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Thomas-Odenthal F, Stein F, Vogelbacher C, Alexander N, Bechdolf A, Bermpohl F, Bröckel K, Brosch K, Correll CU, Evermann U, Falkenberg I, Fallgatter A, Flinkenflügel K, Grotegerd D, Hahn T, Hautzinger M, Jansen A, Juckel G, Krug A, Lambert M, Leicht G, Leopold K, Meinert S, Mikolas P, Mulert C, Nenadić I, Pfarr JK, Reif A, Ringwald K, Ritter P, Stamm T, Straube B, Teutenberg L, Thiel K, Usemann P, Winter A, Wroblewski A, Dannlowski U, Bauer M, Pfennig A, Kircher T. Larger putamen in individuals at risk and with manifest bipolar disorder. Psychol Med 2024:1-11. [PMID: 38801091 DOI: 10.1017/s0033291724001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Individuals at risk for bipolar disorder (BD) have a wide range of genetic and non-genetic risk factors, like a positive family history of BD or (sub)threshold affective symptoms. Yet, it is unclear whether these individuals at risk and those diagnosed with BD share similar gray matter brain alterations. METHODS In 410 male and female participants aged 17-35 years, we compared gray matter volume (3T MRI) between individuals at risk for BD (as assessed using the EPIbipolar scale; n = 208), patients with a DSM-IV-TR diagnosis of BD (n = 87), and healthy controls (n = 115) using voxel-based morphometry in SPM12/CAT12. We applied conjunction analyses to identify similarities in gray matter volume alterations in individuals at risk and BD patients, relative to healthy controls. We also performed exploratory whole-brain analyses to identify differences in gray matter volume among groups. ComBat was used to harmonize imaging data from seven sites. RESULTS Both individuals at risk and BD patients showed larger volumes in the right putamen than healthy controls. Furthermore, individuals at risk had smaller volumes in the right inferior occipital gyrus, and BD patients had larger volumes in the left precuneus, compared to healthy controls. These findings were independent of course of illness (number of lifetime manic and depressive episodes, number of hospitalizations), comorbid diagnoses (major depressive disorder, attention-deficit hyperactivity disorder, anxiety disorder, eating disorder), familial risk, current disease severity (global functioning, remission status), and current medication intake. CONCLUSIONS Our findings indicate that alterations in the right putamen might constitute a vulnerability marker for BD.
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Affiliation(s)
- Florian Thomas-Odenthal
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Christoph Vogelbacher
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
- Translational Clinical Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Nina Alexander
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kyra Bröckel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Ulrika Evermann
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany; German Center for Mental Health (DZPG), partner site Tübingen, Germany
| | - Kira Flinkenflügel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
- Core-Facility BrainImaging, Faculty of Medicine, Philipps-Universität Marburg, Marburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, Bochum, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Bonn, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Pavol Mikolas
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Psychiatry, Justus Liebig University, Giessen, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Kai Ringwald
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Thomas Stamm
- Department of Psychiatry and Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical Psychiatry and Psychotherapy Brandenburg Medical School, Neuruppin, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Lea Teutenberg
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Katharina Thiel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Paula Usemann
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Alexandra Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
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Flaaten CB, Melle I, Bjella T, Engen MJ, Åsbø G, Wold KF, Widing L, Gardsjord E, Øie MG, Lyngstad SH, Haatveit B, Simonsen C, Ueland T. Long-term course of cognitive functioning in bipolar disorder: A ten-year follow-up study. Bipolar Disord 2024; 26:136-147. [PMID: 37356974 DOI: 10.1111/bdi.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Cognitive impairments are common in bipolar disorder (BD), but the long-term course remains understudied. Longitudinal data on cognitive functioning from the start of the first treatment could help clarify pathophysiological processes that shape the illness outcome. We here aim to investigate the 10-year cognitive course in BD compared to healthy controls (HC) and the effects of clinical symptoms on cognitive trajectories. METHODS Fifty-six BD participants recruited within their first year of treatment and 108 HC completed clinical and cognitive assessments at baseline and 10-year follow-up. We derived eight cognitive domain scores and a cognitive composite score, which were further investigated using linear mixed model analyses. Correlation analyses were used to assess associations between the composite score and depressive, manic and psychotic symptoms. RESULTS BD participants performed poorer than HCs in all domains except mental speed and verbal fluency. Verbal learning and memory, verbal fluency and the composite score improved over time in both BD participants and HC, while short-term memory, mental speed, psychomotor speed and working memory were stable. We found no significant correlations between cognition and symptom level at either time point in BD participants. CONCLUSIONS We found evidence of long-term cognitive stability or improvement in BD participants from first treatment to 10-year follow-up. Though the BD group was impaired in all domains except mental speed and verbal fluency, the change in cognitive functioning was parallel to that of HCs. These findings are not consistent with the notion of neuroprogression in BD.
