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Wakonigg Alonso C, McElhatton F, O'Mahony B, Campbell M, Pollak TA, Stokes PRA. The blood-brain barrier in bipolar disorders: A systematic review. J Affect Disord 2024; 361:434-444. [PMID: 38897301 DOI: 10.1016/j.jad.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/13/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Bipolar disorders (BD) are chronic, debilitating disorders. The blood-brain barrier (BBB) has been increasingly investigated in BD. This systematic review aimed to assess the available evidence on the relationship between BD and markers of BBB dysfunction. METHODS A systematic search in PubMed, Embase, PsycINFO, CINAHL and Web of Science was run where the primary outcomes were BBB markers such as S100B, albumin ratio, matrix metalloproteinase (MMP), cell adhesion molecule (CAM), and tight junction proteins. Techniques included blood, cerebrospinal fluid (CSF), post-mortem, genetic and imaging methods in BD compared to healthy controls. RESULTS 55 studies were identified, 38 of which found an association between BD and markers of BBB dysfunction. 16/29 studies found increased blood/CSF albumin ratio, S100B, CAMs or MMP levels in BD participants compared to controls. 5/19 post-mortem studies found increased levels of chondroitin sulphate proteoglycans, intercellular CAM, neurexin or claudin-5 mRNA in distinct locations throughout the brain in BD compared to controls. One imaging study identified extensive BBB leakage in 30 % of BD participants, compared to 0 % in controls. LIMITATIONS The diversity in methodologies used in the included studies makes direct comparison of results challenging. Furthermore, imaging methods are the gold standard, but only one study used them. Other markers are only indicative of BBB permeability. CONCLUSIONS This review suggests an association between BD and BBB dysfunction. Further research is needed to provide definite answers considering the existing literature's limitations, and to clarify whether this association provides a pathogenic mechanism, or is an epiphenomenon of BD.
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Affiliation(s)
- Clara Wakonigg Alonso
- Institute of Psychiatry & Psychology and Neuroscience, King's College London,United Kingdom.
| | - Frances McElhatton
- Institute of Psychiatry & Psychology and Neuroscience, King's College London,United Kingdom
| | - Brian O'Mahony
- Institute of Psychiatry & Psychology and Neuroscience, King's College London,United Kingdom
| | - Matthew Campbell
- Smurfit Institute of Genetics, Trinity College Dublin, Lincoln Place Gate, Dublin 2, Ireland
| | - Thomas A Pollak
- Dept of Psychosis Studies, Institute of Psychiatry & Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust,Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, United Kingdom
| | - Paul R A Stokes
- South London and Maudsley NHS Foundation Trust,Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, United Kingdom; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry & Psychology and Neuroscience, King's College London,United Kingdom
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2
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Brancati GE, De Rosa U, Acierno D, Caruso V, De Dominicis F, Petrucci A, Moriconi M, Elefante C, Gemignani S, Medda P, Schiavi E, Perugi G. Development of a self-report screening instrument for emotional dysregulation: the Reactivity, Intensity, Polarity and Stability questionnaire, screening version (RIPoSt-SV). J Affect Disord 2024; 355:406-414. [PMID: 38570039 DOI: 10.1016/j.jad.2024.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Emotional dysregulation (ED) refers to the inability to manage emotional experiences or expressions hindering goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples exists. We aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40). METHODS 150 adult outpatients with non-psychotic conditions were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Clinically significant ED (CSED) was defined based on the previously suggested approach for ADHD. Differences between patients with and without CSED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30. RESULTS 75 subjects met criteria for CSED (50 %). CSED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected CSED, with accuracy, sensitivity, specificity, positive and negative predictive values of 80 % or higher in both the training and testing sets. LIMITATIONS Tertiary-level; no consensus on criteria; sample size. CONCLUSION The screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Ugo De Rosa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Donatella Acierno
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Valerio Caruso
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Francesco De Dominicis
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy; Mental Health Centre, Local Health Unit 2, Spoleto, Italy
| | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy; Mental Health Centre, Local Health Unit 2, Terni, Italy
| | - Martina Moriconi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Camilla Elefante
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Samuele Gemignani
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Elisa Schiavi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy.
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Simonetti A, Bernardi E, Sani G. Novel Advancements in COVID-19 and Neuroscience. J Pers Med 2024; 14:143. [PMID: 38392577 PMCID: PMC10890030 DOI: 10.3390/jpm14020143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
From an initial cluster of cases reported in Wuhan, the SARS-Cov-2 infection has since spread globally, causing a pandemic that began on 11 March 2020 [...].
