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Wang L, Hu Y, Jiang N, Yetisen AK. Biosensors for psychiatric biomarkers in mental health monitoring. Biosens Bioelectron 2024; 256:116242. [PMID: 38631133 DOI: 10.1016/j.bios.2024.116242] [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: 09/15/2023] [Revised: 01/10/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
Psychiatric disorders are associated with serve disturbances in cognition, emotional control, and/or behavior regulation, yet few routine clinical tools are available for the real-time evaluation and early-stage diagnosis of mental health. Abnormal levels of relevant biomarkers may imply biological, neurological, and developmental dysfunctions of psychiatric patients. Exploring biosensors that can provide rapid, in-situ, and real-time monitoring of psychiatric biomarkers is therefore vital for prevention, diagnosis, treatment, and prognosis of mental disorders. Recently, psychiatric biosensors with high sensitivity, selectivity, and reproducibility have been widely developed, which are mainly based on electrochemical and optical sensing technologies. This review presented psychiatric disorders with high morbidity, disability, and mortality, followed by describing pathophysiology in a biomarker-implying manner. The latest biosensors developed for the detection of representative psychiatric biomarkers (e.g., cortisol, dopamine, and serotonin) were comprehensively summarized and compared in their sensitivities, sensing technologies, applicable biological platforms, and integrative readouts. These well-developed biosensors are promising for facilitating the clinical utility and commercialization of point-of-care diagnostics. It is anticipated that mental healthcare could be gradually improved in multiple perspectives, ranging from innovations in psychiatric biosensors in terms of biometric elements, transducing principles, and flexible readouts, to the construction of 'Big-Data' networks utilized for sharing intractable psychiatric indicators and cases.
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Affiliation(s)
- Lin Wang
- Department of Chemical Engineering, Imperial College London, South Kensington, London, SW7 2BU, UK
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, South Kensington, London, SW7 2BU, UK.
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China; Jinfeng Laboratory, Chongqing, 401329, China.
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, South Kensington, London, SW7 2BU, UK.
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Dell'Osso B, Cremaschi L, Macellaro M, Cafaro R, Girone N. Bipolar disorder staging and the impact it has on its management: an update. Expert Rev Neurother 2024; 24:565-574. [PMID: 38753491 DOI: 10.1080/14737175.2024.2355264] [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: 03/11/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The longitudinal course of bipolar disorder (BD) is associated with an active process of neuroprogression, characterized by structural brain alterations and progressive functional impairment. In the last decades, a growing need of a standardized staging model for BD arose, with the aim of a more appropriate definition of stage-specific clinical manifestations and the identification of more customized therapeutic tools. AREAS COVERED The authors review the literature on clinical aspects, neurobiological correlates and treatment issues related to BD progression. Thereafter, they address the definition, constructs, and evolution of the staging concept, focusing on the clinical applications of BD staging models available in literature. EXPERT OPINION Although several staging models for BD have been proposed to date, their application in clinical practice is still relatively scant. This may have a detrimental impact on the clinical and therapeutic management of BD, in terms of early and proper diagnosis as well as tailored treatment interventions according to the different stages of illness. Future research efforts should tend to the integration of recent insights on neuroimaging and epigenetic markers, toward a standardized and multidimensional staging model.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Laura Cremaschi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Nicolaja Girone
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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Hernandorena CV, Baldessarini RJ, Tondo L, Vázquez GH. Status of Type II vs. Type I Bipolar Disorder: Systematic Review with Meta-Analyses. Harv Rev Psychiatry 2023; 31:173-182. [PMID: 37437249 DOI: 10.1097/hrp.0000000000000371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Analyze and compare the different bipolar disorder (BD) types.• Identify markers that distinguish BD types and explain how the DSM-IV defines the disorder. ABSTRACT Since the status of type II bipolar disorder (BD2) as a separate and distinct form of bipolar disorder (BD) remains controversial, we reviewed studies that directly compare BD2 to type I bipolar disorder (BD1). Systematic literature searching yielded 36 reports with head-to-head comparisons involving 52,631 BD1 and 37,363 BD2 patients (total N = 89,994) observed for 14.6 years, regarding 21 factors (with 12 reports/factor). BD2 subjects had significantly more additional psychiatric diagnoses, depressions/year, rapid cycling, family psychiatric history, female sex, and antidepressant treatment, but less treatment with lithium or antipsychotics, fewer hospitalizations or psychotic features, and lower unemployment rates than BD1 subjects. However, the diagnostic groups did not differ significantly in education, onset age, marital status, [hypo]manias/year, risk of suicide attempts, substance use disorders, medical comorbidities, or access to psychotherapy. Heterogeneity in reported comparisons of BD2 and BD1 limits the firmness of some observations, but study findings indicate that the BD types differ substantially by several descriptive and clinical measures and that BD2 remains diagnostically stable over many years. We conclude that BD2 requires better clinical recognition and significantly more research aimed at optimizing its treatment.
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Affiliation(s)
- Carolina V Hernandorena
- From Braulio A. Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina (Dr. Hernandorena); Department of Psychiatry, Queen's University (Drs. Hernandorena and Vázquez); Harvard Medical School, Boston, MA (Drs. Baldessarini and Tondo); McLean Hospital, Belmont, MA (Drs. Baldessarini, Tondo, and Vázquez); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Dr. Tondo)
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Chakrabarti S. Bipolar disorder in the International Classification of Diseases-Eleventh version: A review of the changes, their basis, and usefulness. World J Psychiatry 2022; 12:1335-1355. [PMID: 36579354 PMCID: PMC9791613 DOI: 10.5498/wjp.v12.i12.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization’s 11th revision of the International Classification of Diseases (ICD-11) including the chapter on mental disorders has come into effect this year. This review focuses on the “Bipolar or Related Disorders” section of the ICD-11 draft. It describes the benchmarks for the new version, particularly the foremost principle of clinical utility. The alterations made to the diagnosis of bipolar disorder (BD) are evaluated on their scientific basis and clinical utility. The change in the diagnostic requirements for manic and hypomanic episodes has been much debated. Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear. The ICD-11 definition of depressive episodes is substantially different, but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low. Unlike the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the ICD-11 has retained the category of mixed episodes. Although the concept of mixed episodes in the ICD-11 is not perfect, it appears to be more inclusive than the DSM-5 approach. Additionally, there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder. The initial results on the reliability and clinical utility of BD are promising, but the newly created diagnostic categories also appear to have some limitations. Although further improvement and research are needed, the focus should now be on facing the challenges of implementation, dissemination, and education and training in the use of these guidelines.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, UT, India
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Olivito G, Lupo M, Siciliano L, Gragnani A, Saettoni M, Pancheri C, Panfili M, Pignatelli F, Delle Chiaie R, Leggio M. Theory of mind profile and cerebellar alterations in remitted bipolar disorder 1 and 2: a comparison study. Front Behav Neurosci 2022; 16:971244. [PMID: 36160679 PMCID: PMC9492864 DOI: 10.3389/fnbeh.2022.971244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
The literature on social cognition abilities in bipolar disorder (BD) is controversial about the occurrence of theory of mind (ToM) alterations. In addition to other cerebral structures, such as the frontal and limbic areas, the processing of socially relevant stimuli has also been attributed to the cerebellum, which has been demonstrated to be involved in the above-mentioned disorder. Nevertheless, the cerebellar contribution to ToM deficits in bipolar patients needs to be elucidated further. To this aim, two tests assessing different components of ToM were used to evaluate the ability to appreciate affective and mental states of others in 17 individuals with a diagnosis of BD type 1 (BD1) and 13 with BD type 2 (BD2), both in the euthymic phase, compared to healthy matched controls. Cerebellar gray matter (GM) volumes were extracted and compared between BD1 and controls and BD2 and controls by using voxel-based morphometry. The results showed that BD1 patients were compromised in the cognitive and advanced components of ToM, while the BD2 ToM profile resulted in a more widespread compromise, also involving affective and automatic components. Both overlapping and differing areas of cerebellar GM reduction were found. The two groups of patients presented a pattern of GM reduction in cerebellar portions that are known to be involved in the affective and social domains, such as the vermis and Crus I and Crus II. Interestingly, in both BD1 and BD2, positive correlations were detected between lower ToM scores and decreased volumes in the cerebellum. Overall, BD2 patients showed a more compromised ToM profile and greater cerebellar impairment than BD1 patients. The different patterns of structural abnormalities may account for the different ToM performances evidenced, thus leading to divergent profiles between BD1 and BD2.
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Affiliation(s)
- Giusy Olivito
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- *Correspondence: Giusy Olivito
| | - Michela Lupo
- Servizio di Tutela della Salute Mentale e Riabilitazione dell’Età Evolutiva ASL, Rome, Italy
| | - Libera Siciliano
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva (SPC), Grosseto, Italy
- Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), Rome, Italy
| | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva (SPC), Grosseto, Italy
- Unità Funzionale Salute Mentale Adulti ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Corinna Pancheri
- Department of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Panfili
- Department of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Delle Chiaie
- Department of Neuroscience and Mental Health–Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Leggio
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Timakum T, Song M, Kim G. Integrated entitymetrics analysis for health information on bipolar disorder using social media data and scientific literature. ASLIB J INFORM MANAG 2022. [DOI: 10.1108/ajim-02-2022-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aimed to examine the mental health information entities and associations between the biomedical, psychological and social domains of bipolar disorder (BD) by analyzing social media data and scientific literature.Design/methodology/approachReddit posts and full-text papers from PubMed Central (PMC) were collected. The text analysis was used to create a psychological dictionary. The text mining tools were applied to extract BD entities and their relationships in the datasets using a dictionary- and rule-based approach. Lastly, social network analysis and visualization were employed to view the associations.FindingsMental health information on the drug side effects entity was detected frequently in both datasets. In the affective category, the most frequent entities were “depressed” and “severe” in the social media and PMC data, respectively. The social and personal concerns entities that related to friends, family, self-attitude and economy were found repeatedly in the Reddit data. The relationships between the biomedical and psychological processes, “afraid” and “Lithium” and “schizophrenia” and “suicidal,” were identified often in the social media and PMC data, respectively.Originality/valueMental health information has been increasingly sought-after, and BD is a mental illness with complicated factors in the clinical picture. This paper has made an original contribution to comprehending the biological, psychological and social factors of BD. Importantly, these results have highlighted the benefit of mental health informatics that can be analyzed in the laboratory and social media domains.
