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Nan X, Li W, Wang L. Functional magnetic resonance imaging studies in bipolar disorder in resting state: A coordinates-based meta-analysis. Psychiatry Res Neuroimaging 2024; 344:111869. [PMID: 39146823 DOI: 10.1016/j.pscychresns.2024.111869] [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: 10/06/2023] [Revised: 07/20/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024]
Abstract
Exploring changes in the intrinsic activity of the brain in people with bipolar disorder (BD) is necessary. However, the findings have not yet led to consistent conclusions. In this regard, this paper aims to extract more obvious differential brain areas and neuroimaging markers, for the purpose of providing assistance for early clinical diagnosis and subsequent treatment. We conducted a meta-analysis of whole-brain resting-state functional magnetic resonance imaging (rs-fMRI) studies using seed-based d-mapping software that examined differences in amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) between patients with BD and healthy controls (HCs). Seed-based d-Mapping (formerly Signed Differential Mapping) with Permutation of Subject Images, or SDM-PSI, is a statistical technique for meta-analyzing studies of differences in brain activity or structure. A total of 16 articles involving 1112 individuals were included in this study for meta-analysis. This paper confidently analyzes the correlation between the clinical scales HAMD, HAMA, and YMRS, and the area of difference. We found significant changes that increased activation in the anterior connective and left lens nucleus, the nucleus of the shell, and BA 48 in BD patients compared with HC (P < 0.05, uncorrected), as well as a significant correlation between HAMD and the left superior frontal gyrus (after FWE correction P < 0.05). Therefore, basal ganglia and frontal cortex may have important significance in the pathogenesis and pathological basis of BD, making it an important issue to be attached importance to.
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Affiliation(s)
- Xia Nan
- Baiyin City Central Hospital, Baiyin, China
| | - Wenling Li
- The NO.2 People's Hospital of Lanzhou, Lanzhou, China
| | - Lin Wang
- Department of Radiology, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China; Cancer Clinical Medical Research Center, Gansu combination of traditional Chinese and Western medicine, Lanzhou, China.
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Zhong R, Wang Z, Zhu Y, Wu X, Wang X, Wu H, Zhou J, Li X, Xu G, Pan M, Chen Z, Li W, Jiao Z, Li M, Zhang Y, Chen J, Chen X, Li N, Sun J, Zhang J, Hu S, Gan Z, Qin Y, Wang Y, Ma Y, Fang Y. Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China. J Affect Disord 2024; 367:333-341. [PMID: 39233245 DOI: 10.1016/j.jad.2024.08.231] [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: 03/01/2024] [Revised: 08/24/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. METHODS NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. RESULTS The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were "cutting" (41.2 %) and "hitting" (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). LIMITATIONS As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. CONCLUSION Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.
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Affiliation(s)
- Rongrong Zhong
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, China
| | - Zuowei Wang
- Shanghai Hongkou Mental Health Center, 200083, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, 200083, China
| | - Yuncheng Zhu
- Shanghai Hongkou Mental Health Center, 200083, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, 200083, China.
| | - XiaoHui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, China
| | - Xiaoping Wang
- The Second Xiangya Hospital of Central South University, 410012, China
| | - Haishan Wu
- The Second Xiangya Hospital of Central South University, 410012, China
| | - Jia Zhou
- Beijing Anding Hospital, Capital Medical University, 100088, China
| | - Xiaohong Li
- Beijing Anding Hospital, Capital Medical University, 100088, China
| | - Guiyun Xu
- The Affiliated Brain Hospital of Guangzhou Medical University, 510370, China
| | - Miao Pan
- The Second Affiliated Hospital of Xinxiang Medical University, 453002, China
| | - Zhiyu Chen
- Hangzhou Seventh People's Hospital, 310063, China
| | - Wenfei Li
- Anhui Mental Health Center, 230022, China
| | - Zhian Jiao
- Shandong Provincial Hospital, 250021, China
| | - Mingli Li
- West China Hospital Sichuan University, 610044, China
| | | | | | - Xiuzhe Chen
- Shandong Mental Health Center, 250014, China
| | - Na Li
- The first Affiliated Hospital of Kunming Medical College, 650032, China
| | - Jing Sun
- Nanjing Brain Hospital, 210024, China
| | - Jian Zhang
- Shenzhen Kang Ning Hospital, 518020, China
| | - Shaohua Hu
- The First Affiliated Hospital Zhejiang University School of Medicine, 310003, China
| | - Zhaoyu Gan
- No. 3 Hospital of Zhongshan University, 510630, China
| | - Yan Qin
- Dalian Seventh People's Hospital, 116086, China
| | - Yumei Wang
- The First Hospital of Hebei Medical University, 50030, China
| | - Yantao Ma
- Peking University Institute of Mental Health, 100191, China
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, China; Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, 200083, China.
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Zimmerman M, Mackin D. Validity of the DSM-5 Mixed Features Specifier Interview. Bipolar Disord 2024; 26:479-487. [PMID: 38684326 DOI: 10.1111/bdi.13436] [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] [Indexed: 05/02/2024]
Abstract
OBJECTIVES To examine the reliability and validity of a semi-structured interview assessing the features of the DSM-5 mixed features specifier. Our goal was to develop an instrument that could be used for both diagnostic and severity measurement purposes. METHODS Four hundred fifty-nine psychiatric patients in a depressive episode were interviewed by a trained diagnostic rater who administered semi-structured interviews including the DSM-5 Mixed Features Specifier Interview (DMSI). We examined the inter-rater reliability and psychometric properties of the DMSI. The patients were rated on clinician rating scales of depression, anxiety, and irritability, and measures of psychosocial functioning, suicidality, and family history of bipolar disorder. RESULTS The DMSI had excellent joint-interview interrater reliability. More than twice as many patients met the DSM-5 mixed features specifier criteria during the week before the assessment than for the majority of the episode (9.4% vs. 3.9%). DMSI total scores were more highly correlated with a clinician-rated measure of manic symptoms than with measures of depression and anxiety. More patients with bipolar depression met the mixed features specifier than patients with MDD. Amongst patients with MDD, those with mixed features more frequently had a family history of bipolar disorder, were more frequently diagnosed with anxiety disorders, attention deficit disorder, and borderline personality disorder, more frequently had attempted suicide, and were more severely depressed, anxious, and irritable. CONCLUSION The DMSI is a reliable and valid measure of the presence of the DSM-5 mixed features specifier in depressed patients as well as the severity of the features of the specifier.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Daniel Mackin
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
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Grover S, Sahoo S, Mishra KK, Deep R, Nebhinani N, Bhattacharya R, Aneja J, Kalivayalil RA, Chaterjee SS, Menon V, Subramanyam AA, Punnoose VP, Desouza A, Mehra A, Subodh BN, Avasthi A. Prevalence of mixed features in patients with first-episode depression: An exploratory multicentric study. Indian J Psychiatry 2023; 65:671-679. [PMID: 37485405 PMCID: PMC10358806 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_113_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/22/2023] [Accepted: 05/06/2023] [Indexed: 07/25/2023] Open
Abstract
