sample size was relatively small. DISCUSSION Our study proposes the suggestive association between polymorphisms in the potential regulatory sites of GDNF and bipolar disorder.
Collapse
Affiliation(s)
- Roghaiyeh Safari
- Department of Molecular Medicine, Dokuz Eylul University, Faculty of Medicine and Institute of Health Sciences, Inciralti, Izmir, Turkey.
| | - Zeliha Tunca
- Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Aysegul Ozerdem
- Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Department of Neuroscience, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Deniz Ceylan
- Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Cigdem Eresen Yazicioglu
- Department of Medical Biology and Genetics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Meral Sakizli
- Department of Medical Biology and Genetics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| |
Collapse
|
27
|
Bernstein EE, Nierenberg AA, Deckersbach T, Sylvia LG. Eating behavior and obesity in bipolar disorder. Aust N Z J Psychiatry 2015; 49:566-72. [PMID: 25586751 DOI: 10.1177/0004867414565479] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with bipolar disorder are more frequently overweight or obese than the general population, but the reasons for this association are unknown. The aim of this study is to further understand the etiology of overweight and obesity in bipolar disorder. METHODS We invited patients in a specialty outpatient bipolar clinic to complete the Eating Inventory. Patients provided self-reported restraint, disinhibition, and perceived hunger as well as general perceptions of dietary intake. RESULTS Sixty-two individuals (37 female) between the ages of 18 and 67 (M = 41.5, SD = 13.38) and with an average body mass index (BMI) of 27.18 (SD = 5.71) completed the survey. Disinhibition and perceived hunger were positively correlated with BMI and self-reported difficulty eating healthy foods. Restraint was positively correlated with healthy eating (ps < .05). Stepwise linear regressions revealed that hunger was the most significant predictor of BMI (F(1) = 8.134, p = .006). Those participants with bipolar I or II disorder reported greater hunger scores (p < .01) and difficulty eating healthily (p < .05) than those without a full diagnosis. CONCLUSIONS These results suggest that disinhibition and perception of hunger may be linked to the disproportionately high rate of obesity in bipolar disorder.
Collapse
Affiliation(s)
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
28
|
Shakeri J, Farnia V, Valinia K, Hashemian AH, Bajoghli H, Holsboer-Trachsler E, Brand S. The relationship between lifetime suicide attempts, serum lipid levels, and metabolic syndrome in patients with bipolar disorders. Int J Psychiatry Clin Pract 2015; 19:124-31. [PMID: 25410158 DOI: 10.3109/13651501.2014.988271] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the relationship between lifetime suicide attempts (SAs), serum lipid values, and metabolic syndrome (MetS) in patients with bipolar disorders (BPD). METHODS Eighty patients with BPD took part in the study (M = 40.60 years). After psychiatric diagnosis, demographic data, SAs, and serum lipids were measured and MetS was calculated. RESULTS 70% reported at least one suicide attempt. 52.5% suffered from MetS. Suicide attempters had higher cholesterol values. SAs were associated with a family history of suicide, current mood state, and lower educational level. SAs were unrelated to MetS. CONCLUSIONS In patients with BPD, against expectations, the occurrence of SAs was associated with higher cholesterol values. Serum lipid values are not suitable as a biological trait marker to predict SAs.
Collapse
Affiliation(s)
- Jalal Shakeri
- Department of Psychiatry, Behavioral Sciences Research Center, Kermanshah University of Medical Sciences , Kermanshah , Iran
| | | | | | | | | | | | | |
Collapse
|
29
|
Bai YM, Su TP, Li CT, Tsai SJ, Chen MH, Tu PC, Chiou WF. Comparison of pro-inflammatory cytokines among patients with bipolar disorder and unipolar depression and normal controls. Bipolar Disord 2015; 17:269-77. [PMID: 25257835 DOI: 10.1111/bdi.12259] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 06/27/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Research evidence has shown that bipolar disorder (BD) and unipolar depression (UD) are both related to inflammatory dysregulation, but few studies have compared the levels of cytokines between these two disorders. METHODS Study subjects were age- and gender-matched outpatients with BD or UD and normal controls (NC). Severities of depression and mania symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). Pro-inflammatory cytokines, including soluble interleukin-6 receptor (sIL-6R), soluble interleukin-2 receptor (sIL-2R), C-reactive protein (CRP), soluble tumor necrosis factor receptor type 1 (sTNF-R1), soluble p-selectin receptor (sP-selectin), and monocyte chemotactic protein-1 (MCP-1), were assessed in all subjects by enzyme-linked immunosorbent assays. RESULTS In all, 130 patients with BD, 149 patients with UD, and 130 NC were enrolled in the study; 67.6% were female and the average age was mean ± standard deviation (SD) 43.5 ± 11.8 years. The BD group had a significantly higher smoking rate, more medical comorbidity, higher body mass index (BMI), and higher levels of sIL-2R, sIL-6R, CRP, sTNF-R1, and MCP-1 (all p < 0.01) than the UD and NC groups. When the remitted patients with BD (YMRS scores ≤ 12) were compared with the patients with UD, controlling for age, MADRS score, smoking, medical comorbidity, and BMI in the regression model, the results showed that the BD group had significantly higher levels of sIL-6R (p < 0.001), CRP (p = 0.045), sTNF-R1 (p = 0.036), and MCP-1 (p = 0.001) than the UD group. CONCLUSIONS Higher levels of sIL-6R, CRP, sTNF-R1, and MCP-1 were noted in BD than in UD. These results may suggest a more severe inflammatory dysregulation in BD. Further studies are required to investigate whether these cytokines could be biomarkers for affective disorders.
