1
|
Affective lability and social functioning in severe mental disorders. Eur Arch Psychiatry Clin Neurosci 2022; 272:873-885. [PMID: 35084540 PMCID: PMC9279216 DOI: 10.1007/s00406-022-01380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Social functioning is impaired in severe mental disorders despite clinical remission, illustrating the need to identify other mechanisms that hinder psychosocial recovery. Affective lability is elevated and associated with an increased clinical burden in psychosis spectrum disorders. We aimed to investigate putative associations between affective lability and social functioning in 293 participants with severe mental disorders (schizophrenia- and bipolar spectrum), and if such an association was independent of well-established predictors of social impairments. The Affective Lability Scale (ALS-SF) was used to measure affective lability covering the dimensions of anxiety-depression, depression-elation and anger. The interpersonal domain of the Social Functioning Scale (SFS) was used to measure social functioning. Correlation analyses were conducted to investigate associations between affective lability and social functioning, followed by a hierarchical multiple regression and follow-up analyses in diagnostic subgroups. Features related to premorbid and clinical characteristics were entered as independent variables together with the ALS-SF scores. We found that higher scores on all ALS-SF subdimensions were significantly associated with lower social functioning (p < 0.005) in the total sample. For the anxiety-depression dimension of the ALS-SF, this association persisted after controlling for potential confounders such as premorbid social functioning, duration of untreated illness and current symptoms (p = 0.019). Our results indicate that elevated affective lability may have a negative impact on social functioning in severe mental disorders, which warrants further investigation. Clinically, it might be fruitful to target affective lability in severe mental disorders to improve psychosocial outcomes.
Collapse
|
2
|
Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
Collapse
Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | |
Collapse
|
3
|
Lobban F, Akers N, Appelbe D, Iraci Capuccinello R, Chapman L, Collinge L, Dodd S, Flowers S, Hollingsworth B, Honary M, Johnson S, Jones SH, Mateus C, Mezes B, Murray E, Panagaki K, Rainford N, Robinson H, Rosala-Hallas A, Sellwood W, Walker A, Williamson PR. A web-based, peer-supported self-management intervention to reduce distress in relatives of people with psychosis or bipolar disorder: the REACT RCT. Health Technol Assess 2021; 24:1-142. [PMID: 32608353 DOI: 10.3310/hta24320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Relatives caring for people with severe mental health problems find information and emotional support hard to access. Online support for self-management offers a potential solution. OBJECTIVE The objective was to determine the clinical effectiveness and cost-effectiveness of an online supported self-management tool for relatives: the Relatives' Education And Coping Toolkit (REACT). DESIGN AND SETTING This was a primarily online (UK), single-blind, randomised controlled trial, comparing REACT plus a resource directory and treatment as usual with the resource directory and treatment as usual only, by measuring user distress and other well-being measures at baseline and at 12 and 24 weeks. PARTICIPANTS A total of 800 relatives of people with severe mental health problems across the UK took part; relatives who were aged ≥ 16 years, were experiencing high levels of distress, had access to the internet and were actively seeking help were recruited. INTERVENTION REACT comprised 12 psychoeducation modules, peer support through a group forum, confidential messaging and a comprehensive resource directory of national support. Trained relatives moderated the forum and responded to messages. MAIN OUTCOME MEASURE The main outcome was the level of participants' distress, as measured by the General Health Questionnaire-28 items. RESULTS Various online and offline strategies, including social media, directed potential participants to the website. Participants were randomised to one of two arms: REACT plus the resource directory (n = 399) or the resource directory only (n = 401). Retention at 24 weeks was 75% (REACT arm, n = 292; resource directory-only arm, n = 307). The mean scores for the General Health Questionnaire-28 items reduced substantially across both arms over 24 weeks, from 40.2 (standard deviation 14.3) to 30.5 (standard