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Kamali M, Stapp EK, Fullerton JM, Ghaziuddin N, Hulvershorn L, McInnis MG, Mitchell PB, Roberts G, Wilcox HC, Nurnberger JI. Examining the association of familial and social stress, trauma, and support on mood, anxiety, and behavioral symptoms and diagnoses in youth at risk for bipolar disorder and controls. J Affect Disord 2024:S0165-0327(24)01167-4. [PMID: 39038624 DOI: 10.1016/j.jad.2024.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Youth with a family history of bipolar disorder (At-Risk) have a higher risk of developing psychiatric disorders and experiencing environmental stressors than youth without such family history (Control). We studied the differential associations of familial and environmental factors on developing psychiatric diagnoses and symptoms, in At-Risk and Control youth. METHODS At-Risk and Control youth (N = 466, ages 9-22) were systematically assessed for severity of symptoms, psychiatric diagnoses, and self-reported measures of stress and social support. We tested the association of family history and measures of stress or support with symptom severity and diagnoses. RESULTS At-Risk youth had higher symptom severity scores and were more frequently diagnosed with psychiatric disorders (all p values < 0.001). When predicting mood symptom severity, family history had an interaction effect with stressful life events (p < 0.001) and number of distinct traumatic events (p = 0.001). In multivariate models, At-Risk status predicted anxiety disorders (OR = 2.7, CI 1.3-5.4, p = 0.005) and anxiety severity (Coefficient = 0.4, CI 0.2-0.7, p < 0.001) but not mood or behavioral disorder diagnoses or severity. LIMITATIONS Measures of stress and social support were based on self-report. Not all participants had passed through the period of risk for developing the outcomes under study and the follow up period was variable. We could not fully study the differential impact of physical or sexual abuse due to low frequency of occurrence in controls. CONCLUSION At-Risk youth exhibit more severe mood symptoms compared to Controls when exposed to similar levels of stress or trauma. At-Risk youth are also more prone to develop anxiety which may be a precursor for bipolar disorder.
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Affiliation(s)
- Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Emma K Stapp
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia & School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Neera Ghaziuddin
- Department of Psychiatry, Child and Adolescent Psychiatry Section, University of Michigan, Ann Arbor, MI, USA
| | | | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Gloria Roberts
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Holly C Wilcox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John I Nurnberger
- Indiana University School of Medicine, Indianapolis, IN, USA; Stark Neurosciences Research Institute, Departments of Psychiatry and Medical and Molecular Genetics, Indianapolis, IN, USA
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Resendes T, Ellenbogen MA, Oldehinkel AJ. Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder. J Child Psychol Psychiatry 2024. [PMID: 38682166 DOI: 10.1111/jcpp.13991] [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] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. METHODS As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report, Family Assessment Device, and an in-house measure, respectively. RESULTS Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. CONCLUSIONS OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.
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Affiliation(s)
- Tiffany Resendes
- Department of Psychology (SP-219), Concordia University, Montreal, QC, Canada
| | - Mark A Ellenbogen
- Department of Psychology (SP-219), Concordia University, Montreal, QC, Canada
| | - Albertine J Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Vreeker A, Horsfall M, Eikelenboom M, Beerthuizen A, Bergink V, Boks MPM, Hartman CA, de Koning R, de Leeuw M, Maciejewski DF, Penninx BWJH, Hillegers MHJ. The Mood and Resilience in Offspring (MARIO) project: a longitudinal cohort study among offspring of parents with and without a mood disorder. BMC Psychiatry 2024; 24:227. [PMID: 38532386 PMCID: PMC10967130 DOI: 10.1186/s12888-024-05555-z] [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] [Received: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND One of the most robust risk factors for developing a mood disorder is having a parent with a mood disorder. Unfortunately, mechanisms explaining the transmission of mood disorders from one generation to the next remain largely elusive. Since timely intervention is associated with a better outcome and prognosis, early detection of intergenerational transmission of mood disorders is of paramount importance. Here, we describe the design of the Mood and Resilience in Offspring (MARIO) cohort study in which we investigate: 1. differences in clinical, biological and environmental (e.g., psychosocial factors, substance use or stressful life events) risk and resilience factors in children of parents with and without mood disorders, and 2. mechanisms of intergenerational transmission of mood disorders via clinical, biological and environmental risk and resilience factors. METHODS MARIO is an observational, longitudinal cohort study that aims to include 450 offspring of parents with a mood disorder (uni- or bipolar mood disorders) and 100-150 offspring of parents without a mood disorder aged 10-25 years. Power analyses indicate that this sample size is sufficient to detect small to medium sized effects. Offspring are recruited via existing Dutch studies involving patients with a mood disorder and healthy controls, for which detailed clinical, environmental and biological data of the index-parent (i.e., the initially identified parent with or without a mood disorder) is available. Over a period of three years, four assessments will take place, in which extensive clinical, biological and environmental data and data on risk and resilience are collected through e.g., blood sampling, face-to-face interviews, online questionnaires, actigraphy and Experience Sampling Method assessment. For co-parents, information on demographics, mental disorder status and a DNA-sample are collected. DISCUSSION The MARIO cohort study is a large longitudinal cohort study among offspring of parents with and without mood disorders. A unique aspect is the collection of granular data on clinical, biological and environmental risk and resilience factors in offspring, in addition to available parental data on many similar factors. We aim to investigate the mechanisms underlying intergenerational transmission of mood disorders, which will ultimately lead to better outcomes for offspring at high familial risk.
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Affiliation(s)
- Annabel Vreeker
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Melany Horsfall
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Merijn Eikelenboom
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marco P M Boks
- Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ricki de Koning
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Max de Leeuw
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
- Mental Health Care Rivierduinen, Bipolar Disorder Outpatient Clinic, Leiden, The Netherlands
| | | | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Stephan NM, van Sprang ED, Wiebenga JXM, Dickhoff J, Schirmbeck F, de Haan L, van Amelsvoort T, Veling W, Alizadeh BZ, Simons CJP, Heering HD. Risk factors for suicidality across psychosis vulnerability spectrum. Schizophr Res 2023; 261:152-160. [PMID: 37769453 DOI: 10.1016/j.schres.2023.09.021] [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: 09/28/2022] [Revised: 06/14/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in individuals with psychotic disorders. Risk factors for suicidality across the psychosis vulnerability spectrum are insufficiently known. METHODS For patients (n = 830), siblings (n = 664) and controls (n = 444), suicidality was assessed by the use of a clinical interview. Multilevel modelling was used to investigate risk factors of suicidality. Lastly, risk factor × familial risk interaction effects were examined. RESULTS Multivariable models revealed a significant relation between suicidality and depressive symptoms across all three groups, and childhood trauma in patients and siblings. The association between suicidality and psychotic-like experiences is more pronounced in siblings compared to controls. CONCLUSION Across the psychosis vulnerability spectrum, depressive symptoms and childhood trauma have been associated with suicidality. Clinicians should pay attention to suicidality in individuals at high familial risk for psychosis with psychotic-like experiences.
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Affiliation(s)
| | - Eleonore Dorothée van Sprang
- Amsterdam UMC, Location VUMC, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jasper Xiao Ming Wiebenga
- Amsterdam UMC, Location VUMC, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - Justine Dickhoff
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Department of Public Mental Health, Central Institute of Mental Health, Faculty Medicine Mannheim, Heidelberg University Mannheim, Germany
| | - Lieuwe de Haan
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, the Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Henriëtte Dorothée Heering
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Department of Research, 113 Suicide Prevention, the Netherlands.
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Sletved KSO, Maiggaard K, Thorup AAE, Kessing LV, Vinberg M. Familial load of psychiatric disorders and overall functioning in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives. Int J Bipolar Disord 2022; 10:28. [PMID: 36469186 PMCID: PMC9723061 DOI: 10.1186/s40345-022-00277-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Overall functioning is already impaired in patients newly diagnosed with bipolar disorder (BD) and, to a lesser degree, also in their unaffected first-degree relatives (UR). Further, aggregation of psychiatric disorders among the patients' first-degree relatives seems to be associated with higher illness burden and poorer prognosis. However, whether this aggregation of psychiatric disorders among first-degree relatives, the familial load (FL), impacts overall functioning in patients newly diagnosed with BD and their UR remains unresolved. METHODS In total, 388 patients newly diagnosed with BD, 144 of their UR and 201 healthy control individuals were included. Overall functioning was assessed using three different assessment methods: The interviewer based "Functioning Assessment Short Test" (FAST), the questionnaire "Work and Social Adjustment Scale" (WSAS) and six outcome measures covering the participants' socio-economic status (SES); educational achievement, employment, work ability, relationship, cohabitation and marital status. Familial load of psychiatric disorder was assessed using the "Family History Research Diagnostic Criteria" interview. Associations between FL and overall functioning in patients and UR were investigated categorically using logistic and continuously in linear regression models. RESULTS Contrasting with the hypotheses, the FL of psychiatric disorders was not associated with impaired overall functioning, neither in patients newly diagnosed with BD nor in their UR. CONCLUSION The findings indicate that impaired functioning in the early phase of BD is not associated with aggregation of psychiatric disorders among first-degree relatives. The observed functional impairment in patients newly diagnosed with BD seems driven by the personal impact of the disorder rather than the impact of having first-degree relatives with psychiatric disorders.
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Affiliation(s)
- Kimie Stefanie Ormstrup Sletved
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Maiggaard
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.425848.70000 0004 0639 1831Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.425848.70000 0004 0639 1831Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Vedel Kessing
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Northern Zealand, Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
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Bolton S, Joyce DW, Gordon-Smith K, Jones L, Jones I, Geddes J, Saunders KEA. Psychosocial markers of age at onset in bipolar disorder: a machine learning approach. BJPsych Open 2022; 8:e133. [PMID: 35844202 PMCID: PMC9344222 DOI: 10.1192/bjo.2022.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown. AIMS We aim to identify psychosocial factors associated with bipolar disorder AAO. METHOD Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure. RESULTS We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = -0.2855), regular cannabis use in the year before onset (β = -0.2765), death of a close family friend or relative in the 6 months before onset (β = -0.2435), family history of suicide (β = -0.1385), schizotypal personality traits (β = -0.1055) and irritable temperament (β = -0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575). CONCLUSIONS The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.