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Affiliation(s)
- Alessio Simonetti
- Department of Neurosciences, Sensory Organs and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Evelina Bernardi
- Department of Neurosciences, Sensory Organs and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Neurosciences, Sensory Organs and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Sensory Organs and Chest, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Simonetti A, Luciano M, Sampogna G, Rocca BD, Mancuso E, De Fazio P, Di Nicola M, Di Lorenzo G, Pepe M, Sambataro F, Signorelli MS, Koukopoulos AE, Chiaie RD, Fiorillo A, Sani G. Effect of affective temperament on illness characteristics of subjects with bipolar disorder and major depressive disorder. J Affect Disord 2023; 334:227-237. [PMID: 37156280 DOI: 10.1016/j.jad.2023.04.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/18/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Affective temperaments represent the stable, biologically determined substrates of mood disorders. The relationship between affective temperaments and bipolar disorder (BD) or major depressive disorder (MDD) has been described. However, the strength of such relationship should be tested while considering other factors influencing the diagnosis of BD/MDD. Literature also lacks a comprehensive description of the interplay between affective temperament and characteristics of mood disorders. The aim of the present study is to address these issues. METHODS This is a multicentric observational study including 7 Italian university sites. Five-hundred-fifty-five euthymic subjects with BD/MDD were enrolled and further divided in those with hyperthymic (Hyper, N = 143), cyclothymic (Cyclo, N = 133), irritable (Irr, N = 49), dysthymic (Dysth, N = 155), and anxious (Anx N = 76) temperaments. Linear, binary, ordinal and logistic regressions were performed to assess the association between affective temperaments and i) diagnosis of BD/MDD; ii) characteristics of illness severity and course. RESULTS Hyper, Cyclo and Irr were more likely to be associated with BD, together with earlier age of onset and presence of a first-degree relative with BD. Anx and Dysth were more associated with MDD. Differences in association between affective temperaments and characteristics of BD/MDD were observed for hospital admissions, phase-related psychotic symptoms, length and type of depression, comorbidity and pharmacological intake. LIMITATIONS Small sample size, cross-sectional design, recall biases. CONCLUSION Specific affective temperaments were associated to certain characteristics of illness severity and course of BD or MDD. Evaluation of affective temperaments might help a deeper understanding of mood disorders.
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Affiliation(s)
- Alessio Simonetti
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Pasquale De Fazio
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabio Sambataro
- Department of Neuroscience, University of Padova, 35121 Padua, Italy
| | - Maria Salvina Signorelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
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Masi G, Pisano S, Sesso G, Mazzullo C, Berloffa S, Fantozzi P, Narzisi A, Placini F, Valente E, Viglione V, Milone A. Persistent Non-Suicidal Self-Injury and Suicidality in Referred Adolescents: A Longitudinal Study Exploring the Role of Cyclothymic Temperament. Brain Sci 2023; 13:brainsci13050755. [PMID: 37239227 DOI: 10.3390/brainsci13050755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Non-suicidal self-injury (NSSI) is deliberate harm to the body surface without suicidal intent, though it may be a predictor of suicide attempts. Our aim was to test the hypothesis that persisting and recovering NSSI may have a different longitudinal risk for suicidal ideation and behavior and that the intensity of Cyclothymic Hypersensitive Temperament (CHT) may increase this risk. Fifty-five patients (mean age 14.64 ± 1.77 years) referred for mood disorders according to the DSM-5 were consecutively recruited and followed-up for a mean of 19.79 ± 11.67 months and grouped according to the presence/absence of NSSI at baseline and follow-up into three groups: without NSSI (non-NSSI; n = 22), with NSSI recovered at follow-up (past-NSSI; n = 19), and with persistent NSSI at follow-up (pers-NSSI; n = 14). At follow-up, both NSSI groups were more severely impaired and failed to improve internalizing problems and dysregulation symptoms. Both NSSI groups reported higher scores in suicidal ideation compared to non-NSSI, but only pers-NSSI presented higher scores in suicidal behavior. CHT was higher in pers-NSSI, followed by past-NSSI and then by non-NSSI. Our data support a continuity between NSSI and suicidality, and they suggest the prognostic validity of persistent NSSI, associated with highest CHT scores.
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Affiliation(s)
- Gabriele Masi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Simone Pisano
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Gianluca Sesso
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
- Social and Affective Neuroscience Group, Molecular Mind Laboratory, IMT School for Advanced Studies, 55100 Lucca, Italy
| | - Cristina Mazzullo
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Stefano Berloffa
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Pamela Fantozzi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Antonio Narzisi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Francesca Placini
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Elena Valente
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Valentina Viglione
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
| | - Annarita Milone
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Calambrone, Italy
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Abstract
Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world's population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan. Early diagnosis is challenging and misdiagnoses are frequent, potentially resulting in missed early intervention and increasing the risk of iatrogenic harm. Over 15 approved treatments exist for the various phases of bipolar disorder, but outcomes are often suboptimal owing to insufficient efficacy, side effects, or lack of availability. Lithium, the first approved treatment for bipolar disorder, continues to be the most effective drug overall, although full remission is only seen in a subset of patients. Newer atypical antipsychotics are increasingly being found to be effective in the treatment of bipolar depression; however, their long term tolerability and safety are uncertain. For many with bipolar disorder, combination therapy and adjunctive psychotherapy might be necessary to treat symptoms across different phases of illness. Several classes of medications exist for treating bipolar disorder but predicting which medication is likely to be most effective or tolerable is not yet possible. As pathophysiological insights into the causes of bipolar disorders are revealed, a new era of targeted treatments aimed at causal mechanisms, be they pharmacological or psychosocial, will hopefully be developed. For the time being, however, clinical judgment, shared decision making, and empirical follow-up remain essential elements of clinical care. This review provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities available to treat people with bipolar disorder, highlighting recent advances and ongoing therapeutic challenges.
