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Chen PH, Hsiao CY, Chiang SJ, Chung KH, Tsai SY. Association of lipids and inflammatory markers with left ventricular wall thickness in patients with bipolar disorder. J Affect Disord 2024; 358:12-18. [PMID: 38705523 DOI: 10.1016/j.jad.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) face a high risk of heart failure and left ventricular (LV) dysfunction. Despite strong evidence that high LV relative wall thickness (RWT) is a risk marker for heart failure, few studies have evaluated LV RWT and aggravating factors in individuals with BD. METHODS We recruited 104 participants (52 patients with BD and 52 age- and sex-matched mentally healthy controls) to undergo echocardiographic imaging and biochemistry, high-sensitivity C-reactive protein (hs-CRP), and blood cell count measurements. LV RWT was estimated using the following equation: (2 × LV posterior wall end-diastolic thickness)/LV end-diastolic diameter. Clinical data were obtained through interviews and chart reviews. RESULTS The BD group exhibited a significantly greater LV RWT (Cohen's d = 0.53, p = 0.003) and a less favorable mitral valve E/A ratio (Cohen's d = 0.54, p = 0.023) and LV global longitudinal strain (Cohen's d = 0.57, p = 0.047) than did the control group. Multiple linear regression revealed that in the BD group, serum triglyceride levels (β = 0.466, p = 0.001), platelet-to-lymphocyte ratios (β = 0.324, p = 0.022), and hs-CRP levels (β = 0.289, p = 0.043) were all significantly and positively associated with LV RWT. LIMITATIONS This study applied a cross-sectional design, meaning that the direction of causation could not be inferred. CONCLUSIONS Patients with BD are at a risk of heart failure, as indicated by their relatively high LV RWT. Lipid levels and systemic inflammation may explain this unfavorable association.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yi Hsiao
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan; School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Zhou F, Luo B, Zou X, Zou C, Wu D, Wang Z, Bai Y, Zhao M. A Wearable Sandwich Heterostructure Multimode Fiber Optic Microbend Sensor for Vital Signal Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:2209. [PMID: 38610420 PMCID: PMC11014310 DOI: 10.3390/s24072209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
This work proposes a highly sensitive sandwich heterostructure multimode optical fiber microbend sensor for heart rate (HR), respiratory rate (RR), and ballistocardiography (BCG) monitoring, which is fabricated by combining a sandwich heterostructure multimode fiber Mach-Zehnder interferometer (SHMF-MZI) with a microbend deformer. The parameters of the SHMF-MZI sensor and the microbend deformer were analyzed and optimized in detail, and then the new encapsulated method of the wearable device was put forward. The proposed wearable sensor could greatly enhance the response to the HR signal. The performances for HR, RR, and BCG monitoring were as good as those of the medically approved commercial monitors. The sensor has the advantages of high sensitivity, easy fabrication, and good stability, providing the potential for application in the field of daily supervision and health monitoring.
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Affiliation(s)
- Fumin Zhou
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
| | - Binbin Luo
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
| | - Xue Zou
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
- School of Communications and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing 400065, China
| | - Chaoke Zou
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
| | - Decao Wu
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
| | - Zhijun Wang
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
| | - Yunfang Bai
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
| | - Mingfu Zhao
- Chongqing Key Laboratory of Optical Fiber Sensor and Photoelectric Detection, Chongqing University of Technology, Chongqing 400054, China; (F.Z.); (C.Z.); (D.W.); (Z.W.); (Y.B.); (M.Z.)
