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Henry C, Berkovitch L. Mixed features in mood episodes: Mismatch between intensity and valence in emotional responses. Eur Neuropsychopharmacol 2024; 87:13-15. [PMID: 39018770 DOI: 10.1016/j.euroneuro.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/19/2024]
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2
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Bigot M, Alonso M, Houenou J, Sarrazin S, Dargél AA, Lledo PM, Henry C. An emotional-response model of bipolar disorders integrating recent findings on amygdala circuits. Neurosci Biobehav Rev 2020; 118:358-366. [PMID: 32739421 DOI: 10.1016/j.neubiorev.2020.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023]
Abstract
Because of our classification system limitations for defining psychiatric disorders and understanding their physiopathology, a new research area based on dimensions has emerged. It consists of exploring domains derived from fundamental behavioral components linked to neurobiological systems. Emotional processing is among the most affected dimensions in bipolar disorders (BD), but is excluded from the definition criteria. The purpose of this review is to synthesize the emotional responses disruption during the different phases of BD, using intensity and valence as the two key characteristics of emotions. We integrate those emotional disruptions into an original, emotion-based model contrasting with the current diagnostic frame built on mood. Emotional processing is underpinned by cortico-limbic circuits involving the amygdala. Recent publications showed the crucial role of the amygdala in emotional processes triggered by stimuli of negative, but also positive valence. We show how these neuroscience data can provide physiological basis for emotional disturbances observed in BD. We conclude with translational perspectives to improve the current knowledge about neural substrates underlying altered emotional responses characterizing BD.
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Affiliation(s)
- Mathilde Bigot
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France; Sorbonne Université, Collège doctoral, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France
| | - Josselin Houenou
- Université Paris-Est, INSERM, U955, Créteil, France; NeuroSpin, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Gif-sur-Yvette, France
| | - Samuel Sarrazin
- Université Paris-Est, INSERM, U955, Créteil, France; NeuroSpin, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Gif-sur-Yvette, France
| | - Aroldo A Dargél
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France
| | - Chantal Henry
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France; Université de Paris, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France.
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3
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Abstract
Mixed states are frequent clinical pictures in psychiatric practice but are not well described in nosologic systems. Debate exists as to defining mixed states. We review factor and cluster analytical studies and prominent clinical/conceptual models of mixed states. While mania involves standard manic symptoms and depression involves standard depressive symptoms, core additional features of the mixed state are, primarily, psychomotor activation and, secondarily, dysphoria. Those features are more pronounced in mixed mania than in mixed depression but are present in both.
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Affiliation(s)
- Sergio A Barroilhet
- Clínica Psiquiátrica Universitaria, Facultad Medicina Universidad de Chile, Santiago, Chile; Department of Psychiatry, Tufts University, School of Medicine, Tufts Medical Center, Pratt Building, 3rd Floor, 800 Washington Street, Box 1007, Boston, MA 02111, USA.
| | - S Nassir Ghaemi
- Department of Psychiatry, Tufts University, School of Medicine, Tufts Medical Center, Pratt Building, 3rd Floor, 800 Washington Street, Box 1007, Boston, MA 02111, USA; Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
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4
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Affiliation(s)
- Chantal Henry
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France.,Université Paris-Est, UPEC, Créteil, France.,AP-HP, Hôpital H. Mondor-A. Chenevier, Créteil, France
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5
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Dargél AA, Volant S, Saha S, Etain B, Grant R, Azorin JM, Gard S, Bellivier F, Bougerol T, Kahn JP, Roux P, Aubin V, Courtet P, Leboyer M, Scott J, Henry C. Activation Levels, Cardiovascular Risk, and Functional Impairment in Remitted Bipolar Patients: Clinical Relevance of a Dimensional Approach. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:45-47. [PMID: 30308490 DOI: 10.1159/000493690] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Aroldo A Dargél
- Unité Perception et Mémoire, Centre National de la Recherche Scientifique, Institut Pasteur, Paris, France.,Centre Thérapeutique et Préventif de Jour Troubles Bipolaires, Clinique Bellevue, Meudon, France
| | - Stevenn Volant
- Bioinformatics and Biostatistics Hub (C3BI), USR 3756 IP CNRS, Institut Pasteur, Paris, France
| | - Soham Saha
- Unité Perception et Mémoire, Centre National de la Recherche Scientifique, Institut Pasteur, Paris, France
| | - Bruno Etain
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, INSERM UMRS 1144, University Paris Diderot, Paris, France
| | - Rebecca Grant
- Center for Global Health (CGH), Institut Pasteur, Paris, France
| | - Jean-Michel Azorin
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Département de Psychiatrie, Hôpital Sainte-Marguerite, Marseille, France
| | - Sebastian Gard
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Frank Bellivier
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, INSERM UMRS 1144, University Paris Diderot, Paris, France
| | - Thierry Bougerol
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 836, Grenoble, France
| | - Jean-Pierre Kahn
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Centre Hospitalier Universitaire de Nancy - Hôpitaux de Brabois, Université de Lorraine, Nancy, France
| | - Paul Roux
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France.,University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Valerie Aubin
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Philippe Courtet
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Marion Leboyer
- Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France.,Pôle de Psychiatrie, AP-HP, Hôpital H. Mondor - A. Chenevier, Créteil, France.,INSERM, U955, Université Paris-Est, Créteil, France
| | | | - Jan Scott
- Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Chantal Henry
- Unité Perception et Mémoire, Centre National de la Recherche Scientifique, Institut Pasteur, Paris, .,Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, .,Pôle de Psychiatrie, AP-HP, Hôpital H. Mondor - A. Chenevier, Créteil, .,INSERM, U955, Université Paris-Est, Créteil,
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Dargél AA, Godin O, Etain B, Hirakata V, Azorin JM, M'Bailara K, Bellivier F, Bougerol T, Kahn JP, Passerieux C, Aubin V, Courtet P, Leboyer M, Henry C. Emotional reactivity, functioning, and C-reactive protein alterations in remitted bipolar patients: Clinical relevance of a dimensional approach. Aust N Z J Psychiatry 2017; 51:788-798. [PMID: 28374603 DOI: 10.1177/0004867417691850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Inter-episode mood instability has increasingly been considered in bipolar disorder. This study aimed to investigate emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms and functional status. This study also aimed to investigate whether high-sensitivity C-reactive protein, a marker of low-grade inflammation, could be a biological marker of emotional dysregulation in bipolar disorder (BD). METHODS Cross-sectional study of 613 subjects who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for BD recruited from the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort from 2009 to 2014. All patients had been in remission for at least 3 months before assessment. Patients were classified into three groups according to levels of emotional reactivity. Emotional reactivity was assessed by using the Multidimensional Assessment of Thymic States, and functional status was assessed by the Functioning Assessment Short Test. Clinical characteristics and blood sample were collected from all patients. RESULTS In total, 415 (68%) patients had abnormal emotional reactivity. Independent of potential confounders, including age, gender and subthreshold mood symptoms, serum levels of high-sensitivity C-reactive protein were significantly higher in patients with emotional hyper-reactivity (median = 4.0 mg/L, interquartile range = 2.7-5.6), and with emotional hypo-reactivity (median = 3.0 mg/L, interquartile range = 1-4) compared with patients with normal emotional reactivity (median = 0.95 mg/L, interquartile range = 0.4-1.9, p < 0.001). Patients with emotional hyper-reactivity showed significant cognitive functioning impairment ( p < 0.001). CONCLUSIONS Emotional reactivity appears to be a relevant dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms. Levels of high-sensitivity C-reactive protein may be an objective marker of emotional dysregulation in BD. Further studies are needed to confirm our findings.
