1
|
van der Markt A, Klumpers U, Dols A, Korten N, Boks MP, Ophoff RA, Beekman A, Kupka R, van Haren NEM, Schnack H. Accelerated brain aging as a biomarker for staging in bipolar disorder: an exploratory study. Psychol Med 2024; 54:1016-1025. [PMID: 37749940 DOI: 10.1017/s0033291723002829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Two established staging models outline the longitudinal progression in bipolar disorder (BD) based on episode recurrence or inter-episodic functioning. However, underlying neurobiological mechanisms and corresponding biomarkers remain unexplored. This study aimed to investigate if global and (sub)cortical brain structures, along with brain-predicted age difference (brain-PAD) reflect illness progression as conceptualized in these staging models, potentially identifying brain-PAD as a biomarker for BD staging. METHODS In total, 199 subjects with bipolar-I-disorder and 226 control subjects from the Dutch Bipolar Cohort with a high-quality T1-weighted magnetic resonance imaging scan were analyzed. Global and (sub)cortical brain measures and brain-PAD (the difference between biological and chronological age) were estimated. Associations between individual brain measures and the stages of both staging models were explored. RESULTS A higher brain-PAD (higher biological age than chronological age) correlated with an increased likelihood of being in a higher stage of the inter-episodic functioning model, but not in the model based on number of mood episodes. However, after correcting for the confounding factors lithium-use and comorbid anxiety, the association lost significance. Global and (sub)cortical brain measures showed no significant association with the stages. CONCLUSIONS These results suggest that brain-PAD may be associated with illness progression as defined by impaired inter-episodic functioning. Nevertheless, the significance of this association changed after considering lithium-use and comorbid anxiety disorders. Further research is required to disentangle the intricate relationship between brain-PAD, illness stages, and lithium intake or anxiety disorders. This study provides a foundation for potentially using brain-PAD as a biomarker for illness progression.
Collapse
Affiliation(s)
- Afra van der Markt
- Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ursula Klumpers
- Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress, Amsterdam, The Netherlands
| | - Annemiek Dols
- Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands
| | - Nicole Korten
- Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Marco P Boks
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands
| | - Roel A Ophoff
- Department of Psychiatry and Biobehavioral Science, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aartjan Beekman
- Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ralph Kupka
- Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Neeltje E M van Haren
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- Erasmus Medical Center - Sophia, Child and Adolescent Psychiatry and Psychology, Rotterdam, The Netherlands
| | - Hugo Schnack
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands
- Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
2
|
Loo LWJ, Chew QH, Lin SK, Yang SY, Ouyang WC, Chen CK, Park SC, Jang OJ, Park JH, Chee KY, Ding KS, Chong J, Zhang L, Li K, Zhu X, Jatchavala C, Pariwatcharakul P, Kallivayalil RA, Grover S, Avasthi A, Ansari M, Maramis MM, Aung PP, Sartorius N, Xiang YT, Tan CH, Chong MY, Park YC, Kato TA, Shinfuku N, Baldessarini RJ, Sim K. Clozapine Use for Bipolar Disorder: An Asian Psychotropic Prescription Patterns Consortium Study. J Clin Psychopharmacol 2023; 43:278-282. [PMID: 37068038 DOI: 10.1097/jcp.0000000000001693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Pharmacoepidemiological studies of clozapine use to treat bipolar disorder (BD), especially in Asia, are rare, although they can provide insights into associated clinical characteristics and support international comparisons of indications and drug dosing. METHODS We examined the prevalence and clinical correlates of clozapine treatment for BD in 13 Asian countries and regions (China, Hong Kong SAR, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, and Thailand) within an Asian Prescription Patterns Research Consortium. We compared BD patients treated with clozapine or not in initial bivariate comparisons followed by multivariable logistic regression modeling. RESULTS Clozapine was given to 2.13% of BD patients overall, at a mean daily dose of 275 (confidence interval, 267-282) chlorpromazine-equivalent mg/day. Patients receiving clozapine were older, more likely males, hospitalized, currently manic, and given greater numbers of mood-stabilizing and antipsychotic drugs in addition to clozapine. Logistic regression revealed that older age, male sex, current mania, and greater number of other antipsychotics remained significantly associated with clozapine treatment. Clozapine use was not associated with depressed mood, remission of illness, suicidal risk, or electroconvulsive treatment within the previous 12 months. CONCLUSIONS The identified associations of clozapine use with particular clinical features call for vigilance in personalized clinical monitoring so as to optimize clinical outcomes of BD patients and to limit risks of adverse effects of polytherapy.
