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McGrouther CC, Rangan AV, Di Florio A, Elman JA, Schork NJ, Kelsoe J. Heterogeneity analysis provides evidence for a genetically homogeneous subtype of bipolar-disorder. ARXIV 2024:arXiv:2405.00159v1. [PMID: 38745705 PMCID: PMC11092873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Bipolar Disorder (BD) is a complex disease. It is heterogeneous, both at the phenotypic and genetic level, although the extent and impact of this heterogeneity is not fully understood. One way to assess this heterogeneity is to look for patterns in the subphenotype data, identify a more phenotypically homogeneous set of subjects, and perform a genome-wide association-study (GWAS) and subsequent secondary analyses restricted to this homogeneous subset. Because of the variability in how phenotypic data was collected by the various BD studies over the years, homogenizing the phenotypic data is a challenging task, and so is replication. As members of the Psychiatric Genomics Consortium (PGC), we have access to the raw genotypes of 18,711 BD cases and 29,738 controls. This amount of data makes it possible for us to set aside the intricacies of phenotype and allow the genetic data itself to determine which subjects define a homogeneous genetic subgroup. In this paper, we leverage recent advances in heterogeneity analysis to look for distinct homogeneous genetic BD subgroups (or biclusters) that manifest the broad phenotype we think of as Bipolar Disorder. As our data was generated by 27 studies and genotyped on a variety of platforms (OMEX, Affymetrix, Illumina), we use a biclustering algorithm capable of covariate-correction. Covariate-correction is critical if we wish to distinguish disease-related signals from those which are a byproduct of ancestry, study or genotyping platform. We rely on the raw genotyped data and do not include any data generated through imputation. We first apply this covariate-corrected biclustering algorithm to a cohort of 2524 BD cases and 4106 controls from the Bipolar Disease Research Network (BDRN: OMEX). We find evidence of genetic heterogeneity delineating a statistically significant bicluster comprising a subset of BD cases which exhibits a disease-specific pattern of differential-expression across a subset of SNPs. This pattern replicates across the remaining data-sets collected by the PGC containing 5781/8289 (OMEX), 3581/7591 (Illumina), and 6825/9752(Affymetrix) cases/controls, respectively. This bicluster includes subjects diagnosed with bipolar type-I, as well as subjects diagnosed with bipolar type-II. However, the bicluster is enriched for bipolar type-I over type-II and may represent a collection of correlated genetic risk-factors. By investigating the bicluster-informed polygenic-risk-scoring (PRS), we find that the disease-specific pattern highlighted by the bicluster can be leveraged to eliminate noise from our GWAS analyses and improve not only risk prediction, particularly when using only a relatively small subset (e.g., ~ 1%) of the available SNPs, but also SNP replication. Though our primary focus is only the analysis of disease-related signal, we also identify replicable control-related heterogeneity. Covariate-corrected biclustering of raw genetic data appears to be a promising route for untangling heterogeneity and identifying replicable homogeneous genetic subtypes of complex disease. It may also prove useful in identifying protective effects within the control group. This approach circumvents some of the difficulties presented by subphenotype data collected by meta-analyses or 23 andMe, e.g., missingness, assessment variation, and reliance on self-report.
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Affiliation(s)
- Caroline C. McGrouther
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States of America
| | - Aaditya V. Rangan
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States of America
| | - Arianna Di Florio
- School of Medicine, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Jeremy A. Elman
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States of America
| | - Nicholas J. Schork
- The Translational Genomics Research Institute, Quantitative Medicine and Systems Biology, Phoenix, AZ, United States of America
| | - John Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
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Sankaranarayanan A, Ramanathan P, Mathew R, Wilding H, Castle D. Disordered gambling among people with psychotic disorders: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:4. [PMID: 38172155 PMCID: PMC10851698 DOI: 10.1038/s41537-023-00421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
Disorders of gambling are more common among the mentally ill, including in people with psychotic disorders. The aim of this study was to conduct a systematic review of the literature regarding the prevalence and correlates of gambling disorders in people with psychotic disorders. We systematically reviewed English-language literature through searches of six bibliographic databases, all run on 11 November 2022: Medline ALL, Embase, Emcare, APA PsycINFO, CINAHL and the Cochrane Library. Observational studies that reported the prevalence of gambling in psychotic disorders or psychosis among gamblers were included. Studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Tools. Sixteen studies, including 1,116,103 participants, from across a range of settings, were included. Most studies were done on males and recruited participants with a mean age of 40 years. Most of the studies (n = 12) were cross-sectional, and the remaining were case control in design. Most of the studies rated fair in quality. The prevalence of gambling among psychotic population ranged from 0.32 to 19.3%, with the majority of the studies reporting rates between 6.4 and 17%. The rates were 5-25 times higher than in the general population. While there were no consistent associations found with socio-demographic indices, several studies reported an association between gambling behaviours and substance use disorder among those with psychotic illnesses. Our research suggests that clinicians should assess for comorbid gambling among those with psychotic illness, particularly in those with mood symptoms, impulsivity, and substance use disorders. Gambling can negatively impact on their financial and social situations. Future research should study specific strategies or therapies among those with comorbid gambling and psychotic disorders.
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Affiliation(s)
- Anoop Sankaranarayanan
- Blacktown and Mt Druitt Mental Health Service, Western Sydney LHD Mental Health Service, Sydney, Australia.
