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Doane MJ, Jauregui A, Panchmatia HR. Matched Comparison Examining the Effect of Obesity on Clinical, Economic, and Humanistic Outcomes in Patients with Bipolar I Disorder. Adv Ther 2024; 41:3807-3819. [PMID: 39115592 PMCID: PMC11399203 DOI: 10.1007/s12325-024-02953-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/22/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Bipolar I disorder (BD-I) is associated with an increased risk of obesity, but few studies have evaluated the real-world clinical, humanistic, and economic effects associated with obesity in people with BD-I. METHODS This was a retrospective, cross-sectional analysis of responses to the 2016 and 2020 National Health and Wellness surveys. Respondents (18-64 years) with a self-reported physician diagnosis of BD-I were matched to controls without BD-I based on demographic and health characteristics. Respondents were categorized by body mass index as underweight/normal weight (< 25 kg/m2), overweight (25 to < 30 kg/m2), or obese (≥ 30 kg/m2). Multivariable regression models were used to compare obesity-related comorbidities, healthcare resource utilization (HCRU), health-related quality of life (HRQoL), work productivity, and indirect and direct costs. RESULTS Before matching, the BD-I cohort was younger than the non-BD-I cohort and included more female and white respondents and a greater proportion covered by Medicaid or Medicare. After matching, the BD-I and non-BD-I cohorts had similar characteristics. A total of 5418 respondents (BD-I, n = 1806; matched controls, n = 3612) were analyzed. Obese respondents with BD-I reported the highest adjusted prevalences of high blood pressure (50%), high cholesterol (35%), sleep apnea (27%), osteoarthritis (17%), type 2 diabetes (12%), and liver disease (4%). Obesity in respondents with BD-I was associated with the lowest HRQoL scores. Measures of work impairment were highest in respondents with BD-I and obesity, as was HCRU. Respondents with BD-I and obesity had the highest associated total indirect and direct medical costs ($25,849 and $44,482, respectively). CONCLUSION Obese respondents with BD-I had greater frequencies of obesity-related comorbidities, higher HCRU, lower HRQoL, greater work impairments, and higher indirect and direct medical costs. These findings highlight the real-world burden of obesity in people with BD-I and the importance of considering treatments that may reduce this burden.
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Affiliation(s)
- Michael J Doane
- Health Economics and Outcomes Research, Alkermes, Inc., 900 Winter St., Waltham, MA, 02451-1420, USA.
| | - Adam Jauregui
- Cerner Enviza, an Oracle Company, North Kansas City, MO, USA
| | - Hemangi R Panchmatia
- Health Economics and Outcomes Research, Alkermes, Inc., 900 Winter St., Waltham, MA, 02451-1420, USA
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Warner A, Holland C, Lobban F, Bentley L, Tyler E, Palmier-Claus J. Quality of life in older adults with mood states associated with bipolar disorder: A secondary analysis of the English longitudinal study of ageing data. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39128891 DOI: 10.1111/bjc.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 07/28/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder. METHODS The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure. RESULTS The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group. CONCLUSIONS Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes.
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Affiliation(s)
- Aaron Warner
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Carol Holland
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
- Lancashire and South Cumbria Care NHS Foundation Trust, Lancashire, UK
| | - Lee Bentley
- Manchester Metropolitan University, Manchester, UK
| | - Elizabeth Tyler
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Jasper Palmier-Claus
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
- Lancashire and South Cumbria Care NHS Foundation Trust, Lancashire, UK
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Yin C, Yan J, Wang J, Wang T, Li H, Wang Y, Wang H, Feng S, Liang Y. Spatial analysis of the prevalence of abdominal obesity in middle-aged and older adult people in China: exploring the relationship with meteorological factors based on gender differences. Front Public Health 2024; 12:1426295. [PMID: 39100945 PMCID: PMC11294229 DOI: 10.3389/fpubh.2024.1426295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Background In recent years, the incidence of abdominal obesity among the middle-aged and older adult population in China has significantly increased. However, the gender disparities in the spatial distribution of abdominal obesity incidence and its relationship with meteorological factors among this demographic in China remain unclear. This gap in knowledge highlights the need for further research to understand these dynamics and inform targeted public health strategies. Methods This study utilized data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) to analyze the incidence of abdominal obesity among the middle-aged and older adult population in China. Additionally, meteorological data were collected from the National Meteorological Information Center. Using Moran's I index and Getis-Ord Gi* statistical methods, the spatial distribution characteristics of abdominal obesity incidence were examined. The influence of various meteorological factors on the incidence of abdominal obesity in middle-aged and older adult males and females was investigated using the q statistic from the Geodetector method. Furthermore, Multi-Scale Geographically Weighted Regression (MGWR) analysis was employed to explore the impact of meteorological factors on the spatial heterogeneity of abdominal obesity incidence from a gender perspective. Results The spatial distribution of abdominal obesity among middle-aged and older adult individuals in China exhibits a decreasing trend from northwest to southeast, with notable spatial autocorrelation. Hotspots are concentrated in North and Northeast China, while cold spots are observed in Southwest China. Gender differences have minimal impact on spatial clustering characteristics. Meteorological factors, including temperature, sunlight, precipitation, wind speed, humidity, and atmospheric pressure, influence incidence rates. Notably, temperature and sunlight exert a greater impact on females, while wind speed has a reduced effect. Interactions among various meteorological factors generally demonstrate bivariate enhancement without significant gender disparities. However, gender disparities are evident in the influence of specific meteorological variables such as annual maximum, average, and minimum temperatures, as well as sunlight duration and precipitation, on the spatial heterogeneity of abdominal obesity incidence. Conclusion Meteorological factors show a significant association with abdominal obesity prevalence in middle-aged and older adults, with temperature factors playing a prominent role. However, this relationship is influenced by gender differences and spatial heterogeneity. These findings suggest that effective public health policies should be not only gender-sensitive but also locally adapted.