Collapse
Affiliation(s)
- Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital; Department of Psychiatry, College of Medicine, National Yang-Ming University
| | | | | | | | | | | | | |
Collapse
|
30
|
A naturalistic retrospective review of weight gain in bipolar patients treated with second generation antipsychotics. J Clin Psychopharmacol 2015; 35:192-3. [PMID: 25587693 DOI: 10.1097/jcp.0000000000000271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Sylvia LG, Shelton RC, Kemp DE, Bernstein EE, Friedman ES, Brody BD, McElroy SL, Singh V, Tohen M, Bowden CL, Ketter TA, Deckersbach T, Thase ME, Reilly-Harrington NA, Nierenberg AA, Rabideau DJ, Kinrys G, Kocsis JH, Bobo WV, Kamali M, McInnis MG, Calabrese JR. Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Bipolar Disord 2015; 17:212-23. [PMID: 25130321 DOI: 10.1111/bdi.12243] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/15/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Individuals with bipolar disorder have high rates of other medical comorbidity, which is associated with higher mortality rates and worse course of illness. The present study examined common predictors of medical comorbidity. METHODS The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month, randomized comparative effectiveness trial. Baseline assessments included current and lifetime DSM-IV-TR diagnoses, demographic information, psychiatric and medical history, severity of psychiatric symptoms, level of functioning, and a fasting blood draw. Medical comorbidities were categorized into two groups: cardiometabolic (e.g., diabetes, hyperlipidemia, and metabolic syndrome) and non-cardiovascular (e.g., seizures, asthma, and cancer). Additionally, we looked at comorbid substance use (e.g., smoking and drug dependence). RESULTS We found that 96.3% of participants had at least one other medical comorbidity. Older age predicted a greater likelihood of having a cardiometabolic condition. Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition, but a greater chance of having other types of medical comorbidity. Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed, less time spent manic/hypomanic, and longer duration of illness. Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides. CONCLUSIONS There appears to be a substantial medical burden associated with bipolar disorder, highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients.
Collapse
Affiliation(s)
- Louisa G Sylvia
- Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Lack D, Holt RIG, Baldwin DS. Poor monitoring of physical health in patients referred to a mood disorders service. Ther Adv Psychopharmacol 2015; 5:22-5. [PMID: 25653827 PMCID: PMC4315671 DOI: 10.1177/2045125314560734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Severe mental illness is associated with significantly increased morbidity and mortality, most commonly from cardiovascular disease. Much of the risk is explicable by potentially modifiable factors such as diabetes and dyslipidaemia, and regular screening of patients with severe mental illness is recommended. Screening and intervention for physical illness among people with schizophrenia is often suboptimal, but little is known about monitoring physical health in patients with affective (mood and anxiety) disorders. METHOD Electronic and paper records were examined for evidence of monitoring of cardiovascular disease risk factors in the 12 months prior to assessment in patients attending a tertiary referral specialist service for affective disorders over a period of 39 months. The number of contacts with healthcare services was calculated for each patient to provide an estimate of the opportunities for monitoring. RESULTS Notes for 113 patients were examined. The mean number of contacts with outpatient services in the 12 months before assessment was 6.9 (standard deviation 7.7). Documented evidence of physical-health monitoring was seen in only 29 patients: monitoring was more commonly undertaken in patients with recurrent unipolar depression and in those who had undergone recent inpatient treatment. Contacts that could have allowed monitoring of physical health were common. DISCUSSION Although most patients had multiple contacts with health services in the 12-month period before their assessment in the service, there was little evidence of use of primary-prevention measures to reduce the risks of diabetes and cardiovascular disease in this vulnerable population.