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Affiliation(s)
- Sorcha Bolton
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK
| | - Dan W Joyce
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | | | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
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Fico G, Oliva V, De Prisco M, Giménez-Palomo A, Sagué-Vilavella M, Gomes-da-Costa S, Garriga M, Solé E, Valentí M, Fanelli G, Serretti A, Fornaro M, Carvalho AF, Vieta E, Murru A. The U-shaped relationship between parental age and the risk of bipolar disorder in the offspring: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2022; 60:55-75. [PMID: 35635997 DOI: 10.1016/j.euroneuro.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/06/2023]
Abstract
Parenthood age may affect the risk for the development of different psychiatric disorders in the offspring, including bipolar disorder (BD). The present systematic review and meta-analysis aimed to appraise the relationship between paternal age and risk for BD and to explore the eventual relationship between paternal age and age at onset of BD. We searched the MEDLINE, Scopus, Embase, PsycINFO online databases for original studies from inception, up to December 2021. Random-effects meta-analyses were conducted. Sixteen studies participated in the qualitative synthesis, of which k = 14 fetched quantitative data encompassing a total of 13,424,760 participants and 217,089 individuals with BD. Both fathers [adjusted for the age of other parent and socioeconomic status odd ratio - OR = 1.29(95%C.I. = 1.13-1.48)] and mothers aged ≤ 20 years [(OR = 1.23(95%C.I. = 1.14-1.33)] had consistently increased odds of BD diagnosis in their offspring compared to parents aged 25-29 years. Fathers aged ≥ 45 years [adjusted OR = 1.29 (95%C.I. = 1.15-1.46)] and mothers aged 35-39 years [OR = 1.10(95%C.I. = 1.01-1.19)] and 40 years or older [OR = 1.2(95% C.I. = 1.02-1.40)] likewise had inflated odds of BD diagnosis in their offspring compared to parents aged 25-29 years. Early and delayed parenthood are associated with an increased risk of BD in the offspring. Mechanisms underlying this association are largely unknown and may involve a complex interplay between psychosocial, genetic and biological factors, and with different impacts according to sex and age range. Evidence on the association between parental age and illness onset is still tentative but it points towards a possible specific effect of advanced paternal age on early BD-onset.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain; Department of Neuroscience, Section of Psychiatry, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Eva Solé
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele Fornaro
- Department of Neuroscience, Section of Psychiatry, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Andre F Carvalho
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Vic., Australia 6 Perinatal Health Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Deakin University, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain.
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
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8
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Moulin F, Gholam M, Strippoli MPF, Castelao E, Merikangas KR, Stapp EK, Marquet P, Aubry JM, Plessen KJ, Di Giacomo F, Glaus J, Pistis G, Lavigne B, Elowe J, Ranjbar S, Preisig M, Vandeleur CL. Environmental factors in offspring of parents with mood disorders and their role in parent-child transmission: findings from a 14-year prospective high-risk study. Int J Bipolar Disord 2022; 10:11. [PMID: 35386056 PMCID: PMC8986929 DOI: 10.1186/s40345-022-00257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The factors involved in the transmission of mood disorders are only partially elucidated. Aside from genes, the family environment might play a crucial role in parent–child transmission. Our goals were to (1) assess the associations of parental bipolar disorder (BPD) and Major Depressive Disorder (MDD) with individual or shared family environmental factors, including traumatic events in offspring, parental separation, family cohesion and parental attitudes; and 2) test whether these factors were mediators of the association between exposure to parental mood disorders and the onset of these disorders in offspring. Methods The sample stems from an ongoing family high-risk study of mood disorders conducted in the French-speaking part of Switzerland. Given the strong impact of the age of onset of parental disorders on their transmission to children, parental disorders were dichotomized according to the onset (cut-off 21 years). Probands with early-onset (n = 30) and later-onset BPD (n = 51), early-onset (n = 21) and later-onset MDD (n = 47) and controls (n = 65), along with their spouses (n = 193) and offspring (n = 388; < 18 years on study inclusion), were assessed over a mean follow-up duration of 14 years (s.d: 4.6). The environmental measures were based on reports by offspring collected before the onset of their first mood episode. Results Offspring of probands with later-onset BPD and offspring of probands with both early-onset and later-onset MDD reported traumatic events more frequently than comparison offspring, whereas exposure to parental separation was more frequent in all groups of high-risk offspring. Moreover, several familial environment scores including parenting attitudes differed between offspring of probands with BPD and comparison offspring. However, none of these factors were mediators of the parent–child transmission of BPD. Among the environmental factors, traumatic events were shown to be modest mediators of the transmission of early-onset MDD. Conclusions Our data do not support the implication of the assessed environmental factors in the parent–child transmission of BPD. In contrast to BPD, traumatic events partially mediate the parent–child transmission of early-onset MDD, which has important implications for intervention and prevention. Early therapeutic efforts in offspring exposed to these events are likely to reduce their deleterious impact on the risk of subsequent MDD.
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Affiliation(s)
- Flore Moulin
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland.,INSERM U 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Mehdi Gholam
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland
| | - Marie-Pierre F Strippoli
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Emma K Stapp
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Pierre Marquet
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,International Research Unit in Neurodevelopment and Child Psychiatry, Laval University, Quebec, Canada
| | - Jean-Michel Aubry
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Kerstin J Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Francesca Di Giacomo
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, North Sector, Canton of Vaud, Yverdon, Switzerland
| | - Jennifer Glaus
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgio Pistis
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland
| | - Benjamin Lavigne
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, West Sector, Canton of Vaud, Prangins, Switzerland
| | - Julien Elowe
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, North and West Sectors, Canton of Vaud, Yverdon and Prangins, Switzerland
| | - Setareh Ranjbar
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland
| | - Caroline L Vandeleur
- Department of Psychiatry, Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Route de Cery 25, Prilly, Switzerland.
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9
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van Sprang ED, Maciejewski DF, Milaneschi Y, Elzinga BM, Beekman ATF, Hartman CA, van Hemert AM, Penninx BWJH. Familial risk for depressive and anxiety disorders: associations with genetic, clinical, and psychosocial vulnerabilities. Psychol Med 2022; 52:696-706. [PMID: 32624018 PMCID: PMC8961330 DOI: 10.1017/s0033291720002299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In research and clinical practice, familial risk for depression and anxiety is often constructed as a simple Yes/No dichotomous family history (FH) indicator. However, this measure may not fully capture the liability to these conditions. This study investigated whether a continuous familial loading score (FLS), incorporating family- and disorder-specific characteristics (e.g. family size, prevalence of depression/anxiety), (i) is associated with a polygenic risk score (PRS) for major depression and with clinical/psychosocial vulnerabilities and (ii) still captures variation in clinical/psychosocial vulnerabilities after information on FH has been taken into account. METHODS Data came from 1425 participants with lifetime depression and/or anxiety from the Netherlands Study of Depression and Anxiety. The Family Tree Inventory was used to determine FLS/FH indicators for depression and/or anxiety. RESULTS Persons with higher FLS had higher PRS for major depression, more severe depression and anxiety symptoms, higher disease burden, younger age of onset, and more neuroticism, rumination, and childhood trauma. Among these variables, FH was not associated with PRS, severity of symptoms, and neuroticism. After regression out the effect of FH from the FLS, the resulting residualized measure of FLS was still associated with severity of symptoms of depression and anxiety, rumination, and childhood trauma. CONCLUSIONS Familial risk for depression and anxiety deserves clinical attention due to its associated genetic vulnerability and more unfavorable disease profile, and seems to be better captured by a continuous score that incorporates family- and disorder-specific characteristics than by a dichotomous FH measure.
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Affiliation(s)
- Eleonore D. van Sprang
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dominique F. Maciejewski
- Department of Developmental Psychopathology, Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yuri Milaneschi
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bernet M. Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Catharina A. Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, Groningen, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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10
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Kuang L, Gao W, Wang L, Guo Y, Cao W, Cui D, Jiao Q, Qiu J, Su L, Lu G. Increased resting-state brain entropy of parahippocampal gyrus and dorsolateral prefrontal cortex in manic and euthymic adolescent bipolar disorder. J Psychiatr Res 2021; 143:106-112. [PMID: 34479001 DOI: 10.1016/j.jpsychires.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/01/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alterations of brain signal complexity may reflect brain functional abnormalities. In adolescent bipolar disorder (ABD) distribution of brain regions showing abnormal complexity in different mood states remains unclear. We aimed to analyze brain entropy (BEN) alteration of functional magnetic resonance imaging (fMRI) signal to observe spatial distribution of complexity in ABD patients, as well as the relationship between this variation and clinical variables. METHODS Resting-state fMRI data were acquired from adolescents with bipolar disorder (BD) who were in manic (n = 19) and euthymic (n = 20) states, and from healthy controls (HCs, n = 17). The differences in BEN among the three groups, and their associations with clinical variables, were examined. RESULTS Compared to HCs, manic and euthymic ABD patients showed increased BEN in right parahippocampal gyrus (PHG) and left dorsolateral prefrontal cortex (DLPFC). There was no significant difference of BEN between the manic and the euthymic ABD groups. In manic ABD patients, right PHG BEN exhibited significantly positive relationship with episode times. CONCLUSIONS Increased BEN in right PHG and left DLPFC in ABD patients may cause dysfunction of corticolimbic circuitry which is important to emotional processing and cognitive control. The positive correlation between PHG BEN and episode times of manic ABD patients further expressed a close association between brain complexity and clinical symptoms. From the perspective of brain temporal dynamics, the present study complements previous findings that have reported corticolimbic dysfunction as an important contributor to the pathophysiology of BD. BEN may provide valuable evidences for understanding the underlying mechanism of ABD.
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Affiliation(s)
- Liangfeng Kuang
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luoyu Wang
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongxin Guo
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weifang Cao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Dong Cui
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Qing Jiao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Linyan Su
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China
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11
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Menculini G, Balducci PM, Attademo L, Bernardini F, Moretti P, Tortorella A. Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review. ACTA ACUST UNITED AC 2020; 56:medicina56120689. [PMID: 33322430 PMCID: PMC7763529 DOI: 10.3390/medicina56120689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/29/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: A deeper comprehension of the role that environmental risk factors play in the development of adolescent Bipolar Disorder (BD), as well as in the evolution of high-risk states for BD, may entangle further prevention and treatment advances. The present systematic review is aimed at critically summarizing evidence about the role that environmental risk factors play in the development of BD in adolescence and their interaction with BD high-risk states. Materials and Methods: MEDLINE/Pubmed, Scopus and Web of Science datasets were systematically searched until 4 September 2020. Original studies that reported information about the role of environmental risk factors in the development of BD during adolescence, or assessing their influence on the development of psychopathology in high-risk states for BD, were considered for inclusion. Two blind researchers performed title/abstract, full-text screening, and hand-screening of relevant references. The risk of bias was assessed by means of the Newcastle-Ottawa Scale. Results: Fourteen studies were included in the review. Negative stressful life events, particularly sexual and physical abuse, but also emotional mistreatment, were associated with more severe psychopathology in adolescents with BD, as well as with higher risk for developing mood disorders in BD offspring. Similar findings were detected for familial environment-related features, such as parental rejection and low perceived care, while no univocal results were found when analyzing familial functioning. Conclusions: The present systematic review confirmed the relevant role that environmental risk factors, particularly negative stressful live events and family-related features, play in the development of BD psychopathology during adolescence. Future studies are expected to clarify possible further environmental factors that may be implicated in the development of BD during youth that may serve as target of prevention and early treatment strategies.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, 06132 Perugia, Italy; (G.M.); (P.M.B.); (P.M.)
| | - Pierfrancesco Maria Balducci
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, 06132 Perugia, Italy; (G.M.); (P.M.B.); (P.M.)
