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Lee H, Jang J, Kang HS, Lee J, Lee D, Yu H, Ha TH, Park J, Myung W. Understanding of Depressive Symptomatology across Major Depressive Disorder and Bipolar Disorder: A Network Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:32. [PMID: 38256293 PMCID: PMC10818784 DOI: 10.3390/medicina60010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Depressive symptoms are prominent in both major depressive disorder (MDD) and bipolar disorder (BD). However, comparative research on the network structure of depressive symptoms in these two diagnostic groups has been limited. This study aims to compare the network structure of depressive symptoms in MDD and BD, providing a deeper understanding of the depressive symptomatology of each disorder. Materials and Methods: The Zung Self-Rating Depressive Scale, a 20-item questionnaire, was administered to assess the depressive symptoms in individuals with MDD (n = 322) and BD (n = 516). A network analysis was conducted using exploratory graph analysis (EGA), and the network structure was analyzed using regularized partial correlation models. To validate the dimensionality of the Zung SDS, principal component analysis (PCA) was adopted. Centrality measures of the depressive symptoms within each group were assessed, followed by a network comparison test between the two groups. Results: In both diagnostic groups, the network analysis revealed four distinct categories, aligning closely with the PCA results. "Depressed affect" emerged as the most central symptom in both MDD and BD. Furthermore, non-core symptoms, "Personal devaluation" in MDD and "Confusion" in BD, displayed strong centrality. The network comparison test did not reveal significant differences in the network structure between MDD and BD. Conclusions: The absence of significant differences in the network structures between MDD and BD suggests that the underlying mechanisms of depressive symptoms may be similar across these disorders. The identified central symptoms, including "Depressed affect", in both disorders and the distinct non-core symptoms in each highlight the complexity of the depressive symptomatology. Future research should focus on validating these symptoms as therapeutic targets and incorporate various methodologies, including non-metric dimension reduction techniques or canonical analysis.
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Affiliation(s)
- Hyukjun Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Junwoo Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Hyo Shin Kang
- Department of Psychology, Kyungpook National University, Daegu 41566, Republic of Korea;
| | - Jakyung Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Daseul Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
| | - Jungkyu Park
- Department of Psychology, Kyungpook National University, Daegu 41566, Republic of Korea;
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (H.L.); (J.J.); (J.L.); (D.L.); (H.Y.); (T.H.H.)
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03087, Republic of Korea
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2
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Ouali U, Zgueb Y, Jouini L, Aissa A, Jomli R, Ouertani A, Omrani A, Nacef F, Carta MG, Preti A. Accuracy of the Arabic HCL - 32 and MDQ in detecting patients with bipolar disorder. BMC Psychiatry 2023; 23:70. [PMID: 36703141 PMCID: PMC9878752 DOI: 10.1186/s12888-023-04529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Studies about the two most used and validated instruments for the early detection of Bipolar Disorder (BD), the 32 - item Hypomania Checklist (HCL - 32) and the Mood Disorder Questionnaire (MDQ), are scarce in non-Western countries. This study aimed to explore the reliability, factor structure, and criterion validity of their Arabic versions in a sample of Tunisian patients diagnosed with mood disorders. METHODS The sample included 59 patients with BD, 86 with unipolar Major Depressive Disorder (MDD) and 281 controls. Confirmatory factor analysis was applied to show that a single global score was an appropriate summary measure of the screeners in the sample. Receiver Operating Characteristic analysis was used to assess the capacity of the translated screeners to distinguish patients with BD from those with MDD and controls. RESULTS Reliability was good for both tools in all samples. The bifactor implementation of the most reported two-factor model had the best fit for both screeners. Both were able to distinguish patients diagnosed with BD from putatively healthy controls, and equally able to distinguish patients diagnosed with BD from patients with MDD. CONCLUSION Both screeners work best in excluding the presence of BD in patients with MDD, which is an advantage in deciding whether or not to prescribe an antidepressant.