deviation 15.6), with no significant difference between arms (mean difference -1.39, 95% confidence interval -3.60 to 0.83; p = 0.22). At 12 weeks, the General Health Questionnaire-28 items scores were lower in the REACT arm than in the resource directory-only arm (-2.08, 95% confidence interval -4.14 to -0.03; p = 0.027), but this finding is likely to be of limited clinical significance. Accounting for missing data, which were associated with higher distress in the REACT arm (0.33, 95% confidence interval -0.27 to 0.93; p = 0.279), in a longitudinal model, there was no significant difference between arms over 24 weeks (-0.56, 95% confidence interval -2.34 to 1.22; p = 0.51). REACT cost £142.95 per participant to design and deliver (£62.27 for delivery only), compared with £0.84 for the resource directory only. A health economic analysis of NHS, health and Personal Social Services outcomes found that REACT has higher costs (£286.77), slightly better General Health Questionnaire-28 items scores (incremental General Health Questionnaire-28 items score adjusted for baseline, age and gender: -1.152, 95% confidence interval -3.370 to 1.065) and slightly lower quality-adjusted life-year gains than the resource directory only; none of these differences was statistically significant. The median time spent online was 50.8 minutes (interquartile range 12.4-172.1 minutes) for REACT, with no significant association with outcome. Participants reported finding REACT a safe, confidential environment (96%) and reported feeling supported by the forum (89%) and the REACT supporters (86%). No serious adverse events were reported. LIMITATIONS The sample comprised predominantly white British females, 25% of participants were lost to follow-up and dropout in the REACT arm was not random. CONCLUSIONS An online self-management support toolkit with a moderated group forum is acceptable to relatives and, compared with face-to-face programmes, offers inexpensive, safe delivery of National Institute for Health and Care Excellence-recommended support to engage relatives as peers in care delivery. However, currently, REACT plus the resource directory is no more effective at reducing relatives' distress than the resource directory only. FUTURE WORK Further research in improving the effectiveness of online carer support interventions is required. TRIAL REGISTRATION Current Controlled Trials ISRCTN72019945. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 32. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nadia Akers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | | | - Lesley Chapman
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lizzi Collinge
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Susanna Dodd
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Sue Flowers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Bruce Hollingsworth
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mahsa Honary
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Katerina Panagaki
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Naomi Rainford
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Anna Rosala-Hallas
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Walker
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Paula R Williamson
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| |
Collapse
|
4
|
Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [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] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
Collapse
Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Lobban F, Appelbe D, Appleton V, Aref-Adib G, Barraclough J, Billsborough J, Fisher NR, Foster S, Gill B, Glentworth D, Harrop C, Johnson S, Jones SH, Kovacs TZ, Lewis E, Mezes B, Morton C, Murray E, O’Hanlon P, Pinfold V, Rycroft-Malone J, Siddle R, Smith J, Sutton CJ, Viglienghi P, Walker A, Wintermeyer C. An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare.
Objectives
Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT.
Design
This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed.
Setting
Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south).
Participants
In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up.
Interventions
REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams.
Main outcome measures
The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)].
Results
Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant.
Conclusions
Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions.
Limitations
REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited.