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Tondo L, Miola A, Pinna M, Contu M, Baldessarini RJ. Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. Int J Bipolar Disord 2022; 10:21. [PMID: 35918560 PMCID: PMC9346033 DOI: 10.1186/s40345-022-00268-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/17/2022] [Indexed: 12/17/2022] Open
Abstract
Objective To compare characteristics of bipolar disorder patients diagnosed as DSM-5 types I (BD-1) vs. II (BD-2). Methods We compared descriptive, psychopathological, and treatment characteristics in a sample of 1377 consenting, closely and repeatedly evaluated adult BD patient-subjects from a specialty clinic, using bivariate methods and logistic multivariable modeling. Results Factors found more among BD-2 > BD-1 cases included: [a] descriptors (more familial affective disorder, older at onset, diagnosis and first-treatment, more education, employment and higher socioeconomic status, more marriage and children, and less obesity); [b] morbidity (more general medical diagnoses, less drug abuse and smoking, more initial depression and less [hypo]mania or psychosis, longer episodes, higher intake depression and anxiety ratings, less mood-switching with antidepressants, less seasonal mood-change, greater %-time depressed and less [hypo]manic, fewer hospitalizations, more depression-predominant polarity, DMI > MDI course-pattern, and less violent suicidal behavior); [c] specific item-scores with initial HDRS21 (higher scores for depression, guilt, suicidality, insomnia, anxiety, agitation, gastrointestinal symptoms, hypochondriasis and weight-loss, with less psychomotor retardation, depersonalization, or paranoia); and [d] treatment (less use of lithium or antipsychotics, more antidepressant and benzodiazepine treatment). Conclusions BD-2 was characterized by more prominent and longer depressions with some hypomania and mixed-features but not mania and rarely psychosis. BD-2 subjects had higher socioeconomic and functional status but also high levels of long-term morbidity and suicidal risk. Accordingly, BD-2 is dissimilar to, but not necessarily less severe than BD-1, consistent with being distinct syndromes.
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Affiliation(s)
- Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States. .,Department of Psychiatry, Harvard Medical School, Boston, MA, United States. .,Lucio Bini Mood Disorder Center, Via Cavalcanti 28, Cagliari, Italy.
| | - Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States.,Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Marco Pinna
- Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padua, Italy.,Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Center, Via Cavalcanti 28, Cagliari, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Sugawara N, Adachi N, Kubota Y, Watanabe Y, Miki K, Azekawa T, Edagawa K, Katsumoto E, Hongo S, Goto E, Ueda H, Kato M, Yoshimura R, Nakagawa A, Kikuchi T, Tsuboi T, Watanabe K, Shimoda K, Yasui-Furukori N. Determinants of three-year clinical outcomes in real-world outpatients with bipolar disorder: The multicenter treatment survey for bipolar disorder in psychiatric outpatient clinics (MUSUBI). J Psychiatr Res 2022; 151:683-692. [PMID: 35675718 DOI: 10.1016/j.jpsychires.2022.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/07/2022] [Accepted: 05/20/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is limited evidence regarding predictors of long-term clinical outcomes in patients with bipolar disorder (BD). The objective of this study was to describe 3-year clinical outcomes and identify their predictors from participants in the multicenter treatment survey for BD in psychiatric outpatient clinics (MUSUBI). METHODS The MUSUBI was a naturalistic study investigating patients with BD in real-world clinical practice. Our study extracted data regarding 1647 outpatients with BD from 2016, 2017, and 2019 as baseline, 1-year, and 3-year assessments. As clinical outcomes, we assessed the presence of time ill (depressive and manic) during the 1 year prior to the 3-year assessment and durable remission (53 weeks or more) prior to the 3-year assessment. RESULTS Participants with durable remission prior to the 3-year assessment had significant associations with diagnosis of a personality disorder and duration of continuous remission at baseline. Regarding the presence of depressive symptoms during the 1 year prior to the 3-year assessment, work status, Global Assessment of Functioning (GAF) scores, suicidal ideation, and duration of continuous remission at baseline had significant associations with this outcome. CONCLUSIONS At the 3-year assessment, 19.3% of participants (318/1647) achieved durable remission, while 47.5% of them (782/1647) were not remitted. Our findings can help clinicians predict the illness course of BD by understanding demographic and clinical characteristics.
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Affiliation(s)
- Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan; The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Yoichiro Watanabe
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Kazuhira Miki
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Koji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
| | - Masaki Kato
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan; Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
| | - Reiji Yoshimura
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan; Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan.
| | - Atsuo Nakagawa
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Toshiaki Kikuchi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Takashi Tsuboi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan; Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.
| | - Koichiro Watanabe
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan; Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan; The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan; The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
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Van Meter A, Correll CU, Ahmad W, Dulin M, Saito E. Symptoms and Characteristics of Youth Hospitalized for Depression: Subthreshold Manic Symptoms Can Help Differentiate Bipolar from Unipolar Depression. J Child Adolesc Psychopharmacol 2021; 31:545-552. [PMID: 34637626 DOI: 10.1089/cap.2021.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Most people who have major depressive disorder (MDD) or bipolar disorder (BD) will have their first episode of depression in adolescence. However, in the absence of significant [hypo]manic symptoms, there are no clear guidelines for distinguishing bipolar from unipolar depression, which can lead to misdiagnosis and ineffective/harmful treatment. We aimed to compare phenomenological differences among youth with MDD or BD hospitalized for an acute episode of depression. Methods: A retrospective electronic chart review of adolescents hospitalized in an acute care inpatient unit who had a discharge diagnosis of MDD, MDD with mixed or psychotic features (MDD+), BD-I-current episode depressed, or BD-II-current episode depressed, was performed. Results: Altogether, 598 patients (mean age = 15.1 ± 1.5 years, female = 71%, and White = 46%) met study inclusion criteria, i.e., BD-I: n = 39, BD-II: n = 84, MDD: n = 422, and MDD+: n = 53 patients. The admission Hamilton Depression Rating Scale (HAMD) total score was significantly higher in the BD-I (29.3 ± 9.1) and MDD+ (31.2 ± 9.3) groups versus the MDD group (24.3 ± 9.7) (p < 0.05). Although there were some group differences in the severity of individual depression symptoms, these did not line up neatly across BD and MDD groups. At admission, Young Mania Rating Scale (YMRS) total scores were significantly higher in the BD-I (14.4 ± 7.4), BD-II (13.8 ± 6.5), and MDD+ groups (14.3 ± 6.6) versus the MDD group (8.2 ± 4.6, p < 0.05). Additionally, 9 of 11 and 4 of 11 YMRS items scored significantly higher in the BD-II and BD-I groups versus the MDD group, respectively. The motor activity and hypersexuality items, in particular, were scored consistently higher in the BD groups than MDD groups. Limitations: All diagnoses were made based on a clinical interview and not a structured diagnostic interview, and some of the subgroup sample sizes were relatively modest, limiting the power for group comparisons. Conclusion: The presence of subsyndromal manic symptoms during an episode of MDD currently offers the clearest way by which to differentiate bipolar depression from unipolar depression.
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Affiliation(s)
- Anna Van Meter
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA.,Feinstein Institutes for Medical Research, Institute for Behavioral Science, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA.,Feinstein Institutes for Medical Research, Institute for Behavioral Science, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Wasiq Ahmad
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
| | - Morganne Dulin
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
| | - Ema Saito
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
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Olivito G, Lupo M, Gragnani A, Saettoni M, Siciliano L, Pancheri C, Panfili M, Cercignani M, Bozzali M, Chiaie RD, Leggio M. Aberrant Cerebello-Cerebral Connectivity in Remitted Bipolar Patients 1 and 2: New Insight into Understanding the Cerebellar Role in Mania and Hypomania. THE CEREBELLUM 2021; 21:647-656. [PMID: 34432230 PMCID: PMC9325834 DOI: 10.1007/s12311-021-01317-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 01/04/2023]
Abstract
Bipolar disorder (BD) is a major mental illness characterized by periods of (hypo) mania and depression with inter-episode remission periods. Functional studies in BD have consistently implicated a set of linked cortical and subcortical limbic regions in the pathophysiology of the disorder, also including the cerebellum. However, the cerebellar role in the neurobiology of BD still needs to be clarified. Seventeen euthymic patients with BD type1 (BD1) (mean age/SD, 38.64/13.48; M/F, 9/8) and 13 euthymic patients with BD type 2 (BD2) (mean age/SD, 41.42/14.38; M/F, 6/7) were compared with 37 sex- and age-matched healthy subjects (HS) (mean age/SD, 45.65/14.15; M/F, 15/22). T1 weighted and resting-state functional connectivity (FC) scans were acquired. The left and right dentate nucleus were used as seed regions for the seed based analysis. FC between each seed and the rest of the brain was compared between patients and HS. Correlations between altered cerebello-cerebral connectivity and clinical scores were then investigated. Different patterns of altered dentate-cerebral connectivity were found in BD1 and BD2. Overall, impaired dentate-cerebral connectivity involved regions of the anterior limbic network specifically related to the (hypo)manic states of BD. Cerebello-cerebral connectivity is altered in BD1 and BD2. Interestingly, the fact that these altered FC patterns persist during euthymia, supports the hypothesis that cerebello-cerebral FC changes reflect the neural correlate of subthreshold symptoms, as trait-based pathophysiology and/or compensatory mechanism to maintain a state of euthymia.