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Tsai SY, Kuo CJ, Sajatovic M, Huang YJ, Chen PH, Chung KH. Lithium exposure and chronic inflammation with activated macrophages and monocytes associated with atherosclerosis in bipolar disorder. J Affect Disord 2022; 314:233-240. [PMID: 35878826 DOI: 10.1016/j.jad.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/09/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atherosclerosis accounts for cardiovascular diseases (CVDs). This study aimed to explore the association between carotid intima-media thickness (CIMT), psycho-pharmacotherapy, and inflammatory markers along with other molecules related to atherosclerosis in bipolar disorder (BD). METHODS The euthymic patients with bipolar I disorder (BD-I) aged over 20 years were recruited to measure CIMT through ultrasound and the blood levels of lipid profiles, soluble tumor necrosis factor receptor-1 (sTNF-R1), soluble interleukin-6 receptor (sIL-6R), monocyte chemoattractant protein-1, chitinase 3-like 1, endothelial adhesive proteins, and thrombin-antithrombin complex. RESULTS Participants were 103 BD-I patients with mean 44.3 years old. The ratio of lithium exposure in relation to illness chronicity and the current daily dosage of lithium therapy exhibited an inverse relationship with CIMT in the entire sample. After controlling for age and BMI, multivariate regression indicated that a higher lithium level was significantly associated with decreased CIMT in the entire sample, high-risk (those with CVDs or endocrine diseases, N = 48), middle-risk (those without CVDs and endocrine diseases, N = 55), and low-risk (those aged <45 years in the middle-risk subgroup, N = 43) subgroups. Furthermore, higher levels of sTNF-R1 in the entire sample and high-risk subgroup and sIL-6R in the middle- and low-risk subgroups were statistically associated with greater CIMT. LIMITATION The age range was too wide to control for the effect of age on CIMT and medication. CONCLUSIONS Lithium exposure may be a protective factor for atherosclerosis progression in BD-I. The chronic inflammation in BD-I with activated macrophages and monocytes may link with the atherosclerosis development over time.
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Affiliation(s)
- Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Chian-Jue Kuo
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yu-Jui Huang
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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Hsu JH, Chien IC, Lin CH. Increased risk of ischemic heart disease in patients with bipolar disorder: A population-based study. J Affect Disord 2021; 281:721-726. [PMID: 33223233 DOI: 10.1016/j.jad.2020.11.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/10/2020] [Accepted: 11/08/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study investigated the national prevalence and incidence of ischemic heart disease and associated factors among Taiwanese patients with bipolar disorder. METHODS We used a random sample of 766,427 subjects who were ≥18 years old from the National Health Research Institute database in 2005. Subjects with at least one primary diagnosis of bipolar disorder or ischemic heart disease were identified. We compared the prevalence and incidence of ischemic heart disease in bipolar patients and the general population in 2005 and the same cohort from 2006 to 2010. These associated factors with respect to ischemic heart disease among patients with bipolar disorder were also analyzed. RESULTS The prevalence of ischemic heart disease in patients with bipolar disorder was 1.69 times higher than in the general population (7.85% vs 4.67%; odds ratio 1.69; 95% confidence interval, 1.41-2.03) in 2005. The average annual incidence of ischemic heart disease in patients with bipolar disorder was also 1.60 times higher than in the general population (2.02% vs 1.24; risk ratio 1.60; 95% confidence interval, 1.36-1.90) from 2006 to 2010. The higher prevalence of ischemic heart disease among bipolar patients was associated with increased age, diabetes, hypertension, and antidepressant use. CONCLUSIONS Patients with bipolar disorder had a significantly higher prevalence and incidence of ischemic heart disease than the general population in both sexes, especially at younger ages. Among patients with bipolar disorder, older age, and hyperlipidemia were risk factors of ischemic heart disease.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
| | - I-Chia Chien
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Heng Lin