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Affiliation(s)
- Chaohui Yin
- School of Resources and Environment, Henan Agricultural University, Zhengzhou, Henan, China
| | - Jinlong Yan
- Department of Geography and Spatial Information Techniques, Ningbo University, Ningbo, China
| | - Junqi Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianyi Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Hangyu Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Wang
- College of Acu-moxibustion and Massage, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Haifeng Wang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xianyang, China
| | - Shixing Feng
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Xianyang, China
- Centre France Chine de la Médecine Chinoise, Selles sur Cher, France
| | - Yafeng Liang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Kadriu B, Deng ZD, Kraus C, Johnston JN, Fijtman A, Henter ID, Kasper S, Zarate CA. The impact of body mass index on the clinical features of bipolar disorder: A STEP-BD study. Bipolar Disord 2024; 26:160-175. [PMID: 37536999 PMCID: PMC10839568 DOI: 10.1111/bdi.13370] [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: 08/05/2023]
Abstract
INTRODUCTION The effects of body mass index (BMI) on the core symptoms of bipolar disorder (BD) and its implications for disease trajectory are largely unexplored. OBJECTIVE To examine whether BMI impacted hospitalization rate, medical and psychiatric comorbidities, and core symptom domains such as depression and suicidality in BD. METHODS Participants (15 years and older) were 2790 BD outpatients enrolled in the longitudinal STEP-BD study; all met DSM-IV criteria for BD-I, BD-II, cyclothymia, BD NOS, or schizoaffective disorder, bipolar subtype. BMI, demographic information, psychiatric and medical comorbidities, and other clinical variables such as bipolarity index, history of electroconvulsive therapy (ECT), and history of suicide attempts were collected at baseline. Longitudinal changes in Montgomery-Åsberg Depression Rating Scale (MADRS) score, Young Mania Rating Scale (YMRS) score, and hospitalizations during the study were also assessed. Depending on the variable of interest, odds-ratios, regression analyses, factor analyses, and graph analyses were applied. RESULTS A robust increase in psychiatric and medical comorbidities was observed, particularly for baseline BMIs >35. A significant relationship was noted between higher BMI and history of suicide attempts, and individuals with BMIs >40 had the highest prevalence of suicide attempts. Obese and overweight individuals had a higher bipolarity index (a questionnaire measuring disease severity) and were more likely to have received ECT. Higher BMIs correlated with worsening trajectory of core depression symptoms and with worsening lassitude and inability to feel. CONCLUSIONS In BD participants, elevated BMI was associated with worsening clinical features, including higher rates of suicidality, comorbidities, and core depression symptoms.
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Affiliation(s)
- Bashkim Kadriu
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Zhi-De Deng
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Christoph Kraus
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
- Department of Psychiatry and Psychotherapy, Medical
University of Vienna, Vienna, Austria
| | - Jenessa N. Johnston
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
- Division of Medical Sciences, University of Victoria,
Victoria, BC, Canada
| | - Adam Fijtman
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Ioline D. Henter
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Siegfried Kasper
- Center for Brain Research Department of Molecular
Neuroscience, Medical University of Vienna, Vienna, Austria
| | - Carlos A. Zarate
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
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Almeida OP, Etherton-Beer C, Sanfilippo F, Page A. Health morbidities associated with the dispensing of lithium to males and females: Cross-sectional analysis of the 10 % Pharmaceutical Benefits Scheme sample for 2022. J Affect Disord 2024; 344:503-509. [PMID: 37852583 DOI: 10.1016/j.jad.2023.10.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This study examined the association of gender on the physical morbidity of individuals likely living with bipolar disorder (BD) using a comprehensive health-related database. It investigated the association between lithium dispensing (a surrogate marker for BD) and other health morbidities, considering age and sex. METHODS The cross-sectional study design used the 10 % Schedule of Pharmaceutical Benefits Scheme (PBS) database in Australia for 2022. Medication dispensing, age, and sex were available. A validated algorithm inferred 45 health morbidities from dispensed medicines. Statistical analyses, including logistic regression, assessed the relationship between lithium dispensing, sex, and age with inferred health morbidities. RESULTS The sample consisted of 1,594,112 individuals aged 10 to over 95 years. A higher proportion of women than men were dispensed lithium (0.33 % vs 0.30 %). Lithium dispensing and age were associated with higher prevalence of inferred morbidities. Women dispensed lithium had a greater physical health burden compared to men, with higher odds of chronic airways diseases, diabetes, ischaemic heart disease/hypertension, inflammation, pain, psychosis, and steroid-responsive diseases. Conversely, women dispensed lithium had lower odds of cardiac arrhythmias and hypothyroidism compared to men. CONCLUSIONS This study provides evidence that individuals with BD, indicated by the dispensing of lithium, experience a relatively higher frequency of physical health morbidities, with women being disproportionally affected compared to men. The findings highlight the need for comprehensive care for people living with BD, particularly women.
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Affiliation(s)
| | | | - Frank Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, Australia
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Slabe Z, Balesar RA, Verwer RWH, Van Heerikhuize JJ, Pechler GA, Zorović M, Hoogendijk WJ, Swaab DF. Alterations in pituitary adenylate cyclase-activating polypeptide in major depressive disorder, bipolar disorder, and comorbid depression in Alzheimer's disease in the human hypothalamus and prefrontal cortex. Psychol Med 2023; 53:7537-7549. [PMID: 37226771 PMCID: PMC10755247 DOI: 10.1017/s0033291723001265] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/01/2023] [Accepted: 04/13/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) is involved in the stress response and may play a key role in mood disorders, but no information is available on PACAP for the human brain in relation to mood disorders. METHODS PACAP-peptide levels were determined in a major stress-response site, the hypothalamic paraventricular nucleus (PVN), of people with major depressive disorder (MDD), bipolar disorder (BD) and of a unique cohort of Alzheimer's disease (AD) patients with and without depression, all with matched controls. The expression of PACAP-(Adcyap1mRNA) and PACAP-receptors was determined in the MDD and BD patients by qPCR in presumed target sites of PACAP in stress-related disorders, the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC). RESULTS PACAP cell bodies and/or fibres were localised throughout the hypothalamus with differences between immunocytochemistry and in situ hybridisation. In the controls, PACAP-immunoreactivity-(ir) in the PVN was higher in women than in men. PVN-PACAP-ir was higher in male BD compared to the matched male controls. In all AD patients, the PVN-PACAP-ir was lower compared to the controls, but higher in AD depressed patients compared to those without depression. There was a significant positive correlation between the Cornell depression score and PVN-PACAP-ir in all AD patients combined. In the ACC and DLPFC, alterations in mRNA expression of PACAP and its receptors were associated with mood disorders in a differential way depending on the type of mood disorder, suicide, and psychotic features. CONCLUSION The results support the possibility that PACAP plays a role in mood disorder pathophysiology.