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Affiliation(s)
- Camilla Bärthel Flaaten
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Bjella
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Johan Engen
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway
| | - Gina Åsbø
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristin Fjelnseth Wold
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Line Widing
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend Gardsjord
- Division of Mental Health and Addiction, Unit for Early Intervention in Psychosis, Oslo University Hospital, Oslo, Norway
| | | | - Siv Hege Lyngstad
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway
| | - Beathe Haatveit
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Martini J, Bröckel KL, Leopold K, Berndt C, Sauer C, Maicher B, Juckel G, Krüger-Özgürdal S, Fallgatter AJ, Lambert M, Bechdolf A, Reif A, Matura S, Biere S, Kittel-Schneider S, Stamm T, Bermpohl F, Kircher T, Falkenberg I, Jansen A, Dannlowski U, Correll CU, Fusar-Poli P, Hempel LM, Mikolas P, Ritter P, Bauer M, Pfennig A. Young people at risk for developing bipolar disorder: Two-year findings from the multicenter prospective, naturalistic Early-BipoLife study. Eur Neuropsychopharmacol 2024; 78:43-53. [PMID: 37913697 DOI: 10.1016/j.euroneuro.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
Early identification and intervention of individuals with an increased risk for bipolar disorder (BD) may improve the course of illness and prevent long‑term consequences. Early-BipoLife, a multicenter, prospective, naturalistic study, examined risk factors of BD beyond family history in participants aged 15-35 years. At baseline, positively screened help-seeking participants (screenBD at-risk) were recruited at Early Detection Centers and in- and outpatient depression and attention-deficit/hyperactivity disorder (ADHD) settings, references (Ref) drawn from a representative cohort. Participants reported sociodemographics and medical history and were repeatedly examined regarding psychopathology and the course of risk factors. N = 1,083 screenBD at-risk and n = 172 Ref were eligible for baseline assessment. Within the first two years, n = 31 screenBD at-risk (2.9 %) and none of Ref developed a manifest BD. The cumulative transition risk was 0.0028 at the end of multistep assessment, 0.0169 at 12 and 0.0317 at 24 months (p = 0.021). The transition rate with a BD family history was 6.0 %, 4.7 % in the Early Phase Inventory for bipolar disorders (EPIbipolar), 6.6 % in the Bipolar Prodrome Interview and Symptom Scale-Prospective (BPSS-FP) and 3.2 % with extended Bipolar At-Risk - BARS criteria). In comparison to help-seeking young patients from psychosis detection services, transition rates in screenBD at-risk participants were lower. The findings of Early-BipoLife underscore the importance of considering risk factors beyond family history in order to improved early detection and interventions to prevent/ameliorate related impairment in the course of BD. Large long-term cohort studies are crucial to understand the developmental pathways and long-term course of BD, especially in people at- risk.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Kyra Luisa Bröckel
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital at Urban and Vivantes Hospital at Friedrichshain, Berlin, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Birgit Maicher
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Andreas J Fallgatter
- Tübingen Center for Mental Health (TüCMH), Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital at Urban and Vivantes Hospital at Friedrichshain, Berlin, Germany; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Silvia Biere
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic, Hospitals of Ruppin - Medical School Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department for Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Irina Falkenberg
- Department for Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Andreas Jansen
- Department for Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Christoph U Correll
- Department of Child- and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paolo Fusar-Poli
- EPIC Lab, Department of Psychosis Studies, King's College London, London, UK; Department of Brain and Behavioral Health Sciences, University of Pavia, Pavia, Italy
| | - Lisa Marie Hempel
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Pavol Mikolas
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany.
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Risk factors for new-onset bipolar disorder in a community cohort: A five-year follow up study. Psychiatry Res 2021; 303:114109. [PMID: 34284307 DOI: 10.1016/j.psychres.2021.114109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/15/2022]
Abstract
The aim of this study was to assess the risk factors for new-onset Bipolar Disorder (BD) in a community sample of young adults. This is a prospective cohort study including a population-based sample of young adults aged between 18-24 years. The baseline took place from 2007 to 2009, and 1560 subjects were included. Five years after, 1244 individuals were re-evaluated (79.7% retention). Substance abuse/dependence was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and mental disorders were assessed using the Mini International Neuropsychiatric Interview 5.0 (MINI) at both waves. The cumulative incidence of BD in five years was 4.6%. There was no significant association between sociodemographic factors and BD incidence. Tobacco, cannabis, cocaine/crack, other substances abuse/dependence increased the relative risk for BD. Depressive, anxiety, post-traumatic stress disorders, and the suicide risk increased the relative risk to BD. Depressive episode was the strongest risk factor for BD, followed by other mental disorders and substance abuse/dependence in a probabilistic community sample of young adults. Preventive actions in mental health directed at the non-clinical population are needed for early detection and better management of BD.