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Affiliation(s)
- Uta Ouali
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010, La Manouba, Tunisia. .,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia. .,Research Laboratory LR18SP03, Tunis, Tunisia.
| | - Lamia Jouini
- grid.418149.10000 0000 8631 6364Centre de Compétences en Psychiatrie et Psychothérapie, Pôle de Psychiatrie et Psychothérapie, Hôpital du Valais (HVS)- Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Amina Aissa
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Rabaa Jomli
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Abdelhafidh Ouertani
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Adel Omrani
- Tunisian Bipolar Forum, Erable Médical Cabinet 324, Tunis, Tunisia
| | - Fethi Nacef
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Mauro G. Carta
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- grid.7605.40000 0001 2336 6580Department of Neuroscience, University of Turin, Turin, Italy
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Sayyah M, Delirrooyfard A, Rahim F. Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:349-361. [PMID: 35588536 PMCID: PMC9169473 DOI: 10.1590/1516-4446-2021-2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD). METHODS We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed. RESULTS Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II). CONCLUSION The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.
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Affiliation(s)
- Mehdi Sayyah
- Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Delirrooyfard
- Department of Emergency, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Research Center of Thalassemia & Hemoglobinopathies, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Wang YY, Xu DD, Feng Y, Chow IHI, Ng CH, Ungvari GS, Wang G, Xiang YT. Short versions of the 32-item Hypomania Checklist: A systematic review. Perspect Psychiatr Care 2020; 56:102-111. [PMID: 31066059 DOI: 10.1111/ppc.12388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Bipolar disorder (BD) is frequently misdiagnosed, which can lead to negative outcomes. The 32-item Hypomania Checklist (HCL-32) is one of the most widely used self-reported screening instruments for hypomanic symptoms, which has several short versions. This systematic review examined the psychometric properties of HCL-32 short versions. DESIGN AND METHODS Five international databases were systematically and independently searched by two researchers for studies that developed the HCL short versions. Basic demographic and clinical characteristics and the psychometric properties of the HCL short versions were recorded. FINDINGS Eighteen studies were identified. The majority of the HCL short versions showed satisfactory to good psychometric properties. PRACTICE IMPLICATIONS Validated HCL short versions with satisfactory psychometric properties may be helpful in screening for BD.
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Affiliation(s)
- Yuan-Yuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom.,Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Dan-Dan Xu
- School of Food Engineering, Faculty of Science, Harbin University, Heilongjiang, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Ines H I Chow
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame Australia/Graylands Hospital, Perth, Australia.,Division of Psychiatry, University of Western Australia, Perth, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
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5
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Mistry S, Escott-Price V, Florio AD, Smith DJ, Zammit S. Genetic risk for bipolar disorder and psychopathology from childhood to early adulthood. J Affect Disord 2019; 246:633-639. [PMID: 30611060 DOI: 10.1016/j.jad.2018.12.091] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/29/2018] [Accepted: 12/24/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Studying the phenotypic manifestations of increased genetic liability for Bipolar Disorder (BD) can increase understanding of this disorder. AIMS We assessed whether genetic risk for BD was associated with childhood psychopathology and features of hypomania in young adulthood within a large population-based birth cohort. METHODS We used data from the second Psychiatric Genetics Consortium Genome Wide Association Study (GWAS) for Bipolar Disorder to construct a polygenic risk score (PRS) for each individual in the Avon Longitudinal Study of Parents and Children (ALSPAC). Linear and logistic regression models were used to assess associations between the BD-PRS and emotional/behavioural difficulties, attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) traits in childhood, as well as hypomania in early adulthood (sample sizes from 2654 to 6111). RESULTS The BD-PRS was not associated with total hypomania score, but was weakly associated with a binary measure of hypomania (OR = 1.13, 95%CI 0.98,1.32; p = 0.097), and particularly at higher hypomania symptom thresholds (strongest evidence OR = 1.33, 95%CI 1.07, 1.65; p = 0.01). The BD-PRS was also associated with ADHD (OR = 1.31, 95%CI 1.10, 1.57; p = 0.018), but not with other childhood psychopathology. LIMITATIONS The PRS only captures common genetic variation and currently explains a relatively small proportion of the variance for BD. CONCLUSIONS The BD-PRS was associated with ADHD in childhood, and weakly with adult hypomania, but not with other psychopathology examined. Our findings suggest that genetic risk for BD does not appear to manifest in childhood to the same extent as schizophrenia genetic risk has been reported to do.