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Affiliation(s)
- Aroldo A Dargél
- 1 Unité Perception et Mémoire, Institut Pasteur, Paris, France.,2 Unité Mixte de Recherche, Centre National de la Recherche Scientifique, Paris, France
| | - Ophelia Godin
- 3 INSERM UMRS 943, UPMC Université, Paris, France.,4 Fondation FondaMental, Fondation de cooperation scientifique, Créteil, France
| | - Bruno Etain
- 4 Fondation FondaMental, Fondation de cooperation scientifique, Créteil, France.,5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,6 Université Paris-Est, UMR_S955, UPEC, Créteil, France.,7 Pôle de Psychiatrie, Hôpital H. Mondor-A. Chenevier, AP-HP, Créteil, France
| | - Vânia Hirakata
- 8 Grupo de Pós-Graduação e Pesquisa, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jean-Michel Azorin
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,9 Service de psychiatrie adulte, Centre Expert Trouble Bipolaire, Hôpital Charles Perrens, Bordeaux, France
| | - Katia M'Bailara
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,9 Service de psychiatrie adulte, Centre Expert Trouble Bipolaire, Hôpital Charles Perrens, Bordeaux, France.,10 Laboratory of Psychology 'Health and Quality of Life' EA 4139, Université Bordeaux Segalen, Bordeaux, France
| | - Frank Bellivier
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,11 AP-HP, GH Saint-Louis-Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, France
| | - Thierry Bougerol
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,12 University Joseph Fourier, Grenoble, France.,13 Centre Hospitalier Universitaire de Grenoble, Grenoble, France.,14 Grenoble Institut des Neurosciences (GIN), Inserm U 836, Chemin Fortuné Ferrini, La Tronche, France
| | - Jean-Pierre Kahn
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,15 Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Christine Passerieux
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,16 Centre Hospitalier de Versailles, Le Chesnay, France.,17 Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Valerie Aubin
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,18 Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Philippe Courtet
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,19 Psychiatric Emergency Department, CHRU Montpellier, France.,20 INSERM U1061, Montpellier University, Montpellier, France
| | - Marion Leboyer
- 4 Fondation FondaMental, Fondation de cooperation scientifique, Créteil, France.,5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,6 Université Paris-Est, UMR_S955, UPEC, Créteil, France.,7 Pôle de Psychiatrie, Hôpital H. Mondor-A. Chenevier, AP-HP, Créteil, France
| | - Chantal Henry
- 1 Unité Perception et Mémoire, Institut Pasteur, Paris, France.,5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,6 Université Paris-Est, UMR_S955, UPEC, Créteil, France.,7 Pôle de Psychiatrie, Hôpital H. Mondor-A. Chenevier, AP-HP, Créteil, France
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7
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Ayub Dargél A, Masson M, Henry C. The RANZCP guidelines: Managing mood disorders in the real world. Aust N Z J Psychiatry 2016; 50:1198-1199. [PMID: 27789652 DOI: 10.1177/0004867416676373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aroldo Ayub Dargél
- Institut Pasteur, Unité Perception et Mémoire, UMR 3571, Paris, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France
| | - Marc Masson
- Service Hospitalo Universitaire, Centre Hospitalier Sainte-Anne, Paris, France.,Nightingale Hospitals Paris-Clinique du Château, Garches, France
| | - Chantal Henry
- Institut Pasteur, Unité Perception et Mémoire, UMR 3571, Paris, France .,Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France.,INSERM U955, Créteil, France.,Université Paris-Est Créteil (UPEC), Créteil, France.,Pôle de Psychiatrie, AP-HP, Hôpital H. Mondor - A. Chenevier, Créteil, France
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Perich T, Hadzi-Pavlovic D, Frankland A, Breakspear M, Loo C, Roberts G, Holmes-Preston E, Mitchell PB. Are there subtypes of bipolar depression? Acta Psychiatr Scand 2016; 134:260-7. [PMID: 27324550 DOI: 10.1111/acps.12615] [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] [Accepted: 05/31/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate for subtypes of bipolar depression using latent class analysis (LCA). METHOD Participants were recruited through a bipolar disorder (BD) clinic. LCA was undertaken using: (i) symptoms reported on the SCID-IV for the most severe lifetime depressive episode; (ii) lifetime illness features such as age at first depressive and hypo/manic episodes; and (iii) family history of BD and unipolar depression. To explore the validity of any demonstrated 'classes', clinical, demographic and treatment correlates were investigated. RESULTS A total of 243 BD subjects (170 with BD-I and 73 with BD-II) were included. For the combined sample, we found two robust LCA solutions, with two and three classes respectively. There were no consistent solutions when the BD-I and BD-II samples were considered separately. Subjects in class 2 of the three-class solution (characterised by anxiety, insomnia, reduced appetite/weight loss, irritability, psychomotor retardation, suicidal ideation, guilt, worthlessness and evening worsening) were significantly more likely to be in receipt of government financial support, suggesting a particularly malign pattern of symptoms. CONCLUSION Our study suggests the existence of two or three distinct classes of bipolar depression and a strong association with functional outcome.