- Translational Health Research Institute, Faculty of Medicine, Western Sydney University, Sydney, Australia.
| | - Preethi Ramanathan
- Blacktown and Mt Druitt Mental Health Service, Western Sydney LHD Mental Health Service, Sydney, Australia
| | - Rinu Mathew
- Blacktown and Mt Druitt Mental Health Service, Western Sydney LHD Mental Health Service, Sydney, Australia
| | - Helen Wilding
- Senior Research Librarian, St Vincent's Health Library Service, St Vincent's Hospital, Melbourne, Australia
| | - David Castle
- Professor of Psychiatry, Centre for Mental Health Service Innovation and University of Tasmania, Hobart, Australia
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Molander O, Månsson V, Berman AH, Grant JE, Wennberg P. Assessing Gambling Disorder Using Semistructured Interviews or Self-Report? Evaluation of the Structured Clinical Interview for Gambling Disorder Among Swedish Gamblers. Assessment 2023; 30:2387-2397. [PMID: 36680458 PMCID: PMC10623606 DOI: 10.1177/10731911221147038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Structured Clinical Interview for Gambling Disorder (SCI-GD) has the potential to bridge a diagnostic clinical gap, but psychometric evaluations have been scarce, in particular in relation to self-reported diagnostic criteria. This study analyzed existing data, including Swedish gamblers (N = 204) from treatment- and help-seeking contexts, self-help groups, and the general population, who were interviewed with the SCI-GD and completed self-report measures. The results indicated that fewer individuals fulfilled the diagnostic criteria for gambling disorder (GD) with the SCI-GD (n = 110, 54%), compared to a self-report Diagnostic and Statistical Manual of Mental Disorders:5th Edition (DSM-5) questionnaire on GD (n = 145, 71%; p < .001). Agreement between interviews and self-reported criteria was generally low (Fleiss kappa range: 0.31-0.52; r range: 0.35-0.55). A Rasch analysis showed that specific diagnostic criteria varied in difficulty, indicating a general pattern of higher item difficulty for the SCI-GD compared to self-reported DSM-5 criteria. Both the SCI-GD and the self-reported DSM-5 criteria performed well in terms of internal consistency, convergent, and discriminant validity. We conclude that the SCI-GD is a reliable and valid diagnostic tool to assess GD among individuals with various gambling behavior patterns. Further research-related and clinical implications are discussed.
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Affiliation(s)
- Olof Molander
- Karolinska Institutet, Stockholm, Solna, Sweden
- Stockholm Region Health Services, Sweden
| | - Viktor Månsson
- Karolinska Institutet, Stockholm, Solna, Sweden
- Stockholm Region Health Services, Sweden
| | - Anne H. Berman
- Karolinska Institutet, Stockholm, Solna, Sweden
- Uppsala University, Sweden
| | | | - Peter Wennberg
- Karolinska Institutet, Stockholm, Solna, Sweden
- Stockholm University, Sweden
- Inland Norway University of Applied Sciences, Lillehammer, Norway
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Preuss UW, Hesselbrock MN, Hesselbrock VM. A Prospective Comparison of Bipolar I and II Subjects with and without Comorbid Cannabis Use Disorders from the COGA Dataset. Brain Sci 2023; 13:1130. [PMID: 37626487 PMCID: PMC10452678 DOI: 10.3390/brainsci13081130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE The comorbidity of alcohol and substance use disorders among persons with bipolar disorder is elevated, as indicated by epidemiological and clinical studies. Following alcohol use, cannabis is the most frequently used and abused illicit substance among bipolar individuals, and such use may lead to comorbid cannabis use disorders (CUD). Previous research indicated that CUDs were related to a more severe course of bipolar disorder and higher rates of other comorbid alcohol and substance use disorders. Few studies, however, have conducted longitudinal research on this comorbidity. The aim of this study is to investigate the influence of CUD on the course of bipolar I and II individuals during a 5-year follow-up. METHODS The characteristics of bipolar disorder, cannabis use disorders, and other alcohol and substance use disorders, as well as comorbid mental disorders, were assessed using a standardized semi-structured interview (SSAGA) at both baseline and the 5-year follow-up. N = 180 bipolar I and II patients were subdivided into groups of with and without comorbid cannabis use disorders (CUD). RESULTS Of the 77 bipolar I and 103 bipolar II patients, n = 65 (36.1%) had a comorbid diagnosis of any CUD (DSM-IV cannabis abuse or dependence). Comorbid bipolar patients with CUD had higher rates of other substance use disorders and posttraumatic stress disorders, more affective symptoms, and less psychosocial functioning at baseline and at 5-year follow-up. In contrast to previously reported findings, higher rates of anxiety disorders and bipolar disorder complications (e.g., mixed episodes, rapid cycling, and manic or hypomanic episodes) were not found. The effect of CUD on other substance use disorders was confirmed using moderation analyses. CONCLUSIONS A 5-year prospective evaluation of bipolar patients with and without CUD confirmed previous investigations, suggesting that the risk of other substance use disorders is significantly increased in comorbid individuals. CUD has a moderation effect, while no effect was found for other mental disorders. Findings from this study and previous research may be due to the examination of different phenotypes (Cannabis use vs. CUD) and sample variation (family study vs. clinical and epidemiological populations).
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Affiliation(s)
- Ulrich W. Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, RKH Hospital Ludwigsburg, 71640 Ludwigsburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Michie N. Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06032, USA; (M.N.H.); (V.M.H.)
| | - Victor M. Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06032, USA; (M.N.H.); (V.M.H.)
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Szerman N, Basurte-Villamor I, Vega P, Mesías B, Martínez-Raga J, Ferre F, Arango C. Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles. Eur Neuropsychopharmacol 2023; 66:78-91. [PMID: 36516511 DOI: 10.1016/j.euroneuro.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.
