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Hu S, Wang F, Huang Q, Chen Y, Lyu D, Zhou N, Wang M, Zhang M, Xu C, Mueller I, Yao G, Liu X, Zhang Q, Hong W. Eveningness is associated with more severe depressive symptoms independently of sleep quality and fatigue level only in first-episode but not recurrent depression in major depressive disorder. Chronobiol Int 2024; 41:987-995. [PMID: 39007882 DOI: 10.1080/07420528.2024.2378958] [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: 01/14/2024] [Revised: 06/24/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
People with an evening chronotype have an increased risk of experiencing a major depressive disorder (MDD). It is unclear if this effect is predominantly related to the initial development of MDD or also present in recurrent episodes. The current study aimed to investigate if the association between chronotype and depressive severity in MDD patients is comparable in MDD patients with first and recurrent episodes. 386 MDD patients, 70.7% females and aged between 16 and 64, participated in the study. The Morningness - Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Multidimensional Fatigue Inventory (MFI20), and Quick Inventory of Depressive Symptomatology (QIDS-SR16) were administered to participants to determine chronotype, sleep quality, fatigue level, and depressive severity, respectively. Multivariate regression models were utilized to analyze how chronotype influences depressive severity. The study showed that chronotype, sleep quality, and fatigue level were all associated with depressive severity. Eveningness significantly predicted an increase in depressive severity independently of sleep quality and fatigue level only in patients with the first episode (-0.068, p = 0.010), but not in patients with recurrent episodes (0.013, p = 0.594). Circadian-focused treatment should be considered in first-episode depression only.
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Affiliation(s)
- Shuang Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ni Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai, China
| | - Meiti Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengke Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuchen Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ivo Mueller
- Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
- School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guanqun Yao
- School of Medicine, Tsinghua University, Beijing, China
| | - Xirui Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinting Zhang
- Shanghai Key Lab of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
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Wu Z, Wang J, Zhang C, Peng D, Mellor D, Luo Y, Fang Y. Clinical distinctions in symptomatology and psychiatric comorbidities between misdiagnosed bipolar I and bipolar II disorder versus major depressive disorder. BMC Psychiatry 2024; 24:352. [PMID: 38730288 PMCID: PMC11088069 DOI: 10.1186/s12888-024-05810-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND To explore the demographic and clinical features of current depressive episode that discriminate patients diagnosed with major depressive disorder (MDD) from those with bipolar I (BP-I) and bipolar II (BP-II) disorder who were misdiagnosed as having MDD . METHODS The Mini-International Neuropsychiatric Interview (MINI) assessment was performed to establish DSM-IV diagnoses of MDD, and BP-I and BP-II, previously being misdiagnosed as MDD. Demographics, depressive symptoms and psychiatric comorbidities were compared between 1463 patients with BP-I, BP-II and MDD from 8 psychiatric settings in mainland China. A multinomial logistic regression model was performed to assess clinical correlates of diagnoses. RESULTS A total of 14.5% of the enrolled patients initially diagnosed with MDD were eventually diagnosed with BP. Broad illness characteristics including younger age, higher prevalence of recurrence, concurrent dysthymia, suicidal attempts, agitation, psychotic features and psychiatric comorbidities, as well as lower prevalence of insomnia, weight loss and somatic symptoms were featured by patients with BP-I and/or BP-I, compared to those with MDD. Comparisons between BP-I and BP-II versus MDD indicated distinct symptom profiles and comorbidity patterns with more differences being observed between BP-II and MDD, than between BP-I and MDD . CONCLUSION The results provide evidence of clinically distinguishing characteristics between misdiagnosed BP-I and BP- II versus MDD. The findings have implications for guiding more accurate diagnoses of bipolar disorders.
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Affiliation(s)
- Zhiguo Wu
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine and Health Sciences, Shanghai, China.
| | - Jun Wang
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Chen Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, Australia
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
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McGinty KR, Janos J, Seay J, Youngstrom JK, Findling RL, Youngstrom EA, Freeman AJ. Comparing self-reported quality of life in youth with bipolar versus other disorders. Bipolar Disord 2023; 25:648-660. [PMID: 36917024 DOI: 10.1111/bdi.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES This study benchmarks quality of life (QoL) of youth with bipolar disorder (BD) against healthy youth, youth with chronic medical conditions, and youth with other psychiatric disorders. The relative impacts of depressive, (hypo)manic, mixed, and externalizing symptoms on QoL are tested for youth with BD. METHOD In total, 657 youth completed the Schedule for Affective Disorders and Schizophrenia for Children (KSADS), the KSADS depression and mania scales, the Parent General Behavior Inventory (PGBI), and the Child Behavior Checklist (CBCL). Youth-reported QoL was determined by the Revised Children Quality of Life Questionnaire (KINDL) and was compared to healthy youth, youth with chronic medical conditions, and youth with other psychiatric disorders. RESULTS Youth with BD reported poorer QoL overall and on most subscales compared to healthy youth, youth with chronic medical conditions, youth with behavior disorders, and youth with other non-behavior/non-mood disorders. QoL in youth with BD did not differ significantly from QoL in youth with unipolar depression. Parent-report and interview-rated depressive symptoms were associated with decreases in Total QoL and all QoL subscales except Family. Externalizing symptoms were associated with decreases in Family QoL and increases in Friend QoL, and (hypo)manic symptoms were associated with increases in Emotional Well-Being QoL. CONCLUSIONS Depressive symptoms may drive the decline in QoL causing youth with BD to rate their QoL worse than healthy youth, youth with chronic medical conditions, and youth with behavior disorders, but not worse than youth with unipolar depression.
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Affiliation(s)
- Kayla R McGinty
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Jessica Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia Seay
- Naval Health Research Center, San Diego, California, USA
| | - Jennifer K Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew J Freeman
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
- Inspiring Children Foundation, Henderson, Nevada, USA
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Wang TW, Gong J, Wang Y, Liang Z, Pang KL, Wang JS, Zhang ZG, Zhang CY, Zhou Y, Li JC, Wang YN, Zhou YJ. Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients. Curr Med Sci 2023; 43:998-1004. [PMID: 37558867 DOI: 10.1007/s11596-023-2772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) has a higher prevalence in adolescents with depressive disorders than in community adolescents. This study examined the differences in NSSI behaviors between adolescents with unipolar depression (UD) and those with bipolar depression (BD). METHODS Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China. The methods, frequency, and function of NSSI were assessed by Functional Assessment of Self-Mutilation. The Beck Suicide Ideation Scale was used to evaluate adolescents' suicidal ideation, and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms. RESULTS The UD group had higher levels of depression (19.16 vs.17.37, F=15.23, P<0.001) and anxiety symptoms (17.73 vs.16.70, F=5.00, P=0.026) than the BD group. Adolescents with BD had a longer course of NSSI than those with UD (2.00 vs.1.00 year, Z=-3.39, P=0.001). There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups. Depression (r=0.408, P<0.01) and anxiety (r=0.391, P<0.01) were significantly and positively related to NSSI frequency. CONCLUSION Adolescents with BD had a longer course of NSSI than those with UD. More importantly, NSSI frequency were positively and strongly correlated with depression and anxiety symptoms, indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents' NSSI behaviors.
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Affiliation(s)
- Ting-Wei Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Jian Gong
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yang Wang
- College of Management, Shenzhen University, Shenzhen, 518000, China
| | - Zhen Liang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518000, China
| | - Ke-Liang Pang
- School of Pharmaceutical Sciences, IDG/McGovern Institute for Brain Research, Tsinghua University-Peking University Joint Center for Life Sciences, Tsinghua University, Beijing, 100000, China
| | - Jie-Si Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100000, China
| | - Zhi-Guo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518000, China
| | - Chun-Yan Zhang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Yue Zhou
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jun-Chang Li
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Yan-Ni Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China.
| | - Yong-Jie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China.
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Yu H, Ni P, Tian Y, Zhao L, Li M, Li X, Wei W, Wei J, Du X, Wang Q, Guo W, Deng W, Ma X, Coid J, Li T. Association of the plasma complement system with brain volume deficits in bipolar and major depressive disorders. Psychol Med 2023; 53:6102-6112. [PMID: 36285542 DOI: 10.1017/s0033291722003282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Inflammation plays a crucial role in the pathogenesis of major depressive disorder (MDD) and bipolar disorder (BD). This study aimed to examine whether the dysregulation of complement components contributes to brain structural defects in patients with mood disorders. METHODS A total of 52 BD patients, 35 MDD patients, and 53 controls were recruited. The human complement immunology assay was used to measure the levels of complement factors. Whole brain-based analysis was performed to investigate differences in gray matter volume (GMV) and cortical thickness (CT) among the BD, MDD, and control groups, and relationships were explored between neuroanatomical differences and levels of complement components. RESULTS GMV in the medial orbital frontal cortex (mOFC) and middle cingulum was lower in both patient groups than in controls, while the CT of the left precentral gyrus and left superior frontal gyrus were affected differently in the two disorders. Concentrations of C1q, C4, factor B, factor H, and properdin were higher in both patient groups than in controls, while concentrations of C3, C4 and factor H were significantly higher in BD than in MDD. Concentrations of C1q, factor H, and properdin showed a significant negative correlation with GMV in the mOFC at the voxel-wise level. CONCLUSIONS BD and MDD are associated with shared and different alterations in levels of complement factors and structural impairment in the brain. Structural defects in mOFC may be associated with elevated levels of certain complement factors, providing insight into the shared neuro-inflammatory pathogenesis of mood disorders.
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Affiliation(s)
- Hua Yu
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peiyan Ni
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Yang Tian
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Liansheng Zhao
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Mingli Li
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Xiaojing Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Wei
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jinxue Wei
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Xiangdong Du
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Qiang Wang
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Wanjun Guo
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaohong Ma
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Jeremy Coid
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Comparison of bipolar disorder type II and major depressive disorder. J Affect Disord 2023; 323:204-212. [PMID: 36410453 DOI: 10.1016/j.jad.2022.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/03/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Compare patients diagnosed as DSM-5 type II bipolar disorder (BD2) vs. major depressive disorder (MDD). METHODS We compared characteristics of 3246 closely and repeatedly evaluated, consenting, adult patient-subjects (n = 706 BD2, 2540 MDD) at a specialty clinic using bivariate methods and multivariable modeling. RESULTS Factors more associated with BD2 than MDD included: [a] descriptors (more familial psychiatric, mood and bipolar disorders and suicide; younger at onset, diagnosis and first-treatment; more education; more unemployment; fewer marriages and children; higher cyclothymic, hyperthymic and irritable temperament ratings, lower anxious); [b] morbidity (more hypomanic, mixed or panic first episodes; more co-occurring general medical diagnoses, more Cluster B personality disorder diagnoses and ADHD; more alcohol and drug abuse and smoking; shorter depressive episodes and interepisode periods; lower intake ratings of depression and anxiety, higher for hypomania; far more mood-switching with antidepressants; lower %-time depressed; DMI > MDI course-pattern in BD2; more suicide attempts and violent suicidal behavior); [c] item-scores with intake HDRS21 higher for suicidality, paranoia, anhedonia, guilt, and circadian variation; lower somatic anxiety, depressed mood, insight, hypochondriasis, agitation, and insomnia; and [d] treatment (more lithium, mood-stabilizing anticonvulsants and antipsychotics, less antidepressants and benzodiazepines). CONCLUSIONS BD2 and MDD subjects differed greatly in many descriptive, psychopathological and treatment measures, notably including more familial risk, earlier onset, more frequent recurrences and greater suicidal risk with BD2. Such differences can contribute to improving differentiation of the disorders and planning for their treatment.
