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Dallaspezia S, Cardaci V, Mazza MG, De Lorenzo R, Rovere Querini P, Colombo C, Benedetti F. Higher Seasonal Variation of Systemic Inflammation in Bipolar Disorder. Int J Mol Sci 2024; 25:4310. [PMID: 38673894 PMCID: PMC11049938 DOI: 10.3390/ijms25084310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Seasonal rhythms affect the immune system. Evidence supports the involvement of immuno-inflammatory mechanisms in bipolar disorder (BD), with the neutrophil to lymphocyte ratio (NLR), and the systemic immune-inflammatory index (SII; platelets × neutrophils/lymphocytes) consistently reported to be higher in patients with BD than in HC, but seasonal rhythms of innate and adaptive immunity have never been studied. We retrospectively studied NLR and SII in 824 participants divided into three groups: 321 consecutively admitted inpatients affected by a major depressive episode in course of BD, and 255 consecutively admitted inpatients affected by obsessive-compulsive disorder (OCD; positive psychiatric control), and 248 healthy controls (HC). Patients with BD showed markedly higher markers of systemic inflammation in autumn and winter, but not in spring and summer, in respect to both HC and patients with OCD, thus suggesting a specific effect of season on inflammatory markers in BD, independent of a shared hospital setting and drug treatment. Given that systemic inflammation is emerging as a new marker and as target for treatment in depressive disorders, we suggest that seasonal rhythms should be considered for tailoring antidepressant immuno-modulatory treatments in a precision medicine approach.
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Affiliation(s)
- Sara Dallaspezia
- Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (S.D.); (M.G.M.)
| | - Vincenzo Cardaci
- Università Vita-Salute San Raffaele, 20132 Milano, Italy; (V.C.); (P.R.Q.); (C.C.)
| | - Mario Gennaro Mazza
- Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (S.D.); (M.G.M.)
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, 20132 Milano, Italy;
| | - Patrizia Rovere Querini
- Università Vita-Salute San Raffaele, 20132 Milano, Italy; (V.C.); (P.R.Q.); (C.C.)
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, 20132 Milano, Italy;
| | - Cristina Colombo
- Università Vita-Salute San Raffaele, 20132 Milano, Italy; (V.C.); (P.R.Q.); (C.C.)
- Mood Disorders Unit, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Francesco Benedetti
- Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (S.D.); (M.G.M.)
- Università Vita-Salute San Raffaele, 20132 Milano, Italy; (V.C.); (P.R.Q.); (C.C.)
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Blanken MAJT, Oudega ML, Almeida OP, Schouws SNTM, Orhan M, Beunders AJM, Klumpers UMH, Sonnenberg C, Blumberg HP, Eyler LT, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Rajji T, Rej S, Sarna K, Sutherland A, Yala J, Vieta E, Tsai S, Briggs FBS, Sajatovic M, Dols A. Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project. Am J Geriatr Psychiatry 2024; 32:326-338. [PMID: 37981507 DOI: 10.1016/j.jagp.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Sex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. METHODS This Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. RESULTS Regarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. CONCLUSION Our findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.
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Affiliation(s)
- Machteld A J T Blanken
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Mardien L Oudega
- Department of Psychiatry (MLO), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam Public Health, Mental Health Program, GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Osvaldo P Almeida
- Medical School (OPA), University of Western Australia, Perth, Australia
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Melis Orhan
- Department of Clinical Psychology (MO), Leiden University, Leiden, The Netherlands
| | - Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Ursula M H Klumpers
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Caroline Sonnenberg
- GGZ Parnassia NH, Specialized Mental Health Care (CS), Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry (HPB), Yale School of Medicine, New Haven, CT
| | - Lisa T Eyler
- Department of Psychiatry (LTE), University of California San Diego, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA
| | - Brent P Forester
- Division of Geriatric Psychiatry (BPF), McLean Hospital, Harvard Medical School, Boston, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry (OVF), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry (AG), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benoit H Mulsant
- Department of Psychiatry (BHM) and Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division (TR), Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine (KS), Cleveland, OH
| | - Ashley Sutherland
- Department of Psychiatry (AS), University of California San Diego, San Diego, CA
| | - Joy Yala
- Case Western Reserve University School of Medicine (JY), Cleveland, OH
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit (EV), Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Shangying Tsai
- Department of Psychiatry (ST), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Farren B S Briggs
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Annemiek Dols
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands; Department of Psychiatry (AD), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Vieta E, Ghorpade S, Biswas A, Sarkar A, Phansalkar A, Cooper J. Lamotrigine efficacy, safety, and tolerability for women of childbearing age with bipolar I disorder: Meta-analysis from four randomized, placebo-controlled maintenance studies. Eur Neuropsychopharmacol 2024; 78:81-92. [PMID: 37775363 DOI: 10.1016/j.euroneuro.2023.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
This meta-analysis investigated the efficacy, safety, and tolerability of lamotrigine versus placebo in preventing relapse and recurrence of mood episodes in women of childbearing age with bipolar I disorder. Following up to 16 weeks' open-label lamotrigine treatment, responders were randomized to double-blind treatment, including lamotrigine 100-400 mg/day or placebo, in four trials of up to 76 weeks. Women aged 18-45 years who received ≥ 1 dose of study treatment and had ≥ 1 efficacy assessment in the double-blind phase were pooled for efficacy analysis. The primary outcome was median time to intervention for any mood episode (TIME). Of 717 eligible women in the open-label phase, 287 responded and were randomized to lamotrigine (n = 153) or placebo (n = 134). The randomized group had a mean (SD) of 2.0(2.02) manic and 2.5(2.02) depressive episodes in the 3 years before screening. Median TIME was 323 days with lamotrigine and 127 days with placebo (HR 0.69; 95% CI 0.49, 0.96; p = 0.030). Lamotrigine delayed time to intervention for any depressive episode (HR 0.59; 95% CI 0.39, 0.90; p = 0.014) with no treatment difference for manic episodes (HR 0.91; 95% CI 0.52, 1.58; p = 0.732). 2/717 (< 1%) participants experienced serious rash-related adverse events (AEs) during the open-label phase, and 52/717 (7%) had non-serious rash-related events leading to study withdrawal. Incidence of AEs and AEs leading to withdrawal were similar between lamotrigine and placebo groups. Lamotrigine delayed relapse and recurrence of mood episodes, largely by preventing depressive episodes, and was well tolerated in women of childbearing age.
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Affiliation(s)
- Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Berardelli I, Aguglia A, Amerio A, Sarubbi S, Rogante E, Trocchia MA, Zelletta D, Longhini L, Erbuto D, Pastorino F, Lamis DA, Innamorati M, Serafini G, Pompili M. Characterization of Psychiatric Inpatients: The Role of Gender Differences in Clinical and Pharmacological Patterns. J Psychiatr Pract 2024; 30:2-12. [PMID: 38227722 DOI: 10.1097/pra.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Severe mental disorders that require hospitalization are disabling conditions that contribute to the burden of mental diseases. They pose increased clinical challenges and highlight the need to thoroughly explore variables emerging from daily clinical practice. In this study, we assessed to what extent gender differences may characterize a large population of psychiatric inpatients. METHODS We conducted a cross-sectional study in 2 Italian teaching medical centers, which included 2358 patients who were consecutively admitted to the psychiatric emergency units. We explored and characterized gender differences for variables such as prevalence of psychiatric diagnosis, presence of suicidal ideation, suicide attempts, age at onset of psychiatric illness, presence of substance or alcohol abuse, length of stay, number of hospitalizations, presence of involuntary admission, type of discharge from the hospital, and pharmacological treatment at discharge. RESULTS Female patients were primarily diagnosed with bipolar disorder or personality disorders. Female patients had a significantly higher prevalence of lifetime suicide attempts (23.1% vs. 16.5%, P<0.001) and a longer length of hospitalization (11.43±10.73 d vs. 10.52±10.37 d, t=-2.099, gl=2356, P=0.036) compared with male patients. Male patients had more involuntary admissions (25.1% vs. 19.7%, χ2=9.616, gl=1, P=0.002), more use of illicit substances (34.1% vs. 20.9%, χ2=51.084, gl=1, P<0.001), and higher rates of alcohol abuse (21.3% vs. 14.7%, χ2=17.182, gl=1, P<0.001) compared with female patients. Finally, antidepressants and lithium were prescribed more frequently to the female patients, whereas other mood stabilizers were more often prescribed to the male patients. CONCLUSIONS Our real-world results highlighted gender differences among patients with severe mental disorders admitted to psychiatric units, and suggest further investigations that may help in understanding trajectories accompanying disabling clinical conditions.
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Yang R, Zhao Y, Tan Z, Lai J, Chen J, Zhang X, Sun J, Chen L, Lu K, Cao L, Liu X. Differentiation between bipolar disorder and major depressive disorder in adolescents: from clinical to biological biomarkers. Front Hum Neurosci 2023; 17:1192544. [PMID: 37780961 PMCID: PMC10540438 DOI: 10.3389/fnhum.2023.1192544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Mood disorders are very common among adolescents and include mainly bipolar disorder (BD) and major depressive disorder (MDD), with overlapping depressive symptoms that pose a significant challenge to realizing a rapid and accurate differential diagnosis in clinical practice. Misdiagnosis of BD as MDD can lead to inappropriate treatment and detrimental outcomes, including a poorer ultimate clinical and functional prognosis and even an increased risk of suicide. Therefore, it is of great significance for clinical management to identify clinical symptoms or features and biological markers that can accurately distinguish BD from MDD. With the aid of bibliometric analysis, we explore, visualize, and conclude the important directions of differential diagnostic studies of BD and MDD in adolescents. Materials and methods A literature search was performed for studies on differential diagnostic studies of BD and MDD among adolescents in the Web of Science Core Collection database. All studies considered for this article were published between 2004 and 2023. Bibliometric analysis and visualization were performed using the VOSviewer and CiteSpace software. Results In total, 148 publications were retrieved. The number of publications on differential diagnostic studies of BD and MDD among adolescents has been generally increasing since 2012, with the United States being an emerging hub with a growing influence in the field. Boris Birmaher is the top author in terms of the number of publications, and the Journal of Affective Disorders is the most published journal in the field. Co-occurrence analysis of keywords showed that clinical characteristics, genetic factors, and neuroimaging are current research hotspots. Ultimately, we comprehensively sorted out the current state of research in this area and proposed possible research directions in future. Conclusion This is the first-ever study of bibliometric and visual analyses of differential diagnostic studies of BD and MDD in adolescents to reveal the current research status and important directions in the field. Our research and analysis results might provide some practical sources for academic scholars and clinical practice.