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Affiliation(s)
- Néstor Szerman
- WADD and WPA Section Dual Disorders, Mental Health and Psychiatric Institute, Gregorio Marañon University Hospital, Madrid, Spain.
| | - Ignacio Basurte-Villamor
- Department of Psychiatry and Behavioral Health, Clínica López Ibor, Madrid, Spain; School of Medicine, Universidad Europea de Madrid, Spain.
| | - Pablo Vega
- Institute for Addictions, Madrid Salud, Madrid City Council, Madrid, Spain
| | - Beatriz Mesías
- Institute for Addictions, Madrid Salud, Madrid City Council, Madrid, Spain
| | - José Martínez-Raga
- Department of Psychiatry and Clinical Psychology, Hospital Universitario Doctor Peset & University of Valencia
| | - Francisco Ferre
- Institute of Psychiatry and Mental Health, Gregorio Marañón University Hospital, Madrid, School of Medicine, Universidad Complutense de Madrid, CIBERSAM, Spain
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Gregorio Marañón University Hospital, Madrid, School of Medicine, Universidad Complutense de Madrid, CIBERSAM, Spain
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Dowling N, Merkouris S, Lubman D, Thomas S, Bowden-Jones H, Cowlishaw S. Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database Syst Rev 2022; 9:CD008936. [PMID: 36130734 PMCID: PMC9492444 DOI: 10.1002/14651858.cd008936.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. OBJECTIVES The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). SELECTION CRITERIA We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). MAIN RESULTS We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks. Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%). AUTHORS' CONCLUSIONS This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.
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Affiliation(s)
- Nicki Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | - Dan Lubman
- Turning Point, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Shane Thomas
- School of Health, Federation University, Melbourne, Australia
- Research School of Population Health, Australian National University, Melbourne, Australia
- Peking University, Beijing, China
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic UK, Faculty of Brain Sciences, UCL, London, UK
- Department of Psychiatry, Cambridge University, Cambridge, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Blair J, Brozena J, Matthews M, Richardson T, Abdullah S. Financial technologies (FinTech) for mental health: The potential of objective financial data to better understand the relationships between financial behavior and mental health. Front Psychiatry 2022; 13:810057. [PMID: 36424989 PMCID: PMC9680645 DOI: 10.3389/fpsyt.2022.810057] [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: 11/05/2021] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Financial stability is a key challenge for individuals with mental illnesses. Symptomatic periods often manifest in poor financial decision-making including compulsive spending and risky behaviors. This article explores research opportunities and challenges in developing financial technologies (FinTech) to support individuals with mental health. Specifically, we focus on how objective financial data might lead to novel mental health assessment and intervention methods. We have used data from one individual with bipolar disorder (BD) (i.e., an N = 1 case study) to illustrate feasibility of collecting and analyzing objective financial data alongside mental health factors. While we have not found statistically significant trends nor our findings are generalizable beyond this case, our approach provides an insight into the potential of using objective financial data to identify early warning signs and thereby, enable preemptive care for individuals with serious mental illnesses. We have also identified challenges of accessing objective financial data. The paper outlines what data is currently available, what can be done with it, and what factors to consider when working with financial data. We have also explored future directions for developing interventions to support financial well-being and stability. Furthermore, we have described the technical, ethical, and equity challenges for financial data-driven assessments and intervention methods, as well as provided a broad research agenda to address these challenges.
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Affiliation(s)
- Johnna Blair
- College of Information Sciences and Technology, Penn State University, State College, PA, United States
| | - Jeff Brozena
- College of Information Sciences and Technology, Penn State University, State College, PA, United States
| | - Mark Matthews
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Thomas Richardson
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Saeed Abdullah
- College of Information Sciences and Technology, Penn State University, State College, PA, United States
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Preuss UW, Schaefer M, Born C, Grunze H. Bipolar Disorder and Comorbid Use of Illicit Substances. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111256. [PMID: 34833474 PMCID: PMC8623998 DOI: 10.3390/medicina57111256] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.
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Affiliation(s)
- Ulrich W. Preuss
- Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640 Ludwigsburg, Germany
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität, Halle-Wittenberg, Julius-Kühn-Str. 7, 06112 Halle/Saale, Germany
- Correspondence:
| | - Martin Schaefer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany;
- Klinik für Psychiatrie und Psychotherapie (CCM), Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
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Vita A, Bastiani L, Turrina C, Benedetti E, Bergamini A, Molinaro S. At-risk gambling in patients with severe psychiatric illness and in community subjects matched for age and sex. Psychiatry Res 2021; 304:114142. [PMID: 34340131 DOI: 10.1016/j.psychres.2021.114142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/15/2022]
Abstract
In the recent literature the rates of gambling in psychiatric patients have been compared only indirectly with those found in community samples and no study has so far matched a clinical sample with community controls. We selected 875 outpatients attending two community mental health centers and 3.500 community subjects, matched for age and sex. At-risk gambling was defined according to the four categories of the Canadian Problem Gambling Index (CPGI) scores: 0 no-risk, 1-2 low-risk, 3-7 moderate-risk, 8+ high-risk. Data were also collected on substance, alcohol, and tobacco use. Patients were diagnosed with schizophrenia, bipolar disorder, unipolar depression, cluster B personality. At-risk gambling was significantly higher in psychiatric patients compared to community subjects. In the univariate multinomial logistic regression analysis, high-risk gambling was associated with lifetime substance use and being unmarried, moderate-risk with age at onset of alcohol use and lifetime tobacco use, and low-risk with higher education. In the multinomial logistic regression analysis high risk-gambling in psychiatric patients was four times that of community controls, while in substance users high-risk gambling was two times that of non-users. The results suggest that screening for gambling could improve the care of psychiatric patients who suffer from a comorbid behavioral addiction.
