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Ioannou M, Olsson S, Bakken Wold A, Dellepiane M, Steingrímsson S. Approaching "highly sensitive person" as a cultural concept of distress: a case-study using the cultural formulation interview in patients with bipolar disorder. Front Psychiatry 2023; 14:1148646. [PMID: 37810603 PMCID: PMC10558047 DOI: 10.3389/fpsyt.2023.1148646] [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: 01/20/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Background Psychiatric patients may refer to concepts neither medically accepted nor easily understood to describe their experiences when seeking medical care. These concepts may lie outside the clinician's cultural references and consequently hinder the diagnostic consultation. In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the clinical instrument Cultural Formulation Interview (CFI) was included. The CFI aims to facilitate the gathering and synthesis of culturally relevant clinical information. The notion of Cultural Concepts of Distress (CCD) was also introduced in DSM-5. The CCD include the subterms of the cultural syndrome, cultural explanation, and cultural idiom of distress. No previous study has used CFI for conceptualizing a cultural notion as a CCD. This study aimed to approach the cultural notion of being a highly sensitive person (HSP) in patients with bipolar disorder (BD) by applying the CFI. The cultural notion of HSP has garnered great interest globally, although scientific evidence is limited. No direct correlation between BD and HSP was hypothesized before or during the study process. Methods In this case study, three patients with BD who reported being HSP were interviewed using the CFI. Furthermore, the applicability of the CCD was examined based on the outcomes of the CFI using an interpretive approach. Results All three patients reported that the CFI facilitated the clinical consultation, and in one of the cases, it may also have increased the treatment engagement. Based on the synthesis of the CFI outcomes in these illustrative cases, HSP could be understood as a cultural syndrome, a cultural explanation, and a cultural idiom of distress. Conclusion By applying a person-centered perspective, CFI was used for the conceptualization of a cultural notion as a CCD (i.e., HSP in our study). Moreover, the cases highlight the complexity of illness insight in BD as a medical phenomenon when patients' illness perspectives are taken into consideration. Future studies need to further examine the clinical relevance of the CFI in the management of BD.
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Affiliation(s)
- Michael Ioannou
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofia Olsson
- Region Skåne, Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Lund, Sweden
| | - Ane Bakken Wold
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marzia Dellepiane
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrímsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bipolar Disorder in pediatric patients: A nationwide retrospective study from 2000 to 2015. J Affect Disord 2022; 298:277-283. [PMID: 34715176 DOI: 10.1016/j.jad.2021.10.113] [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: 07/12/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pediatric Bipolar Disorder (BD) has been the focus of increased attention. To date, in Portugal, there is no evidence available for pediatricBD-related hospitalization rates. This study aimed to describe and characterize all pediatric hospitalizations with a primary diagnosis of BD registered in Portugal from 2000 to 2015. METHODS A retrospective observational study was conducted. Pediatric (< 18 years) inpatient episodes with a primary diagnosis of BD were selected from a national administrative database. The ICD-9-CM codes 296.x (excluding 296.2x, 296.3x and 296.9x) identified the diagnosis of interest. Additionally, age at discharge, sex, psychiatric comorbidities, length of stay (LoS), admission type and date, in-hospital mortality and hospital charges were analyzed. RESULTS A total of 348 hospitalizations, representing 258 patients, were identified. The overall population-based rate of hospitalizations was 1.18/100 000 youths. A non-linear increase throughout the study period was found. Patients were mostly female (60.6%), with a median age of 16 years (Q1-Q3:14-17). Admissions were mostly emergent (81%), and the median LoS was 14 days (Q1-Q3:7-24). Moreover, about 26% of all episodes were readmissions. Mean estimated charges per episode were 3503.10€, totalizing 1.20M€. LIMITATIONS Limitations include the use of secondary data and the retrospective nature of the study. CONCLUSIONS Annual rates of pediatric BD hospitalizations showed a non-linear increase. These findings may contribute to better understand the pediatric BD burden. Nevertheless, more research is warranted, to better characterize sociodemographic and clinical trends in pediatric BD to prevent the high number of acute hospitalizations and readmissions of these patients.