- CSM Terni, Department of Mental Health, AUSL Umbria 2, Via Bramante 40, 05100 Terni, Italy
| | - Luigi Attademo
- SPDC Potenza, Department of Mental Health, ASP Basilicata, Italian National Health Service, Via Petrone, 85100 Potenza, Italy;
| | - Francesco Bernardini
- Department of Mental Health, AsFO Friuli Occidentale, Via Vecchia Ceramica 1, 33170 Pordenone, Italy;
| | - Patrizia Moretti
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, 06132 Perugia, Italy; (G.M.); (P.M.B.); (P.M.)
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, 06132 Perugia, Italy; (G.M.); (P.M.B.); (P.M.)
- Correspondence: ; Tel.: +39-(07)-5578-3194
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12
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The Dutch Bipolar Offspring Study: Cognitive Development and Psychopathology. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1559-1567. [PMID: 30887148 DOI: 10.1007/s10802-019-00532-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Various aspects of the relationship between cognitive impairment and bipolar disorder are not clear yet. This study examines cognitive and educational functioning prospectively in offspring at familial risk for bipolar disorder, in order to improve our understanding of the association between cognitive functioning and psychopathology. Bipolar offspring (N = 92) from the prospective Dutch bipolar offspring study were evaluated at adolescence and adulthood for IQ estimate, educational achievement and development of any psychiatric disorder. The main outcome was IQ estimate after 12 years of follow-up (offspring mean age 28 years). Generalized estimating equation (GEE) analyses showed that any lifetime DSM-IV axis I diagnosis was related to a lower cognitive outcome at adulthood as compared to unaffected bipolar offspring. No specific association was found for type of diagnosis. Early onset psychopathology (diagnosis at or before age 15 years) was significantly related to lower IQ estimate at adulthood, indicating a sensitive period for neurocognitive development.
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13
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Carmassi C, Shear KM, Corsi M, Bertelloni CA, Dell’Oste V, Dell’Osso L. Mania Following Bereavement: State of the Art and Clinical Evidence. Front Psychiatry 2020; 11:366. [PMID: 32435209 PMCID: PMC7218050 DOI: 10.3389/fpsyt.2020.00366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
Bereavement is the state of loss, determined in most of the cases by the death of a close person. It is probably the greatest sorrow that can occur in an individual life. Grief is a normal, healthy response to loss, evolving through stages in the process of mourning. In some cases, bereavement may lead to the outburst of manic episode: despite literature data being scarce, reports have explored this important clinical entity, variously called as "funeral mania" or "bereavement mania". We systematically reviewed the literature exploring the possible relationships between bereavement and the onset of a manic episode, both first or recurrent pre-existing episode, besides describing a case report on a manic episode in the aftermath of a loss event, with an accurate evaluation of prior mild mood spectrum instability, supporting the role of loss-events as potential risk factor for bipolar illness progression. This article tries summarizing existing evidence on the debate whether clinicians should consider mania as a possible bereavement reaction.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Martina Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Valerio Dell’Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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14
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Comes AL, Czamara D, Adorjan K, Anderson-Schmidt H, Andlauer TFM, Budde M, Gade K, Hake M, Kalman JL, Papiol S, Reich-Erkelenz D, Klöhn-Saghatolislam F, Schaupp SK, Schulte EC, Senner F, Juckel G, Schmauß M, Zimmermann J, Reimer J, Reininghaus E, Anghelescu IG, Konrad C, Thiel A, Figge C, von Hagen M, Koller M, Dietrich DE, Stierl S, Scherk H, Witt SH, Sivalingam S, Degenhardt F, Forstner AJ, Rietschel M, Nöthen MM, Wiltfang J, Falkai P, Schulze TG, Heilbronner U. The role of environmental stress and DNA methylation in the longitudinal course of bipolar disorder. Int J Bipolar Disord 2020; 8:9. [PMID: 32048126 PMCID: PMC7013010 DOI: 10.1186/s40345-019-0176-6] [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: 09/25/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stressful life events influence the course of affective disorders, however, the mechanisms by which they bring about phenotypic change are not entirely known. METHODS We explored the role of DNA methylation in response to recent stressful life events in a cohort of bipolar patients from the longitudinal PsyCourse study (n = 96). Peripheral blood DNA methylomes were profiled at two time points for over 850,000 methylation sites. The association between impact ratings of stressful life events and DNA methylation was assessed, first by interrogating methylation sites in the vicinity of candidate genes previously implicated in the stress response and, second, by conducting an exploratory epigenome-wide association analysis. Third, the association between epigenetic aging and change in stress and symptom measures over time was investigated. RESULTS Investigation of methylation signatures over time revealed just over half of the CpG sites tested had an absolute difference in methylation of at least 1% over a 1-year period. Although not a single CpG site withstood correction for multiple testing, methylation at one site (cg15212455) was suggestively associated with stressful life events (p < 1.0 × 10-5). Epigenetic aging over a 1-year period was not associated with changes in stress or symptom measures. CONCLUSIONS To the best of our knowledge, our study is the first to investigate epigenome-wide methylation across time in bipolar patients and in relation to recent, non-traumatic stressful life events. Limited and inconclusive evidence warrants future longitudinal investigations in larger samples of well-characterized bipolar patients to give a complete picture regarding the role of DNA methylation in the course of bipolar disorder.
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Affiliation(s)
- Ashley L Comes
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany. .,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany.
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804, Munich, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Heike Anderson-Schmidt
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Till F M Andlauer
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804, Munich, Germany.,Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Katrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Maria Hake
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Farah Klöhn-Saghatolislam
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, 44791, Bochum, Germany
| | - Max Schmauß
- Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, University of Augsburg, 86156, Augsburg, Germany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, 26160, Bad Zwischenahn, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, 8036, Graz, Austria
| | | | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, 27356, Rotenburg, Germany
| | - Andreas Thiel
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, 27356, Rotenburg, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, 26160, Oldenburg, Germany
| | - Martin von Hagen
- Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, 37269, Eschwege, Germany
| | - Manfred Koller
- Asklepios Specialized Hospital, 37081, Göttingen, Germany
| | - Detlef E Dietrich
- AMEOS Clinical Center Hildesheim, 31135, Hildesheim, Germany.,Center für Systems Neuroscience (ZSN) Hannover, 30559, Hannover, Germany.,Department of Psychiatry, Medical School of Hannover, 30625, Hannover, Germany
| | | | - Harald Scherk
- AMEOS Clinical Center Osnabrück, 49088, Osnabrück, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Sugirthan Sivalingam
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany.,Center for Human Genetics, University of Marburg, 35033, Marburg, Germany.,Department of Biomedicine, University of Basel, 4031, Basel, Switzerland.,Department of Psychiatry (UPK), University of Basel, 4002, Basel, Switzerland
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), 37075, Göttingen, Germany.,iBiMED, Medical Sciences Department, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
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15
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van der Markt A, Klumpers UMH, Dols A, Draisma S, Boks MP, van Bergen A, Ophoff RA, Beekman ATF, Kupka RW. Exploring the clinical utility of two staging models for bipolar disorder. Bipolar Disord 2020; 22:38-45. [PMID: 31449716 PMCID: PMC7065163 DOI: 10.1111/bdi.12825] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the clinical utility of two staging models for bipolar disorder by examining distribution, correlation, and the relationship to external criteria. These are primarily defined by the recurrence of mood episodes (model A), or by intra-episodic functioning (model B). METHODS In the Dutch Bipolar Cohort, stages according to models A and B were assigned to all patients with bipolar-I-disorder (BD-I; N = 1396). The dispersion of subjects over the stages was assessed and the association between the two models calculated. For both models, change in several clinical markers were concordant with the stage was investigated. RESULTS Staging was possible in 87% of subjects for model A and 75% for model B. For model A, 1079 participants (93%) were assigned to stage 3c (recurrent episodes). Subdividing stage 3c with cut-offs at 5 and 10 episodes resulted in subgroups containing 242, 510, and 327 subjects. For model B, most participants were assigned to stage II (intra-episodic symptoms, N = 431 (41%)) or stage III (inability to work, N = 451 (43%)). A low association between models was found. For both models, the clinical markers "age at onset," "treatment resistance," and "episode acceleration" changed concordant with the stages. CONCLUSION The majority of patients with BD-I clustered in recurrent stage 3 of Model A. Model B showed a larger dispersion. The stepwise change in several clinical markers supports the construct validity of both models. Combining the two staging models and sub-differentiating the recurrent stage into categories with cut-offs at 5 and 10 lifetime episodes improves the clinical utility of staging for individual patients.
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Affiliation(s)
- Afra van der Markt
- PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Ursula M. H. Klumpers
- Psychiatry, Amsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Annemiek Dols
- PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Psychiatry, Amsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Stasja Draisma
- PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Marco P. Boks
- Department of PsychiatryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Annet van Bergen
- Department of PsychiatryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Roel A. Ophoff
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
- Center for Neurobehavioral GeneticsSemel Institute for Neuroscience and Human BehaviorUniversity of California Los AngelesLos AngelesCAUSA
- Department of Human GeneticsUniversity of CaliforniaLos AngelesCAUSA
| | - Aartjan T. F. Beekman
- PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Ralph W. Kupka
- PsychiatryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
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Endedijk HM, Nelemans SA, Schür RR, Boks MPM, van Lier P, Meeus W, Branje S, Vinkers CH. The Role of Stress and Mineralocorticoid Receptor Haplotypes in the Development of Symptoms of Depression and Anxiety During Adolescence. Front Psychiatry 2020; 11:367. [PMID: 32499723 PMCID: PMC7242744 DOI: 10.3389/fpsyt.2020.00367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/14/2020] [Indexed: 12/26/2022] Open
Abstract
Adolescence is a critical developmental period characterized by heightened levels of depressive and anxiety symptoms. Experiencing chronic or environmental stress, for example, as a result of traumatic events or insensitive parenting, increases the risk for depression and anxiety. However, not all adolescents develop depressive or anxiety symptoms following environmental stressors, due to differences in stress resilience. One of the factors involved in stress resilience is enhanced functionality of the mineralocorticoid receptor (MR), one of the two brain receptors for the stress hormone cortisol. High levels of MR functionality result in relatively lower rates of depression, particularly in women that experienced stress. However, much less is known about MR functionality in relation to the development of adolescent depression and to other internalizing behavior problems such as anxiety. We therefore examined whether the effects of a functional MR haplotype (i.e., the MR CA haplotype) on the development of depressive and anxiety symptoms are sex-dependent, as well as interact with environmental stressors. In a community sample of adolescents (N = 343, 9 waves between age 13 and 24), environmental stressors were operationalized as parental psychological control and childhood trauma. Results showed a sex-dependent effect of MR CA haplotype on the development of depressive symptoms but not for anxiety symptoms. MR CA haplotypes were protective for girls but not for boys. This study sheds more light on the sex-dependent effects of MR functionality related to the development of depressive and anxiety symptoms during adolescence.