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Affiliation(s)
- Zala Slabe
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
- University of Ljubljana, Faculty of Medicine, Institute of Pharmacology and Experimental Toxicology, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Rawien A. Balesar
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Ronald W. H. Verwer
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Joop J. Van Heerikhuize
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Gwyneth A. Pechler
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
- University of Ljubljana, Faculty of Medicine, Institute of Pharmacology and Experimental Toxicology, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Maja Zorović
- University of Ljubljana, Faculty of Medicine, Institute of Pathophysiology, Zaloška 4, 1000 Ljubljana, Slovenia
| | - Witte J.G. Hoogendijk
- Erasmus University Medical Centre, Department of Psychiatry, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Dick F. Swaab
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
- University of Ljubljana, Faculty of Medicine, Institute of Pharmacology and Experimental Toxicology, Korytkova 2, 1000 Ljubljana, Slovenia
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Wang Y, Liu Y, Zhang X, Wu Q. Sex-Based Differences and Risk Factors for Comorbid Nonalcoholic Fatty Liver Disease in Patients with Bipolar Disorder: A Cross-Sectional Retrospective Study. Diabetes Metab Syndr Obes 2023; 16:3533-3545. [PMID: 37954889 PMCID: PMC10637207 DOI: 10.2147/dmso.s428523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Sex-based differences in patients with bipolar disorders (BD) are well recognized, and it is well known that the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) are both higher in men than in women. Although metabolic disorders such as NAFLD are common in patients with BD, sex differences and risk factors for NAFLD comorbidity in these patients have not been thoroughly explored. This study aimed to investigate sex differences in patients with comorbid NAFLD and BD and associated risk factors. Methods This retrospective cross-sectional study included 710 patients with BD. Clinical data of patients with BD, including information on fasting glucose, liver function-related enzymes, relevant lipid data, uric acid, the triglyceride-glucose index (TyG), and demographics, were derived from the hospital electronic medical record system from June 2020 to July 2022. We performed logistic regression analysis and calculated the odds ratios with 95% confidence intervals of factors using t-tests, χ²-tests, and receiver operating characteristic. NAFLD was diagnosed using liver ultrasonography. Results The prevalence of NAFLD was higher in male patients with BD than in female patients (50.9% vs 38.5%), and there were significant differences in the years of education and marital status (all P<0.05). Regression analysis showed that the risk factors for comorbidities were the body mass index (BMI), fasting glucose, and apolipoprotein B levels in male patients and the BMI, bipolar disease course, glutamine transpeptidase levels, and the TyG in female patients. Conclusion Sex-based differences exist in risk factors and in the prevalence of comorbid NAFLD among patients with BD. BMI is a sex-independent risk factor, and clinical attention should be targeted to risk factors associated with comorbid NAFLD related to sex, especially in female patients with BD who presenting a high TyG index.
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Affiliation(s)
- Ying Wang
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
| | - Yiyi Liu
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
| | - Xun Zhang
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
| | - Qing Wu
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
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Liu Q, Wang L, Zhen F, An C. Occurrence of metabolic syndrome in untreated bipolar disorders: a cross-sectional study. Acta Neuropsychiatr 2023:1-6. [PMID: 37842830 DOI: 10.1017/neu.2023.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This cross-sectional study aimed to observe the occurrence of metabolic syndrome in untreated individuals with bipolar disorders. METHODS A total of 125 untreated individuals with bipolar disorders were collected as the study group, and 201 cases from the health examination centre of our hospital were selected as the control group. The participants enrolled were assessed for general demographic data, case characteristics, and metabolic indexes including body mass index (BMI), blood pressure, triglyceride, high-density lipoprotein-cholesterol, cholesterol, low-density lipoprotein-cholesterol, and fasting plasma glucose. RESULTS The incidence of metabolic syndrome in the bipolar disorders group was higher compared to the control group (9.6% VS. 8.5%). After calibrating sex and age data, a significant difference between the two groups was observed (P < 0.05). Diastolic and systolic blood pressure were higher in the bipolar disorders group compared to the control group (P < 0.01). Men with bipolar disorders had a higher risk of developing metabolic syndrome than women (14.5% vs. 5.8%). Bipolar disorders, sex, age, and BMI were identified as independent risk factors for metabolic syndrome. No significant difference was found in terms of metabolic index and incidence of metabolic syndrome between individuals with depressive episodes (n = 37) and manic episodes (n = 75). CONCLUSION Patients with bipolar disorders were found to have a higher risk of developing metabolic syndrome than healthy individuals. Bipolar disorders, male sex, age, and BMI may contribute to an increased risk of developing metabolic syndrome.
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Affiliation(s)
- Qianli Liu
- Mental Health Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Mental Health Institute of Hebei Medical University, Shijiazhuang, China
- Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
- Hebei Key Laboratory of Brain Science and Psychiatric-Psychologic Disease, Shijiazhuang, China
| | - Lan Wang
- Mental Health Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Mental Health Institute of Hebei Medical University, Shijiazhuang, China
- Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
- Hebei Key Laboratory of Brain Science and Psychiatric-Psychologic Disease, Shijiazhuang, China
| | - Fengya Zhen
- Mental Health Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Mental Health Institute of Hebei Medical University, Shijiazhuang, China
- Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
- Hebei Key Laboratory of Brain Science and Psychiatric-Psychologic Disease, Shijiazhuang, China
| | - Cuixia An
- Mental Health Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Mental Health Institute of Hebei Medical University, Shijiazhuang, China
- Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
- Hebei Key Laboratory of Brain Science and Psychiatric-Psychologic Disease, Shijiazhuang, China
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Iwata M, Hatano M, Ito K, Matsuzaki H, Yamada S. Clinical Laboratory Data in Japan: A Comparative Study of Patients with Psychiatric Disorders and the General Population. Neuropsychiatr Dis Treat 2023; 19:2061-2068. [PMID: 37810950 PMCID: PMC10557983 DOI: 10.2147/ndt.s425541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/16/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Several nationwide population-based studies have reported that patients with psychiatric disorders are at higher risk of developing chronic kidney disease, chronic liver disease, and metabolic syndrome than the general population; however, there are insufficient studies in the Japanese population. Thus, we aimed to clarify the influence of psychiatric disorders on clinical laboratory data in the Japanese population. Patients and Methods This cross-sectional study was based on medical records from the Department of Psychiatry at Fujita Health University Hospital and the 6th National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan (specific health checkups in 2018) in the Ministry of Health, Labor and Welfare. The primary endpoint was the incidence of clinical laboratory abnormalities in patients with psychiatric disorders and the general Japanese population. Results Compared to the general Japanese population, patients with psychiatric disorders had significantly higher rates of the following clinical laboratory abnormalities: estimated glomerular filtration rate, alanine transaminase, aspartate aminotransferase (AST), body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), triglycerides, and hemoglobin A1c (HbA1c). In the age-specific analysis, AST, BMI, HDL-C, and HbA1c levels were more frequently abnormal in patients with psychiatric disorders only in the 40-49 and 50-59 age groups. Conclusion Our results showed that patients with psychiatric disorders have higher rates of various clinical laboratory abnormalities than the general Japanese population, with stronger influences in the middle-aged group. These data suggest the importance of monitoring and preventing chronic diseases in patients with psychiatric disorders in Japan.