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Youngstrom EA, Perez Algorta G, Youngstrom JK, Frazier TW, Findling RL. Evaluating and Validating GBI Mania and Depression Short Forms for Self-Report of Mood Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:579-595. [PMID: 32401546 DOI: 10.1080/15374416.2020.1756301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To evaluate short forms of free self-report mania and depression scales, evaluating their reliability, content coverage, criterion validity, and diagnostic accuracy.Method: Youths age 11 to 18 years seeking outpatient mental health services at either an Academic medical clinic (N = 427) or urban Community mental health center (N = 313), completed the General Behavior Inventory (GBI) and other rating scales. Youths and caregivers completed semi-structured interviews to establish diagnoses and mood symptom severity, with GBI scores masked during diagnosis. Ten- and seven-item short forms, psychometric projections, and observed performance were tested first in the Academic sample and then externally cross-validated in the Community sample.Results: All short forms maintained high reliability (all alphas >.80 across both samples), high correlations with the full-length scales (r.85 to.96), excellent convergent and discriminant validity with mood, behavior, and demographic criteria, and diagnostic accuracy undiminished compared to using the full-length scales. Ten-item scales showed advantages in terms of coverage; the 7 Up showed slightly weaker performance.Conclusions: Present analyses evaluated and externally cross-validated short forms that maintain high reliability and content coverage, and show strong criterion validity and diagnostic accuracy - even when used in an independent sample with very different demographics and referral patterns. The short forms appear useful in clinical applications including initial evaluation, as well as in research settings where they offer an inexpensive quantitative score. Short forms are available in more than two dozen languages. Future work should further evaluate sensitivity to treatment effects and cultural invariance.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights
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Duffy A, Carlson G, Dubicka B, Hillegers MHJ. Pre-pubertal bipolar disorder: origins and current status of the controversy. Int J Bipolar Disord 2020; 8:18. [PMID: 32307651 PMCID: PMC7167382 DOI: 10.1186/s40345-020-00185-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence from epidemiological, clinical and high-risk studies has established that the peak period of risk for onset of bipolar disorder spans late adolescence and early adulthood. However, the proposal of the existence of a pre-pubertal form of bipolar disorder manifesting in early childhood created substantial debate. In this narrative review, the literature and contributing factors pertaining to the controversy surrounding the proposed pre-pubertal bipolar disorder subtype are discussed. The resolution of the debate and lessons learned are highlighted. MAIN BODY In the mid 1990s US researchers proposed that chronic irritability and explosive temper in pre-pubertal children with pre-existing ADHD and/or other learning and developmental disorders might represent a variant of mania. A number of factors contributed to this proposal including severely ill children with no diagnostic home given changes in the ADHD DSM diagnostic criteria and over-reliance on symptoms and structured interviews rather than on a clinical assessment incorporating developmental history, social context and clinical course. Prospective studies of children at high familial risk did not support the proposed pre-pubertal bipolar phenotype; but rather provided convergent evidence that bipolar disorder onset in adolescence and early adulthood not uncommonly preceded by sleep and internalizing symptoms and most often debuting as depression in adolescence (after puberty). Epidemiological studies of population and hospital discharge data provided evidence that the pre-pubertal bipolar phenotype was largely a US driven phenomenon. CONCLUSIONS Psychiatric diagnosis is particularly challenging given the current lack of objective biomarkers. However, validity and utility of clinical diagnoses can be strengthened if all available predictive information is used to formulate a diagnosis. As in other areas of medicine, critical information required to make a valid diagnosis includes developmental history, clinical course, family history and treatment response-weighed against the known trajectories of classical disorders. Moreover, given that psychiatric disorders are in evolution over childhood and adolescence and symptoms, in of themselves, are often non-specific, a thorough clinical assessment incorporating collateral history and psychosocial context is paramount. Such an approach might have avoided or at least brought a more timely resolution to the debate on pre-pubertal mania.
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Affiliation(s)
- A. Duffy
- Queen’s University, Kingston, Canada
- Department of Psychiatry, University Oxford, Oxford, UK
| | - G. Carlson
- Renaissance School of Medicine, Stonybrook University, Stony Brook, NY USA
| | - B. Dubicka
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M. H. J. Hillegers
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Lee HS, Kwon Y, Shon SH, Park KJ, Kim HW. Exploratory Factor Analysis of the Adolescent Version of the General Behavior Inventory in Korean Youth. Soa Chongsonyon Chongsin Uihak 2019; 30:168-177. [PMID: 32595338 PMCID: PMC7298903 DOI: 10.5765/jkacap.190023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/26/2022] Open
Abstract
Objectives: We examined the factor structure of the Adolescent version of the General Behavior Inventory (A-GBI) for Koreans. Methods: We retrospectively reviewed the medical records of 220 adolescents (age, 12–18 years) who completed the A-GBI through the Department of Psychiatry at Asan Medical Center, Seoul, Korea, from October 2011 to December 2018. Caregivers of the study participants completed the Parent version of the GBI (P-GBI) 10-item Mania Scale. The adolescents were evaluated based on the A-GBI, Children’s Depression Inventory (CDI), and Revised-Children’s Manifest Anxiety Scale (RCMAS). Subsequently, an exploratory factor analysis (EFA) using the maximum likelihood method with direct oblimin rotation and correlation analyses with other scales were performed. Results: The EFA identified a two-factor structure as having the best fit: factor I included depressive symptoms and factor II included hypomanic/biphasic symptoms. Factor I was very strongly correlated with the A-GBI depressive subscale (r=0.990, p<0.001) and strongly correlated with CDI (r=0.764, p<0.001) and RCMAS (r=0.666, p<0.001). Factor II was also very strongly correlated with the A-GBI hypomanic/biphasic subscale (r=0.877, p<0.001) and weakly correlated with CDI (r=0.274, p<0.001) and RCMAS (r=0.332, p<0.001). Conclusion: The above findings support a two-dimensional model of mood symptoms in Korean youth.