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Martini J, Leopold K, Pfeiffer S, Berndt C, Boehme A, Roessner V, Fusar-Poli P, Young AH, Correll CU, Bauer M, Pfennig A. Early detection of bipolar disorders and treatment recommendations for help-seeking adolescents and young adults: Findings of the Early Detection and Intervention Center Dresden. Int J Bipolar Disord 2021; 9:23. [PMID: 34215910 PMCID: PMC8253866 DOI: 10.1186/s40345-021-00227-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early identification and intervention of individuals with risk factors for or subtle prodromal symptoms of bipolar disorders (BD) may improve the illness course and prevent adverse long-term consequences. Methods We examined sociodemographic, clinical and psychopathological characteristics of help-seeking adolescents and young adults who consulted the Early Detection and Intervention Center Dresden at the University of Dresden (Germany) and presented with or without pre-defined at-risk criteria for BD. The standardized diagnostic procedure for all help-seeking youth included a comprehensive psychiatric history and a structured clinical interview. When BD at-risk state was suspected, early detection instruments (EPIbipolar, BPSS-FP) were applied. Treatment recommendations were formulated in multi-professional case conferences. Results Out of 890 help-seeking persons between 05/2009 and 04/2018, 582 (65%) completed the diagnostic process. Of these, 24 (4%) had manifest BD and 125 (21%) fulfilled at-risk BD criteria (age = 23.9 ± 0.6 years, female = 62%). Of the pre-defined main risk factors, family history for BD was reported in 22% of the at-risk persons, (hypo-)mania risk state in 44%, and increasing cyclothymic mood swings with increased activity in 48%. The most common secondary risk factors were decreased psychosocial functioning (78%), lifetime diagnosis of depressive disorder (67%) and specific sleep/circadian rhythm disturbances (59%). Substance use was very common in subjects at-risk for BD (cannabis = 50%, alcohol = 33%) and highest in patients with BD (cannabis = 75%, alcohol = 40%). Psychiatric treatment history, including psychopharmacological therapy, was similar between the groups, while treatment recommendations differed, with more advice for psychotherapy and antidepressants in the at-risk group with a lifetime diagnosis of depression and more advice for specialized BD treatment including mood stabilizers in patients with BD. Conclusion This analysis on the phenomenology of different BD at-risk stages suggests that early detection of individuals presenting with suggested risk factors for the development of BD is feasible in help-seeking young people. Future research should further develop/test stage-specific prevention and early targeted intervention approaches that were described in a naturalistic setting.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Boehme
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Veit Roessner
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Paolo Fusar-Poli
- Early Psychosis: Intervention and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Christoph U Correll
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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6
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Adorjan K, Schulze TG, Budde M, Heilbronner U, Tessema F, Mekonnen Z, Falkai P. [Neurogenetics of schizophrenia: findings from studies based on data sharing and global partnerships]. DER NERVENARZT 2021; 92:199-207. [PMID: 33439287 DOI: 10.1007/s00115-020-01052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
Schizophrenic psychoses are the result of a multifactorial process in which not only environmental influences but also genetic factors play an important role. These factors are based on a complex mode of inheritance that involves a large number of genetic variants. In the last three decades, biological psychiatric research has focused closely on molecular genetic aspects of the hereditary basis of schizophrenic psychoses. In particular, international consortia are combining cohorts from individual researchers, creating continuously increasing sample sizes and thus increased statistical power. As part of the Psychiatric Genomics Consortium (PGC), genome-wide association studies with tens of thousands of patients and controls have for the first time found robustly replicable markers for schizophrenic psychoses. Through intensive phenotyping, first approaches to a transdiagnostic clinical reclassification of severe mental illnesses have been established in the longitudinal PsyCourse study of the UMG Göttingen and the LMU Munich, allowing new biologically validated disease subgroups with prognostic value to be identified. For the first time environmental factors could even be examined in an African cohort that contribute to the development of the psychosis. In the coming years, the enormous technical progress in the area of genomic high-throughput technologies (next-generation sequencing) is expected to provide new knowledge not only about the influence of frequently occurring single nucleotide polymorphisms but also about rare variants. For the successful use of this technological revolution an exchange of data between research groups is essential.
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Affiliation(s)
- K Adorjan
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nussbaumstr. 7, 80336, München, Deutschland.
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland.
- Center for International Health (CIH), LMU Munich, München, Deutschland.