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Affiliation(s)
- Sumit Mistry
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK.
| | - Valentina Escott-Price
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK
| | - Arianna D Florio
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, 1 Lilybank Gardens, University of Glasgow, UK
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
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6
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Fornaro M, Anastasia A, Valchera A, Carano A, Orsolini L, Vellante F, Rapini G, Olivieri L, Di Natale S, Perna G, Martinotti G, Di Giannantonio M, De Berardis D. The FDA "Black Box" Warning on Antidepressant Suicide Risk in Young Adults: More Harm Than Benefits? Front Psychiatry 2019; 10:294. [PMID: 31130881 PMCID: PMC6510161 DOI: 10.3389/fpsyt.2019.00294] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
The decision made in the year 2004 by the U.S. Food and Drug Administration (FDA) to require a boxed warning on antidepressants regarding the risk of suicidality in young adults still represents a matter of controversy. The FDA warning was grounded on industry-sponsored trials carried one decade ago or earlier. However, within the past decade, an increasing number of reports have questioned the actual validity of the FDA warning, especially considering a decline in the prescription of the antidepressant drugs associated with an increase in the rate of suicidal events among people with severe depression. The present report provides an overview of the FDA black box warning, also documenting two Major Depressive Disorder patients whose refusal to undergo a pharmacological antidepressant treatment possibly led to an increased risk for suicidal behaviors. The concerns raised by the FDA black box warning need to be considered in real-world clinical practice, stating the associated clinical and public health implications.
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Affiliation(s)
- Michele Fornaro
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy
| | - Annalisa Anastasia
- Polyedra Research Group, Teramo, Italy.,Alma Mater S.P.A. Villa Camaldoli, Naples, Italy
| | - Alessandro Valchera
- Alma Mater S.P.A. Villa Camaldoli, Naples, Italy.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Alessandro Carano
- Polyedra Research Group, Teramo, Italy.,NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Laura Orsolini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, United Kingdom
| | - Federica Vellante
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Gabriella Rapini
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Luigi Olivieri
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Serena Di Natale
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Como, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University G. D'Annunzio, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University G. D'Annunzio, Chieti, Italy
| | - Domenico De Berardis
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy.,NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
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7
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Zimmerman M, Holst CG. Screening for psychiatric disorders with self-administered questionnaires. Psychiatry Res 2018; 270:1068-1073. [PMID: 29908784 DOI: 10.1016/j.psychres.2018.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/06/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
Given the time demands of clinical practice it is not surprising that diagnoses are sometimes missed. To improve diagnostic recognition, self-administered screening scales have been recommended. A problem with much of the research effort on screening scales is the confusion between diagnostic testing and screening. It is important for a screening test to have high sensitivity because the more time intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. Investigators vary in how they analyze their data in determining the recommended cutoff score on a self-administered screening questionnaire. To illustrate this, in the present report we examined how often each of the different approaches towards determining a cutoff score on bipolar disorder screening scales were used. We reviewed 68 reports of the performance of the 3 most commonly researched bipolar disorder screening scales to determine how the recommended cutoff on the scale was derived. Most studies recommended a cutoff point on the screening scale that optimized the level of agreement with the diagnostic gold standard. Only 11 (16.2%) studies recommended a cutoff that prioritized the scale's sensitivity. It is important for clinicians to understand the difference between screening and diagnostic tests. The results of the present study indicate that most studies of the performance of the 3 most commonly studied bipolar disorder screening measures have taken the wrong approach in deriving the cutoff score on the scale for the purpose of screening.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
| | - Carolina Guzman Holst
- Department of Psychiatry and Human Behavior, Brown Medical School, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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8