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Affiliation(s)
- Antonio Vita
- Department of Experimental and Clinical Sciences, University of Brescia, Italy. Department of Mental Health, ASST-Spedali Civili, Brescia, Italy
| | - Luca Bastiani
- Institute of Clinical Physiology, National Council of Research (CNR), Rome, Italy
| | - Cesare Turrina
- Department of Experimental and Clinical Sciences, University of Brescia, Italy. Department of Mental Health, ASST-Spedali Civili, Brescia, Italy.
| | - Elisa Benedetti
- Institute of Clinical Physiology, National Council of Research (CNR), Rome, Italy
| | - Annalisa Bergamini
- Department of Experimental and Clinical Sciences, University of Brescia, Italy. Department of Mental Health, ASST-Spedali Civili, Brescia, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Council of Research (CNR), Rome, Italy
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10
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Wolf A, Ueda K. Contribution of Eye-Tracking to Study Cognitive Impairments Among Clinical Populations. Front Psychol 2021; 12:590986. [PMID: 34163391 PMCID: PMC8215550 DOI: 10.3389/fpsyg.2021.590986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/07/2021] [Indexed: 11/29/2022] Open
Abstract
In the field of psychology, the merge of decision-theory and neuroscientific methods produces an array of scientifically recognized paradigms. For example, by exploring consumer’s eye-movement behavior, researchers aim to deepen the understanding of how patterns of retinal activation are being meaningfully transformed into visual experiences and connected with specific reactions (e.g., purchase). Notably, eye-movements provide knowledge of one’s homeostatic balance and gatekeep information that shape decisions. Hence, vision science investigates the quality of observed environments determined under various experimental conditions. Moreover, it answers questions on how human process visual stimuli and use gained information for a successful strategy to achieve certain goals. While capturing cognitive states with the support of the eye-trackers progresses at a relatively fast pace in decision-making research, measuring the visual performance of real-life tasks, which require complex cognitive skills, is tentatively translated into clinical experiments. Nevertheless, the potential of the human eye as a highly valuable source of biomarkers has been underlined. In this article, we aim to draw readers attention to decision-making experimental paradigms supported with eye-tracking technology among clinical populations. Such interdisciplinary approach may become an important component that will (i) help in objectively illustrating patient’s models of beliefs and values, (ii) support clinical interventions, and (iii) contribute to health services. It is possible that shortly, eye-movement data from decision-making experiments will grant the scientific community a greater understanding of mechanisms underlining mental states and consumption practices that medical professionals consider as obsessions, disorders or addiction.
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Affiliation(s)
- Alexandra Wolf
- JSPS International Research Fellow, Research Center for Applied Perceptual Science, Kyushu University, Fukuoka, Japan
| | - Kazuo Ueda
- Unit of Perceptual Psychology, Dept. Human Science, Research Center for Applied Perceptual Science, Division of Auditory and Visual Perception Research, Research and Development Center for Five-Sense Devices, Kyushu University, Fukuoka, Japan
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11
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Beyer DKE, Horn L, Klinker N, Freund N. Risky decision-making following prefrontal D1 receptor manipulation. Transl Neurosci 2021; 12:432-443. [PMID: 34760299 PMCID: PMC8569284 DOI: 10.1515/tnsci-2020-0187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
The prefrontal dopamine D1 receptor (D1R) is involved in cognitive processes. Viral overexpression of this receptor in rats further increases the reward-related behaviors and even its termination induces anhedonia and helplessness. In this study, we investigated the risky decision-making during D1R overexpression and its termination. Rats conducted the rodent version of the Iowa gambling task daily. In addition, the methyl CpG–binding protein-2 (MeCP2), one regulator connecting the dopaminergic system, cognitive processes, and mood-related behavior, was investigated after completion of the behavioral tasks. D1R overexpressing subjects exhibited maladaptive risky decision-making and risky decisions returned to control levels following termination of D1R overexpression; however, after termination, animals earned less reward compared to control subjects. In this phase, MeCP2-positive cells were elevated in the right amygdala. Our results extend the previously reported behavioral changes in the D1R-manipulated animal model to increased risk-taking and revealed differential MeCP2 expression adding further evidence for a bipolar disorder-like phenotype of this model.
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Affiliation(s)
- Dominik K. E. Beyer
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
| | - Lisa Horn
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
| | - Nadine Klinker
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
| | - Nadja Freund
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
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12
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Stokes PRA, Jokinen T, Amawi S, Qureshi M, Husain MI, Yatham LN, Strang J, Young AH. Pharmacological Treatment of Mood Disorders and Comorbid Addictions: A Systematic Review and Meta-Analysis: Traitement Pharmacologique des Troubles de L'humeur et des Dépendances Comorbides: Une Revue Systématique et une Méta-Analyse. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:749-769. [PMID: 32302221 PMCID: PMC7564307 DOI: 10.1177/0706743720915420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Addiction comorbidity is an important clinical challenge in mood disorders, but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in people with mood disorders and addiction comorbidity. METHODS A systematic search of placebo-controlled randomized controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD), and comorbid addictions was performed. Treatment-related effects on mood and addiction measures were assessed in a meta-analysis, which also estimated risks of participant dropout and adverse effects. RESULTS A total of 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (standardized mean difference [SMD] = -0.15; 95% confidence interval [95% CI], -0.29 to -0.02; P = 0.03) but not BD depressive symptoms (SMD = -0.09; 95% CI, -0.22 to 0.03; P = 0.15). Quetiapine significantly improved manic symptoms (SMD = -0.23; 95% CI, -0.39 to -0.06; P = 0.008) but not BD depressive symptoms (SMD = -0.07; 95% CI, -0.23 to 0.10; P = 0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD = -0.16; 95% CI, -0.30 to -0.03; P = 0.02). Imipramine improved MDD depressive symptoms (SMD = -0.58; 95% CI, -1.03 to -0.13; P = 0.01) but Selective serotonin reuptake Inhibitors (SSRI)-based treatments had no effect (SMD = -0.06; 95% CI, -0.30 to 0.17; P = 0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence. CONCLUSIONS Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms, and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI's for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and comorbid addictions.