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Affiliation(s)
- Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy
| | | | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Nestsiarovich A, Reps JM, Matheny ME, DuVall SL, Lynch KE, Beaton M, Jiang X, Spotnitz M, Pfohl SR, Shah NH, Torre CO, Reich CG, Lee DY, Son SJ, You SC, Park RW, Ryan PB, Lambert CG. Predictors of diagnostic transition from major depressive disorder to bipolar disorder: a retrospective observational network study. Transl Psychiatry 2021; 11:642. [PMID: 34930903 PMCID: PMC8688463 DOI: 10.1038/s41398-021-01760-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Many patients with bipolar disorder (BD) are initially misdiagnosed with major depressive disorder (MDD) and are treated with antidepressants, whose potential iatrogenic effects are widely discussed. It is unknown whether MDD is a comorbidity of BD or its earlier stage, and no consensus exists on individual conversion predictors, delaying BD's timely recognition and treatment. We aimed to build a predictive model of MDD to BD conversion and to validate it across a multi-national network of patient databases using the standardization afforded by the Observational Medical Outcomes Partnership (OMOP) common data model. Five "training" US databases were retrospectively analyzed: IBM MarketScan CCAE, MDCR, MDCD, Optum EHR, and Optum Claims. Cyclops regularized logistic regression models were developed on one-year MDD-BD conversion with all standard covariates from the HADES PatientLevelPrediction package. Time-to-conversion Kaplan-Meier analysis was performed up to a decade after MDD, stratified by model-estimated risk. External validation of the final prediction model was performed across 9 patient record databases within the Observational Health Data Sciences and Informatics (OHDSI) network internationally. The model's area under the curve (AUC) varied 0.633-0.745 (µ = 0.689) across the five US training databases. Nine variables predicted one-year MDD-BD transition. Factors that increased risk were: younger age, severe depression, psychosis, anxiety, substance misuse, self-harm thoughts/actions, and prior mental disorder. AUCs of the validation datasets ranged 0.570-0.785 (µ = 0.664). An assessment algorithm was built for MDD to BD conversion that allows distinguishing as much as 100-fold risk differences among patients and validates well across multiple international data sources.
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Affiliation(s)
- Anastasiya Nestsiarovich
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Center for Global Health, Albuquerque, NM, USA
| | - Jenna M Reps
- Janssen Research and Development, Raritan, NJ, USA
| | - Michael E Matheny
- Vanderbilt University, Department of Biomedical Informatics, Department of Medicine, Department of Biostatistics, Nashville, TN, USA
- Tennessee Valley Healthcare System VA, Nashville, TN, USA
| | - Scott L DuVall
- Veterans Affairs Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - Kristine E Lynch
- Veterans Affairs Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - Maura Beaton
- Columbia University Irving Medical Center, Department of Biomedical Informatics, New York, NY, USA
| | - Xinzhuo Jiang
- Columbia University Irving Medical Center, Department of Biomedical Informatics, New York, NY, USA
| | - Matthew Spotnitz
- Columbia University Irving Medical Center, Department of Biomedical Informatics, New York, NY, USA
| | - Stephen R Pfohl
- Stanford University, Stanford Center for Biomedical Informatics Research, Stanford, CA, USA
| | - Nigam H Shah
- Stanford University, Stanford Center for Biomedical Informatics Research, Stanford, CA, USA
| | | | | | - Dong Yun Lee
- Ajou University School of Medicine, Department of Psychiatry, Suwon, Republic of Korea
| | - Sang Joon Son
- Ajou University School of Medicine, Department of Psychiatry, Suwon, Republic of Korea
| | - Seng Chan You
- Ajou University School of Medicine, Department of Biomedical Informatics, Suwon, Republic of Korea
| | - Rae Woong Park
- Ajou University School of Medicine, Department of Biomedical Informatics, Suwon, Republic of Korea
| | - Patrick B Ryan
- Janssen Research and Development, Raritan, NJ, USA
- Columbia University Irving Medical Center, Department of Biomedical Informatics, New York, NY, USA
| | - Christophe G Lambert
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Center for Global Health, Albuquerque, NM, USA.
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Center for Global Health, Division of Translational Informatics, Albuquerque, NM, USA.
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8
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Impact of bipolar disorder on health-related quality of life and work productivity: Estimates from the national health and wellness survey in Japan. J Affect Disord 2021; 295:203-214. [PMID: 34479128 DOI: 10.1016/j.jad.2021.07.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies have shown that bipolar disorder (BD) patients frequently present with difficulties in interpersonal relationships, education or employment and suffer poorer quality of life. This study aimed to estimate the impact of BD on health-related quality of life (HRQOL), work productivity loss and indirect costs. METHODS Data was from the online, self-administered 2019 National Health and Wellness Survey. Outcomes were compared for those who self-reported a physician diagnosis of BD (N=179), major depressive disorder (MDD, N=1,549) and controls who have never experienced BD, MDD and schizophrenia (N=27,485). RESULTS The lifetime prevalence was estimated to be 0.60% for BD and 5.16% for MDD. Significantly lower Mental Component Summary (MCS), Role Component Summary (RCS) scores and EuroQol 5-dimension scale (EQ-5D-5L) summary index and significantly higher presenteeism, total work productivity impairment and activity impairment assessed by Work Productivity and Activity Impairment questionnaire and indirect costs for BD versus controls and BD PHQ-9≥10 versus PHQ-9<10 were observed. Compared to MDD patients, BD patients had significantly lower RCS score and greater work productivity loss and activity impairment. The national morbidity cost of BD in Japan was estimated to be Japanese yen 1,236 billion using a human-capital approach. LIMITATIONS The data used were self-reported and is cross-sectional in nature, thus causal relationship cannot be assumed. CONCLUSION BD patients and those with severe depressive symptoms experience significantly poorer HRQOL and greater work productivity loss and indirect costs. These findings highlight the importance of proper screening, diagnosis and treatment of BD and bipolar depression.
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Peterson EC, Rosenberg BM, Hough CM, Sandman CF, Neilson C, Miklowitz DJ, Kaiser RH. Behavioral mediators of stress-related mood symptoms in adolescence & young adulthood. J Affect Disord 2021; 294:94-102. [PMID: 34274793 PMCID: PMC8915485 DOI: 10.1016/j.jad.2021.06.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stress is a risk factor for unipolar and bipolar mood disorders, but the mechanisms linking stress to specific symptoms remain elusive. Behavioral responses to stress, such as impulsivity and social withdrawal, may mediate the associations between stress and particular mood symptoms. METHODS This study evaluated behavioral mediators of the relationship between self-reported intensity of daily stress and mood symptoms over up to eight weeks of daily diary surveys. The sample included individuals with unipolar or bipolar disorders, or with no psychiatric history (n = 113, ages 15-25). RESULTS Results showed that higher daily stress was related to higher severity of mania, and this pathway was mediated by impulsive behaviors. Higher stress also predicted higher severity of anhedonic depression, and social withdrawal mediated this relationship. A k-means clustering analysis revealed six subgroups with divergent profiles of stress-behavior-symptom pathways. LIMITATIONS Given the observational study design, analyses cannot determine causal relationships amongst these variables. Further work is needed to determine how relationships between these variables may vary based on stressor type, at different timescales, and within different populations. CONCLUSIONS Findings support a theoretical model in which impulsivity and social withdrawal act as behavioral mediators of the relationship between stress and mood symptoms. Additionally, distinct patterns of reactivity distinguished subgroups of people vulnerable to particular types of mood symptoms. These results provide novel information about how stress-reactive behaviors relate to specific mood symptoms, which may have clinical relevance as targets of intervention.
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Affiliation(s)
- Elena C Peterson
- Department of Psychology & Neuroscience, University of Colorado Boulder, Boulder, CO 80309, United States
| | - Benjamin M Rosenberg
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Christina M Hough
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Christina F Sandman
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Chiara Neilson
- Department of Psychology & Neuroscience, University of Colorado Boulder, Boulder, CO 80309, United States
| | - David J Miklowitz
- Semel Institute, University of California Los Angeles, Los Angeles, CA 90024, United States
| | - Roselinde H Kaiser
- Department of Psychology & Neuroscience, University of Colorado Boulder, Boulder, CO 80309, United States.
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10
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Thase ME, Harrington A, Calabrese J, Montgomery S, Niu X, Patel MD. Evaluation of MADRS severity thresholds in patients with bipolar depression. J Affect Disord 2021; 286:58-63. [PMID: 33677183 DOI: 10.1016/j.jad.2021.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Montgomery-Åsberg Depression Rating Scale (MADRS) is commonly used to assess depression symptom changes in clinical trials; however, the score itself can be difficult to interpret without clinical context. Categories of depression severity corresponding to MADRS total score have not been established for bipolar depression, which was the objective of this study. METHODS Data were pooled from 3 randomized, double-blind, placebo-controlled trials of cariprazine in patients with bipolar I depression; placebo and cariprazine arms were pooled. An anchor-based approach was used to map MADRS total score to the clinician-rated, 7-category Clinical Global Impression of Severity scale (CGI-S). Spearman's correlation coefficient was used to assess associations between MADRS total and CGI-S scores. Optimal MADRS severity thresholds for each CGI-S category was determined via Youden index using receiver operating characteristic (ROC) analyses. RESULTS Using data from 1523 patients with bipolar depression, mean MADRS total scores were positively correlated with mean CGI-S scores at week 6 (r = 0.87; P<.0001). Using ROC curves, MADRS severity thresholds corresponding to each CGI-S category were estimated with high sensitivity and specificity: 0-6 for "normal, not at all ill", 7-12 for "borderline mentally ill", 13-18 for "mildly ill", 19-23 for "moderately ill", 24-36 for "markedly ill", 37-39 for "severely ill", and ≥40 for "extremely ill". CONCLUSIONS Utilizing data from 3 clinical trials of patients with bipolar depression, MADRS severity thresholds were identified. These empirical findings may help clinicians contextualize MADRS results from bipolar clinical research and apply to their practice. TRIAL REGISTRATION clinicaltrials.gov NCT01396447, NCT02670538, NCT02670551.
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Affiliation(s)
| | | | - Joseph Calabrese
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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11
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Fridgeirsson EA, Deng ZD, Denys D, van Waarde JA, van Wingen GA. Electric field strength induced by electroconvulsive therapy is associated with clinical outcome. Neuroimage Clin 2021; 30:102581. [PMID: 33588322 PMCID: PMC7895836 DOI: 10.1016/j.nicl.2021.102581] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/31/2022]
Abstract
The clinical effect of electroconvulsive therapy (ECT) is mediated by eliciting a generalized seizure, which is achieved by applying electrical current to the head via scalp electrodes. The anatomy of the head influences the distribution of current flow in each brain region. Here, we investigated whether individual differences in simulated local electrical field strength are associated with ECT efficacy. We modeled the electric field of 67 depressed patients receiving ECT. Patient's T1 magnetic resonance images were segmented, conductivities were assigned to each tissue and the finite element method was used to solve for the electric field induced by the electrodes. We investigated the correlation between modelled electric field and ECT outcome using voxel-wise general linear models. The difference between bilateral (BL) and right unilateral (RUL) electrode placement was striking. Even within electrode configuration, there was substantial variability between patients. For the modeled BL placement, stronger electric field strengths appeared in the left hemisphere and part of the right temporal lobe. Importantly, a stronger electric field in the temporal lobes was associated with less optimal ECT response in patients treated with BL-ECT. No significant differences in electric field distributions were found between responders and non-responders to RUL-ECT. These results suggest that overstimulation of the temporal lobes during BL stimulation has negative consequences on treatment outcome. If replicated, individualized pre-ECT computer-modelled electric field distributions may inform the development of patient-specific ECT protocols.
