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Chumakov E, Ashenbrenner Y, Gvozdetskii A, Limankin O, Petrova N. Individual Burden of Illness Index in Bipolar Disorder Remission: A Cross-Sectional Study. CONSORTIUM PSYCHIATRICUM 2024; 5:17-30. [PMID: 39072003 PMCID: PMC11272304 DOI: 10.17816/cp15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/31/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND A population-based method for estimating disease burden is commonly used. Nevertheless, these measurements do not entirely capture the comprehensive burden of illness on an individual patient. To address the problem, the Individual Burden of Illness Index (IBI index) Index was created and validated, specifically for major depressive disorder. The IBI represents the overall influence of the condition, encompassing distress from symptom intensity, functional impairment, and the patient's quality of life. AIM The aim of the study was to approve and validate the IBI index for the integral assessment of disease burden in patients with bipolar disorder (BD) in remission. METHODS The cross-sectional study was conducted in the outpatient psychiatric services in Saint Petersburg, Russia, from April through October 2020. Eighty-five patients aged 18 to 45 (mean age 36.6±5.7 years) with BD (type I - 75%, n=64; type II - 25%, n=21) in remission were examined. The study procedure included a structured clinical interview and the use of clinical scales: the World Health Organization's Quality of Life Questionnaire, Hamilton Rating Scale for Depression (HDRS), Young Mania Rating Scale (YMRS), and Personal and the Social Performance Scale. RESULTS The principal component analysis in accordance with the adjusted one showed that the burden of illness in patients with BD in remission is directly related to the severity of residual depressive symptoms, reflected in the HDRS score: as the HDRS score increases (0.27, p <0.001), residual mania (-0.14, p <0.001), social functioning (-0.06, p <0.001), and quality of life (-0.04, p <0.001) decrease. In contrast, when there are remaining residual mania symptoms, as indicated by the YMRS score, the result tends to be a lower burden, better social functioning, and enhanced quality of life. CONCLUSION The study has demonstrated through statistical means a successful adaptation and validation of the previously calculated IBI index for patients with BD in remission. Residual affective symptoms were shown to have different impacts on the social functioning of patients with BD in remission, indicating the need for a timely assessment and targeted therapy of these symptoms in such patients.
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Fortea L, Ysbaek-Nielsen AT, Macoveanu J, Petersen JZ, Fisher PM, Kessing LV, Knudsen GM, Radua J, Vieta E, Miskowiak KW. Aberrant resting-state functional connectivity underlies cognitive and functional impairments in remitted patients with bipolar disorder. Acta Psychiatr Scand 2023; 148:570-582. [PMID: 37688285 DOI: 10.1111/acps.13615] [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] [Received: 02/07/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is commonly associated with cognitive impairments, that directly contribute to patients' functional disability. However, there is no effective treatment targeting cognition in BD. A key reason for the lack of pro-cognitive interventions is the limited insight into the brain correlates of cognitive impairments in these patients. This is the first study investigating the resting-state neural underpinnings of cognitive impairments in different neurocognitive subgroups of patients with BD. METHOD Patients with BD in full or partial remission and healthy controls (final sample of n = 144 and n = 50, respectively) underwent neuropsychological assessment and resting-state functional magnetic resonance imaging. We classified the patients into cognitively impaired (n = 83) and cognitively normal (n = 61) subgroups using hierarchical cluster analysis of the four cognitive domains. We used independent component analysis (ICA) to investigate the differences between the neurocognitive subgroups and healthy controls in resting-state functional connectivity (rsFC) in the default mode network (DMN), executive central network (ECN), and frontoparietal network (FPN). RESULTS Cognitively impaired patients displayed greater positive rsFC within the DMN and less negative rsFC within the ECN than healthy controls. Across cognitively impaired patients, lower positive connectivity within DMN and lower negative rsFC within ECN correlated with worse global cognitive performance. CONCLUSION Cognitive impairments in BD seem to be associated with a hyper-connectivity within the DMN, which may explain the failure to suppress task-irrelevant DMN activity during the cognitive performance, and blunted anticorrelation in the ECN. Thus, aberrant connectivity within the DMN and ECN may serve as brain targets for pro-cognitive interventions.