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Affiliation(s)
- Giusy Olivito
- Department of Psychology, Sapienza University of Rome, Via Dei Marsi, 78, 00185, Rome, Italy.,IRCCS Fondazione Santa Lucia, 00179, Rome, Italy
| | - Michela Lupo
- Servizio di Tutela della Salute Mentale e Riabilitazione dell'Età Evolutiva ASL, Roma 2, 00145, Rome, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SPC, 58100, Grosseto, Italy.,Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), 00185, Rome, Italy
| | - Marco Saettoni
- Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), 00185, Rome, Italy.,Unità funzionale salute mentale adulti ASL, Toscana nord-ovest, Valle del Serchio, 55100, Pisa, Italy
| | - Libera Siciliano
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, 00185, Rome, Italy
| | - Corinna Pancheri
- Department of Neuroscience and Mental Health - Policlinico Umberto I Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Matteo Panfili
- Department of Neuroscience and Mental Health - Policlinico Umberto I Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Mara Cercignani
- Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9RR, UK
| | - Marco Bozzali
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126, Turin, Italy.,Department of Neuroscience, Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex, BN1 9RR, UK
| | - Roberto Delle Chiaie
- Department of Neuroscience and Mental Health - Policlinico Umberto I Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, Via Dei Marsi, 78, 00185, Rome, Italy. .,IRCCS Fondazione Santa Lucia, 00179, Rome, Italy.
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11
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Affective and non-affective cognition in patients with bipolar disorder type I and type II in full or partial remission: Associations with familial risk. J Affect Disord 2021; 283:207-215. [PMID: 33561801 DOI: 10.1016/j.jad.2021.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/09/2021] [Accepted: 01/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The upcoming conversion of the ICD-11 will subdivide patients with bipolar disorder (BD) into BD type I (BD-I) and BD type II (BD-II). This study aimed to investigate whether cognitive impairments could aid as objective cognitive biomarkers for recently diagnosed BD subtypes by comparing cognitive profiles between BD subtypes, their unaffected relatives (UR), and healthy controls (HC). METHODS The sample included 76 patients with BD-I, 149 patients with BD-II, 28 UR of patients with BD-I (UR-I), 50 UR of patients with BD-II (UR-II) and 168 HC from the Bipolar Illness Onset study, who were assessed with an extensive non-affective and affective cognitive test battery. RESULTS The results showed no significant differences in affective or non-affective cognition between BD-I and BD-II. Compared to HC, patients with BD-I (but not BD-II) showed worse performance in verbal fluency (p = .01) and were slower at recognising fearful faces (p = .045), while patients with BD-II (but not BD-I) displayed generally poorer recognition of facial expressions (p = .02). Only UR-I showed lower performance on verbal fluency (p = .049) and aberrant affective cognition (ps≤.047) compared to HC. LIMITATIONS The potential confounding effects of medication were not explored. CONCLUSIONS The lack of significant differences in cognitive profiles between recently diagnosed BD-I and BD-II suggests that neither affective nor non-affective cognition are indicative of BD subtype.
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12
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Clinical and genetic differences between bipolar disorder type 1 and 2 in multiplex families. Transl Psychiatry 2021; 11:31. [PMID: 33431802 PMCID: PMC7801527 DOI: 10.1038/s41398-020-01146-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023] Open
Abstract
The two major subtypes of bipolar disorder (BD), BD-I and BD-II, are distinguished based on the presence of manic or hypomanic episodes. Historically, BD-II was perceived as a less severe form of BD-I. Recent research has challenged this concept of a severity continuum. Studies in large samples of unrelated patients have described clinical and genetic differences between the subtypes. Besides an increased schizophrenia polygenic risk load in BD-I, these studies also observed an increased depression risk load in BD-II patients. The present study assessed whether such clinical and genetic differences are also found in BD patients from multiplex families, which exhibit reduced genetic and environmental heterogeneity. Comparing 252 BD-I and 75 BD-II patients from the Andalusian Bipolar Family (ABiF) study, the clinical course, symptoms during depressive and manic episodes, and psychiatric comorbidities were analyzed. Furthermore, polygenic risk scores (PRS) for BD, schizophrenia, and depression were assessed. BD-I patients not only suffered from more severe symptoms during manic episodes but also more frequently showed incapacity during depressive episodes. A higher BD PRS was significantly associated with suicidal ideation. Moreover, BD-I cases exhibited lower depression PRS. In line with a severity continuum from BD-II to BD-I, our results link BD-I to a more pronounced clinical presentation in both mania and depression and indicate that the polygenic risk load of BD predisposes to more severe disorder characteristics. Nevertheless, our results suggest that the genetic risk burden for depression also shapes disorder presentation and increases the likelihood of BD-II subtype development.
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13
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Pjrek E, Friedrich ME, Cambioli L, Dold M, Jäger F, Komorowski A, Lanzenberger R, Kasper S, Winkler D. The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:17-24. [PMID: 31574513 DOI: 10.1159/000502891] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bright light therapy (BLT) has been used as a treatment for seasonal affective disorder (SAD) for over 30 years. This meta-analysis was aimed to assess the efficacy of BLT in the treatment of SAD in adults. METHOD We performed a systematic literature search including randomized, single- or double-blind clinical trials investigating BLT (≥1,000 lx, light box or light visor) against dim light (≤400 lx) or sham/low-density negative ion generators as placebo. Only first-period data were used from crossover trials. The primary outcome was the post-treatment depression score measured by validated scales, and the secondary outcome was the rate of response to treatment. RESULTS A total of 19 studies finally met our predefined inclusion criteria. BLT was superior over placebo with a standardized mean difference of -0.37 (95% CI: -0.63 to -0.12) for depression ratings (18 studies, 610 patients) and a risk ratio of 1.42 (95% CI: 1.08-1.85) for response to active treatment (16 studies, 559 patients). We found no evidence for a publication bias, but moderate heterogeneity of the studies and a moderate-to-high risk of bias. CONCLUSIONS BLT can be regarded as an effective treatment for SAD, but the available evidence stems from methodologically heterogeneous studies with small-to-medium sample sizes, necessitating larger high-quality clinical trials.
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Affiliation(s)
- Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Luca Cambioli
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.,Competence Center for Eating Behavior, Obesity and the Psyche, Zofingen Hospital, Zofingen, Switzerland
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Fiona Jäger
- University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Komorowski
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria,
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14
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Almeida HS, Mitjans M, Arias B, Vieta E, Ríos J, Benabarre A. Genetic differences between bipolar disorder subtypes: A systematic review focused in bipolar disorder type II. Neurosci Biobehav Rev 2020; 118:623-630. [DOI: 10.1016/j.neubiorev.2020.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/07/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
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15
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Vangala S, Beebani G, Thiem R, Dereczyk A. Mania Associated With Supratherapeutic Tacrolimus Levels in a Patient With No Psychiatric History. PSYCHOSOMATICS 2020; 61:769-773. [PMID: 32660875 DOI: 10.1016/j.psym.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sindhura Vangala
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI.
| | - Ganj Beebani
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI
| | - Rachel Thiem
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI
| | - Aimee Dereczyk
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI
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16
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Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis. PLoS One 2020; 15:e0232798. [PMID: 32437356 PMCID: PMC7241702 DOI: 10.1371/journal.pone.0232798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023] Open
Abstract
The treatment of depressive symptoms of bipolar disorder (BD) has received increasing attention. Recently, some studies have shown that bright light therapy (BLT) seems to be useful for BD depression. This meta-analysis is intended to further elucidate the role of BLT in depressive symptoms in patients with BD. Register of Systematic Reviews PROSPERO: CRD 420191 33642.Randomized controlled trials and cohort studies were retrieved in PubMed, Cochrane Library, EMbase, Web of Science, CINHAL, CBM, CNKI, VIP, and Wanfang from their foundation to March 2020, and other sources as supplement was also retrieved. Data were extracted after strict evaluation of literature quality by two researchers, and Meta-analysis was conducted on literatures that met the inclusion criteria. Meta-analysis was performed using Revman 5.3 software. In total, 12 studies including 847 patients with BD depression were included in our meta-analysis. A meta-analysis found significant differences between BLT and placebo for the following outcomes: (1) depression severity before and after BLT [SMD = -0.43, 95% CI (-0.73,-0.13), P<0.05] in RCT and [SMD = -2.12, 95% CI (-2.3,-1.94), P<0.05] in cohort studies.; (2) the efficacy of duration/timing of light therapy for depressive symptoms in BD [I2 = 85%, SMD = -1.88, 95% CI (-2.04, -1.71),P<0.05] and [I2 = 71%, SMD = -2.1,95% CI(-2.24, -1.96), P<0.05]; (3) the efficacy of different color/color temperatures for depressive symptoms in BD [I2 = 0%, SMD = -0.56, 95% CI (-0.92, -0.19), P<0.05] and [I2 = 97%, SMD = -1.74, 95% CI (-1.99, -1.49), P<0.05].We performed a subgroup meta-analysis of studies that used different light intensities. The results showed that light intensity≥5000 lux significantly reduced the severity of depression. And patients without psychotropic drugs revealed significantly decreased disease severity [I2 = 0%, SMD = -0.6, 95% CI (-1.06,-0.13), P<0.05]. Limitations of the study include studies only assessed short-term effects, and insufficient duration may underestimate adverse reactions and efficacy. Our results highlight the significant efficiency of BLT in the treatment of bipolar depression. Prospective studies with more rigorous design and consistent follow-up.
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17
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Wang YS, Lee SY, Chen SL, Chang YH, Wang TY, Lin SH, Wang CL, Huang SY, Lee I, Chen P, Yang Y, Lu RB. Role of DRD2 and ALDH2 genes in bipolar II disorder with and without comorbid anxiety disorder. Eur Psychiatry 2020; 29:142-8. [DOI: 10.1016/j.eurpsy.2013.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 05/05/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022] Open
Abstract
AbstractThe presence of comorbid anxiety disorders (AD) and bipolar II disorders (BP-II) compounds disability complicates treatment, worsens prognosis, and has been understudied. The genes involved in metabolizing dopamine and encoding dopamine receptors, such as aldehyde dehydrogenase 2 (ALDH2) and dopamine D2 receptor (DRD2) genes, may be important to the pathogenesis of BP-II comorbid with AD. We aimed to clarify ALDH2 and DRD2 genes for predisposition to BP-II comorbid with and without AD. The sample consisted of 335 subjects BP-II without AD, 127 subjects BP-II with AD and 348 healthy subjects as normal control. The genotypes of the ALDH2 and DRD2 Taq-IA polymorphisms were determined using polymerase chain reactions plus restriction fragment length polymorphism analysis. Logistic regression analysis showed a statistically significant association between DRD2 Taq-I A1/A2 genotype and BP-II with AD (OR = 2.231, P = 0.021). Moreover, a significant interaction of the DRD2 Taq-I A1/A1 and the ALDH2*1*1 genotypes in BP-II without AD was revealed (OR = 5.623, P = 0.001) compared with normal control. Our findings support the hypothesis that a unique genetic distinction between BP-II with and without AD, and suggest a novel association between DRD2 Taq-I A1/A2 genotype and BP-II with AD. Our study also provides further evidence that the ALDH2 and DRD2 genes interact in BP-II, particularly BP-II without AD.