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Maremmani AGI, Bacciardi S, Somers JM, Nikoo M, Schütz C, Jang KL, Krausz M. Substance Dependence Among Bipolar, Unipolar Depression and Psychotic Homeless: A Canadian National Study. Front Psychiatry 2018; 9:701. [PMID: 30618874 PMCID: PMC6305348 DOI: 10.3389/fpsyt.2018.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/03/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Homeless individuals are often mischaracterized as members of a homogeneous population that suffers from a wide mental health and addiction issues, with little consideration of potentially important differences within or between samples. The aim of the present study was to investigate the comorbidy of alcohol and/or substance dependence (ASD) and major psychiatric diagnoses (bipolar disorder, unipolar depression, and psychotic disorder) in a large Canadian sample of homeless individuals, and to examine potential sources of variability including location and ethnicity. Materials and Methods: A sample of 1,585 homeless individuals were assessed for alcohol and/or substance dependence and bipolar disorder, unipolar depression and psychotic disorder with the Mini-International Neuropsychiatric Interview (version 6.0). Regional and ethnic differences in major psychiatric diagnoses between homeless with and without ASD were examined using univariate (i.e., chi-square) and multivariate (i.e., logistic regression) statistics. Results: Members of the sample with ASD were found to be younger, Aboriginal, less well-educated, and born in the Americas. They were more significantly more prevalent in Western Canada and less prevalent in Central and Eastern Canada. The odds of having ASD were higher among people affected by bipolar disorder and (to a less extent) unipolar depression. Limitations: Data collected were self-reported and no urinalyses were performed. We considered diagnosis of ASD according to the previous 12 months only. Conclusions: Homeless people with major mental illness are at high risk for concurrent ASD, however the prevalence of ASD varies significantly between cities, and based on ethnicity and specific psychiatric diagnosis (with greater prevalence in individuals affected by bipolar disorder and, to a less extent, unipolar depression). Clinicians, administrators and policy makers should develop and deliver services based on careful assessment of the local population.
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Affiliation(s)
- Angelo G I Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy.,Local Health Unit (Versilia Zone), Department of Psychiatry, North-Western Tuscany Region, Viareggio, Italy
| | - Silvia Bacciardi
- "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Julian M Somers
- Somers Research Group, Faculty of Health Science, Simon Fraser University, Barnaby, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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9
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Zimmerman M. Screening for bipolar disorder with self-administered questionnaires: A critique of the concept and a call to stop publishing studies of their performance in psychiatric samples. Depress Anxiety 2017; 34:779-785. [PMID: 28872771 DOI: 10.1002/da.22644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/21/2017] [Accepted: 04/18/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.,Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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10
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Meyer TD, Castelao E, Gholamrezaee M, Angst J, Preisig M. Hypomania Checklist-32 - cross-validation of shorter versions screening for bipolar disorders in an epidemiological study. Acta Psychiatr Scand 2017; 135:539-547. [PMID: 28281293 DOI: 10.1111/acps.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Self-reports such as Hypomania Checklist (HCL-32) can be used to enhance recognition of bipolar disorders, but they are often too long and only validated in clinical samples. The objectives of this study are therefore to test whether (i) the HCL-32 can be used for screening in the community and (ii) whether two previously suggested shorter versions would do as well. METHOD Data stemmed from the CoLaus|PsyColaus, a prospective cohort study which included randomly selected residents aged 35-66 years from an urban area. Participants underwent semistructured interviews to assess DSM-IV disorders and 1712 of them completed the HCL-32. RESULTS Forty individuals (2.3%) were diagnosed as having BD. Compared to others, participants with BD scored significantly higher on the HCL-32. The HCL-32 had a sensitivity of 0.78 and specificity of 0.68. Very similar figures were found for two previously proposed shorter versions with 16 and 20 items. The results of confirmatory factor analysis and item response theory (IRT) models supported the postulated two-factor structure for the three HCL versions. CONCLUSION Despite the low base rate of BD in this sample, the screening properties of the HCL-32 remained almost as good. Importantly, two previously proposed shorter versions performed as well, suggesting that those could be used without losing essential information.
