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Rai S, Griffiths KR, Breukelaar IA, Barreiros AR, Boyce P, Hazell P, Foster SL, Malhi GS, Harris AWF, Korgaonkar MS. Common and differential neural mechanisms underlying mood disorders. Bipolar Disord 2022; 24:795-805. [PMID: 35972439 DOI: 10.1111/bdi.13248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite homogenous clinical presentations between bipolar and unipolar disorders, there are distinct neurobiological differences. Chronicity of illness may be a factor impacting and sustaining certain neural features. The goal of this study was to investigate common and shared neural mechanisms underlying mood disorders, and possible sustained neural changes relating to illness chronicity by investigating a cohort of euthymic patients with bipolar disorder (BD), unipolar depression who had responded to treatment (treatment-sensitive depression, TSD), and a chronically treatment-resistant depressed (TRD) group. METHODS One hundred and seventy-two participants (40 BD, 39 TSD, 40 TRD, and 53 age-gender-matched healthy controls) underwent resting-state fMRI scans. Seed-based and independent component analyses were performed to investigate group differences in resting-state connectivity between the four groups. RESULTS All three clinical groups had significantly lower connectivity within the frontoparietal network (FPN) relative to controls. TRD and BD were significantly different from TSD (TRD, BD > TSD) but were not significantly different from each other. TRDs were also significantly different from both BD and TSD for salience network connectivity with the posterior cingulate (DMN) and the FPN with frontal pole (DMN). Additionally, the BD group exhibited greater DMN-FPN (sgACC-RDLPFC) connectivity relative to TRD, TSD, and controls, which was correlated with a previous number of depressive episodes, in the BD group only. CONCLUSIONS BD demonstrated shared and differential connectivity features relative to symptomatic TRD and euthymic TSD groups. The increased sgACC-RDLPFC connectivity in BD and its correlation with a number of depressive episodes could be a neural feature associated with illness chronicity.
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Affiliation(s)
- Sabina Rai
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ana R Barreiros
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Boyce
- Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Philip Hazell
- Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Sheryl L Foster
- Department of Radiology, Westmead Hospital, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Gin S Malhi
- Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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2
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Marwaha S, Hett D, Johnson S, Fowler D, Hodgekins J, Freemantle N, McCrone P, Everard L, Jones P, Amos T, Singh S, Sharma V, Birchwood M. The impact of manic symptoms in first-episode psychosis: Findings from the UK National EDEN study. Acta Psychiatr Scand 2021; 144:358-367. [PMID: 33864251 DOI: 10.1111/acps.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The extant literature is inconsistent over whether manic symptoms in first-episode psychosis (FEP) impact on its development and trajectory. This study addressed the following: (1) Does Duration of Untreated Illness (DUI) and Duration of Untreated Psychosis (DUP) differ between FEP patients with and without manic symptoms? (2) Do manic symptoms in FEP have an impact on time to remission over 1 year? METHODS We used data from the National EDEN study, a longitudinal cohort of patients with FEP accessing early intervention services (EIS) in England, which measured manic, positive and negative psychotic symptoms, depression and functioning at service entry and 1 year. Data from 913 patients with FEP (639 without manic symptoms, 237 with manic symptoms) were analysed using both general linear modelling and survival analysis. RESULTS Compared to FEP patients without manic symptoms, those with manic symptoms had a significantly longer DUI, though no difference in DUP. At baseline, people with manic symptoms had higher levels of positive and negative psychotic symptoms, depression and worse functioning. At 12 months, people with manic symptoms had significantly poorer functioning and more positive psychotic symptoms. The presence of manic symptoms delayed time to remission over 1 year. There was a 19% reduced rate of remission for people with manic symptoms compared to those without. CONCLUSIONS Manic symptoms in FEP are associated with delays to treatment. This poorer trajectory persists over 1 year. They appear to be a vulnerable and under-recognised group for poor outcome and need more focussed early intervention treatment.