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18
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Cansız A, İnce B. Evaluation of 2D:4D digit ratio in bipolar 1 disorder patients and its relationship with treatment response. Early Hum Dev 2020; 143:104971. [PMID: 32086117 DOI: 10.1016/j.earlhumdev.2020.104971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The role of sex steroids in bipolar disorder (BD) has been demonstrated in adults. We aimed to evaluate the 2D:4D ratio, which indirectly reflects prenatal sex steroids, in BD. Another purpose of this study was to determine the relationship between clinical features, especially lithium response, and digit ratio. METHODS The study included 74 patients with bipolar 1 disorder and 74 healthy individuals matched according to age, gender, and educational status. The digit ratio was calculated by dividing the index finger (2D) length by the ring finger (4D) length in both hands. A lithium response scale was used to evaluate the lithium response history. RESULTS There was no difference in 2D:4D ratio between the patients and controls in either right or left hands. The digit ratio was not different between groups with and without suicide attempts. The 2D:4D ratio in the patient group was lower in individuals unresponsive to lithium therapy than in partial and good responders for both right and left hands. DISCUSSION According to the results of our study, the 2D:4D ratio in the BD group was not different from healthy controls but was lower in patients unresponsive to lithium. In this respect, the 2D:4D ratio can be considered as a biomarker for lithium response in BD. In large-sample studies, the 2D:4D ratio should be investigated for pathophysiology and treatment response of BD.
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Affiliation(s)
- Alparslan Cansız
- Harran University, Faculty of Medicine, Department of Psychiatry, Şanlıurfa-Mardin Motorway 18.km Osmanbey, 63140 Şanlıurfa, Turkey.
| | - Bahri İnce
- Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, 34147 Istanbul, Turkey
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19
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Abstract
The issue of categorical vs. dimensional classification of bipolar disorder continues to generate controversy as it has for generations. Despite the evidence that no psychiatric disorder has discrete boundaries separating pathological and nonpathological states, and within a disorder, no clear differences separate subtypes-which would suggest a more dimensional approach-there are valid reasons to continue with our current categorical system, which distinguishes bipolar I from bipolar II disorder. Complicating the issue, a number of interested constituencies, including patients and their families, clinicians, scientists/researchers, and governmental agencies and insurance companies have different interests and needs in this controversy. This paper reviews both the advantages and disadvantages of continuing the bipolar I/bipolar II split vs. redefining bipolar disorder as one unified diagnosis. Even with one unified diagnosis, other aspects of psychopathology can be used to further describe and classify the disorder. These include both predominant polarity and categorizing symptoms by ACE-activity, cognition and energy. As a field, we must decide whether changing our current classification before we have a defining biology and genetic profile of bipolar disorder is worth the disruption in our current diagnostic system.
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Affiliation(s)
- Michael Gitlin
- Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, USA.,Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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20
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Kim SC, Cho CH, Lee Y, Seo JY, Ahn YM, Kim SJ, Ha TH, Cha B, Moon E, Park DY, Baek JH, Kang HJ, An H, Lee HJ. Similarities of Aspects of Biological Rhythms between Major Depression and Bipolar II Disorder Compared to Bipolar I Disorder: A Finding from the Early-Onset Mood Disorder Cohort. Psychiatry Investig 2019; 16:829-835. [PMID: 31648425 PMCID: PMC6877457 DOI: 10.30773/pi.2019.0232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The biological rhythm is closely related to mood symptoms. The purpose of this study was to assess the differences in biological rhythms among subjects with mood disorder [bipolar I disorder (BD I), bipolar II disorder (BD II), major depressive disorder (MDD)] and healthy control subjects. METHODS A total of 462 early-onset mood disorder subjects were recruited from nine hospitals. The controls subjects were recruited from the general population of South Korea. Subject groups and control subject were evaluated for the Korean language version of Biological Rhythms Interview of Assessment in Neuropsychiatry (K-BRIAN) at the initial evaluation. RESULTS The mean K-BRIAN scores were 35.59 [standard deviation (SD)=13.37] for BD I, 43.05 (SD=11.85) for BD II, 43.55 (SD=12.22) for MDD, and 29.1 (SD=8.15) for the control group. In the case of mood disorders, biological rhythm disturbances were greater than that in the control group (p<0.05). A significant difference existed between BD I and BD II (BD I <BD II, p<0.001) and between BD I and MDD (BD I<MDD, p< 0.001) but no difference was observed between BD II and MDD. CONCLUSION BD II and MDD are similar to each other but different from BD I in biological rhythm patterns in early-onset mood disorder cases. Biological rhythm disturbances are similar for early-onset major depression and BD II.
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Affiliation(s)
- Su Cheol Kim
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea.,Chronobiology Institute, Korea University, Seoul, Republic of Korea
| | - Yujin Lee
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea.,Chronobiology Institute, Korea University, Seoul, Republic of Korea
| | - Ju Yeon Seo
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea.,Chronobiology Institute, Korea University, Seoul, Republic of Korea
| | - Yong-Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyon Ha
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Busan National University School of Medicine, Busan, Republic of Korea
| | - Dong Yeon Park
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University College of Medicine, Gwangju, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea.,Chronobiology Institute, Korea University, Seoul, Republic of Korea
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21
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Abstract
Objective: We reviewed important clinical aspects of bipolar depression, a progressive psychiatric condition that is commonly treated in primary care. Bipolar depression is associated with considerable burden of illness, high suicide risk, and greater morbidity and mortality than bipolar mania. Methods: We identified articles relevant to our narrative review using a multistep search of the literature and applying terms that were relevant to bipolar depression or bipolar disorder. Results: Bipolar depression accounts for the majority of time spent unwell for patients with bipolar disorder; high rates of morbidity and mortality arise from full symptomatic episodes and interepisode subsyndromal symptoms. Bipolar depression is an important contributor to long-term dysfunction for patients with bipolar disorder due to psychosocial impairment, loss of work productivity and high rates of substance abuse. Missed and delayed diagnosis is prevalent due to overlapping symptoms with unipolar depression and other diagnoses. Medical comorbidities (i.e. cardiovascular disease, hypertension, obesity, metabolic syndrome) and psychiatric comorbidities (i.e. anxiety disorder, personality disorder, eating disorder, attention-deficit/hyperactivity disorder) are common. Currently, only three treatments are FDA-approved for bipolar depression; monotherapy antidepressants are not a recommended treatment option. Conclusions: Bipolar disorder is common among primary care patients presenting with depression; it is often treated exclusively in primary care. Clinicians should be alert for symptoms of bipolar disorder in undiagnosed patients, know what symptoms probabilistically suggest bipolar versus unipolar depression, have expertise in providing ongoing treatment to diagnosed patients, and be knowledgeable about managing common medication-related side effects and comorbidities. Prompt and accurate diagnosis is critical.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network , Toronto , Canada
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22
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Malhi GS, Outhred T, Irwin L. Bipolar II Disorder Is a Myth. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:531-536. [PMID: 31060361 PMCID: PMC6681518 DOI: 10.1177/0706743719847341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Gin S Malhi
- 1 University of Sydney, Northern Clinical School, Sydney, NSW, Australia.,2 Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Tim Outhred
- 1 University of Sydney, Northern Clinical School, Sydney, NSW, Australia.,2 Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Lauren Irwin
- 1 University of Sydney, Northern Clinical School, Sydney, NSW, Australia.,2 Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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23
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Nierenberg AA. Bipolar II Disorder Is NOT a Myth. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:537-540. [PMID: 31340671 PMCID: PMC6681510 DOI: 10.1177/0706743719852096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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24
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Vieta E. Bipolar II Disorder: Frequent, Valid, and Reliable. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:541-543. [PMID: 31340672 PMCID: PMC6681515 DOI: 10.1177/0706743719855040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Eduard Vieta
- 1 Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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25
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Sentissi O, Popovic D, Moeglin C, Stukalin YB, Mosheva M, Vieta E, Serretti A, Souery D. Predominant polarity in bipolar disorder patients: The COPE bipolar sample. J Affect Disord 2019; 250:43-50. [PMID: 30826493 DOI: 10.1016/j.jad.2019.02.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The concept of predominant polarity (PP) is defined as presenting more symptoms of one polarity. Previous studies have defined PP as one polarity (either a depression or mania episode) occurring during at least two-thirds of the lifetime. METHODS We conducted an observational study with the COPE-BD (Clinical Outcome and Psycho-Education for Bipolar Disorder, Clinical Outcome Measures Section) dataset to identify the diagnostic and treatment differences between bipolar disorder (BD) patients with and without PP. RESULTS The final sample included 210 BD-I (59.0%) and 146 BD-II (41.0%) patients. Of these, 28.9% patients presented predominant polarity (PP): 62 (17.4%) of those patients were depressed polarity predominant (DPP), 41 (11.5%) were manic polarity predominant (MPP), and 253 (71.1%) met criteria for bipolar disorders but did not present with PP. In comparison to this group of BD patients with undetermined polarity, the group of BD patients with PP presented more rapid cycling. Furthermore, in the undetermined polarity group, the onset of illness occurred earlier, and the duration of the illness was longer, with more hypomanic/manic and depressive episodes than patients who met the PP criteria. LIMITATIONS This study has a naturalistic and retrospective design and does not allow a specific follow-up of polarity over time. CONCLUSIONS These different clinical characteristics underline the importance of considering PP in patients with BD, and justify the need for differential treatment approach which could have an impact on patients' prognosis. Yet, more independent and prospective research is needed to confirm these findings, especially with the new classification of DSM-5 concerning mixed states.