Background and Aim There is limited literature on the prevalence of mixed features in patients with depression, especially from countries in Asia. Our aim was to evaluate the prevalence of "mixed features" in patients with first-episode depression. Materials and Methods Patients with first-episode depression were evaluated for the presence of mixed features as per the Diagnostic and Statistical Manual (DSM)-5 criteria. They were additionally evaluated on Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Results About one-sixth (16%) of the patients fulfilled the DSM-5 criteria for the mixed features specifier. The most common manic/hypomanic clinical feature was increased talkativeness or pressure of speech, followed by elevated expansive mood (12.5%), and inflated self-esteem or grandiosity was the least common feature (8.7%). Those with mixed features had higher prevalence of comorbid tobacco dependence and psychotic symptoms. In terms of frequency of depressive symptoms as assessed on HDRS, compared to those without mixed features, those with mixed features had higher frequency of symptoms such as depressed mood, insomnia during early hours of morning, work and activities, agitation, gastrointestinal somatic symptoms, genital symptoms, hypochondriasis, and poorer insight. Conclusion Mixed features specifier criteria were fulfilled by 16% patients with first-episode depression. This finding suggests that the extension of this specifier to depression can be considered as a useful step in understanding the symptom profile of patients with depression.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kshirod K. Mishra
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ranjan Bhattacharya
- Department of Psychiatry, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India
| | - Jitender Aneja
- Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Roy A. Kalivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Seshadri S. Chaterjee
- Department of Psychiatry, Diamond Harbour Government Medical College and Hospital, West Bengal, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Alka A. Subramanyam
- Department of Psychiatry, TNMC and BYL Nair Medical College, Mumbai, Maharashtra, India
| | | | - Avinash Desouza
- Department of Psychiatry, LTM Medical College, Mumbai, Maharashtra, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - BN Subodh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Grover S, Adarsh H. A comparative study of prevalence of mixed features in patients with unipolar and bipolar depression. Asian J Psychiatr 2023; 81:103439. [PMID: 36645972 DOI: 10.1016/j.ajp.2022.103439] [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: 11/14/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is a lack of data on the mixed specifier from developing countries like India. AIM In this background, the present study aimed to evaluate the prevalence of "mixed specifier" in patients with unipolar depression and bipolar depression. The additional aim was to evaluate the sociodemographic and clinical correlates of the mixed specifier. METHODOLOGY 110 patients (51 diagnosed with current episode unipolar depression and 59 diagnosed with current episode bipolar depression) were evaluated on DSM-5 criteria for mixed specifier for depression, Clinically Useful Depression Outcome Scale, Koukopoulos Mixed Depression Rating Scale, Hamilton depression rating scale (HDRS) and Young mania rating scale. RESULT According to DSM-5, 11 (21.56%) out of the 51 patients with unipolar depression fulfilled at least 3 out of the 7 criteria for the mixed specifier for depression, and 14 (23.72%) out of 59 patients with bipolar depression fulfilled the criteria for the mixed specifier, with no significant difference in the prevalence across the 2 groups. There was no significant difference in the sociodemographic and clinical profile of those with and without mixed features in both unipolar and bipolar depression groups. However, those with mixed and without mixed features differ on certain depressive symptoms as assessed on HDRS. CONCLUSIONS About one-fifth of patients with unipolar and bipolar depression have mixed features during the acute phase of depression.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Himani Adarsh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Comparison of bipolar disorder type II and major depressive disorder. J Affect Disord 2023; 323:204-212. [PMID: 36410453 DOI: 10.1016/j.jad.2022.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/03/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Compare patients diagnosed as DSM-5 type II bipolar disorder (BD2) vs. major depressive disorder (MDD). METHODS We compared characteristics of 3246 closely and repeatedly evaluated, consenting, adult patient-subjects (n = 706 BD2, 2540 MDD) at a specialty clinic using bivariate methods and multivariable modeling. RESULTS Factors more associated with BD2 than MDD included: [a] descriptors (more familial psychiatric, mood and bipolar disorders and suicide; younger at onset, diagnosis and first-treatment; more education; more unemployment; fewer marriages and children; higher cyclothymic, hyperthymic and irritable temperament ratings, lower anxious); [b] morbidity (more hypomanic, mixed or panic first episodes; more co-occurring general medical diagnoses, more Cluster B personality disorder diagnoses and ADHD; more alcohol and drug abuse and smoking; shorter depressive episodes and interepisode periods; lower intake ratings of depression and anxiety, higher for hypomania; far more mood-switching with antidepressants; lower %-time depressed; DMI > MDI course-pattern in BD2; more suicide attempts and violent suicidal behavior); [c] item-scores with intake HDRS21 higher for suicidality, paranoia, anhedonia, guilt, and circadian variation; lower somatic anxiety, depressed mood, insight, hypochondriasis, agitation, and insomnia; and [d] treatment (more lithium, mood-stabilizing anticonvulsants and antipsychotics, less antidepressants and benzodiazepines). CONCLUSIONS BD2 and MDD subjects differed greatly in many descriptive, psychopathological and treatment measures, notably including more familial risk, earlier onset, more frequent recurrences and greater suicidal risk with BD2. Such differences can contribute to improving differentiation of the disorders and planning for their treatment.
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Affiliation(s)
- Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy
| | | | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Huang H, Nissen N, Lim CT, Gören JL, Spottswood M, Huang H. Treating Bipolar Disorder in Primary Care: Diagnosis, Pharmacology, and Management. Int J Gen Med 2022; 15:8299-8314. [PMID: 36447648 PMCID: PMC9701507 DOI: 10.2147/ijgm.s386875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 09/10/2023] Open
Abstract
Bipolar disorder is a chronic mental illness associated with early mortality, elevated risk of comorbid cardiovascular disease, enormous burden of disability, and large societal costs. Patients often seek treatment for symptoms of bipolar disorder in the primary care setting but are frequently misdiagnosed. This article provides primary care providers with an evidence-based approach to the screening, diagnosis, and pharmacological management of bipolar disorder. Guidance is also provided for helping patients connect with higher levels of specialty psychiatric care when clinically indicated.
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Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicholas Nissen
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Christopher T Lim
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jessica L Gören
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- Department of Pharmacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, USA
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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McInnis MG, Andreassen OA, Andreazza AC, Alon U, Berk M, Brister T, Burdick KE, Cui D, Frye M, Leboyer M, Mitchell PB, Merikangas K, Nierenberg AA, Nurnberger JI, Pham D, Vieta E, Yatham LN, Young AH. Strategies and foundations for scientific discovery in longitudinal studies of bipolar disorder. Bipolar Disord 2022; 24:499-508. [PMID: 35244317 PMCID: PMC9440950 DOI: 10.1111/bdi.13198] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Bipolar disorder (BD) is a complex and dynamic condition with a typical onset in late adolescence or early adulthood followed by an episodic course with intervening periods of subthreshold symptoms or euthymia. It is complicated by the accumulation of comorbid medical and psychiatric disorders. The etiology of BD remains unknown and no reliable biological markers have yet been identified. This is likely due to lack of comprehensive ontological framework and, most importantly, the fact that most studies have been based on small nonrepresentative clinical samples with cross-sectional designs. We propose to establish large, global longitudinal cohorts of BD studied consistently in a multidimensional and multidisciplinary manner to determine etiology and help improve treatment. Herein we propose collection of a broad range of data that reflect the heterogenic phenotypic manifestations of BD that include dimensional and categorical measures of mood, neurocognitive, personality, behavior, sleep and circadian, life-story, and outcomes domains. In combination with genetic and biological information such an approach promotes the integrating and harmonizing of data within and across current ontology systems while supporting a paradigm shift that will facilitate discovery and become the basis for novel hypotheses.