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Affiliation(s)
- T Perich
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia.,Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - A Frankland
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - M Breakspear
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia.,Berghofer Queensland Institute of Medical Research, Brisbane, Qld, Australia
| | - C Loo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - G Roberts
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - E Holmes-Preston
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - P B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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La dépression bipolaire : quels marqueurs cliniques de réponse au traitement et quelles alternatives thérapeutiques pour les formes résistantes ? Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.159] [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] [Indexed: 11/18/2022] Open
Abstract
Face aux difficultés persistantes pour traiter efficacement la dépression bipolaire et à la complexité des guidelines, il est indispensable d’identifier des prédicteurs de réponse aux traitements médicamenteux afin d’améliorer le pronostic fonctionnel des patients. Des études cliniques avec une approche dimensionnelle ont montré que les dépressions bipolaires pouvaient être caractérisées par la réactivité émotionnelle , celle-ci pouvant constituer un marqueur d’intérêt de réponse aux traitements pharmacologiques. Dans cette perspective, l’utilisation de modèles statistiques de trajectoire pour différencier des profils cliniques de réponses aux traitements a permis de montrer que l’hyperréactivité émotionnelle serait un facteur prédictif d’une bonne réponse aux antipsychotiques atypiques. Cependant, certaines dépressions bipolaires avec une hyporéactivité émotionnelle semblent résister aux traitements classiques. De ce fait, plusieurs études ont testé l’intérêt de thérapeutiques moins conventionnelles dans le traitement des dépressions bipolaires résistantes aux traitements habituels . Le pramipexole est un agoniste dopaminergique dont la particularité est d’avoir une affinité sélective pour les récepteurs D3 de la voie mésolimbique. Les données actuelles concernant l’efficacité antidépressive de ce traitement dans les dépressions bipolaires résistantes semblent en faveur de taux de réponses et de rémission significativement plus importants et plus précoces (dès la 3e semaine) en comparaison à des antidépresseurs classiques ou d’un placebo, et d’une bonne tolérance . Une série d’observations cliniques chez 64 patients souffrant de dépression (uni ou bipolaire) suivis en ambulatoire a montré une efficacité du pramipexole sur les symptômes de dépression dans un délai de 3 à 17 jours à des doses moyennes de 1,4 mg/j. L’hyporéactivité émotionnelle pourrait être un indicateur d’une meilleure efficacité du traitement. Nous proposons dans ce symposium de mettre en perspective les caractéristiques cliniques des dépressions bipolaires qui pourraient orienter le choix du clinicien entre antipsychotiques atypiques, antidépresseurs et thérapeutiques innovantes.
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Abstract
Approximately 40% of patients with bipolar disorder experience mixed episodes, defined as a manic state with depressive features, or manic symptoms in a patient with bipolar depression. Compared with bipolar patients without mixed features, patients with bipolar mixed states generally have more severe symptomatology, more lifetime episodes of illness, worse clinical outcomes and higher rates of comorbidities, and thus present a significant clinical challenge. Most clinical trials have investigated second-generation neuroleptic monotherapy, monotherapy with anticonvulsants or lithium, combination therapy, and electroconvulsive therapy (ECT). Neuroleptic drugs are often used alone or in combination with anticonvulsants or lithium for preventive treatment, and ECT is an effective treatment for mixed manic episodes in situations where medication fails or cannot be used. Common antidepressants have been shown to worsen mania symptoms during mixed episodes without necessarily improving depressive symptoms; thus, they are not recommended during mixed episodes. A greater understanding of pathophysiological processes in bipolar disorder is now required to provide a more accurate diagnosis and new personalised treatment approaches. Targeted, specific treatments developed through a greater understanding of bipolar disorder pathophysiology, capable of affecting the underlying disease processes, could well prove to be more effective, faster acting, and better tolerated than existing therapies, therefore providing better outcomes for individuals affected by bipolar disorder. Until such time as targeted agents are available, second-generation neuroleptics are emerging as the treatment of choice in the management of mixed states in bipolar disorder.
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11
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Mathieu F, Etain B, Daban C, Raymond R, Raust A, Cochet B, Gard S, M'Bailara K, Desage A, Kahn JP, Wajsbrot-Elgrabli O, Cohen RF, Azorin JM, Leboyer M, Bellivier F, Scott J, Henry C. Affect intensity measure in bipolar disorders: a multidimensional approach. J Affect Disord 2014; 157:8-13. [PMID: 24581821 DOI: 10.1016/j.jad.2013.12.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Emotional dysregulation, characterized by high levels of both arousal and intensity of emotional responses, is a core feature of bipolar disorders (BDs). In non-clinical populations, the 40-item Affect Intensity Measure (AIM) can be used to assess the different dimensions of emotional reactivity. METHODS We analyzed the factor structure of the AIM in a sample of 310 euthymic patients with BD using Principal Component Analysis and examined associations between AIM sub-scale scores and demographic and illness characteristics. RESULTS The French translation of the AIM demonstrated good reliability. A four-factor solution similar to that reported in non-clinical samples (Positive Affectivity, Unpeacefulness [lack of Serenity], Negative Reactivity, Negative Intensity), explained 47% of the total variance. Age and gender were associated with Unpeacefulness and Negative reactivity respectively. 'Unpeacefulness' was also positively associated with psychotic symptoms at onset (p=0.0006), but negatively associated with co-morbid substance misuse (p=0.008). Negative Intensity was positively associated with social phobia (p=0.0005). LIMITATIONS We cannot definitively exclude a lack of statistical power to classify all AIM items. Euthymia was carefully defined, but a degree of 'contamination' of the self-reported levels of emotion reactivity may occur because of subsyndromal BD symptoms. It was not feasible to control for the possible impact of on-going treatments. CONCLUSIONS The AIM scale appears to be a useful measure of emotional reactivity and intensity in a clinical sample of patients with BD, suggesting it can be used in addition to other markers of BD characteristics and sub-types.
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Affiliation(s)
- F Mathieu
- Inserm, UMR-S958 - Génétique des Diabètes, Site Villemin, Paris, France.
| | - B Etain
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France; Fondation Fondamental, Créteil, France
| | - C Daban
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | | | - A Raust
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | - B Cochet
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | - S Gard
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France; Laboratoire de Psychologie EA 4139, Université Victor Segalen, Bordeaux, France
| | - K M'Bailara
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France; Laboratoire de Psychologie EA 4139, Université Victor Segalen, Bordeaux, France
| | - A Desage
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France; Laboratoire de Psychologie EA 4139, Université Victor Segalen, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
| | - O Wajsbrot-Elgrabli
- Fondation Fondamental, Créteil, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
| | - R F Cohen
- Fondation Fondamental, Créteil, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
| | - J M Azorin
- Fondation Fondamental, Créteil, France; Pôle Universitaire de Psychiatrie, Hôpital Ste Marguerite, Marseille, France
| | - M Leboyer
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France; Fondation Fondamental, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France
| | - F Bellivier
- Inserm, U955, Créteil, France; Fondation Fondamental, Créteil, France; APHP, Hôpital Fernand Widal, Pôle Addictologie-Toxicologie-Psychiatrie, Paris, France
| | - J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | - C Henry
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France; Fondation Fondamental, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France
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Mixed-state bipolar I and II depression: time to remission and clinical characteristics. J Affect Disord 2014; 152-154:340-6. [PMID: 24144581 DOI: 10.1016/j.jad.2013.09.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 09/06/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state. METHODS The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission. RESULTS The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD. LIMITATIONS We investigated only inpatients and therefore could not comment on outpatients. CONCLUSIONS These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state.
