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Chumakov E, Ashenbrenner Y, Gvozdetskii A, Limankin O, Petrova N. Individual Burden of Illness Index in Bipolar Disorder Remission: A Cross-Sectional Study. CONSORTIUM PSYCHIATRICUM 2024; 5:17-30. [PMID: 39072003 PMCID: PMC11272304 DOI: 10.17816/cp15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/31/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND A population-based method for estimating disease burden is commonly used. Nevertheless, these measurements do not entirely capture the comprehensive burden of illness on an individual patient. To address the problem, the Individual Burden of Illness Index (IBI index) Index was created and validated, specifically for major depressive disorder. The IBI represents the overall influence of the condition, encompassing distress from symptom intensity, functional impairment, and the patient's quality of life. AIM The aim of the study was to approve and validate the IBI index for the integral assessment of disease burden in patients with bipolar disorder (BD) in remission. METHODS The cross-sectional study was conducted in the outpatient psychiatric services in Saint Petersburg, Russia, from April through October 2020. Eighty-five patients aged 18 to 45 (mean age 36.6±5.7 years) with BD (type I - 75%, n=64; type II - 25%, n=21) in remission were examined. The study procedure included a structured clinical interview and the use of clinical scales: the World Health Organization's Quality of Life Questionnaire, Hamilton Rating Scale for Depression (HDRS), Young Mania Rating Scale (YMRS), and Personal and the Social Performance Scale. RESULTS The principal component analysis in accordance with the adjusted one showed that the burden of illness in patients with BD in remission is directly related to the severity of residual depressive symptoms, reflected in the HDRS score: as the HDRS score increases (0.27, p <0.001), residual mania (-0.14, p <0.001), social functioning (-0.06, p <0.001), and quality of life (-0.04, p <0.001) decrease. In contrast, when there are remaining residual mania symptoms, as indicated by the YMRS score, the result tends to be a lower burden, better social functioning, and enhanced quality of life. CONCLUSION The study has demonstrated through statistical means a successful adaptation and validation of the previously calculated IBI index for patients with BD in remission. Residual affective symptoms were shown to have different impacts on the social functioning of patients with BD in remission, indicating the need for a timely assessment and targeted therapy of these symptoms in such patients.
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Azevedo J, Carreiras D, Guiomar R, Martins MJ, Macedo A, Castilho P. Validation of the Bipolar Recovery Questionnaire for the Portuguese Population: Recovery and Predictors in People with Bipolar Disorder. ACTA MEDICA PORT 2024; 37:368-378. [PMID: 38621253 DOI: 10.20344/amp.20790] [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: 10/09/2023] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The paradigm in mental health care is progressively moving towards a recovery-focused perspective. Thus, there is a need for validated instruments to measure recovery in bipolar disorder (BD). The Bipolar Recovery Questionnaire (BRQ) is the most used instrument to assess it. The aim of this study was to translate and perform a cross-cultural adaptation of the BRQ to European Portuguese (PT-PT) and to explore further associations of recovery with sociodemographic and emotional regulation, as well as recovery predictors to inform future research and clinical practice. METHODS The BRQ was forward-translated and back-translated until a consensus version was found, and a test-retest design was used to assess temporal stability. Participants were recruited in public hospitals and organizations supporting people with BD, either referred by their psychiatrists or psychologists or through self-referral. Eighty-eight individuals diagnosed with BD were recruited to complete a battery of Portuguese-validated self-report questionnaires to assess recovery (BRQ), clinical mood symptoms (Hospital Anxiety and Depression Scale), affect (Positive and Negative Affect Scale), well-being (brief Quality of Life for Bipolar Disorder; Satisfaction with Life Scale) and emotion regulation (Difficulties in Emotion Regulation Scale). RESULTS The BRQ showed excellent internal consistency with a Cronbach alpha of 0.92, and test-retest exhibited good reliability (r = 0.88). Construct validity was confirmed through/by positive and moderate correlations with quality of life (QoL; r = 0.58) and positive affect (r = 0.52), and negative moderate correlations with depression (r = -0.64), and negative affect (r = -0.55). Both satisfaction with life (β = 0.38, p = 0.010) and recovery (β = 0.34, p = 0.022) impacted quality of life, supporting the BRQ's incremental validity. Depressive symptoms and emotion dysregulation accounted for 51% of its variance. CONCLUSION The BRQ is a valid and reliable instrument to measure recovery in people with BD in the Portuguese population and is suitable for both clinical and research contexts.
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Affiliation(s)
- Julieta Azevedo
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra; Institute of Psychological Medicine (IPM). Faculdade de Medicina. Universidade de Coimbra. Coimbra; School of Psychology and Sport Science. Bangor University. Bangor. United Kingdom
| | - Diogo Carreiras
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra; Instituto Superior Miguel Torga. Coimbra. Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Portugal
| | - Maria João Martins
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra; Institute of Psychological Medicine (IPM). Faculdade de Medicina. Universidade de Coimbra. Coimbra; Serviços Médicos Universitários. Universidade de Coimbra. Coimbra. Portugal
| | - António Macedo
- Institute of Psychological Medicine (IPM). Faculdade de Medicina. Universidade de Coimbra. Coimbra; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT). Coimbra; Centro Hospitalar e Universitário de Coimbra (CHUC). Coimbra. Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Portugal
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Ciftci E, Farhad S, Metin B, Tarhan N. Neurocognition across bipolar disorder phases compared to healthy subjects. Cogn Neuropsychiatry 2024; 29:73-86. [PMID: 38335235 DOI: 10.1080/13546805.2024.2313387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Bipolar disorder (BD) is associated with cognitive abnormalities that may persist during euthymia and are linked to poor occupational performance. The cognitive differences between phases of BD are not well known. Therefore, a cross-sectional study with a relatively large population was conducted to evaluate the differences among BD phases in a wide range of neurocognitive parameters. METHODS Neuropsychological profile of 169 patients with a diagnosis of BD in manic, depressive, mixed, and euthymic phases between the ages of 18 and 70 years were compared to 45 healthy individuals' between ages of 24 and 69 years. The working memory (digit-span backward test), face recognition, executive functions (verbal fluency and Stroop test), face recognition, and visual and verbal memory (immediate and delayed recall) were evaluated. For BD subgroup analyses, we used the Kruskal-Wallis (KW) test. Then, for the comparison of BD versus healthy individuals, we used the Mann-Whitney U (MWU) test. RESULTS Analyses based on non-parametric tests showed impairments in BD for all tests. There were no significant differences between phases. CONCLUSION Cognitive performance in patients with BD appears to be mostly unrelated to the phase of the disorder, implying that cognitive dysfunction in BD is present even during remission.
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Affiliation(s)
- Elvan Ciftci
- Department of Psychiatry, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
| | - Shams Farhad
- Clinical Neuroscience, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
| | - Baris Metin
- Department of Neurology, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
| | - Nevzat Tarhan
- Department of Psychiatry, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
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Mengistu ME, Berassa SH, Kassaw AT, Dagnew EM, Mekonen GA, Birarra MK. Assessments of functional outcomes and its determinants among bipolar disorder patients in Northwest Ethiopia comprehensive specialized hospitals: a multicenter hospital-based study. Ann Gen Psychiatry 2023; 22:14. [PMID: 37024899 PMCID: PMC10077702 DOI: 10.1186/s12991-023-00444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Bipolar disorder is a severe and chronic mental illness that could continue for a lifetime. Although it is a leading cause of disability and impairments for significant numbers of patients, the levels of functional outcomes have not been studied in Ethiopia. Therefore, this study aimed to assess the functional outcome levels and associated factors among bipolar disorder patients in Northwest Ethiopia. METHOD Hospital-based cross-sectional study was employed among bipolar disorder patients attending psychiatric clinics, in Northwest Ethiopia, from April to June 2021. Systematic random sampling was used to get respondents. Descriptive and inferential statistics were done. Data were entered into EpiData version 4.6.02 and exported to SPSS Version 22 for analysis. Bivariable and multivariable binary logistic regression analysis was used to identify the factors associated with functional outcome levels, and p value < 0.05 was considered significant with 95% CI. RESULT Of the total 423 study participants approached, only 411 completed the questionnaire, with a response rate of 97.2%. The median (IQR) level of functional outcome was 6 (0-22) and 40% of the study subjects were impaired. Leisure time was the most normal functioning domain (92.2%), whereas cognitive (43.5%) and occupational (41.6%) domains were the most impaired domains. Unemployment (AOR (95%CI) = 3.9 (1.46-10.49), obesity (AOR (95% CI) = 6.5 (1.22-34.58), depressed and manic mood phases (AOR (95%CI) = 5.2 (2.84-9.35) and (AOR (95%CI) = 7.8 (3.31-18.34) respectively, medication non-adherence (AOR (95% CI) = 3.2 (1.71-6.05), and relapsed once or ≥ twice (AOR (95%CI) = 2.2 (1.25-3.98) and (AOR (95%CI) = 8.3 (2.73-25.30), respectively, were some of the important predictor variables that were significantly associated to the functional impairments levels. CONCLUSION The median of functional outcomes levels was found in an acceptable range; however, significant numbers of bipolar patients were functionally impaired. Moreover, patients still need unrestricted interventions in the cognitive and occupational functional domains. Socio-demographic, clinical, medication, and psychosocial variables were significantly associated with functional outcomes. Bipolar patients need to be followed and managed to improve their functional outcome and all stakeholders should be involved to achieve the recommended levels.