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Affiliation(s)
- Ruilan Yang
- CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yanmeng Zhao
- Southern Medical University, Guangzhou, Guangdong, China
| | - Zewen Tan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Juan Lai
- CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kangrong Lu
- School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xuemei Liu
- CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
- University of Chinese Academy of Sciences, Beijing, China
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Miola A, Fountoulakis KN, Baldessarini RJ, Veldic M, Solmi M, Rasgon N, Ozerdem A, Perugi G, Frye MA, Preti A. Prevalence and outcomes of rapid cycling bipolar disorder: Mixed method systematic meta-review. J Psychiatr Res 2023; 164:404-415. [PMID: 37429185 DOI: 10.1016/j.jpsychires.2023.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
Rapid-cycling in bipolar disorder (RC-BD) is associated with greater illness morbidity and inferior treatment response but many aspects remain unclear, prompting this systematic review of its definitions, prevalence, and clinical characteristics. We searched multiple literature databases through April 2022 for systematic reviews or meta-analyses on RC-BD and extracted associated definitions, prevalence, risk-factors, and clinical outcomes. We assessed study quality (NIH Quality Assessment Tool) and levels of evidence (Oxford criteria). Of 146 identified reviews, 22 fulfilling selection criteria were included, yielding 30 studies involving 13,698 BD patients, of whom 3777 (27.6% [CI: 26.8-28.3]) were considered RC-BD, as defined in 14 reports by ≥4 recurrences/year within the past 12 months or in any year, without considering responsiveness to treatment. Random-effects meta-analytically pooled one-year prevalence was 22.3% [CI: 14.4-32.9] in 12 reports and lifetime prevalence was 35.5% [27.6-44.3] in 18 heterogenous reports. Meta-regression indicated greater lifetime prevalence of RC-BD among women than men (p=0.003). Association of RC-BD with suicide attempts, and unsatisfactory response to mood-stabilizers was supported by strong evidence (Level 1); associations with childhood maltreatment, mixed-features, female sex, and type-II BD had moderate evidence (Level 2). Other factors: genetic predisposition, metabolic disturbances or hypothyroidism, antidepressant exposure, predominant depressive polarity (Level 3), along with greater illness duration and immune-inflammatory dysfunction (Level 4) require further study. RC-BD was consistently recognized as having high prevalence (22.3%-35.5% of BD cases) and inferior treatment response. Identified associated factors can inform clinical practice. Long-term illness-course, metabolic factors, and optimal treatment require further investigation.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience, University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA.
| | - Konstantinos N Fountoulakis
- Department of Psychiatry III, School of Medicine Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Natalie Rasgon
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Giulio Perugi
- Psychiatry Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Antonio Preti
- Department of Neuroscience, University of Turin, via Cherasco 15, 10126, Turin, Italy; Eating Disorders Center, Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
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Apicella M, Serra G, Iannoni ME, Trasolini M, Maglio G, Andracchio E, Vicari S. Gender Differences in the Psychopathology of Mixed Depression in Adolescents with a Major Depressive Episode. Curr Neuropharmacol 2023; 21:1343-1354. [PMID: 36237159 PMCID: PMC10324339 DOI: 10.2174/1570159x20666221012113458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Gender differences have been reported in the severity and psychopathological features of major depressive disorders among adults but are poorly reported in adolescent samples. OBJECTIVE This study aimed to examine gender differences in the psychopathology of mixed depression among adolescents. METHODS We analyzed 341 outpatients with the current major depressive episode (MDE) retrospectively to identify patients with DSM-5 MDE with mixed features. We compared examiner-rated depressive and (hypo)manic symptoms and self- and parent-reported symptoms between sexes. RESULTS We identified 76 patients with an MDE with mixed features (67.1% females, 32.9% with bipolar disorder). Depression severity was significantly greater in females versus males (CDRS-R total score 56.2 vs. 48.2, p = 0.014). Depressive symptoms were significantly and independently found to be more severe among females in a logistic regression model, including excessive fatigue (OR 1.68; p = 0.025), low self-esteem (OR 1.67; p = 0.04), excessive weeping (OR 1.62; p = 0.021), and CBCL AAA index (OR 1.04; p = 0.015). None of the depressive symptoms scored greater in males. Males had higher levels of motor activity (2.12 vs. 1.69; p = 0.048) and pressured speech (1.80 vs. 1.24; p = 0.004). Self-rated anxiety (69.3 vs. 56.8, p = 0.047) and CBCL AAA index (207 vs. 189; p = 0.007) were higher in females. CONCLUSION Adolescent depression with mixed features is more severe in women, with a higher expression of core affective symptoms and excessive fatigue. While in males, slightly higher levels of psychomotor activation are reported, in females, emotional dysregulation and excessive weeping may subtend a difference in a broader spectrum of mixed features.
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Affiliation(s)
- Massimo Apicella
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Serra
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Elena Iannoni
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Monia Trasolini
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gino Maglio
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elisa Andracchio
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Department of Neuroscience, Child Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
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8
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Millan DM, Clark CT, Sakowicz A, Grobman WA, Miller ES. Optimization of the Mood Disorder Questionnaire in identification of perinatal bipolar disorder. Am J Obstet Gynecol MFM 2023; 5:100777. [PMID: 36280148 DOI: 10.1016/j.ajogmf.2022.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The recognition of bipolar disorder during the perinatal period is often challenging because birthing people most commonly present in a depressive episode. The phenotypic expression of episodes of bipolar depression is difficult to differentiate from major depressive disorder and can lead to misdiagnosis and inappropriate treatment. The Mood Disorder Questionnaire is a readily available screening tool for bipolar disorder that has been validated in previous studies for use in the general and perinatal populations. However, the discriminatory capacity of the Mood Disorder Questionnaire for perinatal people who screen positive for depression in nonpsychiatric settings is still unclear. OBJECTIVE This study aimed to evaluate the discriminatory capacity of the Mood Disorder Questionnaire to identify bipolar disorder in perinatal people who screen positive for depression on the Patient Health Questionnaire-9. STUDY DESIGN This retrospective cohort study included individuals enrolled in the Collaborative Care Model for Perinatal Depression Support Services, a collaborative care program for perinatal mental health services implemented in a quaternary care setting, from January 2017 to April 2021. All individuals completed the Mood Disorder Questionnaire and psychiatric evaluation by a licensed clinical social worker. Clinical and sociodemographic characteristics were compared between those with and without a clinical diagnosis of bipolar disorder using bivariable analyses. The discriminatory capacity and test characteristics of the Mood Disorder Questionnaire were assessed at each score cutoff using the gold standard of a psychiatric clinical evaluation for comparison. RESULTS From January 2017 to April 2021, 1510 birthing people were enrolled in the Collaborative Care Model for Perinatal Depression Support Services and included in this study. Among this group, 62 (4.1%) were diagnosed with bipolar disorder by psychiatric clinical evaluation using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. A score of ≥7 on question 1 is often used in the general population to identify bipolar disorder, which has a 60% sensitivity and 88% specificity in our perinatal sample with an area under the receiver operating characteristic curve of 0.74 (95% confidence interval, 0.72-0.76). Lowering the threshold to ≥4 improves sensitivity to 81% and the discriminatory capacity to an area under the receiver operating characteristic curve of 0.75 (95% confidence interval, 0.70-0.80), at the expense of a reduction in specificity to 69%. CONCLUSION The administration of the Mood Disorder Questionnaire in the perinatal period can help to identify which individuals who have screened positive for depression on the Patient Health Questionnaire-9 are at risk of a bipolar or unipolar disorder. In this context, lowering the Mood Disorder Questionnaire score threshold from that used in the nonperinatal population down to 4 improves test characteristics and reduces the risk of a missed diagnosis of bipolar disorder.
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Affiliation(s)
- Danielle M Millan
- The Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Millan and Drs Clark and Miller).
