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Coello K, Holstad Pedersen H, Munkholm K, Lie Kjærstad H, Stanislaus S, Rye Ostrowski S, Faurholt-Jepsen M, Miskowiak KW, Frikke-Schmidt R, Vinberg M, Thorn Ekstrøm C, Lyng Forman J, Vedel Kessing L. A composite immune and vascular stress marker in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives. Brain Behav Immun 2024; 118:449-458. [PMID: 38508346 DOI: 10.1016/j.bbi.2024.03.029] [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: 10/24/2023] [Revised: 02/15/2024] [Accepted: 03/17/2024] [Indexed: 03/22/2024] Open
Abstract
AIMS Substantial evidence emphasizes immune dysregulation in patients with bipolar disorder (BD). However, whether immune dysregulation is present already in the early illness stages of BD or even precedes development of BD is largely unknown. In this study we compared immune and vascular stress markers in patients newly diagnosed with BD, their unaffected first-degree relatives (UR) and healthy control individuals (HC) and investigated the ability a composite immune and vascular stress marker to discriminate between the three groups of participants. METHODS In a unique sample including 373 patients newly diagnosed with BD, 95 UR and 190 HC, we compared 47 immune and vascular stress markers at the baseline visit in the ongoing longitudinal Bipolar Illness Onset study. For comparison of individual immune and vascular stress markers between groups, we applied linear mixed models, whereas the composite immune and vascular stress marker was investigated using the SuperLearner ensemble-method. RESULTS Compared with HC, patients newly diagnosed with BD had higher levels of the anti-inflammatory interleukin-1 receptor antagonist (IL-1RA) and IL-10, and of the pro-inflammatory IL-6, eotaxin, monocyte chemoattractant protein-1 (MCP-1), MCP-4, Macrophage Derived Chemokine (MDC), and Thymus and Activation-Regulated Chemokine (TARC) in analyses adjusted for sex and age ranging from 26 % higher levels of IL-6 (1.26, 95 %CI: [1.12-1.43], p < 0.001, adjusted p = 0.009) and IL-10 (1.26, 95 %CI: [1.09-1.46], p = 0.002, adjusted p = 0.049), respectively, to 9 % higher eotaxin levels (1.09, 95 %CI: [1.04-1.15], p = 0.001, adjusted p = 0.024). Of these, MDC levels were 12 % higher in BD compared with UR (1.12, 95 %CI: [1.02-1.22], p = 0.001, adjusted p = 0.024). For all other markers, UR showed no difference from patients with BD or HC. Based on a data-driven model, a composite marker including all 47 immune and vascular stress markers, sex, age, BMI, smoking status, and alcohol intake, discriminated patients with BD from HC with a with an area under the receiver operating curve (AUC) of 0.76 (95 % CI: 0.75-0.77) CONCLUSIONS: Higher levels of pro-inflammatory and anti-inflammatory immune markers are present in patients newly diagnosed with BD but not in UR compared with HC, supporting immune dysregulation playing a role in the pathophysiology of BD.
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Affiliation(s)
- Klara Coello
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark.