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Affiliation(s)
| | - Ole A. Andreassen
- NORMENT CentreUniversity of Oslo and Oslo University HospitalOsloNorway
| | - Ana C. Andreazza
- Department of Pharmacology & ToxicologyTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | | | - Michael Berk
- Deakin UniversityIMPACT – the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthGeelongAustralia
- OrygenThe National Centre of Excellence in Youth Mental HealthCentre for Youth Mental HealthFlorey Institute for Neuroscience and Mental Health and the Department of PsychiatryThe University of MelbourneMelbourneAustralia
| | - Teri Brister
- National Alliance on Mental IllnessArlingtonVirginiaUSA
| | | | - Donghong Cui
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghai Mental Health CenterShangaiChina
| | | | - Marion Leboyer
- Département de psychiatrieUniversité Paris Est Creteil (UPEC)AP‐HPHôpitaux Universitaires H. MondorDMU IMPACTINSERM, translational NeuropsychiatryFondation FondaMentalCreteilFrance
| | | | - Kathleen Merikangas
- Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | | | | | - Daniel Pham
- Milken InstituteCenter for Strategic PhilanthopyWashingtonDistrict of ColumbiaUSA
| | - Eduard Vieta
- Bipolar and Depressive disorders UnitHospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaCataloniaSpain
| | | | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College London & South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamKentUK
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Olgiati P, Fanelli G, Serretti A. Obsessive-compulsive symptoms in major depressive disorder correlate with clinical severity and mixed features. Int Clin Psychopharmacol 2022; 37:166-172. [PMID: 35191860 DOI: 10.1097/yic.0000000000000396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obsessive-compulsive symptoms (OCS) are often reported in patients with bipolar disorder. The aim of this study was to investigate OCS and their related clinical features in major depressive disorder (MDD). The analysis involved 482 outpatients with MDD collected within the Combining Medications to Enhance Depression outcomes trial, who were assessed with scales for depression, suicidality, irritability, hypomanic symptomatology, and other comorbid psychiatric manifestations. OCS were reported in 27% of the sample. Patients with MDD experiencing OCS were found to differ from those not experiencing OCS by a greater severity of depression (d = 0.41, P = 0.0001), more hypomanic symptoms (d = 0.48, P < 0.0001) and mixed features (22% vs. 10%, P = 0.001), increased levels of suicidal thoughts (d = 0.40, P = 0.0001), a lower likelihood of achieving remission after antidepressant treatment (19% vs. 33%, P = 0.0109), as well as more comorbid anxiety disorders (i.e. panic disorder: d = 0.98, P < 0.0001; generalized anxiety disorder: d = 0.74, P < 0.0001; social phobia: d = 0.71, P < 0.0001), and post-traumatic stress disorder (d = 0.81, P < 0.0001). In light of these findings, clinicians should pay more attention to the occurrence of OCS in MDD, as these symptoms may reflect greater clinical severity, poorer treatment outcome, and increased risk for bipolarity.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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10
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Fico G, Anmella G, Sagué-Villavella M, Gomez-Ramiro M, Hidalgo-Mazzei D, Vieta E, Murru A. Undetermined predominant polarity in a cohort of bipolar disorder patients: Prevalent, severe, and overlooked. J Affect Disord 2022; 303:223-229. [PMID: 35181382 DOI: 10.1016/j.jad.2022.02.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/13/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Predominant polarity (PP) is a concept used to define patients with bipolar disorder (BD) as presenting a tendency to manifest depressive (DPP) or manic (MPP) episodes. Still, the high percentage of patients with an undetermined PP (UPP), has been overlooked in most studies. Thus, we aimed to study UPP and outline its socio-demographic, clinical, and treatment-related features. METHODS Patients were recruited from a BD specialized unit. The sample was divided into three groups according to PP and socio-demographic and clinical variables were compared. Significant variables at univariate comparisons were included in multivariate logistic regression with UPP as the dependent variable. RESULTS A total of 708 BD patients were included, of which 437 with UPP (61.7%). UPP was associated with a higher number of affective relapses, when compared with DPP or MPP (χ2= 28.704, p<0.001). Mixed episodes (OR=1.398; CI=1.118-1.749), aggressive behaviour (OR=1.861; CI=1.190-2.913), seasonality (OR=2.025; CI= 1.289-3.501) and treatment with lamotrigine (OR= 2.101; CI=1.244-3.550) were significantly associated with UPP at the logistic regression. LIMITATIONS Recall bias may have occurred due to mixed episode diagnostic criteria change over the years. No data on the patients' follow-up has been reported on predominant polarity changes. CONCLUSIONS UPP is associated with a higher number of relapses, and different clinical variables related to a severe course of illness. Considering PP in patients with BD may guide the choice for differential treatment approaches having an impact on BD course of illness and patients' prognosis and recovery.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Maria Sagué-Villavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Marta Gomez-Ramiro
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
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11
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Fei Y, Liu L, Zheng D, Li X, Li W, Yang H, Yang B, Yi Z, Huang L, Wang Y, Wang P, Li Z, Wang Z. Reliability and validity of the Chinese version of the CUDOS-M in patients with mood disorders: A multicenter study across China. J Affect Disord 2021; 294:723-729. [PMID: 34343931 DOI: 10.1016/j.jad.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/20/2021] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A useful scale for identification of mixed features in major depressive episodes (MDE) patients is urgent in China. This study aimed to evaluate the reliability and validity of the Chinese version of the Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 mixed features specifier (Chinese-CUDOS-M) in MDE patients. METHODS A total of 152 MDE patients were recruited and assessed using Chinese-CUDOS-M, Patient Health Questionnaire-9 (PHQ-9) and 32-item Hypomania Checklist (HCL-32). Principal component analysis (PCA) and exploratory factor analysis (EFA) were conducted. The predictive validity was calculated by the area under the receiver operating characteristic curve (AUROC). RESULTS The Cronbach's alpha of Chinese-CUDOS-M was 0.85. PCA showed three common factors with eigenvalue greater than 1; the eigenvalue of factor I was 4.96, with 38.1% of variance explanation. Chinese-CUDOS-M depression subscale was associated with PHQ-9 (r = 0.83, p<0.01), and manic subscale was associated with HCL-32 (r = 0.73, p< 0.01). AUROC of the Chinese-CUDOS-M for patients with mixed depression was 0.90 (95%CI: 0.85-0.95), with a cut-off value of 7, sensitivity of 0.95, and specificity of 0.73. Furthermore, AUROC was 0.88 in patients with major depressive disorder (MDD), with a cut-off value of 7, sensitivity of 0.96, and specificity of 0.71. AUROC was 0.92 in bipolar disorder (BD) depression patients, with a cut-off value of 9, sensitivity of 0.89, and specificity of 0.87. CONCLUSION Our study shows that the Chinese-CUDOS-M can identify mixed features in both MDD and BD depression with satisfactory reliability and validity.
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Affiliation(s)
- Yue Fei
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Lei Liu
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Denise Zheng
- McGovern Medical School, Houston, Texas, United States of America
| | - Xujuan Li
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Hangzhou, China
| | - Wenfei Li
- Anhui Mental Health Center, Hefei, China
| | | | | | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leping Huang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Yu Wang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Ping Wang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zuowei Wang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China; School of Medicine, Shanghai University, Shanghai, China.