- Taichung Veterans General Hospital, Taichung, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Gregório ML, Wazen GLL, Kemp AH, Milan-Mattos JC, Porta A, Catai AM, de Godoy MF. Non-linear analysis of the heart rate variability in characterization of manic and euthymic phases of bipolar disorder. J Affect Disord 2020; 275:136-144. [PMID: 32658816 DOI: 10.1016/j.jad.2020.07.012] [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: 02/06/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND - Bipolar Disorder (BD) has been associated with autonomic nervous system (ANS) dysregulation, with a consequent increase in mortality. Recent work highlights the non-linear analysis of ANS function. Our objective was to compare ANS modulation using recurrence plots (RP) and symbolic analysis (SA) in manic and euthymic phases of BD to controls. METHODS - Eighteen male patients (33.1 ± 12.0 years) were assessed during mania and at discharge in the euthymic phase compared and to a healthy group matched by age (33.9 ± 10.8 years). Electrocardiographic series (1000 RR intervals, at rest, in supine position) were captured using Polar Advantage RS800CX equipment and Heart Rate Variability (HRV) was analysed using RP and SA. Statistical analysis was performed using ANOVA with Tukey's post-test. The threshold for statistical significance was set at P < 0.05 and Cohen's d effect size was also quantified considering d > 0.8 as an important effect. The study was registered into the Clinical Trials Registration (ClinicalTrials.gov: NCT01272518). RESULTS Manic group presented significantly higher linearity before treatment (P<0.05) compared to controls considering RP variables. Cohen's d values had a large effect size ranging from 0.888 to 1.227. In the manic phase, SA showed predominance of the sympathetic component (OV%) with reduction of the parasympathetic component (2LV% and 2UV%) with reversion post treatment including higher Shannon Entropy (SE) indicating higher complexity. LIMITATIONS - short follow-up (1 month) and small number of patients. CONCLUSIONS - Non-linear analyzes may be used as supplementary tools for understanding autonomic function in BD during mania and after drug treatment.
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Affiliation(s)
- Michele Lima Gregório
- Transdisciplinary Nucleus for the Study of Chaos and Complexity, NUTECC, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil.
| | - Guilherme Luiz Lopes Wazen
- Department of Psychiatry, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil
| | - Andrew Haddon Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Singleton Park, Wales SA2 8PP, United Kingdom
| | - Juliana Cristina Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil.
| | - Moacir Fernandes de Godoy
- Transdisciplinary Nucleus for the Study of Chaos and Complexity, NUTECC, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil; Department of Cardiology and Cardiovascular Surgery, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 5416 CEP, 15090-000 São José do Rio Preto, SP, Brazil
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Peterman JS, Marshall DF, Lamping E, Easter RE, Babu P, Langenecker SA, McInnis MG, Ryan KA. Decreased working memory capacity among individuals with a mood disorder who have increased metabolic burden. J Affect Disord 2020; 266:387-393. [PMID: 32056904 DOI: 10.1016/j.jad.2020.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 01/10/2020] [Accepted: 01/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Individuals with mood disorders experience a higher rate of obesity than the general population, putting them at risk for poorer outcomes. The relationship between obesity and a core feature of the mood disorders, neurocognition, is less understood. We examined the interaction of obesity as indexed by body mass index (BMI) and working memory performance in a large sample of individuals with bipolar disorder (BD), major depressive disorder (MDD), and healthy controls (HC). METHODS Participants with BD (n = 133), MDD (n = 78), and HC (n = 113) (age range 18-40) completed a spatial working memory (SWM) task that included three-graded increases in the number of target locations. Participants were subdivided by BMI classification into six diagnostic-BMI (BMI groups: Normal Weight, Overweight/Obese) subgroups. Performance on the task was indexed by number of errors within each difficulty level. RESULTS The number of errors, across all groups, increased with task difficulty. There was an interaction between errors and diagnostic-BMI group. Post-hoc analyses indicated that while the Normal Weight-BD group did not differ in performance from the other groups, the Overweight/Obese-BD group performed significantly worse than HC groups. LIMITATIONS Metabolic effects of psychotropic medications due to the naturalistic nature of the study, younger age of the MDD sample, and utilizing self-reported indicators of obesity may limit generalizability. CONCLUSIONS Individuals with BD with increased metabolic burden exhibit increased working memory errors than non-psychiatric controls who also have increased metabolic burden. Future work could address prevention and amelioration of such difficulties to reduce associated functional morbidity.