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Affiliation(s)
- Egill Axfjord Fridgeirsson
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, United States
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands; The Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | | | - Guido A van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands.
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12
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Ozcan H, Takim U. 50 Useful Sociodemographic and Clinical Tips to Overcome the Challenge Differentiating Bipolar Depression from Unipolar Depression. Eurasian J Med 2021; 53:64-66. [PMID: 33716534 PMCID: PMC7929576 DOI: 10.5152/eurasianjmed.2021.20064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Halil Ozcan
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ugur Takim
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
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13
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Bessonova L, Ogden K, Doane MJ, O'Sullivan AK, Tohen M. The Economic Burden of Bipolar Disorder in the United States: A Systematic Literature Review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:481-497. [PMID: 32982338 PMCID: PMC7489939 DOI: 10.2147/ceor.s259338] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022] Open
Abstract
Bipolar disorder (BD) is a mood disorder with subtypes characterized by episodes of mania, hypomania, and/or depression. BD is associated with substantial economic burden, and the bipolar I disorder (BD-I) subtype is associated with high medical costs. This review further evaluated the economic burden of BD and BD-I in the United States (US), describing health-care resource utilization (HCRU) and sources of direct medical and indirect costs. Data were obtained from systematic searches of MEDLINE®, EMBASE®, and National Health Service Economic Evaluation Database. Citations were screened to identify primary research studies (published 2008-2018) on the economic burden of BD/BD-I or its treatment in real-world settings. Reported costs were converted to 2018 US dollars. Of identified abstracts (N=4111), 56 studies were included. The estimated total annual national economic burden of BD/BD-I was more than $195 billion, with approximately 25% attributed to direct medical costs. Individuals with BD/BD-I used health-care services more frequently and had higher direct medical costs than matched individuals without the disease. Drivers of higher direct costs included frequent psychiatric interventions, presence of comorbid medical/psychiatric conditions, and both suboptimal medication adherence and clinical management. Indirect costs (eg, unemployment, lost work productivity for patients/caregivers) accounted for 72-80% of the national economic burden of BD/BD-I. Different definitions for study populations and cost categories limited comparisons of economic outcomes. This review builds on existing literature describing the economic burden of BD and confirmed cost drivers of BD/BD-I. Improved clinical management of BD/BD-I and associated comorbidities, together with better medication adherence, may reduce health-care costs and improve patient outcomes.
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Affiliation(s)
- Leona Bessonova
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Kristine Ogden
- Evidence, Worldwide Clinical Trials, Morrisville, NC, USA
| | - Michael J Doane
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Amy K O'Sullivan
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
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14
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Crowe M, Porter R, Douglas K, Inder M, Lacey C, Jordan J, Wells H. Patients' experiences of cognitive functioning in recurrent depression: A qualitative study. J Psychiatr Ment Health Nurs 2020; 27:321-329. [PMID: 31981272 DOI: 10.1111/jpm.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recurrent depressive episodes involve significant morbidity, suicide risk and recurrent hospitalizations. In both major depressive disorder and bipolar disorder, there are significant impairments in functioning following resolution of acute symptoms. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides an in-depth qualitative understanding of the subjective experience of cognitive impairment following a depressive episode in a recurrent mood disorder. It identifies descriptions of two types of experience (being stuck and being preoccupied with one's thoughts) that led to impairments in concentration, memory, organization and decision-making. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to develop an awareness of the impact of cognitive difficulties in the process of recovery from recurrent mood disorders. Mental health nurses need to provide knowledgeable reassurance, information and interventions to people who experience cognitive difficulties to provide a framework of understanding that promotes recovery. ABSTRACT: Introduction People who experience recurrent depressive episodes often have ongoing cognitive problems that impact on their functional recovery. These cognitive difficulties have been identified as impacting on social, interpersonal and occupational functioning and can result in vulnerability to relapse. Aim The aim of this qualitative study was to explore participants' subjective experiences of cognitive impairment after discharge from mental health services following treatment for recurrent depression. Methods The study was designed as a qualitative study in order to best capture participants' subjective experiences. Data were collected by semi-structured interviews and were analysed using a process of thematic analysis. Results Twenty participants took part in this study. All participants described experiences of either 1) "being stuck"; or 2) "being preoccupied with own thoughts"; however, all participants described the experiences in the third theme: "it stops you living to your potential." Implications for practice In order to promote recovery in a meaningful way, mental health nurses need to provide information about and strategies for managing cognitive difficulties associated with recurrent mood disorders.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hayley Wells
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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15
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O'Donovan C, Alda M. Depression Preceding Diagnosis of Bipolar Disorder. Front Psychiatry 2020; 11:500. [PMID: 32595530 PMCID: PMC7300293 DOI: 10.3389/fpsyt.2020.00500] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
This paper focuses on depression that precedes an onset of manifest bipolar disorder as early stage bipolar disorder. First, we review how to pragmatically identify the clinical characteristics of patients presenting with an episode of depression who subsequently go on to develop episodes of mania or hypomania. The existing literature shows a strong consensus: accurate identification of depression with early onset and recurrent course with multiple episodes, subthreshold hypomanic and/or mixed symptoms, and family history of bipolar disorder or completed suicide have been shown by multiple authors as signs pointing to bipolar diagnosis. This contrasts with relatively limited information available to guide management of such "pre-bipolar" (pre-declared bipolar) patients, especially those in the adult age range. Default assumption of unipolar depression at this stage carries significant risk. Antidepressants are still the most common pharmacological treatment used, but clinicians need to be aware of their potential harm. In some patients with unrecognized bipolar depression, antidepressants can not only produce switch to (hypo)mania, but also mixed symptoms, or worsening of depression with an increased risk of suicide. We review pragmatic management strategies in the literature beyond clinical guidelines that can be considered for this at-risk group encompassing the more recent child and adolescent literature. In the future, genetic research could make the early identification of bipolar depression easier by generating informative markers and polygenic risk scores.
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Affiliation(s)
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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16
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Tanner JA, Hensel J, Davies PE, Brown LC, Dechairo BM, Mulsant BH. Economic Burden of Depression and Associated Resource Use in Manitoba, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:338-346. [PMID: 31835904 PMCID: PMC7265616 DOI: 10.1177/0706743719895342] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterize the health-care utilization and economic burden associated with depression in Manitoba, Canada. METHODS Patient-level data were retrieved from the Manitoba Centre for Health Policy administrative, clinical, and laboratory databases for the study period of January 1, 1996, through December 31, 2016. Patients were assigned to the depression cohort based on diagnoses recorded in hospitalizations and outpatient physician claims, as well as antidepressant prescription drug claims. A comparison cohort of nondepressed subjects, matched with replacement for age, gender, place of residence (urban vs. rural), and index date, was created. Demographics, comorbidities, intentional self-harm, mortality, health-care utilization, prescription drug utilization, and costs of health-care utilization and social services were compared between depressed patients and matched nondepressed patients, and incidence rate ratios and hazard ratios were reported. RESULTS There were 190,065 patients in the depression cohort and 378,177 patients in the nondepression cohort. Comorbidities were 43% more prevalent among depressed patients. Intentional self-harm, all-cause mortality, and suicide mortality were higher among patients with depression than the nondepression cohort. Health-care utilization-including hospitalizations, physician visits, physician-provided psychotherapy, and prescription drugs-was higher in the depression than the nondepression cohort. Mean health-care utilization costs were 3.5 times higher among depressed patients than nondepressed patients ($10,064 and $2,832, respectively). Similarly, mean social services costs were 3 times higher ($1,522 and $510, respectively). Overall, depression adds a total average cost of $8,244 (SD = $40,542) per person per year. CONCLUSIONS Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.
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Affiliation(s)
- Julie-Anne Tanner
- Tanenbaum Pharmacogenetics Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Assurex Health Ltd., Toronto, Ontario, Canada
| | - Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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17
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"Do depressive and manic symptoms differentially impact on functioning in acute depression? Results from a large, cross-sectional study". J Affect Disord 2020; 261:30-39. [PMID: 31600585 DOI: 10.1016/j.jad.2019.09.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 09/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Diagnostic criteria for a major depressive episode capture heterogeneous presentations across unipolar (UD) and bipolar (BD) and first-onset (FDE) depression. We evaluated the contribution of each depressive and (hypo)manic symptom to worse functioning in UD/BD/FDE subgroups. METHODS A post-hoc analysis of the BRIDGE-II-Mix study. Acutely depressed patients were stratified into UD, BD and FDE. Each (hypo)manic or depressive symptom was included in a diagnosis-specific logistic regression model with functioning as dependent variable. Better/worse functioning was set with median diagnosis-specific GAF scores cutoffs. All p values were two-tailed. Statistical significance was set at p < 0.05. RESULTS A total of 2768/2811 depressed individuals were enrolled. In BD (N = 716), "recurrent thoughts of death" (OR 2.48, p < 0.0001) and "feelings of worthlessness" (OR 2.28, p < 0.0001) among depressive symptoms, "aggressiveness" (OR 1.67, p = 0.022) as the unique (hypo)manic symptom, significantly contributed to worse functioning. In UD (N = 1357), "depressed mood" (OR 5.6, p = 0.031) and "diminished interest or pleasure" (OR 4.77, p < 0.0001) among depressive, "grandiosity" (OR 3.5, p = 0.014) among (hypo)manic symptoms, most significantly contributed to worse functioning. In FDE (N = 677) "recurrent thoughts of death" (OR 1.99, p < 0.0001) and "insomnia/hypersomnia" (OR 1.88, p = 0.039) among depressive, "grandiosity" (OR 5.98, p = 0.038) as (hypo)manic symptoms significantly contributed to worse functioning. LIMITATIONS The post-hoc and cross-sectional design do not allow for prognostic or causal inferences. CONCLUSIONS Key depressive and (hypo)manic symptoms distinctively associate with worse functional outcome in acute depression, with differential diagnostic-specific magnitude of effect. Core depressive symptoms are associated with worse functioning in unipolar depression, but not in bipolar or first-episode depression.
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Alcohol Consumption and Bipolar Disorder in a Colombian Population Sample. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:44-52. [PMID: 32081208 DOI: 10.1016/j.rcp.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/14/2017] [Accepted: 03/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is reported to be the mental disorder with the highest rate of comorbidity with substance use disorders (SUD). More than half of patients with BD have been found to have disorders associated with alcohol use. METHODS A secondary analysis was performed in a population sample of Colombian adults. The aim was to identify bipolar-alcohol comorbidity and factors related to the use of alcohol in people with BD. The diagnosis of BD among participants was made with the "Composite International Diagnostic Interview" (CIDI-CAPI) and the pattern of alcohol consumption in the last year was evaluated with the AUDIT C screening tool. RESULTS It was found that all patients with BD had some type of problematic alcohol consumption pattern. Women with BD were at greater risk of having a dependence-type pattern, using nicotine and marijuana and, among those living in urban areas, had higher rates of suicidal ideation, although that risk was lower if they were in a stable relationship. DISCUSSION Some of the related factors we identified are new with respect to previous publications and others have already been described in similar studies. CONCLUSIONS Given the importance of such factors in the management of this population and their prognosis, these findings highlight the need to determine consumption patterns of alcohol and other substances in patients with BD.