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Affiliation(s)
- Miko Iwata
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masakazu Hatano
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kana Ito
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Haruna Matsuzaki
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shigeki Yamada
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Doane MJ, Thompson J, Jauregui A, Gasper S, Csoboth C. Clinical, Economic, and Humanistic Outcomes Associated with Obesity Among People with Bipolar I Disorder in the United States: Analysis of National Health and Wellness Survey Data. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:681-689. [PMID: 37743958 PMCID: PMC10516196 DOI: 10.2147/ceor.s411928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction People living with bipolar I disorder (BD-I) have an increased risk for obesity compared with the general population that may be related to genetic, lifestyle, and treatment factors. Few studies have examined possible effects of obesity on those living with BD-I. This study examined relationships between obesity and clinical, humanistic, and economic outcomes among adults with BD-I. Methods This retrospective, cross-sectional study analyzed survey responses from a nationally representative sample of US adults participating in the 2016 or 2020 National Health and Wellness Survey. Respondents (18-64 years) with a self-reported physician diagnosis of BD-I were included and categorized by body mass index: underweight/normal weight (<25 kg/m2), overweight (25 to <30 kg/m2), or obese (≥30 kg/m2). Adjusted analyses assessed comorbidities, health-related quality of life (HRQoL), work productivity, health care resource utilization (HCRU), and economic outcomes. Results In total, responses from 1,853 participants were analyzed; most were female (65%) and white (62%). Respondents with obesity had the highest prevalence of medical comorbidities, including high blood pressure (52%), sleep apnea (37%), hypercholesterolemia (34%), and type 2 diabetes (12%). Obesity was generally associated with the lowest scores of physical health and HRQoL. Activity impairment scores were highest among respondents with obesity, as were numbers of hospitalizations and emergency department visits in the previous 6 months. Respondents with obesity incurred higher annual indirect and direct medical costs ($28,178 and $37,771, respectively) when compared with the underweight/normal weight ($23,823 and $32,227, respectively) and overweight ($24,312 and $35,231, respectively) groups. Conclusion In this nationally representative sample, obesity was associated with several outcomes that may negatively affect people living with BD-I, including medical comorbidities, higher HCRU, HRQoL impairments, and greater indirect and direct medical costs. These findings highlight the importance of considering the presence of or risk for obesity and associated medical comorbidities when treating BD-I.
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11
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Wang Y, Tan H, Zheng H, Ma Z, Zhan Y, Hu K, Yang Z, Yao Y, Zhang Y. Exposure to air pollution and gains in body weight and waist circumference among middle-aged and older adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 869:161895. [PMID: 36709892 DOI: 10.1016/j.scitotenv.2023.161895] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Emerging research suggested a nexus between air pollution exposure and risks of overweight and obesity, while existing longitudinal evidence was extensively sparse, particularly in densely populated regions. This study aimed to quantify concentration-response associations of changes in weight and waist circumference (WC) related to air pollution in Chinese adults. METHODS We conceived a nationally representative longitudinal study from 2011 to 2015, by collecting 34,854 observations from 13,757 middle-aged and older adults in 28 provincial regions of China. Participants' height, weight and WC were measured by interviewers using standardized devices. Concentrations of major air pollutants including fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) predicted by well-validated spatiotemporal models were assigned to participants according to their residential cities. Possible exposure biases were checked through 1000 random simulated exposure at individual level, using a Monte Carlo simulation approach. Linear mixed-effects models were applied to estimate the relationships of air pollution with weight and WC changes, and restricted cubic spline functions were adopted to smooth concentration-response (C-R) curves. RESULTS Each 10-μg/m3 rise in PM2.5, NO2 and O3 was associated with an increase of 0.825 (95% confidence interval: 0.740, 0.910), 0.921 (0.811, 1.032) and 1.379 (1.141, 1.616) kg in weight, respectively, corresponding to WC gains of 0.688 (0.592, 0.784), 1.189 (1.040, 1.337) and 0.740 (0.478, 1.002) cm. Non-significant violation for linear C-R relationships was observed with exception of NO2-weight and PM2.5/NO2-WC associations. Sex-stratified analyses revealed elevated vulnerability in women to gain of weight in exposure to PM2.5 and NO2. Sensitive analyses largely supported our primary findings via assessing exposure estimates from 1000 random simulations, and performing reanalysis based on non-imputed covariates and non-obese participants, as well as alternative indicators (i.e., body mass index and waist-to-height ratio). CONCLUSIONS We found positively robust associations of later-life exposure to air pollutants with gains in weight and WC based on a national sample of Chinese adult men and women. Our findings suggested that mitigation of air pollution may be an efficient intervention to relieve obesity burden.
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Affiliation(s)
- Yaqi Wang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Huiyue Tan
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China; Healthcare Associated Infection Control Department, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China
| | - Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Zongwei Ma
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Yu Zhan
- Department of Environmental Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Kejia Hu
- Institute of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Zhiming Yang
- School of Economics and Management, University of Science and Technology Beijing, Beijing 100083, China
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing 100871, China
| | - Yunquan Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
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12
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Chen PH, Tsai SY, Pan CH, Chen YL, Chang HM, Su SS, Chen CC, Kuo CJ. Sex-specific risk profiles for suicide mortality in bipolar disorder: incidence, healthcare utilization and comorbidity. Psychol Med 2023; 53:1500-1509. [PMID: 34779754 DOI: 10.1017/s003329172100307x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity. METHODS Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case-control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities. RESULTS Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls. CONCLUSIONS Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Counseling Psychology, Chinese Culture University, Taipei, Taiwan
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
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13
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Mu L, Yu F, Xia J, Lang X, Haque A, Wu HE, Zhang XY. Association between high BMI and high homocysteine levels in Chinese patients with bipolar disorder. J Affect Disord 2021; 295:284-290. [PMID: 34482060 DOI: 10.1016/j.jad.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 07/25/2021] [Accepted: 08/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bipolar disorder (BD) has been associated with an increased prevalence of weight gain and abnormally elevated plasma homocysteine (Hcy) levels. However, the relationship between BMI and Hcy in BD patients has not been investigated. This study aimed to explore this relationship in Chinese patients with BD. METHODS Plasma Hcy levels, socio-demographic parameters, clinical and anthropometric data were collected from 195 BD inpatients and 84 healthy controls. The level of plasma Hcy was determined by high-performance liquid chromatography. Body mass index (BMI) was calculated by body weight divided by the square of the height. The participants were divided into a high BMI group and a low BMI group using 24 kg/m2 as a threshold. RESULTS The prevalence of high BMI was slightly elevated in BD patients in comparison to healthy controls. Patients with elevated BMI had significantly higher Hcy levels than patients with low BMI. Hcy level was an independent contributor of the occurrence of high BMI in BD patients. The level of Hcy was positively correlated with BMI in BD patients. In addition, depressive episodes of BD were positively correlated with the prevalence of high BMI and married BD patients were more likely to have high BMI levels. CONCLUSIONS There is a close relationship between BMI and plasma Hcy levels in patients with BD, suggesting that Hcy may be an important indicator for BD-induced weight gain. This finding provides a new avenue for weight management of BD patients and to help avoid the potential risk of cardiovascular diseases.
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Affiliation(s)
- Li Mu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China; Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Dalian, China
| | - Feng Yu
- Qingdao mental health center, Qingdao University, Qingdao, China
| | - Jiejing Xia
- Qingdao mental health center, Qingdao University, Qingdao, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Anam Haque
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China.