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Affiliation(s)
- Hinke M Endedijk
- Department of Youth and Family, Utrecht University, Utrecht, Netherlands
| | | | - Remmelt R Schür
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marco P M Boks
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pol van Lier
- Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wim Meeus
- Department of Youth and Family, Utrecht University, Utrecht, Netherlands
| | - Susan Branje
- Department of Youth and Family, Utrecht University, Utrecht, Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands.,Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Amsterdam, Netherlands
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17
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Calabrò M, Crisafulli C, Di Nicola M, Colombo R, Janiri L, Serretti A. FKBP5 Gene Variants May Modulate Depressive Features in Bipolar Disorder. Neuropsychobiology 2019; 78:104-112. [PMID: 31071710 DOI: 10.1159/000499976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous evidence suggested the possible association of FK506 binding protein 5 (FKBP5) gene variants in bipolar disorder (BPD). OBJECTIVE Given the need of refinement of the findings obtained in large but poorly phenotyped samples, this study investigated the possible role of variants within FKBP5 in a small but deeply phenotyped BPD sample. METHODS A sample (N = 131) of bipolar patients were investigated with 10 polymorphisms within the FKBP5 gene. A control sample (N = 65) was also used for the analyses. Treatment response and remission of symptoms were evaluated using of the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Young Mania Rating Scale (YMRS). The same analyses were also performed on the depressive subsample of BPD (D.BPD). RESULTS rs3800373 was associated with disorder risk in the depressive BPD subsample with the G allele being more frequent in subjects with a D.BPD phenotype. This was the only association that survived statistical correction. CONCLUSIONS rs3800373 FKBP5 may increase the risk of developing predominantly depressed BPD, probably through the creation of an enhancer consensus sequence in the 3'UTR of the gene, thus potentially increasing its expression. This finding seems to be partially supported by literature data, which evidenced increased levels of FKBP5 in psychiatric subjects.
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Affiliation(s)
- Marco Calabrò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Concetta Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Marco Di Nicola
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Colombo
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Janiri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy,
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18
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Bifulco A, Kagan L, Spence R, Nunn S, Bailey‐Rodriguez D, Hosang G, Taylor M, Fisher HL. Characteristics of severe life events, attachment style, and depression – Using a new online approach. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 58:427-439. [DOI: 10.1111/bjc.12221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lisa Kagan
- Department of Psychology Middlesex University London UK
| | - Ruth Spence
- Department of Psychology Middlesex University London UK
| | - Stephen Nunn
- Department of Psychology Middlesex University London UK
| | | | - Georgina Hosang
- Centre for Psychiatry Wolfson Institute of Preventive Medicine Barts & London School of Medicine & Dentistry Queen Mary University of London UK
| | | | - Helen L. Fisher
- Social Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London UK
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19
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Bifulco A, Spence R, Nunn S, Kagan L, Bailey-Rodriguez D, Hosang GM, Taylor M, Fisher HL. Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity, and Association With Depression. JMIR Ment Health 2019; 6:e10675. [PMID: 30622088 PMCID: PMC6329417 DOI: 10.2196/10675] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/11/2018] [Accepted: 07/26/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. OBJECTIVE The objective of our study was to test CLEAR's reliability, validity, and association with depression. METHODS CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression. RESULTS CLEAR demonstrated good test-retest reliability for the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 2.60, P=.90). CONCLUSIONS CLEAR has acceptable reliability and validity and predicts depression. It, therefore, has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders.
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Affiliation(s)
- Antonia Bifulco
- Centre for Abuse and Trauma Studies, Department of Psychology, Middlesex University, London, United Kingdom
| | - Ruth Spence
- Centre for Abuse and Trauma Studies, Department of Psychology, Middlesex University, London, United Kingdom
| | - Stephen Nunn
- Centre for Abuse and Trauma Studies, Department of Psychology, Middlesex University, London, United Kingdom
| | - Lisa Kagan
- Centre for Abuse and Trauma Studies, Department of Psychology, Middlesex University, London, United Kingdom
| | - Deborah Bailey-Rodriguez
- Centre for Abuse and Trauma Studies, Department of Psychology, Middlesex University, London, United Kingdom
| | - Georgina M Hosang
- Wolfson Institute of Preventive Medicine, Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Matthew Taylor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Helen L Fisher
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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20
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Prevalence of psychopathology in bipolar high-risk offspring and siblings: a meta-analysis. Eur Child Adolesc Psychiatry 2018; 27:823-837. [PMID: 28936622 DOI: 10.1007/s00787-017-1050-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 09/13/2017] [Indexed: 02/08/2023]
Abstract
This meta-analysis aimed to update existing data on the comparison of prevalence rates of psychopathology primarily among offspring with at least one parent with bipolar disorder (BD) and offspring of parents without psychiatric illness. Seventeen studies were derived from a systematic search of PsychInfo, Medline, Scopus and Embase. Inclusion criteria were use of a control offspring group, standardized diagnostic procedures and reporting of clear frequency data. Risk of psychopathology was estimated by aggregating frequency data from selected studies. Compared to control offspring, high-risk BD offspring are nine times more likely to have a bipolar-type disorder, almost two and a half times more likely to develop a non-BD affective disorder and over two times more likely to develop at least one anxiety disorder. High-risk offspring also showed a significant increased risk of other non-mood psychopathology such as attention deficit hyperactivity disorder (ADHD), any type of behavioral disorder and substance use disorder (SUDs). Risk of developing a broad range of affective and non-affective psychopathology is significantly higher in high-risk BD offspring. Identifying clinical presentations of this genetically high-risk cohort is important in establishing appropriate preventative treatment.
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Abstract
SummaryWe offer a contemporary review of studies of the offspring of parents with bipolar disorder and explore the clinical characteristics of these populations. We discuss how different methodological approaches may influence study findings and may explain some of the heterogeneity in the results reported. We also highlight some of the environmental risk factors that may increase the likelihood of transition from an ‘at-risk’ or high-risk state to bipolar disorder. Last, we briefly discuss the implications of study findings for early intervention strategies and comment on such issues as genetic counselling and primary and early secondary prevention programmes.
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22
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Salagre E, Dodd S, Aedo A, Rosa A, Amoretti S, Pinzon J, Reinares M, Berk M, Kapczinski FP, Vieta E, Grande I. Toward Precision Psychiatry in Bipolar Disorder: Staging 2.0. Front Psychiatry 2018; 9:641. [PMID: 30555363 PMCID: PMC6282906 DOI: 10.3389/fpsyt.2018.00641] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022] Open
Abstract
Personalized treatment is defined as choosing the "right treatment for the right person at the right time." Although psychiatry has not yet reached this level of precision, we are on the way thanks to recent technological developments that may aid to detect plausible molecular and genetic markers. At the moment there are some models that are contributing to precision psychiatry through the concept of staging. While staging was initially presented as a way to categorize patients according to clinical presentation, course, and illness severity, current staging models integrate multiple levels of information that can help to define each patient's characteristics, severity, and prognosis in a more precise and individualized way. Moreover, staging might serve as the foundation to create a clinical decision-making algorithm on the basis of the patient's stage. In this review we will summarize the evolution of the bipolar disorder staging model in relation to the new discoveries on the neurobiology of bipolar disorder. Furthermore, we will discuss how the latest and future progress in psychiatry might transform current staging models into precision staging models.
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Affiliation(s)
- Estela Salagre
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Alberto Aedo
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Bipolar Disorders Unit, Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adriane Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Pharmacology and Postgraduate Program: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Silvia Amoretti
- Barcelona Clínic Schizophrenia Unit, Hospital Clinic de Barcelona, CIBERSAM, Barcelona, Spain
| | - Justo Pinzon
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maria Reinares
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Michael Berk
- IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
| | | | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Iria Grande
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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23
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Alda M, Manchia M. Personalized management of bipolar disorder. Neurosci Lett 2017; 669:3-9. [PMID: 29208408 DOI: 10.1016/j.neulet.2017.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is one of the most serious psychiatric disorders. The rates of disability, the risk of suicide attempts and their high lethality, as well as frequent and severe psychiatric and medical comorbidities, put it among the major causes of mortality and disability worldwide. At the same time, many patients can do well when treated properly. In this review, we focus on those aspects of the clinical care that offer the potential of individualized approach, in the context of the recent technology driven advances in the comprehension of the neurobiological underpinnings of BD. We first review those clinical and biological factors that can help identifying individuals at high risk of developing BD. Among these are a family history of BD and/or completed suicide, prodromal symptoms (in childhood and/or adolescence) such as anxiety and mood lability, early onset, and poor response to antidepressants. Panels of genetic markers are also being studied to identify subjects at risk for BD. Further, neuroimaging studies have found an increased gray matter density in the right Inferior Frontal Gyrus (rIFG) as a possible risk marker of BD. We then examine clinical factors that influence the initiation, selection and possibly discontinuation of long-term treatment. Lastly, we discuss the risk of side effects in BD, and their relevance for treatment adherence and for treatment monitoring. In summary, we discuss how a personalized approach in BD can be implemented through the identification of specific clinical and molecular predictors. We show that the realization of a personalized management of BD is not only of a theoretical value, but has substantial clinical repercussions, resulting in a significant reduction of the long-term morbidity and mortality associated to BD.