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Affiliation(s)
- T D Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Castelao
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - M Gholamrezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - M Preisig
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
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Fornaro M, De Berardis D, Mazza M, Pino M, Favaretto E, Bedani F, Wieser C, Indelicato L, Paternò VF, Lo Monaco F, Dugo F, Ventriglio A, Mungo S, Selle V, Valchera A, Elassy M, Martinotti G, De Bartolomeis A, Iasevoli F, Tomasetti C, Avvisati L, Tartaglione S, Perna G, Cattaneo CI, Consoli G, Romano A, Del Debbio A, Martino M, D' Angelo E, De Pasquale C, Koshy AS, Angst J. Factor structure and reliability of the Italian adaptation of the Hypomania Check List-32, second revision (HCL-32-R2). J Affect Disord 2015; 178:112-20. [PMID: 25805403 DOI: 10.1016/j.jad.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients. METHODS A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS In our sample (n=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2. LIMITATIONS No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE. CONCLUSIONS Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy; Polyedra Research Group, Italy.
| | - Domenico De Berardis
- Polyedra Research Group, Italy; National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | - Monica Mazza
- Polyedra Research Group, Italy; Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy.
| | - Mariachiara Pino
- Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy.
| | - Ettore Favaretto
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Fulvio Bedani
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Christian Wieser
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Luisa Indelicato
- Department of Education Science, University of Catania, Catania, Italy.
| | - Vito Fabio Paternò
- Centro siciliano per la cura di Depressione e Ansia (CESIDEA), Catania, Italy; Ospedale San Raffaele, Milano, Italy.
| | | | - Febronia Dugo
- Department of Education Science, University of Catania, Catania, Italy.
| | - Antonio Ventriglio
- Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy.
| | - Sergio Mungo
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | - Alessandro Valchera
- Polyedra Research Group, Italy; Casa di Cura Villa San Giuseppe, Via dei Girasoli, n.6, 63100 Ascoli Piceno, Italy.
| | - Mai Elassy
- Department of Psychiatry, Mansoura Faculty of Medicine, Mansoura City, Egypt.
| | - Giovanni Martinotti
- Polyedra Research Group, Italy; Department of Neuroscience and Imaging, University "G. d׳Annunzio", Chieti, Italy.
| | - Andrea De Bartolomeis
- Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Felice Iasevoli
- Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Carmine Tomasetti
- Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy; National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy.
| | - Livia Avvisati
- Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Sergio Tartaglione
- National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy.
| | - Giampaolo Perna
- Polyedra Research Group, Italy; Department of Clinical Neuroscience, San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy.
| | | | | | - Anna Romano
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | | | - Matteo Martino
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | | | - Ann Sarah Koshy
- St. John׳s National Academy of Health Sciences, Bangalore, India.
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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Mamah D, Owoso A, Sheffield JM, Bayer C. The WERCAP Screen and the WERC Stress Screen: psychometrics of self-rated instruments for assessing bipolar and psychotic disorder risk and perceived stress burden. Compr Psychiatry 2014; 55:1757-71. [PMID: 25128205 DOI: 10.1016/j.comppsych.2014.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Identification of individuals in the prodromal phase of bipolar disorder and schizophrenia facilitates early intervention and promises an improved prognosis. There are no current assessment tools for clinical risk symptoms of bipolar disorder, and psychosis-risk assessment generally involves semi-structured interviews, which are time consuming and rater dependent. We present psychometric data on two novel quantitative questionnaires: the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen for assessing bipolar and psychotic disorder risk traits, and the accompanying WERC Stress Screen for assessing individual and total psychosocial stressor severities. METHODS Prevalence rates of the WERCAP Screen were evaluated among 171 community youth (aged 13-24 years); internal consistency was assessed and k-means cluster analysis was used to identify symptom groups. In 33 participants, test-retest reliability coefficients were assessed, and ROC curve analysis was used to determine the validity of the psychosis section of the WERCAP Screen (pWERCAP) against the Structured Interview of Psychosis-Risk Symptoms (SIPS). Correlations of the pWERCAP, the affectivity section of the WERCAP Screen (aWERCAP) and the WERC Stress Screen were examined to determine the relatedness of scores with cognition and clinical measures. RESULTS Cluster analysis identified three groups of participants: a normative (47%), a psychosis-affectivity (18%) and an affectivity only (35%) group. Internal consistency of the aWERCAP and pWERCAP resulted in alphas of 0.87 and 0.92, and test-retest reliabilities resulted in intraclass correlation coefficients of 0.76 and 0.86 respectively. ROC curve analysis showed the optimal cut-point on the pWERCAP as a score of >30 (sensitivity: 0.89; specificity: 1.0). There was a significant negative correlation between aWERCAP scores and total cognition (R=-0.42), and between pWERCAP scores and sensorimotor processing speed. Total stress scores correlated significantly with scores on the aWERCAP (R=0.88), pWERCAP (R=0.62) and total cognition (R=-0.44). CONCLUSIONS Our results show that the WERCAP Screen and the WERC Stress Screen are easy to administer and derived scores are related to cognitive and clinical traits. This suggests that their use could have particular benefits for epidemiologic studies and in busy clinical settings. Longitudinal studies would be required to evaluate clinical outcomes with high questionnaire scores.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University, St. Louis, Missouri.