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Affiliation(s)
- Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica (FCRB), Barcelona, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Alexander T Ysbaek-Nielsen
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Neurocognition and Emotion in Affective Disorders Centre (NEAD), Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeff Zarp Petersen
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Neurocognition and Emotion in Affective Disorders Centre (NEAD), Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica (FCRB), Barcelona, Spain
- Centro de Investigacisón Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica (FCRB), Barcelona, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
- Centro de Investigacisón Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Barcelona, Spain
| | - Kamilla W Miskowiak
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Neurocognition and Emotion in Affective Disorders Centre (NEAD), Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Hamada F, Hori H, Iida H, Yokoyama H, Sugawara H, Hatanaka A, Gotoh L, Ogata M, Kumagai H, Yano R, Tomiyama Y, Yoshida T, Yamaguchi Y, Asada R, Masuda M, Okamoto Y, Kawasaki H. Effects of Exercise on Functional Recovery in Patients with Bipolar Depression: A Study Protocol for a Randomized Controlled Trial. Metabolites 2023; 13:981. [PMID: 37755261 PMCID: PMC10536584 DOI: 10.3390/metabo13090981] [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: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Treatment of bipolar disorder is prone to prolongation despite various treatments, including medication. The efficacy of exercise treatment (i.e., interventions involving physical exercise and sports intervention) for major depressive disorders has been reported for depressive symptoms, cognitive function, and sleep disturbances. However, its efficacy for bipolar disorder has yet to be established. We designed a randomized, controlled, double-blind clinical trial that includes 100 patients with bipolar disorder aged 20-65 years. This will be a cluster-randomized, two-group trial that will be conducted in ten psychiatric hospitals. The hospitals will be randomly assigned to an exercise intervention + treatment as usual (exercise) group or a placebo exercise intervention (stretching) + treatment as usual (control) group. Patients will be assessed using an extensive battery of clinical tests, physical parameters, sleep status, biological parameters (cytokines, neurotrophic factors), and genetic parameters (DNA and RNA) at baseline after a 6-week intervention period, at 10-week follow-up, and at 6-month follow-up. This innovative study may provide important evidence for the effectiveness of exercise in the treatment of bipolar depression based on clinical, biological, genetic, and physiological markers.
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Affiliation(s)
- Fumito Hamada
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroyuki Yokoyama
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroko Sugawara
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Akito Hatanaka
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Leo Gotoh
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
- Laboratory of Neuroscience, Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan
| | - Muneaki Ogata
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroki Kumagai
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Rika Yano
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Yuko Tomiyama
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Tetsuya Yoshida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Yoshimi Yamaguchi
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Ryo Asada
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Masato Masuda
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Yuta Okamoto
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroaki Kawasaki
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
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Zarp Petersen J, Varo C, Skovsen CF, Ott CV, Kjaerstad HL, Vieta E, Harmer CJ, Knudsen GM, Kessing LV, Macoveanu J, Miskowiak KW. Neuronal underpinnings of cognitive impairment in bipolar disorder: A large data-driven functional magnetic resonance imaging study. Bipolar Disord 2022; 24:69-81. [PMID: 33955648 DOI: 10.1111/bdi.13100] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/22/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cognitive impairment occurs in approximately 50% of remitted patients with bipolar disorder (BD). However, there exists no treatment with replicated and robust efficacy on cognition in BD. This is partially due to limited insight into the neuronal underpinnings of cognitive impairment in these patients. This is the first study to investigate neuronal underpinnings of cognitive impairment in a large functional magnetic resonance imaging (fMRI) dataset comparing neural activity patterns between distinct neurocognitive subgroups of partially or fully remitted patients with BD. METHODS Patients (n = 153) and healthy controls (HC) (n = 52) underwent neuropsychological assessment and fMRI, during which they performed a verbal N-back working memory (WM) task. Based on hierarchical cluster analysis of neuropsychological test performance, patients were grouped into one of two neurocognitive subgroups (cognitively impaired, n = 91; cognitively normal compared to HC, n = 62) that were compared on WM-related neural activity. RESULTS Cognitively impaired patients displayed WM-related hypo-activity in left dorsolateral prefrontal cortex and frontal and parietal regions within a cognitive control network (CCN) as well as hyper-activity in the default mode network (DMN) compared to cognitively normal patients. In contrast, cognitively normal patients only exhibited hypo-activity within a small cluster in the superior frontal gyrus relative to HC. CONCLUSIONS Cognitive impairment in BD seems to originate from a failure to recruit key regions in the CCN and to suppress task-irrelevant DMN activity during cognitive performance. These results highlight modulation of aberrant dorsal prefrontal and DMN activity as a putative target for pro-cognitive treatment in BD.