| | - Crystal T Clark
- The Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Millan and Drs Clark and Miller); Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clark and Miller)
| | - Allie Sakowicz
- Wake Forest University School of Medicine, Winston-Salem, NC (Dr Sakowicz)
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH (Dr Grobman)
| | - Emily S Miller
- The Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Millan and Drs Clark and Miller); Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clark and Miller); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Miller)
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9
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Salagre E, Rohde C, Vieta E, Østergaard SD. Electroconvulsive therapy following incident bipolar disorder: When, how, and for whom? Bipolar Disord 2022; 24:817-825. [PMID: 36064283 PMCID: PMC10087321 DOI: 10.1111/bdi.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The use of electroconvulsive therapy (ECT) in the treatment of bipolar disorder (BD) remains poorly described. Based on data from Danish registries with complete nationwide coverage, this study of patients with incident BD aimed to describe when, how, and for whom ECT is used in the context of BD. METHODS We identified patients receiving their first diagnosis of BD in the period from 2008 to 2018, who subsequently received ECT. Descriptive statistics were used to clarify when, how, and for whom ECT is used. RESULTS We identified 1338 patients with incident BD who subsequently received ECT. The median age at the first ECT session was 50.6 years (interquartile range [IQR]: 26.4), and 62% of those treated with ECT were female. The median time from the diagnosis of BD to the first ECT treatment was 0.6 years (IQR: 2.6), and 58% of the patients receiving ECT had the first treatment within the first year after being diagnosed with BD. The most common indication for the first ECT treatment was depression (mainly non-psychotic depression), followed by mania (mainly psychotic mania). The first ECT session was typically provided to inpatients (97%), upon patient consent (98%) and with bilateral electrode placement (60%). CONCLUSIONS A substantial proportion of the patients with incident BD who receive ECT require this treatment within the first year after the diagnosis. The most common indication for ECT is depression followed by (psychotic) mania. Inpatient voluntary ECT using bilateral electrode placement is the most common form of administration.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Søren D Østergaard
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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10
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Burdick KE, Millett CE, Yocum AK, Altimus CM, Andreassen OA, Aubin V, Belzeaux R, Berk M, Biernacka JM, Blumberg HP, Cleare AJ, Diaz-Byrd C, Dubertret C, Etain B, Eyler LT, Forester BP, Fullerton JM, Frye MA, Gard S, Godin O, Haffen E, Klaus F, Lagerberg TV, Leboyer M, Martinez-Aran A, McElroy S, Mitchell PB, Olie E, Olorunfemi P, Passerieux C, Peters AT, Pham DL, Polosan M, Potter JR, Sajatovic M, Samalin L, Schwan R, Shanahan M, Solé B, Strawbridge R, Stuart AL, Torres I, Ueland T, Vieta E, Williams LJ, Wrobel AL, Yatham LN, Young AH, Nierenberg AA, McInnis MG. Predictors of functional impairment in bipolar disorder: Results from 13 cohorts from seven countries by the global bipolar cohort collaborative. Bipolar Disord 2022; 24:709-719. [PMID: 35322518 PMCID: PMC9500115 DOI: 10.1111/bdi.13208] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/25/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Persistent functional impairment is common in bipolar disorder (BD) and is influenced by a number of demographic, clinical, and cognitive features. The goal of this project was to estimate and compare the influence of key factors on community function in multiple cohorts of well-characterized samples of individuals with BD. METHODS Thirteen cohorts from 7 countries included n = 5882 individuals with BD across multiple sites. The statistical approach consisted of a systematic uniform application of analyses across sites. Each site performed a logistic regression analysis with empirically derived "higher versus lower function" as the dependent variable and selected clinical and demographic variables as predictors. RESULTS We found high rates of functional impairment, ranging from 41 to 75%. Lower community functioning was associated with depressive symptoms in 10 of 12 of the cohorts that included this variable in the analysis. Lower levels of education, a greater number of prior mood episodes, the presence of a comorbid substance use disorder, and a greater total number of psychotropic medications were also associated with low functioning. CONCLUSIONS The bipolar clinical research community is poised to work together to characterize the multi-dimensional contributors to impairment and address the barriers that impede patients' complete recovery. We must also identify the core features which enable many to thrive and live successfully with BD. A large-scale, worldwide, prospective longitudinal study focused squarely on BD and its heterogeneous presentations will serve as a platform for discovery and promote major advances toward optimizing outcomes for every individual with this illness.
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Affiliation(s)
- Katherine E Burdick
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Cara M Altimus
- The Milken Institute, Washington, District of Columbia, USA
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Valerie Aubin
- Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Raoul Belzeaux
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Joanna M Biernacka
- Mayo Clinic Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Department of Quantitative Health Sciences, Mayo Clinic, Rocester, MN, USA
| | | | - Anthony J Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Caroline Dubertret
- Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Bruno Etain
- Université de Paris, AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS, Paris, France
| | - Lisa T Eyler
- University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark A Frye
- Mayo Clinic Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sébastien Gard
- Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Ophelia Godin
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Créteil, France
- APHP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Emmanuel Haffen
- Clinical Psychiatry Department, Treatment-Resistant Depression Fondamental Expert Center, EA 481 Neurosciences, Bourgogne Franche Comté University, Besançon, France
| | - Federica Klaus
- University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marion Leboyer
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Créteil, France
- APHP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Susan McElroy
- SLM Lindner Center of HOPE, Mason, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Philip B Mitchell
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Emilie Olie
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Phebe Olorunfemi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Passerieux
- Service Hospitalo-Universitaire de psychiatrie d'adulte et d'addictologie, Centre Hospitalier de Versailles, INSERM UMR1018, DisAP-DevPsy-CESP, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Amy T Peters
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L Pham
- The Milken Institute, Washington, District of Columbia, USA
| | - Mircea Polosan
- Univ. Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France
| | - Julia R Potter
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha Sajatovic
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ludovic Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), Clermont-Ferrand, France
| | - Raymund Schwan
- Université de Lorraine, Inserm U 1114, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie CPN, Laxou, France
| | - Megan Shanahan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Amanda L Stuart
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ivan Torres
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Torrill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Lana J Williams
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Aragno E, Fagiolini A, Cuomo A, Paschetta E, Maina G, Rosso G. Impact of menstrual cycle events on bipolar disorder course: a narrative review of current evidence. Arch Womens Ment Health 2022; 25:257-266. [PMID: 35237876 DOI: 10.1007/s00737-022-01217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
Abstract
Several lines of research suggest that reproductive-related hormonal events may affect the course of bipolar disorder in some women. However, data on associations between bipolar disorder and menarche, menstrual cycle, and menopause are mixed. This article reviews the literature on the potential effects of menarche, menstrual cycle, and menopause on bipolar disorder.A narrative review of published articles on bipolar disorder and menstrual cycle events was conducted. The primary outcome assessed was the impact of menarche, menstrual cycle and menopause on the course of bipolar illness. Databases searched were PubMed, Ovid, Scopus, PsycINFO, Medline, and Cochrane Libraries from inception to August 2021.Twenty-two studies were identified and included in the narrative synthesis. Research suggested that a subset of women with bipolar disorder are vulnerable to the impact of menstrual cycle events. Menarche seems to be associated with age at onset of bipolar illness especially in case of bipolar disorder type I and the specific age at menarche may predict some clinical features of the disorder. Menstrual cycle likely affects the course of bipolar disorder but the pattern of mood variability is not clear. Menopause appears to be not only a period of vulnerability to mood alteration, especially depressive episodes, and impairment of quality of life, but also a potential trigger of bipolar illness onset.The impact of menarche, menstrual cycle, and menopause on bipolar disorder is largely understudied. Preliminary evidence suggests that a subset of women with bipolar disorder may have their mood shifts affected by menstrual cycle events, with different patterns depending on the type of bipolar disorder also. Further researches are needed to deep the impact of menarche, menstrual cycle, and menopause on bipolar illness.
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Affiliation(s)
- Elena Aragno
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | | | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Gianluca Rosso
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy. .,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy.
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12
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Della Vecchia S, Marchese M, Santorelli FM, Sicca F. Kir4.1 Dysfunction in the Pathophysiology of Depression: A Systematic Review. Cells 2021; 10:2628. [PMID: 34685608 PMCID: PMC8534194 DOI: 10.3390/cells10102628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
A serotonergic dysfunction has been largely postulated as the main cause of depression, mainly due to its effective response to drugs that increase the serotonergic tone, still currently the first therapeutic line in this mood disorder. However, other dysfunctional pathomechanisms are likely involved in the disorder, and this may in part explain why some individuals with depression are resistant to serotonergic therapies. Among these, emerging evidence suggests a role for the astrocytic inward rectifier potassium channel 4.1 (Kir4.1) as an important modulator of neuronal excitability and glutamate metabolism. To discuss the relationship between Kir4.1 dysfunction and depression, a systematic review was performed according to the PRISMA statement. Searches were conducted across PubMed, Scopus, and Web of Science by two independent reviewers. Twelve studies met the inclusion criteria, analyzing Kir4.1 relationships with depression, through in vitro, in vivo, and post-mortem investigations. Increasing, yet not conclusive, evidence suggests a potential pathogenic role for Kir4.1 upregulation in depression. However, the actual contribution in the diverse subtypes of the disorder and in the comorbid conditions, for example, the epilepsy-depression comorbidity, remain elusive. Further studies are needed to better define the clinical phenotype associated with Kir4.1 dysfunction in humans and the molecular mechanisms by which it contributes to depression and implications for future treatments.
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Affiliation(s)
- Stefania Della Vecchia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy;
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Maria Marchese
- Department of Molecular Medicine, IRCCS Stella Maris Foundation, Via dei Giacinti 2, 56128 Pisa, Italy;
| | - Filippo Maria Santorelli
- Department of Molecular Medicine, IRCCS Stella Maris Foundation, Via dei Giacinti 2, 56128 Pisa, Italy;
| | - Federico Sicca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy;
- Child Neuropsychiatric Unit, USL Centro Toscana, 59100 Prato, Italy
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13
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Kozak K, Smith PH, Lowe DJ, Weinberger AH, Cooper ZD, Rabin RA, George TP. A systematic review and meta-analysis of sex differences in cannabis use disorder amongst people with comorbid mental illness. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:535-547. [PMID: 34280058 PMCID: PMC9144491 DOI: 10.1080/00952990.2021.1946071] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND While males are more likely diagnosed with cannabis use disorder (CUD), females are more susceptible to developing and maintaining CUD. Yet, for both sexes, CUD is associated with high rates of comorbid mental illness (MI). OBJECTIVES To identify and compare sex differences in the prevalence of comorbid CUD amongst individuals with/without MIs. METHODS This systematic review generated pooled odds ratios (OR) and 95% confidence intervals (CI) from 37 studies (including clinical trials, cohort, and case-control studies) among individuals with and without MIs, quantifying sex differences in rates of comorbid CUD. A meta-analysis was also completed. RESULTS In the CUD-only group, males were twice as likely to have CUD than females (OR = 2.0, CI = 1.9-2.1). Among MIs, males were more likely than females to have CUD comorbid with schizophrenia (OR ~2.6, CI = 2.5-2.7) and other psychotic, mood, and substance use disorders (1> OR <2.2, CI = 0.7-2.6). The reverse association (females > males) was observed for anxiety disorders and antisocial personality disorder (OR = 0.8, CI = 0.7-1.0). Among females, MIs increased the likelihood of having CUD, except for psychotic disorders and depression. A meta-analysis was inconclusive due to high heterogeneity across studies. Thus, comparisons across MI groups were not possible. CONCLUSION While males are more likely to be diagnosed with CUD, there are important sex differences in the prevalence of CUD across MI diagnoses that should be taken into account when approaching CUD prevention and determining treatment efficacy.