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Affiliation(s)
- Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | - Danielle Hett
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Linda Everard
- National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | | | - Tim Amos
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Swaran Singh
- Mental Health and Well-being, University of Warwick Medical School, Warwick University, Coventry, UK
| | | | - Max Birchwood
- Mental Health and Well-being, University of Warwick Medical School, Warwick University, Coventry, UK
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3
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Fatt SJ, Mond J, Bussey K, Griffiths S, Murray SB, Lonergan A, Hay P, Pike K, Trompeter N, Mitchison D. Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder. Early Interv Psychiatry 2021; 15:577-584. [PMID: 32426938 DOI: 10.1111/eip.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/15/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
AIM Many adolescents who meet diagnostic criteria for an eating disorder do not self-identify as having a problem and may consequently be less likely to seek help. Extant research investigating self-identification has been limited to specific populations (ie, girls meeting criteria for bulimic-type eating disorders). This study investigated how self-identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self-identification was related to help-seeking in adolescents. METHODS Participants included 1002 Australian school students (75.5% female, Mage = 15.14 years, SD = 1.40) who met DSM-5 diagnostic criteria for an eating disorder. An online survey assessed self-identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help-seeking for a body image problem, and other potential correlates of self-identification (demographics, psychological distress, social function, weight and shape concerns). RESULTS Approximately, 2 in 3 adolescents with an eating disorder self-identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self-identify. When adjusting for covariates, only sex remained significantly associated with self-identification. Adolescents who self-identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates. CONCLUSIONS Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered.
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Affiliation(s)
- Scott J Fatt
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathleen Pike
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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4
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Martin-Key NA, Olmert T, Barton-Owen G, Han SYS, Cooper JD, Eljasz P, Farrag LP, Friend LV, Bell E, Cowell D, Tomasik J, Bahn S. The Delta Study - Prevalence and characteristics of mood disorders in 924 individuals with low mood: Results of the of the World Health Organization Composite International Diagnostic Interview (CIDI). Brain Behav 2021; 11:e02167. [PMID: 33960714 PMCID: PMC8213940 DOI: 10.1002/brb3.2167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The Delta Study was undertaken to improve the diagnosis of mood disorders in individuals presenting with low mood. The current study aimed to estimate the prevalence and explore the characteristics of mood disorders in participants of the Delta Study, and discuss their implications for clinical practice. METHODS Individuals with low mood (Patients Health Questionnaire-9 score ≥5) and either no previous mood disorder diagnosis (baseline low mood group, n = 429), a recent (≤5 years) clinical diagnosis of MDD (baseline MDD group, n = 441) or a previous clinical diagnosis of BD (established BD group, n = 54), were recruited online. Self-reported demographic and clinical data were collected through an extensive online mental health questionnaire and mood disorder diagnoses were determined with the World Health Organization Composite International Diagnostic Interview (CIDI). RESULTS The prevalence of BD and MDD in the baseline low mood group was 24% and 36%, respectively. The prevalence of BD among individuals with a recent diagnosis of MDD was 31%. Participants with BD in both baseline low mood and baseline MDD groups were characterized by a younger age at onset of the first low mood episode, more severe depressive symptoms and lower wellbeing, relative to the MDD or low mood groups. Approximately half the individuals with BD diagnosed as MDD (49%) had experienced (hypo)manic symptoms prior to being diagnosed with MDD. CONCLUSIONS The current results confirm high under- and misdiagnosis rates of mood disorders in individuals presenting with low mood, potentially leading to worsening of symptoms and decreased well-being, and indicate the need for improved mental health triage in primary care.
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Affiliation(s)
- Nayra A Martin-Key
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Tony Olmert
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | | | - Sung Yeon Sarah Han
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Jason D Cooper
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Pawel Eljasz
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK.,Psyomics Ltd, Cambridge, UK
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5
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Rai S, Griffiths K, Breukelaar IA, Barreiros AR, Chen W, Boyce P, Hazell P, Foster S, Malhi GS, Bryant RA, Harris AWF, Korgaonkar MS. Investigating neural circuits of emotion regulation to distinguish euthymic patients with bipolar disorder and major depressive disorder. Bipolar Disord 2021; 23:284-294. [PMID: 33369067 DOI: 10.1111/bdi.13042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/20/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder (BD) are initially diagnosed as having major depressive disorder (MDD), and emotional lability is a key aspect of both sets of mood disorders. However, it remains unknown whether differences in the regulation of emotions through cognitive reappraisal may serve to distinguish BD and MDD. Therefore, we examined this question in euthymic BD and MDD patients. METHODS Thirty-eight euthymic BD, 33 euthymic MDD and 37 healthy control (HC) participants, matched for age, gender and depression severity, engaged in an emotion regulation (ER) cognitive reappraisal task during an fMRI scan were examined. Participants either reappraised (Think condition) or passively watched negative (Watch condition) or neutral (Neutral condition) pictures and rated their affect. Activation and connectivity analyses were used to examine group differences in reappraisal (Think vs Watch) and reactivity (Watch vs Neutral) conditions in ER-specific neural circuits. RESULTS Irrespective of group, participants rated most negatively the images during the Watch condition relative to Think and Neutral conditions, and more negatively to Think relative to Neutral. Notably, BD participants exhibited reduced subgenual anterior cingulate activation (sgACC) relative to MDD during reappraisal, but exhibited greater sgACC activation relative to MDD during reactivity, whereas MDD participants elicited greater activation in right amygdala relative to BD during reactivity. We found no group differences in task-related connectivity. CONCLUSIONS Euthymic BD and MDD patients engage differential brain regions to process and regulate emotional information. These differences could serve to distinguish the clinical groups and provide novel insights into the underlying pathophysiology of BD.