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12
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Pastrnak M, Simkova E, Novak T. Insula activity in resting-state differentiates bipolar from unipolar depression: a systematic review and meta-analysis. Sci Rep 2021; 11:16930. [PMID: 34417487 PMCID: PMC8379217 DOI: 10.1038/s41598-021-96319-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Symptomatic overlap of depressive episodes in bipolar disorder (BD) and major depressive disorder (MDD) is a major diagnostic and therapeutic problem. Mania in medical history remains the only reliable distinguishing marker which is problematic given that episodes of depression compared to episodes of mania are more frequent and predominantly present at the beginning of BD. Resting-state functional magnetic resonance imaging (rs-fMRI) is a non-invasive, task-free, and well-tolerated method that may provide diagnostic markers acquired from spontaneous neural activity. Previous rs-fMRI studies focused on differentiating BD from MDD depression were inconsistent in their findings due to low sample power, heterogeneity of compared samples, and diversity of analytical methods. This meta-analysis investigated resting-state activity differences in BD and MDD depression using activation likelihood estimation. PubMed, Web of Science, Scopus and Google Scholar databases were searched for whole-brain rs-fMRI studies which compared MDD and BD currently depressed patients between Jan 2000 and August 2020. Ten studies were included, representing 234 BD and 296 MDD patients. The meta-analysis found increased activity in the left insula and adjacent area in MDD compared to BD. The finding suggests that the insula is involved in neural activity patterns during resting-state that can be potentially used as a biomarker differentiating both disorders.
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Affiliation(s)
- Martin Pastrnak
- National Institute of Mental Health, Clinic, 250 67, Klecany, Czech Republic.
- 3rd Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic.
| | - Eva Simkova
- National Institute of Mental Health, Clinic, 250 67, Klecany, Czech Republic
- 3rd Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic
| | - Tomas Novak
- National Institute of Mental Health, Clinic, 250 67, Klecany, Czech Republic
- 3rd Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic
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13
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Vázquez GH, Bahji A, Undurraga J, Tondo L, Baldessarini RJ. Efficacy and Tolerability of Combination Treatments for Major Depression: Antidepressants plus Second-Generation Antipsychotics vs. Esketamine vs. Lithium. J Psychopharmacol 2021; 35:890-900. [PMID: 34238049 PMCID: PMC8358538 DOI: 10.1177/02698811211013579] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Successful treatment of major depressive disorder (MDD) can be challenging, and failures ("treatment-resistant depression" [TRD]) are frequent. Steps to address TRD include increasing antidepressant dose, combining antidepressants, adding adjunctive agents, or using nonpharmacological treatments. Their relative efficacy and tolerability remain inadequately tested. In particular, the value and safety of increasingly employed second-generation antipsychotics (SGAs) and new esketamine, compared to lithium as antidepressant adjuncts remain unclear. METHODS We reviewed randomized, placebo-controlled trials and used random-effects meta-analysis to compare odds ratio (OR) versus placebo, as well as numbers-needed-to-treat (NNT) and to-harm (NNH), for adding SGAs, esketamine, or lithium to antidepressants for major depressive episodes. RESULTS Analyses involved 49 drug-placebo pairs. By NNT, SGAs were more effective than placebo (NNT = 11 [CI: 9-15]); esketamine (7 [5-10]) and lithium (5 [4-10]) were even more effective. Individually, aripiprazole, olanzapine+fluoxetine, risperidone, and ziprasidone all were more effective (all NNT < 10) than quetiapine (NNT = 13), brexpiprazole (16), or cariprazine (16), with overlapping NNT CIs. Risk of adverse effects, as NNH for most-frequently reported effects, among SGAs versus placebo was 5 [4-6] overall, and highest with quetiapine (NNH = 3), lowest with brexpiprazole (19), 5 (4-6) for esketamine, and 9 (5-106) with lithium. The risk/benefit ratio (NNH/NNT) was 1.80 (1.25-10.60) for lithium and much less favorable for esketamine (0.71 [0.60-0.80]) or SGAs (0.45 [0.17-0.77]). CONCLUSIONS Several modern antipsychotics and esketamine appeared to be useful adjuncts to antidepressants for acute major depressive episodes, but lithium was somewhat more effective and better tolerated. LIMITATIONS Most trials of adding lithium involved older, mainly tricyclic, antidepressants, and the dosing of adjunctive treatments were not optimized.
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Affiliation(s)
- Gustavo H. Vázquez
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Queen’s University, Kingston, Canada,Gustavo H. Vázquez, Department of Psychiatry, Queen’s University, 752 King Street, Kingston, ON K7P0H9, Canada.
| | - Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Juan Undurraga
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA,Department of Neurology & Psychiatry, Clinica Alemana Universidad del Desarrollo, Santiago, Chile,Early Intervention Program, Instituto Psiquiátrico Dr J. Horwitz Barak, Santiago, Chile
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, McLean Hospital & Harvard Medical School, Boston, MA, USA,Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Ross J. Baldessarini
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, McLean Hospital & Harvard Medical School, Boston, MA, USA
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14
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Hart KL, Pellegrini AM, Forester BP, Berretta S, Murphy SN, Perlis RH, McCoy TH. Distribution of agitation and related symptoms among hospitalized patients using a scalable natural language processing method. Gen Hosp Psychiatry 2021; 68:46-51. [PMID: 33310013 PMCID: PMC7855889 DOI: 10.1016/j.genhosppsych.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Agitation is a common feature of many neuropsychiatric disorders. OBJECTIVE Understanding the prevalence, implications, and characteristics of agitation among hospitalized populations can facilitate more precise recognition of disability arising from neuropsychiatric diseases. METHODS We developed two agitation phenotypes using an expansion of expert curated term lists. These phenotypes were used to characterize five years of psychiatric admissions. The relationship of agitation symptoms and length of stay was examined. RESULTS Among 4548 psychiatric admissions, 1134 (24.9%) included documentation of agitation based on the primary agitation phenotype. These symptoms were greater among individuals with public insurance, and those with mania and psychosis compared to major depressive disorder. Greater symptoms were associated with longer hospital stay, with ~0.9 day increase in stay for every 10% increase in agitation phenotype. CONCLUSION Agitation was common at hospital admission and associated with diagnosis and longer length of stay. Characterizing agitation-related symptoms through natural language processing may provide new tools for understanding agitated behaviors and their relationship to delirium.
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Affiliation(s)
- Kamber L. Hart
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA
| | | | - Brent P. Forester
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
| | - Sabina Berretta
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; McLean Hospital, 115 Mill St, Belmont, MA 02478, USA.