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Atzeni T, Henry C, Minois I, Gard S, Desage A, Zanouy L, M'bailara K. From inhibition to activation, from emotional hyporeactivity to emotional hyperreactivity: two pathways to discriminate mood in bipolar disorders. Psychiatry Res 2013; 209:50-4. [PMID: 23218441 DOI: 10.1016/j.psychres.2012.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/20/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Abstract
To better explore the clinical heterogeneity of bipolar mood states, we developed a dimensional scale for assessing all mood episodes (depressive, hypomanic, manic, mixed states) using the same tool. The Multidimensional Assessment of Thymic States (MATHYS) (Henry et al., 2008) provides two scores, a total score measuring a level of activation and a sub-score of emotional reactivity. The aim of this study was to establish the appropriate cut-off in total activation versus inhibition and in the emotional reactivity sub-score in bipolar disorders. Patients (n=187) during an acute episode and controls (n=89) filled in the MATHYS. Receiver Operating Characteristic (ROC) curves were obtained to estimate the sensitivity and specificity of the global score and the emotional reactivity sub-score of the MATHYS, in order to differentiate patients from controls. ROC curves showed very satisfactory sensitivity and specificity levels both for the total score and the sub-score of emotional reactivity, thus providing an appropriate cut-off. Concerning the total score between 0 and 200, patients with a score lower than 91 had significant global inhibition and those with a score higher than 109 had significant global activation. Regarding the emotional reactivity sub-score between 0 and 40, patients with a score lower than 16 had significant emotional hyporeactivity and those with a score higher than 24 had significant emotional hyperreactivity. Our results provide cut-offs for the MATHYS to identify patients in an acute phase.
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Affiliation(s)
- Thierry Atzeni
- Psychology Laboratory, EA4139, Université Bordeaux Segalen, 3ter place de la Victoire, Bordeaux, France
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Abstract
The combination of depression and activation presents clinical and diagnostic challenges. It can occur, in either bipolar disorder or major depressive disorder, as increased agitation as a dimension of depression. What is called agitation can consist of expressions of painful inner tension or as disinhibited goal-directed behavior and thought. In bipolar disorder, elements of depression can be combined with those of mania. In this case, the agitation, in addition to increased motor activity and painful inner tension, must include symptoms of mania that are related to goal-directed behavior or manic cognition. These diagnostic considerations are important, as activated depression potentially carries increased behavioral risk, especially for suicidal behavior, and optimal treatments for depressive episodes differ between bipolar disorder and major depressive disorder.
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Affiliation(s)
- Alan C Swann
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Road, Room 3216, Houston, TX 77054, USA.
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15
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Abstract
Bipolar disorder refers to a group of affective disorders, which together are characterised by depressive and manic or hypomanic episodes. These disorders include: bipolar disorder type I (depressive and manic episodes: this disorder can be diagnosed on the basis of one manic episode); bipolar disorder type II (depressive and hypomanic episodes); cyclothymic disorder (hypomanic and depressive symptoms that do not meet criteria for depressive episodes); and bipolar disorder not otherwise specified (depressive and hypomanic-like symptoms that do not meet the diagnostic criteria for any of the aforementioned disorders). Bipolar disorder type II is especially difficult to diagnose accurately because of the difficulty in differentiation of this disorder from recurrent unipolar depression (recurrent depressive episodes) in depressed patients. The identification of objective biomarkers that represent pathophysiologic processes that differ between bipolar disorder and unipolar depression can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Neuroimaging studies could help the identification of biomarkers that differentiate bipolar disorder from unipolar depression, but the problem in detection of a clear boundary between these disorders suggests that they might be better represented as a continuum of affective disorders. Innovative combinations of neuroimaging and pattern recognition approaches can identify individual patterns of neural structure and function that accurately ascertain where a patient might lie on a behavioural scale. Ultimately, an integrative approach, with several biological measurements using different scales, could yield patterns of biomarkers (biosignatures) to help identify biological targets for personalised and new treatments for all affective disorders.
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Affiliation(s)
- Mary L Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Geoffroy PA, Etain B, Jamain S, Bellivier F, Leboyer M. [Early onset bipolar disorder: validation from admixture analyses and biomarkers]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:240-8. [PMID: 23547648 DOI: 10.1177/070674371305800410] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Bipolar affective disorder (BD) is a multifactorial disorder with heterogeneous clinical presentations, in particular according to age at onset (AAO). The relevance of such an indicator has been discussed as a potential specifier in future nosographical classification. METHOD We summarize available evidence of admixture analyses and biomarkers in early onset BD. RESULTS Numerous clinical arguments have led us to conclude that the early onset BD subgroup is clinically homogeneous, with particular, recurrent, and severe characteristics.Eight admixture studies have demonstrated the existence of 3 subgroups of patients with BD according to AAO (early, intermediate, and late AAO), with 2 cut-off points of 21 (21.33) [SD 1.41]) and 35 years (34.67 [SD 5.52]). Differential clinical features and outcome measures characterize the early onset subgroup: higher rate of suicide attempts, rapid cycling, alcohol and drugs misuse, psychotic symptoms, and comorbid anxiety disorders. This may partially explain the delayed diagnosis and late initiation of mood stabilizers. Genetic, biological, imaging, and cognitive arguments may be considered as potential markers in providing external validity of the existence of this early onset subgroup. Implementation of AAO in the algorithms of treatment may be discussed, although the level of proof for focused medication strategies remains to be consolidated. CONCLUSION Given the high frequency (44.80%) of early onset BD, awareness of clinicians should be stimulated to provide an early and accurate detection, preventive strategies, and possibly specific treatments.The forthcoming DSM-5 should include AAO as a specifier, given its relevance for course and outcome.
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Affiliation(s)
- Pierre Alexis Geoffroy
- Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, et Fondation Fonda Mental, Créteil, France
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Henry C, Luquiens A, Lançon C, Sapin H, Zins-Ritter M, Gerard S, Perrin E, Falissard B, Lukasiewicz M. Inhibition/activation in bipolar disorder: validation of the Multidimensional Assessment of Thymic States scale (MAThyS). BMC Psychiatry 2013; 13:79. [PMID: 23510483 PMCID: PMC3600043 DOI: 10.1186/1471-244x-13-79] [Citation(s) in RCA: 14] [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: 11/29/2012] [Accepted: 03/05/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND One of the major issues in clinical practice is the accurate differential diagnosis between mixed states and depression, often leading to inappropriate prescriptions of antidepressants in mixed states, and as a consequence, increasing the risk of manic switch and suicide. In order to better define the spectrum of mixed states, it may be useful to develop a dimensional approach. In this context, the MAThyS (Multidimensional Assessment of Thymic States) scale was built to assess activation/inhibition levels in all bipolar mood episodes, and to determine whether a clinical description in terms of activation/inhibition can help better define bipolar states with which both manic and depressive symptoms are associated. The aim of this paper is the validation of the MAThyS scale in 141 bipolar patients in acute states (manic, hypomanic, mixed, or depressive). METHODS The validation of the MAThyS scale was the primary outcome of this 24-week, phase III, open-label, olanzapine single-arm clinical trial. Principal component, factorial analysis, and Cronbach's coefficient calculation (internal consistency) were performed. Concurrent validity (correlations with 17-item Hamilton Depression Rating Scale [HAMD-17], Hamilton Anxiety Rating Scale [HAMA], and Young Mania Rating Scale [YMRS]) and responsiveness to the clinical intervention were assessed (change in MAThyS scale and effect size) at 6 and 24 weeks. RESULTS Scree plot of eigenvalues identified a 2-dimension structure ("activation/inhibition level" and "emotional component"). Psychometric properties were good: Cronbach's coefficient was >0.9. Concurrent validity was good with low correlation (-0.19) with the HAMA scale and a higher correlation at baseline with the YMRS (0.72) and HAMD-17(-0.43). As expected, the activation state was predominant in manic, hypomanic, and mixed states while inhibition was predominant in depressive states. MAThyS score improvement was observed (effect size: -0.3 at 6 and 24 weeks). CONCLUSIONS The MAThyS demonstrated good psychometric properties. The MAThyS scale may help clinicians to better discriminate and follow bipolar episodes, especially the broad spectrum of mixed episodes.