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - M Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - U Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - F Tessema
- Department of Epidemiology, Faculty of Public Health, Gilgel Gibe Filed Research Center, Jimma University, Jimma, Äthiopien
| | - Z Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Äthiopien
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nussbaumstr. 7, 80336, München, Deutschland
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7
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Rabelo-da-Ponte FD, Feiten JG, Mwangi B, Barros FC, Wehrmeister FC, Menezes AM, Kapczinski F, Passos IC, Kunz M. Early identification of bipolar disorder among young adults - a 22-year community birth cohort. Acta Psychiatr Scand 2020; 142:476-485. [PMID: 32936930 DOI: 10.1111/acps.13233] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We set forth to build a prediction model of individuals who would develop bipolar disorder (BD) using machine learning techniques in a large birth cohort. METHODS A total of 3748 subjects were studied at birth, 11, 15, 18, and 22 years of age in a community birth cohort. We used the elastic net algorithm with 10-fold cross-validation to predict which individuals would develop BD at endpoint (22 years) at each follow-up visit before diagnosis (from birth up to 18 years). Afterward, we used the best model to calculate the subgroups of subjects at higher and lower risk of developing BD and analyzed the clinical differences among them. RESULTS A total of 107 (2.8%) individuals within the cohort presented with BD type I, 26 (0.6%) with BD type II, and 87 (2.3%) with BD not otherwise specified. Frequency of female individuals was 58.82% (n = 150) in the BD sample and 53.02% (n = 1868) among the unaffected population. The model with variables assessed at the 18-year follow-up visit achieved the best performance: AUC 0.82 (CI 0.75-0.88), balanced accuracy 0.75, sensitivity 0.72, and specificity 0.77. The most important variables to detect BD at the 18-year follow-up visit were suicide risk, generalized anxiety disorder, parental physical abuse, and financial problems. Additionally, the high-risk subgroup of BD showed a high frequency of drug use and depressive symptoms. CONCLUSIONS We developed a risk calculator for BD incorporating both demographic and clinical variables from a 22-year birth cohort. Our findings support previous studies in high-risk samples showing the significance of suicide risk and generalized anxiety disorder prior to the onset of BD, and highlight the role of social factors and adverse life events.
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Affiliation(s)
- F D Rabelo-da-Ponte
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
| | - J G Feiten
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
| | - B Mwangi
- Department of Psychiatry & Behavioral Sciences, UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - F C Barros
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - F C Wehrmeister
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - A M Menezes
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - F Kapczinski
- National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - I C Passos
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
| | - M Kunz
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
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8
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Stamm TJ, Zwick JC, O'Malley G, Sondergeld LM, Hautzinger M. Adjuvant psychotherapy in early-stage bipolar disorder: study protocol for a randomized controlled trial. Trials 2020; 21:845. [PMID: 33050952 PMCID: PMC7552468 DOI: 10.1186/s13063-020-04755-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Bipolar disorders are serious illnesses with a chronic course and a high rate of relapse. Typically, bipolar disorders onset during adolescence or early adulthood, with patients experiencing significant personal and social costs as a consequence of their illness. Despite this, to date, there is limited (controlled) evidence regarding the effectiveness of psychotherapy during the critical stages of the disorder (e.g., early onset). Some preliminary studies suggest that targeted, tailored early interventions in particular may improve disease prognosis. The proposed study examines the effectiveness of group psychotherapy on relapse prevention, global adaptive functioning, and neuropsychological functioning in early-stage bipolar disorder. Methods In this multicenter randomized controlled trial (RCT), 300 patients with bipolar disorder are randomized to one of two group psychotherapies: Specific Emotional-Cognitive Therapy (SECT; intervention group) or Emotion-Focused Supportive Therapy (EFST; active control group). Each therapy comprises of a total of 48-h sessions (delivered once a month) over a period of 4 months. Assessments take place at baseline (t1); 6 months follow-up, i.e., post-intervention (t2); 12 months follow-up (t3); and 18 months follow-up (t4), whereby 18 months follow-up is the primary time point of interest. Discussion The goal of this study is to test the effects of an innovative, specific group therapy relative to an active control condition in terms of rates of relapse, global functioning, and neuropsychological functioning. Pending the outcomes of the trial, it will be possible to establish a firm evidence base for accessible group psychotherapy adjuvant to routine psychiatric care for individuals with bipolar disorder. Trial registration USA: ClinicalTrials.gov NCT02506322. Registered on 19 December 2014; Germany: German Clinical Trials Register DRKS00006013. Registered on21 May 2015
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Affiliation(s)
- Thomas J Stamm