| | - Shawn N. Murphy
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Roy H. Perlis
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Thomas H. McCoy
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Corresponding author at: Massachusetts General Hospital, 185 Cambridge Street, 6th Floor, Boston, MA 02114, USA. (T.H. McCoy)
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15
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McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, Vieta E, Vinberg M, Young AH, Mansur RB. Bipolar disorders. Lancet 2020; 396:1841-1856. [PMID: 33278937 DOI: 10.1016/s0140-6736(20)31544-0] [Citation(s) in RCA: 393] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
Bipolar disorders are a complex group of severe and chronic disorders that includes bipolar I disorder, defined by the presence of a syndromal, manic episode, and bipolar II disorder, defined by the presence of a syndromal, hypomanic episode and a major depressive episode. Bipolar disorders substantially reduce psychosocial functioning and are associated with a loss of approximately 10-20 potential years of life. The mortality gap between populations with bipolar disorders and the general population is principally a result of excess deaths from cardiovascular disease and suicide. Bipolar disorder has a high heritability (approximately 70%). Bipolar disorders share genetic risk alleles with other mental and medical disorders. Bipolar I has a closer genetic association with schizophrenia relative to bipolar II, which has a closer genetic association with major depressive disorder. Although the pathogenesis of bipolar disorders is unknown, implicated processes include disturbances in neuronal-glial plasticity, monoaminergic signalling, inflammatory homoeostasis, cellular metabolic pathways, and mitochondrial function. The high prevalence of childhood maltreatment in people with bipolar disorders and the association between childhood maltreatment and a more complex presentation of bipolar disorder (eg, one including suicidality) highlight the role of adverse environmental exposures on the presentation of bipolar disorders. Although mania defines bipolar I disorder, depressive episodes and symptoms dominate the longitudinal course of, and disproportionately account for morbidity and mortality in, bipolar disorders. Lithium is the gold standard mood-stabilising agent for the treatment of people with bipolar disorders, and has antimanic, antidepressant, and anti-suicide effects. Although antipsychotics are effective in treating mania, few antipsychotics have proven to be effective in bipolar depression. Divalproex and carbamazepine are effective in the treatment of acute mania and lamotrigine is effective at treating and preventing bipolar depression. Antidepressants are widely prescribed for bipolar disorders despite a paucity of compelling evidence for their short-term or long-term efficacy. Moreover, antidepressant prescription in bipolar disorder is associated, in many cases, with mood destabilisation, especially during maintenance treatment. Unfortunately, effective pharmacological treatments for bipolar disorders are not universally available, particularly in low-income and middle-income countries. Targeting medical and psychiatric comorbidity, integrating adjunctive psychosocial treatments, and involving caregivers have been shown to improve health outcomes for people with bipolar disorders. The aim of this Seminar, which is intended mainly for primary care physicians, is to provide an overview of diagnostic, pathogenetic, and treatment considerations in bipolar disorders. Towards the foregoing aim, we review and synthesise evidence on the epidemiology, mechanisms, screening, and treatment of bipolar disorders.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation Strategic Research Centre, School of Medicine, Deakin University, Melbourne, VIC, Australia; Mental Health Drug and Alcohol Services, Barwon Health, Geelong, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Elisa Brietzke
- Department of Psychiatry, Adult Division, Kingston General Hospital, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carlos López-Jaramillo
- Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia; Mood Disorders Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gin S Malhi
- Discipline of Psychiatry, Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Academic Psychiatry, Northern Sydney Local Health District, Sydney, Australia
| | | | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maj Vinberg
- Department of Psychiatry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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16
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McIntyre RS, Lipsitz O, Rodrigues NB, Lee Y, Cha DS, Vinberg M, Lin K, Malhi GS, Subramaniapillai M, Kratiuk K, Fagiolini A, Gill H, Nasri F, Mansur RB, Suppes T, Ho R, Rosenblat JD. The effectiveness of ketamine on anxiety, irritability, and agitation: Implications for treating mixed features in adults with major depressive or bipolar disorder. Bipolar Disord 2020; 22:831-840. [PMID: 32406161 DOI: 10.1111/bdi.12941] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the effectiveness of intravenous (IV) ketamine on anxiety, irritability, agitation, and suicidality, in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD). METHOD Adults (N = 201) with treatment-resistant MDD or BD received repeat-dose IV ketamine treatment at a community-based clinic. Mixed features were measured using symptoms of anxiety, irritability, and agitation (AIA), as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. The Quick Inventory for Depressive Symptomatology Self-Report-16 (QIDS-SR16 ) was used to measure overall treatment response, and the QIDS-SR16 suicidal ideation (SI) item was used to measure change in SI symptoms with ketamine treatment. The anxiety, irritability, and agitation items on the GAD-7 were used to assess effectiveness of IV ketamine in treating symptoms of mixed features. RESULTS In this retrospective analysis, 113 participants met AIA criteria. Participants with AIA experienced a significantly greater reduction in overall depressive symptoms (F(1, 558) = 9.49, P = .002), SI (F(1, 558) = 3.103, P = .079), anxiety (F(1, 198) = 5.52, P = .007), irritability (F(1, 198) = 28.35, P < .001), and agitation as measured by "trouble relaxing" (F(1, 198) = 6.70, P = .010) from baseline compared to the non-AIA group, regardless of number of treatments received. CONCLUSIONS Our preliminary results suggest that IV ketamine is effective in rapidly treating AIA and SI in adults with treatment-resistant mood disorders. This observation suggests that IV ketamine could be considered a treatment alternative for adults with MDD or BD presenting with mixed features.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada
| | - Maj Vinberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kangguang Lin
- Department of Affective Disorder, the Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Laboratory of Emotion and Cognition, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - Gin S Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Trisha Suppes
- VA Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Roger Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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17
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Factors associated with single versus multiple suicide attempts in depressive disorders. J Affect Disord 2020; 277:306-312. [PMID: 32858311 DOI: 10.1016/j.jad.2020.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 08/09/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many risk factors for suicidal behavior have been identified. Much less has been done to associate risk factors with recurrence of suicidal behavior. METHODS We compared prevalence of 30 potential risk factors among 8496 depressive patient-subjects from the BRIDGE consortium with no (NSA, n = 6267), one (1SA, n = 1123), or repeated (≥2) suicide attempts (RSA, n = 1106). RESULTS Prevalence of most factors ranked: RSA ≥ 1SA > NSA, with a notable opposite trend for the diagnosis of type II bipolar disorder (BD). Factors independently and significantly more present among RSA than 1SA subjects were: borderline personality, substance abuse, mood-switching with antidepressant treatment, female sex, and unsatisfactory response to antidepressant treatment. There also were notably strong associations of RSA with type I or probable BD and associated factors, including family history of BD, young onset, mixed and psychotic features. LIMITATIONS Potential effects of treatment on risk of suicidal acts could not be evaluated adequately, as well as associations between levels of suicidal behavior and eventual death by suicide. CONCLUSIONS In a large cohort of depressive patients, there were significant associations not only with suicidal behavior generally, but also with the intensity of suicide attempts.
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18
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Clinical correlates of DSM-5 mixed features in bipolar disorder: A meta-analysis. J Affect Disord 2020; 276:234-240. [PMID: 32697704 DOI: 10.1016/j.jad.2020.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/13/2020] [Accepted: 07/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Systematic data on clinical correlates of mixed features in bipolar disorder are not available, so far. We conducted a systematic review and meta-analysis estimating the association between DSM-5 mixed features and candidate characteristics in depressive and manic/hypomanic episodes. METHODS We included observational studies indexed in the main electronic databases. The association between DSM-5 mixed features and relevant correlates was estimated using odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (CIs), for categorical and continuous variables, respectively. Analyses were based on random effects models. RESULTS Eight studies were included, involving 3070 individuals (1495 with a major depressive episode and 1575 with hypo/manic episode). No clinical characteristics were associated with mixed features in subjects with a depressive episode. Among subjects with a manic/hypomanic episode, those with mixed features were more likely to have a history of suicide attempts (OR: 2.37; 95%CI: 1.42 to 3.94; I2=39.7%), co-occurring anxiety disorders (OR: 2.67; 95%CI: 1.28 to 5.57; I2=0%), and a rapid cycling course (OR=4.23; 95%CI: 1.29 to 13.81; I2=0%), with less severe manic symptoms (SMD=-0.40; 95%CI: -0.65 to -0.16; I2=0%). LIMITATIONS (1) the heterogeneity of methods across studies and the inconsistency of findings; (2) the limited amount of data on correlates of DSM-5 mixed features; (3) the possible influence of publication bias. CONCLUSIONS Findings of this meta-analysis show that mixed features among individuals with a manic/hypomanic episode may identify a special clinical population, characterized not only by depressive symptoms, but also by anxiety, rapid cycling, and suicidality.