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Affiliation(s)
- Joel S Peterman
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA; Physical Medicine and Rehabilitation, Virginia Mason Medical Center Seattle, WA USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA
| | - Elena Lamping
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA
| | - Rebecca E Easter
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA
| | - Pallavi Babu
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA
| | | | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C Ann Arbor 48105 MI, USA.
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Tsai S. Evidence for vagal-immune dysregulation in bipolar disorder. Asian J Psychiatr 2020; 50:101947. [PMID: 32109804 DOI: 10.1016/j.ajp.2020.101947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/08/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.
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Baldessarini RJ, Vázquez GH, Tondo L. Bipolar depression: a major unsolved challenge. Int J Bipolar Disord 2020; 8:1. [PMID: 31903509 PMCID: PMC6943098 DOI: 10.1186/s40345-019-0160-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
| | - Gustavo H Vázquez
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.,Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
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Lee HC, Hsu JL, Chen PH, Chung KH, Huang YJ, Tsai SY. High risk of silent stroke in older bipolar patients with typical-onset age. Psychogeriatrics 2019; 19:355-362. [PMID: 30734419 DOI: 10.1111/psyg.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/23/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
AIM Older patients with bipolar disorder (BD) are at a high risk of stroke. Silent stroke could be neglected in BD patients after middle age, particularly in those with illness onset at the young age. Therefore, we investigated the morbidity and related factors for stroke in older BD patients with typical-onset age. METHODS Older patients with bipolar I disorder (age > 50 years) and their illness onset prior to the age of 40 years were recruited. After whole-brain magnetic resonance imaging was conducted, the patients were divided into stroke and non-stroke groups. Clinical data were obtained by reviewing all available medical records and directly interviewing the patients along with their reliable family members. RESULTS We recruited 62 patients with a mean age of 60.4 years and illness onset at the mean age of 28.4 years. Cerebral infarction or old stroke was observed in 24 (38.7%) patients, including 22 without any reported clinical history of stroke. That is, silent stroke (n = 22) was detected in 36.7% of 60 patients without clinical history of stroke. The stroke group had significantly higher mean numbers of lifetime mood episodes (P = 0.006) than the non-stroke one. Logistic regression analysis showed that 10 or more prior mood episodes (odds ratio = 3.43, 95% confidence interval = 1.12-10.47, P < 0·04) was significantly associated with the occurrence of stroke. The two study groups did not exhibit any other differences in demographic and clinical variables, such as age, laboratory or physical measurements during the last acute psychiatric hospitalisation, body mass index, and substance use problems and concurrent medical diseases. CONCLUSIONS High morbidity of stroke, particularly silent stroke, could be found in older bipolar patients with typical-onset age. In addition to traditional risk factors, the number of recurrent mood episodes in a lifetime may increase the risk of stroke in older BD patients.