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Affiliation(s)
- Han-Sung Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yejin Kwon
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Hyun Shon
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Jeong Park
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo-Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Tapsell R, Hallett C, Mellsop G. The rate of mental health service use in New Zealand as analysed by ethnicity. Australas Psychiatry 2018; 26:290-293. [PMID: 28691522 DOI: 10.1177/1039856217715989] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare by ethnicity the rates of apparent new referrals and admissions to mental health services for selected major diagnostic groupings. METHOD Using a Ministry of Health database covering all referrals and admissions to New Zealand's Mental Health services in 2014 and who had not been patients in the preceding six years, population adjusted rates of presentation were calculated and compared across the two major New Zealand ethnic groupings. RESULTS Population corrected rates of apparently new cases of schizophrenia are more than twice as common in Māori as in non-Māori. Major depression is also significantly more common in Māori. That same trend was not evident for bipolar patients. CONCLUSIONS These ethnically associated apparent differences in the rates of schizophrenia and depression need both confirmation and explanation.
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Affiliation(s)
- Rees Tapsell
- Director of Clinical Services, Mental Health and Addictions Services, Waikato District Health Board, Hamilton; Honorary Senior Lecturer, Department of Psychiatry, Waikato Campus, University of Auckland, Auckland, New Zealand
| | - Charlene Hallett
- Research Consultant and Independent Scholar, Waikato, New Zealand
| | - Graham Mellsop
- Professor of Psychiatry, Department of Psychiatry, Waikato Clinical Campus, University of Auckland, Auckland, New Zealand
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Ryles F, Meyer TD, Adan-Manes J, MacMillan I, Scott J. A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders. Int J Bipolar Disord 2017; 5:4. [PMID: 28155204 PMCID: PMC5289931 DOI: 10.1186/s40345-017-0071-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults). METHODS Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood. RESULTS Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity. CONCLUSIONS Despite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders.
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Affiliation(s)
- Faye Ryles
- Early Intervention in Psychiatry Hub, NTW NHS Trust, Newcastle upon Tyne, UK
| | - Thomas D. Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, TX USA
| | | | - Iain MacMillan
- Early Intervention in Psychiatry Hub, NTW NHS Trust, Newcastle upon Tyne, UK
| | - Jan Scott
- Academic Psychiatry, Wolfson Unit, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA. More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neurosci Biobehav Rev 2017; 74:204-213. [PMID: 28119069 DOI: 10.1016/j.neubiorev.2017.01.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/18/2017] [Indexed: 02/05/2023]
Abstract
Evidence of a high or increasing incidence of childhood onset bipolar disorder in the United States (US) has been viewed skeptically. Here we review evidence that childhood onsets of bipolar disorder are more common in the US than in Europe, treatment delays are longer, and illness course is more adverse and difficult. Epidemiological data and studies of offspring at high risk also support these findings. In our cohort of outpatients with bipolar disorder, two of the major vulnerability factors for early onset - genetics and environmental adversity in childhood - were also greater in the US than in Europe. An increased familial loading for multiple psychiatric disorders was apparent in 4 generations of the family members of the patients from the US, and that familial burden was linked to early onset bipolar disorder. Since both early onset and treatment delay are risk factors for a poor outcome in adulthood, new clinical, research, and public health initiatives are needed to begin to address and ameliorate this ongoing and potentially devastating clinical situation.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA.
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Ralph Kupka
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MI, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Heinz Grunze
- Paracelsius Medical University, Salzburg, Austria
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA
| | | | - Willem A Nolen
- University Medical Center, University of Groningen, Groningen, The Netherlands
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Oedegaard CH, Berk L, Berk M, Youngstrom EA, Dilsaver SC, Belmaker RH, Oedegaard KJ, Fasmer OB, Engebretsen IM. An ISBD perspective on the sociocultural challenges of managing bipolar disorder: A content analysis. Aust N Z J Psychiatry 2016; 50:1096-1103. [PMID: 27742913 DOI: 10.1177/0004867416668790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinical management of bipolar disorder patients might be affected by culture and is further dependent on the context of healthcare delivery. There is a need to understand how healthcare best can be delivered in various systems and cultures. The objective of this qualitative study was to gain knowledge about culture-specific values, beliefs and practices in the medical care provided to patients with bipolar disorders from a provider perspective in various areas of the world. SAMPLING AND METHODS The International Society for Bipolar Disorders (ISBD) network provided the framework for this qualitative study. An electronic interview with open-ended questions was administered to 19 international experts on bipolar spectrum disorder representing the International Society for Bipolar Disorders chapter network in 16 countries and six continents. In addition, there were two in-depth interviews with bipolar spectrum disorder experts done prior to the survey. The data were analysed using content analysis, and the information was structured using the software NVivo by QSR International Pty Ltd. FINDINGS All participants described sociocultural factors as important in healthcare delivery to bipolar patients in their part of the world, both in accessing healthcare and in providing culturally appropriate care. Factors that affected the provider's ability to supply good clinical management of patients were access to treatment options and long-term follow-up, as well as general strategies to combat stigma. In some societies, the patients' use of alternative treatments, gender issues and religion were also important factors. Understanding the impact of such culturally specific factors was overall regarded as essential for proper treatment interventions. CONCLUSION Sociocultural factors clearly affect the nature and quality of medical services delivered to bipolar patients. Financial, social and cultural factors affect patients' health-seeking behaviour, and this highlights the need for knowledge about such factors in order to adequately identify and treat bipolar patients globally. Culturally adapted training and psychoeducation programmes are particularly warranted.