| | - Helle Holstad Pedersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Klaus Munkholm
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | | | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Coello K, Kuchinke OV, Kjærstad HL, Miskowiak KW, Faurholt-Jepsen M, Vinberg M, Kessing LV. Differences in clinical presentation between newly diagnosed bipolar I and II disorders: A naturalistic study. J Affect Disord 2024; 351:95-102. [PMID: 38244799 DOI: 10.1016/j.jad.2024.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
AIM This naturalistic clinical study aims to investigate differences between newly diagnosed patients with bipolar type I (BDI) and bipolar type II (BDII) disorders in socio-demographic and clinical characteristics, affective symptoms, cognition, functioning and comorbidity with personality disorders. METHODS The BD diagnosis and type were confirmed using the Schedules for Clinical Assessment in Neuropsychiatry. Affective symptoms were assessed with the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Major Depressive Index, and the Altman Self-Rating Mania Scale. Functional impairment was assessed with the Functional Assessment Short Test. Cognitive impairment was evaluated by the Screen for Cognitive Impairment in Psychiatry and the Cognitive Complaints in Bipolar Disorder Rating Assessment. Finally, comorbid personality disorders were assessed with the Standardized Assessment of Personality-Abbreviated Scale and structured interview Structured Clinical Interview for DSM-disorders. RESULTS 383 newly diagnosed patients were included (BDI: n = 125; BDII: n = 258). Against expectations, we found no more depressive symptoms in BDII compared with BDI nor any differences in cognitive, childhood trauma or overall functional impairment. The only difference was lower occupational impairment in the BDII group. LIMITATIONS The self-reported measures of cognitive difficulties and childhood trauma involved potential bias (recall or other). Despite BD being newly diagnosed a diagnostic delay was observed. CONCLUSION Patients newly diagnosed with BDII and BDI had similar burdens of depressive symptoms and cognitive and overall functional impairment, however patients with BDI had lower occupational functioning. No statistically significant difference was found in prevalence of comorbid personality disorders between patients with BDI and BDII.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Oscar Vittorio Kuchinke
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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de Azevedo Cardoso T, Kochhar S, Torous J, Morton E. Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions. JMIR Ment Health 2024; 11:e58631. [PMID: 38557724 PMCID: PMC11019420 DOI: 10.2196/58631] [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: 03/20/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Bipolar disorder (BD) impacts over 40 million people around the world, often manifesting in early adulthood and substantially impacting the quality of life and functioning of individuals. Although early interventions are associated with a better prognosis, the early detection of BD is challenging given the high degree of similarity with other psychiatric conditions, including major depressive disorder, which corroborates the high rates of misdiagnosis. Further, BD has a chronic, relapsing course, and the majority of patients will go on to experience mood relapses despite pharmacological treatment. Digital technologies present promising results to augment early detection of symptoms and enhance BD treatment. In this editorial, we will discuss current findings on the use of digital technologies in the field of BD, while debating the challenges associated with their implementation in clinical practice and the future directions.
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Affiliation(s)
- Taiane de Azevedo Cardoso
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- JMIR Publications, Toronto, ON, Canada
| | | | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emma Morton
- School of Psychological Sciences, Monash University, Clayton, Australia
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Nkire N, Kinsella A, Russell V, Waddington JL. Duration of the psychosis prodrome and its relationship to duration of untreated psychosis across all 12 DSM-IV psychotic diagnoses: Evidence for a trans-diagnostic process associated with resilience. Eur Neuropsychopharmacol 2024; 80:5-13. [PMID: 38128335 DOI: 10.1016/j.euroneuro.2023.12.005] [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: 05/23/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
While duration of the psychosis prodrome (DPP) attracts attention in relation to the developmental trajectory of psychotic illness and service models, fundamental issues endure in the context of dimensional-spectrum models of psychosis. Among 205 epidemiologically representative subjects in the Cavan-Monaghan First Episode Psychosis Study, DPP was systematically quantified and compared, for the first time, across all 12 DSM-IV psychotic diagnoses. DPP was also compared with duration of untreated psychosis (DUP) and each was then analysed in relation to premorbid features across three age ranges: <12, 12-15 and 16-18 years. For each diagnosis, medians for both DPP and DUP were shorter than means, indicating common right-skewed distributions. Rank orders for both DPP and DUP were longest for schizophrenia, intermediate for other schizophrenia-spectrum psychoses, psychotic depression and psychotic disorder not otherwise specified, and shortest for brief psychotic disorder, bipolar disorder and substance-induced psychotic disorder, though with overlapping right-skewed distributions. DPP was longer than DUP for all diagnoses except substance-induced psychotic disorder. Across functional psychotic diagnoses, longer DPP was predicted by higher premorbid intelligence and better premorbid adjustment during age 16-18 years. These findings indicate that, trans-diagnostically, DPP and DUP share right-skewed continuities, in accordance with a dimensional-spectrum model of psychotic illness, and may reflect a unitary process that has been dichotomized at a subjective threshold along its trajectory. Better premorbid functioning during age 16-18 years appears to confer resilience by delaying progression to overt psychotic symptoms and may constitute a particular target period for psychosocial interventions.