Trial registration
Current Controlled Trials ISRCTN16267685.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Fiona Lobban
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | | | | | | | - Naomi R Fisher
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Bethany Gill
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Steven H Jones
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Elizabeth Lewis
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | | | | | | | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Chris J Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | | | - Andrew Walker
- Division of Health Research, Lancaster University, Lancaster, UK
| | | |
Collapse
|
6
|
Lobban F, Akers N, Appelbe D, Chapman L, Collinge L, Dodd S, Flowers S, Hollingsworth B, Johnson S, Jones SH, Mateus C, Mezes B, Murray E, Panagaki K, Rainford N, Robinson H, Rosala-Hallas A, Sellwood W, Walker A, Williamson P. Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial. BMC Psychiatry 2020; 20:160. [PMID: 32290827 PMCID: PMC7158157 DOI: 10.1186/s12888-020-02545-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Relatives Education And Coping Toolkit (REACT) is an online supported self-management toolkit for relatives of people with psychosis or bipolar designed to improve access to NICE recommended information and emotional support. AIMS Our aim was to determine clinical and cost-effectiveness of REACT including a Resource Directory (RD), versus RD-only. METHODS A primarily online, observer-blind randomised controlled trial comparing REACT (including RD) with RD only (registration ISRCTN72019945). Participants were UK relatives aged > = 16, with high distress (assessed using the GHQ-28), and actively help-seeking, individually randomised, and assessed online. Primary outcome was relatives' distress (GHQ-28) at 24 weeks. Secondary outcomes were wellbeing, support, costs and user feedback. RESULTS We recruited 800 relatives (REACT = 399; RD only = 401) with high distress at baseline (GHQ-28 REACT mean 40.3, SD 14.6; RD only mean 40.0, SD 14.0). Median time spent online on REACT was 50.8 min (IQR 12.4-172.1) versus 0.5 min (IQR 0-1.6) on RD only. Retention to primary follow-up (24 weeks) was 75% (REACT n = 292 (73.2%); RD-only n = 307 (76.6%)). Distress decreased in both groups by 24 weeks, with no significant difference between the two groups (- 1.39, 95% CI -3.60, 0.83, p = 0.22). Estimated cost of delivering REACT was £62.27 per person and users reported finding it safe, acceptable and convenient. There were no adverse events or reported side effects. CONCLUSIONS REACT is an inexpensive, acceptable, and safe way to deliver NICE-recommended support for relatives. However, for highly distressed relatives it is no more effective in reducing distress (GHQ-28) than a comprehensive online resource directory. TRIAL REGISTRATION ISRCTN72019945 prospectively registered 19/11/2015.
Collapse
Affiliation(s)
- Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Nadia Akers
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- grid.10025.360000 0004 1936 8470Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - Lesley Chapman
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lizzi Collinge
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Susanna Dodd
- grid.10025.360000 0004 1936 8470Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - Sue Flowers
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Bruce Hollingsworth
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steven H. Jones
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ceu Mateus
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Elizabeth Murray
- grid.83440.3b0000000121901201e-Health and Primary Care, Primary Care & Population Health Institute of Epidemiology & Health, Faculty of Pop Health Sciences, University College London, London, UK
| | - Katerina Panagaki
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Naomi Rainford
- grid.10025.360000 0004 1936 8470Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - Heather Robinson
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Anna Rosala-Hallas
- grid.10025.360000 0004 1936 8470Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - William Sellwood
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Walker
- grid.9835.70000 0000 8190 6402Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Paula Williamson
- grid.10025.360000 0004 1936 8470Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| |
Collapse
|
7
|
Bennett F, Hodgetts S, Close A, Frye M, Grunze H, Keck P, Kupka R, McElroy S, Nolen W, Post R, Schärer L, Suppes T, Sharma AN. Predictors of psychosocial outcome of bipolar disorder: data from the Stanley Foundation Bipolar Network. Int J Bipolar Disord 2019; 7:28. [PMID: 31840207 PMCID: PMC6911815 DOI: 10.1186/s40345-019-0169-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Impairments in psychosocial functioning have been demonstrated in 30-60% of adults with bipolar disorder (BD). However, the majority of studies investigating the effect of comorbid mental health disorders and age at onset outcomes in BD have focused on traditional outcome measures such as mood symptoms, mortality and treatment response. Therefore, this project aimed to investigate the impact of comorbid mental health disorders and age at onset on longitudinal psychosocial outcome in participants with BD. METHOD Mixed effects modelling was conducted using data from the Stanley Foundation Bipolar Network. Baseline factors were entered into a model, with Global Assessment of Functioning (GAF) score as the longitudinal outcome measure. Relative model fits were calculated using Akaike's Information Criterion. RESULTS No individual comorbidities predicted lower GAF scores, however an interaction effect was demonstrated between attention deficit hyperactivity disorder (ADHD) and any anxiety disorder (t = 2.180, p = 0.030). Participants with BD I vs BD II (t = 2.023, p = 0.044) and those in the lowest vs. highest income class (t = 2.266, p = 0.024) predicted lower GAF scores. Age at onset (t = 1.672, p = 0.095) did not significantly predict GAF scores. CONCLUSIONS This is the first study to demonstrate the negative psychosocial effects of comorbid anxiety disorders and ADHD in BD. This study adds to the growing database suggesting that comorbid mental health disorders are a significant factor hindering psychosocial recovery.