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Affiliation(s)
- Christine H Oedegaard
- Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Lesley Berk
- IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Melbourne School of Population and Global Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Eric A Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Robert H Belmaker
- Beersheva Mental Health Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ketil J Oedegaard
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway .,Division of Psychiatry, Haukeland University hospital, Bergen, Norway
| | - Ole B Fasmer
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway.,Division of Psychiatry, Haukeland University hospital, Bergen, Norway
| | - Ingunn M Engebretsen
- Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway
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Algorta GP, Dodd AL, Stringaris A, Youngstrom EA. Diagnostic efficiency of the SDQ for parents to identify ADHD in the UK: a ROC analysis. Eur Child Adolesc Psychiatry 2016; 25:949-57. [PMID: 26762184 PMCID: PMC4990620 DOI: 10.1007/s00787-015-0815-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/23/2015] [Indexed: 02/06/2023]
Abstract
Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey (N = 18,232 youths 5-15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework.
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Affiliation(s)
- Guillermo Perez Algorta
- The Spectrum Centre, Lancaster University, Furness Building, C73, Bailrigg, Lancaster, LA1 4YT, UK.
| | - Alyson Lamont Dodd
- The Spectrum Centre, Lancaster University, Furness Building, C73, Bailrigg, Lancaster, LA1 4YT, UK
| | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Eric A Youngstrom
- Department of Psychology and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Liang J, Matheson BE, Douglas JM. Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:1926-1940. [PMID: 27346929 PMCID: PMC4916917 DOI: 10.1007/s10826-015-0351-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Misdiagnoses of racial/ethnic minority youth's mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: 1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth's mental health problems are misdiagnosed? 2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included "race", "ethnicity", "minority", "culture", "children", "youth", "adolescents", "mental health", "psychopathology", "diagnosis", "misdiagnosis", "miscategorization", "underdiagnosis", and "overdiagnosis". Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth's emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.
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Affiliation(s)
- June Liang
- University of California, San Diego, Department of Pediatrics
| | - Brittany E. Matheson
- University of California, San Diego, Department of Pediatrics
- San Diego State University/University of California Joint Doctoral Program in Clinical Psychology
| | - Jennifer M. Douglas
- University of California, San Diego, Department of Pediatrics
- San Diego State University/University of California Joint Doctoral Program in Clinical Psychology
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Clacey J, Goldacre M, James A. Paediatric bipolar disorder: international comparisons of hospital discharge rates 2000-2010. BJPsych Open 2015; 1:166-171. [PMID: 27703743 PMCID: PMC4995564 DOI: 10.1192/bjpo.bp.115.001933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/31/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Controversy surrounds the diagnosis and prevalence of paediatric bipolar disorder, with estimates varying considerably between countries. AIMS To determine the international hospital discharge rates for paediatric bipolar disorder compared with all other psychiatric diagnoses. METHOD We used national data-sets from 2000 to 2010 from England, Australia, New Zealand, the USA and Germany. RESULTS For those aged under 20 years, the discharge rates for paediatric bipolar disorder per 100 000 population were: USA 95.6, Australia 11.7, New Zealand 6.3, Germany 1.5 and England 0.9. The most marked divergence in discharge rates was in 5- to 9-year-olds: USA 27, New Zealand 0.22, Australia 0.14, Germany 0.03 and England 0.00. CONCLUSIONS The disparity between US and other discharge rates for paediatric bipolar disorder is markedly greater than the variation for child psychiatric discharge rates overall, and for adult rates of bipolar disorder. This suggests there may be differing diagnostic practices for paediatric bipolar disorder in the USA. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © 2015 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Joe Clacey
- Joe Clacey, BM, BCh BA (Hons), Highfield Unit, Warneford Hospital, Oxford
| | - Michael Goldacre
- Michael Goldacre, FFPH, FRCP, BM BCh, BA (Hons), Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anthony James
- Anthony James, MBBS, MRCP, MRCPsych, MPhil, MA (Oxon), Department of Psychiatry, University of Oxford, and Highfield Unit, Warneford Hospital, Oxford, UK
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Koenders MA, Spijker AT, Hoencamp E, Haffmans JPM, Zitman FG, Giltay EJ. Effects of mood state on divided attention in patients with bipolar disorder: evidence for beneficial effects of subclinical manic symptoms. Psychiatry Res 2014; 220:302-8. [PMID: 25129563 DOI: 10.1016/j.psychres.2014.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/19/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
A relatively small number of studies have been dedicated to the differential effects of the current mood state on cognition in patients with a bipolar disorder (BD). The aim of the current study was to investigate the effect of current mood state on divided attention (DA) performance, and specifically examine possible beneficial effects of the (hypo-) manic state. Over a maximum period of 24 months, medication use, divided attention test (a subtest of the Test for Attentional Performance (TAP)) was assessed every 6 months in 189 outpatients with BD. Data were analyzed with multilevel regression analysis (i.e. linear mixed models). DA performance varied considerable over time within patients. Corrected for psychotropic medication a significant quadratic relationship between manic symptoms and DA performance was found, with mild hypomanic symptoms having a positive influence on divided attention scores and moderate to severe manic symptoms having a negative influence. No association between depressive symptoms and DA performance was found. In future research on mania and cognition as well as in the clinical practice both the beneficial and negative effects of mania should be taken into account.