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Affiliation(s)
- Melak Erara Mengistu
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Science, Gondar, Ethiopia
| | - Simegnew Handebo Berassa
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, Addis Ababa, Ethiopia
| | - Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Medicine and Health Science, Woldia University, P.O. Box: 400, Woldia, Ethiopia.
| | - Ephrem Mebratu Dagnew
- Department of Pharmacy, College of Medicine and Health Science, Debre Markos University Debre Markos, Debre Markos, Ethiopia
| | - Gizework Alemnew Mekonen
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Science, Gondar, Ethiopia
| | - Mequanent Kassa Birarra
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Science, Gondar, Ethiopia
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Wang W, Du J, Li S, Xie G, Xu J, Ren Y. Demographic, clinical and biochemical correlates of the length of stay for different polarities in Chinese inpatients with bipolar disorder: A real-world study. Front Hum Neurosci 2023; 17:1135403. [PMID: 36936616 PMCID: PMC10014706 DOI: 10.3389/fnhum.2023.1135403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction: Many patients with bipolar disorder (BD) need hospitalization, while the number of hospital beds for these patients is limited. Managing the length of stay (LOS) is an effective solution to this issue. Research on LOS and its influencing factors in BD is limited in China. This study aimed to identify the factors relevant to LOS in different polarities in Chinese patients with BD. Method: This was a real-world, cross-sectional study. Data were obtained from the electronic medical record system. Patients admitted to Beijing Anding Hospital between Jan 2014 and Dec 2017 and diagnosed with BD were included. Demographic information, clinical characteristics, and biochemical variables were collected. Patients were classified into short and long LOS groups based on a cutoff value. A univariate study and a multivariate logistic regression analysis were performed to identify variables related to LOS in various BD polarities. The receiver operating characteristic (ROC) analysis was utilized to evaluate the discrimination accuracy of the regression model. Result: Four thousand six hundred and seventy-five visits from 4,451 individuals were included in the analysis. For the whole sample, unmarried status, psychotic features, and family history of mental disorders were positively associated with long LOS (all p < 0.05). There was an additive interaction between a family history of mental disorders and polarities (p < 0.05). For manic episodes, unmarried status, psychotic features, and family history of mental disorders were positively associated with long LOS (all p < 0.05). For depressive episodes, psychotic features and high-density lipoprotein cholesterol (HDLC) levels were positively associated with long LOS (all p < 0.05). For mixed states, unmarried status was positively associated with long LOS, while low-density lipoprotein cholesterol (LDLC) levels were negatively associated with LOS (all p < 0.05). The area under the curve (AUC) values for depressive episodes, manic episodes, and mixed states in the combined model were 0.587, 0.553, and 0.619, respectively (all p < 0.05). Discussion: The findings suggested that LOS correlates differed by polarity, with marital status, psychotic features, a family history of mental disorders, and lipid levels strongly linked with LOS in patients with BD.
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Affiliation(s)
- Wei Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing Du
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sheng Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gaoming Xie
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jinjie Xu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jinjie Xu Yanping Ren
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- *Correspondence: Jinjie Xu Yanping Ren
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Mezes B, Lobban F, Costain D, Hillier L, Longson D, Varese F, Jones SH. Recovery beyond clinical improvement - Recovery outcomes measured for people with bipolar disorder between 1980 and 2020. J Affect Disord 2022; 309:375-392. [PMID: 35469910 DOI: 10.1016/j.jad.2022.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Outcome measurement in bipolar disorder (BD) traditionally focused on clinical improvement without considering other domains. Improvement trajectories in clinical and social-functional domains are different and can simultaneously appear in one while not in other domains. Measuring personal recovery (PR) has become a priority internationally. This review explored the shift in research investigating operational recovery definitions and underpinning factors of recovery in BD over the past four decades. METHODS Studies defining recovery domains (other than clinical recovery) in BD were systematically reviewed; operational recovery definitions and factors assessed in association with recovery were thematically categorised and integrated in a narrative synthesis. RESULTS Thirty-three studies, comprising 3638 participants from 19 countries were included. Identified operational recovery definition themes included i) PR ii) social-functional (SFR), and iii) occupational-residential (ORR) recovery. Examined factors were grouped as demographic, clinical and psychosocial factors. Predominantly demographic factors were linked to ORR and clinical factors to SFR. Depressive symptomatology was the only clinical factor associated with PR. Research investigating psychosocial factors in PR is emerging and has showed that resilience and appraisals of mood seem to be associated with PR. LIMITATIONS Studies not available in English or examining functioning without defining recovery were excluded. CONCLUSIONS Earlier operational recovery definitions of ORR and SFR were often arbitrary and inconsistent, and predominantly focused on clinical and demographic underpinning factors. While research attempts to follow the significant policy shifts towards personalised care by measuring what matters to individuals and exploring broader underpinning psychosocial factors, it is still lagging behind.
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Affiliation(s)
- Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK; Centre of Resilience for Social Justice, School of Sport and Health Sciences, University of Brighton, Brighton, UK.
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Deborah Costain
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Laura Hillier
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Damien Longson
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Filippo Varese
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, the University of Manchester, Manchester, UK
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
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Koene J, Zyto S, van der Stel J, van Lang N, Ammeraal M, Kupka RW, van Weeghel J. The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review. Int J Bipolar Disord 2022; 10:8. [PMID: 35286505 PMCID: PMC8921376 DOI: 10.1186/s40345-022-00255-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning. Objectives The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation. Methods We applied the methodological framework as described by Arksey and O’Malley (Int J Soc Res Methodol Theory Pract 8:19–32, 2005) and Levac et al. (Implement Sci 5:1–9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results. Results The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined. Conclusion Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00255-7.
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Affiliation(s)
- Juul Koene
- University of Applied Sciences Leiden, Leiden, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Susan Zyto
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. .,Mental Health Service Organisation North Holland North, Hoorn, The Netherlands.
| | | | | | - Marion Ammeraal
- GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands.,Phrenos Center of Expertise, Utrecht, The Netherlands
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Kupka R, Duffy A, Scott J, Almeida J, Balanzá‐Martínez V, Birmaher B, Bond DJ, Brietzke E, Chendo I, Frey BN, Grande I, Hafeman D, Hajek T, Hillegers M, Kauer‐Sant’Anna M, Mansur RB, van der Markt A, Post R, Tohen M, Tremain H, Vazquez G, Vieta E, Yatham LN, Berk M, Alda M, Kapczinski F. Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force. Bipolar Disord 2021; 23:659-678. [PMID: 34174130 PMCID: PMC9290926 DOI: 10.1111/bdi.13105] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Clinical staging is widely used in medicine to map disease progression, inform prognosis, and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking. METHODS Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders. RESULTS Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthreshold stages, and to various clinical stages of BD as it is currently diagnosed. CONCLUSION The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light.