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Rong H, Xie XH, Zhao J, Lai WT, Wang MB, Xu D, Liu YH, Guo YY, Xu SX, Deng WF, Yang QF, Xiao L, Zhang YL, He FS, Wang S, Liu TB. Similarly in depression, nuances of gut microbiota: Evidences from a shotgun metagenomics sequencing study on major depressive disorder versus bipolar disorder with current major depressive episode patients. J Psychiatr Res 2019; 113:90-99. [PMID: 30927646 DOI: 10.1016/j.jpsychires.2019.03.017] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND To probe the differences of gut microbiota among major depressive disorder (MDD), bipolar disorder with current major depressive episode (BPD) and health participants. METHODS Thirty one MDD patients, thirty BPD patients, and thirty healthy controls (HCs) were recruited. All the faecal samples were analyzed by shotgun metagenomics sequencing. Except for routine analyses of alpha diversity, we specially designed a new indicator, the Gm coefficient, to evaluate the inequality of relative abundances of microbiota for each participant. RESULTS The Gm coefficients are significant decreased in both MDD and BPD groups. The relative abundances of increased phyla Firmicutes and Actinobacteria and decreased Bacteroidetes were significantly in the MDD and BPD groups. At genus level, four of top five enriched genera (Bacteroides, Clostridium, Bifidobacterium, Oscillibacter and Streptococcus) were found increased significantly in the MDD and BPD groups compared with HCs. The genera Escherichia and Klebsiella showed significant changes in abundances only between the BPD and HC groups. At the species level, compared with BPD patients, MDD patients had a higher abundance of Prevotellaceae including Prevotella denticola F0289, Prevotella intermedia 17, Prevotella ruminicola, and Prevotella intermedia. Furthermore, the abundance of Fusobacteriaceae, Escherichia blattae DSM 4481 and Klebsiella oxytoca were significantly increased, whereas the Bifidobacterium longum subsp. infantis ATCC 15697 = JCM 1222 was significantly reduced in BPD group compared with MDD group. CONCLUSIONS Our study suggested that gut microbiota may be involved in the pathogenesis of both MDD and BPD patients, and the nuances of bacteria may have the potentiality of being the biomarkers of MDD and BPD.
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Affiliation(s)
- Han Rong
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China; Affiliated Shenzhen Clinical College of Psychiatry, Jining Medical University, Jining, Shandong, China
| | - Xin-Hui Xie
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China; Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China; Laboratory of Brain Stimulation and Biological Psychiatry, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Jie Zhao
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Wen-Tao Lai
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Ming-Bang Wang
- Xiamen Branch, Shanghai Key Laboratory of Birth Defects, Division of Neonatology, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, 201102, China
| | - Dan Xu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yang-Hui Liu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yuan-Yuan Guo
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Shu-Xian Xu
- Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Wen-Feng Deng
- Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Qi-Fan Yang
- Center of Acute Psychiatry Service, Second People's Hospital of Huizhou, Huizhou, Guangdong, China
| | - Li Xiao
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Ying-Li Zhang
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | | | - Sheng Wang
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Tie-Bang Liu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.
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Maes M, Moraes JB, Congio A, Bonifacio KL, Barbosa DS, Vargas HO, Michelin AP, Carvalho AF, Nunes SOV. Development of a Novel Staging Model for Affective Disorders Using Partial Least Squares Bootstrapping: Effects of Lipid-Associated Antioxidant Defenses and Neuro-Oxidative Stress. Mol Neurobiol 2019; 56:6626-6644. [PMID: 30911933 DOI: 10.1007/s12035-019-1552-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/13/2019] [Indexed: 12/14/2022]
Abstract
Although, staging models gained momentum to stage define affective disorders, no attempts were made to construct mathematical staging models using clinical and biomarker data in patients with major depression and bipolar disorder. The aims of this study were to use clinical and biomarker data to construct statistically derived staging models, which are associated with early lifetime traumata (ELTs), affective phenomenology, and biomarkers. In the current study, 172 subjects participated, 105 with affective disorders (both bipolar and unipolar) and 67 controls. Staging scores were computed by extracting latent vectors (LVs) from clinical data including ELTs, recurring flare ups and suicidal behaviors, outcome data such as disabilities and health-related quality of life (HR-QoL), and paraoxonase (PON)1 actvities and nitro-oxidative stress biomarkers. Recurrence of episodes and suicidal behaviors could reliably be combined into a LV with adequate composite reliability (the "recurrence LV"), which was associated with female sex, the combined effects of multiple ELTs, disabilities, HR-QoL, and impairments in cognitive tests. All those factors could be combined into a reliable "ELT-staging LV" which was significantly associated with nitro-oxidative stress biomarkers. A reliable LV could be extracted from serum PON1 activities, recurrent flare ups, disabilities, and HR-QoL. Our ELT-staging index scores the severity of a relevant affective dimension, shared by both major depression and bipolar disorder, namely the trajectory from ELTs, a relapsing course, and suicidal behaviors to progressive disabilities. Patients were classified into three stages, namely an early stage, a relapse-regression stage, and a suicidal-regression stage. Lowered lipid-associated antioxidant defenses may be a drug target to prevent the transition from the early to the later regression stages.
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Affiliation(s)
- Michael Maes
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil. .,Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand. .,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria. .,IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Juliana Brum Moraes
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
| | - Ana Congio
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
| | - Kamila Landucci Bonifacio
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
| | - Decio Sabbatini Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
| | - Heber Odebrecht Vargas
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
| | - Ana Paula Michelin
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Sandra Odebrecht Vargas Nunes
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, Londrina, PR, 60 86035-380, Brazil
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Olfson M, Wang S, Wall M, Marcus SC, Blanco C. Trends in Serious Psychological Distress and Outpatient Mental Health Care of US Adults. JAMA Psychiatry 2019; 76:152-161. [PMID: 30484838 PMCID: PMC6439744 DOI: 10.1001/jamapsychiatry.2018.3550] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Reports of a recent increase in US outpatient mental health care raise questions about whether it has been driven by rising rates of psychological distress and whether mental health treatment has become either more or less focused on people with higher levels of distress. OBJECTIVE To characterize national trends in serious psychological distress and trends in outpatient mental health service use by adults with and without serious psychological distress. DESIGN, SETTING, AND PARTICIPANTS The 2004-2005, 2009-2010, and 2014-2015 Medical Expenditure Panel Surveys (MEPS) were nationally representative surveys taken in US households. The analysis was limited to participants 18 years or older. Dates of this analysis were February 2018 to April 2018. MAIN OUTCOMES AND MEASURES Annual national trends in the percentages of adults with serious psychological distress (Kessler 6 scale score ≥13), outpatient mental health service use (outpatient visit with a mental disorder diagnosis, psychotherapy visit, or psychotropic medication), and type of psychotropic medication use (antidepressants, anxiolytics/sedatives, antipsychotics, mood stabilizers, and stimulants). Age- and sex-adjusted odds ratios of the associations of survey period with the odds of serious psychological distress, outpatient mental health service use, and outpatient mental health service use were stratified by level of psychological distress. RESULTS The analysis involved 139 862 adult participants from the 2004-2005, 2009-2010, and 2014-2015 MEPS, including 51.67% women, 48.33% men, 67.11% white adults, and 32.89% nonwhite adults, with an overall mean (SE) age of 46.41 (0.14) years. Serious psychological distress declined overall from 4.82% (2004-2005) to 3.71% (2014-2015), including significant declines among young (3.94% to 3.07%), middle-aged (5.52% to 4.36%), and older adults (5.24% to 3.79%); men (3.94% to 3.09%) and women (5.64% to 4.29%); and major racial/ethnic groups (white, 4.52% to 3.82%; African American, 5.12% to 3.64%; Hispanic, 6.03% to 3.55%; and other, 5.22% to 3.26%). Overall, the percentage of adults receiving any outpatient mental health service increased from 19.08% (2004-2005) to 23.00% (2014-2015) (adjusted odds ratio, 1.25; 95% CI, 1.17-1.34). Although the proportionate increase in outpatient mental health service use for adults with serious psychological distress (54.17% to 68.40%) was larger than that for adults with less serious or no psychological distress (17.26% to 21.08%), the absolute increase in outpatient mental health service use was almost completely the result of growth in outpatient mental health service use by individuals with less serious or no psychological distress. CONCLUSIONS AND RELEVANCE The recent increase in outpatient mental health service use occurred during a period of decline in serious psychological distress. Adults with less serious psychological distress accounted for most of the absolute increase in outpatient mental health service use, while adults with serious psychological distress experienced a greater relative increase in outpatient mental health service use.
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Affiliation(s)
- Mark Olfson
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Shuai Wang
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melanie Wall
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Steven C. Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia
| | - Carlos Blanco
- National Institute on Drug Abuse, Bethesda, Maryland
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22
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Patella AM, Jansen K, Cardoso TDA, Souza LDDM, Silva RAD, Coelho FMDC. Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults. J Affect Disord 2019; 243:103-107. [PMID: 30241024 DOI: 10.1016/j.jad.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/29/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression. OBJECTIVE To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions. METHODS This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances. RESULTS The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028). LIMITATIONS The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression. CONCLUSION Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.
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Affiliation(s)
| | - Karen Jansen
- Graduate Program in Health and Behavior, Translational Science on Brain Disorders, Catholic University of Pelotas, RS, Brazil
| | - Taiane de Azevedo Cardoso
- Graduate Program in Health and Behavior, Translational Science on Brain Disorders, Catholic University of Pelotas, RS, Brazil; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Luciano Dias de Mattos Souza
- Graduate Program in Health and Behavior, Translational Science on Brain Disorders, Catholic University of Pelotas, RS, Brazil
| | - Ricardo Azevedo da Silva
- Graduate Program in Health and Behavior, Translational Science on Brain Disorders, Catholic University of Pelotas, RS, Brazil
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23
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Ghanbari Jolfaei A, Ataei S, Ghayoomi R, Shabani A. High Frequency of Bipolar Disorder Comorbidity in Medical Inpatients. IRANIAN JOURNAL OF PSYCHIATRY 2019; 14:60-66. [PMID: 31114619 PMCID: PMC6505055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Bipolar disorder is a severe, disabling, and recurring disorder. Some studies have shown that the frequency of bipolar disorder in patients with medical diseases is higher than healthy controls. The aim of this study was to investigate the frequency of bipolar disorders in medically ill patients hospitalized in Iranian general hospitals. Method : In this cross sectional study, 697 inpatients (342 men, 49.1%) from different wards of 3 general hospitals, with the mean age of 39.3+-10, were enrolled in the study using nonprobability sampling. Demographic questionnaire, Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) were used. Inclusion criteria were as follow: informed consent, age 18-65 years, ability to speak Persian, and having at least middle school education. Results: The frequency of bipolar disorder was 12.1% and 20.8% based on BSDS and MDQ, respectively. The results of both tests were positive in 7.9% of hospitalized patients. The frequency of bipolar mood disorder was significantly higher in single patients and in those with comorbidity of alcohol and substance use disorders. Conclusion: Considering the high frequency of bipolar mood disorders in hospitalized medically ill patients and its probable effects on compliance and prognosis, early screening, diagnosis, and treatment of bipolar mood disorders is important in these patients.