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Affiliation(s)
- Sabina Rai
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Kristi Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Ana R Barreiros
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Wenting Chen
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Westmead, NSW, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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6
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Drange OK, Sæther SG, Finseth PI, Morken G, Vaaler AE, Arntsen V, Henning O, Andreassen OA, Elvsåshagen T, Malt UF, Bøen E. Differences in course of illness between patients with bipolar II disorder with and without epileptiform discharges or other sharp activity on electroencephalograms: a cross-sectional study. BMC Psychiatry 2020; 20:582. [PMID: 33287748 PMCID: PMC7720555 DOI: 10.1186/s12888-020-02968-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A diagnosis of bipolar II disorder requires that the symptoms cannot be better explained by a medical condition. Epilepsy is in some cases associated with an affective syndrome mimicking an unstable bipolar II disorder. Epileptiform discharges on electroencephalograms (EEGs) are typical, but not pathognomonic, for epilepsy. A previous study has found a high frequency of epileptiform discharges and other sharp activity among patients with bipolar disorder. The aim of the study was to identify if epileptic discharges or other sharp activity per se are associated with an altered course of illness among patients with bipolar II disorder. METHODS Eighty six patients diagnosed with bipolar II disorder at two psychiatric departments were interviewed about prior course of illness and assessed with EEGs. The patients were split into two groups based on the presence (n = 12) or absence (n = 74) of epileptiform discharges or other sharp activity. Wilcoxon rank sum test, Fisher's exact test, and Pearson's chi squared test were used to assess differences between the groups on six variables of course of illness. RESULTS Patients with epileptiform discharges or other sharp activity had a history of more hypomanic episodes per year (median (interquartile range (IQR)) 1.5 (3.2) vs. 0.61 (1.1), p = 0.0090) and a higher hypomania:depression ratio (median (IQR) 3.2 (16) vs. 1.0 (1.0), p = 0.00091) as compared to patients without. None of the patients with epileptiform discharges or other sharp activity had self-reported epileptic seizures in their history. CONCLUSIONS Epileptiform discharges or other sharp activity on EEGs are associated with more hypomanic episodes and an increased hypomania:depression ratio. Our results warrant replication in prospective studies, but suggest that EEG findings could be of prognostic importance for patients diagnosed with bipolar II disorder in psychiatric care. TRIAL REGISTRATION ClinicalTrials.gov ( NCT00201526 ).