| | - Akinkunle Owoso
- Department of Psychiatry, Washington University, St. Louis, Missouri
| | - Julia M Sheffield
- Department of Psychology, Washington University, St. Louis, Missouri
| | - Chelsea Bayer
- Department of Psychiatry, Washington University, St. Louis, Missouri
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Bae M, Lee K, Baek JH, Kim JS, Cho Y, Ryu S, Ha K, Hong KS. Lifetime experiences of hypomanic symptoms are associated with delayed and irregular sleep-wake cycle and seasonality in non-clinical adult samples. Compr Psychiatry 2014; 55:1111-5. [PMID: 24666716 DOI: 10.1016/j.comppsych.2014.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Disturbances of the sleep-wake cycle and seasonality have been reported in patients with bipolar disorder (BD). Considering that BD seems to be a spectrum condition in terms of clinical and biological characteristics, circadian and seasonal rhythm related to BD could be detected in non-clinical individuals with subthreshold bipolarity. The aim of this study was to screen past hypomanic symptoms in non-clinical samples and investigate their association with deviated sleep-wake cycle and seasonality. METHODS Lifetime history of hypomanic symptoms was assessed with the Hypomania Checklist-32 (HCL-32). Circadian preference, variability of sleep-wake time and seasonal changes in mood and behavior were evaluated on a lifetime-basis in non-clinical adult samples (n=313), using the Composite Scale of Morningness (CSM), the Sleep Timing Questionnaire (STQ), and the Seasonal Pattern Assessment Questionnaire (SPAQ). RESULTS Two subdomains of hypomanic symptoms were identified through factor analysis of HCL-32, i.e., "active/elated" factor and "irritable/risk-taking" factor. The HCL-32 total score (p<0.001) and the "active/elated" factor score (p=0.028) were weakly correlated only with seasonality, whereas the "irritable/risk-taking" factor score was associated not only with seasonality (p<0.001), but also with evening preference (p<0.001) and irregularity of sleep-wake times (p=0.001~0.011). CONCLUSION Circadian and seasonal characteristics related to BD are also associated with a past history of hypomanic symptoms in non-clinical samples, especially "irritable/risk-taking" symptoms, suggesting the existence of subclinical presentation of BD and their biological traits.