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Affiliation(s)
- Paul R A Stokes
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London Maudsley Foundation Trust and King's College London, United Kingdom
| | - Tahir Jokinen
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Sami Amawi
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mutahira Qureshi
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom
| | - Muhammad Ishrat Husain
- Department of Psychiatry, University of Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | | | - John Strang
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London Maudsley Foundation Trust and King's College London, United Kingdom.,Department of Addictions, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London Maudsley Foundation Trust and King's College London, United Kingdom
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13
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Scavone C, Stelitano B, Rafaniello C, Rossi F, Sportiello L, Capuano A. Drugs-Induced Pathological Gambling: An Analysis of Italian Spontaneous Reporting System. J Gambl Stud 2020; 36:85-96. [PMID: 30671764 PMCID: PMC7026297 DOI: 10.1007/s10899-019-09828-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pathological gambling has been reported as a direct complication of Parkinson’s disease and its pharmacological treatment based on dopamine agonists. Moreover, further medications (not dopamine agonists) were associated to the occurrence of gambling disorder. We aim to analyze the spontaneous reports of gambling disorder on the whole Italian territory with a focus on Campania Region (Southern Italy) from January 1st 2002 to July 31st 2018. We analyzed gambling disorder’s reports across the 2002–2018 period in the Italian spontaneous reporting database (Rete Nazionale di Farmacovigilanza—RNF), with a focus on Campania region. 94 suspected cases of gambling disorder associated to apomorphine, aripiprazole, cabergoline, levodopa, levodopa and derivatives in association with entacapone/benserazide and carbidopa, pergolide, pramipexole, ropinirole, and rotigotine were reported into the RNF. Of these cases, two related to pramipexole and one to aripiprazole were sent to Campania Pharmacovigilance Regional Centre. Although it is widely recognized that dopamine agonists may induce behavioral disorders, Parkinson’s disease is itself associated to pathological gambling, compulsive shopping and eating. Since our results could not clarify the correlation between Parkinson’s disease, its pharmacological treatment and pathological gambling, in order to better define this correlation there is a need to conduct further ad hoc observational studies.
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Affiliation(s)
- Cristina Scavone
- Department of Experimental Medicine Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Via Costantinopoli 16, 80138, Naples, Italy.
| | - Barbara Stelitano
- Department of Experimental Medicine Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Via Costantinopoli 16, 80138, Naples, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Via Costantinopoli 16, 80138, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Via Costantinopoli 16, 80138, Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Via Costantinopoli 16, 80138, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Via Costantinopoli 16, 80138, Naples, Italy
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14
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Kirschner M, Rabinowitz A, Singer N, Dagher A. From apathy to addiction: Insights from neurology and psychiatry. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109926. [PMID: 32171904 DOI: 10.1016/j.pnpbp.2020.109926] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/21/2022]
Abstract
The tendency to engage in addictive behaviors has long been tied to the actions of the dopamine system. Early theories were based on the fact that all addictive drugs and behaviors (such as gambling) increase dopamine levels in the striatum, and the evidence that dopamine signaled reward or reward prediction error. However, with a changing emphasis of addiction away from purely pharmacological models that emphasize tolerance and withdrawal, towards one of behavioral dyscontrol, is there still a place for abnormal dopamine signaling in addiction? Here we recast the dopamine theory of addiction based on the idea that tonic dopamine may index a continuous phenotype that goes from apathy to impulsivity and compulsivity. Higher tonic dopamine signaling would make individuals vulnerable to drug reinforcement and cue-induced craving. We relate this to computational models of dopamine signaling, and review clinical and neuroimaging evidence from Parkinson's Disease, schizophrenia and bipolar disorder in support of this model.
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Affiliation(s)
- Matthias Kirschner
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Canada; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - Arielle Rabinowitz
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Canada
| | - Neomi Singer
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Canada
| | - Alain Dagher
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Canada.
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15
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Gan Z, Zhang M, Han H, Zhu Q, Li K. Ziprasidone in the treatment of bipolar disorder with comorbid obsessive-compulsive disorder and gambling disorder. Bipolar Disord 2020; 22:425-428. [PMID: 32315490 DOI: 10.1111/bdi.12917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Zhaoyu Gan
- Department of Psychiatry, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming Zhang
- Department of Psychiatry, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongying Han
- Department of Psychiatry, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qi Zhu
- Department of Psychiatry, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kanglai Li
- Department of Very Important Patient, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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16
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Lewis KJS, Richards A, Karlsson R, Leonenko G, Jones SE, Jones HJ, Gordon-Smith K, Forty L, Escott-Price V, Owen MJ, Weedon MN, Jones L, Craddock N, Jones I, Landén M, O’Donovan MC, Di Florio A. Comparison of Genetic Liability for Sleep Traits Among Individuals With Bipolar Disorder I or II and Control Participants. JAMA Psychiatry 2020; 77:303-310. [PMID: 31751445 PMCID: PMC6902167 DOI: 10.1001/jamapsychiatry.2019.4079] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Insomnia, hypersomnia, and an evening chronotype are common in individuals with bipolar disorder (BD), but whether this reflects shared genetic liability is unclear. Stratifying by BD subtypes could elucidate this association and inform sleep and BD research. OBJECTIVE To assess whether polygenic risk scores (PRSs) for sleep traits are associated with BD subtypes I and II. DESIGN, SETTING, AND PARTICIPANTS This case-control study was conducted in the United Kingdom and Sweden with participants with BD and control participants. Multinomial regression was used to assess whether PRSs for insomnia, daytime sleepiness, sleep duration, and chronotype are associated with BD subtypes compared with control participants. Affected individuals were recruited from the Bipolar Disorder Research Network. Control participants were recruited from the 1958 British Birth Cohort and the UK Blood Service. Analyses were repeated in an independent Swedish sample from August 2018 to July 2019. All participants were of European ancestry. EXPOSURES Standardized PRSs derived using alleles from genome-wide association studies of insomnia, sleep duration, daytime sleepiness, and chronotype. These were adjusted for the first 10 population principal components, genotyping platforms, and sex. MAIN OUTCOMES AND MEASURES Association of PRSs with BD subtypes, determined by semistructured psychiatric interview and case notes. RESULTS The main analysis included 4672 participants with BD (3132 female participants [67.0%]; 3404 with BD-I [72.9%]) and 5714 control participants (2812 female participants [49.2%]). Insomnia PRS was associated with increased risk of BD-II (relative risk [RR], 1.14 [95% CI, 1.07-1.21]; P = 8.26 × 10-5) but not BD-I (RR, 0.98 [95% CI, 0.94-1.03]; P = .409) relative to control participants. Sleep-duration PRS was associated with BD-I (RR, 1.10 [95% CI, 1.06-1.15]; P = 1.13 × 10-5) but not BD-II (RR, 0.99 [95% CI, 0.93-1.06]; P = .818). Associations between (1) insomnia PRS and BD-II and (2) sleep-duration PRS and BD-I were replicated in the Swedish sample of 4366 individuals with BD (2697 female participants [61.8%]; 2627 with BD-I [60.2%]) and 6091 control participants (3767 female participants [61.8%]). Chronotype and daytime-sleepiness PRS were not associated with BD subtypes. CONCLUSIONS AND RELEVANCE Per this analysis, BD subtypes differ in genetic liability to insomnia and hypersomnia, providing further evidence that the distinction between BD-I and BD-II has genetic validity. This distinction will be crucial in selecting participants for future research on the role of sleep disturbance in BD.