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Affiliation(s)
- Karolina Kozak
- Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Philip H. Smith
- Department of Kinesiology and Health, Miami University, Oxford, Ohio, USA
| | - Darby J.E Lowe
- Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ziva D Cooper
- Department of Psychiatry and Biobehavioral Science, University of California, Los Angeles (UCLA), Los Angeles, California, USA
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Rachel A. Rabin
- Department of Psychiatry, McGill University and the Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - Tony P. George
- Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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The Prevalence of Cannabis Use Disorder Comorbidity in Individuals With Bipolar Disorder: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Fusar-Poli L, Amerio A, Cimpoesu P, Grimaldi Filioli P, Natale A, Zappa G, Aguglia E, Amore M, Serafini G, Aguglia A. Gender Differences in Complete Blood Count and Inflammatory Ratios among Patients with Bipolar Disorder. Brain Sci 2021; 11:brainsci11030363. [PMID: 33809378 PMCID: PMC8000131 DOI: 10.3390/brainsci11030363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Evidence suggested that inflammation may be involved in the etiopathogenesis of bipolar disorder (BD), a chronic psychiatric condition affecting around 2–3% of the general population. However, little is known regarding potential gender differences in peripheral biomarkers of BD, such as neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios. Methods: In total, 197 females and 174 males with BD in different phases (i.e., (hypo)mania, depression, euthymia) were recruited. A blood sample was drawn to perform a complete blood count (CBC). NLR, PLR, and MLR were subsequently calculated, and differences were computed according to the illness phase and gender. Results: PLR was consistently higher in (hypo)manic than depressed patients, in both males and females. No significant gender differences in PLR value were found when considering only (hypo)mania. Conversely, NLR was increased in (hypo)mania only among males, and gender differences were retrieved in the (hypo)manic subgroup. The findings related to MLR were only marginally significant. Higher platelets values were associated with (hypo)mania only in the female group. Basophils and eosinophils appeared gender- but not state-dependent. Conclusions: Our findings provide further evidence that increased PLR levels may be associated with (hypo)mania in bipolar patients, regardless of gender. Moreover, the usefulness of NLR as a peripheral biomarker of BD appeared limited to males while the role of platelets to females. As CBC represents a low-cost and easily accessible test, researchers should investigate in-depth its potential usefulness as a biomarker of BD and other psychiatric disorders.
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Affiliation(s)
- Laura Fusar-Poli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (L.F.-P.); (A.N.); (E.A.)
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02110, USA
| | - Patriciu Cimpoesu
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Pietro Grimaldi Filioli
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Antimo Natale
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (L.F.-P.); (A.N.); (E.A.)
| | - Guendalina Zappa
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (L.F.-P.); (A.N.); (E.A.)
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (P.C.); (P.G.F.); (G.Z.); (M.A.); (G.S.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence:
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Jiang X, Wu F, Zhang Y, Li H, Kang J, Kong L, Wang F, Tang Y. Gender differences of amplitude of low-frequency fluctuations in bipolar disorder: A resting state fMRI study. J Affect Disord 2021; 280:189-196. [PMID: 33217701 DOI: 10.1016/j.jad.2020.11.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/27/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The clinical and epidemiological features of bipolar disorder (BD) between females and males have many differences. The association between brain function and gender in BD is unknown. This research aimed to investigate the association between brain function and gender in BD by using amplitude of low-frequency fluctuations (ALFFs). METHODS Ninety-eight patients (49 females and 49 males) with BD and 171 matched healthy controls (HCs, 89 females and 82 males) were recruited for resting-state functional magnetic resonance imaging. ALFF was used to estimate brain function. RESULTS A main effect of diagnosis in ALFF was observed in the dorsal lateral prefrontal cortex (DLPFC), ventral prefrontal cortex (VPFC), caudate and occipital lobe. A main effect of gender in ALFF was found in the right VPFC, DLPFC, thalamus, and occipital lobe. A main effect of diagnosis gender interaction in ALFF was observed in the left DLPFC. Analyses of two-sample t-test indicated that male patients with BD had increased ALFF in the right hippocampus, right amygdala, left caudate, and left DLPFC, and decreased ALFF in the occipital lobe compared with male HC. Female patients with BD demonstrated increased ALFF in the right VPFC and right DLPFC compared with female HC. Male patients with BD exhibited increased ALFF in the right VPFC and left DLPFC and decreased ALFF in the occipital lobe compared with female patients with BD. LIMITATIONS This study did not consider the effect of medications and emotional states on brain activity. CONCLUSIONS Results suggested gender differences in the dysfunctions of the cortico-limbic neural system in BD.
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Affiliation(s)
- Xuejun Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Department of Gerontology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Feng Wu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yifan Zhang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Huizi Li
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiahui Kang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Department of Gerontology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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17
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Dell'Osso B, Cafaro R, Ketter TA. Has Bipolar Disorder become a predominantly female gender related condition? Analysis of recently published large sample studies. Int J Bipolar Disord 2021; 9:3. [PMID: 33392912 PMCID: PMC7779377 DOI: 10.1186/s40345-020-00207-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023] Open
Abstract
Bipolar Disorders (BD) are disabling and severe psychiatric disorders, commonly perceived as equally affecting both men and women. The prevalence of BD in the general population has been growing over the last decade, however, few epidemiological studies are available regarding BD gender distribution, leaving unanswered the question whether the often reported increment of BD diagnosis could be gender specific. In fact, BD in female patients can often be misdiagnosed as MDD, leaving such women non correctly treated for longer times than their male counterparts. From this perspective, we searched literature for large sample (> 1000 subjects) studies published in the last decade (2010 onward) on BD patients. We included ten large sample studies that reported the gender distribution of their samples, and we therefore analysed them. Our results show a higher preponderance of female patients in every sample and sub-sample of BDI and BDII, supporting our hypothesis of an increase in BD diagnosis in females. BD in women presents with higher rates of rapid cycling, depressive polarity and suicide attempts, characteristics of non inferior severity compared to males; prompt recognition and adequate treatment of BD is therefore crucial to reduce risks and improve quality of life of affected women. In this regard, our results could lead the way for national or international epidemiological studies with the aim of more accurately assessing gender-specific prevalence of BD.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Mental Health, University of Milan, ASST Fatebenefratelli-Sacco, Milano, Italy. .,CRC Aldo Ravelli, Milano, Italy. .,Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA.
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Mental Health, University of Milan, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Terence A Ketter
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
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18
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Grunze H, Schaefer M, Scherk H, Born C, Preuss UW. Comorbid Bipolar and Alcohol Use Disorder-A Therapeutic Challenge. Front Psychiatry 2021; 12:660432. [PMID: 33833701 PMCID: PMC8021702 DOI: 10.3389/fpsyt.2021.660432] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40-70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.
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Affiliation(s)
- Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
- *Correspondence: Heinz Grunze
| | - Martin Schaefer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik, und Suchtmedizin, Evang. Kliniken Essen-Mitte, Essen, Germany
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christoph Born
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ulrich W. Preuss
- Vitos Klinik Psychiatrie und Psychotherapie, Herborn, Germany
- Klinik für Psychiatrie, Psychotherapie, und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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19
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Dallaspezia S, Benedetti F. Antidepressant light therapy for bipolar patients: A meta-analyses. J Affect Disord 2020; 274:943-948. [PMID: 32664036 DOI: 10.1016/j.jad.2020.05.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/21/2020] [Accepted: 05/16/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUNDS Bipolar depression is still a very difficult to treat condition with low success rates of antidepressant drugs, high rates of morbidity and suicide risk and antidepressant-emergent mania risk. Despite a growing body of evidence has been generated over the last decade about Light Therapy (LT) as an effective treatment for depression the management of it continues to be a point of debate for Bipolar Disorder especially when considering non-seasonal pattern. METHODS We systematically screened current literature using the PubMed electronic platform. We considered "mood disorder", "depression" and "light therapy" as keywords for the search. RESULTS We retrieved 1907 papers. After the screening, we selected 11 papers to be included in the analysis, treating 195 patients affected by bipolar depression. 5 studies were RCT studies. The overall analysis, including non-RCTs, showed a positive effect of the treatment in all the included studies (ESs: -1.46, 95% CI:-1.677 to -1.242; p<0.001). A significant effect of LT compared to placebo was found also in RCTs (ESs: -0.501, 95% CI: - 0.777 to -0.225; p<0.001). LIMITATIONS A high heterogeneity between the studies was found when including non-RCTs and the number of RCTs was small CONCLUSION: We confirmed the -efficacy of LT as antidepressant non-pharmacological therapy also in bipolar depression.
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Affiliation(s)
- Sara Dallaspezia
- Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan.
| | - Francesco Benedetti
- Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan
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20
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The prevalence of anxiety and its association with the quality of life and illness severity among bipolar affective disorder patients in a developing country. Asian J Psychiatr 2020; 52:102044. [PMID: 32344280 DOI: 10.1016/j.ajp.2020.102044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
The objective of the study was to determine the prevalence of anxiety symptoms and describe the association with illness severity, quality of life (QOL) and current medications among patients with BPAD who are currently in remission. A descriptive cross-sectional study conducted among outpatient clinic patients at the University Professorial Unit of University of Ruhuna, Sri Lanka. The study population consisted of patients diagnosed with BPAD and who are currently in remission. Anxiety symptoms among BPAD patients were assessed using the DASS-21 anxiety subscale and QOL was assessed using WHOQoL-BREF. Medications and severity of illness related information were gathered from both the patent and from their medical records. The study population consisted of 145 patients. The prevalence of anxiety among patients with BPAD who are currently in remission was 48.3 % (95 %CI 40.0-56.6). Multiple logistic regression revealed that being anxious was independently associated with currently not being married (aOR 2.92) and currently not being employed (aOR 2.1). Presence of anxiety significantly reduced the QOL in all the domains. Having anxiety was significantly associated with having one or more relapses within the past three years (aOR 4.1), one or more hospital admissions within the past three years (aOR 6.1), needing more psychoactive medications to maintain a euthymic state (aOR 7.7), and one or more suicidal attempts in the past (aOR 6.5). Anxiety was highly prevalent among patients with BPAD. Those with anxiety experienced significantly lower QOL and were found to be having significantly high adverse outcomes from the disease.