Collapse
Affiliation(s)
- David Lack
- Alexandra Hospital, Worcestershire Acute NHS Trust, Redditch, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK
| | - David S Baldwin
- Professor of Psychiatry, Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, University Department of Psychiatry, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK
| |
Collapse
|
33
|
Ahmadpanah M, Haghighi M, Jahangard L, Borzoei S, Heshmati S, Bajoghli H, Holsboer-Trachsler E, Brand S. No evidence for metabolic syndrome and lipid profile differences in patients suffering from bipolar I disorder with and without suicide attempts. Int J Psychiatry Clin Pract 2015; 19:168-73. [PMID: 25969160 DOI: 10.3109/13651501.2015.1049277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the present study was to provide further evidence of (1) metabolic syndrome and blood lipid profile differences between suicide attempting and non-attempting patients with bipolar disorder (BPD) I and to assess these differences (2) as a function of acute depressive or manic phase. METHODS Fifty inpatients (mean age: 36.14 years 48% males) with BPD I took part in the study. After recruitment, patients were clustered in four groups: 13 suicide attempters (SAs) assessed during a manic phase, 12 SAs assessed during a depressive phase, 15 non-SAs assessed during a manic phase, and 10 non-SAs assessed during a depressive phase. Body mass index (BMI), metabolic syndrome, blood pressure, blood lipids (cholesterol, high- and low-density lipids, and triglyceride), and fasting blood sugar were assessed. RESULTS Neither metabolic syndrome, blood lipid values, fasting blood sugar, nor BMI or blood pressure differed between the SAs and non-SAs, or between patients in an acute manic phase and those in a depressed phase. The overall prevalence of metabolic syndrome was 26.0%. CONCLUSION Among patients with BPD I neither the occurrence of metabolic syndrome nor lipid values or fasting blood sugar are reliable biomarkers of suicidal behavior during either acute depressive or manic phase.
Collapse
Affiliation(s)
- Mohammad Ahmadpanah
- a Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medial Sciences , Hamadan , Iran
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Assies J, Mocking RJT, Lok A, Ruhé HG, Pouwer F, Schene AH. Effects of oxidative stress on fatty acid- and one-carbon-metabolism in psychiatric and cardiovascular disease comorbidity. Acta Psychiatr Scand 2014; 130:163-80. [PMID: 24649967 PMCID: PMC4171779 DOI: 10.1111/acps.12265] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in severe psychiatric disorders (depression, schizophrenia). Here, we provide evidence of how the effects of oxidative stress on fatty acid (FA) and one-carbon (1-C) cycle metabolism, which may initially represent adaptive responses, might underlie comorbidity between CVD and psychiatric disorders. METHOD We conducted a literature search and integrated data in a narrative review. RESULTS Oxidative stress, mainly generated in mitochondria, is implicated in both psychiatric and cardiovascular pathophysiology. Oxidative stress affects the intrinsically linked FA and 1-C cycle metabolism: FAs decrease in chain length and unsaturation (particularly omega-3 polyunsaturated FAs), and lipid peroxidation products increase; the 1-C cycle shifts from the methylation to transsulfuration pathway (lower folate and higher homocysteine and antioxidant glutathione). Interestingly, corresponding alterations were reported in psychiatric disorders and CVD. Potential mechanisms through which FA and 1-C cycle metabolism may be involved in brain (neurocognition, mood regulation) and cardiovascular system functioning (inflammation, thrombosis) include membrane peroxidizability and fluidity, eicosanoid synthesis, neuroprotection and epigenetics. CONCLUSION While oxidative-stress-induced alterations in FA and 1-C metabolism may initially enhance oxidative stress resistance, persisting chronically, they may cause damage possibly underlying (co-occurrence of) psychiatric disorders and CVD. This might have implications for research into diagnosis and (preventive) treatment of (CVD in) psychiatric patients.
Collapse
Affiliation(s)
- J Assies
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, Amsterdam
| | | | | | | | | | | |
Collapse
|
35
|
Development, validation and initial outcomes of a questionnaire to investigate the views of nurses working in a mental health setting regarding a cardiometabolic health nursing role. Arch Psychiatr Nurs 2014; 28:123-7. [PMID: 24673787 DOI: 10.1016/j.apnu.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/30/2013] [Accepted: 12/14/2013] [Indexed: 11/23/2022]
Abstract
People with serious mental illness experience disparities in primary health care. One solution is a specialist nursing position responsible for the coordination of the primary care of people with serious mental illness. However the views of nurses regarding this proposed role are only beginning to emerge. This study reports the readability, factorability, internal consistency and responses from a questionnaire regarding the views of nurses working in a mental health setting regarding the proposed role. The questionnaire was determined to have adequate readability, and internal consistency. Nurses are positive towards the development of the role however the cost-effectiveness should be considered.
