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Zhu T, Kou R, Hu Y, Yuan M, Yuan C, Luo L, Zhang W. Dissecting clinical and biological heterogeneity in clinical states of bipolar disorder: a 10-year retrospective study from China. Front Psychiatry 2023; 14:1128862. [PMID: 38179244 PMCID: PMC10764613 DOI: 10.3389/fpsyt.2023.1128862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives To dissect clinical and biological heterogeneity in clinical states of bipolar disorder (BD), and investigate if neuropsychological symptomatology, comorbidity, vital signs, and blood laboratory indicators are predictors of distinct BD states. Methods A retrospective BD cohort was established with data extracted from a Chinese hospital's electronic medical records (EMR) between 2009 and 2018. Subjects were inpatients with a main discharge diagnosis of BD and were assessed for clinical state at hospitalization. We categorized all subjects into manic state, depressive state, and mixed state. Four machine learning classifiers were utilized to classify the subjects. A Shapley additive explanations (SHAP) algorithm was applied to the classifiers to aid in quantifying and visualizing the contributions of each feature that drive patient-specific classifications. Results A sample of 3,085 records was included (38.54% as manic, 56.69% as depressive, and 4.77% as mixed state). Mixed state showed more severe suicidal ideation and psychomotor abnormalities, while depressive state showed more common anxiety, sleep, and somatic-related symptoms and more comorbid conditions. Higher levels of body temperature, pulse, and systolic and diastolic blood pressures were present during manic episodes. Xgboost achieved the best AUC of 88.54% in manic/depressive states classification; Logistic regression and Random forest achieved the best AUCs of 75.5 and 75% in manic/mixed states and depressive/mixed states classifications, respectively. Myocardial enzymes and the non-enzymatic antioxidant uric acid and bilirubin contributed significantly to distinguish BD clinical states. Conclusion The observed novel biological associations with BD clinical states confirm that biological heterogeneity contributes to clinical heterogeneity of BD.
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Affiliation(s)
- Ting Zhu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Ran Kou
- Business School, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Cui Yuan
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
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Yatham LN, Chakrabarty T, Bond DJ, Schaffer A, Beaulieu S, Parikh SV, McIntyre RS, Milev RV, Alda M, Vazquez G, Ravindran AV, Frey BN, Sharma V, Goldstein BI, Rej S, O'Donovan C, Tourjman V, Kozicky JM, Kauer-Sant'Anna M, Malhi G, Suppes T, Vieta E, Kapczinski F, Kanba S, Lam RW, Kennedy SH, Calabrese J, Berk M, Post R. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations. Bipolar Disord 2021; 23:767-788. [PMID: 34599629 DOI: 10.1111/bdi.13135] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendations were not provided-a critical gap which the current update aims to address. METHOD Overview of research regarding mixed presentations in BD, with treatment recommendations developed using a modified CANMAT/ISBD rating methodology. Limitations are discussed, including the dearth of high-quality data and reliance on expert opinion. RESULTS No agents met threshold for first-line treatment of DSM-5 manic or depressive episodes with mixed features. For mania + mixed features second-line treatment options include asenapine, cariprazine, divalproex, and aripiprazole. In depression + mixed features, cariprazine and lurasidone are recommended as second-line options. For DSM-IV defined mixed episodes, with a longer history of research, asenapine and aripiprazole are first-line, and olanzapine (monotherapy or combination), carbamazepine, and divalproex are second-line. Research on maintenance treatments following a DSM-5 mixed presentation is extremely limited, with third-line recommendations based on expert opinion. For maintenance treatment following a DSM-IV mixed episode, quetiapine (monotherapy or combination) is first-line, and lithium and olanzapine identified as second-line options. CONCLUSION The CANMAT and ISBD groups hope these guidelines provide valuable support for clinicians providing care to patients experiencing mixed presentations, as well as further influence investment in research to improve diagnosis and treatment of this common and complex clinical state.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Bond
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queens University, Kingston, Ontario, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Queens University, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & Gynaecology, Western University, London, Ontario, Canada
| | | | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valerie Tourjman
- Department of Psychiatry and addiction, University of Montreal, Montreal, QC, Canada
| | | | - Marcia Kauer-Sant'Anna
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gin Malhi
- Department of Psychiatry, University of Sydney, Sydney, Australia
| | - Trisha Suppes
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Calabrese
- Department of Psychiatry, Western Reserve University, Cleveland, Ohio, USA
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Robert Post
- Department of Psychiatry, George Washington University, Washington, District of Columbia, USA