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19
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Jakobsen P, Garcia-Ceja E, Riegler M, Stabell LA, Nordgreen T, Torresen J, Fasmer OB, Oedegaard KJ. Applying machine learning in motor activity time series of depressed bipolar and unipolar patients compared to healthy controls. PLoS One 2020; 15:e0231995. [PMID: 32833958 PMCID: PMC7446864 DOI: 10.1371/journal.pone.0231995] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022] Open
Abstract
Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.
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Affiliation(s)
- Petter Jakobsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- * E-mail:
| | | | - Michael Riegler
- Simula Metropolitan Center for Digitalisation, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Lena Antonsen Stabell
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Jim Torresen
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole Bernt Fasmer
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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20
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Sani G, Tondo L, Undurraga J, Vázquez GH, Salvatore P, Baldessarini RJ. Melancholia: does this ancient concept have contemporary utility? Int Rev Psychiatry 2020; 32:466-470. [PMID: 32172612 DOI: 10.1080/09540261.2019.1708708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many efforts have been made to develop coherent and clinically useful categories of depressive illness, especially to facilitate prediction of morbidity and guide treatment-response. They include proposals to resurrect the ancient concept of melancholia, as a form of severe depression with particular symptomatic and proposed psychobiological characteristics. However, modern research is inconsistent in supporting differences between melancholic and nonmelancholic depression. In our recent study of over 3200 patient-subjects with DSM-5 major depressive episodes with/without melancholic characteristics, and matched for illness severity, prevalence of melancholic features was 35.2% with remarkably few clinical and demographic differences between melancholic and nonmelancholic subjects. Also, our systematic review of trials comparing melancholic and nonmelancholic subjects found little difference in responses to antidepressant treatments. These findings indicate that the concept of melancholia may have limited value for clinical prediction and treatment-selection. Overlap of symptoms in melancholic and nonmelancholic depression, based on DSM criteria, may limit distinction of melancholia; alternative definitions can be sought, and psychomotor retardation is a particularly strong differentiating feature. For now, however, melancholia seems best considered a state-dependent depression-type strongly associated with greater symptomatic severity, rather than a distinct syndrome. Its DSM-5 current status as a depression-type specifier seems appropriate, and it may be a logical target for genetic and other biomedical studies.
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Affiliation(s)
- Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Leonardo Tondo
- Centro Lucio Bini, Rome, Italy.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,International Consortium for the Research on Mood and Psychotic Disorders, McLean Hospital, Belmont, MA, USA
| | - Juan Undurraga
- International Consortium for the Research on Mood and Psychotic Disorders, McLean Hospital, Belmont, MA, USA.,Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.,Early Intervention Program, Instituto Psiquiátrico Dr J. Horwitz Barak, Santiago, Chile
| | - Gustavo H Vázquez
- International Consortium for the Research on Mood and Psychotic Disorders, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Paola Salvatore
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,International Consortium for the Research on Mood and Psychotic Disorders, McLean Hospital, Belmont, MA, USA.,Section of Psychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,International Consortium for the Research on Mood and Psychotic Disorders, McLean Hospital, Belmont, MA, USA
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21
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Baldessarini RJ, Tondo L. Suicidal Risks in 12 DSM-5 Psychiatric Disorders. J Affect Disord 2020; 271:66-73. [PMID: 32312699 DOI: 10.1016/j.jad.2020.03.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/22/2020] [Accepted: 03/24/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE As modern studies evaluating suicidal behaviors in large samples of major psychiatric disorder patients are rare, we compared suicidal risks associated with a variety of psychiatric diagnoses. METHODS We quantified rates of intake suicidal ideation and lifetime attempts, suicides, and violent acts (attempts + suicides) in 6050 adult patients in a European psychiatric center, diagnosed with 12 prevalent, DSM-5 psychiatric disorders. RESULTS Ideation ranged from 53.9% of subjects with bipolar disorder (BD) with mixed features, to 8.70% in anxiety disorders. Subjects making at least one suicide attempt were most prevalent in BD with mixed or psychotic features. Suicide rates ranked: substance abuse > BD with psychotic features > psychotic disorders ≥ BD-I > major depressive disorder (MDD). Suicidal intensity (acts/100 PEY) was highest with BD, psychotic disorders, and MDD; lethality (lower attempt/suicide ratio) was greatest with substance abuse, psychotic disorders, and BD with psychotic features. Rates of suicidal acts in BD vs. MDD were similarly high among ever-hospitalized subjects but much lower in never-hospitalized MDD subjects. Women had higher overall risks of ideation and attempts, but violent acts and suicide were more likely among men, whereas SMR for suicide was greater among women, presumably reflecting very low risks among women in the regional general population. CONCLUSIONS Suicidal risks were particularly high in BD with psychotic or mixed features as well as with substance abuse and in severe MDD with hospitalization.
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Affiliation(s)
- R J Baldessarini
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | - L Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy
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22
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Sverdlichenko I, Jansen K, Souza LDDM, da Silva RA, Kapczinski F, Cardoso TDA. Mixed episodes and suicide risk: A community sample of young adults. J Affect Disord 2020; 266:252-257. [PMID: 32056885 DOI: 10.1016/j.jad.2020.01.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/11/2019] [Accepted: 01/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicide is the second leading cause of death among young adults worldwide, and few studies have assessed the factors associated with suicidality in this specific population. Thus, the aim of this study was to assess the association between mixed episodes and suicidality in a community sample of young adults. For this aim, we compared young adults in a mixed episode with individuals in a depressive or (hypo)manic episode, and community controls. METHOD This is a cross-sectional population-based study including young adults aged 18-24 years old. Information about participants' age, sex, self-reported skin color and study status were obtained using a sociodemographic questionnaire. Mixed, (hypo)manic and depressive episodes, as well as suicide risk were assessed using the Mini International Neuropsychiatric Interview. RESULTS The sample included 1560 individuals. Young adults in a mixed episode showed a 13.50 times higher probability to have suicide risk, as compared to community controls (p < 0.001), 5.67 higher probability to have suicide risk as compared to individuals in a (hypo)manic episode (p < 0.001), and 2.18 times higher probability to have suicide risk as compared to young adults in a depressive episode (p < 0.001). LIMITATION The assessment of suicide risk includes both suicide attempts and ideation. CONCLUSION Young adults in a mixed episode showed a higher rate of suicide risk than individuals with depression or mania/hypomania. Considering the already increasing prevalence of suicide among young adults, there is an urgent need for the early diagnosis and treatment of mixed episodes in this specific population.
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Affiliation(s)
- Irina Sverdlichenko
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Karen Jansen
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | | | | | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Taiane de Azevedo Cardoso
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Department of Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.
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23
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Pompili M, Vazquez GH, Forte A, Morrissette DA, Stahl SM. Pharmacologic Treatment of Mixed States. Psychiatr Clin North Am 2020; 43:167-186. [PMID: 32008683 DOI: 10.1016/j.psc.2019.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite the relatively high prevalence of mixed symptoms and features among patients with mood disorders, the current literature supporting the specific efficacy of second-generation antipsychotics and mood stabilizers for the treatment of mixed symptoms is limited. Several studies have demonstrated that acute affective episodes with mixed symptoms or features tend to respond unsatisfactory to treatments that are usually more effective for the management of other affective phases. There is clearly a need for clinical trials in order to determine the more adequate pharmacologic option for the treatment of individuals suffering from affective episodes with mixed features.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Gustavo H Vazquez
- Department of Psychiatry, Queen's University, 752 King Street West, Kingston, Ontario K7L 4X3, Canada; International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA
| | - Alberto Forte
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Department Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Debbi Ann Morrissette
- Neuroscience Education Institute, 5900 La Place Court, Suite 120, Carlsbad, CA 92008, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; University of Cambridge, Cambridge, UK
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24
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Tondo L, Vazquez GH, Baldessarini RJ. Suicidal Behavior Associated with Mixed Features in Major Mood Disorders. Psychiatr Clin North Am 2020; 43:83-93. [PMID: 32008690 DOI: 10.1016/j.psc.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Mixed features of the opposite nominal mood-polarity are increasingly recognized in both depressive and [hypo]manic phases of major affective disorders. They are associated with major increases of risk of suicidal behaviors. The authors reviewed the association of suicidal behavior with mixed features in both major depressive and bipolar disorders, as well as potentially relevant adverse effects of antidepressant treatment and use of alternative treatments aimed at minimizing agitation and suicidal risk.