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Affiliation(s)
- Othman Sentissi
- Department of Mental Health and Psychiatry, Address: CAPPI Jonction, 35 Rue des Bains, 1205 Geneva, Switzerland.
| | | | - Clotilde Moeglin
- Department of Mental Health and Psychiatry, Address: CAPPI Jonction, 35 Rue des Bains, 1205 Geneva, Switzerland
| | | | | | - Eduard Vieta
- Bipolar Disorders Program, Hospital Clinic, Barcelona, Spain
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, and Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium
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26
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Affiliation(s)
- G S Malhi
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - L Irwin
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - T Outhred
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, Stein DJ, Maercker A, Tyrer P, Claudino A, Garralda E, Salvador‐Carulla L, Ray R, Saunders JB, Dua T, Poznyak V, Medina‐Mora ME, Pike KM, Ayuso‐Mateos JL, Kanba S, Keeley JW, Khoury B, Krasnov VN, Kulygina M, Lovell AM, de Jesus Mari J, Maruta T, Matsumoto C, Rebello TJ, Roberts MC, Robles R, Sharan P, Zhao M, Jablensky A, Udomratn P, Rahimi‐Movaghar A, Rydelius P, Bährer‐Kohler S, Watts AD, Saxena S. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019; 18:3-19. [PMID: 30600616 PMCID: PMC6313247 DOI: 10.1002/wps.20611] [Citation(s) in RCA: 305] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Michael B. First
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Cary S. Kogan
- School of PsychologyUniversity of OttawaOttawaONCanada
| | - Steven E. Hyman
- Stanley Center for Psychiatric ResearchBroad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMAUSA
| | - Oye Gureje
- Department of PsychiatryUniversity of IbadanIbadanNigeria
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Dan J. Stein
- Department of PsychiatryUniversity of Cape Town, and South African Medical Research Council Unit on Risk and Resilience in Mental DisordersCape TownSouth Africa
| | | | - Peter Tyrer
- Centre for Mental HealthImperial CollegeLondonUK
| | - Angelica Claudino
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | - Luis Salvador‐Carulla
- Research School of Population HealthAustralian National UniversityCanberraACTAustralia
| | - Rajat Ray
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - John B. Saunders
- Centre for Youth Substance Abuse ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Tarun Dua
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | - Vladimir Poznyak
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | | | - Kathleen M. Pike
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - José L. Ayuso‐Mateos
- Department of PsychiatryUniversidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La PrincesaMadridSpain
| | | | - Jared W. Keeley
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Brigitte Khoury
- Department of PsychiatryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Valery N. Krasnov
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Maya Kulygina
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Anne M. Lovell
- Institut National de la Santé et de la Recherche Médicale U988ParisFrance
| | - Jair de Jesus Mari
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | | | - Tahilia J. Rebello
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Michael C. Roberts
- Office of Graduate Studies and Clinical Child Psychology ProgramUniversity of KansasLawrenceKSUSA
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Pratap Sharan
- Department of PsychiatryAll India Institute of Medical SciencesNew DelhiIndia
| | - Min Zhao
- Shanghai Mental Health Center and Department of PsychiatryShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Assen Jablensky
- Centre for Clinical Research in NeuropsychiatryUniversity of Western AustraliaPerthWAAustralia
| | - Pichet Udomratn
- Department of PsychiatryPrince of Songkla UniversityHat YaiThailand
| | - Afarin Rahimi‐Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical SciencesTehranIran
| | - Per‐Anders Rydelius
- Department of Child and Adolescent PsychiatryKarolinska InstituteStockholmSweden
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28
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Song J, Kuja-Halkola R, Sjölander A, Bergen SE, Larsson H, Landén M, Lichtenstein P. Specificity in Etiology of Subtypes of Bipolar Disorder: Evidence From a Swedish Population-Based Family Study. Biol Psychiatry 2018; 84:810-816. [PMID: 29331354 DOI: 10.1016/j.biopsych.2017.11.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/03/2017] [Accepted: 11/10/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Uncertainty remains whether bipolar I disorder (BDI) and bipolar II disorder (BDII) differ etiologically. We used a population-based family sample to examine the etiological boundaries between BDI and BDII by assessing their familial aggregation/coaggregation and by assessing the coaggregation between them and schizophrenia, depression, attention-deficit/hyperactivity disorder, eating disorders, autism spectrum disorder, substance use disorders, anxiety disorders, and personality disorders. METHODS By linking Swedish national registers, we established a population-based cohort (N = 15,685,511) and identified relatives with different biological relationships. Odds ratios (ORs) were used to measure the relative risk of BDI and BDII in relatives of individuals diagnosed with BDI (n = 4309) and BDII (n = 4178). The heritability for BDI and BDII and the genetic correlation across psychiatric disorders were estimated by variance decomposition analysis. RESULTS Compared with the general population, the OR of BDI was 17.0 (95% confidence interval [CI] 13.1-22.0) in first-degree relatives of BDI patients, higher than that of BDII patients (OR 9.8, 95% CI 7.7-12.5). The ORs of BDII were 13.6 (95% CI 10.2-18.2) in first-degree relatives of BDII patients and 9.8 (95% CI 7.7-12.4) in relatives of BDI patients. The heritabilities for BDI and BDII were estimated at 57% (95% CI 32%-79%) and 46% (95% CI 21%-67%), respectively, with a genetic correlation estimated as 0.78 (95% CI 0.36-1.00). The familial coaggregation of other psychiatric disorders, in particular schizophrenia, showed different patterns for BDI and BDII. CONCLUSIONS Our results suggest a distinction between BDI and BDII in etiology, partly due to genetic differences.
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Affiliation(s)
- Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Stanley Center for Psychiatric Research, the Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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29
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Chang YH, Wang TY, Lee SY, Chen SL, Huang CC, Chen PS, Yang YK, Hong JS, Lu RB. Memory Impairment and Plasma BDNF Correlates of the BDNF Val66Met Polymorphism in Patients With Bipolar II Disorder. Front Genet 2018; 9:583. [PMID: 30542371 PMCID: PMC6277750 DOI: 10.3389/fgene.2018.00583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/09/2018] [Indexed: 11/13/2022] Open
Abstract
Studies suggest that a functional polymorphism of brain-derived neurotrophic factor (BDNF), polymorphism BDNF Val66Met affects cognitive functions, however, the effect is unclear in bipolar II (BD-II) disorder. We used the Wechsler Memory Scale-third edition (WMS-III), the presence of the BDNF Val66Met polymorphism, and plasma concentrations of BDNF to investigate the association between memory impairment and BDNF in BD-II disorder. We assessed the memory functions of 228 BD-II patients and 135 healthy controls (HCs). BD-II patients had significantly lower scores on five of the eight WMS-III subscales. In addition to education, the BDNF polymorphism were associated with the following subscales of WMS-III, auditory delayed memory, auditory delayed recognition memory and general memory scores in BD-II patients, but not in HC. Moreover, BD-II patients with the Val-homozygote scored significantly higher on the visual immediate memory subscale than did those with the Met/Met and Val/Met polymorphisms. The significantly positive effect of the Val-homozygote did not have a significantly positive effect on memory in the HC group, however. We found no significant association between BDNF polymorphisms and plasma concentrations of BDNF. The plasma BDNF was more likely to be associated with clinical characteristics than it was with memory indices in the BD-II group. The impaired memory function in BD-II patients might be dependent upon the association between the BDNF Val66Met polymorphism and peripheral BDNF levels.
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Affiliation(s)
- Yun-Hsuan Chang
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Yun Wang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Dou-Liou Branch, Department of Psychiatry, National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, Kaohsiung Veteran's General Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shiou-Lan Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,M.Sc. Program in Tropical Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Chun Huang
- Dou-Liou Branch, Department of Psychiatry, National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Dou-Liou Branch, Department of Psychiatry, National Cheng Kung University Hospital, Yunlin, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jau-Shyong Hong
- Neurobiology Laboratory, National Institutes of Health/National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Beijing YiNing Hospital, Beijing, China
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30
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Electrocardiographic and Electrooculographic Responses to External Emotions and Their Transitions in Bipolar I and II Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050884. [PMID: 29710812 PMCID: PMC5981923 DOI: 10.3390/ijerph15050884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/11/2018] [Accepted: 04/27/2018] [Indexed: 12/26/2022]
Abstract
Bipolar disorder has two main types, bipolar I (BD I) and II (BD II), which present different affective states and personality characteristics, they might present different modes of emotional regulation. We hypothesized that the electrocardiogram and electrooculogram to external emotions are different in BD I and BD II. We asked 69 BD I and 54 BD II patients, and 139 healthy volunteers to undergo these tests in response to disgust, erotica, fear, happiness, neutral, and sadness, and their transitions. Their affective states were also measured. The heart rate in BD I was significantly higher under background fear after target neutral. The eyeball movement was quicker in BD I under target happiness after background disgust; in BD I under target sadness after background disgust; and in BD I under background disgust after target neutral. Some electrocardiographic and electrooculographic changes were correlated with affective states in patients. BD I and BD II had different physiological responses to external emotions and their transitions, indicating different pathophysiologies and suggesting different emotional-therapies for BD I and BD II.
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31
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Parker GB, Tavella G. Design limitations to bipolar II treatment efficacy studies: A challenge and a revisionist strategy. J Affect Disord 2018; 229:334-341. [PMID: 29331691 DOI: 10.1016/j.jad.2017.12.072] [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: 07/18/2017] [Revised: 11/20/2017] [Accepted: 12/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trials examining medication efficacy for bipolar II disorder commonly employ a set of standardized interval measures to assess outcomes. The key issue is whether such interval measures pick up changes in the severity, duration and frequency of depressive, hypomanic and euthymic episodes. METHOD We examine the application of measures most commonly used to monitor progress in nine studies involving participants with a bipolar II disorder and published in journals with a moderate to high impact factor. RESULTS Studies rarely provided interval details for assessing depressive and hypomanic symptoms. None specified whether ratings of depressive and hypomanic symptoms were based on severity, duration or number of symptoms, and none recorded any data on euthymic periods. LIMITATIONS Our sample of reviewed studies was small and our analyses focused only on the three most commonly used outcome measures. We advocate for complementary subjective daily mood monitoring strategies but recognize that such strategies need to be validated in future studies. CONCLUSIONS We argue that interval ratings undertaken weekly or over longer periods may compromise efficacy data. We recommend that userguides be developed to ensure standard outcome measures are employed consistently across trials, and that specific details be published in trial papers about how measures were employed and what mood episode characteristics were measured at each assessment. We also argue for daily ratings to be used as an outcome measure to provide data on severity, frequency and duration of depressive, hypomanic and euthymic periods in intervention studies of those with a bipolar II disorder.