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14
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Cuellar-Barboza AB, Cabello-Arreola A, Winham SJ, Colby C, Romo-Nava F, Nunez NA, Morgan RJ, Gupta R, Bublitz JT, Prieto ML, De Filippis EA, Lopez-Jimenez F, McElroy SL, Biernacka JM, Frye MA, Veldic M. Body mass index and blood pressure in bipolar patients: Target cardiometabolic markers for clinical practice. J Affect Disord 2021; 282:637-643. [PMID: 33445086 DOI: 10.1016/j.jad.2020.12.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/07/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the association between cardiometabolic markers and bipolar disorder (BD), examining the impact of sex and cardiometabolic medication use, from a large case-control biorepository of more than 1300 participants. PATIENTS AND METHODS Recruited from July 2009 through September 2017, cardiometabolic markers were harvested from electronic health records (EHR) of participants (n=661) from the Mayo Clinic Individualized Medicine Biobank for Bipolar Disorder and Mayo Clinic Biobank age-sex-matched controls (n=706). Markers were compared between cases and controls using logistic regression, stratified by sex, adjusting for cardiometabolic medications and current smoking status. We studied the effect of psychotropics in case-only analyses. RESULTS The mean age of the sample was 52.5 ± 11.6 years and 55% were female. BD patients had higher rates of smoking, but lower utilization of lipid-lowering medication compared with controls. After adjustment, BD was associated with obesity [Odds ratio (CI) 1.62 (1.22-2.15)], elevated systolic blood pressure (SBP) [2.18 (1.55-3.06)] and elevated triglycerides [1.58 (1.13-2.2)]. When stratified by sex, obesity [1.8 (1.23-2.66)] and systolic blood pressure [2.32 (1.46-3.7)] were associated with BD females compared to female controls; however, only systolic blood pressure [2.04 (1.23-3.42)] was associated with male bipolars compared to male controls. Psychotropics were marginally associated with mean BMI, abnormal triglycerides, and HbA1c. LIMITATIONS EHR cross-sectional data CONCLUSION: To our knowledge, this is the largest case controlled study to date to explore the association between cardiometabolic markers and bipolar disorder adjusting for utilization of cardiometabolic medication. Identification of significant, non-laboratory based cardiometabolic markers that are associated with increased risk of major cardiovascular adverse events in patients with bipolar disorder, underscores, both the utility and importance of risk monitoring that can be easily done in community mental health centers.
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Affiliation(s)
- Alfredo B Cuellar-Barboza
- Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Stacey J Winham
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Colin Colby
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, Ohio; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Robert J Morgan
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Ruchi Gupta
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Joshua T Bublitz
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Miguel L Prieto
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota; Department of Psychiatry, Facultad de Medicina, Universidad de los Andes, Santiago, Chile; Mental Health Service, Clínica Universidad de los Andes, Santiago, Chile; Center for Biomedical Research and Innovation, Universidad de los Andes, Santiago, Chile
| | | | | | - Susan L McElroy
- Lindner Center of HOPE, Mason, Ohio; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joanna M Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota.
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15
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Barcella CA, Mohr G, Kragholm K, Christensen D, Gerds TA, Polcwiartek C, Wissenberg M, Bang C, Folke F, Torp-Pedersen C, Kessing LV, Gislason GH, Bach Søndergaard K. Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia. Heart 2021; 107:1544-1551. [PMID: 33452118 DOI: 10.1136/heartjnl-2020-318078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Patients with bipolar disorder and schizophrenia are at high cardiovascular risk; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared with the general population remains scarcely investigated. METHODS We conducted a nested case-control study using Cox regression to assess the association of bipolar disorder and schizophrenia with the HRs of OHCA of presumed cardiac cause (2001-2015). Reported are the HRs with 95% CIs overall and in subgroups defined by established cardiac disease, cardiovascular risk factors and psychotropic drugs. RESULTS We included 35 017 OHCA cases and 175 085 age-matched and sex-matched controls (median age 72 years and 66.9% male). Patients with bipolar disorder or schizophrenia had overall higher rates of OHCA compared with the general population: HR 2.74 (95% CI 2.41 to 3.13) and 4.49 (95% CI 4.00 to 5.10), respectively. The association persisted in patients with both cardiac disease and cardiovascular risk factors at baseline (bipolar disorder HR 2.14 (95% CI 1.72 to 2.66), schizophrenia 2.84 (95% CI 2.20 to 3.67)) and among patients without known risk factors (bipolar disorder HR 2.14 (95% CI 1.09 to 4.21), schizophrenia HR 5.16 (95% CI 3.17 to 8.39)). The results were confirmed in subanalyses only including OHCAs presenting with shockable rhythm or receiving an autopsy. Antipsychotics-but not antidepressants, lithium or antiepileptics (the last two only tested in bipolar disorder)-increased OHCA hazard compared with no use in both disorders. CONCLUSIONS Patients with bipolar disorder or schizophrenia have a higher rate of OHCA compared with the general population. Cardiac disease, cardiovascular risk factors and antipsychotics represent important underlying mechanisms.
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Affiliation(s)
- Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Grimur Mohr
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Daniel Christensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Thomas A Gerds
- The Danish Heart Foundation, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Casper Bang
- Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerod, Denmark.,Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerod, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
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16
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Regan AS, Valcourt SC. Metabolic Syndrome in Bipolar Disorder: Review and Management. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200713-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Goldstein BI, Baune BT, Bond DJ, Chen P, Eyler L, Fagiolini A, Gomes F, Hajek T, Hatch J, McElroy SL, McIntyre RS, Prieto M, Sylvia LG, Tsai S, Kcomt A, Fiedorowicz JG. Call to action regarding the vascular-bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders. Bipolar Disord 2020; 22:440-460. [PMID: 32356562 PMCID: PMC7522687 DOI: 10.1111/bdi.12921] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular-bipolar link remains underrecognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. METHODS An international group of experts completed a selective review of the literature, distilling core themes, identifying limitations and gaps in the literature, and highlighting future directions to bridge these gaps. RESULTS The association between bipolar disorder and vascular disease is large in magnitude, consistent across studies, and independent of confounding variables where assessed. The vascular-bipolar link is multifactorial and is difficult to study given the latency between the onset of bipolar disorder, often in adolescence or early adulthood, and subsequent vascular disease, which usually occurs decades later. As a result, studies have often focused on risk factors for vascular disease or intermediate phenotypes, such as structural and functional vascular imaging measures. There is interest in identifying the most relevant mediators of this relationship, including lifestyle (eg, smoking, diet, exercise), medications, and systemic biological mediators (eg, inflammation). Nonetheless, there is a paucity of treatment studies that deliberately engage these mediators, and thus far no treatment studies have focused on engaging vascular imaging targets. CONCLUSIONS Further research focused on the vascular-bipolar link holds promise for gleaning insights regarding the underlying causes of bipolar disorder, identifying novel treatment approaches, and mitigating disparities in cardiovascular outcomes for people with bipolar disorder.