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Affiliation(s)
- Chantal Henry
- INSERM, U995, IMRB, Department of Genetics, AP-HP, Henri Mondor-Albert Chenevier Group, Psychiatry, Univ Paris 12, Faculty of Medicine, IFR10, Créteil, France
| | - Amandine Luquiens
- AP-HP, Paul-Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
| | - Christophe Lançon
- Self-Perceived Health Assessment Research Unit, School of Medicine, La Timone University, Marseille, 13005, France,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - Hélène Sapin
- Eli Lilly and Company, 24 Boulevard Vital Bouhot, Neuilly-Sur-Seine, 92200, France
| | | | - Stephanie Gerard
- Eli Lilly and Company, 24 Boulevard Vital Bouhot, Neuilly-Sur-Seine, 92200, France
| | - Elena Perrin
- Eli Lilly and Company, 24 Boulevard Vital Bouhot, Neuilly-Sur-Seine, 92200, France
| | - Bruno Falissard
- AP-HP, Paul-Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France,INSERM, U669, Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
| | - Michael Lukasiewicz
- AP-HP, Paul-Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France,INSERM, U669, Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
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M'bailara K, Cosnefroy O, Vieta E, Scott J, Henry C. Group-based trajectory modeling: a novel approach to examining symptom trajectories in acute bipolar episodes. J Affect Disord 2013; 145:36-41. [PMID: 22884011 DOI: 10.1016/j.jad.2012.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pattern analysis can aid understanding of trajectories of symptom evolution. However, most studies focus on relatively homogeneous disorders with a restricted range of outcomes, prescribed a limited number of classes of medication. We explored the utility of pattern analysis in defining short-term outcomes in a heterogeneous clinical sample with acute bipolar disorders. METHOD In a naturalistic observational study, we used Group-based trajectory modeling (GBTM) to define trajectories of symptom change in 118 bipolar cases recruited during an acute DSM IV episode: major depression (56%), (hypo)mania (26%), and mixed states (18%). Symptoms were assessed weekly for a month using the MATHYS, which measures symptoms independent of episode polarity. RESULTS Four trajectories of symptom change were identified: Persistent Inhibition, Transient Inhibition, Transient Activation and Over-activation. However, counter to traditional predictions, we observed that bipolar depression shows a heterogeneous response pattern with cases being distributed approximately equally across trajectories that commenced with inhibition and activation. LIMITATIONS The observational period focuses on acute outcomes and so we cannot use the findings to predict whether the trajectories lead to stable improvement or whether the clinical course for some clusters is cyclical. As in all GBTM, the terms used for each trajectory are subjective, also the modeling programme we used assumes dropouts are random, which is clearly not always the case. CONCLUSION This paper highlights the potential importance of techniques such as GBTM in distinguishing the different response trajectories for acutely ill bipolar cases. The use of the MATHYS provides further critical insights, demonstrating that clustering of cases with similar response patterns may be independent of episodes defined by mood state.
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Affiliation(s)
- Katia M'bailara
- University Bordeaux, Psychologie, Santé et Qualité de vie, EA4139, F-33000 Bordeaux, France.
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Perturbations de la réactivité émotionnelle et du sommeil dans les troubles bipolaires en période intercritique. Encephale 2012; 38 Suppl 4:S173-8. [DOI: 10.1016/s0013-7006(12)70096-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Henry C, Phillips M, Leibenluft E, M'Bailara K, Houenou J, Leboyer M. Emotional dysfunction as a marker of bipolar disorders. Front Biosci (Elite Ed) 2012; 4:2622-30. [PMID: 22652673 PMCID: PMC3927326 DOI: 10.2741/e578] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Assessment of emotional reactivity, defined as rapid emotional responses to salient environmental events, has been neglected in mood disorders. This article reviews data showing the relevance of using emotional reactivity to better characterize bipolar mood episodes. METHOD We reviewed clinical data on emotional reactivity during all phases of bipolar disorders (euthymic, manic, mixed and depressive states) and brain-imaging, neurochemical, genetic studies related to emotional reactivity disturbances. RESULT Euthymic bipolar patients show mild abnormalities (hypersensitivity to emotional stimuli and higher arousability) in comparison to controls. Both manic and mixed states are characterized by a significant increase in emotional reactivity. Furthermore, emotional reactivity may discriminate between two types of bipolar depression, the first being characterized by emotional hypo-reactivity and global behavioral inhibition, the second by emotional hyper-reactivity. Brain-imaging studies can help to identify the underlying mechanisms involved in disturbances of emotional reactivity. CONCLUSION Emotional reactivity can be used to refine more homogeneous pathophysiological subtypes of mood episodes. Future research should explore possible correlations between biomarkers, response to treatments and these clinical phenotypes.
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Affiliation(s)
- Chantal Henry
- INSERM, U955, IMRB, departement de Genetique, Creteil, F-94000, France.
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M'Bailara K, Atzeni T, Colom F, Swendsen J, Gard S, Desage A, Henry C. Emotional hyperreactivity as a core dimension of manic and mixed states. Psychiatry Res 2012; 197:227-30. [PMID: 22414662 DOI: 10.1016/j.psychres.2011.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 08/30/2011] [Accepted: 12/01/2011] [Indexed: 11/16/2022]
Abstract
Despite its obvious importance in mood disorders, characterization of emotional reactivity has been neglected in bipolar disorders. Concerning manic states and the current classification, the main criterion is the presence of an elevated or expansive mood. In contrast to this characteristic and often prolonged mood state, emotional reactivity refers to a brief evoked response to salient emotional stimuli. The goal of this study was to assess the intensity of emotional responses triggered by viewing slides in bipolar patients with manic or mixed states. Our hypothesis was that all emotional responses are exacerbated, whatever the valence of the stimuli. We compared 33 patients with manic or mixed states with 33 matched euthymic patients and 33 healthy control subjects. Arousal and attribution of valence were assessed while subjects viewed slides taken from the International Affective Picture System (positive, neutral and negative slides). Patients with manic or mixed states reported a higher arousal when viewing all types of slides in comparison with the other groups. Concerning attribution of valence, patients with manic or mixed states assessed neutral slides as more pleasant. When bipolar patients with manic and mixed states are placed in front of positive, neutral and negative slides, the slides trigger a higher intensity of emotions, whatever the valence of the emotional stimuli. These results strengthen the importance of emotional hyperreactivity as a core dimension in manic and mixed states in bipolar disorder.