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Affiliation(s)
- Manja A Koenders
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands.
| | - Annet T Spijker
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands
| | - Erik Hoencamp
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Judith P M Haffmans
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Frans G Zitman
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - Erik J Giltay
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
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Bellivier F, Etain B, Malafosse A, Henry C, Kahn JP, Elgrabli-Wajsbrot O, Jamain S, Azorin JM, Frank E, Scott J, Grochocinski V, Kupfer DJ, Golmard JL, Leboyer M. Age at onset in bipolar I affective disorder in the USA and Europe. World J Biol Psychiatry 2014; 15:369-76. [PMID: 22188366 DOI: 10.3109/15622975.2011.639801] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To test for differences in reported age at onset (AAO) of bipolar I affective disorder in clinical samples drawn from Europe and the USA. METHODS Admixture analysis was used to identify the model best fitting the observed AAO distributions of two large samples of bipolar I patients from Europe and USA (n = 3616 and n = 2275, respectively). Theoretical AAO functions were compared between the two samples. RESULTS The model best fitting the observed distribution of AAO in both samples was a mixture of three Gaussian distributions. The theoretical AAO functions of bipolar I disorder differed significantly between the European and USA populations, with further analyses indicating that (i) the proportion of patients belonging to the early-onset subgroup was higher in the USA sample (63 vs. 25%) and (ii) mean age at onset (±SD) in the early-onset subgroup was lower for the USA sample (14.5 ± 4.9 vs. 19 ± 2.7 years). CONCLUSIONS The models best describing the reported AAO distributions of European and USA bipolar I patients were remarkably stable. The intermediate- and late-onset subgroups had similar characteristics in the two samples. However, the theoretical AAO function differed significantly between the USA and European samples due to the higher proportion of patients in the early-onset subgroup and the lower mean age-at-onset in the USA sample.
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Affiliation(s)
- Frank Bellivier
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie , Créteil, F-94000 , France
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15
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A comparison of American and English hospital discharge rates for pediatric bipolar disorder, 2000 to 2010. J Am Acad Child Adolesc Psychiatry 2014; 53:614-24. [PMID: 24839880 PMCID: PMC4473258 DOI: 10.1016/j.jaac.2014.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 01/31/2014] [Accepted: 03/05/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Controversy exists over the diagnosis and prevalence of pediatric bipolar disorder (PBD). Although several small surveys suggest that the rate of the PBD diagnosis in clinical settings is higher in the United States than in other countries, no comprehensive cross-national comparisons of clinical practice have been performed. Here, we used longitudinal national datasets from 2000 to 2010 to compare US and English hospital discharge rates for PBD in patients aged 1 to 19 years. METHOD We used the English National Health Service (NHS) Hospital Episode Statistics (HES) dataset and the United States National Hospital Discharge Survey (NHDS) to compare US and English discharge rates for PBD (bipolar I disorder [BP-I], bipolar II disorder [BP-II], bipolar disorder not otherwise specified [BP-NOS], and cyclothymia). We also conducted cross-national comparisons for all other psychiatric diagnoses in youth and for adults with bipolar disorder (BD). RESULTS There was a 72.1-fold difference in discharge rates for PBD in youth between the United States and England (United States, 100.9 per 100,000 population, 95% confidence interval = 98.1-103.8, versus England, 1.4 per 100,000 population, 95% CI = 1.4-1.5). After controlling for cross-national differences in length of stay, discharge rates for PBD remained 12.5 times higher in the United States than in England. For all other child psychiatric diagnoses, the discharge rate was 3.9-fold higher, and for adults with BD 7.2-fold higher, in the United States than in England. CONCLUSION The disparity between US and English discharge rates for PBD is markedly greater than the disparity for child psychiatric discharge rates overall and for adult rates of BD. This suggests that the difference in discharge rates for PBD may be due to differing diagnostic practices for PBD in the United States versus in England.
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Targum SD, Nakagawa A, Sato Y. A cross-cultural comparison study of depression assessments conducted in Japan. Ann Gen Psychiatry 2013; 12:9. [PMID: 23551964 PMCID: PMC3620710 DOI: 10.1186/1744-859x-12-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 03/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The advent of global clinical trials has necessitated the use of English-based rating instruments in diverse cultures where English is clearly not the primary language. The cross-cultural applicability of rating instruments developed in one language with only one cultural group is an important issue in both research and clinical settings where these instruments might be used. We examined the cross-cultural applicability of the Montgomery-Asberg Depression Rating Scale (MADRS) in Japan. METHODS As part of a rater-training program for a clinical trial in Japan, we assessed inter-rater agreement using two videotaped MADRS interviews administered in Japanese and produced with English subtitles. We looked for possible interpretational variance that might have been generated by cultural differences between Japanese raters in Japan and English-speaking raters in the USA scoring the same interviews. RESULTS The US and Japanese raters demonstrated high inter-rater agreement and no significant scoring difference on the total MADRS score. The subtitles in English did not adversely affect the overall scoring.We separately analyzed the 10 individual items from each of the two MADRS interviews used for rater training. Of the 20 items, 18 were concordant between the US and Japanese raters. In one interview, the US raters scored lassitude significantly higher (p = 0.013) and the inability to feel significantly lower (p = 0.037) than the Japanese raters, reflecting a possible interpretational difference on these items. CONCLUSION Although developed in Europe, these findings support the general applicability of the MADRS to assess the severity of depressive symptoms in Japan. We did note significant scoring differences on 2 of the 20 individual items, suggesting a possible cultural difference. It is possible that more interviews might have revealed more interpretational differences. These findings highlight the need for cultural familiarity when assessing psychiatric patients.