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Affiliation(s)
- Gordon B Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
| | - Gabriela Tavella
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
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32
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Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, Gao K, Miskowiak KW, Grande I. Bipolar disorders. Nat Rev Dis Primers 2018. [PMID: 29516993 DOI: 10.1038/nrdp.2018.8] [Citation(s) in RCA: 426] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene-environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, Victoria, Australia.,The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.,Human Genetics Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Trisha Suppes
- Bipolar and Depression Research Program, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA.,Bipolar and Depression Research Program, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph R Calabrese
- Mood and Anxiety Clinic, The Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Keming Gao
- Mood and Anxiety Clinic, The Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Iria Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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33
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Tondo L, Vázquez GH, Baldessarini RJ. Depression and Mania in Bipolar Disorder. Curr Neuropharmacol 2018; 15:353-358. [PMID: 28503106 PMCID: PMC5405618 DOI: 10.2174/1570159x14666160606210811] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/22/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Episode duration, recurrence rates, and time spent in manic and depressive phases of bipolar disorder (BD) is not well defined for subtypes of the disorder. METHODS We reviewed the course, timing, and duration of episodes of mania and depression among 1130 clinically treated DSM-IV-TR BD patients of various types, and compared duration and rates as well as total proportion of time in depressive versus manic episodes during 16.7 average years at risk. RESULTS As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P). Recurrence rates (episodes/year) and proportion of time in depression and their ratios to mania were highest in BD-II and BD-Mx subjects, with more manias/year in psychotic and BD-I subjects. In most BD-subtypes, except with psychotic features, there was more time in depressive than manic morbidity, owing mainly to longer depressive than manic episodes. The proportion of time in depression was highest among those who followed a predominant DMI course, whereas total time in mania was greatest in BD with psychotic features and BD-I. and with an MDI course. CONCLUSIONS Subtypes of BD patients differed little in episode-duration, which was consistently much longer for depression. The findings underscore the limited control of bipolar depression with available treatments.
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Affiliation(s)
- Leonardo Tondo
- The International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy
| | - Gustavo H Vázquez
- The International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Neuroscience, Palermo University, Buenos Aires, Argentina
| | - Ross J Baldessarini
- The International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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34
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 909] [Impact Index Per Article: 151.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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Luo X, Chen G, Jia Y, Gong J, Qiu S, Zhong S, Zhao L, Chen F, Lai S, Qi Z, Huang L, Wang Y. Disrupted Cerebellar Connectivity With the Central Executive Network and the Default-Mode Network in Unmedicated Bipolar II Disorder. Front Psychiatry 2018; 9:705. [PMID: 30618876 PMCID: PMC6305495 DOI: 10.3389/fpsyt.2018.00705] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022] Open
Abstract
Objective: Bipolar disorder (BD) is a common psychiatric disease. Although structural and functional abnormalities of the cerebellum in BD patients have been reported by recent neuroimaging studies, the cerebellar-cerebral functional connectivity (FC) has not yet been examined. The present study aims to investigate the FC between the cerebellum and cerebrum, particularly the central executive network (CEN) and the default-mode network (DMN) in bipolar II disorder (BD II). Methods: Ninety-four patients with unmedicated BD II depression and 100 healthy controls (HCs) underwent the resting-state functional magnetic resonance imaging. Seed-based connectivity analyses were performed using cerebellar seeds previously identified as being involved in the CEN (bilateral Crus Ia) and DMN (bilateral Crus Ib). Results: Compared with HCs, BD II depression patients appeared decreased FC in the right Crus Ia-left dorsal lateral prefrontal cortex (dlPFC) and -left anterior cingulate cortex (ACC), the right Crus Ib-left medial prefrontal cortex (mPFC), -left middle temporal gyrus (MTG), and -left inferior temporal gyrus (ITG). No altered FC between the left Crus Ia or Crus Ib and the cerebral regions was found. Conclusions: Patients with BD II depression showed disrupted FC between the cerebellum and the CEN (mainly in the left dlPFC and ACC) and DMN (mainly in the left mPFC and temporal lobe), suggesting the significant role of the cerebellum-CEN and -DMN connectivity in the pathogenesis of BD.
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Affiliation(s)
- Xiaomei Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - JiaYing Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China.,The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaojuan Qiu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lianping Zhao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
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Kurumaji A, Itasaka M, Uezato A, Takiguchi K, Jitoku D, Hobo M, Nishikawa T. A distinctive abnormality of diffusion tensor imaging parameters in the fornix of patients with bipolar II disorder. Psychiatry Res Neuroimaging 2017; 266:66-72. [PMID: 28609689 DOI: 10.1016/j.pscychresns.2017.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 12/01/2022]
Abstract
Diffusion tensor imaging (DTI) studies have revealed a changed integrity in the white matter of bipolar disorder. However, only a few investigations have examined bipolar II disorder (BP-II). A cross-sectional study was conducted to compare thirty-eight patients with BP-II (mean age = 38.26 years, F/M = 19/19) with thirty-eight age- and gender-matched healthy controls (mean age = 34.45 years, F/M = 18/20). Tract Based Spatial Statistics (TBSS) analysis of the fractional anisotropy (FA) was done with age, gender and education years as covariates, then a complementary atlas-based region-of-interest (ROI) analysis including the axial diffusivity (AD) and radial diffusivity (RD) was conducted to obtain further information. The patients with BP-II showed a significant decrease in FA in the corpus callosum (commissure fibers), fornix (association fibers) and right anterior corona radiata (projection fibers) compared to the controls. Moreover, a significant increase in the RD was observed in all of the fibers of the BP-II patients, while the AD significantly increased only in the fornix of the patients. Thus, in addition to the abnormal integrity of the commissure and projection fibers, the present study suggested an involvement of the limbic association fibers in the pathophysiology of BP-II induced by a distinctive neuropathology.
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Affiliation(s)
- Akeo Kurumaji
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Michio Itasaka
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Akihito Uezato
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazuo Takiguchi
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Daisuke Jitoku
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Mizue Hobo
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Toru Nishikawa
- Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Janiri D, Sani G, Rossi PD, Piras F, Iorio M, Banaj N, Giuseppin G, Spinazzola E, Maggiora M, Ambrosi E, Simonetti A, Spalletta G. Amygdala and hippocampus volumes are differently affected by childhood trauma in patients with bipolar disorders and healthy controls. Bipolar Disord 2017; 19:353-362. [PMID: 28699182 DOI: 10.1111/bdi.12516] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Volumetric studies on deep gray matter structures in bipolar disorder (BP) have reported contrasting results. Childhood trauma, a relevant environmental stressor for BP, could account for the variability of the results, modulating differences in the amygdala and hippocampus in patients with BP compared with healthy controls (HC). Our study aimed to test this hypothesis. METHODS We assessed 105 outpatients, diagnosed with bipolar disorder type I (BP-I) or bipolar disorder type II (BP-II) according to DSM-IV-TR criteria, and 113 HC subjects. History of childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ). High-resolution magnetic resonance imaging was performed on all subjects and volumes of the amygdala, hippocampus, nucleus accumbens, caudate, pallidum, putamen, and thalamus were measured using FreeSurfer. RESULTS Patients with BP showed a global reduction of deep gray matter volumes compared to HCs. However, childhood trauma modulated the impact of the diagnosis specifically on the amygdala and hippocampus. Childhood trauma was associated with bilateral decreased volumes in HCs and increased volumes in patients with BP. CONCLUSIONS The results suggest that childhood trauma may have a different effect in health and disease on volumes of gray matter in the amygdala and hippocampus, which are brain areas specifically involved in response to stress and emotion processing.
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Affiliation(s)
- Delfina Janiri
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Gabriele Sani
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.,Centro Lucio Bini, Rome, Italy.,Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Pietro De Rossi
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.,Centro Lucio Bini, Rome, Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Piras
- IRCCS Santa Lucia Foundation, Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, Rome, Italy.,Museo storico della fisica e Centro studi e ricerche Enrico Fermi, Rome, Italy
| | - Mariangela Iorio
- IRCCS Santa Lucia Foundation, Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - Nerisa Banaj
- IRCCS Santa Lucia Foundation, Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - Giulia Giuseppin
- Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario A.Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Spinazzola
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Matteo Maggiora
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Elisa Ambrosi
- IRCCS Santa Lucia Foundation, Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, Rome, Italy.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alessio Simonetti
- Centro Lucio Bini, Rome, Italy.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gianfranco Spalletta
- IRCCS Santa Lucia Foundation, Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, Rome, Italy.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Phelps JR, James J. Psychiatric consultation in the collaborative care model: The “bipolar sieve” effect. Med Hypotheses 2017; 105:10-16. [DOI: 10.1016/j.mehy.2017.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/19/2017] [Accepted: 06/23/2017] [Indexed: 01/10/2023]
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Zhu Q, Wang J, Shen C, Fan H, Zhang B, Ma G, Lu Y, Wang W. Inhibitory brainstem reflexes under external emotional-stimuli in bipolar I and II disorders. BMC Psychiatry 2017; 17:224. [PMID: 28629452 PMCID: PMC5477268 DOI: 10.1186/s12888-017-1390-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Bipolar disorder types I (BD I) and II (BD II) might present different dysfunctions of the cortex and brainstem, as reflected by the second exteroceptive suppression period of temporalis muscle activity (ES2) under different stimuli of external emotions. METHODS This study included 30 BD I and 20 BD II patients, and 40 healthy volunteers. All participants were invited to answer the Mood Disorder Questionnaire, the Hypomania Checklist-32, and the Plutchik-van Praag Depression inventory, as well as to undergo the ES2 test under external emotional-stimuli (emotional pictures plus sounds) of Disgust, Erotica, Fear, Happiness, and Sadness. RESULTS The scale scores were elevated in both patient groups, but were not correlated with ES2 parameters. Compared to healthy controls, BD I showed prolonged ES2 latency under Erotica, and their perceived happiness and sadness intensities were negatively correlated with the respective ES2 durations, while BD II showed prolonged ES2 latencies under Disgust and Happiness, and shortened ES2 durations under Disgust, Happiness and Sadness. Moreover, ES2 duration under Sadness was significantly shorter in BD II than that in BD I. CONCLUSIONS The cortico-brainstem inhibitory dysfunctions in BD I and BD II was different, and this difference was independent of the patient's ongoing emotions. Our study thus provides some hints to distinguish the two types of bipolar disorders.