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21
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Manchia M, Vieta E, Smeland OB, Altimus C, Bechdolf A, Bellivier F, Bergink V, Fagiolini A, Geddes JR, Hajek T, Henry C, Kupka R, Lagerberg TV, Licht RW, Martinez-Cengotitabengoa M, Morken G, Nielsen RE, Pinto AG, Reif A, Rietschel M, Ritter P, Schulze TG, Scott J, Severus E, Yildiz A, Kessing LV, Bauer M, Goodwin GM, Andreassen OA. Translating big data to better treatment in bipolar disorder - a manifesto for coordinated action. Eur Neuropsychopharmacol 2020; 36:121-136. [PMID: 32536571 DOI: 10.1016/j.euroneuro.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is a major healthcare and socio-economic challenge. Despite its substantial burden on society, the research activity in BD is much smaller than its economic impact appears to demand. There is a consensus that the accurate identification of the underlying pathophysiology for BD is fundamental to realize major health benefits through better treatment and preventive regimens. However, to achieve these goals requires coordinated action and innovative approaches to boost the discovery of the neurobiological underpinnings of BD, and rapid translation of research findings into development and testing of better and more specific treatments. To this end, we here propose that only a large-scale coordinated action can be successful in integrating international big-data approaches with real-world clinical interventions. This could be achieved through the creation of a Global Bipolar Disorder Foundation, which could bring government, industry and philanthropy together in common cause. A global initiative for BD research would come at a highly opportune time given the seminal advances promised for our understanding of the genetic and brain basis of the disease and the obvious areas of unmet clinical need. Such an endeavour would embrace the principles of open science and see the strong involvement of user groups and integration of dissemination and public involvement with the research programs. We believe the time is right for a step change in our approach to understanding, treating and even preventing BD effectively.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Olav B Smeland
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Andreas Bechdolf
- Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Frank Bellivier
- Université de Paris and INSERM UMRS 1144, Paris, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Hopital Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Veerle Bergink
- Department of Psychiatry - Erasmus Medical Center, Rotterdam, the Netherlands; Department of Psychiatry, Department of Obstetrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - John R Geddes
- Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; National Institute of Mental Health, Klecany, Czech Republic
| | - Chantal Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, F-75014 Paris, France
| | - Ralph Kupka
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, Netherlands
| | - Trine V Lagerberg
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Psychiatry - Aalborg University Hospital, Aalborg, Denmark
| | | | - Gunnar Morken
- Østmarka Department of Psychiatry, St Olav University Hospital, Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Healthsciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Psychiatry - Aalborg University Hospital, Aalborg, Denmark
| | - Ana Gonzalez Pinto
- Hospital Universitario de Alava. BIOARABA, UPV/EHU. CIBERSAM. Vitoria, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany and German Society for Bipolar Disorders (DGBS), Frankfurt am Main, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Phillip Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilian University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University of Munich, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jan Scott
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Hopital Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Department of Mental Health, Faculty of Medicine and Healthsciences, Norwegian University of Science and Technology, Trondheim, Norway; Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Aysegul Yildiz
- Dokuz Eylül University Department of Psychiatry, Izmir, Turkey
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen and University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Guy M Goodwin
- Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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22
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El-Mallakh RS, Nuss S, Gao D, Gao Y, Ahmad SC, Schrodt C, Adler C. Asenapine in the Treatment of Bipolar Depression. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:8-18. [PMID: 32214517 PMCID: PMC7093720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Asenapine, a potent serotonin 7 (5-HT7) receptor antagonist, was examined for efficacy as an antidepressant in depressed bipolar subjects. It was predicted that subjects with the genetic variant of the short form of the serotonin transporter (5HTTR) would be more likely to respond. EXPERIMENTAL DESIGN A subset of patients participating in a randomized, placebo-controlled study of the efficacy of asenapine in bipolar I depression also underwent genetic testing for the 5HTTR. Montgomery Åsberg Depression Rating Scale (MADRS) score was ≥ 26 prior to randomization to asenapine or placebo for 8 weeks. Gene testing was performed before breaking the blind. PRINCIPAL OBSERVATIONS Nine patients completing the study also underwent gene testing. At study end, the average MADRS improvement was -19.80 ± SD 8.59 for the 4 people randomized to asenapine and -3.80 ± 9.01 for the 5 people receiving placebo (P = 0.021, t = 2.88). Anxiety, as measured by the Hamilton Anxiety Rating Scale (HAM-A), also improved in asenapine-treated patients (-15.40 ± 6.15 vs. -2.80 ± 7.95, P = 0.023, t = 2.803). Six participants had the short form of the 5HTTR, and it is believed they influenced the significant outcome in this small sample. CONCLUSIONS While this is a very small sample, asenapine appears to have a beneficial effect on both depression and anxiety in depressed bipolar I patients compared to treatment with placebo. Due to the large fraction of subjects with the short form, the hypothesis that the SF-5HTTR might increase asenapine response could not be adequately tested.
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Affiliation(s)
- Rif S El-Mallakh
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Sharon Nuss
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Dong Gao
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Yonglin Gao
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Surriya Colleen Ahmad
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Clare Schrodt
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Caleb Adler
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
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23
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Ragazan DC, Eberhard J, Berge J. Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study. Front Psychiatry 2020; 11:598946. [PMID: 33262715 PMCID: PMC7688467 DOI: 10.3389/fpsyt.2020.598946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006-2014. Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables. Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56-84%), carbamazepine by 44% (18-62%), aripiprazole by 29% (13-42%), and valproate by 23% (11-33%); whereas among males, ziprasidone by 65% (41-79%). Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes.
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Affiliation(s)
- Dragos C Ragazan
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Vancouver Coastal Health Authority, University of British Columbia Hospital Detwiller Pavilion, Vancouver, BC, Canada
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden
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24
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Delvecchio G, Ciappolino V, Perlini C, Barillari M, Ruggeri M, Altamura AC, Bellani M, Brambilla P. Cingulate abnormalities in bipolar disorder relate to gender and outcome: a region-based morphometry study [corrected]. Eur Arch Psychiatry Clin Neurosci 2019; 269:777-784. [PMID: 29594394 DOI: 10.1007/s00406-018-0887-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/16/2018] [Indexed: 12/22/2022]
Abstract
Structural magnetic resonance imaging (MRI) studies reported gray matter (GM) loss in bipolar disorder (BD) in cingulate cortices, key regions subserving emotional regulation and cognitive functions in humans. The aim of this study was to further explore cingulate GM volumes in a sizeable group of BD patients with respect to healthy controls, particularly investigating the impact of gender and clinical variables. 39 BD patients (mean Age = 48.6 ± 9.7, 15 males and 24 females) and 39 demographically matched healthy subjects (mean Age = 47.9 ± 9.1, 15 males and 24 females) underwent a 1.5T MRI scan. GM volumes within the cingulate cortex were manually detected, including anterior and posterior regions. BD patients had decreased left anterior cingulate volumes compared with healthy controls (F = 6.7, p = 0.01). Additionally, a significant gender effect was observed, with male patients showing reduced left anterior cingulate cortex (ACC) volumes compared to healthy controls (F = 5.1, p = 0.03). Furthermore, a significant inverse correlation between right ACC volumes and number of hospitalizations were found in the whole group of BD patients (r = - 0.51, p = 0.04) and in male BD patients (r = - 0.88, p = 0.04). Finally, no statistically significant correlations were observed in female BD patients. Our findings further confirm the putative role of the ACC in the pathophysiology of BD. Interestingly, this study also suggested the presence of gender-specific GM volume reductions in ACC in BD, which may also be associated to poor outcome.
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Affiliation(s)
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Interuniversity Centre for Behavioural Neurosciences, AOUI Verona, Verona, Italy
| | - Marco Barillari
- Section of Radiology, Department of Neurological and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Mirella Ruggeri
- Interuniversity Centre for Behavioural Neurosciences, AOUI Verona, Verona, Italy.,Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
| | - Marcella Bellani
- Interuniversity Centre for Behavioural Neurosciences, AOUI Verona, Verona, Italy.,Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy. .,Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA.
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25
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Ragazan DC, Eberhard J, Ösby U, Berge J. Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005-2014: A register-based study. J Affect Disord 2019; 256:183-191. [PMID: 31177046 DOI: 10.1016/j.jad.2019.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 05/27/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. METHODS Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005-2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic features, mixed, and other. Psychotropic therapies preceding the corresponding admissions were attained from the Prescribed Drug Register. Mixed-effects zero-truncated negative binomial regressions were employed to model the length of stay per admission. RESULTS Analysis included 39,653 admissions by 16,271 inpatients (60.0% women). Overall, when compared to men, women spent 7.5% (95% CI: 4.2-11.0%, p < 0.001) extra days hospitalized per admission. However, upon adjusting for candidate confounders, including the bipolar subtype, and selected comorbidities and psychotropics, the association weakened wherein women then spent 3.7% (95% CI: 0.1-6.9%, p = 0.028) extra days hospitalized per admission. LIMITATIONS The integrity of register data can be variable and the adherence to outpatient dispensed psychotropics could not be validated. CONCLUSION Although the influence of gender on the bipolar disorder inpatient length of stay is evident, other factors attenuate and better explain this crude observation.
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Affiliation(s)
- Dragos C Ragazan
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden.
| | - Jonas Eberhard
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden
| | - Urban Ösby
- Karolinska Institutet, Dept. of Clinical Neuroscience, Stockholm, Sweden
| | - Jonas Berge
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden
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26
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Pedrotti Moreira F, Cardoso TC, Mondin TC, Wiener CD, de Mattos Souza LD, Oses JP, Jansen K, da Silva RA. Serum level of nerve growth factor is a potential biomarker of conversion to bipolar disorder in women with major depressive disorder. Psychiatry Clin Neurosci 2019; 73:590-593. [PMID: 31170316 DOI: 10.1111/pcn.12896] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to identify biomarkers associated with major depressive disorder (MDD) and conversion from MDD to bipolar disorder (BD) in an outpatient sample of women. METHODS This was a longitudinal study including women diagnosed with MDD and aged 18 to 60 years. The follow-up was 3 years. The diagnosis was performed using the Mini International Neuropsychiatric Interview Plus. Blood collection was just performed in the first phase. Serum interleukin-6, tumor necrosis factor-α, brain-derived neurotrophic factor, glial cell-derived neurotrophic factor, and nerve growth factor (NGF) levels were measured using a commercial immunoassay kit. RESULTS We included 156 women. The conversion rate from MDD to BD was 15.4% (n = 24). NGF serum levels were increased in patients who converted to BD compared to the remitted MDD group and current MDD group (P = 0.013). The Bonferroni post-hoc test for multiple comparisons revealed significant differences for higher NGF levels in patients who converted to BD compared to patients with current MDD (P = 0.037). Interleukin-6, tumor necrosis factor-α, brain-derived neurotrophic factor, and glial cell-derived neurotrophic factor serum levels did not differ among the groups. CONCLUSION Our results suggest that NGF might be a useful biomarker associated with early detection of conversion to BD, helping clinicians in the clinical diagnosis.