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Affiliation(s)
- O K Drange
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
- Division of Mental Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - S G Sæther
- Division of Mental Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - P I Finseth
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - G Morken
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - V Arntsen
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - O Henning
- National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - O A Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - T Elvsåshagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - U F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - E Bøen
- Psychosomatic and CL Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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7
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Meyer TD, Crist N, La Rosa N, Ye B, Soares JC, Bauer IE. Are existing self-ratings of acute manic symptoms in adults reliable and valid?-A systematic review. Bipolar Disord 2020; 22:558-568. [PMID: 32232950 DOI: 10.1111/bdi.12906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Depression research historically uses both self- and clinician ratings of symptoms with significant and substantial correlations. It is often assumed that manic patients lack insight and cannot accurately report their symptoms. This delayed the development of self-rating scales for mania, but several scales now exist and are used in research. Our objective is to systematically review the literature to identify existing self-ratings of symptoms of (hypo)mania and to evaluate their psychometric properties. METHODS PubMed, Web of Knowledge, and Ovid were searched up until June 2018 using the keywords: "(hypo)mania," "self-report," and "mood disorder" to identify papers which included data on the validity and reliability of self-rating scales for (hypo)mania in samples including patients with bipolar disorder. RESULTS We identified 55 papers reporting on 16 different self-rating scales claiming to assess (hypo)manic symptoms or states. This included single item scales, but also some with over 40 items. Three of the scales, the Internal State Scale (ISS), Altman Self-Rating Mania Scale (ASRM), and Self-Report Manic Inventory (SRMI), provided data about reliability and/or validity in more than three independent studies. Validity was mostly assessed by comparing group means from individuals in different mood states and sometimes by correlation to clinician ratings of mania. CONCLUSIONS ASRM, ISS, and SRMI are promising self-rating tools for (hypo)mania to be used in clinical contexts. Future studies are, however, needed to further validate these measures; for example, their associations between each other and sensitivity to change, especially if they are meant to be outcome measures in studies.
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Affiliation(s)
- Thomas D Meyer
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Nicholas Crist
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Nikki La Rosa
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.,Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Biyu Ye
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jair C Soares
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Isabelle E Bauer
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
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8
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Lin ECL, Weintraub MJ, Miklowitz DJ, Chen PS, Lee SK, Chen HC, Lu RB. The associations between illness perceptions and social rhythm stability on mood symptoms among patients with bipolar disorder. J Affect Disord 2020; 273:517-523. [PMID: 32560948 PMCID: PMC9012307 DOI: 10.1016/j.jad.2020.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 04/01/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The association between illness perceptions and the effectiveness of patients' illness-management strategies has been supported across a range of medical and psychiatric disorders. Few studies have examined these variables or their association in bipolar disorder (BD). This study examined the main and interactive associations between illness perceptions and one important illness management strategy - social rhythms stability on mood symptom severity in adults with BD. METHODS A cross-sectional study with 131 patients with BD in Taiwan was conducted using clinician- and patient-rated mood symptoms, self-reported illness perceptions, and a measure of daily and nightly social rhythms. RESULTS Illness perceptions were associated with mood symptom severity, but social rhythms were not. Unfavorable illness perceptions (e.g., beliefs of experiencing more BD symptoms, having stronger emotional responses to the illness) were associated with more severe mood symptoms. Favorable illness perceptions (e.g., beliefs of being able to understand and control the illness) were associated with less severe mood symptoms, with personal control as the strongest correlate of mood symptom severity. Finally, social rhythm stability moderated the relationship between unfavorable illness perceptions and clinician-rated manic symptoms. LIMITATIONS The cross-sectional design limits our ability to make causal conclusions. Also, the effects pertain to patients in remission and may not generalize to more severely ill or hospitalized bipolar patients. CONCLUSIONS This study indicates that in patients with BD, illness perceptions are associated with symptom severity. Interventions to enhance favorable IPs and reduce unfavorable IPs may improve mood outcomes, particularly when patients have adopted regular social rhythms.
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Affiliation(s)
- Esther Ching-Lan Lin
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Taiwan.
| | - Marc J Weintraub
- Department of Psychiatry and Behavioral Sciences, UCLA Semel Institute, University of California, Los Angeles, CA, USA
| | - David J Miklowitz
- Department of Psychiatry and Behavioral Sciences, UCLA Semel Institute, University of California, Los Angeles, CA, USA
| | - Po-See Chen
- Department of Psychiatry, College of Medicine, National Cheng Kung University and Hospital, Taiwan
| | - Shih-Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Tsaotun Township, Nantou County 542, Taiwan
| | - Hsin-Chi Chen
- Department of Nursing, National Cheng Kung University and Hospital, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, College of Medicine, National Cheng Kung University and Hospital, Taiwan
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9
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Bipolar spectrum in major depressive disorders. Eur Arch Psychiatry Clin Neurosci 2018; 268:741-748. [PMID: 30032467 DOI: 10.1007/s00406-018-0927-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/16/2018] [Indexed: 01/23/2023]
Abstract
Growing evidence for the spectrum concept of most mental disorders, particularly mood disorders, has challenged the arbitrary distinctions inherent in the contemporary categorical diagnostic classification system. Detection of manic symptoms in the context of episodes of depression is particularly important because of the implications for differential treatment of bipolar vs unipolar depression. The purpose of this study is to characterize the magnitude and clinical correlates of subthreshold manic syndromes or symptoms among people with major depressive disorder (MDD) compared to those without a history of manic symptoms. We defined two subthreshold manifestations-manic syndrome or symptoms-that did not include a criterion for duration. In the context of MDD, we found that the clinical correlates of those with the subthreshold manic syndrome were more similar to those with bipolar-II disorder than to MDD alone, whereas those with manic symptoms only were intermediate between those with subthreshold manic syndrome and MDD alone. These results confirm the spectrum concept of mania and suggest that a manic syndrome should be considered when evaluating people with MDD.