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Affiliation(s)
- Katia M'Bailara
- Laboratory of Psychology, University Bordeaux Segalen, Bordeaux, France.
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Swartz HA, Levenson JC, Frank E. Psychotherapy for Bipolar II Disorder: The Role of Interpersonal and Social Rhythm Therapy. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2012; 43:145-153. [PMID: 26612968 PMCID: PMC4657867 DOI: 10.1037/a0027671] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although bipolar II disorder is a highly prevalent, chronic illness that is associated with burdensome psychosocial impairment, relatively little is known about the best ways to treat the disorder. Moreover, psychosocial interventions for the management of bipolar II disorder have been largely unexplored, leaving psychologists with few evidence-based recommendations for best treatment practices. In this article, we provide information about interpersonal and social rhythm therapy (IPSRT), an empirically supported treatment for bipolar I disorder that has preliminary evidence supporting its efficacy in bipolar II disorder. After reviewing the phenomenology of bipolar II disorder and differentiating it from bipolar I disorder, we summarize the extant empirical support for using psychotherapy in the management of bipolar II disorder. We explore what is known about the role of psychotherapy in the management of bipolar II disorder as well as lacunae in the evidence base. Next, we introduce IPSRT and discuss how it has been adapted for use as a treatment for individuals suffering from bipolar II disorder. Specific strategies of the treatment are detailed, and preliminary evidence for the efficacy of IPSRT in bipolar II disorder is described. Finally, we present a case vignette demonstrating the use of IPSRT for an individual with bipolar II disorder.
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Improvement in Fatigue, Sleepiness, and Health-Related Quality of Life with Bright Light Treatment in Persons with Seasonal Affective Disorder and Subsyndromal SAD. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:543906. [PMID: 21747994 PMCID: PMC3123908 DOI: 10.1155/2011/543906] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 11/26/2022]
Abstract
Objective. To investigate the effects of bright light treatment for secondary outcome measures and to explore and validate empirically derived subgroups and treatment effects in subgroups. Methods. A descriptive design. A sample of forty-nine persons (mean age of 45.8) with clinically assessed seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD) participated in a two-group clinical trial evaluating the effects of treatment with bright light therapy. A person-oriented cluster analysis was applied to study treatment effects in subgroups. Results. For the merged group, sleepiness (Epworth Sleepiness Scale), fatigue (fatigue questionnaire), and health-related quality of life (SF-36) were improved at posttreatment, and results were maintained at the one-month followup. Three distinct subgroups had a high level of fatigue in common, while the level of excessive daytime sleepiness and depressed mood differed between the subgroups. Over time, all subgroups improved following ten days treatment in a light room. Conclusion. Fatigue, excessive daytime sleepiness, and health-related quality of life improve in a similar way as depressed mood following treatment with bright light. The treatment was effective irrespective of the severity of the disorder, that is, for persons with SAD and subsyndromal SAD.
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Terciarismo en psiquiatría: el Programa de Trastornos Bipolares del Clínic de Barcelona. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:1-4. [DOI: 10.1016/j.rpsm.2011.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 02/04/2023]
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Abstract
Bipolar depressions can present all the clinical aspects from a major depressive episode with a mild intensity to severe one. However, part of this severity comes from the bipolarity by itself. Bipolar disorders belong to the 10 most disabling conditions in the world. Moreover, the complexity of bipolar depressions comes also from the complexity to treat them. Antidepressants are difficult to use in bipolar subjects because the risk of switch, the possible induction of rapid cycles or of a chronic dysphoric state. Currently, guidelines are not very helpful for the choice of the treatment in case of an acute major depressive disorder. Indeed, the current guidelines give the choice between a mood stabilizer alone or associated with an antidepressant, either between an antipsychotic more or less associated with an antidepressant. A better understanding of the clinical heterogeneity of bipolar depression could help to solve a part of this complexity.
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Affiliation(s)
- C Henry
- Université Paris 12, Faculté de Médecine, IFR10, Créteil, F-94000.
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Pringuey D, Cherikh F, Tible O, Giordana B. Traitement d’un premier épisode dépressif dans le cadre du trouble bipolaire. Encephale 2010; 36 Suppl 1:S27-33. [DOI: 10.1016/s0013-7006(10)70007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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M'bailara K, Demotes-Mainard J, Swendsen J, Mathieu F, Leboyer M, Henry C. Emotional hyper-reactivity in normothymic bipolar patients. Bipolar Disord 2009; 11:63-9. [PMID: 19133967 DOI: 10.1111/j.1399-5618.2008.00656.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Normothymic states in bipolar disorders are generally considered to be devoid of severe symptoms. However, bipolar patients present subsyndromal symptoms for half of their lives, and often have comorbid psychiatric disorders. If we go beyond the concept of temperamental features, can we identify certain emotional characteristics distinguishing normothymic bipolar patients from normal controls? We previously showed, using self-completed questionnaires, that normothymic bipolar patients display higher levels of emotional lability and intensity than controls. OBJECTIVES The aim of this study was to assess the emotional reactivity of normothymic bipolar patients, comparing such patients with a normal control group during an experimental mood induction procedure. METHOD We evaluated the subjective emotional reactivity of 145 subjects (90 control subjects and 55 normothymic bipolar patients), using an emotional induction method based on the viewing of a set of 18 pictures (6 positive, 6 negative, 6 neutral) extracted from the International Affective Picture System. Subjective valence and arousal were recorded with the Self-Assessment Manikin. We also recorded startle reflexes, triggered by a tone occurring during the viewing of two-thirds of the pictures. We controlled for confounding factors, such as concurrent treatments, in all analyses. RESULTS Normothymic bipolar patients and normal controls assessed valence and arousal similarly for positive and negative images. However, neutral images were considered more pleasant [F(1,143) = 8.4; p = 0.004] and induced a higher level of arousal [F(1,143) = 12.3; p = 0.001] in normothymic bipolar patients than in control subjects. Neutral pictures also triggered a stronger startle reflex in normothymic bipolar patients compared to controls [F(3,123) = 3.1; p = 0.03]. CONCLUSION Normothymic bipolar patients displayed emotional hyper-reactivity, mostly evidenced in neutral situations. This feature may be linked to emotional dysregulation and is a potential endophenotype and/or a risk factor for bipolar disorders. This trait may be responsible for vulnerability to minor stressful events in everyday life. These findings have potential implications for the daily management of bipolar disorder between crises.