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Affiliation(s)
- Jeff Zarp Petersen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cecilie F Skovsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Caroline V Ott
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne L Kjaerstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Gitte M Knudsen
- Neurobiology Research Unit and The Center for Experimental Medicine Neuropharmacology, Neurobiology Research Unit and Center for Integrated Molecular Imaging, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Valls È, Bonnín CM, Torres I, Brat M, Prime-Tous M, Morilla I, Segú X, Solé B, Torrent C, Vieta E, Martínez-Arán A, Reinares M, Sánchez-Moreno J. Efficacy of an integrative approach for bipolar disorder: preliminary results from a randomized controlled trial. Psychol Med 2021; 52:1-12. [PMID: 33858527 PMCID: PMC9811269 DOI: 10.1017/s0033291721001057] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bipolar disorder (BD) represents one of the most therapeutically complex psychiatric disorders. The development of a feasible comprehensive psychological approach to complement pharmacotherapy to improve its clinical management is required. The main objective of the present randomized controlled trial (RCT) was to test the efficacy of a novel adjunctive treatment entitled integrative approach in patients with BD, including: psychoeducation, mindfulness training, and functional remediation. METHODS This is a parallel two-armed, rater-blind RCT of an integrative approach plus treatment as usual (TAU), v. TAU alone. Participants were recruited at the Hospital Clinic of Barcelona and randomized to one of the two conditions. They were assessed at baseline and after finishing the intervention. The main outcome variable included changes in psychosocial functioning assessed through the Functioning Assessment Short Test (FAST). RESULTS After finishing the treatment, the repeated-measures analyses revealed a significant group × time interaction in favor of the patients who received the integrative approach (n = 28) compared to the TAU group (n = 37) (Pillai's trace = 0.10; F(1,57) = 6.9; p = 0.01), improving the functional outcome. Significant effects were also found in two out of the six domains of the FAST, including the cognitive domain (Pillai's trace = 0.25; F(1,57) = 19.1; p < 0.001) and leisure time (Pillai's trace = 0.11; F(1,57) = 7.15; p = 0.01). Regarding the secondary outcomes, a significant group × time interaction in Hamilton Depression Rating Scale changes was detected (Pillai's trace = 0.08; F(1,62) = 5.6; p = 0.02). CONCLUSION This preliminary study suggests that the integrative approach represents a promising cost-effective therapy to improve psychosocial functioning and residual depressive symptoms in patients suffering from BD.
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Affiliation(s)
- Èlia Valls
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - C. Mar Bonnín
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Imma Torres
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Mercè Brat
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Mireia Prime-Tous
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Ivette Morilla
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Xavier Segú
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Brisa Solé
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Carla Torrent
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - María Reinares
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - José Sánchez-Moreno
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
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