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Affiliation(s)
- Ralph Kupka
- Department of PsychiatryAmsterdam Public Mental Health Research InsituteAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | - Anne Duffy
- Department of PsychiatryDivision of Student Mental HealthQueen's UniversityCote Sharp Student Wellness CentreKingstonONCanada,Department of PsychiatryUniversity of OxfordOxfordUK
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Brain and Mind CentreThe University of SydneySydneyNSWAustralia
| | - Jorge Almeida
- Department of Psychiatry and Behavior SciencesDell Medical SchoolUniversity of Texas at AustinAustinTXUSA
| | - Vicent Balanzá‐Martínez
- Teaching Unit of Psychiatry and Psychological MedicineDepartment of MedicineUniversity of ValenciaCIBERSAMValenciaSpain
| | | | - David J. Bond
- Department of Psychiatry and Behavioral SciencesUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Elisa Brietzke
- Department of PsychiatryQueen's University School of MedicineKingstonONCanada,Centre for Neuroscience StudiesQueen’s UniversityKingstonONCanada
| | - Ines Chendo
- Psychiatry DepartmentDepartment of NeurosciencesHospital Santa MariaLisbonPortugal,Clínica Universitária de PsiquiatriaFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada,Mood Disorders Program and Women's Health Concerns ClinicSt. Joseph's Healthcare HamiltonHamiltonONCanada
| | - Iria Grande
- Barcelona Bipolar Disorders and Depressive UnitHospital ClinicInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Danella Hafeman
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center‐Sophia Children’s HospitalRotterdamThe Netherlands
| | - Marcia Kauer‐Sant’Anna
- Department of PsychiatryFaculty of MedicineUniversidade Federal do Rio Grande do Sul (UFRGSHospital de Clínicas de Porto Alegre (HCPAPorto AlegreBrazil
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - Afra van der Markt
- Department of PsychiatryAmsterdam Public Mental Health Research InsituteAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | - Robert Post
- George Washington University School of MedicineWashingtonDCUSA,Bipolar Collaborative NetworkBethesdaMDUSA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral SciencesUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | - Hailey Tremain
- Centre for Mental HealthFaculty of Health Arts and DesignSwinburne UniversityMelbourneVicAustralia,OrygenThe National Centre of Excellence in Youth Mental HealthParkvilleVicAustralia
| | | | - Eduard Vieta
- Hospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Michael Berk
- IMPACT – the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthDeakin UniversityGeelongVicAustralia,OrygenThe National Centre of Excellence in Youth Mental HealthCentre for Youth Mental HealthFlorey Institute for Neuroscience and Mental HealthDepartment of PsychiatryThe University of MelbourneMelbourneVicAustralia
| | - Martin Alda
- Department of PsychiatryMood Disorders ClinicDalhousie UniversityHalifaxNCCanada
| | - Flávio Kapczinski
- St. Joseph’s Healthcare Hamilton McMaster UniversityHamiltonONCanada,Universidade Federal do Rio Grande do SulUFRGSPorto AlegreBrazil
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Vieta E, Calabrese JR, Whelan J, Tohen M, Earley WR. The efficacy of cariprazine on function in patients with bipolar depression: a post hoc analysis of a randomized controlled trial. Curr Med Res Opin 2021; 37:1635-1643. [PMID: 34034612 DOI: 10.1080/03007995.2021.1932446] [Citation(s) in RCA: 5] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Individuals with bipolar depression often experience functional impairment that interferes with recovery. These analyses examined the effects of cariprazine on functional outcomes in patients with bipolar I disorder. METHODS Prespecified analyses of data from a randomized, double-blind, placebo-controlled pivotal trial of cariprazine in bipolar I depression (NCT01396447) evaluated mean changes from baseline to week 8 in Functional Assessment Short Test (FAST) total score. Post hoc analyses with no adjustment for multiplicity evaluated FAST subscale scores, functional recovery and remission (FAST total score ≤11 and ≤20, respectively), and 30% or 50% improvement from baseline. RESULTS There were 393 patients with bipolar I disorder (placebo = 132; cariprazine: 1.5 mg/d = 135, 3 mg/d = 126) in the FAST analysis population. Statistically significant differences were noted for cariprazine 1.5 mg/d versus placebo in mean change from baseline in FAST total score (p<.01) and on 5 of 6 subscale scores (p<.05); cariprazine 3 mg/d was significantly different than placebo on the Interpersonal Relationship subscale (p<.05). Rates of functional remission and recovery, and ≥30% or ≥50% improvement were significantly greater for cariprazine 1.5 mg/d versus placebo (p<.05 all); the percentage of patients with ≥30% improvement was significantly different for cariprazine 3 mg/d versus placebo (p<.05). CONCLUSION At week 8, statistically significant improvements in FAST outcomes were observed for cariprazine versus placebo in patients with bipolar I depression; more consistent results were noted for 1.5 mg/d than 3 mg/d. In addition to improving bipolar depression symptoms, these results suggest that cariprazine may improve functional outcomes.
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Affiliation(s)
- Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Joseph R Calabrese
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jessica Whelan
- Department of Nursing, Maryville University, Saint Louis, MO, USA
- Holon Inclusive Health Care, Dupo, IL, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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10
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Liu X, Ma X, Wang W, Zhang J, Sun X, Luo X, Zhang Y. The functional impairment of different subtypes and occupational states in euthymic patients with bipolar disorder. BMC Psychiatry 2021; 21:240. [PMID: 33957876 PMCID: PMC8103625 DOI: 10.1186/s12888-021-03242-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim was to explore the associations between clinical symptoms, demographic variables, social and neurocognitive functioning in euthymic patients with bipolar disorder (BD) stratified by subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)) and occupational status (employed/unemployed), and to highlight the significance of occupational status when assessing social and neurocognitive functioning in euthymic BD patients. METHODS A total of 81 euthymic BD patients were participated in the study. The severity of the depressive and manic/hypomanic symptoms was measured using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Social functioning and neurocognitive functioning were evaluated by the Functioning Assessment Short Test (FAST) and neurocognitive measures, respectively. RESULTS Employed BD patients displayed greater social functioning (autonomy, occupational functioning, interpersonal relationship domain) and better verbal learning performance and speed of processing than unemployed BD patients. The correlation between neurocognitive functioning and social functioning was stronger in the employed group than in the unemployed group. There were no significant differences in neurocognitive and social functioning between the BD-I and BD-II groups, and the correlation between neurocognitive functioning and social functioning was similar between the BD-I and BD-II groups. CONCLUSION Employed BD patients may present greater occupational functioning and interpersonal relationships, as well as better verbal learning performance and speed of processing.
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Affiliation(s)
- Xinyu Liu
- Henan Key Laboratory of Neurorestoratology, the first Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | | | - Wenchen Wang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Jian Zhang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Xia Sun
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yong Zhang
- Henan Key Laboratory of Neurorestoratology, the first Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China.
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COVID-19 lockdown in people with severe mental disorders in Spain: Do they have a specific psychological reaction compared with other mental disorders and healthy controls? Schizophr Res 2020; 223:192-198. [PMID: 32771308 PMCID: PMC7381938 DOI: 10.1016/j.schres.2020.07.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic and the lockdown restrictions could have adverse consequences for patients with severe mental disorders (SMD). Here, we aim to compare the early psychological impact (depression, anxiety, and stress responses, intrusive and avoidant thoughts, and coping strategies) on people with SMD (n = 125) compared with two control groups: common mental disorders (CMD, n = 250) and healthy controls (HC, n = 250). An anonymous online questionnaire using a snowball sampling method was conducted from March 19-26, 2020 and included sociodemographic and clinical data along with the DASS-21 and IES scales. We performed descriptive and bivariate analyses and multinomial and linear regression models. People with SMD had higher anxiety, stress, and depression responses than HC, but lower scores than CMD in all domains. Most people with SMD (87.2%) were able to enjoy free time, although control groups had higher percentages. After controlling for confounding factors, anxiety was the only significant psychological domain with lower scores in HC than people with SMD (OR = 0.721; 95% CI: 0.579-0.898). In the SMD group, higher anxiety was associated with being single (beta = 0.144), having COVID-19 symptoms (beta = 0.146), and a higher score on the stress subscale of DASS-21 (beta = 0.538); whereas being able to enjoy free time was a protective factor (beta = -0.244). Our results showed that patients with SMD reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public, and suggesting this domain could be a criterion for early intervention strategies and closer follow-up.
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12
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Wang H, Xiao L, Wang HL, Wang GH. Efficacy and safety of lurasidone versus placebo as adjunctive to mood stabilizers in bipolar I depression: A meta-analysis. J Affect Disord 2020; 264:227-233. [PMID: 32056755 DOI: 10.1016/j.jad.2019.11.031] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/17/2019] [Accepted: 11/09/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few evidence-based treatments and guidelines reflect greater uncertainty regarding consensus treatment algorithms than those for unipolar disorder. This meta-analysis aimed to evaluate the efficacy and side effects of lurasidone by comparing with placebo in bipolar I depression. METHODS Electronic databases, such as PubMed, the Cochrane Library, Web of Science, and Embase, were searched until May 30, 2018, for randomized controlled trials on comparison lurasidone therapy with placebo. The primary efficacy assessment included MADRS total score and CGI-BP-S total score, the secondary efficacy assessment included the response and the remission rates and the safety and tolerability were also evaluated applying the Simpson-Angus Scale. RESULTS The meta-analysis compromised 7 studies. Efficacy analysis suggested that lurasidone was more effective than placebo: MADRS total score (MD:-4.31, 95%CI: (-6.93,-1.7), P = 0.001) and the CGI-BP-S total score (MD:-0.37, 95%CI: (-0.59,-0.15), P = 0.0008) were obtained for both lurasidone-treated and placebo groups. Response rates (RR: 1.73, 95%CI: (1.46, 2.05), P < 0.00001) and Remission rates (RR: 1.57, 95%CI: (1.38, 1.79), P < 0.00001). The safety analysis between lurasidone and placebo showed no difference: at least one event (RR: 1.12, 95% CI :(1.00, 1.26), p = 0.05 and the influence on glucose (MD: 0.35, 95% CI :(-1.09, 1.79), p = 0.63. LIMITATION The present conclusion is limited by the limited included studies. The different dose of lurasidone should be considered in the future. CONCLUSION Compared with placebo, adjunctive lurasidone significantly improved depressive symptoms and is very well tolerated with minimal side effects on the endocrine and cardiovascular systems in clinical patients with bipolar I depression. Key words: Bipolar I depression; Lurasidone; Meta-analysis; Remission rates; Adverse effect.
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Affiliation(s)
- Hui Wang
- Department of Psychiatry, Renmin hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Ling Xiao
- Department of Psychiatry, Renmin hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Hui-Ling Wang
- Department of Psychiatry, Renmin hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China.
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13
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Chen M, Fitzgerald HM, Madera JJ, Tohen M. Functional outcome assessment in bipolar disorder: A systematic literature review. Bipolar Disord 2019; 21:194-214. [PMID: 30887632 PMCID: PMC6593429 DOI: 10.1111/bdi.12775] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Functional impairment is an important driver of disability in patients with bipolar disorder (BD) and can persist even when symptomatic remission has been achieved. The objectives of this systematic literature review were to identify studies that assessed functioning in patients with BD and describe the functional scales used and their implementation. METHODS A systematic literature review of English-language articles published between 2000 and 2017 reporting peer-reviewed, original research related to functional assessment in patients with BD was conducted. RESULTS A total of 40 articles met inclusion criteria. Twenty-four different functional scales were identified, including 13 clinician-rated scales, 7 self-reported scales, and 4 indices based on residential and vocational data. The Global Assessment of Functioning (GAF) and the Functional Assessment Short Test (FAST) were the most commonly used global and domain-specific scales, respectively. All other scales were used in ≤2 studies. Most studies used ≥1 domain-specific scale. The most common applications of functional scales in these studies were evaluations of the relationships between global or domain-specific psychosocial functioning and cognitive functioning (eg, executive function, attention, language, learning, memory) or clinical variables (eg, symptoms, duration of illness, number of hospitalizations, number of episodes). CONCLUSIONS The results of this review show growing interest in the assessment of functioning in patients with BD, with an emphasis on specific domains such as work/educational, social, family, and cognitive functioning and high utilization of the GAF and FAST scales in published literature.