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Affiliation(s)
- Katia M'bailara
- Département de Psychiatrie Adulte, CHS Charles Perrens, Bordeaux, France
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Lang JP, Michel L, Melin P, Schoeffler M, Gauchet A, Rousseaux C, Cartier V, Henry C. Management of psychiatric disorders and addictive behaviors in patients with viral hepatitis C in France. ACTA ACUST UNITED AC 2009; 33:1-7. [PMID: 19135326 DOI: 10.1016/j.gcb.2008.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 10/10/2008] [Accepted: 10/21/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Guidelines concerning the management of psychiatric disorders and addictive behaviors in patients with chronic hepatitis C and the conditions of collaboration between hepatogastroenterologists, infectiologists, psychiatrists and psychologists have not been published. This has a negative influence on optimal therapeutic management of chronic hepatitis C virus (HCV) infection. The aim of this study was to describe the current clinical practices for ambulatory management of psychiatric disorders and addictions, and the influence of a possible psychiatric and/or psychological collaboration. PATIENTS AND METHODS A retrospective survey was conducted among 101 clinicians treating patients with chronic hepatitis C. Data were collected from personal interviews with the managing clinicians and from the files of patients with chronic hepatitis C patients who presented psychiatric disorders. RESULTS Analysis of the 101 interviews and 598 patient files showed that 19% of patients had not received an optimal treatment for their HCV infection because of a psychiatric problem, and that less than 50% of the managing clinicians were working in collaboration with a psychiatrist or a psychologist. In conclusion, lack of collaboration between hepatogastroenterologists and psychiatrists could be deleterious for the optimal treatment of HCV infected patients. Improvement is required.
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Affiliation(s)
- J-P Lang
- Pôle de psychiatrie et d'addictologie, centre hospitalier d'Erstein, 13, route de Kraft, 67152 Erstein, France.
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Abstract
PURPOSE OF REVIEW Bipolar disorder is a complex clinical entity that presents with pleomorphic signs and symptoms varying from depression to hypomania, full-blown mania, mixed states, and psychosis. Therefore, the assessment of patients with bipolar disorder poses a difficult challenge to clinicians, who may find themselves puzzled when having to choose among the many instruments available. This paper aims at briefly reviewing these instruments. RECENT FINDINGS Observer-rated and self-completed instruments for the assessment of depressive, manic, and psychotic symptoms in patients with bipolar disorder are described with emphasis on topics of increasing interest in recent times, such as the assessment of bipolar depression, self-rating of manic symptoms, daily mood monitoring, screening, and early recognition of bipolar disorder. SUMMARY The use of standardized assessment instruments has many advantages as it enables clinicians to be more systematic and it allows greater precision, increased sensitivity to change, and opportunity to identify longitudinal patterns. Knowledge of available options for the assessment of patients with bipolar disorder may help clinicians and researchers to choose the most appropriate instruments for their specific needs.
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Bauer M, Glenn T, Grof P, Rasgon NL, Marsh W, Sagduyu K, Alda M, Lewitzka U, Schmid R, Whybrow PC. Relationship between adjunctive medications for anxiety and time spent ill in patients with bipolar disorder. Int J Psychiatry Clin Pract 2009; 13:70-7. [PMID: 24946124 DOI: 10.1080/13651500802450514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective. Many patients with bipolar disorder take adjunctive medications for anxiety. Using naturalistic data, we investigated the relationship between the use of adjunctive anxiolytics and the time spent in episodes or with subsyndromal mood symptoms. Methods. This was a post-hoc analysis of 310 patients with bipolar disorder who previously recorded mood and medications daily for 5 months using ChronoRecord software. One hundred patients were taking adjunctive anxiolytics for at least 50% of days; 210 were not. Of the 100 patients, 73 were taking a benzodiazepine. All patients taking anxiolytics were also receiving treatments for bipolar disorder. Results. Patients with bipolar disorder who were taking adjunctive medications for anxiety spent more time ill. Comparing patients who were taking or not taking anxiolytics, the mean days spent either in any episode or with subsyndromal symptoms was 45.6 vs. 29.6%, respectively (P<0.001), the mean days in any episode was 17.1 vs. 9.2%, respectively (P=0.016), and the mean days with subsyndromal depression was 26.4 vs. 16.2%, respectively (P=0.004). Conclusion. While this methodology cannot determine causality, these findings highlight the need for controlled studies of the long-term impact of adjunctive medications for anxiety on mood symptoms in patients being treated for bipolar disorder.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
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Henry C, M'Bailara K, Mathieu F, Poinsot R, Falissard B. Construction and validation of a dimensional scale exploring mood disorders: MAThyS (Multidimensional Assessment of Thymic States). BMC Psychiatry 2008; 8:82. [PMID: 18803831 PMCID: PMC2561027 DOI: 10.1186/1471-244x-8-82] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 09/19/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics. This leads to some confusion to define appropriate therapeutic strategies. A dimensional approach might help to better define bipolar moods states and more specifically those with mixed features. Therefore, we proposed a new tool based on a dimensional approach, built with a priori five sub-scales and focus on emotional reactivity rather than exclusively on mood tonality. This study was designed to validate this MAThyS Scale (Multidimensional Assessment of Thymic States). METHODS One hundred and ninety six subjects were included: 44 controls and 152 bipolar patients in various states: euthymic, manic or depressed. The MAThyS is a visual analogic scale consisting of 20 items. These items corresponded to five quantitative dimensions ranging from inhibition to excitation: emotional reactivity, thought processes, psychomotor function, motivation and sensory perception. They were selected as they represent clinically relevant quantitative traits. RESULTS Confirmatory analyses demonstrated a good validity for this scale, and a good internal consistency (Cronbach's alpha coefficient = 0.95). The MathyS scale is moderately correlated of both the MADRS scale (depressive score; r = -0.45) and the MAS scale (manic score; r = 0.56). When considering the Kaiser-Guttman rule and the scree plot, our model of 5 factors seems to be valid. The four first factors have an eigenvalue greater than 1.0 and the eigenvalue of the factor five is 0.97. In the scree plot, the "elbow", or the point at which the curve bends, indicates 5 factors to extract. This 5 factors structure explains 68 per cent of variance. CONCLUSION The characterisation of bipolar mood states based on a global score assessing inhibition/activation process (total score of the MATHyS) associated with descriptive analysis on sub-scores such as emotional reactivity (rather than the classical opposition euphoria/sadness) can be useful to better understand the broad spectrum of mixed states.