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10
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Validation of the Bipolar Spectrum Diagnostic Scale in Mexican Psychiatric Patients. THE SPANISH JOURNAL OF PSYCHOLOGY 2018; 21:E60. [PMID: 30477597 DOI: 10.1017/sjp.2018.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The Bipolar Spectrum Diagnostic Scale (BSDS) is widely validated and used as a screening tool for bipolar disorder. However, there is no BSDS validated version for its use in Mexican population. The aim of the present study was to examine the BSDS diagnostic capacity, and to evaluate its criterion validity and internal consistency for its use in Mexican psychiatric patients. We recruited 200 patients who attended the psychiatric outpatient service of a Mental Health Specialized Hospital and were screened for bipolar disorder using BSDS. To determine the cut-off point, sensitivity and specificity, we used the SCID-I diagnosis as the gold standard in 100 participants with bipolar disorder and 100 with major depression. Internal consistency according to Cronbach's coefficient alpha was .81. The area under ROC curve for the overall discriminability of BSDS against the criterion of SCID-I for bipolar disorder was .90. Finally, a cut-off value of 12 reached the most stable sensitivity and specificity, with predictive powers higher than .80. In conclusion, the properties of the scale including internal consistency, sensitivity and specificity, make of BSDS a valuable instrument for screening bipolar disorder in Mexican psychiatric population.
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van den Heuvel S, Goossens P, Terlouw C, Schoonhoven L, van Achterberg T. Informal Caregivers' Learning Experiences With Self-Management Support of Individuals Living With Bipolar Disorder: A Phenomenological Study. J Am Psychiatr Nurses Assoc 2018; 24:531-541. [PMID: 29313419 DOI: 10.1177/1078390317752864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The degree of informal caregiver involvement influences the self-management of individuals living with bipolar disorder (BD). OBJECTIVE This article aims to provide a description of informal caregivers' learning experiences in self-management support of BD in order to guide professionals in tailoring future psychosocial and psychoeducational interventions. DESIGN In-depth open interviews with 10 informal caregivers of patients with BD who followed treatment in the context of specialized outpatient bipolar care were conducted. RESULTS Four learning phases emerged from the phenomenological analysis describing the informal caregivers learning process: (1) understanding BD, (2) overcoming the dilemmas in self-management support for individuals living with BD, (3) dividing tasks and responsibilities, and (4) acquiring a personal definition of self-management support for individuals living with BD. CONCLUSION By grasping the concept of BD, informal caregivers gradually learn how to overcome dilemmas resulting from living with someone with BD, and how to control the expression of emotions. They learn to reflect on the nature of conflicts and how to share the responsibilities of illness management with individuals living with BD and professionals. Mastering these skills eventually allows them to define and delimit their supporting informal caregiver role in the self-management of BD. PRACTICE IMPLICATIONS Our findings provide information regarding the educational needs of informal caregivers to tailor counseling, and psychosocial and psychoeducational interventions in specialized outpatient care for individuals living with BD.