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Affiliation(s)
- Maxine Chen
- Medical AffairsOtsuka Pharmaceutical Development & Commercialization, IncPrincetonNew Jersey
| | | | - Jessica J. Madera
- Medical AffairsOtsuka Pharmaceutical Development & Commercialization, IncPrincetonNew Jersey
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral SciencesUniversity of New MexicoAlbuquerqueNew Mexico
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14
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Bonnín CDM, Reinares M, Martínez-Arán A, Jiménez E, Sánchez-Moreno J, Solé B, Montejo L, Vieta E. Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. Int J Neuropsychopharmacol 2019; 22:467-477. [PMID: 31093646 PMCID: PMC6672628 DOI: 10.1093/ijnp/pyz018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
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Affiliation(s)
- Caterina del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,Correspondence: Anabel Martínez-Arán, PhD, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Catalonia ()
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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15
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Possible association between social cognition and metabolic dysfunctions in Bipolar Disorder and Schizophrenia: Preliminary results. J Affect Disord 2019; 246:828-835. [PMID: 30795487 DOI: 10.1016/j.jad.2018.12.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/17/2018] [Accepted: 12/24/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Social cognition (SC) and Theory of Mind (ToM) are compromised in patients with Schizophrenia (SKZ) and Bipolar Disorder (BD) and an increased frequency of metabolic abnormalities is reported in both disorders. Obesity seems associated with cognitive impairments The aim of our study is thus to assess the relationship between obesity and ToM in SKZ and BD. METHODS 36 stabilized outpatients (18 SKZ and 18 BD) were recruited and completed Reading the Mind in the Eyes Test, Italian version and Faux Pas Recognition Test, adult version. BMI was calculated from self-reported height and weight. Two different Generalized Linear Models were created including performance in Eyes test and in Faux Pas test as outcomes and BMI as covariate. RESULTS After stratifying for sex, we found a significant relationship between BMI and Faux Pas performance for male patients (p = 0.017), without significant interactions between sex and diagnosis. These results suggest a BMI effect on both affective and cognitive ToM in male patients. LIMITATIONS Major confounders need to be considered: the greater number of subjects with SKZ in male subsample, a possible influence of neurocognitive performance, small sample size and self-reported BMI. CONCLUSIONS There could be a relationship between ToM and metabolic dysfunctions, at least in male patients. The exact nature of this relationship has yet to be determined; an interesting theoretical framework is based on a combination of increased brain energy request and inefficient peripheral compensatory mechanisms, resulting in inefficient energy allocation to the brain.
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16
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Sanchez-Moreno J, Bonnin CM, González-Pinto A, Amann BL, Solé B, Balanzá-Martinez V, Arango C, Jiménez E, Tabarés-Seisdedos R, Garcia-Portilla MP, Ibáñez A, Crespo JM, Ayuso-Mateos JL, Martinez-Aran A, Torrent C, Vieta E. Factors associated with poor functional outcome in bipolar disorder: sociodemographic, clinical, and neurocognitive variables. Acta Psychiatr Scand 2018; 138:145-154. [PMID: 29726004 DOI: 10.1111/acps.12894] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar disorder(BD) presenting moderate-severe levels of functional impairment. METHODS Two-hundred and thirty-nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run. RESULTS The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM-D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance. CONCLUSIONS Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.
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Affiliation(s)
- J Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - C M Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - A González-Pinto
- Álava University Hospital, CIBERSAM, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - B L Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Department of Psychiatry, Parc de Salut Mar, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - B Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - V Balanzá-Martinez
- Department of Medicine, CIBERSAM, INCLIVA, University of Valencia, Valencia, Spain.,Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - C Arango
- Child and Adolescent Psychiatry Department, Hospital Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - E Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - R Tabarés-Seisdedos
- Department of Medicine, CIBERSAM, INCLIVA, University of Valencia, Valencia, Spain
| | - M P Garcia-Portilla
- Department of Psychiatry, School of Medicine, CIBERSAM Instituto de Neurociencias del Principado de Asturias, INEUROPA, Servicio de Salud del Principado de Asturias (SESPA), University of Oviedo, Oviedo, Spain
| | - A Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERSAM, Universidad de Alcalá, Madrid, Spain
| | - J M Crespo
- Department of Psychiatry, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, University Hospital of Bellvitge, Barcelona, Spain
| | - J L Ayuso-Mateos
- Department of Psychiatry, IIS-IP, CIBERSAM, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - C Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - E Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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Abstract
The current study focused on the association between resilience and social functioning in patients with bipolar disorder (BD). Forty clinically stable patients with BD type I and BD type II, as well as 40 healthy controls, matched for age, sex, and educational background were enrolled. Clinical status was assessed by the Montgomery-Åsberg Depression Rating Scale and the Young Mania Rating Scale. Functioning was evaluated by the Mini International Classification of Functioning, Disability and Health rating of activities and participation in mental illnesses, and the Social and Occupational Functioning Scale. Resilience was measured by the Connor-Davidson Resilience scale. Patients demonstrated significantly lower resilience levels compared with healthy individuals. A stepwise regression analysis indicated that only resilience contributed significantly to social functioning's outcome. Because resilience may constitute a social functioning moderator in clinically stable patients with BD, a paradigm shift toward protective factors could lead to implementation of resilience-oriented interventions designed specifically for patients with BD.
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18
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O'Donnell LA, Deldin PJ, Grogan-Kaylor A, McInnis MG, Weintraub J, Ryan KA, Himle JA. Depression and executive functioning deficits predict poor occupational functioning in a large longitudinal sample with bipolar disorder. J Affect Disord 2017; 215:135-142. [PMID: 28319690 DOI: 10.1016/j.jad.2017.03.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/16/2017] [Accepted: 03/05/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is characterized by impairments in psychosocial functioning with occupational disability being one of the most significant. Depression and neurocognitive deficits are features of BD most commonly associated with poor occupational functioning (OF). Few studies have examined these features over an extended period of time focusing on distinct aspects of work functioning. METHODS This longitudinal study included 273 adults with bipolar I disorder (N=173), bipolar II disorder (N=69), and bipolar not otherwise specified (N=31). The participants underwent an annual clinical assessment, neuropsychological testing, and work functioning measures over 5 years. We employed multilevel modeling (MLM) to determine which demographic, clinical, and neurocognitive characteristics influence 4 aspects of work functioning (work attendance, conflict, enjoyment, performance) over this 5-year period. LIMITATIONS Work functioning was measured using a self-report measure, which may be confounded by responder bias and is not tailored for distinct occupations. Due to insufficient power, medication use was not accounted for and our sample may not generalize to the broader BD population. RESULTS Using MLM, those with higher levels of depression and greater cognitive flexibility deficits were more likely to experience poorer work attendance (p<0.01), lower quality of work (p<0.01), and reduced satisfaction from work (p<0.001). These occupational hardships persisted over the 5-year period. CONCLUSIONS This study emphasizes the need for interventions that specifically focus on the treatment of depressive symptoms and neurocognitive deficits within the context of work functioning, particularly attendance at work, to enable BD patients to live more productive, financially secure, and satisfying lives.
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Affiliation(s)
- Lisa A O'Donnell
- Departments of Social Work and Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
| | - Patricia J Deldin
- Department of Psychology, University of Michigan, 2255 East Hall, Ann Arbor, MI 48109, USA.
| | - Andrew Grogan-Kaylor
- Department of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA.
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
| | - Jenna Weintraub
- Department of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA.
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
| | - Joseph A Himle
- Department of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA.
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Samalin L, Boyer L, Murru A, Pacchiarotti I, Reinares M, Bonnin CM, Torrent C, Verdolini N, Pancheri C, de Chazeron I, Boucekine M, Geoffroy PA, Bellivier F, Llorca PM, Vieta E. Residual depressive symptoms, sleep disturbance and perceived cognitive impairment as determinants of functioning in patients with bipolar disorder. J Affect Disord 2017; 210:280-286. [PMID: 28068616 DOI: 10.1016/j.jad.2016.12.054] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/07/2016] [Accepted: 12/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many patients with bipolar disorder (BD) experience residual symptoms during their inter-episodic periods. The study aimed to analyse the relationship between residual depressive symptoms, sleep disturbances and self-reported cognitive impairment as determinants of psychosocial functioning in a large sample of euthymic BD patients. METHODS This was a cross-sectional study of 468 euthymic BD outpatients. We evaluated the residual depressive symptoms with the Bipolar Depression Rating Scale, the sleep disturbances with the Pittsburgh Sleep Quality Index, the perceived cognitive performance using visual analogic scales and functioning with the Functioning Assessment Short Test. Structural equation modelling (SEM) was used to describe the relationships among the residual depressive symptoms, sleep disturbances, perceived cognitive performance and functioning. RESULTS SEM showed good fit with normed chi square=2.46, comparative fit index=0.94, root mean square error of approximation=0.05 and standardized root mean square residuals=0.06. This model revealed that residual depressive symptoms (path coefficient =0.37) and perceived cognitive performance (path coefficient=0.27) were the most important features significantly related to psychosocial functioning. Sleep disturbances were indirectly associated with functioning via residual depressive symptoms and perceived cognitive performance (path coefficient=0.23). CONCLUSIONS This study contributes to a better understanding of the determinants of psychosocial functioning during the inter-episodic periods of BD patients. These findings should facilitate decision-making in therapeutics to improve the functional outcomes of BD during this period.