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Qureshi MM, Young AH. Hamlet's augury: how to manage discontinuation of mood stabilizers in bipolar disorder. Ther Adv Psychopharmacol 2021; 11:20451253211000612. [PMID: 33796268 PMCID: PMC7968017 DOI: 10.1177/20451253211000612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 01/26/2023] Open
Abstract
Research has generated good quality evidence about the treatment and management of bipolar disorder in acute and, to some degree, sub-acute/continuation phases. This has informed various guidelines about the treatment and management of bipolar disorder (BD). However, for the long-term or maintenance phase of illness, most guidelines peter out and, in the absence of sufficiently high-quality research evidence, remain vague. This is particularly evident for the important clinical question of discontinuing mood stabilizing pharmacological agents after a period of remission has been achieved. The aim of this review is to put together current existing evidence about discontinuing mood stabilizers after a period of remission in order to come up with a structured and coherent strategy for managing such discontinuation and to make recommendations for future research. To this end, we reviewed the main relevant treatment guidelines and subsequent evidence following the publication of these guidelines. The current recommended long-term treatment of BD is usually considered within the same principles applicable to any chronic health condition (e.g. hypertension or diabetes) where the focus is on continuing treatment at minimum effective medication dose often life-long, switching to alternative choice of medication due to side-effects and very few, if any, indications for complete cessation. However, in the absence of strong evidence on long-term treatment and the high rate of non-concordance in BD, medication discontinuation is a very important aspect of the treatment that should be given due consideration at every aspect of the treatment.
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Affiliation(s)
- Mutahira M Qureshi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO72, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Cerimele JM, Goldberg SB, Miller CJ, Gabrielson SW, Fortney JC. Systematic Review of Symptom Assessment Measures for Use in Measurement-Based Care of Bipolar Disorders. Psychiatr Serv 2019; 70:396-408. [PMID: 30717645 PMCID: PMC6543835 DOI: 10.1176/appi.ps.201800383] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Utilization of measurement-based care (MBC) for bipolar disorders is limited, in part because of uncertainty regarding the utility of available measures. The aim of this study was to synthesize the literature on patient-reported and clinician-observed measures of symptoms of bipolar disorder and the potential use of these measures in MBC. METHODS A systematic review of multiple databases (PubMed, Embase, PsycINFO, Cochrane Library, and other gray literature) was conducted in June 2017 to identify validated measures. Data on the psychometric properties of each measure were extracted and used to assess the measure's clinical utility on the basis of established guidelines. RESULTS Twenty-eight unique measures were identified in 39 studies, including four patient-reported and six clinician-observed measures assessing manic symptoms, three patient-reported and five clinician-observed measures of depressive symptoms, and six patient-reported and four clinician-observed measures of both symptom types. Patient-reported measures with the highest clinical utility included the Altman Self-Rating Mania Scale for assessment of manic symptoms, the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) (depressive symptoms), and the Internal State Scale (both types). Highly rated clinician (C)-observed scales were the Bech-Rafaelsen Mania Rating Scale (mania), the QIDS-C (depressive symptoms), and the Bipolar Inventory of Symptoms Scale (both types). CONCLUSIONS Suitable choices are available for MBC of bipolar disorders. The choice of a measure could be informed by clinical utility score and may also depend on how clinicians or practices weigh each category of the clinical utility scale and on the clinical setting and presenting problem.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - Simon B Goldberg
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - Christopher J Miller
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - Stephen W Gabrielson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
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Bowden C, Martinez M. Are traditional approaches diminishing the bipolar drug pipeline? Expert Opin Pharmacother 2018; 19:525-528. [DOI: 10.1080/14656566.2018.1454429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Charles Bowden
- Biomedical Development Corporation, San Antonio, TX, USA
| | - Melissa Martinez
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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6
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Abstract
Various terms have been used to describe mania when it is accompanied by depressive symptoms. In this article, we attempt to define and discuss 3 of these terms: dysphoric mania, mixed state, and mania with mixed features specifier. We conclude that whatever term is used, it is important to be aware that mania is more often unpleasant than pleasant, and that the unpleasantness is not limited to depression.