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Affiliation(s)
- Nnamdi Nkire
- Drumalee Primary Care Centre, Cavan-Monaghan Mental Health Service, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anthony Kinsella
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vincent Russell
- Drumalee Primary Care Centre, Cavan-Monaghan Mental Health Service, Cavan, Ireland; Department of Psychiatry, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
| | - John L Waddington
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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5
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Liao CH, Chang CS, Kung PT, Chou WY, Tsai WC. Stroke and suicide among people with severe mental illnesses. Sci Rep 2024; 14:4991. [PMID: 38424228 PMCID: PMC10904760 DOI: 10.1038/s41598-024-55564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
The associations between people with severe mental illnesses (SMI) and the risks of stroke, suicide, and death remain unclear. We examined healthcare service usage among adults with and without SMI and explored the risk of stroke, suicide, and death. We divided 18-80-year-old adults with SMI into catastrophic and non-catastrophic illness groups. These groups were subjected to a 1:5:5 propensity score matching with people without SMI. Data on demographic characteristics, economic factors, environmental factors, comorbid conditions, self-injury behavior, the number of outpatients and ED visits, and hospitalization were collected. The primary outcomes were risks of stroke, suicide, and death. We included 19,570 people with catastrophic SMI, 97,850 with non-catastrophic SMI, and 97,850 controls. Patients with SMI, especially those with catastrophic illnesses, had higher stroke risk, suicide, and death than those without SMI. People with SMI used health services more frequently than those without SMI. Patients with a history of hospitalization or ED access had a higher risk of stroke, suicide, and death. Our data indicate that special attention should be given to patients with SMI, particularly those with a history of healthcare service utilization, such as through more extended hospital stays with high-intensity interventions.
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Affiliation(s)
- Chun-Hui Liao
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chen-Shu Chang
- Department of Neurology, Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central-Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan.
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6
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Grant JE, Chamberlain SR. Duration of untreated illness in gambling disorder. CNS Spectr 2024; 29:54-59. [PMID: 37694344 PMCID: PMC7615660 DOI: 10.1017/s1092852923002444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Gambling disorder is common, affects 0.5-2% of the population, and is under-treated. Duration of untreated illness (DUI) has emerged as a clinically important concept in the context of other mental disorders, but DUI in gambling disorder, has received little research scrutiny. METHODS Data were aggregated from previous clinical trials in gambling disorder with people who had never previously received any treatment. DUI was quantified, and clinical characteristics were compared as a function of DUI status. RESULTS A total of 298 individuals were included, and the mean DUI (standard deviation) was 8.9 (8.4) years, and the median DUI was 6 years. Longer DUI was significantly associated with male gender, older age, earlier age when the person first started to gamble, and family history of alcohol use disorder. Longer DUI was not significantly associated with racial-ethnic status, gambling symptom severity, current depressive or anxiety severity, comorbidities, or disability/functioning. The two groups did not differ in their propensity to drop out of the clinical trials, nor in overall symptom improvement associated with participation in those trials. CONCLUSIONS These data suggest that gambling disorder has a relatively long DUI and highlight the need to raise awareness and foster early intervention for affected and at-risk individuals. Because earlier age at first gambling in any form was strongly linked to longer DUI, this highlights the need for more rigorous legislation and education to reduce exposure of younger people to gambling.