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Affiliation(s)
- Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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24
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Parenting practices in middle childhood mediate the relation between growing up with a parent having bipolar disorder and offspring psychopathology from childhood into early adulthood. Dev Psychopathol 2017; 30:635-649. [DOI: 10.1017/s095457941700116x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractThe offspring of parents with bipolar disorder (OBD) are at high risk for developing mental disorders. In addition to genetic factors, environmental risk is purported to be associated with these negative outcomes. However, few studies have examined this relation. Using concurrent and longitudinal data, we examined if support, structure, and control provided by parents in middle childhood mediated the relation between having a parent with or without bipolar disorder, and offspring mental health. The sample included 145 offspring (77 OBD, 68 controls) aged 4 to 14 years and their parents. Parent and teacher ratings of child behavior were collected, and diagnostic assessments were conducted in offspring 12 years later (n = 101). Bootstrapping analyses showed that low levels of structure mediated the relation between having a parent with bipolar disorder and elevated internalizing and externalizing difficulties during middle childhood. For the longitudinal outcomes, parental control emerged as the strongest mediator of the relation between parents’ bipolar disorder and offspring psychopathology. Suboptimal childrearing may have different immediate and enduring consequences on mental health outcomes in the OBD. Parental structure has robust effects on emotional and behavioral problems in middle childhood, while levels of control promote psychological adjustment in the OBD as they mature.
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25
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Lopizzo N, Tosato S, Begni V, Tomassi S, Cattane N, Barcella M, Turco G, Ruggeri M, Riva MA, Pariante CM, Cattaneo A. Transcriptomic analyses and leukocyte telomere length measurement in subjects exposed to severe recent stressful life events. Transl Psychiatry 2017; 7:e1042. [PMID: 28221367 PMCID: PMC5438034 DOI: 10.1038/tp.2017.5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/23/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023] Open
Abstract
Stressful life events occurring in adulthood have been found able to affect mood and behavior, thus increasing the vulnerability for several stress-related psychiatric disorders. However, although there is plenty of clinical data supporting an association between stressful life events in adulthood and an enhanced vulnerability for psychopathology, the underlying molecular mechanisms are still poorly investigated. Thus, in this study we performed peripheral/whole-genome transcriptomic analyses in blood samples obtained from 53 adult subjects characterized for recent stressful life events occurred within the previous 6 months. Transcriptomic data were analyzed using Partek Genomics Suite; pathway and network analyses were performed using Ingenuity Pathway Analysis and GeneMANIA Software. We found 207 genes significantly differentially expressed in adult subjects who reported recent stressful life experiences (n=21) compared with those without such experiences (n=32). Moreover, the same subjects exposed to such stressful experiences showed a reduction in leukocyte telomere length. A correlation analyses between telomere length and transcriptomic data indicated an association between the exposures to recent stressful life events and the modulation of several pathways, mainly involved in immune-inflammatory-related processes and oxidative stress, such as natural killer cell signaling, interleukin-1 (IL-1) signaling, MIF regulation of innate immunity and IL-6 signaling. Our data suggest an association between exposures to recent stressful life events in adulthood and alterations in the immune, inflammatory and oxidative stress pathways, which could be also involved in the negative effect of stressful life events on leukocyte telomere length. The modulation of these mechanisms may underlie the clinical association between the exposure to recent Stressful life events in adulthood and an enhanced vulnerability to develop psychiatric diseases in adulthood.
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Affiliation(s)
- N Lopizzo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
| | - S Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - V Begni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - S Tomassi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - N Cattane
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
| | - M Barcella
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - G Turco
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - M Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - M A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - C M Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College, London, London, UK
| | - A Cattaneo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College, London, London, UK,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK. E-mail:
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26
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Aldinger F, Schulze TG. Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry Clin Neurosci 2017; 71:6-17. [PMID: 27500795 PMCID: PMC7167807 DOI: 10.1111/pcn.12433] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 01/10/2023]
Abstract
The etiology and clinical course of bipolar disorder are considered to be determined by genetic and environmental factors. Although the kindling hypothesis emphasizes the impact of environmental factors on initial onset, their connection to the outcome and clinical course have been poorly established. Hence, there have been numerous research efforts to investigate the impact of environmental factors on the clinical course of illness. Our aim is to outline recent research on the impact of environmental determinants on the clinical course of bipolar disorder. We carried out a computer-aided search to find publications on an association between environmental factors, life events, and the clinical course of bipolar disorder. Publications in the reference lists of suitable papers have also been taken into consideration. We performed a narrative overview on all eligible publications. The available body of data supports an association between environmental factors and the clinical course of bipolar disorder. These factors comprise prenatal, early-life, and entire lifespan aspects. Given varying sample sizes and several methodological limitations, the reported quality and extent of the association between environmental factors and the clinical course of bipolar disorder should be interpreted with utmost caution. Systematic longitudinal long-term follow-up trials are needed to obtain a clearer and more robust picture.
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Affiliation(s)
- Fanny Aldinger
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University, Munich, Germany
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27
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Muhtadie L, Johnson SL. Threat sensitivity in bipolar disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 124:93-101. [PMID: 25688436 DOI: 10.1037/a0038065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Life stress is a major predictor of the course of bipolar disorder. Few studies have used laboratory paradigms to examine stress reactivity in bipolar disorder, and none have assessed autonomic reactivity to laboratory stressors. In the present investigation we sought to address this gap in the literature. Participants, 27 diagnosed with bipolar I disorder and 24 controls with no history of mood disorder, were asked to complete a complex working memory task presented as "a test of general intelligence." Self-reported emotions were assessed at baseline and after participants were given task instructions; autonomic physiology was assessed at baseline and continuously during the stressor task. Compared to controls, individuals with bipolar disorder reported greater increases in pretask anxiety from baseline and showed greater cardiovascular threat reactivity during the task. Group differences in cardiovascular threat reactivity were significantly correlated with comorbid anxiety in the bipolar group. Our results suggest that a multimethod approach to assessing stress reactivity-including the use of physiological parameters that differentiate between maladaptive and adaptive profiles of stress responding-can yield valuable information regarding stress sensitivity and its associations with negative affectivity in bipolar disorder. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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28
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Childhood trauma and HPA axis functionality in offspring of bipolar parents. Psychoneuroendocrinology 2016; 74:316-323. [PMID: 27710902 DOI: 10.1016/j.psyneuen.2016.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/25/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022]
Abstract
Children of a parent with bipolar disorder (bipolar offspring) have an increased risk for mood disorders. While genetic factors play a significant role in this population, susceptibility to environmental stress may also significantly contribute to this vulnerability for mood disorders. Childhood trauma has consistently been found to increase the risk for mood disorders, with persisting consequences for hypothalamic-pituitary-adrenal (HPA) axis functionality. However, it is currently unknown whether childhood trauma specifically affects HPA axis activity in individuals with a familial risk for bipolar disorder. Therefore, we investigated the effects of childhood trauma on daytime and evening cortisol levels and dexamethasone suppression in bipolar offspring (N=70) and healthy controls (N=44). In our study we found no significant differences in daytime and evening cortisol levels as well as dexamethasone suppression between bipolar offspring and healthy controls (all p-values>0.43). In contrast, childhood trauma differentially affected daytime cortisol levels in the bipolar offspring compared to healthy controls (childhood trauma X bipolar offspring interaction, β=-7.310, p=0.0414) with an effect of childhood trauma on daytime cortisol in bipolar offspring at trend level (p=0.058). In the bipolar offspring group, lifetime or current psychiatric diagnoses, and stressful life events separately did not affect cortisol levels or dexamethasone suppression (all p-values>p=0.50). These findings were independent of current or lifetime psychiatric diagnosis. In conclusion, trauma-related changes in daytime HPA axis activity appear to be a specific trait in bipolar offspring who have increased risk for mood disorders compared to healthy individuals.
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29
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Berghorst LH, Kumar P, Greve DN, Deckersbach T, Ongur D, Dutra S, Pizzagalli DA. Stress and reward processing in bipolar disorder: a functional magnetic resonance imaging study. Bipolar Disord 2016; 18:602-611. [PMID: 27870507 PMCID: PMC5234857 DOI: 10.1111/bdi.12444] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A link between negative life stress and the onset of mood episodes in bipolar disorder (BD) has been established, but processes underlying such a link remain unclear. Growing evidence suggests that stress can negatively affect reward processing and related neurobiological substrates, indicating that a dysregulated reward system may provide a partial explanation. The aim of this study was to test the impact of stress on reward-related neural functioning in BD. METHODS Thirteen euthymic or mildly depressed individuals with BD and 15 controls performed a Monetary Incentive Delay (MID) task while undergoing functional magnetic resonance imaging during no-stress and stress (negative psychosocial stressor involving poor performance feedback and threat of monetary deductions) conditions. RESULTS In hypothesis-driven region-of-interest analyses, a significant group-by-condition interaction emerged in the amygdala during reward anticipation. Relative to controls, while anticipating a potential reward, subjects with BD were characterized by amygdalar hyperactivation in the no-stress condition but hypoactivation during stress. Moreover, relative to controls, subjects with BD had significantly larger amygdala volumes. After controlling for structural differences, the effects of stress on amygdalar function remained, whereas groups no longer differed during the no-stress condition. During reward consumption, a group-by-condition interaction emerged in the putamen due to increased putamen activation in response to rewards in participants with BD during stress, but an opposite pattern in controls. CONCLUSIONS Overall, findings highlight possible impairments in using reward-predicting cues to adaptively engage in goal-directed actions in BD, combined with stress-induced hypersensitivity to reward consumption. Potential clinical implications are discussed.
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Affiliation(s)
| | - Poornima Kumar
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Doug N Greve
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Thilo Deckersbach
- Department of Psychiatry, Harvard Medical School, Boston, MA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Dost Ongur
- Department of Psychiatry, Harvard Medical School, Boston, MA,Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA, USA
| | - Sunny Dutra
- Department of Psychology, Yale University, New Haven, CT
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA
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Childhood adverse life events and parental psychopathology as risk factors for bipolar disorder. Transl Psychiatry 2016; 6:e929. [PMID: 27779625 PMCID: PMC5290348 DOI: 10.1038/tp.2016.201] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/12/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022] Open
Abstract
Childhood adverse events are risk factors for later bipolar disorder. We quantified the risks for a later diagnosis of bipolar disorder after exposure to adverse life events in children with and without parental psychopathology. This register-based population cohort study included all persons born in Denmark from 1980 to 1998 (980 554 persons). Adversities before age 15 years were: familial disruption; parental somatic illness; any parental psychopathology; parental labour market exclusion; parental imprisonment; placement in out-of-home care; and parental natural and unnatural death. We calculated risk estimates of each of these eight life events as single exposure and risk estimates for exposure to multiple life events. Main outcome variable was a diagnosis of bipolar disorder after the age of 15 years, analysed with Cox proportional hazard regression. Single exposure to most of the investigated adversities were associated with increased risk for bipolar disorder, exceptions were parental somatic illness and parental natural death. By far the strongest risk factor for bipolar disorder in our study was any mental disorder in the parent (hazard ratio 3.53; 95% confidence interval 2.73-4.53) and the additional effects of life events on bipolar risk were limited. An effect of early adverse life events on bipolar risk later in life was mainly observed in children without parental psychopathology. Our findings do not exclude early-life events as possible risk factors, but challenge the concept of adversities as important independent determinants of bipolar disorder in genetically vulnerable individuals.