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Affiliation(s)
- Qisha Zhu
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Jiawei Wang
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Chanchan Shen
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Hongying Fan
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Bingren Zhang
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Guorong Ma
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Yanxia Lu
- 0000 0000 8744 8924grid.268505.cDepartment of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang 310058 China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, Zhejiang, 310058, China.
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Ishida T, Donishi T, Iwatani J, Yamada S, Takahashi S, Ukai S, Shinosaki K, Terada M, Kaneoke Y. Elucidating the aberrant brain regions in bipolar disorder using T1-weighted/T2-weighted magnetic resonance ratio images. Psychiatry Res Neuroimaging 2017; 263:76-84. [PMID: 28366873 DOI: 10.1016/j.pscychresns.2017.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/22/2017] [Accepted: 03/17/2017] [Indexed: 01/28/2023]
Abstract
Although diffusion tensor imaging (DTI) have revealed brain abnormalities in bipolar disorder (BD) subjects, DTI methods might not detect disease-related abnormalities in the white matter (WM) where nerve fibers are crossing. We investigated BD myelin-related abnormal brain regions in both gray matter and WM for 29 BD and 33 healthy control (HC) participants using T1-weighted (T1w)/T2-weighted (T2w) ratio images that increase myelin-related contrast irrespective of nerve fiber orientation. To check effect of the brain volume, the results were compared with those of voxel-based morphometry (VBM). We found significantly lower T1w/T2w signal intensity in broad WM regions in BD subjects, including the corpus callosum, corona radiata, internal capsule, middle cerebellar peduncle and cerebellum. Regional volume reduction was found in the WM bilateral posterior thalami and retrolenticular part of the internal capsules of BD subjects. We also performed tract-based spatial statistics (TBSS) in 25 BD and 24 HC participants and compared those for the T1w/T2w ratio images. Both methods detected the BD corpus callosum abnormality. Further, the ratio images detected the corona radiata and the cerebellar abnormality in BD. These results suggest that T1w/T2w ratio image analysis could take a complementary role with the DTI method in elucidating myelin-related abnormalities in BD.
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Affiliation(s)
- Takuya Ishida
- Department of System Neurophysiology, and Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan; Department of Neuropsychiatry, Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.
| | - Tomohiro Donishi
- Department of System Neurophysiology, and Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Jun Iwatani
- Department of Neuropsychiatry, Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Shinichi Yamada
- Department of Neuropsychiatry, Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Shun Takahashi
- Department of Neuropsychiatry, Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Satoshi Ukai
- Department of Neuropsychiatry, Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Kazuhiro Shinosaki
- Department of Neuropsychiatry, Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Masaki Terada
- Wakayama-Minami Radiology Clinic, 870-2 Kimiidera, Wakayama 641-0012, Japan
| | - Yoshiki Kaneoke
- Department of System Neurophysiology, and Graduate School of Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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Janiri D, Di Nicola M, Martinotti G, Janiri L. Who's the Leader, Mania or Depression? Predominant Polarity and Alcohol/Polysubstance Use in Bipolar Disorders. Curr Neuropharmacol 2017; 15:409-416. [PMID: 28503113 PMCID: PMC5405613 DOI: 10.2174/1570159x14666160607101400] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Predominant polarity characterises patients who mainly manifest recurrences of depression or mania/hypomania. Alcohol use disorder (AUD) and polysubstance use (PSU), which often complicate bipolar disorder (BD) and affect its clinical course, can influence predominant polarity. Nevertheless, previous studies have not clarified if BD patients differ in predominant polarity from BD patients with substance use disorder (SUD) comorbidity. OBJECTIVE The aim of this study was to compare predominant polarity between BD without SUD, BD with AUD and BD with PSU. We also investigated the association between predominant polarity and first episode polarity in each diagnostic group. METHOD We evaluated predominant polarity (≥2:1 lifetime depressive vs. manic/hypomanic episodes) in 218 DSM-IV-TR BD patients. Specifically, data were obtained from 86 patients with BD without SUD, 69 patients with BD and AUD, and 63 patients with BD and PSU with alcohol as the primary substance abused. RESULTS The three groups significantly differed for predominant polarity. The most common predominant polarity in BD without SUD was manic, while in BD with AUD and in BD with PSU it was depressive. Uncertain predominant polarity was the least common in BD without SUD and BD with PSU, whereas in BD with AUD, manic predominant polarity was least common. Predominant polarity matched onset polarity in all groups. CONCLUSION BD without SUD, BD with AUD, and BD with PSU have different predominant polarities. The correspondence between predominant polarity and polarity at the onset may impact diagnosis and treatment of BD.
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Affiliation(s)
- Delfina Janiri
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Martinotti
- Department of Neuroscience and Imaging, Institute of Psychiatry, “G. D’Annunzio” University of Chieti, Pescara, Italy
- Clinica Villa Maria Pia, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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Abstract
OBJECTIVE A recent study reported an 8% increase in bipolar diagnoses in public and community mental health services in New South Wales from 2003 to 2014, an increase interpreted by the authors as reflecting increasing diagnostic boundaries of bipolar disorder, and bipolar II in particular. If valid, we would expect an increase in hospital admissions for hypomania as well as for mania and so analysed a relevant dataset to test that hypothesis. METHODS Data were examined for 27,255 individuals hospitalised in NSW psychiatric hospitals over a 14-year period (2000-2014) for ICD-10 diagnosed mania or hypomania and with analyses examining rates of hospitalisation/per year for both mania and for hypomania. RESULTS While overall admissions for mania and hypomania increased over the study period by 16.4%, admissions for mania increased by 31.0% and admissions for hypomania actually decreased by 32.1%. CONCLUSION The increased rate in admissions of those with a bipolar disorder appears to reflect a trend over more than four decades. The hypothesis that any increase in the diagnostic boundaries of bipolar II disorder would be associated with an increase in hospitalisation rates was rejected, with the converse trend being identified.
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Affiliation(s)
- Gordon Parker
- Scientia Professor of Psychiatry, University of New South Wales, Sydney, NSW, and; Professorial Fellow, Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rebecca Graham
- Research Assistant, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder: A naturalistic study. J Affect Disord 2017; 208:521-527. [PMID: 27816324 DOI: 10.1016/j.jad.2016.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022]
Abstract
AIM In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional level, the presence of comorbid personality disorders and coping strategies. METHODS Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style using the Coping Inventory for Stressful Situations. RESULTS In total, 344 patients were included (BD I (n=163) and BD II (n=181). Patients with BD II presented with significantly more depressive symptoms, more cognitive complaints, lower overall functioning, and a higher prevalence of comorbid personality disorders. Finally, they exhibited a trend towards using less adaptive coping styles. LIMITATION It cannot be omitted that some patients may have progressed from BD II to BD I. Most measures were based on patient self report. CONCLUSIONS Overall, BD II was associated with a higher disease burden. Clinically, it is important to differentiate BD II from BD I and research wise, there is a need for tailoring and testing specific interventions towards BD II.
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Dell'Osso B, Grancini B, Vismara M, De Cagna F, Maggi M, Molle M, Cremaschi L, Miller S, Ketter TA, Altamura AC. Age at onset in patients with bipolar I and II disorder: a comparison of large sample studies. J Affect Disord 2016; 201:57-63. [PMID: 27177297 DOI: 10.1016/j.jad.2016.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/14/2016] [Accepted: 04/11/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bipolar Disorder (BD) is a leading cause of disability worldwide and factors contributing to its burden include chronic relapsing course, comorbidity, suicide risk, and early age at onset (AAO). In particular, recent investigation has shown that BD onset may occur earlier than previously believed, even though whether BDI and II are different in such regard is still debated. Reduced samples may, moreover, limit the confidence in the published studies, with geographic issues, in turn, representing potentially conditioning factors. The present review was aimed to select and analyze large sample studies comparing AAO in BDI vs II patients. METHODS A PubMed literature search was performed, considering English-written articles published up to December 2015, comparing AAO in BDI vs II patients with sample size≥100 subjects per group. RESULTS Seventeen studies were considered suitable for revision, with 8 studies reporting statistically significant differences and 9 not. Among studies reporting statistically significant differences, mostly conducted in Europe, 6 showed an earlier AAO in BDI, while 2 in BDII subjects. LIMITATIONS Only studies with large samples included, considering AAO as a continuous variable, and providing a comparison between the bipolar subtypes. CONCLUSIONS Our findings suggest that AAO per se does not seem to reliably differentiate BDI from BDII patients and that such variable should likely be investigated in the context of other clinical characteristics, in order to assess its overall influence over BD course. Geographic factors may, in turn, play a potential role with future investigation warranted to further explore this specific issue.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA.
| | - Benedetta Grancini
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Vismara
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca De Cagna
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Maggi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Molle
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shefali Miller
- Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - Terence A Ketter
- Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Chang TT, Chen SL, Chang YH, Chen PS, Chu CH, Chen SH, Huang SY, Tzeng NS, Wang LJ, Wang TY, Li CL, Chung YL, Hsieh TH, Lee IH, Chen KC, Yang YK, Hong JS, Lu RB, Lee SY. The DRD3 Ser9Gly Polymorphism Predicted Metabolic Change in Drug-Naive Patients With Bipolar II Disorder. Medicine (Baltimore) 2016; 95:e3488. [PMID: 27310943 PMCID: PMC4998429 DOI: 10.1097/md.0000000000003488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with bipolar II disorder (BDII) have a higher prevalence rate of metabolic disturbance. Whether BDII itself, in addition to its current standard treatment, is a risk factor for metabolic syndrome warrants additional study. The dopamine receptor D3 (DRD3) gene, one of the candidate genes for BDII, is also involved in the dopaminergic system. We investigated whether it is related to changes in the metabolic indices of patients with BDII given 12 weeks of standard treatment.Patients with a first diagnosis of BDII (n = 117) were recruited. Metabolic profiles (cholesterol, triglycerides, fasting serum glucose, body mass index) were measured at baseline and at 2, 8, and 12 weeks. The genotype of the DRD3 Ser9Gly polymorphism (rs6280) was determined. Multiple linear regressions with generalized estimating equation methods were used.Seventy-six (65.0%) patients completed the 12-week intervention. Significant differences in triglyceride change were associated with the DRD3 Ser9Gly genotype (P = 0.03). Patients with the Ser/Ser genotype had significantly smaller triglyceride increases and a lower risk of developing metabolic syndrome than did those with the Ser/Gly+Gly/Gly genotype. However, the associations between the DRD3 Ser9Gly polymorphism with changes in triglyceride level become nonsignificant after correcting for multiple comparisons.We conclude that the DRD3 Ser9Gly polymorphism is nominally associated with changes in triglycerides and metabolic syndrome after 12 weeks of standard BDII treatment.