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Affiliation(s)
- Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Samuel R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK; and Southern Health NHS Foundation Trust, Southampton, UK
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7
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Panagiotaropoulou G, Hellberg KLG, Coleman JRI, Seok D, Kalman J, Mitchell PB, Schofield PR, Forstner AJ, Bauer M, Scott LJ, Pato CN, Pato MT, Li QS, Kirov G, Landén M, Jonsson L, Müller-Myhsok B, Smoller JW, Binder EB, Brückl TM, Czamara D, der Auwera SV, Grabe HJ, Homuth G, Schmidt CO, Potash JB, DePaulo RJ, Goes FS, MacKinnon DF, Mondimore FM, Weissman MM, Shi J, Frye MA, Biernacka JM, Reif A, Witt SH, Kahn RR, Boks MM, Owen MJ, Gordon-Smith K, Mitchell BL, Martin NG, Medland SE, Jones L, Knowles JA, Levinson DF, O'Donovan MC, Lewis CM, Breen G, Werge T, Schork AJ, Ophoff R, Ripke S, Loohuis LO. Identifying genetic differences between bipolar disorder and major depression through multiple GWAS. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.29.24301816. [PMID: 38410442 PMCID: PMC10896417 DOI: 10.1101/2024.01.29.24301816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Accurate diagnosis of bipolar disorder (BD) is difficult in clinical practice, with an average delay between symptom onset and diagnosis of about 7 years. A key reason is that the first manic episode is often preceded by a depressive one, making it difficult to distinguish BD from unipolar major depressive disorder (MDD). Aims Here, we use genome-wide association analyses (GWAS) to identify differential genetic factors and to develop predictors based on polygenic risk scores that may aid early differential diagnosis. Methods Based on individual genotypes from case-control cohorts of BD and MDD shared through the Psychiatric Genomics Consortium, we compile case-case-control cohorts, applying a careful merging and quality control procedure. In a resulting cohort of 51,149 individuals (15,532 BD cases, 12,920 MDD cases and 22,697 controls), we perform a variety of GWAS and polygenic risk scores (PRS) analyses. Results While our GWAS is not well-powered to identify genome-wide significant loci, we find significant SNP-heritability and demonstrate the ability of the resulting PRS to distinguish BD from MDD, including BD cases with depressive onset. We replicate our PRS findings, but not signals of individual loci in an independent Danish cohort (iPSYCH 2015 case-cohort study, N=25,966). We observe strong genetic correlation between our case-case GWAS and that of case-control BD. Conclusions We find that MDD and BD, including BD with a depressive onset, are genetically distinct. Further, our findings support the hypothesis that Controls - MDD - BD primarily lie on a continuum of genetic risk. Future studies with larger and richer samples will likely yield a better understanding of these findings and enable the development of better genetic predictors distinguishing BD and, importantly, BD with depressive onset from MDD.
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Affiliation(s)
| | - Kajsa-Lotta Georgii Hellberg
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Darsol Seok
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Janos Kalman
- Institute for Psychiatric Phenomics and Genomics, Ludwig Maximilian University, Munich, Germany
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, School of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, University of New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, University of New South Wales, Australia
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Laura J Scott
- Department of Biostatistics and Center for Statistical Genetics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Carlos N Pato
- Department of Psychiatry, Rutgers University, Rutgers Health, Piscataway, NJ, USA
| | - Michele T Pato
- Department of Psychiatry, Rutgers University, Rutgers Health, Piscataway, NJ, USA
| | - Qingqin S Li
- Janssen Research and Development, Neuroscience, Titusville, NJ, USA
| | - George Kirov
- Cardiff University, Division of Psychological Medicine and Clinical Neuroscience, Cardiff, UK
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lina Jonsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Elisabeth B Binder
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich
| | - Tanja M Brückl
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich
| | - Darina Czamara
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute of Functional Genomics, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Carsten O Schmidt
- Institute for Community Medicine, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - James B Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raymond J DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dean F MacKinnon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francis M Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Myrna M Weissman
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
- Division of Translational Epidemiology & Mental Health Equity, New York State Psychiatric Institute, New York, NY, US
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andreas Reif
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - René R Kahn
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Marco M Boks
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
| | | | - Brittany L Mitchell
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicholas G Martin
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sarah E Medland
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester, UK
| | - James A Knowles
- Department of Genetics, Rutgers University, Piscataway, NJ, US
| | - Douglas F Levinson
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, US
| | - Michael C O'Donovan
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital, Copenhagen, Denmark
- Section for Geogenetics, GLOBE Institute, Faculty of Health and Medical Sciences, Copenhagen University
| | - Andrew J Schork
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Roel Ophoff