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Affiliation(s)
- Benjamin I. Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Bernhard T. Baune
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany,Department of PsychiatryMelbourne Medical SchoolThe University of MelbourneMelbourneVICAustralia,The Florey Institute of Neuroscience and Mental HealthThe University of MelbourneParkvilleVICAustralia
| | - David J. Bond
- Department of Psychiatry and Behavioral ScienceUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Pao‐Huan Chen
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Lisa Eyler
- Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA
| | | | - Fabiano Gomes
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Jessica Hatch
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Susan L. McElroy
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA,Lindner Center of HOPEMasonOHUSA
| | - Roger S. McIntyre
- Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada,Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
| | - Miguel Prieto
- Department of PsychiatryFaculty of MedicineUniversidad de los AndesSantiagoChile,Mental Health ServiceClínica Universidad de los AndesSantiagoChile,Department of Psychiatry and PsychologyMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | - Louisa G. Sylvia
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA,Department of PsychiatryHarvard Medical SchoolCambridgeMAUSA
| | - Shang‐Ying Tsai
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Andrew Kcomt
- Hope+Me—Mood Disorders Association of OntarioTorontoONCanada
| | - Jess G. Fiedorowicz
- Departments of Psychiatry, Internal Medicine, & EpidemiologyCarver College of MedicineUniversity of IowaIowa CityIAUSA
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18
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Mu L, Lin Y, Huang X, Ning Y, Wu F, Zhang XY. Sex differences in the prevalence and clinical correlates of hyperhomocysteinemia in patients with bipolar disorder. Hum Psychopharmacol 2020; 35:e2724. [PMID: 32052509 DOI: 10.1002/hup.2724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sex differences in bipolar disorder are well recognized but little attention has been paid to sex differences in homocysteine or hyperhomocysteinemia in bipolar patients. This study compared gender differences in homocysteine levels and rates of hyperhomocysteinemia in Chinese inpatients with bipolar disorder. METHODS A total of 198 BD patients and 84 healthy controls were enrolled. The Young Mania Rating Scale, Hamilton Depression Rating Scale, and the Clinical Global Impressions-Severity scale were used to assess the affective symptomatology. Fasting plasma Hcy levels were measured by high-performance liquid chromatography. RESULTS Men had higher homocysteine levels than women and the prevalence of hyperhomocysteinemia in male patients was approximately twice that in female patients. Logistic regression analyses showed that HHcy was associated with less frequent use of valproate in males and being overweight in females. Further correlation analysis and multivariate regression analysis demonstrated that Hcy levels were inversely correlated with valproate treatment in men and positively associated with overweight in women. CONCLUSIONS In bipolar patients, there are significant differences between sexes in the levels of homocysteine and prevalence of hyperhomocysteinemia. This appears to be associated with lower prevalence of valproate prescribing in men and with being overweight in women.
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Affiliation(s)
- Li Mu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
| | - Yezhe Lin
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Xingbing Huang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China
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Gender-related patterns of psychiatric disorder clustering among bariatric surgery candidates: A latent class analysis. J Affect Disord 2018; 240:72-78. [PMID: 30056172 DOI: 10.1016/j.jad.2018.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/31/2018] [Accepted: 07/14/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.
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Gender Differences and Comorbidities in U.S. Adults with Bipolar Disorder. Brain Sci 2018; 8:brainsci8090168. [PMID: 30200460 PMCID: PMC6162692 DOI: 10.3390/brainsci8090168] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Past studies have evaluated the association of various comorbidities with bipolar disorder. This study analyzes differences in the prevalence and association of medical and psychiatric comorbidities in bipolar patients by gender. Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (2010–2014). Using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes, we narrowed the study population to comprise those with a primary diagnosis of bipolar disorder and then obtained information about comorbidities. The differences in comorbidities by gender were quantified using chi-square tests and the logistic regression model (odds ratio (OR)). Results: Hypertension (20.5%), asthma (12.5%) and hypothyroidism (8.1%) were the top medical comorbidities found in bipolar patients. Migraine and hypothyroidism were seen three times higher in females (OR = 3.074 and OR = 3.001; respectively). Females with bipolar disorder had higher odds of comorbid inflammatory disorders like asthma (OR = 1.755), Crohn’s disease (OR = 1.197) and multiple sclerosis (OR = 2.440) compared to males. Females had a two-fold higher likelihood of comorbid post-traumatic stress disorder (PTSD) (OR = 2.253) followed by personality disorders (OR = 1.692) and anxiety disorders (OR = 1.663) compared to males. Conclusion: Women with bipolar disorder have a much higher medical comorbidity burden than men and may highly benefit from an integrated team of physicians to manage their condition and improve their health-related quality of life.
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Petri E, Bacci O, Barbuti M, Pacchiarotti I, Azorin JM, Angst J, Bowden CL, Mosolov S, Vieta E, Young AH, Perugi G. Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE-II-Mix study. Bipolar Disord 2017; 19:458-464. [PMID: 28691250 DOI: 10.1111/bdi.12519] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/05/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-Mix study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions. The present post-hoc analysis evaluated the association between obesity and the presence of mixed features and bipolarity. METHODS A total of 2811 MDE subjects were enrolled in a multicenter cross-sectional study. In 2744 patients, the body mass index (BMI) was evaluated. Psychiatric symptoms, and sociodemographic and clinical variables were collected, comparing the characteristics of MDE patients with (MDE-OB) and without (MDE-NOB) obesity. RESULTS Obesity (BMI ≥30) was registered in 493 patients (18%). In the MDE-OB group, 90 patients (20%) fulfilled the DSM-IV-TR criteria for bipolar disease (BD), 225 patients (50%) fulfilled the bipolarity specifier criteria, 59 patients (13%) fulfilled DSM-5 criteria for MDEs with mixed features, and 226 patients (50%) fulfilled Research-Based Diagnostic Criteria for an MDE. Older age, history of (hypo)manic switches during antidepressant treatment, the occurrence of three or more MDEs, atypical depressive features, antipsychotic treatment, female gender, depressive mixed state according to DSM-5 criteria, comorbid eating disorders, and anxiety disorders were significantly associated with the MDE-OB group. Among (hypo)manic symptoms during the current MDE, psychomotor agitation, distractibility, increased energy, and risky behaviors were the variables most frequently associated with MDE-OB group. CONCLUSIONS In our sample, the presence of obesity in patients with an MDE seemed to be associated with higher rates of bipolar spectrum disorders. These findings suggest that obesity in patients with an MDE could be considered as a possible marker of bipolarity.