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Affiliation(s)
- Leonardo Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Lucio Bini Mood Disorders Center, Cagliari, Italy.
| | - Gustavo H Vazquez
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Ross J Baldessarini
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA; Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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25
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Sampogna G, Del Vecchio V, Giallonardo V, Luciano M, Fiorillo A. Diagnosis, Clinical Features, and Therapeutic Implications of Agitated Depression. Psychiatr Clin North Am 2020; 43:47-57. [PMID: 32008687 DOI: 10.1016/j.psc.2019.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Agitated "unipolar" depression is a clinical entity characterized by excitement together with depressed mood during the same episode. The clinical picture of agitated "unipolar" depression is characterized by a depressed and anxious mood with inner, psychic agitation, whereas motor agitation may or may not be present. Some investigators have conceptualized this disorder as a mixed affective state, laying on the bipolar disorder spectrum, but controversies still persist. The diagnosis of agitated "unipolar" depression has important prognostic and therapeutic implications, with many clinicians reporting difficulties to adequately diagnose and treat it.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy.
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples 80138, Italy
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26
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Taş Hİ, Altinbaş K. Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. ACTA ACUST UNITED AC 2020; 57:27-32. [PMID: 32110147 DOI: 10.29399/npa.23610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 08/25/2019] [Indexed: 11/07/2022]
Abstract
Introduction "Depressive disorder with mixed features" has been included in the official classification in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Hypothesizing that difficulties in emotion regulation and affective temperament scores are higher in mixed depression comparing to pure depression, we aimed to evaluate the relationship between these phenomena and mixed symptoms. Methods Depressive patients diagnosed by a psychiatrist according to the DSM-5 and had not received any psychiatric treatment for the last 3 months, were included in the study. The Hamilton Rating Scale (HDRS), modified Hypomania Checklist (mHCL), Difficulties in Emotion Regulation Scale (DERS), and the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire) were applied to all participants. Results Of the 63 participants, 40 (63.5%) were women. The mean age was 37.8±12.4 years while mean duration of education was 10.8±4.3 years. The proportion of mixed-depression assessed by the mHCL was 23.8% (n=15). No significant difference was found between the groups concerning gender, age, family history, age at onset of illness, the total number of episodes and temperament scores. Depressive patients with mixed features had significantly higher DERS nonacceptance subscale scores. Multiple regression analysis demonstrated that the cyclothymic temperament scale scores significantly affected the total mHCL scores. Conclusion In mixed depression group, higher scores in nonacceptance subscale seems to reflect a tendency to fluctuations in the emotional reactions of a person to the stress. Association between mixed depression, DERS nonacceptance subscale and cyclothymic temperament support the spectrum view that mixed depression is placed between pure depression and bipolarity.
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Affiliation(s)
- Halil İbrahim Taş
- Department of Psychiatry, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Kürşat Altinbaş
- Department of Psychiatry, Selçuk University School of Medicine, Konya, Turkey
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27
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Baldessarini RJ, Vázquez GH, Tondo L. Bipolar depression: a major unsolved challenge. Int J Bipolar Disord 2020; 8:1. [PMID: 31903509 PMCID: PMC6943098 DOI: 10.1186/s40345-019-0160-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
| | - Gustavo H Vázquez
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
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28
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Öhlund L, Ott M, Bergqvist M, Oja S, Lundqvist R, Sandlund M, Renberg ES, Werneke U. Clinical course and need for hospital admission after lithium discontinuation in patients with bipolar disorder type I or II: mirror-image study based on the LiSIE retrospective cohort. BJPsych Open 2019; 5:e101. [PMID: 31753046 PMCID: PMC7000990 DOI: 10.1192/bjo.2019.83] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups. AIMS To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder. METHOD Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers. RESULTS For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions. CONCLUSIONS The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission.
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Affiliation(s)
- Louise Öhlund
- Research Registrar, Sunderby Research Unit - Psychiatry, Department of Clinical Sciences, Umeå University, Sweden
| | - Michael Ott
- Consultant Physician, Department of Public Health and Clinical Medicine - Medicine, Umeå University, Sweden
| | - Malin Bergqvist
- Consultant Psychiatrist, Piteå Älvdals Hospital, Department of Psychiatry, Sweden
| | - Sofia Oja
- Consultant Psychiatrist, Department of Psychiatry, Sunderby Hospital, Sweden
| | - Robert Lundqvist
- Statistician, Research Unit, County Council of Norrbotten, Sweden
| | - Mikael Sandlund
- Professor of Psychiatry, Department of Clinical Sciences - Psychiatry, Umeå University, Sweden
| | | | - Ursula Werneke
- Associate Professor of Psychiatry, Sunderby Research Unit - Psychiatry, Department of Clinical Sciences, Umeå University, Sweden
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29
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Serra F, Gordon-Smith K, Perry A, Fraser C, Di Florio A, Craddock N, Jones I, Jones L. Agitated depression in bipolar disorder. Bipolar Disord 2019; 21:547-555. [PMID: 31004555 DOI: 10.1111/bdi.12778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES It has been suggested that agitated depression (AD) is a common, severe feature in bipolar disorder. We aimed to estimate the prevalence of AD and investigate whether presence of AD was associated with episodic and lifetime clinical features in a large well-characterized bipolar disorder sample. METHOD The prevalence of agitation, based on semi-structured interview and medical case-notes, in the most severe depressive episode was estimated in 2925 individuals with DSM-IV bipolar disorder recruited into the UK Bipolar Disorder Research Network. Predictors of agitation were ascertained using symptoms within the same episode and lifetime clinical features using multivariate models. RESULTS 32.3% (n = 946) experienced agitation during the worst depressive episode. Within the same episode, significant predictors of presence of agitation were: insomnia (OR 2.119, P < 0.001), poor concentration (OR 1.966, P = 0.027), decreased libido (OR 1.960, P < 0.001), suicidal ideation (OR 1.861, P < 0.001), slowed activity (OR 1.504, P = 0.001), and poor appetite (OR 1.297, P = 0.029). Over the lifetime illness course, co-morbid panic disorder (OR 2.000, P < 0.001), suicide attempt (OR 1.399, P = 0.007), and dysphoric mania (OR 1.354, P = 0.017) were significantly associated with AD. CONCLUSIONS Agitation accompanied bipolar depression in at least one-third of cases in our sample and was associated with concurrent somatic depressive symptoms, which are also common features of mixed manic states. Furthermore, AD in our sample was associated with lifetime experience of mixed mania, in addition to severe lifetime illness course including comorbid panic disorder and suicidal behavior. Our results have implications for the diagnosis and treatment of agitated features in bipolar depression.