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany. .,Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
| | - Julia C Zwick
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Grace O'Malley
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Lene-Marie Sondergeld
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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9
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Leopold K, Bauer M, Bechdolf A, Correll CU, Holtmann M, Juckel G, Lambert M, Meyer TD, Pfeiffer S, Kittel-Schneider S, Reif A, Stamm TJ, Rottmann-Wolf M, Mathiebe J, Kellmann EL, Ritter P, Krüger-Özgürdal S, Karow A, Sondergeld LM, Roessner V, Sauer C, Pfennig A. Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study. Bipolar Disord 2020; 22:517-529. [PMID: 32112496 DOI: 10.1111/bdi.12894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. METHOD In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. RESULTS Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. CONCLUSIONS Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University Cologne, Köln, Germany
| | - Christoph U Correll
- Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Psychiatry, Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Long Island, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr-University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, Houston, TX, USA
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Josephine Mathiebe
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva L Kellmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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10
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Pfennig A, Leopold K, Martini J, Boehme A, Lambert M, Stamm T, Bermpohl F, Reif A, Kittel-Schneider S, Juckel G, Fallgatter AJ, Kircher T, Jansen A, Pfeiffer S, Berndt C, Rottmann-Wolf M, Sauer C, Ritter P, Correll CU, Bechdolf A, Falkenberg I, Bauer M. Improving early recognition and intervention in people at increased risk for the development of bipolar disorder: study protocol of a prospective-longitudinal, naturalistic cohort study (Early-BipoLife). Int J Bipolar Disord 2020; 8:22. [PMID: 32607662 PMCID: PMC7326843 DOI: 10.1186/s40345-020-00183-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Bipolar disorders (BD) belong to the most severe mental disorders, characterized by an early onset and recurrent, severe episodes or a chronic course with poor psychosocial functioning in a proportion of patients. Many patients with BD experience substantial symptomatology months or even years before full BD manifestation. Adequate diagnosis and treatment is often delayed, which is associated with a worse outcome. This study aims to prospectively evaluate and improve early recognition and intervention strategies for persons at-risk for BD. Methods Early-BipoLife is a prospective-longitudinal cohort study of 1419 participants (aged 15–35 years) with at least five waves of assessment over a period of at least 2 years (baseline, 6, 12, 18 and 24 months). A research consortium of ten university and teaching hospitals across Germany conducts this study. The following risk groups (RGs) were recruited: RG I: help-seeking youth and young adults consulting early recognition centres/facilities presenting ≥ 1 of the proposed risk factors for BD, RG II: in-/outpatients with unipolar depressive syndrome, and RG III: in-/outpatients with attention-deficit/hyperactivity disorder (ADHD). The reference cohort was selected from the German representative IMAGEN cohort. Over the study period, the natural course of risk and resilience factors, early symptoms of BD and changes of symptom severity (including conversion to manifest BD) are observed. Psychometric properties of recently developed, structured instruments on potential risk factors for conversion to BD and subsyndromal symptomatology (Bipolar Prodrome Symptom Scale, Bipolar at-risk criteria, EPIbipolar) and biomarkers that potentially improve prediction are investigated. Moreover, actual treatment recommendations are monitored in the participating specialized services and compared to recently postulated clinical categorization and treatment guidance in the field of early BD. Discussion Findings from this study will contribute to an improved knowledge about the natural course of BD, from the onset of first noticeable symptoms (precursors) to fully developed BD, and about mechanisms of conversion from subthreshold to manifest BD. Moreover, these generated data will provide information for the development of evidence-based guidelines for early-targeted detection and preventive intervention for people at risk for BD.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Boehme
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Andreas J Fallgatter
- Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph U Correll
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, USA.,Department of Child- and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Mansur RB, Lee Y, McIntyre RS, Brietzke E. What is bipolar disorder? A disease model of dysregulated energy expenditure. Neurosci Biobehav Rev 2020; 113:529-545. [PMID: 32305381 DOI: 10.1016/j.neubiorev.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/30/2020] [Accepted: 04/05/2020] [Indexed: 12/24/2022]
Abstract