Collapse
Affiliation(s)
- Francis Bennett
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sophie Hodgetts
- School of Psychology, University of Sunderland, Sunderland, UK
| | - Andrew Close
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Heinz Grunze
- PMU Nuremberg & Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
| | - Paul Keck
- Linder Center of Hope, Mason, OH, USA
- Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Susan McElroy
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem Nolen
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert Post
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Lars Schärer
- Department of Psychiatry, and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Trisha Suppes
- School of Medicine and V.A. Palo Alto Health Care System Palo Alto, Stanford University, Palo Alto, CA, USA
| | - Aditya N Sharma
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
- Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| |
Collapse
|
8
|
Can Psychological, Social and Demographical Factors Predict Clinical Characteristics Symptomatology of Bipolar Affective Disorder and Schizophrenia? Psychiatr Q 2016; 87:501-13. [PMID: 26646576 PMCID: PMC4945684 DOI: 10.1007/s11126-015-9405-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Schizophrenia (SCH) is a complex, psychiatric disorder affecting 1 % of population. Its clinical phenotype is heterogeneous with delusions, hallucinations, depression, disorganized behaviour and negative symptoms. Bipolar affective disorder (BD) refers to periodic changes in mood and activity from depression to mania. It affects 0.5-1.5 % of population. Two types of disorder (type I and type II) are distinguished by severity of mania episodes. In our analysis, we aimed to check if clinical and demographical characteristics of the sample are predictors of symptom dimensions occurrence in BD and SCH cases. We included total sample of 443 bipolar and 439 schizophrenia patients. Diagnosis was based on DSM-IV criteria using Structured Clinical Interview for DSM-IV. We applied regression models to analyse associations between clinical and demographical traits from OPCRIT and symptom dimensions. We used previously computed dimensions of schizophrenia and bipolar affective disorder as quantitative traits for regression models. Male gender seemed protective factor for depression dimension in schizophrenia and bipolar disorder sample. Presence of definite psychosocial stressor prior disease seemed risk factor for depressive and suicidal domain in BD and SCH. OPCRIT items describing premorbid functioning seemed related with depression, positive and disorganised dimensions in schizophrenia and psychotic in BD. We proved clinical and demographical characteristics of the sample are predictors of symptom dimensions of schizophrenia and bipolar disorder. We also saw relation between clinical dimensions and course of disorder and impairment during disorder.
Collapse
|
9
|
Scott J, Grunze H, Meyer TD, Nendick J, Watkins H, Ferrier N. A bipolar II cohort (ABC): The association of functional disability with gender and rapid cycling. J Affect Disord 2015. [PMID: 26209962 DOI: 10.1016/j.jad.2015.06.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bipolar II disorder (BP II) is a chronic, frequently co-morbid, and complex disorder with similar rates of attempted suicide to BP I. However, case identification for BP II studies that is based on clinician diagnosis alone is prone to error. This paper reports on differences between clinical and research diagnoses and then describes the clinical characteristics of a carefully defined BP II cohort. METHODS A cohort of rigorously defined BP II cases were recruited from a range of primary and secondary health services in the North of England to participate in a programme of cross-sectional and prospective studies. Case identification, and rapid cycling, comorbidities and functioning were examined. RESULTS Of 355 probable clinical cases of BP II disorder, 176 (∼50%) met rigorous diagnostic criteria. The sample mean age was ∼44 years, with a mean duration of mood disorder of ∼18 years. Two thirds of the cohort were female (n=116), but only 40% were in paid employment. Current and past year functioning was more impaired in females and those with rapid cycling. LIMITATIONS This paper describes only the preliminary assessments of the cohort, so it was not possible to examine additional factors that may contribute to the explained variance in functioning. CONCLUSIONS This carefully ascertained cohort of BP II cases show few gender differences, except for levels of functional impairment. Interestingly, the most common problem identified with using case note diagnoses of BP II arose because of failure to record prior episodes of mania, not failure to identify hypomania.