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Affiliation(s)
- Katie J. S. Lewis
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Richards
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ganna Leonenko
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Samuel E. Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Hannah J. Jones
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom,National Institute of Health Research Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Katherine Gordon-Smith
- Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom
| | - Liz Forty
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Valentina Escott-Price
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Michael J. Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Michael N. Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom
| | - Nick Craddock
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Ian Jones
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Institute of Neuroscience and Physiology, Sahlgenska Academy at the Gothenburg University, Gothenburg, Sweden
| | - Michael C. O’Donovan
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Arianna Di Florio
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
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17
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Dowling NA, Merkouris SS, Dias S, Rodda SN, Manning V, Youssef GJ, Lubman DI, Volberg RA. The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101784. [PMID: 31759246 DOI: 10.1016/j.cpr.2019.101784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023]
Abstract
Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.
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Affiliation(s)
- N A Dowling
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Melbourne Graduate School of Education, University of Melbourne, Kwong Lee Dow Building, 234 Queensberry Street, Parkville, VIC 3053, Australia.
| | - S S Merkouris
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S Dias
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S N Rodda
- School of Population Health, Faculty of Medical and Health Sciences, 216 Morrin Road, Auckland 1142, New Zealand.
| | - V Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - G J Youssef
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia
| | - D I Lubman
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - R A Volberg
- School of Public Health and Health Sciences, University of Massachusetts, 715 N. Pleasant Street, Amherst, MA 01003, USA.
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18
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The Reciprocal Association between Problem Gambling and Mental Health Symptoms/Substance Use: Cross-Lagged Path Modelling of Longitudinal Cohort Data. J Clin Med 2019; 8:jcm8111888. [PMID: 31698740 PMCID: PMC6912817 DOI: 10.3390/jcm8111888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 02/01/2023] Open
Abstract
To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous alcohol use, daily tobacco use, and drug use) using cross-lagged path models in a prospective general population cohort sample; and (2) determine whether these associations are moderated by age and gender. This study involved secondary data analysis from 1109 respondents who provided data during Wave 2 or 3 (12-months apart) of the Tasmanian Longitudinal Gambling Study (Australia). Depression (odds ratio (OR) = 2.164) and generalized anxiety (OR = 2.300) at Wave 2 were found to have cross-lagged associations with the subsequent development of any-risk gambling (low-risk, moderate-risk, or problem gambling) at Wave 3. Hazardous alcohol use, daily tobacco use, and drug use at Wave 2 were not associated with the development of any-risk gambling at Wave 3. Any-risk gambling at Wave 2 was not associated with the subsequent development of any mental health symptoms or substance use variables at Wave 3. Age and gender failed to be significant moderators in the associations between any-risk gambling and mental health symptoms or substance use variables. Future longitudinal and event-level research is required to further substantiate these prospective relationships, with a view to developing targeted preventions and interventions.
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19
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Varo C, Murru A, Salagre E, Jiménez E, Solé B, Montejo L, Carvalho AF, Stubbs B, Grande I, Martínez-Arán A, Vieta E, Reinares M. Behavioral addictions in bipolar disorders: A systematic review. Eur Neuropsychopharmacol 2019; 29:76-97. [PMID: 30420190 DOI: 10.1016/j.euroneuro.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/18/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
Clinical and epidemiological research suggests that behavioral addictions (BA) are associated with a wide range of psychiatric disorders. However, the relationship between BA and bipolar disorders (BD) has not been thoroughly explored. The aim of this systematic review was to critically summarize and evaluate the current available evidence regarding a possible association between BA and BD. A systematic review of major electronic databases according to PRISMA guidelines was conducted from inception to 31st December 2017. We sought quantitative studies data concerning prevalence of comorbidity, features and treatment related to BA-BD comorbidity. Data were narratively synthesized. Of the 1250 studies returned from the search, a total of 28 articles were included in this review. BA may be overrepresented in BD samples, and the other way around. Pathological gambling and kleptomania were the most prevalent conditions followed by compulsive buying, compulsive sexual behavior and internet addiction. BA was also associated with other mood disorders, anxiety disorders and substance use disorder. BD-BA comorbidity was related with more severe course of illness. Studies on treatment strategies for BD-BA comorbidity are rather limited; only one randomized controlled trial that fulfilled inclusion criteria was identified. Methodological heterogeneity in terms of design and results among studies was found. BD-BA commonly co-occurs although there is a need for rigorous studies. Routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BA and to effectively manage the complex consequences associated with BA-BD comorbidity.