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Affiliation(s)
| | | | - Margherita Barbuti
- University of Pisa, Pisa, Italy.,Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Jules Angst
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | | | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Flores-Ramos M, Leff P, Fernández-Guasti A, Becerra Palars C. Is it important to consider the sex of the patient when using lithium or valproate to treat the bipolar disorder? Pharmacol Biochem Behav 2017; 152:105-111. [DOI: 10.1016/j.pbb.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/12/2023]
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Lackner N, Bengesser SA, Birner A, Painold A, Fellendorf FT, Platzer M, Reininghaus B, Weiss EM, Mangge H, McIntyre RS, Fuchs D, Kapfhammer HP, Wallner-Liebmann SJ, Reininghaus EZ. Abdominal obesity is associated with impaired cognitive function in euthymic bipolar individuals. World J Biol Psychiatry 2016; 17:535-46. [PMID: 26068130 DOI: 10.3109/15622975.2015.1046917] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Overweight/obesity has been implicated to play a role in cognitive deficits in bipolar disorder (BD). This study aims to identify the relationship between body fat distribution and different domains of cognition in BD during euthymia. METHODS A sample of 100 euthymic individuals with BD was measured with a cognitive test battery (i.e., Trail Making Test-A-B/TM-A/B, d2 Test of Attention, Stroop test, California Verbal Learning Test/CVLT) and an anthropometric measures set (body mass index, waist circumference, hip circumference, waist-to-hip-ratio, waist-to-height-ratio, and lipometry). Patient data were compared with a healthy control group (n = 64). RESULTS Results show that overweight patients with BD exhibit lower performance in the TMT-A/B as well as in the free recall performance of the CVLT compared to normal-weight patients with BD and controls. In bipolar individuals, (abdominal) obesity was significantly associated with a poor cognitive performance. In bipolar females, associations with measures of verbal learning and memory were found; in bipolar males, associations with poor performance in the TMT-A/B and in the Stroop interference task were demonstrated. In controls, no associations were found. CONCLUSIONS There are several possible pathways moderating the association between obesity and cognition in BD. Anthropometric and lipometry data underline the substantial mediating impact of body fat distribution on cognition in BD.
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Affiliation(s)
- N Lackner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S A Bengesser
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Birner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Painold
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - F T Fellendorf
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - M Platzer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - B Reininghaus
- b Therapiezentrum Justuspark, Versicherungsanstalt öffentlich Bediensteter , Austria
| | - E M Weiss
- c Department of Biological Psychology , Karl-Franzens University Graz , Graz , Austria
| | - H Mangge
- d Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria.,e BioTechMed-Graz , Graz , Austria
| | - R S McIntyre
- f Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , Canada
| | - D Fuchs
- g Division of Biological Chemistry, Medical University of Innsbruck , Innsbruck , Austria
| | - H P Kapfhammer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S J Wallner-Liebmann
- h Department of Pathophysiology and Immunology , Medical University Graz , Graz , Austria
| | - E Z Reininghaus
- a Department of Psychiatry , Medical University Graz , Graz , Austria
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Hartwig FP, Bowden J, Loret de Mola C, Tovo-Rodrigues L, Davey Smith G, Horta BL. Body mass index and psychiatric disorders: a Mendelian randomization study. Sci Rep 2016; 6:32730. [PMID: 27601421 PMCID: PMC5013405 DOI: 10.1038/srep32730] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/08/2016] [Indexed: 12/14/2022] Open
Abstract
Obesity is a highly prevalent risk factor for cardiometabolic diseases. Observational studies suggest that obesity is associated with psychiatric traits, but causal inference from such studies has several limitations. We used two-sample Mendelian randomization methods (inverse variance weighting, weighted median and MR-Egger regression) to evaluate the association of body mass index (BMI) with three psychiatric traits using data from the Genetic Investigation of Anthropometric Traits and Psychiatric Genomics consortia. Causal odds ratio estimates per 1-standard deviation increment in BMI ranged from 0.88 (95% CI: 0.62; 1.25) to 1.23 (95% CI: 0.65; 2.31) for bipolar disorder; 0.93 (0.78; 1.11) to 1.41 (0.87; 2.27) for schizophrenia; and 1.15 (95% CI: 0.92; 1.44) to 1.40 (95% CI: 1.03; 1.90) for major depressive disorder. Analyses removing potentially influential SNPs suggested that the effect estimates for depression might be underestimated. Our findings do not support the notion that higher BMI increases risk of bipolar disorder and schizophrenia. Although the point estimates for depression were consistent in all sensitivity analyses, the overall statistical evidence was weak. However, the fact that SNP-depression associations were estimated in relatively small samples reduced power to detect causal effects. This should be re-addressed when SNP-depression associations from larger studies become available.
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Affiliation(s)
| | - Jack Bowden
- MRC Integrative Epidemiology Unit, University of Bristol,
Bristol, UK
- MRC Biostatistics Unit, University of Cambridge,
Cambridge, UK
| | | | | | | | - Bernardo Lessa Horta
- Postgraduate Program in Epidemiology, Federal University of
Pelotas, Pelotas, Brazil
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Kim EY, Kim SH, Lee HJ, Kim B, Kim YS, Ahn YM. Sex-specific association between the albumin D-element binding protein gene and metabolic syndrome in patients with bipolar disorder and schizophrenia. Psychiatry Res 2016; 240:47-52. [PMID: 27084990 DOI: 10.1016/j.psychres.2016.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 02/22/2016] [Accepted: 03/25/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Eun Young Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry, Dongguk University Medical School, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Hyun Jeong Lee
- Mental Health Clinic, National Cancer Center, Goyang, Republic of Korea
| | - Bora Kim
- Department of Psychiatry, University of California, San Francisco, USA
| | - Yong Sik Kim
- Department of Neuropsychiatry, Dongguk University Medical School, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Goodrich DE, Klingaman EA, Verchinina L, Goldberg RW, Littman AJ, Janney CA, Kim HM, Maguen S, Hoerster KD, Owen RR, Holleman RG, Roman P, Lai Z, Bowersox NW. Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program. Womens Health Issues 2016; 26:410-9. [PMID: 27365284 DOI: 10.1016/j.whi.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program. PROCEDURES Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment. The cohort included those with International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnoses for SMI, age less than 70 years, and weight data at baseline and one or more follow-up timepoints within approximately 1 year of enrollment (n = 8,943 men; n = 2,245 women). Linear mixed models assessed associations of sex with 6- and 12-month weight change from baseline, adjusting for demographic- and site-level variables. FINDINGS Both sexes averaged 6.4 (standard deviation, 4.6) sessions within 12 months; however, women with and without SMI participated at rates double their respective proportion rates among all VHA users. Participants averaged statistically significant weight loss at 6 months (men, -2.5 lb [95% CI, -2.8 to -2.1]; women, -2.4 lb [95% CI, -3.1 to -1.7]) and 12 months (men, -2.5 lb [95% CI, -2.8 to -2.2]; women, -2.9 lb [95% CI, -3.6 to -2.2]), but no sex-based difference in absolute weight loss at either timepoint. Slightly more women achieved 5% or greater (clinically significant) weight loss at the 12-month follow-up than did men (25.7% vs. 23.0%; p < .05). CONCLUSIONS Women with SMI participated in MOVE! at rates equivalent to or greater than men with SMI, with comparable weight loss. More women were Black, single, had bipolar and posttraumatic stress disorder, and higher service-connected disability, suggesting areas for program customization.