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7
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Arnold JG, Martinez C, Zavala J, Prihoda TJ, Escamilla M, Singh V, Bazan M, Quiñones M, Bowden CL. Investigating symptom domains of bipolar disorder for Spanish-speakers using the Bipolar Inventory of Symptoms Scale. J Affect Disord 2016; 205:239-244. [PMID: 27454409 DOI: 10.1016/j.jad.2016.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/10/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A Spanish language rating scale which assesses the range of bipolar disorder symptoms is needed. There are rating scales commonly used, however they do not address commonly expressed symptoms associated with bipolar disorder and have varied rating systems. There are also few comparisons of symptom severity between Spanish and English speaking patients, due to limitations in available rating scales. METHODS We conducted psychometric assessment of the Spanish language Bipolar Inventory of Symptoms Scale (BISS) (N=71) for persons with bipolar disorder, which assesses 5 domains: mania, depression, irritability, anxiety and psychosis. The Spanish BISS scores were then compared to the MADRS (Montgomery Asberg Depression Rating Scale) and the YMRS (Young Mania Rating Scale) as well as to BISS scores in an English speaking sample (N=102) with bipolar disorder from the same geographic locations. RESULTS Chronbach's alphas for the Spanish BISS ranged from 0.6 to 0.93, with the psychosis domain displaying lower reliability. Correlations with the MADRS and YMRS were good and ranged from 0.70 to 0.88. The BISS differentiated well across mood states in English and Spanish versions, with mood state differentiated well using subscales and domains. For the irritability and anxiety domains, Spanish speaking participants had higher scores than English speakers across mood states. Females showed differences in symptom profiles compared to males. LIMITATIONS The sample sizes in the Spanish speaking manic group were small. The Spanish BISS, tested here primarily in patients of Mexican ancestry, may require revision in other Spanish language populations. CONCLUSIONS The Spanish BISS, a Spanish language symptom rating scale for bipolar disorder, demonstrates good reliability and validity. Clinical assessment in anxiety and irritability domains is particularly relevant in a Spanish speaking sample. Consistent with prior research, females report higher depression, irritability and anxiety scores irrespective of language spoken.
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Affiliation(s)
- Jodi Gonzalez Arnold
- University of Texas Health Science Center, Department of Psychiatry, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.
| | - Cervando Martinez
- University of Texas Health Science Center, Department of Psychiatry, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Juan Zavala
- Texas Tech University Health Sciences Center, Department of Psychiatry, 5001 El Paso Drive, El Paso, TX 79905, United States
| | - Thomas J Prihoda
- University of Texas Health Science Center, Department of Pathology, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Michael Escamilla
- Texas Tech University Health Sciences Center, Department of Psychiatry, 5001 El Paso Drive, El Paso, TX 79905, United States
| | - Vivek Singh
- Texas Tech University Health Sciences Center, Department of Psychiatry, 5001 El Paso Drive, El Paso, TX 79905, United States
| | - Melissa Bazan
- University of Texas Health Science Center, Department of Psychiatry, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Marlon Quiñones
- Laurel Ridge Treatment Center, 17720 Corporate Woods Drive, San Antonio, TX 78259, United States
| | - Charles L Bowden
- University of Texas Health Science Center, Department of Psychiatry, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
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Bowden CL, Mintz J, Tohen M. Multi-state outcome analysis of treatments (MOAT): application of a new approach to evaluate outcomes in longitudinal studies of bipolar disorder. Mol Psychiatry 2016; 21:237-42. [PMID: 25778474 PMCID: PMC4573671 DOI: 10.1038/mp.2015.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 12/02/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022]
Abstract
Survival analyzes are usually based on a single point in time predefined event. Dissatisfied with this approach to evaluating maintenance treatment outcomes, we developed the Multi-state Outcome Analysis of Treatments (MOAT) methodology using a combined database from two FDA registration studies of lamotrigine, lithium and placebo. MOAT partitions total survival time into clinically distinct periods operationally defined by cutpoints on rating scales. For bipolar disorder (BD), the clinical states are remission, subsyndromal and syndromal mania, mixed states or depression. MOAT results can be crossed with information about tolerability and functioning to yield an outcome system integrating efficacy and tolerability. As found in the original analysis, both drugs were associated with longer time in study compared with the placebo. MOAT supplements this by finding that both drugs increased the time remitted compared with placebo. However, a substantial amount of time in all three treatments was spent in subsyndromal depression. Time with manic symptoms was reduced with lithium, but not lamotrigine. Patients on placebo neither benefitted nor had adverse effects from the assignment but experienced more syndromal levels of symptoms and were terminated from the study sooner than either drug treated group. Lithium was associated with both benefit in time manic and worse tolerability compared with placebo. In summary, lamotrigine was associated with limited therapeutic benefit but not harm; lithium with both benefit and harm; and placebo with neither. MOAT describes not only quantity but also quality of time spent in longitudinal studies, providing a more clinically informative picture than Kaplan-Meier survival analysis.