Advances in the understanding and management of bipolar disorder (BD) have been slow to emerge. Despite notable recent developments in neurosciences, our conceptualization of the nature of this mental disorder has not meaningfully progressed. One of the key reasons for this scenario is the continuing lack of a comprehensive disease model. Within the increasing complexity of modern research methods, there is a clear need for an overarching theoretical framework, in which findings are assimilated and predictions are generated. In this review and hypothesis article, we propose such a framework, one in which dysregulated energy expenditure is a primary, sufficient cause for BD. Our proposed model is centered on the disruption of the molecular and cellular network regulating energy production and expenditure, as well its potential secondary adaptations and compensatory mechanisms. We also focus on the putative longitudinal progression of this pathological process, considering its most likely periods for onset, such as critical periods that challenges energy homeostasis (e.g. neurodevelopment, social isolation), and the resulting short and long-term phenotypical manifestations.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Kingston General Hospital, Providence Care Hospital, Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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12
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Budde M, Anderson‐Schmidt H, Gade K, Reich‐Erkelenz D, Adorjan K, Kalman JL, Senner F, Papiol S, Andlauer TFM, Comes AL, Schulte EC, Klöhn‐Saghatolislam F, Gryaznova A, Hake M, Bartholdi K, Flatau L, Reitt M, Quast S, Stegmaier S, Meyers M, Emons B, Haußleiter IS, Juckel G, Nieratschker V, Dannlowski U, Schaupp SK, Schmauß M, Zimmermann J, Reimer J, Schulz S, Wiltfang J, Reininghaus E, Anghelescu I, Arolt V, Baune BT, Konrad C, Thiel A, Fallgatter AJ, Figge C, von Hagen M, Koller M, Lang FU, Wigand ME, Becker T, Jäger M, Dietrich DE, Stierl S, Scherk H, Spitzer C, Folkerts H, Witt SH, Degenhardt F, Forstner AJ, Rietschel M, Nöthen MM, Falkai P, Schulze TG, Heilbronner U. A longitudinal approach to biological psychiatric research: The PsyCourse study. Am J Med Genet B Neuropsychiatr Genet 2019; 180:89-102. [PMID: 30070057 PMCID: PMC6585634 DOI: 10.1002/ajmg.b.32639] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Abstract
In current diagnostic systems, schizophrenia and bipolar disorder are still conceptualized as distinct categorical entities. Recently, both clinical and genomic evidence have challenged this Kraepelinian dichotomy. There are only few longitudinal studies addressing potential overlaps between these conditions. Here, we present design and first results of the PsyCourse study (N = 891 individuals at baseline), an ongoing transdiagnostic study of the affective-to-psychotic continuum that combines longitudinal deep phenotyping and dimensional assessment of psychopathology with an extensive collection of biomaterial. To provide an initial characterization of the PsyCourse study sample, we compare two broad diagnostic groups defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification system, that is, predominantly affective (n = 367 individuals) versus predominantly psychotic disorders (n = 524 individuals). Depressive, manic, and psychotic symptoms as well as global functioning over time were contrasted using linear mixed models. Furthermore, we explored the effects of polygenic risk scores for schizophrenia on diagnostic group membership and addressed their effects on nonparticipation in follow-up visits. While phenotypic results confirmed expected differences in current psychotic symptoms and global functioning, both manic and depressive symptoms did not vary between both groups after correction for multiple testing. Polygenic risk scores for schizophrenia significantly explained part of the variability of diagnostic group. The PsyCourse study presents a unique resource to research the complex relationships of psychopathology and biology in severe mental disorders not confined to traditional diagnostic boundaries and is open for collaborations.
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Affiliation(s)
- Monika Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
| | - Heike Anderson‐Schmidt
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Medical Center GoettingenGoettingenGermany
| | - Katrin Gade
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Medical Center GoettingenGoettingenGermany
| | - Daniela Reich‐Erkelenz
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany
| | - Janos L. Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany,International Max Planck Research School for Translational PsychiatryMax Planck Institute of PsychiatryMunichGermany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany
| | - Till F. M. Andlauer
- Department of Translational PsychiatryMax Planck Institute of PsychiatryMunichGermany
| | - Ashley L. Comes
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,International Max Planck Research School for Translational PsychiatryMax Planck Institute of PsychiatryMunichGermany
| | - Eva C. Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany
| | - Farah Klöhn‐Saghatolislam
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany
| | - Anna Gryaznova
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
| | - Maria Hake
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
| | - Kim Bartholdi
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
| | - Laura Flatau
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
| | - Markus Reitt
- Department of Psychiatry and PsychotherapyUniversity Medical Center GoettingenGoettingenGermany
| | - Silke Quast
- Department of Psychiatry and PsychotherapyUniversity Medical Center GoettingenGoettingenGermany
| | - Sophia Stegmaier
- Department of Psychiatry and PsychotherapyUniversity of TübingenTübingenGermany
| | - Milena Meyers
- Department of PsychiatryRuhr University Bochum, LWL University HospitalBochumGermany
| | - Barbara Emons
- Department of PsychiatryRuhr University Bochum, LWL University HospitalBochumGermany
| | | | - Georg Juckel
- Department of PsychiatryRuhr University Bochum, LWL University HospitalBochumGermany
| | | | - Udo Dannlowski
- Department of PsychiatryUniversity of MünsterMünsterGermany
| | - Sabrina K. Schaupp