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Affiliation(s)
- Fernando S Goes
- Precision Medicine Center of Excellence in Mood Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Cyranka K, Matejko B, Chrobak A, Dudek D, Kieć-Wilk B, Cyganek K, Witek P, Lushchyk M, Krzyżowska S, Małecki MT, Klupa T. Assessment of the spectrum of depression and bipolarity in patients with type 1 diabetes. Diabetes Metab Res Rev 2023; 39:e3583. [PMID: 36270020 DOI: 10.1002/dmrr.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/08/2022] [Accepted: 09/23/2022] [Indexed: 01/10/2023]
Abstract
AIMS The aim of the study was to check the prevalence of unipolarity (depression), bipolarity, as well as the quality of sleep and temperament traits in patients with type 1 diabetes (T1DM) who are provided with optimal conditions of diabetes care and to identify possible risk factors connected with affective traits. MATERIALS AND METHODS Out of the 107 T1DM patients, 78 (54 females, 24 males) were included for the analysis (HbA1c [%] 7.11 ± 1.0, BMI [kg/m2 ] 25.3 ± 5.6; Years of disease duration [N] 13.7 ± 8.3). The patients filled in a set of questionnaires during their regular visit to the outpatient clinic. Three patients from the whole group were on intensive insulin therapy with Multiple Daily Injections (MDI) and Self-Monitoring of Blood Glucose (SMBG), all the rest were on various types of personal insulin pumps (years on insulin pump [N] 9.1 ± 4.5). All the patients were on regular diabetologist care, with regular visits in a Centre for Advanced Technologies in Diabetes (at least every 6 months). RESULTS In QIDS-S (full explanation and abbreviation 26 patients (33.8%) were screened positive for depression, in PHQ (full explanation and ab 57.7% of the patients (45 patients) had symptoms of depression (age was negatively correlated with PHQ score [r = -0.26; p = 0.023]). In CES-D 16 (20%) of the patients assessed their present affect as depressed. None of the analysed clinical variables correlated with depression scores. In the Mood Disorder Questionnaire (MDQ), 16 patients reported having symptoms of bipolarity (20.5% vs. 79.5%). Hypomania Checklist (HCL) analysis indicated 10 patients with bipolar traits (>14) (14.9% vs. 85.1%). None of the analysed clinical variables correlated with HCL results. 11.5% of patients were indicated to be of morning type. Morningness was more often seen in younger patients (r = 0.39; p = 0.001). As many as 46.6% declared that they had poor sleep quality. The temperament traits analysis correlated with clinical parameters: Cyclothymic temperament trait was negatively correlated with age (r = -0.30; p = 0.007) and positively with HbA1c level (r = 0.30; p = 0.025). Hyperthymic temperament was positively correlated with (BMI r = 0.28; p = 0.016). Quality of sleep was highly correlated with depressive symptoms CESD (r = 0.61, p = 0.001), PHQ Score (r = 0.62; p = 0.001), QISD (r = 0.68; p = 0.001) and bipolarity MDQ (p = 0.50, p = 0.001) and HCL (r = 0.42, p = 0.001). In addition, QIDS was shown to be correlated with the following features of temperament: depressive factor (r = 0.41; p = 0.001), irritable factor (r = 0.53; p = 0.001), cyclothymic factor (r = 0.59; p = 0.001), anxious factor (r = 0.58, p = 0.001). CONCLUSIONS The prevalence of affective disorders and poor sleep quality in the examined T1DM patients was much higher than in the general population. Even if the patients have in general good glycaemic control, their mental health condition should not be neglected. Well organised cooperation between patients, diabetologists, psychiatrists and psychotherapists is needed (Clinical Trials Identifier: NCT04616391).
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Affiliation(s)
- Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Bartlomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Adrian Chrobak
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Katarzyna Cyganek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Maxim Lushchyk
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | | | - Maciej Tadeusz Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
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Weiss F, Tidona S, Carli M, Perugi G, Scarselli M. Triple Diagnosis of Attention-Deficit/Hyperactivity Disorder with Coexisting Bipolar and Alcohol Use Disorders: Clinical Aspects and Pharmacological Treatments. Curr Neuropharmacol 2023; 21:1467-1476. [PMID: 36306451 PMCID: PMC10472804 DOI: 10.2174/1570159x20666220830154002] [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] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD), Bipolar Disorder (BD) and Alcohol Use Disorder (AUD) are common medical conditions often coexisting and exerting mutual influence on disease course and pharmacological treatment response. Each disorder, when considered separately, relies on different therapeutic approaches, making it crucial to detect the plausible association between them. Treating solely the emerging condition (e.g., alcoholism) and disregarding the patient's whole psychopathological ground often leads to treatment failure and relapse. Clinical experience and scientific evidence rather show that tailoring treatments for these three conditions considering their co-occurrence as a sole complex disorder yields more fulfilling and durable clinical outcomes. In light of the above considerations, the purpose of the present review is to critically discuss the pharmacological strategies in the personalized treatment of complex conditions defined by ADHD-bipolarityalcoholism coexistence.