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Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France; Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Fondation FondaMental, Créteil, France.
| | - Laurent Boyer
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, Marseille, France
| | - Andrea Murru
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina Mar Bonnin
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Carla Torrent
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Corinna Pancheri
- Policlinico Umberto I of Rome, La Sapienza University of Roma, Department of Neurology and Psychiatry, Rome, Italy
| | - Ingrid de Chazeron
- CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France
| | - Mohamed Boucekine
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, Marseille, France
| | - Pierre-Alexis Geoffroy
- Fondation FondaMental, Créteil, France; Inserm U1144, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisiére - F. Widal,Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France; Inserm U1144, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisiére - F. Widal,Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Pierre-Michel Llorca
- CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France; Fondation FondaMental, Créteil, France
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Duarte W, Becerra R, Cruise K. The Relationship Between Neurocognitive Functioning and Occupational Functioning in Bipolar Disorder: A Literature Review. EUROPES JOURNAL OF PSYCHOLOGY 2016; 12:659-678. [PMID: 27872673 PMCID: PMC5114879 DOI: 10.5964/ejop.v12i4.909] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/21/2016] [Indexed: 01/13/2023]
Abstract
Neurocognitive impairment in Bipolar Disorder (BD) has been widely reported, even during remission. Neurocognitive impairment has been identified as a contributing factor towards unfavourable psychosocial functioning within this population. The objective of this review was to investigate the association between neurocognitive impairment and occupational functioning in BD. A literature review of English-language journal articles from January 1990 to November 2013 was undertaken utilising the PsychINFO, Scopus and Web of Knowledge databases. Studies that made specific reference to occupational outcomes were included, and those that reported on global psychosocial measures were excluded. Majority of the papers reviewed (20 out of 23) identified an association between neurocognitive impairment (particularly in executive functioning, verbal learning and memory, processing speed and attention) and occupational functioning. Several methodological issues were identified. There was a discrepancy in the measures used to assess neurocognitive function across studies and also the definition and measurement of occupational functioning. The clinical features of the samples varied across studies, and confounding variables were intermittently controlled. The review focused on English-language papers only and hence there is a bias toward the Western labour market. These limitations therefore influence the generalizability of the interpreted findings and the reliability of comparisons across studies. Neurocognitive impairment in BD appears to play a role in occupational outcomes. The findings of this review highlight the challenges for future research in this area, particularly in the measurement of neurocognitive and occupational functioning. Incorporating neurocognitive interventions in the treatment of BD, which has traditionally focussed solely on symptomatic recovery, may advance the vocational rehabilitation of these patients.
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Affiliation(s)
- Walace Duarte
- School of Psychology and Social Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rodrigo Becerra
- School of Psychology and Social Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Cruise
- School of Psychology and Social Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Loebel A, Siu C, Rajagopalan K, Pikalov A, Cucchiaro J, Ketter TA. Recovery in bipolar depression: Post-hoc analysis of a placebo-controlled lurasidone trial followed by a long-term continuation study. J Affect Disord 2015; 186:376-82. [PMID: 26363720 DOI: 10.1016/j.jad.2015.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/08/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In this post-hoc analysis, rates of remission and recovery were evaluated in patients with bipolar depression treated with lurasidone. METHODS Outpatients meeting DSM-IV-TR criteria for bipolar I depression, were randomized to 6 weeks of once-daily, double-blind treatment with lurasidone 20-60mg, lurasidone 80-120mg or placebo, followed by a 6-month, open-label, flexible-dose, lurasidone continuation study. Recovery was defined as meeting criteria for combined symptomatic remission (Montgomery-Asberg Depression Rating Scale total score ≤12) and functional remission (all Sheehan Disability Scale domain scores ≤3) sustained for at least 3 months in the 6-month continuation study. RESULTS A significantly higher proportion of lurasidone-treated patients met criteria for combined symptomatic remission and functional remission (33.3%, 91/273) compared to the placebo group (21.0%, 30/143, p<0.05, NNT=9) at the 6-week study endpoint. In the 6-month continuation study, the proportion of lurasidone-treated patients achieving sustained recovery was 60.7% (85/140) and 44.9% (31/69), for patients who continued lurasidone treatment and who switched from placebo to lurasidone, respectively. LIMITATIONS The definition of recovery used has not been previously validated and the analysis was post hoc. Lack of a control group in the continuation study limits data interpretation. CONCLUSIONS Recovery in patients with bipolar depression was assessed based on rates of combined symptomatic and functional remission sustained over time. A majority of patients initially treated with lurasidone in the acute phase achieved recovery status in the continuation study. Treatment with lurasidone (vs. placebo) earlier in the course of the bipolar depressive episode increased the likelihood of subsequent recovery.
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Affiliation(s)
- Antony Loebel
- Sunovion Pharmaceuticals Inc., Marlborough, MA , USA; Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA.
| | - Cynthia Siu
- COS and Associates Ltd., Hong Kong, Hong Kong
| | - Krithika Rajagopalan
- Sunovion Pharmaceuticals Inc., Marlborough, MA , USA; Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA
| | - Andrei Pikalov
- Sunovion Pharmaceuticals Inc., Marlborough, MA , USA; Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA
| | - Josephine Cucchiaro
- Sunovion Pharmaceuticals Inc., Marlborough, MA , USA; Sunovion Pharmaceuticals Inc., Fort Lee, NJ, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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22
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Dawson EL, Shear PK, Howe SR, Adler CM, DelBello MP, Fleck DE, Strakowski SM. Impulsivity predicts time to reach euthymia in adults with bipolar disorder. Bipolar Disord 2014; 16:846-56. [PMID: 25039396 DOI: 10.1111/bdi.12232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Specific demographic and illness characteristics have been identified as predictors of overall morbidity and treatment course among individuals with bipolar disorder. However, the role of specific cognitive limitations on disease severity and treatment response is unclear. The present study evaluated whether impulsiveness during acute mania was a significant predictor of achieving euthymia within one year following psychiatric hospitalization. METHODS Participants were 94 adult inpatients (60 manic) with bipolar I disorder. Baseline symptom severity was assessed using the Young Mania Rating Scale and the Montgomery-Åsberg Depression Rating Scale. Impulsivity was measured with the Stop Signal Task, Degraded Stimulus Continuous Performance Task, Delayed Response Task, and Barratt Impulsiveness Scale-11. RESULTS Individual predictors of time to reach euthymia included fewer depressive symptoms and better impulse control at baseline, later age at illness onset, shorter illness duration, and the absence of comorbid attention-deficit hyperactivity disorder. Self-reported impulsivity was a significant independent predictor of time to euthymia, even after accounting for relevant clinical variables. CONCLUSIONS Better trait impulse control may be associated with better treatment responsiveness among adults with bipolar disorder.
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Affiliation(s)
- Erica L Dawson
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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23
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Pompili M, Innamorati M, Gonda X, Serafini G, Erbuto D, Ricci F, Fountoulakis KN, Lester D, Vazquez G, Rihmer Z, Amore M, Girardi P. Pharmacotherapy in bipolar disorders during hospitalization and at discharge predicts clinical and psychosocial functioning at follow-up. Hum Psychopharmacol 2014; 29:578-88. [PMID: 25366354 DOI: 10.1002/hup.2445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/26/2014] [Accepted: 09/25/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Individuals with bipolar disorder (BD) usually report significant disability and psychosocial impairment. Both the nature and causes associated with this impairment are poorly understood. In particular, research examining the impact of pharmacotherapy on the different aspects of psychosocial functioning in bipolar patients is currently lacking. The aim of this study was to assess to what extent the psychotropic medications used during psychiatric hospitalization and at discharge can predict clinical psychosocial functioning and the severity of the illness at follow-up in inpatients with bipolar disorder (BD). METHODS Patients were 71 adult BD patients contacted on average 31 months after discharge who completed at the follow-up a telephone interview based on the Health of the Nation Outcome Scales (HoNOS). RESULTS All the subjects completed the follow-up assessment between 5 and 75 months after discharge. The mean raw score for the HoNOS-6 was 5.70 ± 5.37. Patients with more severe behavior problems more often had been prescribed atypical antipsychotics and anticonvulsants at discharge. Patients with more severe psychosocial functioning problems more often had a history of suicide attempts, and were more often prescribed anxiolytics during hospitalization and less often prescribed lithium at discharge. CONCLUSIONS Having been prescribed anxiolytics and atypical antipsychotics during hospitalization predicted reduced psychosocial functioning, whereas prescription of lithium at discharge was associated with better psychosocial functioning at follow-up. Future studies are needed in order to investigate how psychosocial functioning may be related in the long-term to pharmacological treatment in patients after discharge.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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24
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Tse S, Murray G, Chung KF, Davidson L, Ng KL, Yu CH. Exploring the recovery concept in bipolar disorder: a decision tree analysis of psychosocial correlates of recovery stages. Bipolar Disord 2014; 16:366-77. [PMID: 24261315 DOI: 10.1111/bdi.12153] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/09/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The recovery movement has generated interest in the concept of personal recovery, but little attention has been paid to it in relation to bipolar disorder (BD). The aim of this study was to examine personal recovery in BD using a staged model, exploring whether different stages are associated with different psychosocial and clinical profiles. METHODS Adults with BD in remission (n = 75) were recruited from an outpatient psychiatric clinic in Hong Kong. Their average age was 45 years, with 11% and 45% working part time and full time, respectively. The data included stages of recovery, sociodemographic characteristics, clinical information, and perceptions of the importance of recovery factors and the resilience-engendering features of health services. Decision tree analysis was used to identify the predictors of stages of recovery, and receiver operating characteristic curves were employed to detect the rates of correct classification within the staged model. RESULTS 'Respect, hope, and self-directed empowerment', older age, binge drinking history, early first diagnosis, and 'meaningful role' were all associated with being in a later stage of personal recovery. The first two variables demonstrated better classification accuracy than the last three. Using these variables, the classification accuracy of Stages 2-4 was adequate. CONCLUSIONS There are associations between the stage of recovery and psychosocial variables among individuals with BD in remission. Interventions that promote 'respect, hope, and self-directed empowerment' have the potential to facilitate personal recovery from BD.