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Affiliation(s)
- David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Elizabeth A Klingaman
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland.
| | - Lilia Verchinina
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Richard W Goldberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland
| | - Alyson J Littman
- Epidemiologic Research and Information Center, VA Puget Sound Medical Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, Michigan
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
| | - Katherine D Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle, Washington; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Richard R Owen
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Pia Roman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Zongshan Lai
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Nicholas W Bowersox
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
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Charlotte M, Schwartz E, Slade E, Medoff D, Li L, Dixon L, Kilbourne AM, Kreyenbuhl J. Gender differences in mood stabilizer medications prescribed to Veterans with serious mental illness. J Affect Disord 2015; 188:112-7. [PMID: 26361066 PMCID: PMC5909958 DOI: 10.1016/j.jad.2015.08.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/13/2015] [Accepted: 08/28/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mood stabilizer medications (MSMs) can induce significant weight gain and other metabolic side effects. Research suggests that women are more susceptible to psychotropic medication-induced metabolic side effects than men. We examined gender differences in the likelihood of receiving an MSM with a lower liability for weight gain using data from the U.S. Department of Veterans Affairs (VA) healthcare system. METHODS We identified 3823 VA patients with a schizophrenia or bipolar disorder diagnosis who initiated treatment with a MSM between 10/2006 and 9/2011. We used multivariable logistic regression analysis to examine gender differences in the likelihood of incident prescription of MSMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and demographic, mental health, and physical health characteristics. RESULTS Overall, 47% of women were prescribed a low metabolic risk MSM compared to 26% of men (p<0.0001). In multivariable analysis, women were 2.19 times as likely as men to be prescribed a low metabolic risk MSM (95% CI: 1.84-2.60, p<0.0001). Several demographic and clinical covariates were also independently related to prescribing of MSMs by level of metabolic risk. LIMITATIONS This study used retrospective administrative data collected from a VA healthcare system database, which does not allow us to understand the context in which MSM treatment decisions were made. CONCLUSIONS Prescribing choices for MSMs by VA mental health prescribers and female Veterans may reflect a growing awareness of the potential adverse health consequences of these treatments in women.
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Affiliation(s)
- Melanie Charlotte
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore, MD, United States.
| | - Elana Schwartz
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD
| | - Eric Slade
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD and University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD
| | - Deborah Medoff
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD and University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD
| | - Lisa Dixon
- Center for Practice Innovations, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY
| | - Amy M. Kilbourne
- Quality Enhancement Research Initiative, VA Health Services Research and Development (HSR&D Program), Washington DC and Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD and University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD
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Baptista T, Sandia I, Fernandez E, Balzán L, Connell L, Uzcátegui E, Serrano A, Pabón A, Angeles F, Araque Y, Delgado H, González A, Alviarez Y, Piãero J, Baptista EAD. Metabolic syndrome and related variables, insulin resistance, leptin levels, and PPAR-γ2 and leptin gene polymorphisms in a pedigree of subjects with bipolar disorder. REVISTA BRASILEIRA DE PSIQUIATRIA 2015. [DOI: 10.1590/1516-4446-2014-1425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | | | | | | | | | | | - Ana Serrano
- Los Andes University Medical School, Venezuela
| | - Albis Pabón
- Los Andes University Medical School, Venezuela
| | | | | | | | | | | | - Jose Piãero
- Los Andes University Medical School, Venezuela
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Mansur RB, Brietzke E, McIntyre RS. Is there a "metabolic-mood syndrome"? A review of the relationship between obesity and mood disorders. Neurosci Biobehav Rev 2015; 52:89-104. [PMID: 25579847 DOI: 10.1016/j.neubiorev.2014.12.017] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 12/19/2014] [Accepted: 12/31/2014] [Indexed: 12/12/2022]
Abstract
Obesity and mood disorders are highly prevalent and co-morbid. Epidemiological studies have highlighted the public health relevance of this association, insofar as both conditions and its co-occurrence are associated with a staggering illness-associated burden. Accumulating evidence indicates that obesity and mood disorders are intrinsically linked and share a series of clinical, neurobiological, genetic and environmental factors. The relationship of these conditions has been described as convergent and bidirectional; and some authors have attempted to describe a specific subtype of mood disorders characterized by a higher incidence of obesity and metabolic problems. However, the nature of this association remains poorly understood. There are significant inconsistencies in the studies evaluating metabolic and mood disorders; and, as a result, several questions persist about the validity and the generalizability of the findings. An important limitation in this area of research is the noteworthy phenotypic and pathophysiological heterogeneity of metabolic and mood disorders. Although clinically useful, categorical classifications in both conditions have limited heuristic value and its use hinders a more comprehensive understanding of the association between metabolic and mood disorders. A recent trend in psychiatry is to move toward a domain specific approach, wherein psychopathology constructs are agnostic to DSM-defined diagnostic categories and, instead, there is an effort to categorize domains based on pathogenic substrates, as proposed by the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC). Moreover, the substrates subserving psychopathology seems to be unspecific and extend into other medical illnesses that share in common brain consequences, which includes metabolic disorders. Overall, accumulating evidence indicates that there is a consistent association of multiple abnormalities in neuropsychological constructs, as well as correspondent brain abnormalities, with broad-based metabolic dysfunction, suggesting, therefore, that the existence of a "metabolic-mood syndrome" is possible. Nonetheless, empirical evidence is necessary to support and develop this concept. Future research should focus on dimensional constructs and employ integrative, multidisciplinary and multimodal approaches.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
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Schwartz E, Charlotte M, Slade E, Medoff D, Li L, Dixon L, Kilbourne A, Kreyenbuhl J. Gender differences in antipsychotics prescribed to veterans with serious mental illness. Gen Hosp Psychiatry 2015; 37:347-51. [PMID: 25936673 PMCID: PMC5909972 DOI: 10.1016/j.genhosppsych.2015.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine gender differences in prescribing of antipsychotic medications (APMs) according to their liability for weight gain and other metabolic side effects. METHOD We identified 4510 patients with schizophrenia or bipolar disorders receiving usual care in a Veterans Affairs (VA) health care network in the U.S. mid-Atlantic region who initiated treatment with an APM between October 2006 and September 2011. We used multivariable logistic regression to examine gender differences in the likelihood of incident prescription of APMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and selected Veteran demographic, mental health and physical health characteristics. RESULTS Overall, 58% of women were prescribed an APM with a low risk of metabolic side effects compared to 45% of men (P<.001). In multivariable analysis, women Veterans were 1.47 times as likely as men to be prescribed a low-metabolic-risk APM (95% confidence interval: 1.26-1.73, P<.001). Several demographic and clinical covariates were also independently related to prescribing of APMs by level of metabolic risk. CONCLUSIONS The results may suggest that prescribing choices for APMs by VA mental health prescribers and female Veterans reflect a growing awareness of the potential adverse health consequences of these treatments in women.
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Affiliation(s)
- Elana Schwartz
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA
| | - Melanie Charlotte
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Eric Slade
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Deborah Medoff
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Lisa Dixon
- Center for Practice Innovations, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - Amy Kilbourne
- Quality Enhancement Research Initiative, VA Health Services Research and Development (HSR&D) Program and Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
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Özerdem A, Rasgon N. Women with bipolar disorder: a lifetime challenge from diagnosis to treatment. Bipolar Disord 2014; 16:1-4. [PMID: 24467468 DOI: 10.1111/bdi.12161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ayşegül Özerdem
- Department of Psychiatry, Dokuz Eylul University, Izmir, Turkey
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