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Affiliation(s)
- Francesco Weiss
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Tidona
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56126, Italy
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56126, Italy
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Sesso G, Brancati GE, Masi G. Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management. Curr Neuropharmacol 2023; 21:911-934. [PMID: 35794777 PMCID: PMC10227908 DOI: 10.2174/1570159x20666220706104117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Bipolar Disorder (BD) is a highly comorbid condition, and rates of cooccurring disorders are even higher in youth. Comorbid disorders strongly affect clinical presentation, natural course, prognosis, and treatment. METHODS This review focuses on the clinical and treatment implications of the comorbidity between BD and Attention-Deficit/Hyperactivity Disorder, disruptive behavior disorders (Oppositional Defiant Disorder and/or Conduct Disorder), alcohol and substance use disorders, Autism Spectrum Disorder, anxiety disorders, Obsessive-Compulsive Disorder, and eating disorders. RESULTS These associations define specific conditions which are not simply a sum of different clinical pictures, but occur as distinct and complex combinations with specific developmental pathways over time and selective therapeutic requirements. Pharmacological treatments can improve these clinical pictures by addressing the comorbid conditions, though the same treatments may also worsen BD by inducing manic or depressive switches. CONCLUSION The timely identification of BD comorbidities may have relevant clinical implications in terms of symptomatology, course, treatment and outcome. Specific studies addressing the pharmacological management of BD and comorbidities are still scarce, and information is particularly lacking in children and adolescents; for this reason, the present review also included studies conducted on adult samples. Developmentally-sensitive controlled clinical trials are thus warranted to improve the prognosis of these highly complex patients, requiring timely and finely personalized therapies.
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Affiliation(s)
- Gianluca Sesso
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
| | | | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
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Favaretto E, Gögele M, Bedani F, Hicks AA, Erfurth A, Perugi G, Pramstaller PP, Melotti R. Pain sensitivity is modulated by affective temperament: Results from the population-based CHRIS Affective Disorder (CHRIS-AD) study. J Affect Disord 2022; 316:209-216. [PMID: 35952933 DOI: 10.1016/j.jad.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/06/2022] [Accepted: 08/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Nociceptive pain modulation is related to psychological and psychiatric conditions. Evidence from clinical studies backs innate temperaments as potential precursors of mood symptoms and disorders, and pain sensitivity. Our study examines the modulation effect of affective temperaments on pain sensitivity in a general population adult sample, accounting for possible intervening mood symptoms, lifetime anxiety and depression, and pain treatments. METHODS The sample is part of the CHRIS-AD study, Italy. Primary outcomes were the pain sensitivity questionnaire PSQ-total intensity score and the experimental pressure pain threshold (PPT). Affective temperaments were evaluated with the TEMPS-M. Lifetime depression, anxiety, current mood disorders, and treatments were self-reported via rating-scales. Directed acyclic graphs theory guided linear and mixed linear regression model analyses. RESULTS Among 3804 participants (aged 18-65; response rate 78.4 %, females 53.3 %, mean age 38.4 years) for any given temperament, both the PSQ-total and the PPT were associated with temperament. The TEMPS-M four cyclothymic-related temperaments aligned on the pain-sensitive pole and the hyperthymic on the pain-resilient pole. The inclusion of current or lifetime mood symptoms, or pain drug use, as possible intervening pathways only partly diluted these associations, with stronger evidence for an effect of trait anxiety. LIMITATIONS The main limitations were the lack of experimental measures of suprathreshold pain intensity perception, and detailed information on affective disorders in the study population. CONCLUSIONS These findings support the hypothesis of a biological dichotomous diathesis of affective temperaments towards pain sensitivity; hyperthymic suggesting protection, whereas cyclothymic suggesting predisposition.
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Affiliation(s)
| | - Martin Gögele
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
| | - Fulvio Bedani
- Department of Psychiatry, General Hospital, Bressanone, Italy
| | - Andrew A Hicks
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
| | - Andreas Erfurth
- Klinik Hietzing, Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria
| | - Giulio Perugi
- Section of Psychiatry, Department of Experimental and Clinic Medicine, University of Pisa, Pisa, Italy
| | - Peter P Pramstaller
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy; Department of Neurology, General Central Hospital, Bolzano, Italy
| | - Roberto Melotti
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
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11
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Rahme C, Hallit R, Akel M, Chalhoub C, Hachem M, Hallit S, Obeid S. Nomophobia and temperaments in Lebanon: Results of a national study. Perspect Psychiatr Care 2022; 58:1607-1612. [PMID: 34741546 DOI: 10.1111/ppc.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Assess the association between nomophobia and temperaments in the Lebanese population. METHODS The cross-sectional study was conducted between January and July 2019 (N = 2260). RESULTS A total of 1089 of the participants (48.3%) appeared to have moderate nomophobia while 349 (15.5%) were found to exhibit severe nomophobia. Multivariable analysis showed that higher hyperthymic temperament (β = -0.34) was associated with less nomophobia, whereas higher irritable temperament (β = 0.43) was associated with more nomophobia. PRACTICAL IMPLICATIONS The findings obtained from our study showed that a more irritable temperament was significantly associated with a more severe nomophobia, while hyperthymic temperament was associated with less nomophobia. They open up new perspectives for the evaluation of the temperaments among nomophobics with a better focus on the personality model and how they can predict nomophobia.