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephan Ripke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- German Center for Mental Health (DZPG), Site Berlin-Potsdam, Germany
| | - Loes Olde Loohuis
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Genetics and Genomics, University of California Los Angeles, Los Angeles, CA, USA
- Department of Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
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8
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Service SK, De La Hoz J, Diaz-Zuluaga AM, Arias A, Pimplaskar A, Luu C, Mena L, Valencia J, Ramírez MC, Bearden CE, Sabbati C, Reus VI, López-Jaramillo C, Freimer NB, Loohuis LMO. Predicting diagnostic conversion from major depressive disorder to bipolar disorder: an EHR based study from Colombia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.28.23296092. [PMID: 37873340 PMCID: PMC10593019 DOI: 10.1101/2023.09.28.23296092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Bipolar Disorder (BD) is a severe and chronic disorder characterized by recurrent episodes of depression, mania, and/or hypomania. Most BD patients initially present with depressive symptoms, resulting in a delayed diagnosis of BD and poor clinical outcomes. This study leverages electronic health record (EHR) data from the Clínica San Juan de Dios Manizales in Colombia to identify features predictive of the transition from Major Depressive Disorder (MDD) to BD. Analyzing EHR data from 13,607 patients diagnosed with MDD over 15 years, we identified 1,610 cases of conversion to BD. Using a multivariate Cox regression model, we identified severity of the initial MDD episode, the presence of psychosis and hospitalization at first episode, family history of mood or psychotic disorders, female gender to be predictive of the conversion to BD. Additionally, we observed associations with medication classes (prescriptions of mood stabilizers, antipsychotics, and antidepressants) and clinical features (delusions, suicide attempt, suicidal ideation, use of marijuana and alcohol use/abuse) derived from natural language processing (NLP) of clinical notes. Together, these risk factors predicted BD conversion within five years of the initial MDD diagnosis, with a recall of 72% and a precision of 38%. Our study confirms many previously identified risk factors identified through registry-based studies (such as female gender and psychotic depression at the index MDD episode), and identifies novel ones (specifically, suicidal ideation and suicide attempt extracted from clinical notes). These results simultaneously demonstrate the validity of using EHR data for predicting BD conversion as well as underscore its potential for the identification of novel risk factors and improving early diagnosis.
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Affiliation(s)
- Susan K Service
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Juan De La Hoz
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Ana M Diaz-Zuluaga
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Alejandro Arias
- Research Group in Psychiatry (GIPSI), Institute of Medical Research, Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Aditya Pimplaskar
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Chuc Luu
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Laura Mena
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Johanna Valencia
- Research Group in Psychiatry (GIPSI), Institute of Medical Research, Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | | | - Carrie E Bearden
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Chiara Sabbati
- Department of Biomedical Data Science, Stanford University, Stanford, USA
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco, San Francisco, USA
| | - Carlos López-Jaramillo
- Research Group in Psychiatry (GIPSI), Institute of Medical Research, Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Nelson B Freimer
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Loes M Olde Loohuis
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
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9
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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Suicidal risk and protective factors in major affective disorders: A prospective cohort study of 4307 participants. J Affect Disord 2023; 338:189-198. [PMID: 37301296 DOI: 10.1016/j.jad.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar disorder (BD) and major depressive disorder (MDD). METHODS In 4307 extensively evaluated major affective-disorder participants with BD (n = 1425) or MDD (n = 2882) diagnosed by current international criteria, we compared characteristics among those with versus without suicidal acts from illness-onset through 8.24 years of follow-up. RESULTS Suicidal acts were identified in 11.4 % of participants; 25.9 % were violent and 6.92 % (0.79 % of all participants) were fatal. Associated risk factors included: diagnosis (BD > MDD), manic/psychotic features in first-episodes, family history of suicide or BD, separation/divorce, early abuse, young at illness-onset, female sex with BD, substance abuse, higher irritable, cyclothymic or dysthymic temperament ratings, greater long-term morbidity, and lower intake functional ratings. Protective factors included marriage, co-occurring anxiety disorder, higher ratings of hyperthymic temperament and depressive first episodes. Based on multivariable logistic regression, five factors remained significantly and independently associated with suicidal acts: BD diagnosis, more time depressed during prospective follow-up, younger at onset, lower functional status at intake, and women > men with BD. LIMITATIONS Reported findings may or may not apply consistently in other cultures and locations. CONCLUSIONS Suicidal acts including violent acts and suicides were more prevalent with BD than MDD. Of identified risk (n = 31) and protective factors (n = 4), several differed with diagnosis. Their clinical recognition should contribute to improved prediction and prevention of suicide in major affective disorders.