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Affiliation(s)
- Steven D Targum
- Clintara LLC, 505 Tremont Street, #907, Boston, MA 02116, USA.
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Youngstrom E, Zhao J, Mankoski R, Forbes RA, Marcus RM, Carson W, McQuade R, Findling RL. Clinical significance of treatment effects with aripiprazole versus placebo in a study of manic or mixed episodes associated with pediatric bipolar I disorder. J Child Adolesc Psychopharmacol 2013; 23:72-9. [PMID: 23480324 PMCID: PMC3696952 DOI: 10.1089/cap.2012.0024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Published studies in adult and pediatric bipolar disorder have used different definitions of treatment response. This analysis aimed to compare different definitions of response in a large sample of children and adolescents. METHODS Anexploratory analysis of a 4-week, multicenter, placebo-controlled study assessed patients (n=296; ages, 10-17 years) with an acute manic/mixed episode associated with BIPOLAR I disorder who were randomized to aripiprazole (10 or 30 mg/day) or placebo. The primary efficacy endpoint was mean change from baseline to week 4 in young mania rating scale (YMRS) total score. Additional assessments included: clinical global impressions-bipolar disorder (CGI-BP) Overall and mania scales, child global assessment scale (CGAS), and parent and subject general behavior inventory. Response was compared across seven operational definitions. Cohen's κ and Spearman's correlation tested relationships between various response definitions or changes in outcome measures and clinically meaningful improvement (defined as a CGI-BP overall improvement score of 1 or 2). RESULTS Response rates varied depending upon the operational definition, but were highest for 95% reliable change (statistical method used to determine individual change from previous assessment) and ≥33% reduction in YMRS total score. Response rate definitions with the highest validity in terms of predicting clinically meaningful improvement were: ≥50% reduction on YMRS (κ=0.64), a composite definition of response (YMRS <12.5, children's depression rating scale-revised (CDRS-R) ≤40, and CGAS ≥51; κ=0.59), and 95% reliable change on the CGAS or 33% reduction on YMRS (κ=0.56). Parent ratings of symptoms were generally better at detecting symptom improvement than were subject ratings (κ=∼0.4-0.5 vs. ∼0.2 when compared with CGI-BP overall improvement score). CONCLUSIONS Clinically meaningful definitions of response in acute treatment of a manic/mixed episode in pediatric subjects include a 50% change in YMRS and a composite measure of response. Parent-reported measures of symptom improvement appear reliable for assessing symptom change.
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Affiliation(s)
- Eric Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Haeri S, Williams J, Kopeykina I, Johnson J, Newmark A, Cohen L, Galynker I. Disparities in diagnosis of bipolar disorder in individuals of African and European descent: a review. J Psychiatr Pract 2011; 17:394-403. [PMID: 22108396 DOI: 10.1097/01.pra.0000407962.49851.ef] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Over the past 3 decades, a wide range of studies in the United States and the United Kingdom has reported that white individuals are more likely to be diagnosed with bipolar and affective disorders, whereas black individuals appear to be at higher risk for schizophrenia spectrum diagnoses. Despite the pressing need for strategies aimed at eliminating racial and cultural disparities in diagnosis and treatment of bipolar disorder, no systematic review of the existing literature in this area has been done. This study draws together the disparate strands of information in a comprehensive overview of the research base in this area. METHODS An electronic literature search of the Medline and PsychINFO databases was conducted in October 2009, supplemented by a review of references in the identified articles, for a total of 51 articles included in this qualitative review. RESULTS Black patients have consistently been found to be more likely than white patients to be diagnosed with schizophrenia rather than bipolar disorder. Four factors were identified as potential contributors to racial disparities in diagnostic rates: clinical presentation and expression of symptoms, access to care, help-seeking behaviors, and clinician judgment. CONCLUSION Despite efforts to curtail the phenomenon, racial disparities in diagnosis of bipolar disorder persist. Racial and cultural elements may affect how patients manifest behaviors and symptoms and how these are interpreted and attributed by clinicians in the diagnostic process. As an appropriate diagnosis determines treatment options and is central to quality of care, incorrect diagnosis can potentially have a negative impact on treatment effectiveness and accuracy of prognosis.