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Affiliation(s)
- Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Ataei
- Minimally Invasive Surgery Research Center, Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Raoofeh Ghayoomi
- Department of Community Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Shahid Mansouri Street, Niyayesh Street, Satarkhan Avenue,Tehran, Iran. Postal Code: 1445613111. Tel: 98-2166551655-60, Fax: 98-2166506853,
| | - Amir Shabani
- Mental Health Research Center, Bipolar Disorders Research Group, Iran University of Medical Sciences, Tehran, Iran
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24
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Abumadini M. Sociodemographic characteristics of adult Saudi patients with mood disorder subtypes. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2019; 7:169-174. [PMID: 31543738 PMCID: PMC6734740 DOI: 10.4103/sjmms.sjmms_60_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/14/2018] [Accepted: 06/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background: The demographic profile and clinical manifestations of mood disorder subtypes can differ across regions; however, there is a lack of studies from Saudi Arabia on the sociodemographic characteristics of adult Saudi patients with mood disorder subtypes. Objective: The study aims to explore the sociodemographic profile of adult Saudi patients with different types of mood disorders. Methods: This retrospective study analyzed the data of all adult Saudi patients (aged ≥18 years) who were diagnosed with a mood disorder and attended the psychiatric outpatient clinic at King Fahd Hospital of the University (KFHU), Al Khobar, Saudi Arabia, between 1982 and 2011. Patients with psychiatric comorbidity were not included in the analyses. Major depressive disorder (depression), bipolar disorder, adjustment disorder and dysthymia were the four subtypes of mood disorder identified in the sample, and all eligible patients were categorized accordingly. Results: A total of 340 patients were included in this study. Slightly less than half (42.4%) the study population were aged 18–30 years. Further, 58% of the patients were females, 67.6% were married and 58.8% were unemployed. Depression was the most common mood disorder (~73%). Of the patients with bipolar disorder (n = 38), more than half were male and aged 18–30 years (~58% each); these percentages were higher than that observed in other subtypes. Conclusion: This study found that among patients at KFHU, depression is the most common mood disorder and that most patients are females. In contrast, bipolar disorder is more common among males. Further in-depth studies in a larger sample size may provide better patient profiling, which can be used for developing effective screening programs.
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25
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Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS). J Affect Disord 2018; 241:319-324. [PMID: 30142591 DOI: 10.1016/j.jad.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. METHODS Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15-64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. RESULTS Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6-24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00-2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81-3.81) persisted in multivariable models. LIMITATION Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. CONCLUSION The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
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26
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Lasebikan VO, Ayinde O, Odunleye M. Assessment of the alcohol consumption among outdoor bar drinkers in Nigeria by qualitative methods. BMC Public Health 2018; 18:318. [PMID: 29510694 PMCID: PMC5840737 DOI: 10.1186/s12889-018-5250-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/02/2018] [Indexed: 01/19/2023] Open
Abstract
Background There are indications that drinking in outdoor bars, such as at motor-parks, by the roadsides or street corners have become popular in Nigeria. Method Three sets of qualitative assessments were carried out from three outdoor bars, randomly selected from 22 of such in Ibadan, Nigeria. The main sources of data were by direct observation and focus group discussion (FGD), conducted by a non-probabilistic sample of outdoor bar drinkers, alcohol vendors and from community members. The qualitative assessments were recorded, followed by a thematic analysis of the contents of the qualitative assessments. Results Widespread use of alcohol was reported. Patrons of outdoor bars reported that their context of drinking was pleasurable to them. Use of local beverages usually called ‘sepe’ is increasing. The majority of them do not have adequate health information about the harmful consequences of alcohol. Alcohol and other substances of abuse were openly displayed, sold and consumed at the study sites. There were poor law provision and enforcement of laws prohibiting open display of alcohol and other substances. Conclusion A high proportion of social drinkers in outdoor bars require intervention for their drinking behaviour. This is important because they have little or no information about the health hazards associated with excessive drinking. Presentation of these findings should contribute to increased awareness and improved response from the policy makers.
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Affiliation(s)
- Victor O Lasebikan
- Department of Psychiatry, College of Medicine, University of Ibadan, PMB, Ibadan, 5116, Nigeria.
| | - Olatunde Ayinde
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Mayokun Odunleye
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
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27
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Sowa-Kućma M, Styczeń K, Siwek M, Misztak P, Nowak RJ, Dudek D, Rybakowski JK, Nowak G, Maes M. Are there differences in lipid peroxidation and immune biomarkers between major depression and bipolar disorder: Effects of melancholia, atypical depression, severity of illness, episode number, suicidal ideation and prior suicide attempts. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:372-383. [PMID: 28867391 DOI: 10.1016/j.pnpbp.2017.08.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is evidence that major depression (MDD) and bipolar disorder (BD) are accompanied by activated immune & oxidative (I&O) pathways. METHODS To compare I&O biomarkers between MDD and BD we assessed serum levels of thiobarbituric acid reactive substances (TBARS; a lipid peroxidation marker), soluble interleukin-2 receptor (sIL-2R), sIL-6R, IL-α, sIL-1R antagonist (sIL-1RA), tumor necrosis factor receptor 60kDa/80kDa (sTNFR60/R80) in 114 MDD and 133 BD patients, and 50 healthy controls. We computed z-unit weighted indices reflecting the 5 cytokine receptor levels (zCytR), cell-mediated immunity (zCMI) and I&O pathways (zCMI+TBARS). RESULTS There are no significant differences in biomarkers between MDD and BD. BD/MDD with atypical features is characterized by increased sIL-6R and TBARS, whereas melancholia is associated with higher TBARS and lower sTNFR60 levels. Severity of illness, as measured with the Hamilton Depression Rating Scale, is correlated with increased sIL-6R, sTNFR80, TBARS, zCytR and zCMI+TBARS. The number of episodes the year prior to blood sampling is positively associated with sTNFR80, TBARS, zCMI, zCMI+TBARS, while number of hospitalizations is positively associated with sIL-1RA. Prior suicidal attempts are associated with increased sIL-1RA, IL-1α, zCMI, TBARS and zCMI+TBARS, while TBARS is associated with current suicidal ideation. CONCLUSIONS There are no I&O biomarker differences between MDD and BD. Atypical depression is associated with increased IL-6 trans-signaling and lipid peroxidation. Severity of depression, number of episodes and suicidal attempts are associated with activated I&O pathways. Increased TBARS is the single best predictor of BD/MDD, atypical depression, melancholia and current suicidal ideation.
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Affiliation(s)
- Magdalena Sowa-Kućma
- Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Department of Neurobiology, Smetna Street 12, 31-343 Krakow, Poland; Department of Human Physiology, Institute of Clinical and Experimental Medicine, Medical Faculty, University of Rzeszow, Al. Kopisto Street 2a, 35-959 Rzeszów, Poland.
| | - Krzysztof Styczeń
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501 Krakow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501 Krakow, Poland
| | - Paulina Misztak
- Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Department of Neurobiology, Smetna Street 12, 31-343 Krakow, Poland; Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Rafał J Nowak
- Department of Drug Management, Jagiellonian University Medical College, Grzegórzecka 20, 31-531 Krakow, Poland
| | - Dominika Dudek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501 Krakow, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland
| | - Gabriel Nowak
- Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Department of Neurobiology, Smetna Street 12, 31-343 Krakow, Poland; Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands
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28
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Rodríguez-Cano E, Alonso-Lana S, Sarró S, Fernández-Corcuera P, Goikolea JM, Vieta E, Maristany T, Salvador R, McKenna PJ, Pomarol-Clotet E. Differential failure to deactivate the default mode network in unipolar and bipolar depression. Bipolar Disord 2017; 19:386-395. [PMID: 28714580 DOI: 10.1111/bdi.12517] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Neuroimaging studies have revealed evidence of brain functional abnormalities in bipolar depressive disorder (BDD) and major depressive disorder (MDD). However, few studies to date have compared these two mood disorders directly. METHODS Matched groups of 26 BDD type I patients, 26 MDD patients and 26 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the n-back working memory task. A whole-brain ANOVA was used to compare the three groups and clusters of significant difference were examined further using region-of-interest (ROI) analysis. RESULTS The whole-brain ANOVA revealed a single cluster of significant difference in the medial frontal cortex. The BDD and MDD patients both showed failure to deactivate in this area compared to the controls. The BDD patients showed significantly greater failure of deactivation than the MDD patients, which was not accounted for by differences in severity or chronicity of illness between them. CONCLUSIONS Failure of deactivation, considered to reflect default mode network dysfunction, is present to a greater extent in bipolar than unipolar depression. The study of this network may be useful in the search for brain markers that distinguish the two disorders.
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Affiliation(s)
- Elena Rodríguez-Cano
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,Benito Menni Complex Assistencial en Salut Mental, Sant Boi, Spain.,Escola de Doctorat, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,CIBERSAM, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,CIBERSAM, Barcelona, Spain
| | | | - José M Goikolea
- CIBERSAM, Barcelona, Spain.,Hospital Clinic, Bipolar Disorders Program, Barcelona, Spain
| | - Eduard Vieta
- CIBERSAM, Barcelona, Spain.,Hospital Clinic, Bipolar Disorders Program, Barcelona, Spain
| | | | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,CIBERSAM, Barcelona, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,CIBERSAM, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,CIBERSAM, Barcelona, Spain
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Guzman-Parra J, Rivas F, Strohmaier J, Forstner A, Streit F, Auburger G, Propping P, Orozco-Diaz G, González MJ, Gil-Flores S, Cabaleiro-Fabeiro FJ, Del Río-Noriega F, Perez-Perez F, Haro-González J, de Diego-Otero Y, Romero-Sanchiz P, Moreno-Küstner B, Cichon S, Nöthen MM, Rietschel M, Mayoral F. The Andalusian Bipolar Family (ABiF) Study: Protocol and sample description. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 11:199-207. [PMID: 28619597 DOI: 10.1016/j.rpsm.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/29/2017] [Accepted: 03/23/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Here, we present the first description of the Andalusian Bipolar Family (ABiF) Study. This longitudinal investigation of families from Andalusia, Spain commenced in 1997 with the aim of elucidating the molecular genetic causes of bipolar affective disorder. The cohort has since contributed to a number of key genetic findings, as reported in international journals. However, insight into the genetic underpinnings of the disorder in these families remains limited. METHOD In the initial 1997-2003 study phase, 100 multiplex bipolar disorder and other mood disorder families were recruited. The ongoing second phase of the project commenced in 2013, and involves follow-up of a subgroup of the originally recruited families. The aim of the follow-up investigation is to generate: i) longitudinal clinical data; ii) results from detailed neuropsychological assessments; and iii) a more extensive collection of biomaterials for future molecular biological studies. RESULTS The ABiF Study will thus generate a valuable resource for future investigations into the aetiology of bipolar affective disorder; in particular the causes of high disease loading within multiply affected families. DISCUSSION We discuss the value of this approach in terms of new technologies for the identification of high-penetrance genetic factors. These new technologies include exome and whole genome sequencing, and the use of induced pluripotent stem cells or model organisms to determine functional consequences.