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Affiliation(s)
- C Varo
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Murru
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - E Salagre
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Jiménez
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Solé
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - L Montejo
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - I Grande
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martínez-Arán
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - M Reinares
- Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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20
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Richardson T, Jansen M, Fitch C. Financial difficulties in bipolar disorder part 1: longitudinal relationships with mental health. J Ment Health 2018; 27:595-601. [DOI: 10.1080/09638237.2018.1521920] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Megan Jansen
- School of Psychology, University of Southampton, Southampton, UK
| | - Chris Fitch
- School of Geographical Sciences, University of Bristol, Clifton, UK
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21
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Jacob L, Haro JM, Koyanagi A. The association between problem gambling and psychotic experiences: Findings from the Adult Psychiatric Morbidity Survey 2007. Schizophr Res 2018; 201:79-84. [PMID: 29804926 DOI: 10.1016/j.schres.2018.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 05/13/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies on the association between psychotic experiences (PEs) and problem gambling are lacking. Thus, we examined the association between PEs and problem gambling in the general UK population. METHODS This study used community-based, cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS) (n = 7403). Ten items from the DSM-IV criteria and the British Gambling Prevalence Survey studies were used to ascertain problem gambling among individuals who gambled in the past 12 months. Respondents were classified as no problem (0 criteria), at-risk (1 or 2 criteria) and problem gambling (≥3 criteria). Past 12-month PE was assessed with the Psychosis Screening Questionnaire. Multivariable logistic regression models were constructed to assess the association between gambling status (exposure variable) and PE (outcome variable). RESULTS The final sample consisted of 7363 people aged ≥16 years with no definite or probable psychosis [mean (SD) age 46.4 (18.6) years; 51.2% females]. The prevalence of PE in those with no problem, at-risk, and problem gambling were 5.1%, 11.1%, and 29.7%, respectively. In the model adjusted for sociodemographics, common mental disorders and risky health behaviors, at-risk (OR = 1.88; 95% CI: 1.11-3.19) and problem gambling (OR = 4.64; 95% CI: 1.78-12.13) were associated with an increased odds for PE. CONCLUSION Problem gambling and PE tend to co-exist. Further research is needed to gain a better understanding of the mechanisms that underlie the association observed.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris 75006, France.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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22
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Bergamini A, Turrina C, Bettini F, Toccagni A, Valsecchi P, Sacchetti E, Vita A. At-risk gambling in patients with severe mental illness: Prevalence and associated features. J Behav Addict 2018; 7:348-354. [PMID: 29865864 PMCID: PMC6174579 DOI: 10.1556/2006.7.2018.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and aims The primary objective of this study was to investigate the prevalence of at-risk gambling in a large, unselected sample of outpatients attending two community mental health centers, to estimate rates according to the main diagnosis, and to evaluate risk factors for gambling. Methods All patients attending the centers were evaluated with the Canadian Problem Gambling Index and the Mini International Neuropsychiatric Interview. Diagnoses were checked with the treating psychiatrists and after a chart review of the university hospital discharge diagnoses. Results The rate of at-risk gambling in 900 patients was 5.3%. In those who gambled over the last year, 10.1% were at-risk gamblers. The rates in the main diagnostic groups were: 4.7% schizophrenia and related disorders, 4.9% bipolar disorder, 5.6% unipolar depression, and 6.6% cluster B personality disorder. In 52.1% of the cases, at-risk gambling preceded the onset of a major psychiatric disorder. In a linear regression analysis, a family history of gambling disorder, psychiatric comorbidities, drug abuse/dependence, and tobacco smoking were significantly associated with at-risk gambling. Discussion and conclusion The results of this study evidenced a higher rate of at-risk gambling compared to community estimates and call for a careful screening for gambling in the general psychiatric population.
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Affiliation(s)
- Annalisa Bergamini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,Department of Mental Health, ASST Spedali Civili, Brescia, Italy,Corresponding author: Prof. Cesare Turrina; Department of Mental Health, ASST Spedali Civili 1, 25100 Brescia, Italy; Phone: +39 030 3995233; Fax: +39 030 3384089; E-mail:
| | - Francesca Bettini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Anna Toccagni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emilio Sacchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,Department of Mental Health, ASST Spedali Civili, Brescia, Italy
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23
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Dowling NA, Merkouris SS, Manning V, Volberg R, Lee SJ, Rodda SN, Lubman DI. Screening for problem gambling within mental health services: a comparison of the classification accuracy of brief instruments. Addiction 2018; 113:1088-1104. [PMID: 29274182 DOI: 10.1111/add.14150] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/22/2017] [Accepted: 12/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Despite the over-representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was to compare the classification accuracy of nine brief problem gambling screening instruments (two to five items) with a reference standard among patients accessing mental health services. DESIGN The classification accuracy of nine brief screening instruments was compared with multiple cut-off scores on a reference standard. SETTING Eight mental health services in Victoria, Australia. PARTICIPANTS A total of 837 patients were recruited consecutively between June 2015 and January 2016. MEASUREMENTS The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen (BPGS) (two- to five-item versions), NODS-CLiP, NODS-CLiP2, Brief Biosocial Gambling Screen (BBGS) and NODS-PERC. The Problem Gambling Severity Index (PGSI) was the reference standard. FINDINGS The five-item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low-risk, moderate-risk or problem gambling) (sensitivity = 0.803, specificity = 0.982, diagnostic efficiency = 0.943). Several shorter instruments adequately detected both problem and moderate-risk, but not low-risk, gambling: two three-item instruments (NODS-CLiP, three-item BPGS) and two four-item instruments (NODS-PERC, four-item BPGS) (sensitivity = 0.854-0.966, specificity = 0.901-0.954, diagnostic efficiency = 0.908-0.941). The four-item instruments, however, did not provide any considerable advantage over the three-item instruments. Similarly, the very brief (two-item) instruments (Lie/Bet and two-item BPGS) adequately detected problem gambling (sensitivity = 0.811-0.868, specificity = 0.938-0.943, diagnostic efficiency = 0.933-0.934), but not moderate-risk or low-risk gambling. CONCLUSIONS The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the five-item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate-risk/problem gambling) can employ the NODS-CLiP or the three-item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the two-item BPGS.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia.,Melbourne Graduate School of Education, University of Melbourne, Australia
| | | | - Victorian Manning
- Turning Point, Eastern Health, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Stuart J Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia.,Turning Point, Eastern Health, Fitzroy, Australia.,School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Dan I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
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24
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Manning V, Dowling N, Lee S, Rodda S, Garfield J, Volberg R, Kulkarni J, Lubman D. Problem gambling and substance use in patients attending community mental health services. J Behav Addict 2017; 6:678-688. [PMID: 29254361 PMCID: PMC6034952 DOI: 10.1556/2006.6.2017.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and aims Relatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia. Methods A total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling. Results The gambling participation rate was 41.6% [95% CI = 38.2-44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0-22.4] as "non-problem gamblers," 7.2% [CI = 5.4-8.9] as "low-risk" gamblers, 8.4% [CI = 6.5-10.2] as "moderate-risk" gamblers, and 6.3% [CI = 4.7-8.0] as "problem gamblers." One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98-9.37]), borderline personality (OR = 2.59 [CI = 1.13-5.94]), bipolar affective (OR = 2.01 [CI = 1.07-3.80]), and psychotic (OR = 1.83 [CI = 1.03-3.25]) disorders were significant predictors of problem gambling. Discussion and conclusions Patients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria's adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling.