Collapse
Affiliation(s)
- Lek Wei Javier Loo
- From theLee Kong Chian School of Medicine, Nanyang Technological University
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | | | - Su-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei
| | | | - Chih-Ken Chen
- Chang Gung Memorial Hospital, Keelung Branch, Keelung
| | | | - Ok-Jin Jang
- Department of Psychiatry, Inje University School of Medicine, Haeundae Paik Hospital, Pusan
| | - Jun Hyuk Park
- Jeju National University Hospital, Jeju University School of Medicine, Jeju, South Korea
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur
| | - Kwong Sen Ding
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan
| | - Jamaline Chong
- Hospital Permai Johor Bahru, Ministry of Health, Johor Bahru, Malaysia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing
| | - Keqing Li
- Hebei Provincial Mental Health Center, Baoding, Hebei
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Margarita M Maramis
- Department of Psychiatry, Dr. Soetomo Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Paing Phyo Aung
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | | | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Mian-Yoon Chong
- Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | | | - Kang Sim
- West Region, Institute of Mental Health, Singapore
| |
Collapse
|
3
|
Lee Y, Lee D, Jung H, Cho Y, Baek JH, Hong KS. Heterogeneous early illness courses of Korean patients with bipolar disorders: replication of the staging model. BMC Psychiatry 2022; 22:684. [PMID: 36333702 PMCID: PMC9636704 DOI: 10.1186/s12888-022-04318-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Clinical staging of bipolar disorder (BD) requires application of real-world data, as the next step in hypothesis. This study used the staging model to analyze the long-term course of BD in Korean patients based on clinical features and treatment responses to map the progression of bipolar illness from its early phase after the onset of illness. METHODS A total of 136 patients diagnosed with BD-I (n = 62) or BD-II (n = 74) were recruited. Their progressive stages were retrospectively evaluated. A multi-state model was used to calculate the probability of progression to each stage. Hazard ratios of covariates expected to influence different courses of BD were calculated. Using the Alda score, long-term responses to mood stabilizers depending on the current stage were compared. RESULTS Several sub-populations showed varied courses during the first five years after the onset of illness, with 41.5% remaining in stage 2 and 53% progressing to higher stages with shortened time for transition. Profiles of patients with BD-I and BD-II were different, suggesting biologically distinct groups. Comorbid psychiatric disorders, such as obsessive-compulsive disorder (OCD) and bulimia nervosa (BN) were associated with a recurrent course (stage 3a or 3b) or a malignant course (stage 3c or 4). Early age of onset, shorter duration of illness, older age at the start of medication, and poor response to lithium affected the illness progression. CONCLUSION We were able to apply the stage model based on episode recurrence patterns in early illness courses of Korean patients with BD. The stage progression pattern differed from the early phase in BD-I and BD-II patients. Psychotic comorbidity, age at onset, age at starting psychiatric treatment showed associations with the illness progression.
Collapse
Affiliation(s)
- Yejin Lee
- grid.414964.a0000 0001 0640 5613Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Korea
| | - Dongbin Lee
- grid.414964.a0000 0001 0640 5613Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Korea ,grid.264381.a0000 0001 2181 989XDepartment of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea
| | - Hyewon Jung
- grid.414964.a0000 0001 0640 5613Samsung Biomedical Research Institute, Seoul, Korea
| | - Yunji Cho
- grid.414964.a0000 0001 0640 5613Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351, Seoul, Korea.
| | - Kyung Sue Hong
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia and Lions Gate Hospital, Vancouver, BC, Canada
| |
Collapse
|