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Affiliation(s)
- Jose Guzman-Parra
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España.
| | - Fabio Rivas
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España
| | - Jana Strohmaier
- Departamento de Epidemiología Genética en Psiquiatría, Instituto Central de Salud Mental, Facultad de Medicina de Mannheim, Universidad de Heidelberg, Mannheim, Alemania
| | - Andreas Forstner
- Instituto de Genética Humana, Universidad de Bonn, Bonn, Alemania; Departamento de Genómica, Life & Brain Center, Universidad de Bonn, Bonn, Alemania
| | - Fabian Streit
- Departamento de Epidemiología Genética en Psiquiatría, Instituto Central de Salud Mental, Facultad de Medicina de Mannheim, Universidad de Heidelberg, Mannheim, Alemania
| | - Georg Auburger
- Clínica de Neurología, Universidad de Frankfurt, Frankfurt, Alemania
| | - Peter Propping
- Instituto de Genética Humana, Universidad de Bonn, Bonn, Alemania; Departamento de Genómica, Life & Brain Center, Universidad de Bonn, Bonn, Alemania
| | - Guillermo Orozco-Diaz
- Unidad de Gestión Clínica del Dispositivo de Cuidados Críticos y Urgencias Coin-Gudalhorce, Málaga, España
| | - Maria José González
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España
| | - Susana Gil-Flores
- Departamento de Salud Mental, Universidad Hospital Reina Sofía, Córdoba, España
| | | | | | - Fermin Perez-Perez
- Departamento de Salud Mental, Hospital de Puerto Real, Puerto Real, Cádiz, España
| | - Jesus Haro-González
- Departamento de Salud Mental, Hospital Punta de Europa, Algeciras, Cádiz, España
| | - Yolanda de Diego-Otero
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España
| | - Pablo Romero-Sanchiz
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España
| | - Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Málaga, España
| | - Sven Cichon
- Departamento de Biomedicina, Universidad de Basel, Basel, Suiza
| | - Markus M Nöthen
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España; Departamento de Genómica, Life & Brain Center, Universidad de Bonn, Bonn, Alemania
| | - Marcella Rietschel
- Departamento de Epidemiología Genética en Psiquiatría, Instituto Central de Salud Mental, Facultad de Medicina de Mannheim, Universidad de Heidelberg, Mannheim, Alemania
| | - Fermin Mayoral
- Unidad de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga, España
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Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B, Grant BF. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. J Psychiatr Res 2017; 84:310-317. [PMID: 27814503 PMCID: PMC7416534 DOI: 10.1016/j.jpsychires.2016.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. METHODS Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. RESULTS Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). CONCLUSIONS Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society.
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Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., Rockville, MD, 20852, USA.
| | - Wilson M. Compton
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd. Rockville, MD 20852
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Benjamin I. Goldstein
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room FG 53, Toronto, Canada, M4N 3M5
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD, 20852, USA.
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
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Sanchez-Moreno J, Martinez-Aran A, Vieta E. Treatment of Functional Impairment in Patients with Bipolar Disorder. Curr Psychiatry Rep 2017; 19:3. [PMID: 28097635 DOI: 10.1007/s11920-017-0752-3] [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] [Indexed: 02/01/2023]
Abstract
Traditionally, functional impairment has received little attention in bipolar disorder, despite the fact that many patients experience significant impairments in daily life. In the last decade, research has changed its focus from clinical remission to functional recovery in bipolar patients as a priority. A literature review of this topic will allow us provide an overview of the relevance of functional impairment as well as the potential factors that can predict or contribute to low functioning in bipolar disorder (BD). Treatment approaches should consider not only euthymia as a goal but also cognitive and functional improvement of patients with such a complex disorder. Functional remediation and psychoeducation among psychological interventions may help to enhance functioning. The combination of cognitive enhancers and cognitive/functional remediation programs may help in improving cognitive and functional impairments. Early interventions are essential to prevent cognitive deficits and disability.
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Affiliation(s)
- Jose Sanchez-Moreno
- Bipolar Disorder Unit. Hospital Clinic, Clinical Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036, Barcelona, Spain
| | - Anabel Martinez-Aran
- Bipolar Disorder Unit. Hospital Clinic, Clinical Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036, Barcelona, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit. Hospital Clinic, Clinical Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036, Barcelona, Spain.
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Differences in symptom expression between unipolar and bipolar spectrum depression: Results from a nationally representative sample using item response theory (IRT). J Affect Disord 2016; 204:24-31. [PMID: 27318596 PMCID: PMC6447294 DOI: 10.1016/j.jad.2016.06.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The inclusion of subsyndromal forms of bipolarity in the fifth edition of the DSM has major implications for the way in which we approach the diagnosis of individuals with depressive symptoms. The aim of the present study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression severity, there are differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) between subjects with and without a lifetime history of manic symptoms. METHODS We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS The items sadness, appetite disturbance and psychomotor symptoms were better indicators of depression severity in participants without a lifetime history of manic symptoms, in a clinically meaningful way. DSM-IV symptoms of MDE were substantially less informative in participants with a lifetime history of manic symptoms than in those without such history. LIMITATIONS Clinical information on DSM-IV depressive and manic symptoms was based on retrospective self-report CONCLUSIONS The clinical presentation of depressive symptoms may substantially differ in individuals with and without a lifetime history of manic symptoms. These findings alert to the possibility of atypical symptomatic presentations among individuals with co-occurring symptoms or disorders and highlight the importance of continued research into specific pathophysiology differentiating unipolar and bipolar depression.
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[Differences in Subjective Experience Between Unipolar and Bipolar Depression]. ACTA ACUST UNITED AC 2016; 45:162-9. [PMID: 27569010 DOI: 10.1016/j.rcp.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/09/2015] [Accepted: 09/25/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION It is important to make distinction between bipolar and unipolar depression because treatment and prognosis are different. Since the diagnosis of the two conditions is purely clinical, find symptomatic differences is useful. OBJECTIVES Find differences in subjective experience (first person) between unipolar and bipolar depression. METHODS Phenomenological-oriented qualitative exploratory study of 12 patients (7 with bipolar depression and 5 with unipolar depression, 3 men and 9 women). We used a semi-structured interview based on Examination of Anomalous Self-Experience (EASE). RESULTS The predominant mood in bipolar depression is emotional dampening, in unipolar is sadness. The bodily experience in bipolar is of a heavy, tired body; an element that inserts between the desires of acting and performing actions and becomes an obstacle to the movement. In unipolar is of a body that feels more comfortable with the stillness than activity, like laziness of everyday life. Cognition and the stream of consciousness: in bipolar depression, compared with unipolar, thinking is slower, as if to overcome obstacles in their course. There are more difficult to understand what is heard or read. Future perspective: in bipolar depression, hopelessness is stronger and broader than in unipolar, as if the very possibility of hope was lost. CONCLUSIONS Qualitative differences in predominant mood, bodily experience, cognition and future perspective were found between bipolar and unipolar depression.
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Weinstock LM, Strong D, Uebelacker LA, Miller IW. Differential endorsement of suicidal ideation and attempt in bipolar versus unipolar depression: a testlet response theory analysis. J Affect Disord 2016; 200:67-73. [PMID: 27128359 PMCID: PMC4898479 DOI: 10.1016/j.jad.2016.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/12/2016] [Accepted: 04/16/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Published data concerning differences in suicide risk across the mood disorders spectrum remain mixed. The current study used testlet response theory methods to evaluate differences in the endorsement of suicidal ideation and attempt in an epidemiological sample of individuals with bipolar and unipolar depression. METHOD Participants with lifetime history of bipolar I (n=1154), bipolar II (n=494), and unipolar (n=5695) depression were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, which included 4 structured queries concerning suicidal ideation/attempt. We estimated differential item functioning between groups with a 2-pl parametric item response model. RESULTS Endorsement of suicide items increased as a function of underlying depression severity. Equating for severity, endorsement of suicidal ideation and attempt was generally more frequent in bipolar versus unipolar depression, and in bipolar I versus bipolar II depression. Yet findings were not consistent across all suicide items, and differences were small in magnitude. LIMITATIONS The NESARC relied upon lifetime endorsement of suicide items, and suicide risk was only evaluated within the context of a major depressive episode. Thus, this study could not evaluate endorsement of suicide items within the context of (hypo)manic or mixed states. CONCLUSION Although there were some group differences, patterns of item endorsement were more similar than different. These data support a transdiagnostic model of suicide that emphasizes underlying depression severity over mood disorder class.
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Affiliation(s)
- Lauren M. Weinstock
- Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, RI, USA, Butler Hospital, Psychosocial Research Program, Providence, RI, USA, Corresponding author at: Alpert Medical School of Brown University and Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA. (L.M. Weinstock)
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, San Diego, CA, USA
| | - Lisa A. Uebelacker
- Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, RI, USA, Butler Hospital, Psychosocial Research Program, Providence, RI, USA
| | - Ivan W. Miller
- Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, RI, USA, Butler Hospital, Psychosocial Research Program, Providence, RI, USA
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Kazemi R, Rostami R, Khomami S, Horacek J, Brunovsky M, Novak T, Fitzgerald PB. Electrophysiological correlates of bilateral and unilateral repetitive transcranial magnetic stimulation in patients with bipolar depression. Psychiatry Res 2016; 240:364-375. [PMID: 27138833 DOI: 10.1016/j.psychres.2016.04.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 03/09/2016] [Accepted: 04/19/2016] [Indexed: 01/23/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have efficacy in the treatment of unipolar depression but limited research has explored the efficacy of rTMS in bipolar depression. Therefore, we conducted a comparative clinical trial evaluating clinical responses to prefrontal bilateral and unilateral rTMS in patients suffering from bipolar depression. We hypothesized that, 1) the response to the treatment would be associated with a decrease in the frequency of beta waves, 2) bilateral stimulation of the cortex would bring about more extensive changes in brain activity than unilateral stimulation, and 3) bilateral stimulation is more effective than unilateral. Thirty patients with bipolar depression were divided into two groups. Bilateral Group (n=15) who received rTMS in the left DLPFC (10Hz) and right DLPFC (1-Hz), and unilateral group (n=15) who received the stimulation only in the right DLPFC (1-Hz) during 20 treatment sessions. The proportion of responders in the bilateral stimulation group was significantly higher than that in the unilateral group [80% versus 47%]. The remission rate was 40% in the bilateral group and 40% in the unilateral group (not significant). In the responders to bilateral rTMS treatment, a significant reduction of alpha1-2, beta 1-3, and gamma frequencies were observed in medial and superior frontal and cingulate gyrus . Responders to the unilateral treatment showed decrease of gamma frequency in postcentral gyrus, precuneus, superior and inferior parietal lobule, Cuneus and angular gyrus. In conclusion, we found that bilateral stimulation was more effective than the unilateral stimulation and evidence that beta frequency activity could possibly be used as a marker for response to rTMS.
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Affiliation(s)
- Reza Kazemi
- Atieh Clinical Neuroscience Center, Tehran, Iran.
| | - Reza Rostami
- Atieh Clinical Neuroscience Center, Tehran, Iran; Psychology Department, Faculty of Psychology and Educational Science, Tehran University, Tehran, Iran
| | - Sanaz Khomami
- Atieh Clinical Neuroscience Center, Tehran, Iran; Psychology Department, Faculty of Psychology and Educational Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Jiri Horacek
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Tomas Novak
- National Institute of Mental Health, Klecany, Czech Republic
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Victoria, Australia
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 468] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Rajagopalan K, Bacci ED, Ng-Mak D, Wyrwich K, Pikalov A, Loebel A. Effects on health-related quality of life in patients treated with lurasidone for bipolar depression: results from two placebo controlled bipolar depression trials. BMC Psychiatry 2016; 16:157. [PMID: 27215976 PMCID: PMC4877991 DOI: 10.1186/s12888-016-0865-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 05/13/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Depressive symptoms associated with bipolar disorder negatively impact health-related quality of life (HRQoL). The efficacy of lurasidone in reducing depressive symptoms has been previously demonstrated. The objective of this study was to examine the direct and indirect effect (mediated through improvement in depression symptoms) of lurasidone in improving patient HRQoL. METHODS A secondary analysis of data was conducted of two 6-week, double-blind, placebo-controlled trials assessing the effect of lurasidone (lurasidone monotherapy [20-60 mg/day or 80-120 mg/day]; lurasidone adjunctive to lithium or valproate [20-120 mg/day]) in patients with bipolar depression. Patient HRQoL was measured using the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q SF). Depression symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS). Analysis of covariance (ANCOVA) was used to estimate the effect of lurasidone on improvement in the Q-LES-Q SF percentage maximum score from baseline to 6 weeks. Path analysis was used to evaluate the total effect (β1), as well as the indirect (β2*β3) and direct (β4) effect of lurasidone on Q-LES-Q SF change through improvements in MADRS. RESULTS A total of 340 and 485 patients from the monotherapy and adjunctive therapy, respectively, were included in the analysis. At 6-weeks, ANCOVA analyses demonstrated that lurasidone provided significant improvement in adjusted mean Q-LES-Q SF scores in comparison to placebo for monotherapy (22.9 and 22.7 vs. 15.2, both p < 0.01) and adjunctive therapy (23.1 vs. 17.9, p = 0.01). Path analyses indicated that lurasidone treatment predicted MADRS improvement (monotherapy: β2 = -0.44, p < 0.001; adjunctive therapy: β2 = -0.34, p = 0.003), which subsequently predicted improvement in Q-LES-Q SF (monotherapy: β3 = -0.73, p < 0.001; adjunctive therapy: β3 = -0.75, p < 0.001); however, the effect of lurasidone on improvement in Q-LES-Q SF was largely mediated by change in MADRS (monotherapy: β4 = 0.11, p = 0.13; adjunctive therapy: β4 = 0.02, p = 0.77). CONCLUSIONS Lurasidone as a monotherapy and adjunctive to lithium or valproate is an effective treatment for improving HRQoL in patients with bipolar depression. However, improvement in HRQoL was not independent of improvement in depression, indicating that the effect of lurasidone on improving patient HRQoL may act through a reduction in depressive symptoms associated with bipolar disorder. TRIAL REGISTRATION Clinicaltrials.gov identifiers: NCT00868699 and NCT00868452 (both registered March 23, 2009).