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Youngstrom EA, Arnold LE, Frazier TW. Bipolar and ADHD Comorbidity: Both Artifact and Outgrowth of Shared Mechanisms. ACTA ACUST UNITED AC 2010; 17:350-359. [PMID: 21278822 DOI: 10.1111/j.1468-2850.2010.01226.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Published rates of comorbidity between pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) have been higher than would be expected if they were independent conditions, but also dramatically different across different studies. This review examines processes that could artificially create the appearance of comorbidity or substantially bias estimates of the ADHD-BPD comorbidity rate, including: categorization of dimensional constructs, overlap among diagnostic criteria, over-splitting, developmental sequencing, and referral or surveillance biases. Evidence also suggests some mechanisms for "true" BPD-ADHD comorbidity, including shared risk factors, distinct subtypes, and weak causal relationships. Keys to differential diagnosis include focusing on episodic presentation and non-overlapping symptoms unique to mania.
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Does clinical judgment of baseline severity and changes in psychopathology depend on the patient population? Results of a CGI and PANSS linking analysis in a naturalistic study. J Clin Psychopharmacol 2010; 30:726-31. [PMID: 21105273 DOI: 10.1097/jcp.0b013e3181faf39b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Linking of the Clinical Global Impression (CGI) Scale and the Positive and Negative Syndrome Scale (PANSS) was performed within a naturalistic sample. Furthermore, these linking results were compared with those derived from randomized controlled trials to examine if the baseline severity might influence the linking results. METHODS Biweekly PANSS and CGI ratings were performed from admission to discharge in 398 schizophrenia patients treated within a naturalistic study. Equipercentile linking was performed using the statistical program, R 2.8.1. To evaluate how the naturalistic study design would influence linkage results, a so-called study sample was computed with patients of the naturalistic study fulfilling common inclusion criteria of randomized controlled trials (n = 199). Patients not fulfilling these criteria (less ill sample) and those fulfilling the criteria (study sample) were compared using confidence intervals. RESULTS We found a considerable difference between the linking of the CGI severity score and the PANSS total score comparing the less ill sample and the study sample. Being considered "mildly ill" at admission in the less ill sample corresponded to a PANSS total score of 47 points and to a PANSS total score of 67 points in the study sample. Considering the linking of the CGI improvement score and PANSS changes, similar results were found for CGI improvement ratings ranging from "very much improved" to "minimally improved". CONCLUSIONS Despite considerable differences, a 50% PANSS reduction was found to correspond to a clinical rating of much improved, which seems to be a suitable definition for response in clinical drug trials.
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Abstract
The idea of a "bipolar spectrum" is controversial due to 1) lack of widely accepted definitions, 2) concern that spectrum definitions might subsume cases with non-bipolar disorders, 3) worry that "diagnostic creep" may lead practitioners to overdiagnose bipolar disorder in marginal cases, and 4) worry that more diagnosis of bipolar spectrum may increase aggressive pharmacotherapy. These concerns are weighed against theoretical and empiric evidence converging in support of the bipolar spectrum as having prognostic and prescriptive validity. Practitioners can use inexpensive and practical strategies to incorporate the spectrum concept into their work while minimizing risks of overdiagnosis or unnecessary medication exposure.
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Affiliation(s)
- Eric Youngstrom
- Departments of Psychiatry and Psychology, University of North Carolina, Chapel Hill, 27599-3270, USA.
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Youngstrom EA, Freeman AJ, Jenkins MM. The assessment of children and adolescents with bipolar disorder. Child Adolesc Psychiatr Clin N Am 2009; 18:353-90, viii-ix. [PMID: 19264268 PMCID: PMC2915577 DOI: 10.1016/j.chc.2008.12.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The overarching goal of this article is to examine the current best evidence for assessing bipolar disorder (BPD) in children and adolescents and provide a comprehensive, evidence-based approach to diagnosis. Evidence- based assessment strategies are organized around the "3 Ps" of clinical assessment: Predict important criteria or developmental trajectories, Prescribe a change in treatment choice, and inform Process of treating the youth and his/her family. The review characterizes BPD in youths-specifically addressing bipolar diagnoses and clinical subtypes; it then provides an actuarial approach to assessment using prevalence of disorder, risk factors, and questionnaires; discusses treatment thresholds; and identifies practical measures of process and outcomes. The clinical tools and risk factors selected for inclusion in this review represent the best empirical evidence in the literature. By the end of the article, clinicians will have a framework and set of clinically useful tools with which to effectively make evidence-based decisions regarding the diagnosis of BPD in children and adolescents.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599-3270, USA.
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Vaccarino AL, Evans KR, Sills TL, Kalali AH. Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression. Depress Anxiety 2009; 25:1006-13. [PMID: 18800370 DOI: 10.1002/da.20435] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although diagnostically dissociable, anxiety is strongly co-morbid with depression. To examine further the clinical symptoms of anxiety in major depressive disorder (MDD), a non-parametric item response analysis on "blinded" data from four pharmaceutical company clinical trials was performed on the Hamilton Anxiety Rating Scale (HAMA) across levels of depressive severity. METHODS The severity of depressive symptoms was assessed using the 17-item Hamilton Depression Rating Scale (HAMD). HAMA and HAMD measures were supplied for each patient on each of two post-screen visits (n=1,668 observations). Option characteristic curves were generated for all 14 HAMA items to determine the probability of scoring a particular option on the HAMA in relation to the total HAMD score. Additional analyses were conducted using Pearson's product-moment correlations. RESULTS Results showed that anxiety-related symptomatology generally increased as a function of overall depressive severity, though there were clear differences between individual anxiety symptoms in their relationship with depressive severity. In particular, anxious mood, tension, insomnia, difficulties in concentration and memory, and depressed mood were found to discriminate over the full range of HAMD scores, increasing continuously with increases in depressive severity. By contrast, many somatic-related symptoms, including muscular, sensory, cardiovascular, respiratory, gastro-intestinal, and genito-urinary were manifested primarily at higher levels of depression and did not discriminate well at lower HAMD scores. CONCLUSIONS These results demonstrate anxiety as a core feature of depression, and the relationship between anxiety-related symptoms and depression should be considered in the assessment of depression and evaluation of treatment strategies and outcome.