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Affiliation(s)
- Samson Tse
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
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25
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Tse S, Chan S, Ng KL, Yatham LN. Meta-analysis of predictors of favorable employment outcomes among individuals with bipolar disorder. Bipolar Disord 2014; 16:217-29. [PMID: 24219657 DOI: 10.1111/bdi.12148] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 06/21/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although several studies have reported on predictors of employment in individuals with bipolar disorder (BD), the magnitude of the impact of these variables is unclear as no previous studies have estimated the collective effect sizes (ESs). The present meta-analysis estimated ESs and explored which of these variables are associated with positive employment outcomes. METHODS We searched for articles published between 2000 and 2011 that reported associations between sociodemographic, clinical, psychosocial, and/or cognitive variables with employment outcomes in BD. Of the 781 articles identified, 22 met the inclusion criteria and were included in the final analysis (n = 6,301). Weighted correlation coefficients (r-index) were computed as ESs for each of the predictor variables, which were grouped into six categories: cognitive performance, symptomatology, sociodemographic factors, course of illness, clinical variables, and other personal factors. The overall ES (Rw) was estimated by assuming random-effect models. Sensitivity analyses were also performed to determine the robustness of the findings. RESULTS Significant predictors of favorable employment outcomes included: cognitive performance (e.g., verbal memory, Rw = 0.33; executive function, Rw = 0.26), sociodemographic factors (e.g., years of education, Rw = 0.23), course of illness (e.g., number of lifetime psychiatric hospitalizations, Rw = -0.35), symptomatology (e.g., depression, Rw = -0.25), and other personal factors (e.g., personality disorder, Rw = -0.49). CONCLUSIONS Overall, the cognitive performance and course of illness had larger average ESs than symptomatology or sociodemographic factors on favorable employment outcomes. These findings may help to guide the design of more effective work interventions for people with BD.
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Affiliation(s)
- Samson Tse
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
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26
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The impact of repeated manic episodes and executive dysfunction on work adjustment in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2014; 264:247-54. [PMID: 23912643 DOI: 10.1007/s00406-013-0431-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/19/2013] [Indexed: 12/18/2022]
Abstract
The aim of this study was to study the clinical and neurocognitive variables that best explain poor work adjustment in a sample of bipolar I euthymic patients. Eighty-five euthymic patients at the Hospital Clinic of Barcelona were assessed for this study by means of a comprehensive neuropsychological battery and a work-focused interview to determine work adjustment. Clinical and sociodemographic variables were also collected. Direct logistic regression was performed to assess the impact of demographic, clinical and neuropsychological variables on the likelihood of presenting poor work adjustment. The model that best fitted contained five variables (Hamilton Depression Rating scores, number of manic episodes, number of perseverative errors in the Wisconsin Card Sorting Test (WCST), number of depressive episodes and Trail Making Test-part B). However, only two out of these variables made a unique statistically significant contribution to the model, which were number of manic episodes (OR 1.401; CI 1.05-1.86; p = 0.021) and number of perseverative errors in the WCST (OR 1.062; CI 1.00-1.12; p = 0.044). The model explained up to 36 % of the variance in work adjustment. This study highlights the role of manic relapses and neurocognitive impairment, specifically the role of executive function, in work adjustment.
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David DP, Soeiro-de-Souza MG, Moreno RA, Bio DS. Facial emotion recognition and its correlation with executive functions in bipolar I patients and healthy controls. J Affect Disord 2014; 152-154:288-94. [PMID: 24211178 DOI: 10.1016/j.jad.2013.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 09/06/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The ability to recognize facial emotions is altered in patients with Bipolar Disorder (BD) during mood episodes and even in euthymia, while cognitive functioning is similarly impaired. This recognition is considered a fundamental skill for successful social interaction. However, it is unclear whether the ability to recognize facial emotions is correlated with the cognitive deficits observed in BD. OBJECTIVE The objective of this study was to evaluate Facial Emotion Recognition (FER) and its correlation with executive function (EF) in BD I patients during mania, depression and euthymia compared to healthy controls. MATERIAL AND METHODS A total of 110 patients with BD I, 18-40 years old were included (41 in manic episode; 31 in depressive episode and 38 euthymic). Patients were assessed for FER and EF (Wisconsin card sorting test - WCST), along with 96 healthy volunteers (18-40 years old) recruited from the University of São Paulo. RESULTS The results showed that BD I patients had lower FER performance compared to controls on fear subtests, happiness, the surprise test, and FER total scores. Moreover, BD I manic patients showed poorer performance for EF compared to controls. Six out of the seven variables of the WCST correlated with FER in both healthy controls and BD euthymic subjects but not in BD patients during mood episodes. CONCLUSION Cognitive deficits and difficulties recognizing facial emotions are present in all mood episodes in BD I patients, even during remission. Although FER is not considered a cognitive domain, these results suggest that, along with EF, it has a complementary function. Hence, further studies should investigate this issue in larger samples and verify whether these similarities also occur at a neurobiological level.
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Affiliation(s)
- Denise Petresco David
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (IPQ HC-FMUSP), Brazil.
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28
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Tse S, Davidson L, Chung KF, Ng KL, Yu CH. Differences and similarities between functional and personal recovery in an Asian population: a cluster analytic approach. Psychiatry 2014; 77:41-56. [PMID: 24575912 DOI: 10.1521/psyc.2014.77.1.41] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study gathers empirical data to test whether two forms of recovery are related: (1) the traditional outcome-based notion of recovery from a mental illness, which is called "functional recovery," and (2) the more recent, consumer-based concept of recovery in mental illness, which is called "personal recovery." A total of 150 Chinese outpatients were recruited, 75 with bipolar disorder and 75 with schizophrenia, as determined by structured clinical interview. Participants were reported to be in clinical remission for at least the previous 6 months by treating psychiatrists. Personal recovery was measured with the Stages of Recovery Scale, and functional recovery was measured with residential and employment status. In addition to clinical and demographic data, self-report measures included functioning (confirmed through chart review) and a survey of the participant's assessment of the importance of various elements of recovery. Personal recovery was significantly correlated with functional recovery; small effect size suggested that the two domains are far from identical. The strength of this correlation was stronger for participants with schizophrenia than for those with bipolar disorder. A cluster analysis also suggested that residential and employment statuses, along with personal recovery scores, were useful in differentiating participants. Patients were more likely to reach better recovery outcomes if they were female, married, had higher family income, and perceived social roles as less important to their recovery. Consistent with the consumer literature, personal recovery is related but still distinct from functional recovery. Personal recovery has more to do with life circumstances than with functioning status alone.
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Van Rheenen TE, Rossell SL. Phenomenological predictors of psychosocial function in bipolar disorder: is there evidence that social cognitive and emotion regulation abnormalities contribute? Aust N Z J Psychiatry 2014; 48:26-35. [PMID: 24126607 DOI: 10.1177/0004867413508452] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder. METHODS This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning; it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD. RESULTS Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs. CONCLUSIONS There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.
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Affiliation(s)
- Tamsyn E Van Rheenen
- 1Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Life and Social Sciences, Swinburne University, Melbourne, Australia
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30
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Samamé C. Social cognition throughout the three phases of bipolar disorder: a state-of-the-art overview. Psychiatry Res 2013; 210:1275-86. [PMID: 24075306 DOI: 10.1016/j.psychres.2013.08.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 08/01/2013] [Accepted: 08/08/2013] [Indexed: 02/09/2023]
Abstract
Although it is now well documented that bipolar disorder (BD) often presents with cognitive deficits and suboptimal social adjustment, the social cognitive profile of the illness throughout its three phases remains unclear. An extensive search was conducted through the online databases EBSCO, PsychInfo, PubMed, ScienceDirect, and Wiley-Blackwell, covering the period between 1990 and 2012. Fifty-one studies comparing the social cognitive performance of bipolar patients with that of healthy controls were identified. Deficits in emotion recognition and theory of mind were found in manic, depressed, and euthymic bipolar subjects. Furthermore, altered face emotion recognition and brain-related abnormalities were noted both in euthymic patients and subjects at risk for BD. The influence of clinical and neurocognitive variables on the social cognitive performance of bipolar patients remains to be ascertained. Future directions for research are discussed.