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Affiliation(s)
- Moonoh Bae
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Sun Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Korea
| | - Youngah Cho
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Korea; Seoul National Hospital, Seoul, Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea; Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
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14
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Martin DJ, Smith DJ. Is there a clinical prodrome of bipolar disorder? A review of the evidence. Expert Rev Neurother 2014; 13:89-98. [DOI: 10.1586/ern.12.149] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fornaro M, De Berardis D, Iasevoli F, Pistorio ML, D'Angelo E, Mungo S, Martino M, Ventriglio A, Cattaneo CI, Favaretto E, Del Debbio A, Romano A, Ciampa G, Elassy M, Perugi G, De Pasquale C. Treatment adherence towards prescribed medications in bipolar-II acute depressed patients: relationship with cyclothymic temperament and "therapeutic sensation seeking" in response towards subjective intolerance to pain. J Affect Disord 2013; 151:596-604. [PMID: 23906864 DOI: 10.1016/j.jad.2013.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment adherence (TA) is crucial during almost any phase of bipolar disorder (BD), including type-II (BD-II) acute depression. While a number of issues have been traditionally accounted on the matter, additional factors should be likewise involved, including affective temperaments and some clinically suggestive psychopathological traits whose systematic assessment represents the aim of this study. METHODS Two hundred and twenty BD-II acute depressed outpatients were consecutively evaluated using the Structured Clinical Interviews for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition Axis-I and II Disorders, Hamilton scales for Depression and Anxiety, Temperament Evaluation of the Memphis Pisa Paris San Diego-Auto-questionnaire-110-item, Visual Analogue Scale (VAS), Zuckerman's Sensation-Seeking Scale-Form-V (SSS-V), Barratt's Impulsivity Scale-11-item, State-Trait Anxiety Inventory modules, Severity module of the Clinical Global Impression Scale for BD, Morisky 8-Item Medication Adherence Scale (MMAS-8) and the Clinician Rating Scale (CRS). Patients were divided into non-adherent vs. treatment-adherent cases depending on MMAS-8+CRS scores. RESULTS In the TA(-) group, higher VAS and cyclothymic temperament scores were highly correlated (r=.699; p≤.001). Those latter scores, along with SSS-V scores and the occurrence of lifetime addiction to painkiller and/or homeopathic medications available over the counter defined a "therapeutic sensation seeking" pattern allowing to correctly classify as much as 93.9% [Exp(B)=3.490; p≤.001] of TA(-) cases (49/220). LIMITS Lack of objective TA measures and systematic pharmacological record; recall bias on some diagnoses; and relatively small sample size. CONCLUSIONS Stating the burden of TA in BD, additional studies on this regard are aimed, ideally contributing to enhance the management of BD itself.
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Affiliation(s)
- Michele Fornaro
- Department of Educational Sciences, University of Catania, via Ofelia n.1, Zip 95125, Catania, Italy.
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, "ASL 4", Teramo, Italy.
| | - Felice Iasevoli
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
| | - Maria Luisa Pistorio
- Department of Educational Sciences, University of Catania, via Ofelia n.1, Zip 95125, Catania, Italy.
| | | | | | - Matteo Martino
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | | | | | | | - Anna Romano
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | | | - Mai Elassy
- Department of Psychiatry, Mansoura University, Egypt.
| | - Giulio Perugi
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | - Concetta De Pasquale
- Department of Educational Sciences, University of Catania, via Ofelia n.1, Zip 95125, Catania, Italy.
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16
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Sensation seeking in major depressive patients: relationship to sub-threshold bipolarity and cyclothymic temperament. J Affect Disord 2013; 148:375-83. [PMID: 23414573 DOI: 10.1016/j.jad.2013.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND High levels of sensation seeking (SS) have been traditionally reported for lifetime bipolar disorder (BD) and/or substance use disorder (SUD) rather than major depressive disorder (MDD). Nonetheless, a renewed clinical attention toward the burden of sub-threshold bipolarity in MDD, solicits for a better assessment of "unipolar" major depressive episodes (MDEs) via characterization of putative differential psychopathological patterns, including SS and predominant affective temperament. METHODS Two hundred and eighty currently depressed cases of MDD and 87 healthy controls were screened using the Zuckerman's sensation seeking scale-Form-V, the Hypomania Check List-32-item (HCL-32), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire-110-item, the Barratt Impulsivity Scale-11-item, the State-Trait Anxiety Inventory modules and the Structured Clinical Interview for DSM-IV axis-I disorders. Cases were divided into HCL-32(+)(sub-threshold bipolar)/HCL-32(-)("true" unipolar depressed) depending on the HCL-32 total score. RESULTS Upon correlation and multivariate regression analyses, the HCL-32(+) patients showed the highest levels of SS, higher prevalence of cyclothymic temperament, and higher rates of multiple lifetime axis-I co-morbidities, including SUD. LIMITS Recall bias on some diagnoses, including BD, grossly matched healthy control group, lack of ad-hoc validated measures for ADHD, SUD, or axis-II disorders. CONCLUSIONS In our sample, the occurrence of higher levels of SS in "sub-threshold" bipolar cases outlined a differential psychopathological profile compared to DSM-defined "true unipolar" cases of MDE. If confirmed by replication studies, these findings may aid clinicians in delivering a more accurate diagnosis and a safer use of antidepressants in some MDD cases.