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Affiliation(s)
| | - Taiane C Cardoso
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Thaíse C Mondin
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.,Department of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Carolina D Wiener
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Jean P Oses
- Department of Biochemistry, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karen Jansen
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Ricardo A da Silva
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
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27
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Pascual-Sánchez A, Jenaro C, Montes-Rodríguez JM. Quality of life in euthymic bipolar patients: A systematic review and meta-analysis. J Affect Disord 2019; 255:105-115. [PMID: 31150940 DOI: 10.1016/j.jad.2019.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/17/2019] [Accepted: 05/18/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with bipolar disorder, even euthymic, could suffer an impairment in their quality of life compared to healthy controls. Since no previous systematic review and meta-analysis has been conducted, the aim of the current study is to conduct a systematic review and meta-analysis of cross-sectional case-controlled studies on quality of life in adult euthymic Bipolar Disorder patients. METHODS A systematic review and meta-analysis that followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) was conducted. Major electronic databases were searched on August 2018 to assess the variables associated with quality of life in euthymic bipolar disorder patients. After selecting case-control studies, data collection, quality assessment and subsequently statistical analysis were done. RESULTS 66 studies were finally selected for systematic review and meta-analysis. Four different quality of life instruments were used among the different studies. Effect size analysis showed that there were significant differences in quality of life outcomes between euthymic bipolar disorder patients and healthy controls (d=-0.922; SE=0.316; 95%CI=-1.541--0.303; p=.004), with lower quality of life in the euthymic patients. Furthermore, time since euthymia explained 15.62% of variability, and age of control group explained 29.6% of variability. No other moderators were statiscally significant. LIMITATIONS The instruments used were heterogeneous. Moreover, the role of other clinical moderators could not be included due to the lack of this information in most of the articles. CONCLUSIONS Quality of life is lower in euthymic bipolar patients than in healthy controls. However, longer time in euthymia is associated with better outcomes.
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Affiliation(s)
- Ana Pascual-Sánchez
- Service of Psychiatry, University Hospital Ramón y Cajal, Ctra. Colmenar Viejo km. 9.1, 28034 Madrid, Spain.
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28
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Validity of the WHIPLASHED as a tool to identify bipolar disorder in women. J Affect Disord 2019; 246:69-73. [PMID: 30578948 PMCID: PMC6563604 DOI: 10.1016/j.jad.2018.12.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/11/2018] [Accepted: 12/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to investigate the validity of the WHIPLASHED clinician-administered interview, a mnemonic of questions on clinical factors and illness course used to screen for bipolar disorder, as a self-report questionnaire. METHODS Participants (n = 82) were females recruited from an outpatient academic women's mental health clinic. Relevant symptom data were extracted from a self-report questionnaire designed to parallel the WHIPLASHED interview questions. A score of ≥5 on WHIPLASHED was defined as a positive screen for bipolar spectrum disorder by its developer. We examined the capacity of self-reported WHIPLASHED scores ≥5 to differentiate bipolar from unipolar depression in women. Diagnostic assessments were conducted with the Mini International Neuropsychiatric Interview. RESULTS Women were diagnosed with unipolar (n = 54) and bipolar (n = 28) depression. The majority of subjects were white (67%), employed (68%) and married (57%) with a mean age of 36.8 years. The receiver operating characteristic curve demonstrated that WHIPLASHED had strong predictive ability (AUC = 0.877) in differentiating bipolar from unipolar depression. A cutoff score of ≥5 generated 96% sensitivity and 52% specificity, while raising the threshold to 6 generated 89% sensitivity and 76% specificity for a bipolar disorder diagnosis. LIMITATIONS Our sample was small and composed of female patients at a single treatment center. CONCLUSIONS In this sample, WHIPLASHED was a valid screening tool to differentiate bipolar from unipolar depression. While existing instruments focus on primary symptoms of bipolar disorder, the WHIPLASHED is useful in exploring subtypes of bipolar disorder in which depression dominates the clinical course.
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Spoorthy MS, Chakrabarti S, Grover S. Comorbidity of bipolar and anxiety disorders: An overview of trends in research. World J Psychiatry 2019; 9:7-29. [PMID: 30631749 PMCID: PMC6323556 DOI: 10.5498/wjp.v9.i1.7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/04/2018] [Accepted: 12/05/2018] [Indexed: 02/05/2023] Open
Abstract
Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder (BD), but it also adversely impacts the course, outcome, and treatment of BD. The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses (n = 103), epidemiological surveys, and large-scale clinical studies. The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time. All types of anxiety disorders were equally common in BD. However, there was a wide variation in rates across different sources, with most of this discrepancy being accounted for by methodological differences between reports. Comorbid anxiety disorders negatively impacted the presentation and course of BD. This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD. Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD. Nevertheless, the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.
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Affiliation(s)
- Mamidipalli Sai Spoorthy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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30
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Panse S, Parikh D. Quality of life in elderly bipolar disorder patients. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_37_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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García-Jiménez J, Álvarez-Fernández M, Aguado-Bailón L, Gutiérrez-Rojas L. Factores asociados a la polaridad predominante en el trastorno bipolar: una revisión sistemática. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:52-62. [DOI: 10.1016/j.rpsm.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/19/2017] [Accepted: 06/14/2017] [Indexed: 01/25/2023]
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32
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Fela-Thomas AL, Olotu OS, Esan O. Risk of manic switch with antidepressants use in patients with bipolar disorder in a Nigerian neuropsychiatric hospital. S Afr J Psychiatr 2018; 24:1215. [PMID: 30473882 PMCID: PMC6244419 DOI: 10.4102/sajpsychiatry.v24i0.1215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 08/21/2018] [Indexed: 11/03/2022] Open
Abstract
Background Depressive disorders are common among those with bipolar affective disorder (BAD) and may necessitate the use of antidepressants. This has been suggested to precipitate manic episodes in some patients. Objectives This study aims to determine the prevalence of and factors associated with manic switch in patients with BAD being treated with antidepressants. Methods Case notes of patients who were treated at a Nigerian neuropsychiatric hospital for a BAD from 2004 to 2015 were reviewed. BAD diagnosis was made using ICD-10 criteria. Treatment for bipolar depression included monotherapy (i.e. antidepressants, antipsychotics or mood stabilisers) or combination therapy (mood stabiliser with an antidepressant or a combination of mood stabilisers, antipsychotics and antidepressants). The primary outcome measure was a switch to mania or hypomania within 12 weeks of commencing an antidepressant. Results Manic or hypomanic switch (MS) was observed in 109 (44.3%) of the participants. Female gender, younger age, number of previous episodes and a past history of psychiatric hospitalisation were all significantly associated with a risk of MS. There was no significant difference in the rate of MS in either those treated with adjunct antidepressants therapy with a mood stabiliser or an antipsychotic or those placed on a combination of antidepressants, antipsychotics and mood-stabilising agents. Conclusion A large proportion of patients with BAD on antidepressants experience medication-induced manic or hypomanic switch.
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Affiliation(s)
| | - Osasu S Olotu
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Nigeria
| | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Nigeria
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Yapici Eser H, Kacar AS, Kilciksiz CM, Yalçinay-Inan M, Ongur D. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry 2018; 9:229. [PMID: 29997527 PMCID: PMC6030835 DOI: 10.3389/fpsyt.2018.00229] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/11/2018] [Indexed: 12/23/2022] Open
Abstract
Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence. Method: We searched PubMed to access relevant articles published until September 2015, using the keywords "Bipolar disorder" or "Affective Psychosis" or "manic depressive" separately with "generalized anxiety," "panic disorder," "social phobia," "obsessive compulsive," and "anxiety." Variables for associated features and prevalence of anxiety disorders were carefully extracted. Results: Lifetime any anxiety disorder comorbidity in BD was 40.5%; panic disorder (PD) 18.1%, generalized anxiety disorder (GAD) 13.3%, social anxiety disorder (SAD) 13.5% and obsessive compulsive disorder (OCD) 9.7%. Current any anxiety disorder comorbidity in BD is 38.2%; GAD is 15.2%, PD 13.3%, SAD 11.7%, and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38% and 34%, PD was 15% and 15%, GAD was 14% and 16.6%, SAD was 8% and 13%, OCD was 8% and 10%, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31% and 37%, PD was 9% and 13%, GAD was 8% and 12%, SAD was 7% and 11%, and OCD was 8% and 7%, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD-SAD comorbidity. History of psychotic features significantly affected current PD and GAD. Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.
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Affiliation(s)
- Hale Yapici Eser
- School of Medicine, Koç University, Sariyer, Turkey.,Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Anil S Kacar
- Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Can M Kilciksiz
- School of Medicine, Koç University, Sariyer, Turkey.,Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Fellinger M, Waldhör T, Blüml V, Williams N, Vyssoki B. Influence of gender on inpatient treatment for bipolar disorder: An analysis of 60,607 hospitalisations. J Affect Disord 2018; 225:104-107. [PMID: 28810176 DOI: 10.1016/j.jad.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The influence of gender on inpatient treatment patterns in bipolar patients is unclear. The aim of this study is to examine whether differences in length of stay and frequency of inpatient episodes, according to ICD-10 bipolar disorder (BD)-subgroups, exist between men and women. METHODS All episodes of a manic (F31.0-2), depressive (F31.3-5) or mixed (F31.6) subtype of BD during an inpatient stay in an Austrian hospital in the period of 2001-2014 were included in this study. Data on episodes was provided by the national statistics agency. Weekly admission rates per 100,000 people were calculated by directly age-standardized rates. RESULTS The database comprised 60,607 admissions (35.8% men). The number of inpatient episodes was significantly higher (p < 0.001) in women in all BD subgroups. Average length of stay in manic (p < 0.001) and depressive (p < 0.001) episodes was shorter in women compared to men. No difference could be found for mixed episodes. LIMITATIONS Only aggregated patient data and no single case histories were available for this study. CONCLUSIONS The current study reveals relevant gender differences regarding inpatient treatment patterns, as women were overrepresented in all BD-subgroups. Despite equal life time prevalence, severe mood episodes lead more often to hospitalisations in women. There is a high necessity to further research the underlying causes of these findings.
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Affiliation(s)
- Matthäus Fellinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Thomas Waldhör
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Austria.