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Affiliation(s)
- Cecilia Samamé
- School of Psychology, University of Buenos Aires, Buenos Aires, Argentina; Bipolar Disorders Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
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Caletti E, Paoli RA, Fiorentini A, Cigliobianco M, Zugno E, Serati M, Orsenigo G, Grillo P, Zago S, Caldiroli A, Prunas C, Giusti F, Consonni D, Altamura AC. Neuropsychology, social cognition and global functioning among bipolar, schizophrenic patients and healthy controls: preliminary data. Front Hum Neurosci 2013; 7:661. [PMID: 24146642 PMCID: PMC3797996 DOI: 10.3389/fnhum.2013.00661] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/23/2013] [Indexed: 12/19/2022] Open
Abstract
This study aimed to determine the extent of impairment in social and non-social cognitive domains in an ecological context comparing bipolar (BD), schizophrenic (SKZ) patients and healthy controls (HC). The sample was enrolled at the Department of Psychiatry of Policlinico Hospital, University of Milan; it includes stabilized SKZ patients (n = 30), euthymic bipolar patients (n = 18) and HC (n = 18). Patients and controls completed psychiatric assessment rating scales, the Brief Assessment of Cognition in Schizophrenia (BACS) and the Executive and Social Cognition Battery (ESCB) that contains both ecological tests of executive function and social cognition, in order to better detect cognitive deficits in patients with normal results in standard executive batteries. The three groups differed significantly for gender and substance abuse, however, the differences did not influence the results. BD patients showed less impairment on cognitive performance compared to SKZ patients, even in “ecological” tests that mimic real life scenarios. In particular, BD performed better than SKZ in verbal memory (p < 0.0038) and BACS symbol coding (p < 0.0043). Regarding the ESCB tests, in the Hotel task SKZ patients completed significantly less tasks (p < 0.001), showed a greater number of errors in Multiple Errands Test (MET-HV) (p < 0.0248) and a worse performance in Theory of Mind (ToM) tests (p < 0.001 for the Eyes test and Faux pas test). Both patients' groups performed significantly worse than HC. Finally, significant differences were found between the two groups in GAF scores, being greater among BD subjects (p < 0.001). GAF was correlated with BACS and ESCB scores showing the crucial role of cognitive and ecological performances in patients' global functioning.
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Affiliation(s)
- Elisabetta Caletti
- Department of Neuroscience and Mental Health, Psychiatric Clinic, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan, Italy
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32
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Levy B, Medina AM, Weiss RD. Cognitive and psychosocial functioning in bipolar disorder with and without psychosis during early remission from an acute mood episode: a comparative longitudinal study. Compr Psychiatry 2013; 54:618-26. [PMID: 23357126 PMCID: PMC4076957 DOI: 10.1016/j.comppsych.2012.12.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 12/17/2012] [Accepted: 12/31/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The current investigation aimed to extend previous findings, which linked psychosis in bipolar disorder (BD) to cognitive impairment during hospital discharge and readmission, by examining the recovery of patients with psychosis who were not re-hospitalized. The study compared mood, cognitive and functional outcomes in patients who had, versus had not, experienced psychosis during a recent psychiatric hospitalization. The hypothesis was that patients admitted to the hospital with psychosis would exhibit more residual symptoms, greater cognitive deficits, and lower psychosocial functioning than patients who presented to care without psychosis. Group differences were expected to emerge both at the time of hospital discharge and at a 3-month follow up. METHOD Fifty-five participants (ages 18-59, 25 women, 20 with psychosis) with BD I disorder completed both assessments, which included a clinical and diagnostic interview, functional evaluation, and the administration of mood measures and a neuropsychological battery. RESULTS The groups were comparable with respect to illness history (e.g., number of previous hospitalizations, age of onset, employment). At discharge and follow-up, the group with psychosis exhibited more mood symptoms, obtained lower GAF scores, and performed more poorly on measures of memory and executive functioning. At follow-up, participants with psychosis exhibited poorer psychosocial adaptation. LIMITATIONS It is possible that some of the observed group differences in cognitive functioning emerged due to differences in medication efficacy or side effects. CONCLUSION The results of this study support the hypothesis that psychosis in BD predicts limited recovery during early remission from mood disturbance, regardless of illness history.
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Affiliation(s)
- Boaz Levy
- Counseling and School Psychology, University of Massachusetts, Boston, MA, USA.
| | - Anna Marie Medina
- Department of Psychology, Gonzaga University, Spokane, Washington, USA
| | - Roger D. Weiss
- Counseling and School Psychology, University of Massachusetts, Boston, MA USA
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Gildengers A, Tatsuoka C, Bialko C, Cassidy KA, Dines P, Emanuel J, Al Jurdi RK, Gyulai L, Mulsant BH, Young RC, Sajatovic M. Correlates of disability in depressed older adults with bipolar disorder. CUTTING EDGE PSYCHIATRY IN PRACTICE 2013; 2013:332-338. [PMID: 24358446 PMCID: PMC3864697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aims To identify clinical factors associated with disability in depressed older adults with bipolar disorder (BPD) receiving lamotrigine. Methods Secondary analysis of a multi-site, 12-week, open-label, uncontrolled study of addon lamotrigine in 57 adults 60 years and older with BD I or II depression. Measures included the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Dementia Rating Scale (DRS), and WHO-Disability Assessment Scale II (WHO-DAS II). Results Medical comorbidiy in this group of elders was substantial, with roughly 60% of subjects having disorders of the vascular, musculoskeletal/integument, and endodrine/metabolic/breast systems. We found significant relationships among mood (MADRS), medical comorbidity (CIRS-G), cognition (DRS), and disability (WHO-DAS II). More severe BPD depression, more medical comorbidity and more impaired cognition were all associated with lower functioning in BPD elders. Conclusions Our findings fit the paradigm shift that has been occurring in BPD, supporting the notion that BPD is not solely an illness of mood but that it affects multiple domains impacting overall functioning.
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Affiliation(s)
- Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Christopher Bialko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Philipp Dines
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - James Emanuel
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic
| | - Rayan K Al Jurdi
- Mental Health Care Line, Michael E. DeBakey, VA medical Center, Baylor College of Medicine
| | - Laszlo Gyulai
- University of Pennsylvania Medical Center and School of Medicine
| | | | | | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
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Cerit C, Filizer A, Tural Ü, Tufan AE. Stigma: a core factor on predicting functionality in bipolar disorder. Compr Psychiatry 2012; 53:484-9. [PMID: 22036011 DOI: 10.1016/j.comppsych.2011.08.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Extant literature indicates that bipolar disorder (BD) is associated with significant poor psychosocial functioning. However, the relationship between functioning and demographic and clinical variables is unclear. The aim of this study is to investigate the predictors of functioning such as demographic and clinical variables, social support, self-perceived stigma, and insight in remitted patients with BD. METHODS Eighty patients with a diagnosis of BD, complete remission according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were included in the final assessment. Bipolar Disorder Functioning Questionnaire, Beck Depression Inventory, Young Mania Rating Scale, Internalized Stigma of Mental Illness Scale, Multidimensional Scale of Perceived Social Support, and Schedule for Assessing the Three Components of Insight were used. Student t test, Pearson correlation analyses, and linear regression analyses were used to assess the pathways effecting on functioning. RESULTS The 3 predictors of functioning were severity of depression, perceived social support, and internalized stigmatization. Severity of depression is considered the strongest predictor, whereas internalized stigmatization has a core role in predicting functioning. Clinical variables such as years of education and number of hospitalization probably have indirect effects on functioning. CONCLUSION Interventions that oppose stigmatization and consideration of mild depressive symptoms will positively affect functioning in remitted patients with BD.
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Affiliation(s)
- Cem Cerit
- Department of Psychiatry, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
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Depp CA, Mausbach BT, Harmell AL, Savla GN, Bowie CR, Harvey PD, Patterson TL. Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 2012; 14:217-26. [PMID: 22548895 PMCID: PMC3396289 DOI: 10.1111/j.1399-5618.2012.01011.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta-analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder. METHODS We conducted a comprehensive meta-analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design. RESULTS The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self-report than performance-based tasks and real-world milestones such as employment. None of the moderator analyses were significant. CONCLUSIONS Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed to a greater extent according to functional measurement approach.