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Affiliation(s)
- C L Bowden
- Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA,Department of Psychiatry, 7703 Floyd Curl Dr, Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA. E-mail:
| | - J Mintz
- Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - M Tohen
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Bowden CL, Singh V. The use of antidepressants in bipolar disorder patients with depression. Expert Opin Pharmacother 2015; 17:17-25. [PMID: 26479314 DOI: 10.1517/14656566.2016.1104299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The proportion of time that bipolar patients experience depressive symptoms and clinical states, with associated psychosocial impairment and elevated risk of suicide, is significantly greater than the time spent in manic/hypomanic forms of bipolar disorders. Yet, manic states and symptoms have been the focus and interest of most clinical research over the past quarter century. Not a single antidepressant approved for treatment of major depressive disorder, as monotherapy, has received regulatory approval for treatment of bipolar depression as monotherapy, despite their common use in bipolar depression. AREAS COVERED We reviewed randomized studies, particularly ones initially intended for registration purposes, and systematic treatment guidelines, in development of this guide to treatment decision and implementation of interventions for depression in bipolar disorders. EXPERT OPINION The Expert Opinion section emphasizes strategies, not individual agents. The efficacious performance of mood stabilizers and second-generation antipsychotics as a component of the strategy is strongly supported by published studies. However, this section relies largely on secondary publications and our combined clinical experience, as few randomized, blinded studies have had, as their focus, the comparison of combined regimens for depression. This article summarizes the design features and results of studies dealing with depressive features and intervention strategies for bipolar disorders. The emphasis of the recommendations is on pragmatic treatment decisions that clinicians can make to enhance the probability of both short and long term benefits for patients.
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Affiliation(s)
- Charles L Bowden
- a Clinical Professor of Psychiatry and Pharmacology , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| | - Vivek Singh
- b Professor and Chairman for Department of Psychiatry, Paul L. Foster School of Medicine , Texas Tech University Health Sciences Center , El Paso , TX , USA
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He H, Xu G, Sun B, Ouyang H, Dang Y, Guo Y, Miao G, Rios C, Akiskal HS, Lin K. The use of 15-point hypomanic checklist in differentiating bipolar I and bipolar II disorder from major depressive disorder. Gen Hosp Psychiatry 2014; 36:347-51. [PMID: 24461731 DOI: 10.1016/j.genhosppsych.2013.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/11/2013] [Accepted: 12/13/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Individuals with bipolar disorder (BP) are often misdiagnosed with major depressive disorder (MDD). In this study, we developed a Chinese version of 15-point hypomania scale (HCL-15) in order to determine its sensitivity and specificity in the diagnosis of BP and BP-II in particular. METHODS A total of 623 individuals suffering a major depressive episode (MDE) were systematically interviewed with both Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Patient Edition, and HCL-15. A cutoff score of 8 or more in HCL-15 was suggested for BP. RESULTS Of the 623 depressed patients, 115 (18.5%) actually required a diagnosis of BP-I, and another 159 (25.5%) could be more appropriately diagnosed with BP-II, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The sensitivity of 15-HCL in detection of BP-II was 0.78 and 0.46 for BP-I; the specificity was 0.9 and 0.69, respectively. The specificity of HCL-15 for BP versus MDD was as high as 0.93. Approximately 60%-80% of all questions in the HCL-15 questionnaire revealed positive responses from patients, while items 11 and 12, measuring the consumption of alcohol, coffee and cigarettes, demonstrated a low positive response rate. CONCLUSIONS The HCL-15 assessment scale was fairly sensitive and highly specific for a BP-II diagnosis but not for a BP-I diagnosis. Some items in the HCL-15 symptom list need to be further modified to better fit Chinese culture and customs. The HCL-15 scale could be a useful tool in clinical practice for screening individuals with BP-II in order to avoid a misdiagnosis of MDD.
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Affiliation(s)
- Hongbo He
- Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University
| | - Guiyun Xu
- Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University; Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University.
| | - Bin Sun
- Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University
| | - Huiyi Ouyang
- Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University
| | - Yamei Dang
- Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University
| | - Yangbo Guo
- Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University; Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University
| | - Guodong Miao
- Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University
| | - Catherine Rios
- International Mood Center, University of California, San Diego, La Jolla, CA, USA
| | - Hagop S Akiskal
- International Mood Center, University of California, San Diego, La Jolla, CA, USA
| | - Kangguang Lin
- Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University; Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong.
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