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Affiliation(s)
- Clara Rahme
- Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon.,Department of Infectious Disease, Notre Dame des Secours University Hospital, Byblos, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Clarissa Chalhoub
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Maria Hachem
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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12
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Zengin İspir G, Danışman M, Tulacı RG, Özdel K. Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder: the preliminary results of a prospective study. J Addict Dis 2022:1-8. [PMID: 35713278 DOI: 10.1080/10550887.2022.2087449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Substance use disorder is a growing health problem all over the world. The coexistence of substance misuse, affective temperaments, and emotion dysregulation has not been studied sufficiently. OBJECTIVE The present study aimed to evaluate the role of affective temperaments and emotion dysregulation on substance use disorder. The Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder study was designed observational. This paper presents only the baseline assessments of the patient and control groups. One-year remission rates of the patients' group will be reported elsewhere after 1-year follow-up. METHODS Sixty-seven patients with opioid use disorder and 68 healthy controls enrolled. All participants were administered to The Structured Clinical Interview for DSM-5, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire, Difficulties in Emotion Regulation Scale, Beck Anxiety Inventory, and Beck Depression Inventory. RESULTS Patients with opioid use disorder had higher scores from all temperamental scales and showed higher difficulties on emotion regulation than the control group. Even controlling the confounding effects of anxiety and depression levels, dysthymic and anxious temperament scores were found correlated with the emotion dysregulation score in the patient group. CONCLUSIONS The emotional traits (i.e., affective temperaments) and emotion regulation abilities play a crucial role in substance use disorder. While managing substance use disorder, being aware of affective temperament characteristics and/or interventions to improve emotion regulation skills may be helpful.
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Affiliation(s)
- Gamze Zengin İspir
- University of Health Science-Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | | | - Rıza Gökçer Tulacı
- University of Health Science-Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Kadir Özdel
- University of Health Science-Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
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13
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Miola A, Cattarinussi G, Antiga G, Caiolo S, Solmi M, Sambataro F. Difficulties in emotion regulation in bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2022; 302:352-360. [PMID: 35093412 DOI: 10.1016/j.jad.2022.01.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe mental disorder characterized by mood swings and functional impairment. Although alterations in emotional regulation (ER) are a key feature, a comprehensive meta-analysis on abnormalities in emotion regulation in BD is still lacking. METHODS We performed a random-effects meta-analysis on studies comparing the ER measured with the Difficulties in Emotion Regulation Scale (DERS) in BD and healthy controls (HC) or borderline personality disorder (BPD) and calculated the standardized mean difference (SMD) of the total DERS score between those with BD and HC (primary outcome). Secondary outcomes were the SMD of the DERS subscales between BD and HC, as well as the SMD of the total score of DERS and the subscales between BD and BPD. RESULTS Twelve studies (858 BD, 540 BPD, 285 HC) were included. Compared to HC, BD showed significantly higher total DERS score (k=8, SMD 0.962, p<0.001) and subscale scores, including non-acceptance (k=6, SMD=0.85, p<0.001), goal-directed behavior (k=6, SMD=0.894, p<0.001), impulse control (k=6, SMD=1.08, p<0.001), strategies (k=6, SMD=1.25, p<0.001) and emotional clarity (k=6, SMD=0.694, p=0.001). Relative to BPD, BD presented significantly lower scores in all the DERS subscales. Sensitivity analyses confirmed the main analyses. The age of the participants and sample size moderated the primary outcome. LIMITATIONS The small number of studies and the cross-sectional design limit the generalizability of the results. CONCLUSIONS Our findings suggest that alterations of specific ER abilities are present in BD and their magnitude is smaller relative to BPD. Future therapeutic interventions should target ER strategies.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Gilberto Antiga
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Stefano Caiolo
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy.
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14
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Pisano S, Sesso G, Senese VP, Catone G, Milone A, Masi G. The assessment of cyclothymic-hypersensitive temperament in youth with mood disorders and attention deficit hyperactivity disorder. J Affect Disord 2022; 298:322-328. [PMID: 34763030 DOI: 10.1016/j.jad.2021.11.013] [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: 08/30/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cyclothymic-hypersensitive temperament (CHT) has been related to both depression and bipolarity, as well as to suicidality. Recently, a psychometrically sound way of assessment has been validated in youth (Cyclothymic-Hypersensitive Temperament Questionnaire, CHTQ), but data on clinical populations are still scant. Aim of our study is to further explore the structure and other psychometric properties of the revised version of CHTQ and its clinical implications in clinical samples. METHODS The study is based on a dataset of patients with unipolar depression, bipolar disorder and attention deficit and hyperactivity disorder (ADHD) (243 patients, 135 males, mean age 14.22 ± 2.16 years, age range 9-18 years), compared to a community sample of adolescents (398 subjects, 95 boys, mean age 15.47 ± 1.96 years, age range 10-18 years) RESULTS: The two-correlated factor structure of CHT has been confirmed, with a moodiness/hypersensitiveness factor, correlated with internalizing symptoms, and an impulsiveness/emotional dysregulation factor, correlated with externalizing symptoms. All CHTQ scores correlate with global functioning. CHTQ total scores discriminate patients from healthy controls. Only CHTQ impulsiveness/emotional dysregulation subscale score is higher in bipolar patients, compared to unipolar depression and ADHD, whereas neither CHTQ moodiness/hypersensitiveness subscale score nor CHTQ total score discriminate between clinical groups. LIMITATION Data on current mood states are unavailable. Patients were recruited in a third level clinic. The unipolar depression group is relatively small. CONCLUSION CHT may be a rapid and reliable screening and diagnostic tool in the clinical practice with youth, exploring the cyclothymic dimension in different psychiatric disorders.