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Affiliation(s)
- Colin A. Depp
- Department of Psychiatry, University of California, San Diego
| | | | | | - Gauri N. Savla
- Department of Psychiatry, University of California, San Diego
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
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Samamé C, Martino DJ, Strejilevich SA. Social cognition in euthymic bipolar disorder: systematic review and meta-analytic approach. Acta Psychiatr Scand 2012; 125:266-80. [PMID: 22211280 DOI: 10.1111/j.1600-0447.2011.01808.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Deficits in social cognition have been reported in euthymic subjects with bipolar disorder (BD). However, some studies have failed to find differences favoring controls. As most investigations have been conducted with small samples, they have not had sufficient power to detect statistically significant differences. Furthermore, studies communicating positive results have scarcely attempted to estimate effect sizes for patient-control differences. The aim of this study was to summarize the findings of reports on social cognition in patients with euthymic BD and to combine their data to identify possible deficits and quantify their magnitude. METHOD Systematic literature review and meta-analysis. RESULTS Impairments of moderate magnitude (0.5 < d < 0.8) were noted across mentalizing skills, whereas small but significant effect sizes (d < 0.5) were observed for facial emotion recognition. No patient-control differences were found for decision-making. CONCLUSION Meta-analytic findings provide evidence for emotion processing and theory of mind deficits in remitted bipolar patients. However, it is not yet clear whether these areas of impairment are related to neurocognitive dysfunctions or to medication effects. The results are discussed with regard to targets for future neuropsychological research on BDs.
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Affiliation(s)
- C Samamé
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, CABA, Argentina
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37
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Torres I, Solé B, Vieta E, Martinez-Aran A. Neurocognitive impairment in the bipolar spectrum. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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38
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Depp CA, Mausbach BT, Bowie C, Wolyniec P, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Harvey PD, Patterson TL. Determinants of occupational and residential functioning in bipolar disorder. J Affect Disord 2012; 136:812-8. [PMID: 22129770 PMCID: PMC3639009 DOI: 10.1016/j.jad.2011.09.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/06/2011] [Accepted: 09/28/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Bipolar disorder is associated with reduced rates of employment and residential independence. The influence of cognitive impairment and affective symptoms on these functional attainments has received little previous attention and is the focus of this study. METHOD A total of 229 adult outpatients with bipolar disorder without active substance use disorders and with an average of mild severity of affective symptoms were included in the analyses. After adjusting for sociodemographic and illness history covariates, univariate and multivariate analyses were used to evaluate the independent and interactive associations of neurocognitive ability, performance-based functional capacity, and affective symptom severity with residential independence, occupational status and number of hours worked. RESULTS A total of 30% of the sample was unemployed and 18% was not independently residing. Neurocognitive ability was the strongest predictor of any employment, but depressive symptom severity was the only variable significantly related to hours worked. The strongest predictor of residential independence was performance-based functional capacity. Affective symptoms and neurocognitive ability were independent (non-interactive) predictors of occupational and residential status. LIMITATIONS This is a cross-sectional study and thus causal direction among variables is unknown. The sample was ethnically homogeneous and thus the results may not generalize to ethnically diverse samples. CONCLUSIONS This study confirmed elevated rates of unemployment and residential non-independence in adults with bipolar disorder. Interventions targeting cognitive deficits and functional capacity may increase the likelihood of any employment or residential independence, respectively. Interventions targeting depressive symptoms may be most influential on work outcomes among those already employed.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA, United States.
| | | | | | - Paula Wolyniec
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Mary H. Thornquist
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - James R. Luke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - John A. McGrath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Ann E. Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami
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Bearden CE, Shih VH, Green MF, Gitlin M, Sokolski KN, Levander E, Marusak S, Hammen C, Sugar CA, Altshuler LL. The impact of neurocognitive impairment on occupational recovery of clinically stable patients with bipolar disorder: a prospective study. Bipolar Disord 2011; 13:323-33. [PMID: 21843272 PMCID: PMC3157039 DOI: 10.1111/j.1399-5618.2011.00928.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Many patients with bipolar disorder do not regain their premorbid level of occupational functioning even after mood episodes have resolved. The reasons for this are not well understood. We evaluated the relationship between neurocognition and occupational function in bipolar disorder patients, following symptomatic recovery. METHODS A total of 79 previously employed adults with bipolar I disorder who achieved symptomatic recovery (i.e., at least six weeks clinically euthymic) following a manic episode underwent a neurocognitive evaluation and assessment of occupational functioning. Study participants were evaluated every three months thereafter for up to nine months. Factor analysis was applied to reduce the initial set of neurocognitive variables to five domains: episodic memory, working memory/attention, executive function, visual scanning, and speed of processing. Multiple logistic regression models were used to examine the joint predictive values of these domains for determining occupational recovery. RESULTS At the time of symptomatic recovery, four of five neurocognitive factors were significant predictors of concomitant occupational recovery and the fifth, executive function, showed a trend in the same direction. For those not occupationally recovered at baseline, longitudinal analyses revealed that changes between baseline and the three-month follow-up timepoint in most cognitive domains were robust and highly significant predictors of occupational recovery at three months. CONCLUSIONS These findings indicate that better neurocognitive function in multiple domains and improvement in these domains over time are strongly predictive of subsequent occupational recovery. Treatments that target cognitive deficit may therefore have potential for improving long-term vocational functioning in bipolar illness.
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Affiliation(s)
- Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
| | - Vivian H Shih
- Department of Biostatistics, UCLA School of Public Health, Los Angeles
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles,VA Greater Los Angeles Healthcare System, Los Angeles
| | - Michael Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
| | - Kenneth N Sokolski
- VA Greater Los Angeles Healthcare System, Los Angeles,Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Eric Levander
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles,VA Greater Los Angeles Healthcare System, Los Angeles
| | - Susan Marusak
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles,VA Greater Los Angeles Healthcare System, Los Angeles
| | | | - Catherine A Sugar
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles,Department of Biostatistics, UCLA School of Public Health, Los Angeles
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles,VA Greater Los Angeles Healthcare System, Los Angeles
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Kumar CTS, Christodoulou T, Vyas NS, Kyriakopoulos M, Corrigall R, Reichenberg A, Frangou S. Deficits in visual sustained attention differentiate genetic liability and disease expression for schizophrenia from Bipolar Disorder. Schizophr Res 2010; 124:152-60. [PMID: 20674278 DOI: 10.1016/j.schres.2010.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 07/07/2010] [Accepted: 07/09/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is mounting evidence for shared genetic liability to psychoses, particularly with respect to Schizophrenia (SZ) and Bipolar Disorder (BD), which may also involve aspects of cognitive dysfunction. Impaired sustained attention is considered a cardinal feature of psychoses but its association with genetic liability and disease expression in BD remains to be clarified. METHODS Visual sustained attention was assessed using the Degraded Symbol Continuous Performance Test (DS-CPT) in a sample of 397 individuals consisting of 50 remitted SZ patients, 119 of their first degree relatives, 47 euthymic BD patients, 88 of their first degree relatives and 93 healthy controls. Relatives with a personal history of schizophrenia or bipolar spectrum disorders were excluded. Performance on the DS-CPT was evaluated based on the response criterion (the amount of perceptual evidence required to designate a stimulus as a target) and sensitivity (a signal-detection theory measure of signal/noise discrimination). RESULTS We found no effect of genetic risk or diagnosis for either disorder on response criterion. In contrast, impaired sensitivity was seen in SZ patients and to a lesser degree in their relatives but not in BD patients and their relatives. These findings were not attributable to IQ, medication, age of onset or duration of illness. CONCLUSIONS Our results argue for the specificity of visual sustained attention impairment in differentiating SZ from BD. They also suggest that compromised visual information processing is a significant contributor to these deficits in SZ.
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Affiliation(s)
- C T S Kumar
- Section of Neurobiology of Psychosis, Institute of Psychiatry, King's College London, UK
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Wingo AP, Baldessarini RJ, Compton MT, Harvey PD. Correlates of recovery of social functioning in types I and II bipolar disorder patients. Psychiatry Res 2010; 177:131-4. [PMID: 20334933 PMCID: PMC2859974 DOI: 10.1016/j.psychres.2010.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 01/28/2010] [Accepted: 02/26/2010] [Indexed: 12/01/2022]
Abstract
Since bipolar disorder (BPD) patients are often functionally impaired, and factors associated with recovery from disability are largely unknown, we investigated demographic, clinical, and neurocognitive correlates of current social functional recovery in 65 stable participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) type I (n=42) or II (n=23) BPD. Regaining highest previous levels of social functioning was rated with the Interpersonal Relationships Questionnaire. We also considered neuropsychological test findings as well as demographic and clinical information including mania and depression symptom-ratings. We examined factors associated with social recovery status using univariate analyses and then multiple logistic regression modeling. Of all subjects, 30 (46%) achieved current social functional recovery and 35 (54%) did not. Younger age (P=0.005) and lesser current depressive symptoms (P=0.02) were associated with social functional recovery, even after controlling for time since the last major mood episode, diagnostic type (II vs. I), co-morbid psychiatric illness, and executive functioning status. The findings are consistent with deleterious effects of even residual depressive symptoms in BPD patients.
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Affiliation(s)
- Aliza P. Wingo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322,Correspondence to: Dr. Aliza P. Wingo, Emory University, Department of Psychiatry and Behavioral Sciences, 101 Woodruff Circle, NE (Suite 4000), Atlanta, GA 30322; Tel 404-727-9253; Fax: 404-727-3233,
| | - Ross J. Baldessarini
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, MA; Psychopharmacology Program and International Consortium for Bipolar Disorder Research, Mailman Research, Center, McLean Division of Massachusetts General Hospital, Belmont, MA 02478-9106
| | - Michael T. Compton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322
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