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Affiliation(s)
- Ting-Ting Chang
- From the Department of Psychiatry, E-Da Hospital, I-Shou University (T-TC); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University (KMU), Lipid Science and Aging Research Center, KMU, Kaohsiung (S-LC); Department of Psychiatry, National Cheng Kung University Hospital, Tainan (S-LC, Y-HC, P-SC, T-YW, C-LL, Y-LC, T-HH, I-HL, K-CC, Y-KY, R-BL, S-YL); Department of Psychology, Asia University, Taichung (Y-HC); Institute of Allied Health, College of Medicine (Y-HC, R-BL); Department of Psychiatry, College of Medicine (P-SC, T-YW, I-HL, K-CC, Y-KY, R-BL, S-YL); Addiction Research Center (P-SC, R-BL); Institute of Molecular Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C-HC); Neurobiology Laboratory, NIH/NIEHS, Research Triangle Park, North Carolina (S-HC, J-SH); Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (S-YH, N-ST); Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung (L-JW); Institute of Basic Medical Sciences, National Cheng Kung University, Tainan (Y-LC); Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin (Y-KY); Institute of Behavioral Medicine Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan (R-BL); Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan (R-BL); Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (S-YL)
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Samalin L, Vieta E, Okasha TA, Uddin MJ, Ahmadi Abhari SA, Nacef F, Mishyiev V, Aizenberg D, Ratner Y, Melas-Melt L, Sedeki I, Llorca PM. Management of bipolar disorder in the intercontinental region: an international, multicenter, non-interventional, cross-sectional study in real-life conditions. Sci Rep 2016; 6:25920. [PMID: 27181262 PMCID: PMC4867470 DOI: 10.1038/srep25920] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/25/2016] [Indexed: 01/29/2023] Open
Abstract
Most of the existing data on real-life management of bipolar disorder are from studies conducted in western countries (mostly United States and Europe). This multinational, observational cohort study aimed to describe the management and clinical outcomes of bipolar patients in real-life conditions across various intercontinental countries (Bangladesh, Egypt, Iran, Israel, Tunisia, and Ukraine). Data on socio-demographic and disease characteristics, current symptomatology, and pharmacological treatment were collected. Comparisons between groups were performed using standard statistical tests. Overall, 1180 patients were included. The median time from initial diagnosis was 80 months. Major depressive disorder was the most common initial diagnosis. Mood stabilizers and antipsychotics were the most common drugs being prescribed at the time of the study. Antidepressants (mainly selective serotonin uptake inhibitors [SSRIs]) were administered to 36.1% of patients. Patients with bipolar I disorder received higher number of antipsychotics and anxiolytics than those with bipolar II disorder (p < 0.001). Presence of depressive symptoms was associated with an increase in antidepressant use (p < 0.001). Bipolar disorder real-life management practice, irrespective of region, shows a delay in diagnosis and an overuse of antidepressants. Clinical decision-making appears to be based on a multidimensional approach related to current symptomatology and type of bipolar disorder.
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Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, EA7280, University of Auvergne, Clermont-Ferrand, France.,Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Tarek Ahmed Okasha
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mm Jalal Uddin
- National Institute of Neurosciences and Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh
| | | | - Fethi Nacef
- Psychiatric Department, Razi Hospital, Manouba, Tunisia
| | | | - Dovi Aizenberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaël Ratner
- Sha'ar Menashe Mental Health Center (MHC), Technion Institute of Technology, Haifa, Israel
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The prevalence and predictors of bipolar and borderline personality disorders comorbidity: Systematic review and meta-analysis. J Affect Disord 2016; 195:105-18. [PMID: 26881339 DOI: 10.1016/j.jad.2016.01.040] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/04/2016] [Accepted: 01/24/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Data about the prevalence of borderline personality (BPD) and bipolar (BD) disorders comorbidity are scarce and the boundaries remain controversial. We conducted a systematic review and meta-analysis investigating the prevalence of BPD in BD and BD in people with BPD. METHODS Two independent authors searched MEDLINE, Embase, PsycINFO and the Cochrane Library from inception till November 4, 2015. Articles reporting the prevalence of BPD and BD were included. A random effects meta-analysis and meta-regression were conducted. RESULTS Overall, 42 papers were included: 28 considering BPD in BD and 14 considering BD in BPD. The trim and fill adjusted analysis demonstrated the prevalence of BPD among 5273 people with BD (39.94 ± 11.78 years, 44% males) was 21.6% (95% CI 17.0-27.1). Higher comorbid BPD in BD were noted in BD II participants (37.7%, 95% CI 21.9-56.6, studies=6) and North American studies (26.2%, 95% CI 18.7-35.3, studies=11). Meta regression established that a higher percentage of males and higher mean age significantly (p<0.05) predicted a lower prevalence of comorbid BPD in BD participants. The trim and fill adjusted prevalence of BD among 1814 people with BPD (32.22 ± 7.35 years, 21.5% male) was 18.5% (95% CI 12.7-26.1). LIMITATIONS Paucity of longitudinal/control group studies and accurate treatment records. CONCLUSIONS BPD-BD comorbidity is common, with approximately one in five people experiencing a comorbid diagnosis. Based on current diagnostic constructs, and a critical interpretation of results, both qualitative and quantitative syntheses of the evidence prompt out the relevance of differences rather similarities between BD and BPD.
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Solé B, Jiménez E, Torrent C, Del Mar Bonnin C, Torres I, Reinares M, Priego Á, Salamero M, Colom F, Varo C, Vieta E, Martínez-Arán A. Cognitive variability in bipolar II disorder: who is cognitively impaired and who is preserved. Bipolar Disord 2016; 18:288-99. [PMID: 27112120 DOI: 10.1111/bdi.12385] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/26/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Although it is well established that euthymic patients with bipolar disorder can have cognitive impairment, substantial heterogeneity exists and little is known about the extent and severity of impairment within the bipolar II disorder subtype. Therefore, the main aim of this study was to analyze cognitive variability in a sample of patients with bipolar II disorder. METHODS The neuropsychological performance of 116 subjects, including 64 euthymic patients with bipolar II disorder and 52 healthy control subjects, was examined and compared by means of a comprehensive neurocognitive battery. Neurocognitive data were analyzed using a cluster analysis to examine whether there were specific groups based on neurocognitive patterns. Subsequently, subjects from each cluster were compared on demographic, clinical, and functional variables. RESULTS A three-cluster solution was identified with an intact neurocognitive group (n = 29, 48.3%), an intermediate or selectively impaired group (n = 24, 40.0%), and a globally impaired group (n = 7, 11.6%). Among the three clusters, statistically significant differences were observed in premorbid intelligence quotient (p = 0.002), global functional outcome (p = 0.021), and leisure activities (p = 0.001), with patients in the globally impaired cluster showing the lowest attainments. No differences in other clinical characteristics were found among the groups. CONCLUSIONS These results confirm that neurocognitive variability is also present among patients with bipolar II disorder. Approximately one-half of the patients with bipolar II disorder were cognitively impaired, and among them 12% were severely and globally impaired. The identification of different cognitive profiles may help to develop cognitive remediation programs specifically tailored for each cognitive profile.
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Affiliation(s)
- Brisa Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Carla Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina Del Mar Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Imma Torres
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ángel Priego
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
| | - Manel Salamero
- Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS CIBERES, Barcelona, Catalonia, Spain
| | - Francesc Colom
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cristina Varo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Samalin L, Murru A, Vieta E. Management of inter-episodic periods in patients with bipolar disorder. Expert Rev Neurother 2016; 16:659-70. [PMID: 27058008 DOI: 10.1080/14737175.2016.1176530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The management of inter-episodic periods of bipolar disorder (BD) appears complex as it combines several therapeutic approaches and takes into account individual characteristics of BD patients. Over recent decades, new evidence has been provided about pharmacological treatments, psychosocial interventions or models of care for the long-term management of BD patients. Considering this, guidelines for the maintenance treatment of BD should be regarded as an evidence-based ground for everyday clinical practice in real-life setting. This article critically reviews recently published clinical guidelines on the management of BD patients during the inter-episodic phases of illness, in order to highlight the consensual or controversial recommendations.
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Affiliation(s)
- Ludovic Samalin
- a Bipolar Disorder Unit, Institute of Neuroscience , Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Spain.,b Department of Psychiatry , CHU Clermont-Ferrand, University of Auvergne , EA 7280 Clermont-Ferrand , France
| | - Andrea Murru
- a Bipolar Disorder Unit, Institute of Neuroscience , Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Spain
| | - Eduard Vieta
- a Bipolar Disorder Unit, Institute of Neuroscience , Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Spain
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Abstract
Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression. Moreover, there are currently no valid biomarkers for the disorder. Therefore, the role of clinical assessment remains key. Detection of hypomanic periods and longitudinal assessment are crucial to differentiate bipolar disorder from other conditions. Current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder is of utmost importance.
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Affiliation(s)
- Iria Grande
- Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, and Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eduard Vieta
- Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
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