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Affiliation(s)
- Chantal Henry
- AP-HP, Henri Mondor-Albert Chenevier Hospitals, Department of Psychiatry, Creteil, F-94000, France.
| | - Katia M'Bailara
- Université Victor Segalen, EA 4139, F-33000, France,AP-HP, Hôpital Paul Brousse, département de santé publique, Villejuif, F-94804, France
| | - Flavie Mathieu
- INSERM, U 841, IMRB, dept of Genetics, Psychiatry Genetics, Creteil, F-94000, France,AP-HP, Hôpital Paul Brousse, département de santé publique, Villejuif, F-94804, France
| | - Rollon Poinsot
- Université Victor Segalen, EA 4139, F-33000, France,AP-HP, Hôpital Paul Brousse, département de santé publique, Villejuif, F-94804, France
| | - Bruno Falissard
- Université Paris 8, Saint-Denis, F-93526, France,Inserm, U669, Paris, F-75679, France,Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, F-75679, France,AP-HP, Hôpital Paul Brousse, département de santé publique, Villejuif, F-94804, France
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Goodwin GM, Anderson I, Arango C, Bowden CL, Henry C, Mitchell PB, Nolen WA, Vieta E, Wittchen HU. ECNP consensus meeting. Bipolar depression. Nice, March 2007. Eur Neuropsychopharmacol 2008; 18:535-49. [PMID: 18501566 DOI: 10.1016/j.euroneuro.2008.03.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 02/22/2008] [Accepted: 03/12/2008] [Indexed: 12/16/2022]
Abstract
DSM-IV, specifically its text revision DSM-IV-TR, remains the preferred diagnostic system. When employed in general population samples, prevalence estimates of bipolar disorder are relatively consistent across studies in Europe and USA. In community studies, first onset of bipolar mood disorder is usually in the mid-teenage years and twenties, and the occurrence of a major depressive episode or hypomania is usually its first manifestation. Since reliable criteria for delineating unipolar (UP) and bipolar (BI) depression cross-sectionally are currently lacking, there is a longitudinal risk - probably over 10% - that initial UP patients ultimately turn out as BP in the longer run. Its early onset implies a severe potential burden of disease in terms of impaired social and neuropsychological development, most of which is attributable to depression. BIPOLAR DEPRESSION IN CHILDREN: Bipolar I disorder is rare in prepubertal children, when defined according to unmodified DSM-IV-TR criteria. A broad diagnosis of bipolar disorder risks confounding with other childhood psychopathology and has less predictive value for bipolar disorder in adulthood than the conservative definition. Nevertheless, empirical studies of drug and other treatments and longitudinal studies to assess validity of the broadly defined phenotype in children and adolescents are desirable, rather than extrapolation from adult bipolar practice. The need for an increased capacity to conduct reliable trials in children and adolescents is a challenge to Europe, whose healthcare system should allow greater participation and collaboration than other regions, via clinical networks. ECNP will aspire to facilitate such developments. BIPOLAR DEPRESSION IN ADULTS - UNIPOLAR/BIPOLAR CONTRAST: Despite some differences in symptom profiles and severity measures, a cross-sectional categorical distinction between bipolar (BP) and unipolar (UP) depression is currently impossible. For regulatory purposes, a major depressive episode, meeting DSM-IV-TR criteria, remains the same diagnosis, irrespective of the overall course of the disorder. However, in refining diagnosis in future studies and DSM-V, a probabilistical approach to the UP/BP distinction is more likely to be informative as recommended by the International Society for Bipolar Disorders (ISBD). Anxiety is a commonly present, often at syndromal levels, in bipolar populations. Thus, RCT inclusion criteria for trials not targeting anxiety, should accept co-morbid anxiety disorders as part of the history and even current anxiety symptoms, where these are not dominating the mental state at recruitment to a study. Rapid cycling patients defined as those suffering from 4 or more episodes per year, may also be recruited into trials of bipolar depression without impairing assay sensitivity. Illness severity critically affects assay sensitivity. The minimum scores for entry into a bipolar depression trials should be >20 on HAM-D (17 item scale). However, efficacy is best detected in patients with HAM-D >24 at baseline. THE USE OF RATING SCALES IN BIPOLAR DEPRESSION: There is some dissatisfaction with the HAM-D or MADRS as the preferred primary outcome for trials, although they probably capture global severity adequately. Secondary measures to capture so-called atypical symptoms (such as hypersomnia or hyperphagia), or specific psychopathology more common in bipolar participants (such as lability of mood), could be informative as secondary measures. TREATMENT STUDIES IN BIPOLAR DEPRESSION: Monotherapy trials against placebo remain the gold-standard design for determining efficacy in bipolar depression. The confounding effects of co-medication are emerging from the literature on antidepressant studies in bipolar depression, often conducted in combination with antimanic agents to avoid possible switch to mood elevation. Three arm trials, including the compound to be tested, placebo, and a standard comparator, are generally preferred in order to ensure assay sensitivity and a better picture of benefit-risk ratio. However, in the absence of any gold-standard, two-arm trials may be enough. If efficacy happens to be proven as monotherapy, new compounds may be tested in adjunctive-medication placebo-controlled designs. Younger adults, without an established need for long-term medication, may be particularly suitable for clinical trials requiring placebo controls. The conversion rate of initial UP depression, converting to become BP in the long run is estimated to be 10%. Switch to mania or hypomania may be the consequence of active treatment for bipolar depression. Some medicines such as the tricyclic antidepressants and venlafaxine may be more likely to provoke switch than others, but this increased rate of switch may not be seen until about 10 weeks of treatment. Twelve week trials against placebo are necessary to determine the risk of switch and to establish continuing effects. Careful assessment at 6-8 weeks is required to ensure that patients who are failing to respond do not continue in a study for unacceptable periods of time. To capture a switch event, studies should include scales to define the phenomenology of the event (e.g. hypomania or mania) and its severity. These may be best applied shortly after the clinical decision that switch is occurring. Long-term treatment is commonly required in bipolar disorder. Trials to detect maintenance of effect or continued response in bipolar depression should follow a 'relapse prevention' design: i.e. patients are treated in an index episode with the medicine of interest and then randomized to either continue the active treatment or placebo. However, acute withdrawal of active medication after treatment response might artificially enhance effect size due to active drug withdrawal effects. A short taper is usually desirable. Longer periods of stabilisation are also desirable for up to 3 months: protocol compliance may then be difficult to achieve in practice and so will certainly make studies more difficult and expensive to conduct. The addition of a medicine to other agents during or after the resolution of a depressive or manic episode, and its subsequent investigation as monotherapy against placebo to prevent further relapse (as in the lamotrigine maintenance trials) is clinically informative. Assay sensitivity and patient acceptability are enhanced if the outcome in long-term studies is 'time to intervention for a new episode' for discontinuation designs.
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Affiliation(s)
- Guy M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
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Guidelines et conférences de consensus sur le traitement des troubles bipolaires. Encephale 2008; 34 Suppl 4:S150-3. [DOI: 10.1016/s0013-7006(08)80627-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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