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Affiliation(s)
- Simone Pisano
- Department of Translational Medical Sciences, University of Naples Federico II, via Pansini 5, Naples 80131, Italy.
| | - Gianluca Sesso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | | | - Gennaro Catone
- Department of Educational, Psychological and Communication Sciences, Suor Orsola Benincasa University, Naples, Italy
| | - Annarita Milone
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Gabriele Masi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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15
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Dib JE, Nehme I, Haddad C, Azar J, Hallit S, Obeid S. Affective temperaments of Lebanese patients with schizophrenia: comparison by gender and severity of psychosis. BMC Res Notes 2021; 14:430. [PMID: 34823586 PMCID: PMC8620946 DOI: 10.1186/s13104-021-05854-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Our aim in this study was to identify affective temperament differences utilizing the TEMPS-A in a large sample size of Lebanese patients with schizophrenia and compare them to healthy controls. Gender differences, demographic factors and degree of psychotic symptoms were also considered. A cross‐sectional study was conducted at the Psychiatric Hospital of the Cross (PHC) from March to June 2019. Two-hundred fifty chronic patients with schizophrenia were compared to 250 healthy controls randomly chosen from the general population. Results Patients with schizophrenia significantly had higher mean depressive, cyclothymic, irritable and anxious temperament scores compared to healthy controls. Healthy controls significantly had a higher mean hyperthymic temperament score compared to patients with schizophrenia. In the group of patients with schizophrenia exclusively, females scored higher in terms of depressive, cyclothymic and anxious temperaments compared to males. In the group of healthy controls, males scored higher in terms of hyperthymic and irritable temperaments compared to females, whereas a higher mean depressive and anxious temperament scores were significantly found in females compared to males. In addition, higher PANSS total scores, as well as higher positive, negative and general subscales scores were significantly associated with higher depressive, cyclothymic, irritable and anxious temperament scores. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05854-8.
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Affiliation(s)
- Joseph E Dib
- Division of Psychiatry and Clinical Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ilige Nehme
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Chadia Haddad
- Institute of Epidemiology and Tropical Neurology, INSERM, University of Limoges, CH Esquirol, UMR 1094, Tropical Neuroepidemiology, GEIST, 87000, Limoges, France.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Epidemiologie Clinique Et Toxicologie, Beirut, Lebanon
| | - Jocelyne Azar
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. .,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Epidemiologie Clinique Et Toxicologie, Beirut, Lebanon. .,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
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16
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Miola A, Baldessarini RJ, Pinna M, Tondo L. Relationships of affective temperament ratings to diagnosis and morbidity measures in major affective disorders. Eur Psychiatry 2021; 64:e74. [PMID: 34812134 PMCID: PMC8715280 DOI: 10.1192/j.eurpsy.2021.2252] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Ratings of affective temperament types show promise in helping to differentiate diagnostic groups among major affective disorders as well as to predict associations with important aspects of morbidity including suicidal risk. METHODS The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-rating (TEMPS-A) questionnaire was completed by 858 unselected, consecutive, consenting adults diagnosed with a DSM-5 major affective disorder (173 bipolar-1 [BD-1]), 250 BD-2, 435 major depressive disorder [MDD]) to score for anxious (anx), cyclothymic (cyc), dysthymic (dys), hyperthymic (hyp), and irritable (irr) affective temperaments. We tested their associations with diagnosis and selected clinical factors, including diagnosis, depression scores, suicidal ideation or acts, substance abuse, episodes/year, and %-time ill. RESULTS Scores for cyc ranked: BD-2 > BD-1 > MDD; anx ranked: MDD > BD-2 > BD-1; irr was greater in BD than MDD; dys was greater in MDD than BD; hyp did not differ by diagnosis. We confirmed associations of suicidal risk with higher scores of all temperament types except lower hyp scores. Higher cyc and irr scores and lower anx scores were associated with substance abuse. Several scores were higher with measures of greater affective morbidity: cyc with current depression, episodes/year, and %-time ill; irr with more episodes and depressions/year and greater %-time manic. Some of these associations were selective for BD or MDD. CONCLUSIONS The findings indicate that TEMPS-A ratings of affective temperament types can contribute to differential diagnoses and predict types and amounts of affective morbidity, as well as detecting suicidal risks.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Pinna
- Lucio Bini Mood Disorders Centers, Cagliari, Italy
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Lucio Bini Mood Disorders Centers, Cagliari, Italy
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17
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A novel multidimensional questionnaire for the assessment of emotional dysregulation in adolescents: Reactivity, Intensity, Polarity and Stability questionnaire-youth version (RIPoSt-Y). J Affect Disord 2021; 291:359-367. [PMID: 34089928 DOI: 10.1016/j.jad.2021.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/09/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The failure to regulate emotions, namely emotional dysregulation (ED), is a relevant construct in adolescent psychiatry, in terms of prognostic and developmental implications. We developed and validated a novel self-report questionnaire for the assessment of ED, the RIPoSt-Y, both in clinical and non-clinical samples. METHODS Items selection and subscales construction were conducted on healthy controls (n=374), while test-retest reliability was evaluated in a subsample (n=72); internal consistency was examined both in the control group and in two clinical samples, respectively including patients with Bipolar Spectrum Disorders (BSD; n=44) and ADHD (n=34). Construct, concurrent and convergent validity were also assessed. RESULTS Thirty-one items were finally retained, and three subscales were identified (Affective Instability, Emotional Reactivity, Interpersonal Sensitivity). Test-retest was significant for each subscale with moderate-to-good correlations, and internal consistency showed good-to-excellent coefficients. Construct validity was supported by significant differences between patients and controls and gender-related differences. Concurrent validity was confirmed through significant associations with two subscales of the CHT-Q, while convergent validity proved to be significant with the CBCL/YSR dysregulation-profile. Cut-offs were also computed to discriminate clinically significant scores of ED. LIMITATIONS The use of a school-based survey to recruit controls could have biased our results; gender distributions between clinical and non-clinical samples were significantly different. CONCLUSIONS Our novel questionnaire proved to be a valid and reliable tool able to assess the presence of ED in youths and to characterize this fundamental construct in its multidimensional facets.