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyBezirkskrankenhaus AugsburgAugsburgGermany
| | - Max Schmauß
- Department of Psychiatry and PsychotherapyBezirkskrankenhaus AugsburgAugsburgGermany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl‐Jaspers‐KlinikBad ZwischenahnGermany
| | - Jens Reimer
- Department of PsychiatryKlinikum Bremen‐OstBremenGermany
| | - Sybille Schulz
- Department of PsychiatryKlinikum Bremen‐OstBremenGermany
| | - Jens Wiltfang
- Department of Psychiatry and PsychotherapyUniversity Medical Center GoettingenGoettingenGermany,German Center for Neurodegenerative Diseases (DZNE)GoettingenGermany,iBiMED, Medical Sciences DepartmentUniversity of AveiroAveiroPortugal
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic MedicineResearch Unit for Bipolar Affective Disorder, Medical University of GrazGrazAustria
| | | | - Volker Arolt
- Department of PsychiatryUniversity of MünsterMünsterGermany
| | - Bernhard T. Baune
- Discipline of Psychiatry, Royal Adelaide HospitalAdelaide Medical School, The University of AdelaideAdelaideAustralia
| | - Carsten Konrad
- Department of Psychiatry and PsychotherapyAgaplesion DiakonieklinikumRotenburgGermany
| | - Andreas Thiel
- Department of Psychiatry and PsychotherapyAgaplesion DiakonieklinikumRotenburgGermany
| | | | - Christian Figge
- Karl‐Jaspers Clinic, European Medical School Oldenburg‐GroningenOldenburgGermany
| | - Martin von Hagen
- Clinic for Psychiatry and PsychotherapyClinical Center Werra‐MeißnerEschwegeGermany
| | | | - Fabian U. Lang
- Department of Psychiatry IIUlm University, Bezirkskrankenhaus GünzburgGünzburgGermany
| | - Moritz E. Wigand
- Department of Psychiatry IIUlm University, Bezirkskrankenhaus GünzburgGünzburgGermany
| | - Thomas Becker
- Department of Psychiatry IIUlm University, Bezirkskrankenhaus GünzburgGünzburgGermany
| | - Markus Jäger
- Department of Psychiatry IIUlm University, Bezirkskrankenhaus GünzburgGünzburgGermany
| | - Detlef E. Dietrich
- AMEOS Clinical Center HildesheimHildesheimGermany,Center for Systems Neuroscience (ZSN)HannoverGermany,Present address:
Burghof‐Klinik RintelnRintelnGermany
| | | | | | | | - Here Folkerts
- Department of Psychiatry, Psychotherapy and PsychosomaticsClinical Center WilhelmshavenWilhelmshavenGermany
| | - Stephanie H. Witt
- Department of Genetic Epidemiology in PsychiatryCentral Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheimGermany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital BonnBonnGermany,Department of GenomicsLife & Brain Center, University of BonnBonnGermany
| | - Andreas J. Forstner
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital BonnBonnGermany,Department of GenomicsLife & Brain Center, University of BonnBonnGermany,Human Genomics Research Group, Department of BiomedicineUniversity of BaselBaselSwitzerland,Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - Marcella Rietschel
- Department of Genetic Epidemiology in PsychiatryCentral Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheimGermany
| | - Markus M. Nöthen
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital BonnBonnGermany,Department of GenomicsLife & Brain Center, University of BonnBonnGermany
| | - Peter Falkai
- Department of Psychiatry and PsychotherapyUniversity Hospital, LMU MunichMunichGermany
| | - Thomas G. Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany,Department of Psychiatry and PsychotherapyUniversity Medical Center GoettingenGoettingenGermany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG)University Hospital, LMU MunichMunichGermany
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13
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Wang Y, Zhong S, Chen G, Liu T, Zhao L, Sun Y, Jia Y, Huang L. Altered cerebellar functional connectivity in remitted bipolar disorder: A resting-state functional magnetic resonance imaging study. Aust N Z J Psychiatry 2018; 52:962-971. [PMID: 29232968 DOI: 10.1177/0004867417745996] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Several recent studies have reported a strong association between the cerebellar structural and functional abnormalities and psychiatric disorders. However, there are no studies to investigate possible changes in cerebellar functional connectivity in bipolar disorder. This study aimed to examine the whole-brain functional connectivity pattern of patients with remitted bipolar disorder II, in particular in the cerebellum. METHODS A total of 25 patients with remitted bipolar disorder II and 25 controls underwent resting-state functional magnetic resonance imaging and neuropsychological tests. Voxel-wise whole-brain connectivity was analyzed using a graph theory approach: functional connectivity strength. A seed-based resting-state functional connectivity analysis was further performed to investigate abnormal functional connectivity pattern of those regions with changed functional connectivity strength. RESULTS Remitted bipolar disorder II patients had significantly decreased functional connectivity strength in the bilateral posterior lobes of cerebellum (mainly lobules VIIb/VIIIa). The seed-based functional connectivity analyses revealed decreased functional connectivity between the right posterior cerebellum and the default mode network (i.e. right posterior cingulate cortex/precuneus and right superior temporal gyrus), bilateral hippocampus, right putamen, left paracentral lobule and bilateral posterior cerebellum and decreased functional connectivity between the left posterior cerebellum and the right inferior parietal lobule and bilateral posterior cerebellum in patients with remitted bipolar disorder II. CONCLUSION Our results suggest that cerebellar dysconnectivity, in particular distributed cerebellar-cerebral functional connectivity, might be associated with the pathogenesis of bipolar disorder.