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | - Nolan Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
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35
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Fleury MJ, Grenier G, Bamvita JM. Associated and mediating variables related to quality of life among service users with mental disorders. Qual Life Res 2017; 27:491-502. [DOI: 10.1007/s11136-017-1717-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/24/2022]
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36
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Millett CE, Mukherjee D, Reider A, Can A, Groer M, Fuchs D, Postolache TT, Kelleher SL, Saunders EF. Peripheral zinc and neopterin concentrations are associated with mood severity in bipolar disorder in a gender-specific manner. Psychiatry Res 2017; 255:52-58. [PMID: 28528241 PMCID: PMC5545151 DOI: 10.1016/j.psychres.2017.05.022] [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] [Received: 11/06/2016] [Accepted: 05/14/2017] [Indexed: 12/20/2022]
Abstract
Bipolar disorder (BD) is a recurrent, episodic mood disorder for which there are no current diagnostic, prognostic or theranostic biomarkers. Two peripheral markers of the acute phase immune response, zinc and neopterin, are consistently associated with severity of depression in literature. Given gender differences in clinical presentation of BD and in inflammatory processes, we aimed to explore the interaction between gender and immune biomarkers to predict mood severity in BD. Participants with DSM IV BD I and II were recruited through the Pennsylvania Psychiatric Institute during an acute mood episode. Healthy controls (HC) were recruited through advertisements. Participants fasted for at least 6h when blood was drawn for biomarkers. We found that zinc concentrations were significantly lower in the BD group at baseline (p<.05), and there was also a significant interaction between gender and zinc (p<.05), associated with depression severity. Also, we found a significant interaction between gender and neopterin, associated with mania severity (p<.05). We found that mania severity was associated with neopterin in men, while depression severity was positively associated with zinc in women. Our report bears replication in larger samples and highlights the potential for differences in the underlying pathophysiology between men and women with BD.
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Affiliation(s)
- Caitlin E. Millett
- Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033,Department of Neural and Behavioral Sciences, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033,Corresponding author Department of Psychiatry Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Mail Code: H073, Hershey, PA 17033-0850. Tel: 717-531-8136; Fax: 717-531-6491.
| | - Dahlia Mukherjee
- Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033
| | - Aubrey Reider
- Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033
| | - Adem Can
- University of Maryland School of Medicine, Baltimore, MD
| | - Maureen Groer
- University of South Florida, School of Nursing, Tampa FL
| | | | - Teodor T. Postolache
- University of Maryland School of Medicine, Baltimore, MD,Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver, CO,The Military and Veteran Microbiome Consortium for Research and Education- MVM –Core, Denver , CO
| | - Shannon L. Kelleher
- Department of Cellular and Molecular Physiology, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033,Department of Pharmacology, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033,Department of Surgery, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033
| | - Erika F.H. Saunders
- Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA 17033,University of Michigan Department of Psychiatry and Depression Center, Ann Arbor, MI 48109
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Sreedhar D, Kulkarni KR, Purty A, Muralidharan K, Janardhan Reddy YC, Jain S. Gender Differences in the 5 Years Course of Bipolar Disorder after a First Manic Episode: A Retrospective Review. Indian J Psychol Med 2017; 39:712-713. [PMID: 29200578 PMCID: PMC5688909 DOI: 10.4103/0253-7176.217020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Divyasree Sreedhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Karishma Rajendra Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhishek Purty
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Syan SK, Minuzzi L, Smith M, Allega OR, Hall GB, Frey BN. Resting state functional connectivity in women with bipolar disorder during clinical remission. Bipolar Disord 2017; 19:97-106. [PMID: 28258639 DOI: 10.1111/bdi.12469] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Periods of euthymia in bipolar disorder (BD) serve as a valuable time to study trait-based pathophysiology. The use of resting state functional connectivity (Rs-FC) can aid in the understanding of BD pathophysiology free of task or mood state biases. The present study investigated two unexplored areas of Rs-FC research in bipolar remission: (i) Rs-FC in women, controlling for the potential influence of premenstrual symptoms, and (ii) the use of both independent component analysis (ICA) and seed-based analysis (SBA) to investigate Rs-FC. METHODS We investigated Rs-FC of the default mode network, meso-paralimbic network and fronto-parietal network in a sample of 32 euthymic women with BD and 36 age-matched controls during the mid-follicular phase of their menstrual cycle. Rs-FC was assessed with ICA and SBA using the posterior cingulate cortex (PCC), amygdala and dorsolateral prefrontal cortex (dlPFC) as seed points for their respective resting state networks. RESULTS In BD, compared to controls, SBAs revealed increased coupling between the PCC and the angular gyrus (P=.002, false discovery rate [FDR]-corrected) and between the right dlPFC and the brainstem (P=.03, FDR-corrected). In BD only, PCC-angular gyrus coupling was correlated with anxiety symptoms. Group differences in Rs-FC using ICA did not survive multiple comparisons. CONCLUSIONS Negative findings from whole-brain ICA Rs-FC may reflect a state of clinical remission in BD. Heightened activation between the PCC and the angular gyrus and between the dlPFC and the brainstem may reflect (i) an abnormal trait integration of affective information during clinical remission and/or (ii) an adaptive compensatory mechanism required for clinical stabilization.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Luciano Minuzzi
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Olivia R Allega
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Geoffrey Bc Hall
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Flores-Ramos M, Leff P, Fernández-Guasti A, Becerra Palars C. Is it important to consider the sex of the patient when using lithium or valproate to treat the bipolar disorder? Pharmacol Biochem Behav 2017; 152:105-111. [DOI: 10.1016/j.pbb.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/12/2023]
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Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:331-349. [PMID: 27476137 DOI: 10.1016/j.jad.2016.07.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/09/2016] [Accepted: 07/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. METHODS A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. LIMITATIONS The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. CONCLUSIONS This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
| | - Gin S Malhi
- Discipline of Psychiatry and CADE Clinic, Royal North Shore Hospital, University of Sydney, NSW, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, NSW, Australia.
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Karanti A, Kardell M, Lundberg U, Landén M. Changes in mood stabilizer prescription patterns in bipolar disorder. J Affect Disord 2016; 195:50-6. [PMID: 26859073 DOI: 10.1016/j.jad.2016.01.043] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/06/2016] [Accepted: 01/28/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lithium is a first line treatment option in bipolar disorder, but several alternative treatments have been introduced in recent years, such as antiepileptic and atypical antipsychotic drugs. Little is known about how this has changed the prescription patterns. We investigated possible changes in the use of mood stabilizers and antidepressants in Sweden during 2007-2013. METHODS Data was collected from Swedish registers: the National Quality Assurance Register for bipolar disorder (BipoläR), the Prescribed Drug Register, and the Patient Register. Logistic regression models with drug use as outcomes were used to adjust for confounding factors such as sex, age, year of registration, and subtypes of bipolar disorder. RESULTS In both bipolar subtypes, lithium use decreased steadily during the study period, while the use of lamotrigine and quetiapine increased. The use of valproate decreased in bipolar II disorder and the use of olanzapine decreased among women. The use of antidepressant remained principally unchanged but increased somewhat in bipolar I disorder. LIMITATIONS We only report data from 2007 as the coverage of BipoläR prior to 2007 was too low to allow for reliable analyses. CONCLUSION Significant changes in the prescription of drugs in the treatment of bipolar disorder have occurred in recent years in Sweden. Further studies are needed to clarify whether these changes alter the outcome in bipolar disorder.
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Affiliation(s)
- Alina Karanti
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; National Quality Register for Bipolar Disorder (BipoläR), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Lundberg
- National Quality Register for Bipolar Disorder (BipoläR), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; National Quality Register for Bipolar Disorder (BipoläR), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jeon HJ, Baek JH, Ahn YM, Kim SJ, Ha TH, Cha B, Moon E, Kang HJ, Ryu V, Cho CH, Heo JY, Kim K, Lee HJ. Review of Cohort Studies for Mood Disorders. Psychiatry Investig 2016; 13:265-76. [PMID: 27247592 PMCID: PMC4878960 DOI: 10.4306/pi.2016.13.3.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 12/28/2022] Open
Abstract
This paper aimed to review currently available cohort studies of subjects with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD). Using the PubMed and KoreaMed databases, we reviewed eight major cohort studies. Most studies recruited participants with MDD and BD separately, so direct comparison of factors associated with diagnostic changes was difficult. Regular and frequent follow-up evaluations utilizing objective mood ratings and standardized evaluation methods in a naturalistic fashion are necessary to determine detailed clinical courses of mood disorders. Further, biological samples should also be collected to incorporate clinical findings in the development of new diagnostic and therapeutic approaches. An innovative cohort study that can serve as a platform for translational research for treatment and prevention of mood disorders is critical in determining clinical, psychosocial, neurobiological and genetic factors associated with long-term courses and consequences of mood disorders in Korean patients.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences & Technology, Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Ha
- Department of Psychiatry, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University College of Medicine, Gwangju, Republic of Korea
| | - Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Mathews SB, Epperson CN. Neuropsychiatric Disorders Among Aging Women: Assessing Risk Factors and Tailoring Treatment. Curr Behav Neurosci Rep 2015. [DOI: 10.1007/s40473-015-0057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nabavi B, Mitchell AJ, Nutt D. A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population. EBioMedicine 2015; 2:1405-19. [PMID: 26629535 PMCID: PMC4634892 DOI: 10.1016/j.ebiom.2015.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. AIMS To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. METHOD Random effects meta-analyses were used to calculate the lifetime prevalence of comorbid generalised anxiety disorder, panic disorder, social anxiety disorder, specific phobia, agoraphobia, obsessive compulsive disorder and posttraumatic stress disorder in bipolar affective disorder. RESULTS 52 studies were included in the meta-analysis. The rate of lifetime comorbidity was as follows: panic disorder 16.8% (95% CI 13.7-20.1), generalised anxiety disorder 14.4% (95% CI 10.8-18.3), social anxiety disorder13.3% (95% CI 10.1-16.9), post-traumatic stress disorder 10.8% (95% CI 7.3-14.9), specific phobia 10.8% (95% CI 8.2-13.7), obsessive compulsive disorder 10.7% (95% CI 8.7-13.0) and agoraphobia 7.8% (95% CI 5.2-11.0). The lifetime prevalence of any anxiety disorders in bipolar disorder was 42.7%. CONCLUSIONS Our results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder. The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap. The treatment of co-existing conditions has clinically remained challenging.