Collapse
Affiliation(s)
- Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, NE4 5PL UK; Centre for Affective Disorders, IPPN, Kings College, London, UK.
| | - Heinz Grunze
- Formerly Institute of Neuroscience, Newcastle University, UK
| | - Thomas D Meyer
- Formerly Institute of Neuroscience, Newcastle University, UK
| | | | - Hannah Watkins
- Formerly Institute of Neuroscience, Newcastle University, UK
| | | |
Collapse
|
10
|
Siegel RS, Freeman AJ, La Greca AM, Youngstrom EA. Peer relationship Difficulties in Adolescents with Bipolar Disorder. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9291-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Scott J, Scott EM, Hermens DF, Naismith SL, Guastella AJ, White D, Whitwell B, Lagopoulos J, Hickie IB. Functional impairment in adolescents and young adults with emerging mood disorders. Br J Psychiatry 2014; 205:362-8. [PMID: 25213156 DOI: 10.1192/bjp.bp.113.134262] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders. AIMS To examine the prevalence of objective, subjective and observer-rated disability in a large, representative sample of young people with a primary mood disorder. METHOD Individuals aged 16-25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale; SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire). RESULTS Of 1241 participants (83% unipolar; 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when current distress levels were taken into account, daily use of cannabis and/or nicotine were significantly associated with impairment, with odds ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders were related to lower SOFAS scores (OR = 2-5). CONCLUSIONS Levels of disability were significant, even in those presenting for mental healthcare for the first time. Functional impairment did not differ between unipolar and bipolar cases, but some evidence suggested that females with bipolar disorder were particularly disabled. The prevalence of comorbid disorders (50%) and polysubstance use (28%) and their association with disability indicate that more meaningful indicators of mood episode outcomes should focus on functional rather than symptom-specific measures. The association between functioning and nicotine use requires further exploration.
Collapse
Affiliation(s)
- Jan Scott
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Daniel F Hermens
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Adam J Guastella
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Django White
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Bradley Whitwell
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Jim Lagopoulos
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| |
Collapse
|
12
|
Østergaard SD, Straszek S, Petrides G, Skadhede S, Jensen SOW, Munk-Jørgensen P, Nielsen J. Risk factors for conversion from unipolar psychotic depression to bipolar disorder. Bipolar Disord 2014; 16:180-9. [PMID: 24215495 DOI: 10.1111/bdi.12152] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 08/01/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Patients with unipolar psychotic depression (PD) are at high risk of developing bipolar disorder (BD). This conversion has important implications for the choice of treatment. This study, therefore, aimed to identify risk factors associated with diagnostic conversion from PD to BD. METHODS We conducted a population-based, historical prospective cohort study by merging data from Danish registers. Patients assigned an ICD-10 diagnosis of PD between 1 January 1995 and 31 December 2007 were identified in the Danish Central Psychiatric Research Register and were followed until the development of BD, death, loss to follow-up, or 31 December 2007. Potential risk factors for conversion to BD, also defined through various Danish registers, were tested in multiple logistic regression analyses with risk expressed as adjusted odds ratios (AOR). RESULTS We identified 8,588 patients with PD, of whom 609 (7.1%) developed BD during follow-up. The following characteristics were significantly associated with diagnostic conversion from PD to BD: early onset of PD [AOR = 0.99 (per year of increasing age), p = 0.044], recurrent depression [AOR = 1.02 (per episode), p = 0.036], living alone (AOR = 1.29, p = 0.007), receiving a disability pension (AOR = 1.55, p < 0.001), and the highest educational level being a technical education (AOR = 1.55, p < 0.001), short-cycle higher education (AOR = 2.65, p < 0.001), or medium-cycle higher education (AOR = 1.75, p < 0.001). CONCLUSIONS Diagnostic conversion to BD was prevalent among patients with PD. The following characteristics were significantly associated with this conversion: early onset of PD, recurrent depression, living alone, receiving a disability pension, and the highest educational level being a technical education, short-cycle higher education, or medium-cycle higher education.
Collapse
Affiliation(s)
- Søren Dinesen Østergaard
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark; Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | |
Collapse
|