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Affiliation(s)
- Ying Wang
- 1 Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,2 Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shuming Zhong
- 3 Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guanmao Chen
- 1 Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tao Liu
- 3 Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China.,4 The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Lianping Zhao
- 1 Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yao Sun
- 2 Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Yanbin Jia
- 3 Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li Huang
- 2 Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
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14
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Rote J, Dingelstadt AML, Aigner A, Bauer M, Fiebig J, König B, Kunze J, Pfeiffer S, Pfennig A, Quinlivan E, Simhandl C, Stamm TJ. Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach. Aust N Z J Psychiatry 2018; 52:876-886. [PMID: 29969910 DOI: 10.1177/0004867418783062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bipolar disorder is a common, severe and chronic mental illness. Despite this, predictors of illness severity remain poorly understood. Impulsivity is reported to be associated with bipolar disorder and aggravating comorbidities. This study therefore sought to examine the predictive value of impulsivity for determining illness severity in euthymic bipolar disorder patients. METHODS Baseline trait impulsivity of 120 bipolar euthymic patients (81 bipolar disorder I [68%], 80 female [67%]) and 51 healthy controls was assessed using Barratt Impulsiveness Scale 11. The impact of impulsivity on illness severity (measured with morbidity index) was prospectively tested in 97 patients with sufficient follow-up data (average observation time: 54.4 weeks), using linear regression analysis. RESULTS Barratt Impulsiveness Scale 11 total (β = 0.01; p < 0.01) and in particular Barratt Impulsiveness Scale 11 attentional subscale scores (β = 0.04; p < 0.001) predicted illness severity in bipolar disorder, while controlling for other clinical variables. Only age at onset persisted as an additional, but less influential predictor. Barratt Impulsiveness Scale 11 total scores and Barratt Impulsiveness Scale 11 attentional subscale scores were significantly higher in euthymic patients compared to controls. This was not observed for the motor or non-planning subscale scores. LIMITATIONS The average year-long observation time might not be long enough to account for the chronic course of bipolar disorder. CONCLUSION Trait impulsivity and particularly attentional impulsivity in euthymic bipolar patients can be strong predictors of illness severity in bipolar disorder. Future studies should explore impulsivity as a risk assessment for morbidity and as a therapeutic target in bipolar disorder patients.
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Affiliation(s)
- Jonas Rote
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Alice-Mai-Ly Dingelstadt
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Annette Aigner
- 3 Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Bauer
- 2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jana Fiebig
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,4 Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Barbara König
- 5 Department of Psychiatry and Psychotherapy, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | | | - Steffi Pfeiffer
- 2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- 2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Esther Quinlivan
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Simhandl
- 7 Bipolar Center Wiener Neustadt, Vienna, Austria.,8 Sigmund Freud Privatuniversität Wien, Vienna, Austria
| | - Thomas J Stamm
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,4 Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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15
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Ritter PS, Schwabedal J, Brandt M, Schrempf W, Brezan F, Krupka A, Sauer C, Pfennig A, Bauer M, Soltmann B, Nikitin E. Sleep spindles in bipolar disorder - a comparison to healthy control subjects. Acta Psychiatr Scand 2018; 138:163-172. [PMID: 29974456 DOI: 10.1111/acps.12924] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Bipolar disorder is a severe mental disorder for which currently no reliable biomarkers exist. It has been shown that patients with schizophrenia but not with unipolar depression have a reduced density of fast sleep spindles during N2 sleep. The aim of this study was to assess fast sleep spindle density in euthymic patients with bipolar disorder. METHODS Patients with bipolar disorder (n = 24) and healthy control subjects (n = 25) were assessed using all-night polysomnography. Sleep spindles within stage N2 sleep were identified by visual inspection and subdivided into fast (>13 Hz) and slow (≤13 Hz) spindles. All spindles were subsequently characterised by density, frequency, amplitude, duration and coherence. RESULTS Euthymic patients with bipolar disorder were found to have a reduced density and a lower mean frequency of fast spindles. Slow spindle density and frequency did not differ between groups. There were no differences regarding amplitude, duration or coherence. CONCLUSIONS A reduction in fast spindle density during N2 sleep points towards thalamic dysfunction as a potential neurobiological mechanism of relevance in bipolar disorder. In addition, a reduced sleep spindle density could be interpreted as a common endophenotype shared with schizophrenia but not unipolar depression and may - if replicated - be of utility in early recognition and risk stratification.
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Affiliation(s)
- P S Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Schwabedal
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - M Brandt
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - W Schrempf
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - F Brezan
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - A Krupka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Sauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - B Soltmann
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - E Nikitin
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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16
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Gitlin MJ. Diagnosing latent bipolar disorder: A clinical dilemma. Bipolar Disord 2018; 20:300-302. [PMID: 29635771 DOI: 10.1111/bdi.12648] [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: 11/29/2022]
Affiliation(s)
- Michael J Gitlin
- Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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17
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18
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Kessing LV. The need for prospective longitudinal cohort studies on the psychopathology and biology early in bipolar disorder: A commentary to the review by Pfennig et al. Aust N Z J Psychiatry 2018; 52:88-89. [PMID: 28673100 DOI: 10.1177/0004867417717799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lars Vedel Kessing
- 1 Psychiatric Center Copenhagen, Department O and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,2 Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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