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Brietzke E, Rosa AR, Pedrini M, Noto MN, Kapczinski F, Scott J. Challenges and developments in research of the early stages of bipolar disorder. ACTA ACUST UNITED AC 2016; 38:329-337. [PMID: 27533022 PMCID: PMC7111347 DOI: 10.1590/1516-4446-2016-1975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/09/2016] [Indexed: 01/02/2023]
Abstract
Recently, attention in the field of bipolar disorder (BD) has focused on prevention, including early detection and intervention, as these strategies have the potential to delay, lessen the severity, or even prevent full-blown episodes of BD. Although knowledge of the neurobiology of BD has advanced substantially in the last two decades, most research was conducted with chronic patients. The objective of this paper is to comprehensively review the literature regarding the early stages of BD, to explore recent discoveries on the neurobiology of these stages, and to discuss implications for research and clinical care. The following databases were searched: PubMed, PsycINFO, Cochrane Library, and SciELO. Articles published in English from inception to December 2015 were retrieved. Several research approaches were used, including examination of offspring studies, retrospective studies, prospective studies of clinical high-risk populations, and exploration of the progression after the first manic episode. Investigations with neuroimaging, cognition assessments, and biomarkers provide promising (although not definitive) evidence of alterations in the neural substrate during the at-risk stage. Research on BD should be expanded to encompass at-risk states and aligned with recent methodological progress in neuroscience.
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Affiliation(s)
- Elisa Brietzke
- Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LINC), UNIFESP, São Paulo, SP, Brazil.,Programa de Intervenção em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Adriane R Rosa
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina, Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.,Departamento de Farmacologia, UFRGS, Porto Alegre, RS, Brazil
| | - Mariana Pedrini
- Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LINC), UNIFESP, São Paulo, SP, Brazil.,Programa de Intervenção em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Mariane N Noto
- Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LINC), UNIFESP, São Paulo, SP, Brazil.,Programa de Intervenção em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Flavio Kapczinski
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina, Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK.,Centre for Affective Disorders, Institute of Psychiatry, King's College London, London, UK
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Streit F, Memic A, Hasandedić L, Rietschel L, Frank J, Lang M, Witt SH, Forstner AJ, Degenhardt F, Wüst S, Nöthen MM, Kirschbaum C, Strohmaier J, Oruc L, Rietschel M. Perceived stress and hair cortisol: Differences in bipolar disorder and schizophrenia. Psychoneuroendocrinology 2016; 69:26-34. [PMID: 27017430 DOI: 10.1016/j.psyneuen.2016.03.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) and schizophrenia (SCZ) are psychiatric disorders with shared and distinct clinical and genetic features. In both disorders, stress increases the risk for onset or relapse and dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis has been reported. The latter is frequently investigated by measuring changes in the hormonal end product of the HPA axis, i.e., the glucocorticoid cortisol, whose concentration exhibits diurnal variation. The analysis of hair cortisol concentration (HCC) is a new method, which allows assessment of cumulative cortisol secretion over the preceding three months. AIMS To explore whether perceived stress and HCC: (i) differ between BD patients, SCZ patients, and controls; (ii) change over disease course; and iii) are associated with an increased genetic risk for BD or SCZ. METHODS 159 SCZ patients, 61 BD patients and 82 controls were included. Assessment included psychopathology, perceived stress, and HCC. Inpatients with an acute episode (38 BD and 77 SCZ) were assessed shortly after admission to hospital and at 3 and 6 months follow-up. Outpatients in remission and controls were assessed at one time point only. Polygenic risk scores for BD and SCZ were calculated based on results of the Psychiatric Genomic Consortium. RESULTS (i) Perceived stress was higher in BD and SCZ patients compared to controls (p<0.02), and was lower in outpatients in remission compared to inpatients on admission. HCC was higher in BD patients compared to SCZ patients and controls (p<0.02), and higher in inpatients on admission than in outpatients in remission (p=0.0012). In BD patients (r=0.29; p=0.033) and SCZ patients (r=0.20; p=0.024) manic symptoms were correlated with HCC. (ii) In both BD and SCZ inpatients, perceived stress decreased over the 6 month study period (p=0.048), while HCC did not change significantly over the 6 month study period. (iii) In controls, but not in the patient groups, the genetic risk score for BD was associated with HCC (r=0.28, p=0.023). CONCLUSIONS While our results are consistent with previous reports of increased perceived stress in BD and SCZ, they suggest differential involvement of the HPA axis in the two disorders. The genetic study supports this latter finding, and suggests that this effect is present below the threshold of manifest disorder.
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Affiliation(s)
- Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
| | - Amra Memic
- Psychiatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lejla Hasandedić
- Psychiatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Psychology Department, Faculty of Letters, Akdeniz University, Antalya, Turkey
| | - Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Maren Lang
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Stefan Wüst
- Institute of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Jana Strohmaier
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Lilijana Oruc
- Psychiatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
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Bootsman F, Kemner SM, Hillegers MHJ, Brouwer RM, Vonk R, van der Schot AC, Hulshoff Pol HE, Nolen WA, Kahn RS, van Haren NEM. The association between hippocampal volume and life events in healthy twins. Hippocampus 2016; 26:1088-95. [DOI: 10.1002/hipo.22589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Florian Bootsman
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Sanne M. Kemner
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Manon H. J. Hillegers
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Rachel M. Brouwer
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Ronald Vonk
- Reinier Van Arkel's; Hertogenbosch The Netherlands
| | | | | | - Willem A. Nolen
- Department of Psychiatry; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - René S. Kahn
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
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Johnson SL, Cuellar A, Gershon A. The Influence of Trauma, Life Events, and Social Relationships on Bipolar Depression. Psychiatr Clin North Am 2016; 39:87-94. [PMID: 26876320 PMCID: PMC4756278 DOI: 10.1016/j.psc.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A growing body of research suggests that the social environment exerts a powerful influence on the course of bipolar depression. This article reviews longitudinal research to suggest that trauma, negative life events, social support deficits, and family difficulties are common and predict a more severe course of depression when present among those diagnosed with bipolar disorder. The triggers of bipolar depression overlap with those documented for unipolar depression, suggesting that many of the treatment targets for unipolar depression may be applicable for bipolar depression.
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Affiliation(s)
- Sheri L. Johnson
- Department of Psychology, University of California Berkeley, 3210 Tolman Hall, MC 1650, Psychology, University of California, Berkeley, CA 94720-1659,
| | | | - Anda Gershon
- Department of Psychiatry, Stanford University, 401 Quarry Road, Stanford, CA 94305-5719,
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35
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Sabariego C, Coenen M, Ballert C, Cabello M, Leonardi M, Anczewska M, Pitkänen T, Raggi A, Mellor B, Covelli V, Świtaj P, Levola J, Schiavolin S, Chrostek A, Bickenbach J, Chatterji S, Cieza A. Determinants of Psychosocial Difficulties Experienced by Persons with Brain Disorders: Towards a 'Horizontal Epidemiology' Approach. PLoS One 2015; 10:e0141322. [PMID: 26675663 PMCID: PMC4682947 DOI: 10.1371/journal.pone.0141322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Persons with brain disorders experience significant psychosocial difficulties (PSD) in daily life, e.g. problems with managing daily routine or emotional lability, and the level of the PSD depends on social, physical and political environments, and psychologic-personal determinants. Our objective is to determine a brief set of environmental and psychologic-personal factors that are shared determinants of PSD among persons with different brain disorders. METHODS Cross-sectional study, convenience sample of persons with either dementia, stroke, multiple sclerosis, epilepsy, migraine, depression, schizophrenia, substance dependence or Parkinson's disease. Random forest regression and classical linear regression were used in the analyses. RESULTS 722 subjects were interviewed in four European countries. The brief set of determinants encompasses presence of comorbidities, health status appraisal, stressful life events, personality changes, adaptation, self-esteem, self-worth, built environment, weather, and health problems in the family. CONCLUSIONS The identified brief set of common determinants of PSD can be used to support the implementation of cross-cutting interventions, social actions and policy tools to lower PSD experienced by persons with brain disorders. This set complements a recently proposed reliable and valid direct metric of PSD for brain disorders called PARADISE24.
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Affiliation(s)
- Carla Sabariego
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- * E-mail:
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | | | - Maria Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Psychiatry Service, Instituto de Investigación del Hospital Universitario de La Princesa (IIS-IP), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta (IRCCS) Foundation, Milan, Italy
| | - Marta Anczewska
- Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta (IRCCS) Foundation, Milan, Italy
| | - Blanca Mellor
- Department of Psychiatry, Universidad Autónoma de Madrid, Psychiatry Service, Instituto de Investigación del Hospital Universitario de La Princesa (IIS-IP), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Venusia Covelli
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta (IRCCS) Foundation, Milan, Italy
| | - Piotr Świtaj
- Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jonna Levola
- A-Clinic Foundation, Helsinki, Finland
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta (IRCCS) Foundation, Milan, Italy
- Division of Neurosurgery II, Neurological Institute Carlos Besta (IRCCS) Foundation, Milan, Italy
| | - Anna Chrostek
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta (IRCCS) Foundation, Milan, Italy
| | | | - Somnath Chatterji
- Department of Measurement and Health Information Systems, Multi-Country Studies, World Health Organization, Geneva, Switzerland
| | - Alarcos Cieza
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, United Kingdom
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Roy A, Hartman CA, Veenstra R, Oldehinkel AJ. Peer dislike and victimisation in pathways from ADHD symptoms to depression. Eur Child Adolesc Psychiatry 2015; 24:887-95. [PMID: 25348085 DOI: 10.1007/s00787-014-0633-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
Abstract
The following hypotheses were tested in a longitudinal, population-based study: (1) Attention deficit hyperactivity disorder (ADHD) symptoms are associated with peer dislike and victimisation; (2) Peer dislike and victimisation increase the risk for subsequent depression; and (3) The effect of ADHD symptoms on depression is partly mediated through peer dislike and victimisation. Gender differences in mediating pathways through peer dislike and victimisation to depression were additionally explored. The Child Behaviour Checklist (CBCL), Youth Self Report (YSR) and Teacher's Checklist of Pathology (TCP) assessed ADHD symptoms in 728 adolescents. Peer nominations were used to assess peer dislike and victimisation. The Composite International Diagnostic Interview (CIDI) was used to assess depression. Effects of peer dislike, victimisation, and ADHD symptoms on depression were modelled using Cox regression. ADHD symptoms were associated with peer dislike (rs = 0.17, p < 0.001) and victimisation (rs = 0.11, p = 0.001). Dislike, victimisation, and ADHD symptoms increased risk for depression. Risk for depression associated with victimisation and ADHD symptoms reduced with time. Dislike and victimisation mediated 7 % of the effect of ADHD symptoms on depression. Pathways through dislike and victimisation were present in girls but not in boys. Peer dislike and victimisation explain, to a limited extent, the prospective association between ADHD and depression, particularly in girls.