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Abstract
PURPOSE To critically review the evidence concerning the implementation of clinical guidelines for bipolar disorder. METHODS A Medline search was made of the literature on the implementation of guidelines in bipolar disorder and mental health. The implementation of non-pharmacological treatments from the 2006 NICE Guideline for Bipolar Disorder was then used as a case example. May's model of normalization of complex interventions was then applied to the NICE guideline recommendations for bipolar disorder. RESULTS The effective local implementation of guidelines requires a detailed understanding of local barriers to their implementation. Some recommendations in the NICE Guideline on advanced directives and management of anxiety disorder in bipolar disorder appear to follow the existing trends in practice and are more likely to be implemented. Interventions concerning the psychological management of bipolar depression and maintenance psychological treatments are going to be the most difficult to implement because of shortages of skilled staff, the absence of specific training and supervision, the requirements for staff to adopt practices that are quite different from what they are used to, and some uncertainty about whether these interventions are effective in the most severe patients. CONCLUSIONS Without a detailed local understanding of the barriers to implementation and the resources and will to overcome them, there is likely to be a considerable local variation in the implementation of guidelines for bipolar disorder. Recommendations that require little change to working practices and resources are most likely to be implemented.
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Affiliation(s)
- Richard Morriss
- Division of Psychiatry, University of Nottingham, Nottingham, UK.
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25
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Abstract
Traditional healers' practices are widespread around the world, yet their diagnostic skills have rarely been investigated. This exploratory study examines whether yachactaitas (Quichua healers) in the Andes identify cases of psychiatric illness in their communities. For over 18 months, ten yachactaitas participated in the identification of 50 individuals with the condition known as llaqui. Medical and psychiatric evaluation indicated that most of those so diagnosed had a DSM-III-R mental disorder. None of the participants with llaqui was considered healthy in biomedical or psychiatric terms. It is suggested that yachactaitas might indeed identify general psychiatric cases in their communities, and that this might be useful for screening purposes.
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Affiliation(s)
- Mario Incayawar
- Runajambi Institute for the Study of Quichua Culture and Health, Otavalo, Ecuador.
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Macmillan I, Howells L, Kale K, Hackmann C, Taylor G, Hill K, Bradford S, Fowler D. Social and symptomatic outcomes of first-episode bipolar psychoses in an early intervention service. Early Interv Psychiatry 2007; 1:79-87. [PMID: 21352111 DOI: 10.1111/j.1751-7893.2007.00014.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM We aimed to establish the relative proportions of all diagnoses in people aged 14-35 years presenting to an early intervention in psychosis service, and to compare demographic variables, symptoms and outcomes between the bipolar psychoses and other psychoses at 3-6 months and 1 year post referral. METHODS Prospective 3- to 6-month diagnostic and symptomatic assessments were carried out. Diagnoses were established using the Diagnostic Interview for Psychoses - Diagnostic Module. Symptoms and outcomes were assessed using standardized instruments at 3-6 months and 1 year. Bipolar diagnoses were grouped together in a bipolar group (n=16) and compared with all other diagnoses, in a non-bipolar group (n=62). Parallel analysis was carried out using groups of lifetime elevated, expansive or irritable mood (n=32) and no lifetime elevated, expansive or irritable mood (n=46). RESULTS Bipolar disorders account for 20.5% of all new presentations to our service. Differences in outcomes over the range of psychotic diagnoses relate to early presence of negative symptoms. Psychoses with bipolar diagnoses or lifetime elevated, expansive or irritable mood showed lower rates of negative symptoms than other psychoses and had a higher quality of life and higher function at 3-6 months and 1 year. CONCLUSIONS Planning for future early intervention services should take the high rate of affective psychoses and their need for diagnosis-specific, evidence-based treatments into account. Lifetime elevated, expansive or irritable mood may predict improved outcomes in early psychoses, possibly mediated by lower levels of negative symptoms.
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Affiliation(s)
- Iain Macmillan
- Early Intervention Service, and University of East Anglia, Norwich, UK.
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Sanderson M. Assessment of manic symptoms in different cultures. Br J Psychiatry 2007; 190:178; author reply 179. [PMID: 17267944 DOI: 10.1192/bjp.190.2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Reed R. Assessment of manic symptoms in different cultures. Br J Psychiatry 2007; 190:178-9; author reply 179. [PMID: 17267943 DOI: 10.1192/bjp.190.2.178a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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