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Affiliation(s)
| | | | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc., Marlborough, MA USA
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Leung CM, Yim CL, Yan CTY, Chan CC, Xiang YT, Mak ADP, Fok MLY, Ungvari GS. The Bipolar II Depression Questionnaire: A Self-Report Tool for Detecting Bipolar II Depression. PLoS One 2016; 11:e0149752. [PMID: 26963908 PMCID: PMC4786156 DOI: 10.1371/journal.pone.0149752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/04/2016] [Indexed: 01/26/2023] Open
Abstract
Bipolar II (BP-II) depression is often misdiagnosed as unipolar (UP) depression, resulting in suboptimal treatment. Tools for differentiating between these two types of depression are lacking. This study aimed to develop a simple, self-report screening instrument to help distinguish BP-II depression from UP depressive disorder. A prototype BP-II depression questionnaire (BPIIDQ-P) was constructed following a literature review, panel discussions and a field trial. Consecutively assessed patients with a diagnosis of depressive disorder or BP with depressive episodes completed the BPIIDQ-P at a psychiatric outpatient clinic in Hong Kong between October and December 2013. Data were analyzed using discriminant analysis and logistic regression. Of the 298 subjects recruited, 65 (21.8%) were males and 233 (78.2%) females. There were 112 (37.6%) subjects with BP depression [BP-I = 42 (14.1%), BP-II = 70 (23.5%)] and 182 (62.4%) with UP depression. Based on family history, age at onset, postpartum depression, episodic course, attacks of anxiety, hypersomnia, social phobia and agoraphobia, the 8-item BPIIDQ-8 was constructed. The BPIIDQ-8 differentiated subjects with BP-II from those with UP depression with a sensitivity/specificity of 0.75/0.63 for the whole sample and 0.77/0.72 for a female subgroup with a history of childbirth. The BPIIDQ-8 can differentiate BP-II from UP depression at the secondary care level with satisfactory to good reliability and validity. It has good potential as a screening tool for BP-II depression in primary care settings. Recall bias, the relatively small sample size, and the high proportion of females in the BP-II sample limit the generalization of the results.
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Affiliation(s)
- Chi Ming Leung
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | - Chi Lap Yim
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | | | - Cheuk Chi Chan
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Arthur D. P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marcella Lei-Yee Fok
- King's College London, King's Health Partners, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gabor S. Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
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McMahon K, Herr NR, Zerubavel N, Hoertel N, Neacsiu AD. Psychotherapeutic Treatment of Bipolar Depression. Psychiatr Clin North Am 2016; 39:35-56. [PMID: 26876317 DOI: 10.1016/j.psc.2015.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach.
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Affiliation(s)
- Kibby McMahon
- Cognitive-Behavioral Research and Treatment Program, Department of Psychology and Neuroscience, Duke University Medical Center, Duke University, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA
| | - Nathaniel R Herr
- Department of Psychology, American University, 4400 Massachusetts Avenue Northwest, Washington, DC 20016, USA
| | - Noga Zerubavel
- Cognitive-Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA
| | - Nicolas Hoertel
- Department of Psychiatry, Corentin Celton Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 4 parvis Corentin Celton, Issy-les-Moulineaux 92130, France; INSERM UMR 894, Psychiatry and Neurosciences Center, 2 ter rue d'Alésia, Paris 75014, France; PRES Sorbonne Paris Cité, Paris Descartes University, 12 Rue de l'École de Médecine, Paris 75006, France
| | - Andrada D Neacsiu
- Cognitive-Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA.
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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42
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Leonpacher AK, Liebers D, Pirooznia M, Jancic D, MacKinnon DF, Mondimore FM, Schweizer B, Potash JB, Zandi PP, Goes FS. Distinguishing bipolar from unipolar depression: the importance of clinical symptoms and illness features. Psychol Med 2015; 45:2437-2446. [PMID: 25851411 PMCID: PMC5693376 DOI: 10.1017/s0033291715000446] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Distinguishing bipolar disorder (BP) from major depressive disorder (MDD) has important relevance for prognosis and treatment. Prior studies have identified clinical features that differ between these two diseases but have been limited by heterogeneity and lack of replication. We sought to identify depression-related features that distinguish BP from MDD in large samples with replication. METHOD Using a large, opportunistically ascertained collection of subjects with BP and MDD we selected 34 depression-related clinical features to test across the diagnostic categories in an initial discovery dataset consisting of 1228 subjects (386 BPI, 158 BPII and 684 MDD). Features significantly associated with BP were tested in an independent sample of 1000 BPI cases and 1000 MDD cases for classifying ability in receiver operating characteristic (ROC) analysis. RESULTS Seven clinical features showed significant association with BPI compared with MDD: delusions, psychomotor retardation, incapacitation, greater number of mixed symptoms, greater number of episodes, shorter episode length, and a history of experiencing a high after depression treatment. ROC analyses of a model including these seven factors showed significant evidence for discrimination between BPI and MDD in an independent dataset (area under the curve = 0.83). Only two features (number of mixed symptoms, and feeling high after an antidepressant) showed an association with BPII versus MDD. CONCLUSIONS Our study suggests that clinical features distinguishing depression in BPI versus MDD have important classification potential for clinical practice, and should also be incorporated as 'baseline' features in the evaluation of novel diagnostic biomarkers.
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Affiliation(s)
- A. K. Leonpacher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D. Liebers
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M. Pirooznia
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D. Jancic
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - D. F. MacKinnon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - F. M. Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B. Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J. B. Potash
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - P. P. Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - F. S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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43
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Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug Alcohol Depend 2015; 149:136-44. [PMID: 25725934 PMCID: PMC4789763 DOI: 10.1016/j.drugalcdep.2015.01.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about to what extent treatment-seeking behavior varies across individuals with alcohol abuse, alcohol dependence, drug abuse, and drug dependence. METHODS The sample included respondents from the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who reported a lifetime diagnosis alcohol abuse, alcohol dependence, drug abuse, or drug dependence. Unadjusted and adjusted hazard ratios are presented for time to first treatment contact by sociodemographic characteristics and comorbid psychiatric disorders. Individuals were censored from the analyses if their condition remitted prior to seeking treatment. RESULTS In the first year after disorder onset, rates of treatment-seeking were 13% for drug dependence, 5% for alcohol dependence, 2% for drug abuse, and 1% for alcohol abuse. The lifetime probability of seeking treatment among individuals who did not remit was also highest for drug dependence (90%), followed by drug abuse (60%), alcohol dependence (54%), and alcohol abuse (16%). Having had previous treatment contact for a substance use disorder (SUD) increased the probability of seeking treatment for another SUD. By contrast, an early age of SUD onset, belonging to an older cohort, and a higher level of education decreased the lifetime probability of treatment contact for SUD. The role of comorbid mental disorders was more complex, with some disorders increasing and other decreasing the probability of seeking treatment. CONCLUSIONS Given high rates of SUD and their substantial health and economic burden, these patterns suggest the need for innovative approaches to increase treatment access for individuals with SUD.
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Affiliation(s)
- Carlos Blanco
- New York State Psychiatric Institute, New York, NY, USA.
| | - Miren Iza
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | | | - Enrique Baca-García
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, USA
| | - Mark Olfson
- New York State Psychiatric Institute, New York, NY, USA
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Pendergast LL, Youngstrom EA, Brown C, Jensen D, Abramson LY, Alloy LB. Structural invariance of General Behavior Inventory (GBI) scores in Black and White young adults. Psychol Assess 2015; 27:21-30. [PMID: 25222430 PMCID: PMC4355320 DOI: 10.1037/pas0000020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the United States, Black and White individuals show discrepant rates of diagnosis of bipolar disorder versus schizophrenia and antisocial personality disorder, as well as disparate access to and utilization of treatment for these disorders (e.g., Alegria, Chatterji, et al., 2008; Chrishon, Anderson, Arora, & Bailey, 2012). Such diagnostic discrepancies might stem from racially related cognitive biases in clinical judgment or from racial biases in measurements of bipolar disorder. The General Behavior Inventory (GBI) is among the most well-validated and widely used measures of bipolar mood symptoms, but the psychometric properties of the GBI have been examined primarily in predominantly White samples. In this study, we used multigroup confirmatory factor analyses (CFA) to examine the invariance of GBI scores across racial groups with a nonclinical sample. Fit was acceptable for tests of configural invariance, equal factor loadings, and equal intercepts, but not invariance of residuals. Findings indicate that GBI scores provide functionally invariant measurement of mood symptoms in both Black and White samples. The use of GBI scores may contribute consistent information to clinical assessments and could potentially reduce diagnostic discrepancies and associated differences in access to and utilization of mental health services.
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Affiliation(s)
- Laura L Pendergast
- Department of Psychological, Organizational, and Leadership Studies in Education
| | - Eric A Youngstrom
- Department of Psychological, Organizational, and Leadership Studies in Education, Temple University
| | | | | | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison
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Giorgi I, Ottonello M, Vittadini G, Bertolotti G. Psychological changes in alcohol-dependent patients during a residential rehabilitation program. Neuropsychiatr Dis Treat 2015; 11:2989-96. [PMID: 26673839 PMCID: PMC4676624 DOI: 10.2147/ndt.s93520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alcohol-dependent patients usually experience negative affects under the influence of alcohol, and these affective symptoms have been shown to decrease as a result of alcohol-withdrawal treatment. A recent cognitive-affective model suggests an interaction between drug motivation and affective symptoms. The aim of this multicenter study was to evaluate the psychological changes in subjects undergoing a residential rehabilitation program specifically designed for alcohol addiction, and to identify at discharge patients with greater affective symptoms and therefore more at risk of relapse. MATERIALS AND METHODS The sample included 560 subjects (mean age 46.91±10.2 years) who completed 28-day rehabilitation programs for alcohol addiction, following a tailored routine characterized by short duration and high intensity of medical and psychotherapeutic treatment. The psychological clinical profiles of anxiety, depression, psychological distress, psychological well-being, and self-perception of a positive change were assessed using the Cognitive Behavioral Assessment - Outcome Evaluation questionnaire at the beginning and at the end of the program. The changes in the psychological variables of the questionnaire were identified and considered as outcome evaluation of the residential intervention. Moreover, differences in the psychological functioning between patients with different characteristics were investigated. RESULTS The score measured by the Cognitive Behavioral Assessment - Outcome Evaluation showed significant improvements in all the psychological characteristics assessed, and the profile at discharge was within the normal scores. Some significant differences were found in relation to specific characteristics of the sample, such as age, sex, level of education, type of intervention, and polysubstance use. CONCLUSION This study shows the changes in psychological profile in subjects undergoing residential rehabilitation from alcohol and how this profile may permit identification of subjects requiring more psychosocial support after discharge.