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Affiliation(s)
| | | | - Amy Perry
- Psychological Medicine, University of Worcester, UK
| | | | | | - Nick Craddock
- National Centre of Mental Health, Cardiff University, UK
| | - Ian Jones
- National Centre of Mental Health, Cardiff University, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, UK
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30
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Serra G, Koukopoulos A, De Chiara L, Koukopoulos AE, Sani G, Tondo L, Girardi P, Reginaldi D, Baldessarini RJ. Early clinical predictors of long-term morbidity in major depressive disorder. Early Interv Psychiatry 2019; 13:999-1002. [PMID: 30511367 DOI: 10.1111/eip.12768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/04/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
Abstract
AIMS To identify early clinical factors predictive of later morbidity in major depressive disorder (MDD). METHODS We analysed factors associated with long-term depressive morbidity (%-time ill) between a first-lifetime major depressive episode and last follow-up of 116 adults diagnosed with DSM-IV major depressive disorder. Bivariate comparisons were followed by multivariable linear regression modelling. RESULTS Three factors were independently associated with an average of 25%-time-depressed over 17 years at risk: (a) agitated-mixed, or psychotic features in initial major depressive episodes, (b) anxiety syndromes prior to a first-lifetime major depressive episode, and (c) anxiety symptoms in childhood. CONCLUSION Early anxiety symptoms and syndromes and agitated-mixed or psychotic initial depressive episodes predicted more long-term depressive morbidity in MDD.
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Affiliation(s)
- Giulia Serra
- Child Psychiatry Unit, Dept. of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Athanasios Koukopoulos
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Lavinia De Chiara
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alexia E Koukopoulos
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Gabriele Sani
- Lucio Bini Mood Disorder Center, Rome, Italy.,NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Leonardo Tondo
- Child Psychiatry Unit, Dept. of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
| | - Paolo Girardi
- Lucio Bini Mood Disorder Center, Rome, Italy.,NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Daniela Reginaldi
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts
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31
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Malhi G, Bell E, Das P, Outhred T. Relating irritability and suicidal ideation using mood and anxiety. EVIDENCE-BASED MENTAL HEALTH 2019; 22:95-99. [PMID: 31248975 PMCID: PMC10270456 DOI: 10.1136/ebmental-2019-300100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/17/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Suicide is common in the context of depression and bipolar disorders, but there remains a lack of understanding as to how suicide ideation, a common symptom of mood disorders, progresses to suicidal behaviour. Irritability, a feature of some types of depression, is thought to contribute to the development of suicidal behaviour, but these associations are not well established. OBJECTIVE To examine the relationship between irritability and suicide ideation according to the subtype of depression expressed in patients with mood disorder. METHODS 75 patients with mood disorders seen at the CADE (Clinical Assessment Diagnostic Evaluation) Clinic underwent clinical assessment for suicidal ideation (Paykel Suicide Scale), symptom severity (Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D) (anxious depression), Montgomery-Åsberg Depression Rating Scale (MADRS) (melancholic depression)) and irritability (item 5 of the YMRS). FINDINGS Interestingly, irritability correlated with mania (r=0.734, p<0.001 (YMRS)) and depressive symptom scores (r=0.369, p<0.001 (MADRS); r=0.477, p<0.001 (HAM-D)), which in turn correlated with suicide ideation scores (r=0.364, p<0.01 (MADRS); r=0.275, p=0.017 (HAM-D)). However, despite this indirect association, there was no direct correlation between irritability and suicide ideation (r=0.050, p>0.05). CONCLUSIONS The nature of the relationship between irritability and suicidal ideation is determined by the emotional context within which irritability operates. CLINICAL IMPLICATIONS Findings suggest that rather than examining irritability alone, consideration of the subtype of depression, especially that of anxious depression, should be paramount in assessing suicide risk.
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Affiliation(s)
- Gin Malhi
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Erica Bell
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Pritha Das
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Tim Outhred
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
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Baldessarini RJ, Tondo L, Pinna M, Nuñez N, Vázquez GH. Suicidal risk factors in major affective disorders. Br J Psychiatry 2019; 215:1-6. [PMID: 31292010 DOI: 10.1192/bjp.2019.167] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.AimsTo identify factors associated with suicidal risk in major mood disorders. METHOD We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis. RESULTS Suicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors. CONCLUSIONS Suicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDD patients.Declaration of interestNo author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.
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Affiliation(s)
- Ross J Baldessarini
- Director,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital; andProfessor,Department of Psychiatry,Harvard Medical School,USA
| | - Leonardo Tondo
- Investigator,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital;Research Associate,Department of Psychiatry,Harvard Medical School,USA;Director,Lucio Bini Mood Disorders Centers,Italy; andInvestigator,Centre for Affective Disorders,Department of Psychological Medicine,Institute of Psychiatry,King's College,London,UK
| | - Marco Pinna
- Investigator,Lucio Bini Mood Disorders Centers,Italy
| | - Nicholas Nuñez
- Investigator,Department of Psychiatry,Queen's University School of Medicine,Canada
| | - Gustavo H Vázquez
- Investigator,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital,USA; andProfessor,Department of Psychiatry,Queen's University School of Medicine,Canada
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Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder. Acta Psychiatr Scand 2019; 139:443-453. [PMID: 30865288 DOI: 10.1111/acps.13021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To (i) validate patient-evaluated mixed symptoms and irritability measured using smartphones against clinical evaluations; (ii) investigate associations between mixed symptoms and irritability with stress, quality of life and functioning, respectively, in patients with bipolar disorder. METHODS A total of 84 patients with bipolar disorder used a smartphone-based system for daily evaluation of mixed symptoms and irritability for nine months. Clinically evaluated symptoms, stress, quality of life and clinically rated functioning were collected multiple times during follow-up. RESULTS Patients presented mild affective symptoms. Patient-reported mixed symptoms and irritability correlated with clinical evaluations. In analyses including confounding factors there was a statistically significant association between both mixed symptoms and irritability and stress (P < 0.0001) and between irritability and both quality of life and functioning (P < 0.0001) respectively. There was no association between mixed mood and both quality of life and functioning. CONCLUSION Mixed symptoms and irritability can be validly self-reported using smartphones in patients with bipolar disorder. Mixed symptoms and irritability are associated with increased stress even during full or partial remission. Irritability is associated with decreased quality of life and functioning. The findings emphasize the clinical importance of identifying inter-episodic symptoms including irritability pointing towards smartphones as a valid tool.
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Affiliation(s)
- M Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - M Frost
- Monsenso ApS, Valby, Denmark
| | - E M Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - J E Bardram
- Department of Applied Mathematics and Computer Science, The Technical University of Denmark, Lyngby, Denmark
| | - M Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - L V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Undurraga J, Sim K, Tondo L, Gorodischer A, Azua E, Tay KH, Tan D, Baldessarini RJ. Lithium treatment for unipolar major depressive disorder: Systematic review. J Psychopharmacol 2019; 33:167-176. [PMID: 30698058 DOI: 10.1177/0269881118822161] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. METHODS With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. RESULTS We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy. CONCLUSIONS The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.
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Affiliation(s)
- Juan Undurraga
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,3 Early Intervention Program, J Horwitz Psychiatric Institute, Santiago, Chile
| | - Kang Sim
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
| | - Leonardo Tondo
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,5 Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,6 Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy
| | - Ariel Gorodischer
- 7 Department of Psychiatry, Universidad de Los Andes, Santiago, Chile
| | - Emilio Azua
- 8 Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kai Hong Tay
- 4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
| | - David Tan
- 4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
| | - Ross J Baldessarini
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,5 Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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