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Affiliation(s)
- Arunima Roy
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands,
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Spence R, Bunn A, Nunn S, Hosang GM, Kagan L, Fisher HL, Taylor M, Bifulco A. Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach. JMIR Res Protoc 2015; 4:e83. [PMID: 26175304 PMCID: PMC4526994 DOI: 10.2196/resprot.4085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 05/07/2015] [Indexed: 12/25/2022] Open
Abstract
Background Severe life events are acknowledged as important etiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared with checklist questionnaire methods and arguments for interview approaches have resurfaced because choosing the appropriate assessment tool provides clarity of information about gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions. Objective (1) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (2) To review life-events measures and key findings related to disorder, exemplifying depression. (3) To describe an ongoing study with a new online measure and to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes. Methods The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties, and utilize calendar-based timing, to improve upon checklist approaches. Results The CLEAR study is in the preliminary stages and its results are expected to be made available by the end of 2015. Conclusions There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life-event data while combating the limitations of interviews (eg, time consuming and costly) and life-event checklists (eg, inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice, and interventions are discussed.
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Affiliation(s)
- Ruth Spence
- Centre for Abuse and Trauma Studies, Middlesex University, London, United Kingdom.
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van Campen JS, Jansen FE, Pet MA, Otte WM, Hillegers MHJ, Joels M, Braun KPJ. Relation between stress-precipitated seizures and the stress response in childhood epilepsy. Brain 2015; 138:2234-48. [DOI: 10.1093/brain/awv157] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/14/2015] [Indexed: 11/14/2022] Open
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Kemner SM, Mesman E, Nolen WA, Eijckemans MJC, Hillegers MHJ. The role of life events and psychological factors in the onset of first and recurrent mood episodes in bipolar offspring: results from the Dutch Bipolar Offspring Study. Psychol Med 2015; 45:2571-2581. [PMID: 25865058 DOI: 10.1017/s0033291715000495] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Life events are an established risk factor for the onset and recurrence of unipolar and bipolar mood episodes, especially in the presence of genetic vulnerability. The dynamic interplay between life events and psychological context, however, is less studied. In this study, we investigated the impact of life events on the onset and recurrence of mood episodes in bipolar offspring, as well as the effects of temperament, coping and parenting style on this association. METHOD Bipolar offspring (n = 108) were followed longitudinally from adolescence to adulthood. Mood disorders were assessed with: the Kiddie Schedule of Affective Disorders and Schizophrenia - Present and Lifetime Version or the Structured Clinical Interview for DSM-IV Axis I disorders; life events with the Life Events and Difficulties Schedule; and psychological measures using the Utrecht Coping List, Temperament and Character Inventory and short-EMBU (memories of upbringing instrument). Anderson-Gill models (an extension of the Cox proportional hazard model) were utilized. RESULTS Life events were associated with an increased risk for first and, although less pronounced, subsequent mood episodes. There was a large confounding effect for the number of previous mood episodes; findings suggest a possible kindling effect. Passive coping style increased the risk of mood episode onset and recurrent episodes, but also altered the effect of life events on mood disorders. Harm avoidance temperament was associated with mood episode recurrence. CONCLUSIONS Life events are especially a risk factor in the onset of mood disorders, though less so in recurrent episodes. Psychological features (passive coping and harm-avoidant temperament) contribute to the risk of an episode occurring, and also have a moderating effect on the association between life events and mood episodes. These findings create potential early intervention strategies for bipolar offspring.
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Affiliation(s)
- S M Kemner
- Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands
| | - E Mesman
- Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands
| | - W A Nolen
- Department of Psychiatry,University of Groningen,University Medical Center Groningen,Groningen,The Netherlands
| | - M J C Eijckemans
- Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,Utrecht,The Netherlands
| | - M H J Hillegers
- Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands
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40
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Kemner SM, van Haren NE, Bootsman F, Eijkemans MJ, Vonk R, van der Schot AC, Nolen WA, Hillegers MH. The influence of life events on first and recurrent admissions in bipolar disorder. Int J Bipolar Disord 2015; 3:6. [PMID: 25717427 PMCID: PMC4339321 DOI: 10.1186/s40345-015-0022-4] [Citation(s) in RCA: 12] [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: 10/26/2014] [Accepted: 01/26/2015] [Indexed: 12/17/2022] Open
Abstract
Background Life events play an important role in the onset and course of bipolar disorder. We will test the influence of life events on first and recurrent admissions in bipolar disorder and their interaction to test the kindling hypothesis. Methods We collected information about life events and admissions across the life span in 51 bipolar patients. We constructed four models to explore the decay of life event effects on admissions. To test their interaction, we used the Andersen-Gill model. Results The relationship between life events and admissions was best described with a model in which the effects of life events gradually decayed by 25% per year. Both life event load and recurrent admissions significantly increased the risk of both first and subsequent admissions. No significant interaction between life event load and number of admissions was found. Conclusions Life events increase the risk of both first and recurrent admissions in bipolar disorder. We found no significant interaction between life events and admissions, but the effect of life events on admissions decreases after the first admission which is in line with the kindling hypothesis.
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Affiliation(s)
- Sanne M Kemner
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, A00.241, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Neeltje Em van Haren
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, A00.241, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Florian Bootsman
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, A00.241, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marinus Jc Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald Vonk
- Reinier van Arkel Group, 's-Hertogenbosch, The Netherlands
| | | | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Manon Hj Hillegers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, A00.241, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Rolim-Neto ML, Alves Silva E, Teixeira Júnior AG, de Sousa Cartaxo J, Rolim Lima NN, Nascimento VB, Vieira dos Santos MDS, Lima da Silva CG, Romero de Sousa SI, da Silva Costa L, Nascimento Neto PJ. Bipolar disorder incidence between children and adolescents: A brief communication. J Affect Disord 2015; 172:171-4. [PMID: 25451413 DOI: 10.1016/j.jad.2014.09.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/24/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bipolar affective disorder is one of most injurious psychiatric diseases, not, rarely leading patient for suicide, and its prevalence keeps increasing worldwide, notably on low and, middle-income countries. For children living in northeast Brazil, extreme social conditions constitute, an environment of special vulnerability. OBJECTIVE Here we show that bipolar disorder incidence, between children and adolescents in this Brazilian region increased 34.2% from 2005 to 2014 and, in, the same area and age group, deaths provoked by self-caused injuries also became progressively, greater. RESULTS According to DATASUS, the Brazilian national databank for public health, information, in the last five years, we observed an increase of Bipolar Disorder incidence rates under, 19 year-old of about 34.2% in the northeast region of Brazil, while the increase for Brazilian general, population was 12.4%. If considered only patients under 10, this number is even greater, of 47.2%. Content of Table 2 shows this disproportion, while comparing the advance of bipolar disorder, morbidity indices nationwide and worldwide. CONCLUSION Children living in Brazil's northeast, region are in a condition of extreme social disadvantage, what can be determinant for the recent and, sequential increase of bipolar disorder prevalence and the mortality in this age-group due to suicide, one of possible reflections of untreated mood disorders. For protecting these children is important to, identify the factors which prevent these illnesses and promote resilience for these young people.
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Affiliation(s)
- Modesto Leite Rolim-Neto
- Department of Medicine, Faculty of Medicine, Federal University of Cariri, UFCA, Barbalha, Ceara, Brazil.
| | - Elizabeth Alves Silva
- Postgraduate Program in Health Sciences, Faculty of Medicine of ABC, Santo André, São Paulo, Brazil
| | | | - Jesus de Sousa Cartaxo
- Postgraduate Program in Health Sciences, Faculty of Medicine of ABC, Santo André, São Paulo, Brazil
| | - Nádia Nara Rolim Lima
- Postgraduate Program in Health Sciences, Faculty of Medicine of ABC, Santo André, São Paulo, Brazil
| | - Vânia Barbosa Nascimento
- Postgraduate Program in Health Sciences, Faculty of Medicine of ABC, Santo André, São Paulo, Brazil
| | - Maria do Socorro Vieira dos Santos
- Postgraduate Program in Health Sciences, Faculty of Medicine of ABC, Santo André, São Paulo, Brazil; Department of Medicine, Faculty of Medicine, Federal University of Cariri, UFCA, Barbalha, Ceara, Brazil
| | - Cláudio Gleidiston Lima da Silva
- Postgraduate Program in Health Sciences, Faculty of Medicine of ABC, Santo André, São Paulo, Brazil; Department of Medicine, Faculty of Medicine, Federal University of Cariri, UFCA, Barbalha, Ceara, Brazil
| | | | - Lucas da Silva Costa
- Department of Medicine, Faculty of Medicine, Federal University of Cariri, UFCA, Barbalha, Ceara, Brazil
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Frías Á, Palma C, Farriols N. Psychosocial interventions in the treatment of youth diagnosed or at high-risk for pediatric bipolar disorder: A review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:146-56. [PMID: 25620426 DOI: 10.1016/j.rpsm.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/17/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade. We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both "multi-family psychoeducational psychotherapy' and "family-focused therapy" are possible effective treatments for PBD. Likewise, "child and family-focused cognitive-behavioral therapy" may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed.