Collapse
|
36
|
Sayyaparaju KK, Grunze H, Fountoulakis KN. When to start aripiprazole therapy in patients with bipolar mania. Neuropsychiatr Dis Treat 2014; 10:459-70. [PMID: 24648740 PMCID: PMC3958500 DOI: 10.2147/ndt.s40066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aripiprazole is a third generation atypical antipsychotic with compelling evidence as a highly effective treatment option in the management of acute manic and mixed episodes of bipolar I disorders. It has a unique mode of action, acting as a partial agonist at dopamine D2 and D3, and serotonin 5-HT1A; and exhibiting antagonistic action at the 5-HT2A and H1 receptors. Overall, it has a favorable safety and tolerability profile, with low potential for clinically significant weight gain and metabolic effects, especially compared to other well-established treatments. It also has a superior tolerability profile when used as maintenance treatment. Side effects like headache, insomnia, and extrapyramidal side effects (EPSEs), such as tremor and akathisia may be treatment limiting in some cases. It is efficacious in both acute mania and mixed states, and in the long-term prevention of manic relapses. Aripiprazole therefore, is a significant player in the current portfolio of anti-manic pharmacological treatments. The data sources for this article are from EMBASE, MEDLINE, and the clinical trial database searches for all the literature published between January 2003 and September 2013. The key search terms were "aripiprazole" combined with "bipolar disorder", "mania", "antipsychotics", "mood stabilizer", "randomized controlled trial", and "pharmacology". Abstracts and proceedings from national and international psychiatric meetings were also reviewed, along with reviews of the reference lists of relevant articles.
Collapse
Affiliation(s)
- Kiran Kumar Sayyaparaju
- Newcastle University, Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, UK
| | - Heinz Grunze
- Newcastle University, Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, UK
- Correspondence: Heinz Grunze, Newcastle University, Institute of Neuroscience, Academic Psychiatry, Campus of Aging and Vitality, Wolfson Research Centre, Westgate Road, Newcastle upon Tyne, UK, Tel +44 0 191 208 1372, Fax +44 0 191 208 1387, Email
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
37
|
Young AH. Not always on the level: service provision for bipolar disorders. Acta Psychiatr Scand 2013:1-2. [PMID: 23581786 DOI: 10.1111/acps.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Sylvia LG, Friedman ES, Kocsis JH, Bernstein EE, Brody BD, Kinrys G, Kemp DE, Shelton RC, McElroy SL, Bobo WV, Kamali M, McInnis MG, Tohen M, Bowden CL, Ketter TA, Deckersbach T, Calabrese JR, Thase ME, Reilly-Harrington NA, Singh V, Rabideau DJ, Nierenberg AA. Association of exercise with quality of life and mood symptoms in a comparative effectiveness study of bipolar disorder. J Affect Disord 2013; 151:722-727. [PMID: 23993440 DOI: 10.1016/j.jad.2013.07.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Individuals with bipolar disorder lead a sedentary lifestyle associated with worse course of illness and recurrence of symptoms. Identifying potentially modifiable predictors of exercise frequency could lead to interventions with powerful consequences on the course of illness and overall health. METHODS The present study examines baseline reports of exercise frequency of bipolar patients in a multi-site comparative effectiveness study of a second generation antipsychotic (quetiapine) versus a classic mood stabilizer (lithium). Demographics, quality of life, functioning, and mood symptoms were assessed. RESULTS Approximately 40% of participants reported not exercising regularly (at least once per week). Less frequent weekly exercise was associated with higher BMI, more time depressed, more depressive symptoms, and lower quality of life and functioning. In contrast, more frequent exercise was associated with experiencing more mania in the past year and more current manic symptoms. LIMITATIONS Exercise frequency was measured by self-report and details of the exercise were not collected. Analyses rely on baseline data, allowing only for association analyses. Directionality and predictive validity cannot be determined. Data were collected in the context of a clinical trial and thus, it is possible that the generalizability of the findings could be limited. CONCLUSION There appears to be a mood-specific relationship between exercise frequency and polarity such that depression is associated with less exercise and mania with more exercise in individuals with bipolar disorder. This suggests that increasing or decreasing exercise could be a targeted intervention for patients with depressive or mood elevation symptoms, respectively.
Collapse
Affiliation(s)
| | | | - James H Kocsis
- Weill Cornell Medical College of Cornell University, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michael E Thase
- Perelman School of Medicine at the University of Pennsylvania, USA
| | | | - Vivek Singh
- University of Texas Health Science Center at San Antonio, USA
| | | | | |
Collapse
|
39
|
Bravo MF, Lahera G, Lalucat L, Fernández-Liria A. Guía de práctica clínica sobre el trastorno bipolar: tratamiento farmacológico y psicosocial. Med Clin (Barc) 2013; 141:305.e1-305.e10. [DOI: 10.1016/j.medcli.2013.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
|