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ANGST JULES, MEYER THOMASD, ADOLFSSON ROLF, SKEPPAR PETER, CARTA MAURO, BENAZZI FRANCO, LU RUBAND, WU YIHSUAN, YANG HAICHEN, YUAN CHENGMEI, MORSELLI PAOLO, BRIEGER PETER, KATZMANN JUDITH, TEIXEIRA LEÃO INESALICE, DEL PORTO JOSÉALBERTO, HUPFELD MORENO DORIS, MORENO RICARDOA, SOARES ODEILTONT, VIETA EDUARD, GAMMA ALEX. Hypomania: a transcultural perspective. World Psychiatry 2010; 9:41-9. [PMID: 20148160 PMCID: PMC2816932 DOI: 10.1002/j.2051-5545.2010.tb00268.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study examined the transcultural robustness of a screening instrument for hypomania, the Hypomania Checklist-32, first revised version (HCL-32 R1). It was carried out in 2606 patients from twelve countries in five geographic regions (Northern, Southern and Eastern Europe, South America and East Asia). In addition, GAMIAN Europe contributed data from its members. Exploratory and confirmatory factor analyses were used to examine the transregional stability of the measurement properties of the HCL-32 R1, including the influence of sex and age as covariates. Across cultures, a two-factor structure was confirmed: the first factor (F1) reflected the more positive aspects of hypomania (being more active, elated, self-confident, and cogni-tively enhanced); the second factor (F2) reflected the more negative aspects (being irritable, impulsive, careless, more substance use). The measurement properties of the HCL-32 R1 were largely invariant across cultures. Only few items showed transcultural differences in their relation to hypomania as measured by the test. F2 was higher among men and in more severe manic syndromes; F1 was highest in North and East Europe and lowest in South America. The scores decreased slightly with age. The frequency of the 32 items showed remarkable similarities across geographic areas, with two excep-tions: South Europeans had lower symptom frequencies in general and East Europeans higher rates of substance use. These findings support the interna-tional applicability of the HCL-32 R1 as a screening instrument for hypomania.
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Affiliation(s)
- JULES ANGST
- Psychiatric Hospital, University of Zurich,
P.O. Box 68, CH-8029 Zurich, Switzerland
| | | | - ROLF ADOLFSSON
- Department of Clinical Sciences, Division of
Psychiatry, University of Umeå, Sweden
| | - PETER SKEPPAR
- Psychiatric Clinic, Sunderby Hospital, Luleå,
Sweden
| | - MAURO CARTA
- Department of Public Health, University of
Cagliari, Italy
| | | | - RU-BAND LU
- Department of Psychiatry, National Chen Kung
University, Taiwan
| | - YI-HSUAN WU
- Department of Psychiatry, National Chen Kung
University, Taiwan
| | - HAI-CHEN YANG
- Shenzhen Mental Health Institute, Shenzhen,
and Mental Health Centre of Shanghai, China
| | - CHENG-MEI YUAN
- Shenzhen Mental Health Institute, Shenzhen,
and Mental Health Centre of Shanghai, China
| | | | - PETER BRIEGER
- Bezirkskrankenhaus Kempten/Allgäu and
Medical Faculty, University of Ulm, Germany
| | | | | | | | | | | | | | - EDUARD VIETA
- Bipolar Disorders Programme, Hospital Clinic,
University of Barcelona, Spain
| | - ALEX GAMMA
- Psychiatric Hospital, University of Zurich,
P.O. Box 68, CH-8029 Zurich, Switzerland
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