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Affiliation(s)
- Victoria Manning
- Turning Point, Eastern Health, Melbourne, VIC, Australia,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia,Corresponding author: Victoria Manning; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia; Phone: +61 3 8413 8413; Fax: +61 3 9416 3420; E-mail:
| | - Nicki. A. Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia,Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Stuart Lee
- Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Simone Rodda
- Turning Point, Eastern Health, Melbourne, VIC, Australia,School of Psychology, Deakin University, Geelong, VIC, Australia,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Joshua Benjamin Bernard Garfield
- Turning Point, Eastern Health, Melbourne, VIC, Australia,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Dan Ian Lubman
- Turning Point, Eastern Health, Melbourne, VIC, Australia,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
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25
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Lewis KS, Gordon-Smith K, Forty L, Di Florio A, Craddock N, Jones L, Jones I. Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. Br J Psychiatry 2017; 211:169-174. [PMID: 28684405 PMCID: PMC5579327 DOI: 10.1192/bjp.bp.117.202259] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023]
Abstract
BackgroundSleep loss may trigger mood episodes in people with bipolar disorder but individual differences could influence vulnerability to this trigger.AimsTo determine whether bipolar subtype (bipolar disorder type I (BP-I) or II (BD-II)) and gender were associated with vulnerability to the sleep loss trigger.MethodDuring a semi-structured interview, 3140 individuals (68% women) with bipolar disorder (66% BD-I) reported whether sleep loss had triggered episodes of high or low mood. DSM-IV diagnosis of bipolar subtype was derived from case notes and interview data.ResultsSleep loss triggering episodes of high mood was associated with female gender (odds ratio (OR) = 1.43, 95% CI 1.17-1.75, P < 0.001) and BD-I subtype (OR = 2.81, 95% CI 2.26-3.50, P < 0.001). Analyses on sleep loss triggering low mood were not significant following adjustment for confounders.ConclusionsGender and bipolar subtype may increase vulnerability to high mood following sleep deprivation. This should be considered in situations where patients encounter sleep disruption, such as shift work and international travel.
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Affiliation(s)
- Katie Swaden Lewis
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Katherine Gordon-Smith
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Liz Forty
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Arianna Di Florio
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Nick Craddock
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lisa Jones
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Ian Jones
- Katie Swaden Lewis, BSc, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatry Genetics and Genomics, Cardiff University, Cardiff; Katherine Gordon-Smith, PhD, Institute of Health & Society, University of Worcester, Worcester; Liz Forty, PhD, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Arianna Di Florio, PhD, MD, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff; Lisa Jones, PhD, Institute of Health & Society, University of Worcester, Worcester; Ian Jones, PhD, MRCPsych, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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26
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Stokes PRA, Kalk NJ, Young AH. Bipolar disorder and addictions: the elephant in the room. Br J Psychiatry 2017; 211:132-134. [PMID: 28864753 DOI: 10.1192/bjp.bp.116.193912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 11/23/2022]
Abstract
Addictions are highly prevalent in bipolar disorder and greatly affect clinical outcomes. In this editorial, we review the evidence that addictions are a key challenge in bipolar disorder, examine putative neurobiological mechanisms, and reflect on the limited clinical trial evidence base with suggestions for treatment strategies and further developments.
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Affiliation(s)
- Paul R A Stokes
- Paul R. A. Stokes, PhD, Nicola J. Kalk, PhD, Allan H. Young, FRCPsych, Centre far Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola J Kalk
- Paul R. A. Stokes, PhD, Nicola J. Kalk, PhD, Allan H. Young, FRCPsych, Centre far Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Allan H Young
- Paul R. A. Stokes, PhD, Nicola J. Kalk, PhD, Allan H. Young, FRCPsych, Centre far Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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27
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 468] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Rashid A. Yonder: Appraisal, district nurses, problem gambling, and Nora Batty. Br J Gen Pract 2015; 65:651. [PMID: 26622020 PMCID: PMC4655720 DOI: 10.3399/bjgp15x687913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- NIHR Academic Clinical Fellow in General Practice, University of Cambridge, Cambridge. E-mail: @Dr_A_Rashid
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