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Affiliation(s)
- Ines Giorgi
- Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, Italy
| | - Marcella Ottonello
- Department of Physical & Rehabilitation Medicine, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Genoa, Italy ; Department of Medicine, PhD Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome, Italy
| | - Giovanni Vittadini
- Alcohol Rehabilitation Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, Italy
| | - Giorgio Bertolotti
- Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Tradate, Italy
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Cabello M, Caballero FF, Chatterji S, Cieza A, Ayuso-Mateos JL. Risk factors for incidence and persistence of disability in chronic major depression and alcohol use disorders: longitudinal analyses of a population-based study. Health Qual Life Outcomes 2014; 12:186. [PMID: 25516069 PMCID: PMC4287194 DOI: 10.1186/s12955-014-0186-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major depression and alcohol use disorders are risk factors for incidence of disability. However, it is still unclear whether a chronic course of these health conditions is also prospectively associated with incidence of disability. The aim of the present study was, first, to confirm whether chronic major depression (MD) and alcohol use disorders (AUD) are, respectively, risk factors for persistence and incidence of disability in the general population; and then to analyze the role of help-seeking behavior in the course of disability among respondents with chronic MD and chronic AUD. METHOD Data from two assessments in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Disability was measured by eight domains of the Short Form 12 Health Survey version 2 (SF-12). Generalized estimating equations and logistic regression models were run to estimate risk factors for persistence and incidence of disability, respectively. RESULTS Analyses conducted on data from the US general population showed that chronic MD was the strongest risk factor for incidence and persistence of disability in the social functioning, emotional role and mental health domains. Chronic AUD were risk factors for incidence and persistence of disability in the vitality, social functioning, and emotional role domains. Within the group of chronic MD, physical comorbidity and help-seeking were associated with persistent disability in most of the SF-12 domains. Help-seeking behavior was also associated with incidence of problems in the mental health domain for the depression group. Regarding the AUD group, comorbidity with physical health problems was a strong risk factor for persistence of disability in all SF-12 domains. Help-seeking behavior was not related to either persistence or incidence of disability in the chronic alcohol group. CONCLUSIONS Chronic MD and chronic AUD are independent risk factors for persistence and incidence of disability in the US general population. People with chronic MD seek help for their problems when they experience persistent disability, whereas people with chronic AUD might not seek any help even if they are suffering from persistent disability.
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Affiliation(s)
- María Cabello
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. .,Instituto de Investigación Sanitaria Princesa (IP), La Princesa University Hospital, Madrid, Spain.
| | - Francisco Félix Caballero
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. .,Instituto de Investigación Sanitaria Princesa (IP), La Princesa University Hospital, Madrid, Spain.
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
| | - Alarcos Cieza
- Disability and Rehabilitation Unit Coordinator, World Health Organization, Geneva, Switzerland.
| | - José Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. .,Instituto de Investigación Sanitaria Princesa (IP), La Princesa University Hospital, Madrid, Spain.
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47
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Dervic K, Garcia-Amador M, Sudol K, Freed P, Brent DA, Mann JJ, Harkavy-Friedman JM, Oquendo MA. Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits. Eur Psychiatry 2014; 30:106-13. [PMID: 25280430 DOI: 10.1016/j.eurpsy.2014.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/12/2014] [Accepted: 06/29/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. METHODS Six hundred and eighty-five (n=685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n=455), Bipolar I (BP-I) disorder (n=151), and Bipolar II (BP-II) (n=79) disorder were compared in terms of their socio-demographic and clinical characteristics. RESULTS Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. CONCLUSION Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.
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Affiliation(s)
- K Dervic
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA; Department of Psychiatry and Behavioral Science, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - M Garcia-Amador
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - K Sudol
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA
| | - P Freed
- 286, Madison Ave, New York, NY 10016, USA
| | - D A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J J Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA
| | | | - M A Oquendo
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA.
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Faedda GL, Serra G, Marangoni C, Salvatore P, Sani G, Vázquez GH, Tondo L, Girardi P, Baldessarini RJ, Koukopoulos A. Clinical risk factors for bipolar disorders: a systematic review of prospective studies. J Affect Disord 2014; 168:314-21. [PMID: 25086290 DOI: 10.1016/j.jad.2014.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early phases and suspected precursor states of bipolar disorder are not well characterized. We evaluate the prevalence, duration, clinical features and predictive value of non-affective psychopathology as clinical risk factors for bipolar disorder in prospective studies. METHODS We screened PubMed, CINAHL, PsycINFO, Embase, SCOPUS, and ISI-Web of Science databases from inception up to January 31, 2014, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and searched: bipolar disorder AND [antecedent⁎ OR predict⁎ OR prodrom⁎ OR prospect⁎ OR risk⁎] AND [diagnosis OR development]. We included only English language reports on prospective, longitudinal studies with two structured clinical assessments (intake and follow-up); no DSM intake diagnosis of bipolar-I or -II; diagnostic outcome was bipolar-I or -II. Details of study design, risk factors, and predictive value were tabulated. RESULTS We found 16 published reports meeting selection criteria, with varying study design. Despite heterogeneity in methods, findings across studies were consistent. Clinical risk factors of bipolar disorder were early-onset panic attacks and disorder, separation anxiety and generalized anxiety disorders, conduct symptoms and disorder, ADHD, impulsivity and criminal behavior. LIMITATIONS Since risk factors identified in some prospective studies are predictive of other conditions besides bipolar disorder, these preliminary findings require replication, and their sensitivity, specificity and predictive value need to be assessed. CONCLUSIONS Clinical risk factors for bipolar disorder typically arise years prior to syndromal onset, include anxiety and behavioral disorders with unclear sensitivity and specificity. Prospectively identified clinical risk factors for bipolar disorder are consistent with retrospective and family-risk studies. Combining clinical risk factors with precursors and family-risk may improve early identification and timely and appropriate treatment of bipolar disorder.
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Affiliation(s)
- Gianni L Faedda
- Lucio Bini Mood Disorders Center, New York, NY, United States; New York University Medical Center & Child Study Center, New York, NY, United States; International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States.
| | - Giulia Serra
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ciro Marangoni
- Section of Neurological, Psychiatric and Psychological Sciences, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Italy
| | - Paola Salvatore
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Section of Psychiatry, Department of Neuroscience, University of Parma, Italy
| | - Gabriele Sani
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, "La Sapienza" University School of Medicine, Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Neuroscience, University of Palermo, Buenos Aires, Argentina
| | - Leonardo Tondo
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Centro Lucio Bini, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Centro Lucio Bini, Cagliari, Italy
| | - Paolo Girardi
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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McIntyre RS, Cha DS, Jerrell JM, Swardfager W, Kim RD, Costa LG, Baskaran A, Soczynska JK, Woldeyohannes HO, Mansur RB, Brietzke E, Powell AM, Gallaugher A, Kudlow P, Kaidanovich-Beilin O, Alsuwaidan M. Advancing biomarker research: utilizing 'Big Data' approaches for the characterization and prevention of bipolar disorder. Bipolar Disord 2014; 16:531-47. [PMID: 24330342 DOI: 10.1111/bdi.12162] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/22/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To provide a strategic framework for the prevention of bipolar disorder (BD) that incorporates a 'Big Data' approach to risk assessment for BD. METHODS Computerized databases (e.g., Pubmed, PsychInfo, and MedlinePlus) were used to access English-language articles published between 1966 and 2012 with the search terms bipolar disorder, prodrome, 'Big Data', and biomarkers cross-referenced with genomics/genetics, transcriptomics, proteomics, metabolomics, inflammation, oxidative stress, neurotrophic factors, cytokines, cognition, neurocognition, and neuroimaging. Papers were selected from the initial search if the primary outcome(s) of interest was (were) categorized in any of the following domains: (i) 'omics' (e.g., genomics), (ii) molecular, (iii) neuroimaging, and (iv) neurocognitive. RESULTS The current strategic approach to identifying individuals at risk for BD, with an emphasis on phenotypic information and family history, has insufficient predictive validity and is clinically inadequate. The heterogeneous clinical presentation of BD, as well as its pathoetiological complexity, suggests that it is unlikely that a single biomarker (or an exclusive biomarker approach) will sufficiently augment currently inadequate phenotypic-centric prediction models. We propose a 'Big Data'- bioinformatics approach that integrates vast and complex phenotypic, anamnestic, behavioral, family, and personal 'omics' profiling. Bioinformatic processing approaches, utilizing cloud- and grid-enabled computing, are now capable of analyzing data on the order of tera-, peta-, and exabytes, providing hitherto unheard of opportunities to fundamentally revolutionize how psychiatric disorders are predicted, prevented, and treated. High-throughput networks dedicated to research on, and the treatment of, BD, integrating both adult and younger populations, will be essential to sufficiently enroll adequate samples of individuals across the neurodevelopmental trajectory in studies to enable the characterization and prevention of this heterogeneous disorder. CONCLUSIONS Advances in bioinformatics using a 'Big Data' approach provide an opportunity for novel insights regarding the pathoetiology of BD. The coordinated integration of research centers, inclusive of mixed-age populations, is a promising strategic direction for advancing this line of neuropsychiatric research.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Sala R, Goldstein BI, Wang S, Blanco C. Childhood maltreatment and the course of bipolar disorders among adults: epidemiologic evidence of dose-response effects. J Affect Disord 2014; 165:74-80. [PMID: 24882181 PMCID: PMC4083555 DOI: 10.1016/j.jad.2014.04.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) is highly prevalent among individuals with bipolar disorders (BP); however few studies have examined its potential role in the course and outcome of individuals with BP. We aim to examine the dose response relationship between the number of types of CM and the course of individuals with BP. METHODS As part of the National Epidemiologic Survey on Alcohol and Related Conditions, 1600 adults who met lifetime DSM-IV criteria for BP-I (n=1172) and BP-II (n=428) were included. Individuals were evaluated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DMS-IV Version and data was analyzed lifetime and from Waves 1 and 2, approximately 3 years apart. RESULTS Around half of individuals with BP had a history of at least one type of CM. Overall, there was a clear dose-response relationship between number of CM and severity of BP across several domains, including clinical characteristics, probability of treatment, lifetime prevalence of psychiatric comorbidity, incidence of anxiety disorders, substance use disorder, and nicotine dependence, and level of psychosocial functioning. LIMITATIONS The interviews were conducted by lay professional interviewers rather than clinicians, use of retrospective report to determine CM in individuals with BP, and not all respondents from Wave 1 were able to be interviewed in Wave 2. CONCLUSIONS The number of types of CM confers developmental differences in the course of BP with a worse course and outcome of BP. Early identification and treatment of CM are warranted to improve the course and outcome of individuals with BP.
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Affiliation(s)
- Regina Sala
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King׳s College London, London, UK.
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Shuai Wang
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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