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18
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Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD. ACTA ACUST UNITED AC 2021; 57:medicina57050489. [PMID: 34066126 PMCID: PMC8151096 DOI: 10.3390/medicina57050489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023]
Abstract
Background and Objectives: Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. Materials and Methods: One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. Results: Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. Conclusions: ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with “sunny” cyclothymic features might escape the attention of clinicians unless ADHD is present.
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19
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Qiu Y, She S, Zhang S, Wu F, Liang Q, Peng Y, Yuan H, Ning Y, Wu H, Huang R. Cortical myelin content mediates differences in affective temperaments. J Affect Disord 2021; 282:1263-1271. [PMID: 33601705 DOI: 10.1016/j.jad.2021.01.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/29/2020] [Accepted: 01/09/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Affective temperaments are regarded as subclinical forms and precursors of mental disorders. It may serve as candidates to facilitate the diagnosis and prediction of mental disorders. Cortical myelination likely characterizes the neurodevelopment and the evolution of cognitive functions and reflects brain functional demand. However, little is known about the relationship between affective temperaments and myelin plasticity. This study aims to analyze the association between the affective temperaments and cortical myelin content (CMC) in human brain. METHODS We measured affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) on 106 healthy adults and used the ratio of T1- and T2-weighted images as the proxy for CMC. Using the unsupervised k-means clustering algorithm, we classified the cortical gray matter into heavily, intermediately, and lightly myelinated regions. The correlation between affective temperaments and CMC was calculated separately for different myelinated regions. RESULTS Hyperthymic temperament correlated negatively with CMC in the heavily myelinated (right postcentral gyrus and bilateral precentral gyrus) and lightly myelinated (bilateral frontal and lateral temporal) regions. Cyclothymic temperament showed a downward parabola-like correlation with CMC across the heavily, intermediately, and lightly myel0inated areas of the bilateral parietal-temporal regions. LIMITATIONS The analysis was constrained to cortical regions. The results were obtained from healthy subjects and we did not acquired data from patients of affective disorder, which may compromise the generalizability of the present findings. CONCLUSION The findings suggest that hyperthymic and cyclothymic temperaments have a CMC basis in extensive brain regions.
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Affiliation(s)
- Yidan Qiu
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education; School of Psychology, Center for Studies of Psychological Application; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Shenglin She
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China
| | - Shufei Zhang
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education; School of Psychology, Center for Studies of Psychological Application; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China
| | - Qunjun Liang
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education; School of Psychology, Center for Studies of Psychological Application; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Yongjun Peng
- Department of Medical Imaging, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, China
| | - Haishan Yuan
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education; School of Psychology, Center for Studies of Psychological Application; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China
| | - Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Ruiwang Huang
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education; School of Psychology, Center for Studies of Psychological Application; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
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20
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Mood disorders comorbidity in obese bariatric patients: the role of the emotional dysregulation. J Affect Disord 2021; 279:46-52. [PMID: 33038699 DOI: 10.1016/j.jad.2020.09.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/25/2020] [Accepted: 09/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obese patients seeking bariatric surgery are known to show high rates of mental disorders, mainly mood and eating disorders. The aim of the present study is to evaluate psychiatric comorbidities, affective temperamental dimensions, emotional dysregulation and impulsivity in a sample of obese bariatric patients, exploring the differences between obese patients with and without mood disorders (MD). METHODS A total of 69 obese patients were consecutively enrolled between March and November 2019 during the presurgical evaluation routinely performed before the bariatric intervention. Sociodemographic and clinical features were collected by psychiatrists during a single consultation. Affective temperaments, emotional dysregulation and impulsivity were also investigated through self-report questionnaires. Epidemiological and clinical variables were compared between patients with and without MD. RESULTS In our sample, almost 3 out of 4 patients presented a lifetime psychiatric disorder, mainly MD (n=33, 48%), binge eating disorder (BED) (n=34, 49%) and anxiety disorders (n=30, 43%). Compared to N-MD patients, those with MD showed higher rates of psychiatric comorbidity with BED, bulimia and panic disorder. In addition, obese patients with MD showed more frequently cyclothymic, depressive and anxious temperaments, and higher mean scores on the psychometric questionnaires assessing emotional dysregulation and impulsivity compared to obese subjects without MD. LIMITATIONS the small sample size, the retrospectively assessment of psychiatric disorders and the self-report questionnaires. CONCLUSIONS A subgroup of obese patients, especially among those with MD, show high emotional dysregulation, affective lability and impulsiveness that could represent suitable substrates for the development of compulsive and addictive eating habits.