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Affiliation(s)
- Behrouz Nabavi
- The Oleaster Centre, Birmingham and Solihull Mental Health NHS Foundation Trust, West Midlands, UK
| | - Alex J Mitchell
- Department of Psycho-oncology, University of Leicester and Leicester Partnership NHS Trust, Leicester, UK
| | - David Nutt
- Centre of Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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Leonpacher AK, Liebers D, Pirooznia M, Jancic D, MacKinnon DF, Mondimore FM, Schweizer B, Potash JB, Zandi PP, Goes FS. Distinguishing bipolar from unipolar depression: the importance of clinical symptoms and illness features. Psychol Med 2015; 45:2437-2446. [PMID: 25851411 PMCID: PMC5693376 DOI: 10.1017/s0033291715000446] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Distinguishing bipolar disorder (BP) from major depressive disorder (MDD) has important relevance for prognosis and treatment. Prior studies have identified clinical features that differ between these two diseases but have been limited by heterogeneity and lack of replication. We sought to identify depression-related features that distinguish BP from MDD in large samples with replication. METHOD Using a large, opportunistically ascertained collection of subjects with BP and MDD we selected 34 depression-related clinical features to test across the diagnostic categories in an initial discovery dataset consisting of 1228 subjects (386 BPI, 158 BPII and 684 MDD). Features significantly associated with BP were tested in an independent sample of 1000 BPI cases and 1000 MDD cases for classifying ability in receiver operating characteristic (ROC) analysis. RESULTS Seven clinical features showed significant association with BPI compared with MDD: delusions, psychomotor retardation, incapacitation, greater number of mixed symptoms, greater number of episodes, shorter episode length, and a history of experiencing a high after depression treatment. ROC analyses of a model including these seven factors showed significant evidence for discrimination between BPI and MDD in an independent dataset (area under the curve = 0.83). Only two features (number of mixed symptoms, and feeling high after an antidepressant) showed an association with BPII versus MDD. CONCLUSIONS Our study suggests that clinical features distinguishing depression in BPI versus MDD have important classification potential for clinical practice, and should also be incorporated as 'baseline' features in the evaluation of novel diagnostic biomarkers.
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Affiliation(s)
- A. K. Leonpacher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D. Liebers
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M. Pirooznia
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D. Jancic
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - D. F. MacKinnon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - F. M. Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B. Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J. B. Potash
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - P. P. Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - F. S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Saunders EF, Fernandez-Mendoza J, Kamali M, Assari S, McInnis MG. The effect of poor sleep quality on mood outcome differs between men and women: A longitudinal study of bipolar disorder. J Affect Disord 2015; 180:90-6. [PMID: 25885066 PMCID: PMC4448970 DOI: 10.1016/j.jad.2015.03.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women. METHODS We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled. RESULTS In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality. LIMITATIONS We measured perception of sleep quality, but not objective changes in sleep. CONCLUSIONS In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD.
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Affiliation(s)
- Erika F.H. Saunders
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA,University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI,University of Michigan Depression Center, Ann Arbor, MI
| | - Julio Fernandez-Mendoza
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Mail Code: HO73, Hershey, PA, USA; Sleep Research & Treatment Center, Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Masoud Kamali
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan Depression Center, Ann Arbor, MI, USA.
| | - Shervin Assari
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Melvin G. McInnis
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI,University of Michigan Depression Center, Ann Arbor, MI
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Benedetti F, Poletti S, Radaelli D, Locatelli C, Pirovano A, Lorenzi C, Vai B, Bollettini I, Falini A, Smeraldi E, Colombo C. Lithium and GSK-3β promoter gene variants influence cortical gray matter volumes in bipolar disorder. Psychopharmacology (Berl) 2015; 232:1325-36. [PMID: 25345732 DOI: 10.1007/s00213-014-3770-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/04/2014] [Indexed: 12/11/2022]
Abstract
RATIONALE Lithium is the mainstay for the treatment of bipolar disorder (BD) and inhibits glycogen synthase kinase-3β (GSK-3β). The less active GSK-3β promoter gene variants have been associated with less detrimental clinical features of BD. GSK-3β gene variants and lithium can influence brain gray and white matter structure in psychiatric conditions, so we studied their combined effect in BD. OBJECTIVES The aim of this study is to investigate the effects of ongoing long-term lithium treatment and GSK-3β promoter rs334558 polymorphism on regional gray matter (GM) volumes of patients with BD. MATERIALS AND METHODS GM volumes were estimated with 3.0 Tesla MRI in 150 patients affected by a major depressive episode in course of BD. Duration of lifetime lithium treatment was retrospectively assessed. Analyses were performed by searching for significant effects of lithium and rs334558 in the whole brain. RESULTS The less active GSK-3β rs334558*G gene promoter variant and the long-term administration of lithium were synergistically associated with increased GM volumes in the right frontal lobe, in a large cluster encompassing the boundaries of subgenual and orbitofrontal cortex (including Brodmann areas 25, 11, and 47). Effects of lithium on GM revealed in rs334558*G carriers only, consistent with previously reported clinical effects in these genotype groups, and were proportional to the duration of treatment. CONCLUSIONS Lithium and rs334558 influenced GM volumes in areas critical for the generation and control of affect, which have been widely implicated in the process of BD pathophysiology. In the light of the protective effects of lithium on white matter integrity, our results suggest that the clinical effects of lithium associate with a neurotrophic effect on the whole brain, probably mediated by GSK-3β inhibition.
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Affiliation(s)
- Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy,
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Abulseoud OA, Gawad NA, Mohamed K, Vadnie C, Camsari UM, Karpyak V, Frye MA, Choi DS. Sex differences in mania phenotype and ethanol consumption in the lateral hypothalamic kindled rat model. Transl Psychiatry 2015; 5:e534. [PMID: 25803497 PMCID: PMC4354358 DOI: 10.1038/tp.2015.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/07/2015] [Accepted: 01/20/2015] [Indexed: 01/03/2023] Open
Abstract
Sex differences have been observed in mania phenotypes in humans. However the mechanisms underlying this difference are poorly understood. Activating the lateral hypothalamus is implicated in manic-like behaviors in rodents. Using newly established lateral hypothalamus kindled (LHK) rat mania model, we investigated sex differences of manic-like behaviors and its correlation with voluntary ethanol intake. We stimulated the lateral hypothalamus bilaterally in the male and female Wistar rats over five consecutive days. We recorded and quantified kindling-induced behaviors for each individual animal. We also assessed ethanol consumption using a two-bottle choice ethanol drinking as well as circadian locomotor activity counts daily throughout the experiment. We found notable sex differences in several aspects of manic-like behaviors during kindling. Males exhibited a significantly increased locomotor activity during the light phase, and reduced rest interval. On the other hand, females displayed significantly higher ethanol consumption and more frequent rearing behavior. However, no sex differences were present in the duration of sexual, feeding or grooming behaviors or in dark-phase activity counts. The excessive alcohol intake in LHK female rats is reminiscent of clinically reported sex differences in bipolar patients while the other phenotypic sex differences such as rearing and locomotor activity are less clearly described in clinical studies. Overall, our results lend further evidence for the validity of the LHK rat as a useful model to study brain region-specific molecular changes during mania and its correlation with alcohol use disorders.
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Affiliation(s)
- O A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - N A Gawad
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - K Mohamed
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - C Vadnie
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - U M Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - V Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - M A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - D-S Choi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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Gender differences in the treatment of patients with bipolar disorder: a study of 7354 patients. J Affect Disord 2015; 174:303-9. [PMID: 25532077 DOI: 10.1016/j.jad.2014.11.058] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/10/2014] [Accepted: 11/29/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gender differences in treatment that are not supported by empirical evidence have been reported in several areas of medicine. Here, the aim was to evaluate potential gender differences in the treatment for bipolar disorder. METHODS Data was collected from the Swedish National Quality Assurance Register for bipolar disorder (BipoläR). Baseline registrations from the period 2004-2011 of 7354 patients were analyzed. Multiple logistic regression analysis was used to study the impact of gender on interventions. RESULTS Women were more often treated with antidepressants, lamotrigine, electroconvulsive therapy, benzodiazepines, and psychotherapy. Men were more often treated with lithium. There were no gender differences in treatment with mood stabilizers as a group, neuroleptics, or valproate. Subgroup analyses revealed that ECT was more common in women only in the bipolar I subgroup. Contrariwise, lamotrigine was more common in women only in the bipolar II subgroup. LIMITATIONS As BipoläR contains data on outpatient treatment of persons with bipolar disorder in Sweden, it is unclear if these findings translate to inpatient care and to outpatient treatment in other countries. CONCLUSIONS Men and women with bipolar disorder receive different treatments in routine clinical settings in Sweden. Gender differences in level of functioning, bipolar subtype, or severity of bipolar disorder could not explain the higher prevalence of pharmacological treatment, electroconvulsive therapy, and psychotherapy in women. Our results suggest that clinicians׳ treatment decisions are to some extent unduly influenced by patients׳ gender.
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Findlay LJ, El-Mallakh P, El-Mallakh RS. Management of bipolar I depression: clinical utility of lurasidone. Ther Clin Risk Manag 2015; 11:75-81. [PMID: 25609973 PMCID: PMC4293929 DOI: 10.2147/tcrm.s57695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Lurasidone is a benzisothiazol derivative second-generation antipsychotic. It has been approved in the United States and Europe for treatment of acute schizophrenia and bipolar depression. In type I bipolar subjects, treatment with lurasidone monotherapy of adjunctive therapy to lithium or valproic acid with doses of 20 to 120 mg once daily with food, results in statistically and clinically significant reduction of depressive symptoms. Patients experience relatively few side effects, which include somnolence, akathisia, nausea, and other gastrointestinal upset. Dopamine related side effects, such as Parkinsonism and elevated prolactin, are rare and mild. Longer term safety data obtained in 6 months long, open continuation observation periods, suggest that metabolic related elevations in weight, glucose, and lipids are absent or minimal. The mechanism of action of lurasidone is not known, but the data are compatible with antagonism of the serotonin 7 receptor. Lurasidone is a new option for the treatment of bipolar depression with relatively few side effects.
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Affiliation(s)
| | | | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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