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Affiliation(s)
- Álvaro Frías
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España.
| | - Cárol Palma
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España
| | - Núria Farriols
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España
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Jansen K, Cardoso TDA, Mondin TC, Matos MBD, Souza LDDM, Pinheiro RT, Magalhães PVDS, Silva RAD. Eventos de vida estressores e episódios de humor: uma amostra comunitária. CIENCIA & SAUDE COLETIVA 2014; 19:3941-6. [DOI: 10.1590/1413-81232014199.12932013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/08/2013] [Indexed: 11/21/2022] Open
Abstract
Transtornos de humor são consequentes de uma interação entre fatores biológicos e ambientais. O objetivo deste estudo foi identificar associações entre eventos vitais estressores e transtornos de humor em uma amostra comunitária de jovens do Sul do Brasil. Trata-se de estudo transversal de base populacional com jovens de 18 a 24 anos. A seleção da amostra foi realizada por conglomerados. Os episódios de alteração do humor foram avaliados através da Mini International Neuropsychiatric Interview , enquanto os eventos vitais estressores foram mensurados através da escala de reajustamento social de Holmes e Rahe. A amostra foi de 1172 jovens. A proporção de eventos vitais estressores no último ano, em cada categoria, no total da amostra, foi de: 53,8% trabalho, 42,4% perda de suporte social, 63,8% família, 50,9% mudanças ambientais, 61,1% dificuldades pessoais e 38,7% finanças. Houve associação significativa entre eventos vitais estressores e episódios de alteração de humor. Foi verificada maior ocorrência de eventos vitais estressores entre os jovens em episódio misto, quando comparados aos jovens em episódio depressivo, (hipo) maníaco e controles. Esses achados sugerem uma interação psicossocial entre eventos vitais estressores e os episódios de alteração de humor.
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Pfennig A, Correll CU, Marx C, Rottmann-Wolf M, Meyer TD, Bauer M, Leopold K. Psychotherapeutic interventions in individuals at risk of developing bipolar disorder: a systematic review. Early Interv Psychiatry 2014; 8:3-11. [PMID: 23968367 DOI: 10.1111/eip.12082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/15/2013] [Indexed: 12/21/2022]
Abstract
AIM Accumulating data show that patients with bipolar disorder (BD) experience substantial symptomatology months or years before full manifestation. Based on the need for early preventive interventions in BD as well as data suggesting effectiveness of psychotherapeutic interventions for BD, we aimed to review the evidence for psychotherapeutic treatments in help-seeking individuals considered at risk for BD (At-Risk-BD). METHODS Searching PubMed and PsycINFO, clinical trial registries and recently published systematic reviews, a systematic review was performed of psychoeducational and psychotherapeutic intervention studies in At-Risk-BD individuals. RESULTS Only three completed studies were identified, two of which were randomized trials (n = 77) and one was an open pilot study (n = 13). Two ongoing studies (projected n = 150 and n = 100, respectively) were found in trial registries. The available evidence suggests potential effectiveness of multi-family psychoeducational psychotherapy and family-focussed therapy for symptom reduction and prevention of BD conversion. CONCLUSIONS Psychotherapeutic treatments are a reasonable starting point for At-Risk-BD subjects when symptom severity, distress and impairment are sufficiently significant to initiate treatment. Ongoing studies will further clarify the effectiveness and timing of psychotherapeutic interventions for At-Risk-BD individuals and whether or not they should be given alone or in conjunction with other treatments. Large multi-site studies with standardized procedures/manuals are needed to advance the field.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische University Dresden, Dresden, Germany
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The development of thought problems: A longitudinal family risk study of offspring of bipolar, unipolar, and well parents. Dev Psychopathol 2013; 25:1079-91. [PMID: 24229550 PMCID: PMC10064983 DOI: 10.1017/s0954579413000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere is growing evidence that many offspring of parents with bipolar disorder (BD) will develop moderate to severe forms of psychopathology during childhood and adolescence, including thought problems. The purpose of this study was to evaluate the developmental progression of thought problems within the context of a family risk study. Repeated assessments of thought problems, spanning approximately 15 years, were conducted in offspring (N= 192 from 98 families) of parents diagnosed with BD (O-BD), unipolar depression (O-UNI), or no significant psychiatric or medical problems (O-WELL). Survival analysis showed that the O-BD group had the greatest estimated probability of developing thought problems over time, followed by O-UNI, and then O-WELL and O-BD exhibiting higher levels of persistence than O-WELL. Parent-reported thought problems in childhood and adolescence predicted a range of problems in young adulthood. Disturbances in reality testing and other atypical behaviors are likely to disrupt progression through important developmental periods and to associate with poor outcomes. These findings are likely relevant to preventing the occurrence or progression of problems in offspring of bipolar parents. The study of thought problems across development represents an important area of continued research in children at risk for development of affective disorders.
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Iosif AM, Sampson AR. A model for repeated clustered data with informative cluster sizes. Stat Med 2013; 33:738-59. [PMID: 24123049 DOI: 10.1002/sim.5988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/02/2013] [Indexed: 11/10/2022]
Abstract
Many chronic diseases or health conditions manifest with recurring episodes, each of which can be characterized by a measure of intensity or severity. Both the number of episodes and the severity of each episode can depend on the latent severity of an individual's underlying condition. Data such as this are commonly gathered repeatedly at fixed follow-up intervals. An example is a study of the association between stressful life events and the onset of depression. Stress exposure is assessed through the frequency and intensity of stressful life events occurring each month. Both the number of events and the intensity of each event at each measurement occasion are informative about the underlying severity of stress over time. One might hypothesize that people that approach the onset of a depressive episode have worse stress profiles than the controls, reflected by both more frequent and more intense stressors. We propose models to analyze data collected repeatedly on both the frequency of an event and its severity when both of these are informative about the underlying latent severity. Maximum likelihood estimators are developed, and simulations with small to moderate sample sizes show that the estimators also have good finite sample properties, and they are robust against misspecification of the model. This method is applied to a psychiatric data set.
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Affiliation(s)
- Ana-Maria Iosif
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, 95616, U.S.A
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Brietzke E, Mansur RB, Soczynska J, Powell AM, McIntyre RS. A theoretical framework informing research about the role of stress in the pathophysiology of bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39:1-8. [PMID: 22613185 DOI: 10.1016/j.pnpbp.2012.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/17/2012] [Accepted: 05/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The staggering illness burden associated with Bipolar Disorder (BD) invites the need for primary prevention strategies. Before preventative strategies can be considered in individuals during a pre-symptomatic period (i.e., at risk), unraveling the mechanistic steps wherein external stress is transduced and interacts with genetic vulnerability in the early stages of BD will be a critical conceptual necessity. METHODS Herein we comprehensively review extant studies reporting on stress and bipolar disorder. The overarching aim is to propose a conceptual framework to inform research about the role of stress in the pathophysiology of BD. Computerized databases i.e. PubMed, PsychInfo, Cochrane Library and Scielo were searched using the following terms: "bipolar disorder" cross-referenced with "stress", "general reaction to stress", "resilience", "resistance", "recovery" "stress-diathesis", "allostasis", and "hormesis". RESULTS Data from literature indicate the existence of some theoretical models to understand the influence of stress in the pathophysiology of BD, including classical stress-diathesis model and new models such as allostasis and hormesis. In addition, molecular mechanisms involved in stress adaptation (resistance, resilience and recovery) can also be translated in research strategies to investigate the impact of stress in the pathophysiology of BD. LIMITATIONS Most studies are retrospective and/or cross sectional, do not consider the period of development, assess brain function with only one or few methodologies, and use animal models which are not always similar to human phenotypes. CONCLUSION The interaction between stress and brain development is dynamic and complex. In this article we proposed a theoretical model for investigation about the role of stress in the pathophysiology of BD, based on the different kinds of stress adaptation response and their putative neurobiological underpinnings.
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Affiliation(s)
- Elisa Brietzke
- Program for Recognition and Intervention in Individuals in at Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
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Parents with bipolar disorder: Are disease characteristics good predictors of psychopathology in offspring? Eur Psychiatry 2012; 28:240-6. [DOI: 10.1016/j.eurpsy.2012.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/22/2012] [Accepted: 03/29/2012] [Indexed: 01/22/2023] Open
Abstract
AbstractPurposeTo investigate rates of psychopathology in the offspring of subjects with bipolar disorder (BP-offspring) compared to the offspring of healthy subjects (HC-offspring) in a Spanish sample and to study possible predictors of psychopathology in BP-offspring.SubjectsFifty BP-offspring from 36 families and 25 HC-offspring from 25 families.MethodsPsychopathology was compared in BP-offspring and HC-offspring. Factors associated with DSM-IV axis I disorders in BP-offspring were analyzed using logistic regression.ResultsHalf of BP-offspring fulfilled the diagnostic criteria for at least one axis I disorder with attention-deficit/hyperactivity disorder (30%), anxiety disorders (14%) and affective disorders (10%) as the most frequent. After controlling for having more than one sibling in the study, the odds ratio for BP-offspring presenting an axis I disorder was 15.02 when a biological parent had bipolar disorder with a lifetime history of psychotic symptoms and 3.34 when one parent had bipolar II disorder. Moreover, a higher Global Assessment of Functioning score in the biological co-parent was associated with a significantly lower frequency of axis I disorders in BP-offspring.Discussion and conclusionsPsychopathology in BP-offspring should be routinely assessed, with special emphasis on children from parents with specific disease characteristics (psychosis, BP II disorder) in order to establish an early diagnosis and appropriate interventions.
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Ostiguy CS, Ellenbogen MA, Walker CD, Walker EF, Hodgins S. Sensitivity to stress among the offspring of parents with bipolar disorder: a study of daytime cortisol levels. Psychol Med 2011; 41:2447-2457. [PMID: 21524333 DOI: 10.1017/s0033291711000523] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND It is well known that the hypothalamic-pituitary-adrenal (HPA) axis is compromised in major depression and bipolar disorder. There is increasing evidence that subtle HPA abnormalities, such as elevated cortisol levels, precede the development of an affective disorder. Interpersonal stress is also associated with the development of affective disorders. The present study sought to determine whether interpersonal chronic and episodic stress moderated the relationship between cortisol levels in the natural environment and risk status, defined as having a parent with bipolar disorder. METHOD Sixty-two offspring of parents with bipolar disorder (OBD) and 60 offspring with no family history of affective disorders (OFH-), aged 19.48 years (s.d.=3.38, range 14-28), completed interviews assessing mental disorders and chronic and episodic stress, and provided saliva samples over 3 days. RESULTS Regression analyses revealed that the OBD who experienced high interpersonal chronic stress displayed a larger cortisol rise following awakening than the OBD reporting low interpersonal chronic stress. The same relationship was also found for levels of non-interpersonal chronic stress. The OBD who reported experiencing severe interpersonal episodic stress exhibited higher levels of daytime cortisol than the OBD reporting interpersonal episodic stress of mild severity. Importantly, none of the above relationships were detected in the OFH-. Each of the interactions between family history of affective disorders and stress remained after controlling for age, gender and offspring lifetime affective disorders and current non-affective disorders. CONCLUSIONS A biological sensitivity to stress may underlie the susceptibility to affective disorders among the OBD.
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Affiliation(s)
- C S Ostiguy
- Centre for Research in Human Development, Concordia University, Montréal, Canada
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