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Affiliation(s)
- Silvio van den Heuvel
- 1 Silvio van den Heuvel, MA, RN, Saxion University of Applied Sciences, Deventer, Netherlands; Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands; Dimence Group, Deventer, Netherlands; KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Peter Goossens
- 2 Peter Goossens, PhD, MANP, RN, FEANS, Dimence, Institute for Mental Healthcare, Deventer, Netherlands; Radboud Institute for Health Sciences, Nijmegen, Netherlands; Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, Netherlands; Ghent University, University Centre of Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Services, Ghent, Belgium
| | - Cees Terlouw
- 3 Cees Terlouw, PhD, Saxion University of Applied Sciences, Deventer, Netherlands
| | - Lisette Schoonhoven
- 4 Lisette Schoonhoven, PhD, RN, FEANS, University of Southampton, Southampton, UK
| | - Theo van Achterberg
- 5 Theo van Achterberg, PhD, RN, FEANS, KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium; Radboud Institute for Health Sciences, Nijmegen, Netherlands; Uppsala University, Uppsala, Sweden
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Bowen R, Peters E, Marwaha S, Baetz M, Balbuena L. Moods in Clinical Depression Are More Unstable than Severe Normal Sadness. Front Psychiatry 2017; 8:56. [PMID: 28446884 PMCID: PMC5388683 DOI: 10.3389/fpsyt.2017.00056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/29/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Current descriptions in psychiatry and psychology suggest that depressed mood in clinical depression is similar to mild sadness experienced in everyday life, but more intense and persistent. We evaluated this concept using measures of average mood and mood instability (MI). METHOD We prospectively measured low and high moods using separate visual analog scales twice a day for seven consecutive days in 137 participants from four published studies. Participants were divided into a non-depressed group with a Beck Depression Inventory score of ≤10 (n = 59) and a depressed group with a Beck Depression Inventory score of ≥18 (n = 78). MI was determined by the mean square successive difference statistic. RESULTS Mean low and high moods were not correlated in the non-depressed group but were strongly positively correlated in the depressed group. This difference between correlations was significant. Low MI and high MI were weakly positively correlated in the non-depressed group and strongly positively correlated in the depressed group. This difference in correlations was also significant. CONCLUSION The results show that low and high moods, and low and high MI, are highly correlated in people with depression compared with those who are not depressed. Current psychiatric practice does not assess or treat MI or brief high mood episodes in patients with depression. New models of mood that also focus on MI will need to be developed to address the pattern of mood disturbance in people with depression.
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Affiliation(s)
- Rudy Bowen
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Evyn Peters
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK.,Affective Disorder Service (IPU 3-8), Caludon Centre, Coventry, UK
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Stubbs B, Vancampfort D, Solmi M, Veronese N, Fornaro M. How common is bipolar disorder in general primary care attendees? A systematic review and meta-analysis investigating prevalence determined according to structured clinical assessments. Aust N Z J Psychiatry 2016; 50:631-9. [PMID: 26764372 DOI: 10.1177/0004867415623857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There are mounting calls for bipolar disorder to be managed in primary care, yet the exact prevalence remains unclear. We conducted a meta-analysis to investigate the prevalence of bipolar disorder in general primary care attendees without other comorbid psychiatric diagnosis. METHOD We systematically searched major electronic databases from inception till 03/2015. Articles were included that reported the prevalence of bipolar disorder determined in line with structured clinical assessment in primary care settings. Two independent authors conducted searches, completed methodological appraisal and extracted data. A random effects meta-analysis and meta-regression were performed. RESULTS Sixteen studies were included accounting for 425,691 participants (mean age = 41.1 years [standard deviation = 7.2 years] 33.3% males). Overall, the global prevalence of bipolar disorder was 1.9% (95% confidence interval = [0.6, 5.4]). The prevalence of bipolar disorder in studies recording a current diagnosis was 3.7% (95% confidence interval = [1.9, 6.0]) and 0.7% (95% confidence interval = [0.2, 1.5]) in studies considering a 12-month period. A diagnosis of bipolar disorder appeared higher in North America (3.7%, 95% confidence interval = [0.9, 8.1]) compared to Europe (0.8%, 95% confidence interval = [0.3, 1.5]). Meta-regression suggests that a more recent publication date (co-efficient = 0.089, 95% confidence interval = [0.0173, 0.1654], z = 2.19, p = 0.01, R(2) = 0.21) and younger age of participants (co-efficient -0.0851, 95% confidence interval = [-0.1696, 0.005], z = -1.97, p = 0.04, R(2) = 0.24) moderated a higher prevalence of bipolar disorder. CONCLUSION The global prevalence of bipolar disorder in primary care is 1.9%, with potentially higher prevalence rates in North America compared to Europe. A more recent study publication date is a significant predictor of higher prevalence of bipolar disorder. Potential reasons/drivers of this are considered within the text.
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Affiliation(s)
- Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK Physiotherapy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Davy Vancampfort
- UPC KU Leuven, Department of Neurosciences, KU Leuven, Kortenberg, Belgium Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Padova, Padova, Italy
| | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
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