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Affiliation(s)
- Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Jung-Lung Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Jui Huang
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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Chen PH, Kao YW, Shia BC, Lin HC, Kang JH. Adverse stroke outcomes among patients with bipolar disorder. PLoS One 2019; 14:e0213072. [PMID: 30830937 PMCID: PMC6398847 DOI: 10.1371/journal.pone.0213072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 02/12/2019] [Indexed: 01/24/2023] Open
Abstract
Failure to deliver the standard stroke care is suspected to be a potential reason for disproportionately high mortality among patients with co-morbid bipolar disorder (BD). Few studies have explored adverse outcomes and medical care costs concurrently (as a proxy for care intensity) among patients with BD admitted for stroke. Data for this nationwide population-based study were extracted from the Taiwan National Health Insurance Research Database, on 580 patients with BD hospitalized for stroke (the study group) and a comparison group consisting of randomly selected 1740 stroke patients without BD matched by propensity scores. Conditional logistic regression was used to estimate odds ratios (OR) for adverse in-hospital outcomes between study group and comparison group. We found that stroke patients with BD had significantly lower in-hospital mortality (3.28% vs. 5.63%), acute respiratory failure (2.59% vs. 5.57%), and use of mechanical ventilation (6.55% vs. 10.23%) than the comparison group. After adjusting for geographical location, urbanization level, monthly income, hypertension, diabetes, hyperlipidemia, and coronary heart disease, the odds of in-hospital mortality, acute respiratory failure, and use of mechanical ventilation in the BD group were 0.56 (95% CI: 0.34–0.92), 0.46 (95% CI: 0.26–0.80), and 0.63 (95% CI: 0.44–0.91), respectively. No differences were found in hospitalization costs and the length of hospital stay. With comparable hospitalization costs and length of hospital stay, we concluded that stroke patients with BD had lower in-hospital mortality and serious adverse events compared to stroke patients without BD.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Wei Kao
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan
| | - Ben-Chang Shia
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Wazen GLL, Gregório ML, Kemp AH, Godoy MFD. Heart rate variability in patients with bipolar disorder: From mania to euthymia. J Psychiatr Res 2018; 99:33-38. [PMID: 29407285 DOI: 10.1016/j.jpsychires.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/23/2017] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
Abstract
Bipolar Disorder (BD) is characterized by the occurrence of mania alternating with euthymia. The aim of the present study was to investigate the impact of BD on the autonomic nervous system, as indicated by heart rate variability (HRV). The study was registered in the Clinical Trials Registration (NCT01272518). Nineteen hospitalized, male patients (age: 34.0 ± 12.3 years) with type I BD were assessed during mania and at discharge on euthymia. HRV data were collected during 20- minutes in supine position at rest, on spontaneous breathing, using the Polar RS 800 CX frequencymeter. HRV measures included variables in time, frequency and non-linear domains. Psychiatric conditions were evaluated by the Mini International Neuropsychiatric Interview (MINI) and the Bech-Rafaelsen mania scale (BRMS). Time domain measures of RMSSD (Cohen's d = 0.668) and pNN50 (Cohen's d = 0.688) increased from first to second assessments. The high-frequency component (HFms2) also increased (Cohen's d = 0.586), while the LF/HF ratio decreased (Cohen's d = 0.785). Non-linear domain measures including the SD1 component (Cohen's d = 0.668), and the SD1/SD2 ratio (Cohen's d = 1.2934) extracted from the Poincare plot analysis increased from first to second assessment. The variables Lmean (Cohen's d = 0.9627), Lmax (Cohen's d = 1.2164), REC% (Cohen's d = 1.0595) and EntShannon (Cohen's d = 1.0607) were higher in mania. By contrast, ApEn (Cohen's d = 0.995) and EntSample (Cohen's d = 1.189) were less during mania, all reflecting ANS improvement. Findings are interpreted in the context of recently published models relating to neurovisceral integration across the continuum of time, and the implications for the future health and wellbeing of patients are considered.
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Affiliation(s)
- Guilherme Luiz Lopes Wazen
- Department of Psychiatry and Medical Psychology of São José do Rio Preto Medical School, Famerp, São José do Rio Preto, São Paulo, Brazil.
| | - Michele Lima Gregório
- Transdisciplinary Nucleus for Chaos and Complexity Studies (NUTECC), São José do Rio Preto Medical School, Famerp, São José do Rio Preto, São Paulo, Brazil
| | - Andrew Haddon Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom; Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil; School of Psychology, University of Sydney, Sydney, Australia
| | - Moacir Fernandes de Godoy
- Transdisciplinary Nucleus for Chaos and Complexity Studies (NUTECC), São José do Rio Preto Medical School, Famerp, São José do Rio Preto, São Paulo, Brazil; Department of Cardiology and Cardiovascular Surgery of São José do Rio Preto Medical School, Famerp, São Paulo, Brazil.
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