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Affiliation(s)
- Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, University of Padova, Padua, Italy.
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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10
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Uhlhaas PJ, Davey CG, Mehta UM, Shah J, Torous J, Allen NB, Avenevoli S, Bella-Awusah T, Chanen A, Chen EYH, Correll CU, Do KQ, Fisher HL, Frangou S, Hickie IB, Keshavan MS, Konrad K, Lee FS, Liu CH, Luna B, McGorry PD, Meyer-Lindenberg A, Nordentoft M, Öngür D, Patton GC, Paus T, Reininghaus U, Sawa A, Schoenbaum M, Schumann G, Srihari VH, Susser E, Verma SK, Woo TW, Yang LH, Yung AR, Wood SJ. Towards a youth mental health paradigm: a perspective and roadmap. Mol Psychiatry 2023; 28:3171-3181. [PMID: 37580524 PMCID: PMC10618105 DOI: 10.1038/s41380-023-02202-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.
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Affiliation(s)
- Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - John Torous
- Division of Digital Psychiatry and Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Shelli Avenevoli
- Office of the Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Tolulope Bella-Awusah
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Andrew Chanen
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Kim Q Do
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Sophia Frangou
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, RWTH, Aachen, Germany
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Francis S Lee
- Department of Psychiatry, Weill Cornell Cornell Medicall College, New York, NY, USA
| | - Cindy H Liu
- Departments of Pediatrics and Psychiatry, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick D McGorry
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Merete Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Hellerup, Denmark
| | - Dost Öngür
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC, Australia
| | - Tomáš Paus
- Departments of Psychiatry and Neuroscience, Faculty of Medicine and Centre Hospitalier Universitaire Sainte Justine, University of Montreal, Montreal, QC, Canada
- Department of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Akira Sawa
- The John Hopkins Schizophrenia Center, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schoenbaum
- Division of Service and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Gunter Schumann
- Centre for Population Neuroscience and Stratified Medicine, ISTBI, Fudan University, Shanghai, China
- Department of Psychiatry and Neuroscience, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, VIC, USA
| | - Ezra Susser
- Departments of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Swapna K Verma
- Department of Psychosis, Institute of Mental Health, Buangkok, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - T Wilson Woo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Laboratory for Cellular Neuropathology, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Alison R Yung
- School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC, Australia
- Department of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephen J Wood
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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11
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Dragasek J, Minar M, Valkovic P, Pallayova M. Factors associated with psychiatric and physical comorbidities in bipolar disorder: a nationwide multicenter cross-sectional observational study. Front Psychiatry 2023; 14:1208551. [PMID: 37559916 PMCID: PMC10407573 DOI: 10.3389/fpsyt.2023.1208551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and disabling affective disorder with significant morbidity and mortality. Despite the high rate of psychiatric and physical health comorbidity, little is known about the complex interrelationships between clinical features of bipolar illness and comorbid conditions. The present study sought to examine, quantify and characterize the cross-sectional associations of psychiatric and physical comorbidities with selected demographic and clinical characteristics of adults with BD. METHODS A nationwide multicenter cross-sectional observational epidemiological study conducted from October 2015 to March 2017 in Slovakia. RESULTS Out of 179 study participants [median age 49 years (interquartile range IQR 38-58); 57.5% females], 22.4% were free of comorbidity, 42.5% had both psychiatric and physical comorbidities, 53.6% at least one psychiatric comorbidity, and 66.5% at least one physical comorbidity. The most prevalent were the essential hypertension (33.5%), various psychoactive substance-related disorders (21.2%), specific personality disorders (14.6%), obesity (14.5%), and disorders of lipoprotein metabolism (14%). The presence of an at least one physical comorbidity, atypical symptoms of BD, and unemployed status were each associated with an at least one psychiatric comorbidity independent of sex, early onset of BD (age of onset <35 years), BD duration and pattern of BD illness progression (p < 0.001). The presence of various psychoactive substance-related disorders, BD duration, atypical symptoms of BD, unemployed status, pension, female sex, and not using antipsychotics were each associated with an at least one physical comorbidity independent of the pattern of BD illness progression (p < 0.001). In several other multiple regression models, the use of antipsychotics (in particular, olanzapine) was associated with a decreased probability of the essential hypertension and predicted the clinical phenotype of comorbidity-free BD (p < 0.05). CONCLUSION This cross-national study has reported novel estimates and clinical correlates related to both the comorbidity-free phenotype and the factors associated with psychiatric and physical comorbidities in adults with BD in Slovakia. The findings provide new insights into understanding of the clinical presentation of BD that can inform clinical practice and further research to continue to investigate potential mechanisms of BD adverse outcomes and disease complications onset.
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Affiliation(s)
- Jozef Dragasek
- 1st Department of Psychiatry, University Hospital of Louis Pasteur and Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
| | - Michal Minar
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Valkovic
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
- Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Maria Pallayova
- 1st Department of Psychiatry, University Hospital of Louis Pasteur and Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
- Department of Human Physiology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
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12
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Di Salvo G, Porceddu G, Albert U, Maina G, Rosso G. Correlates of long duration of untreated illness (DUI) in patients with bipolar disorder: results of an observational study. Ann Gen Psychiatry 2023; 22:12. [PMID: 36959643 PMCID: PMC10035162 DOI: 10.1186/s12991-023-00442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Despite a high number of studies investigating the correlation between long Duration of Untreated Illness (DUI) and poor course of Bipolar Disorder (BD), the results concerning the impact of DUI on some specific factors, such as suicidality and medical comorbidities, are still inconsistent. This cross-sectional observational study aimed at analyzing potential socio-demographic and clinical correlates of long DUI in a large cohort of real-world, well-characterized BD patients. METHODS The socio-demographic and clinical characteristics of 897 patients with BD were collected. The sample was divided for analysis in two groups (short DUI vs long DUI) according to a DUI cutoff of 2 years. Comparisons were performed using χ2 tests for categorical variables and the Kruskal-Wallis test for continuous variables. Logistic regression (LogReg) was used to identify explanatory variables associated with DUI (dependent variable). RESULTS Six-hundred and sixty patients (75.5%) presented long DUI (> 2 years) and mean DUI was 15.7 years. The LogReg analysis confirmed the association of long DUI with bipolar II disorder (p: 0.016), lower age at onset (p < 0.001), depressive predominant polarity (p: 0.018), depressive polarity onset (p < 0.001), longer duration of illness (p < 0.001), lifetime suicide attempts (p: 0.045) and current medical comorbidities (p: 0.019). CONCLUSIONS The present study confirms the association between long DUI and higher risk of suicide attempts in patients with BD. Moreover, an association between long DUI and higher rates of medical conditions has been found.
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Affiliation(s)
- Gabriele Di Salvo
- San Luigi Gonzaga University Hospital, Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Giorgia Porceddu
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- UCO Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano Isontina, ASUGI, Trieste, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga University Hospital, Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Gianluca Rosso
- San Luigi Gonzaga University Hospital, Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
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13
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Mobile Mental Health Units in Heraklion Crete 2013–2022: Progress, Difficulties and Future Challenges. PSYCH 2022. [DOI: 10.3390/psych5010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Mobile mental health units (MMHUs) have been proposed as an effective model to serve the mental health needs of remote underserved areas. In 2013, the Department of Psychiatry, University of Crete, started a pilot MMHU to cover the needs of remote rural areas of the Heraklion Prefecture. The main objectives were early detection, prevention and therapy of patients with severe psychiatric disorders, without access to regular psychiatric care. In addition to regular visits to primary care health centers, a community support network was established. During this 10-year period, the MMHU has evaluated 3343 patients and performed 19,935 visits. The most frequent diagnoses are depression and anxiety (52.7%) whereas psychosis and bipolar disorders are the third (12.7%) and fifth most frequent diagnoses (4.7%). Half of the patients with depression/anxiety were older than 65 years and one third were living alone. Furthermore, the first visit with the MMHU of severely mentally ill was about 15 years later from the self-reported onset of psychotic symptoms. We discuss how to improve our ability to detect and intervene earlier in patients with severe mental illness, and how to address effectively, both pharmacologically and psychosocially, the depression and loneliness of older individuals living in small remote communities.
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