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Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry 2021; 12:628252. [PMID: 34759846 PMCID: PMC8573252 DOI: 10.3389/fpsyt.2021.628252] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, Regional Psychiatric Hospital, Mauer, Austria
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22
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Relationships Among Delayed Sleep Phase Disorder, Emotional Dysregulation, and Affective Temperaments in Adults With Attention Deficit Hyperactivity Disorder and Cyclothymia. J Nerv Ment Dis 2020; 208:857-862. [PMID: 32769692 DOI: 10.1097/nmd.0000000000001209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study aims to explore the relationships between delayed sleep phase disorder (DSPD) and emotional dysregulation in 240 patients (134 with cyclothymia, 81 with attention deficit hyperactivity disorder [ADHD] and 25 with both conditions). DSPD was assessed using the Morningness-Eveningness Questionnaire, followed by a clinical evaluation. Affective temperaments and emotional dysregulation were also investigated through the brief version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego and the Reactivity, Intensity, Polarity, Stability questionnaires, respectively. Clinical variables were compared in patients with and without DSPD, and a logistic regression model was used to identify the predictive value of the clinical characteristics on the presence of DSPD. DSPD patients (19% of the total sample) were significantly younger than patients without DSPD, showed an about 4 times higher lifetime history of comorbid ADHD and cyclothymia, and reported higher scores in the irritable and cyclothymic temperamental subscales and in the affective instability and impulsivity dimensions. In the multiple logistic regression, we found a negative predictive value of increasing age on the presence of DSPD, whereas comorbid cyclothymia and ADHD and cyclothymic temperament seem to represent risk factors for DSPD.
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Barroilhet SA, Ghaemi SN. When and how to use lithium. Acta Psychiatr Scand 2020; 142:161-172. [PMID: 32526812 DOI: 10.1111/acps.13202] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lithium is an old proven medication, but it is infrequently used in current practice. This review examines evidence for its benefits and risks and provides clinical guidance to its use. METHOD Narrative review. RESULTS Besides its benefit in bipolar illness, lithium has important underappreciated proven benefits in prevention of unipolar depression and suicide. Emerging data support neurobiological benefits for cognition and possible dementia prevention. Likely benefits also exist in low doses for mood temperaments (cyclothymia and hyperthymia). High doses (over 1.0 mmol/L) should be avoided since they increase side effects, complications associated with long-term use, and risk of toxicity. Conversely, low dosing can be legitimate, especially for suicide and dementia prevention. Nuisance side effects of lithium may affect adherence, and medically serious side-effects can occur. Managing strategies are available for side effects. CONCLUSION Lithium is the most effective medication in psychiatry, because it has disease-modifying, not just symptomatic, effects. It is effective not only for bipolar illness but also for prevention of suicide, episodes of unipolar depression, mood temperaments, and possibly dementia. Its many benefits need better appreciation, while lowered dosing can reduce risks.
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Affiliation(s)
- S A Barroilhet
- Psychiatry, Faculty of Medicine, University Psychiatric Clinic, University of Chile, Santiago, Chile.,Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - S N Ghaemi
- Psychiatry, Tufts University School of Medicine, Boston, MA, USA.,Psychiatry, Harvard Medical School, Boston, MA, USA
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Affective temperaments and procrastination as mediated by emotional reactivity in a nonclinical adult sample. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2020. [DOI: 10.5114/cipp.2020.96086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundThe study purpose was to assess the relationship between affective temperaments and procrastination and to examine the role of emotional reactivity as a mediator in this relationship. We hypothesized that depressive, cyclothymic, irritable and anxious tem-peraments as well as emotional reactivity would be positively correlated with procrastination while the hyperthymic temperament would be negatively correlated, and that emotional reactivity would mediate the relationship between affective temperaments and procrastination.Participants and procedureThe sample consisted of 315 healthy Caucasian adults (193 women and 122 men) aged 18-69 (M = 31.64, SD = 12.14). The Polish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-Questionnaire (TEMPS-A) was used to assess affective temperaments (depressive, cyclothymic, hyperthymic, irritable and anxious). The temperament traits postulated by the regulative theory of temperament were measured with the Formal Characteristics of Behaviour – Temperament Inventory Revised (FCB-TIR). Procrastination was evaluated via a Polish version of the Pure Procrastination Scale (PPS).ResultsThe affective temperaments positively correlated with procrastination, except for hyperthymic temperament (negative correla-tion). Emotional reactivity and perseveration had a positive relationship with procrastination, while briskness, endurance and rhythmicity had a negative correlation. Cyclothymic temperament and emotional reactivity were found to be significant predic-tors of procrastination; hyperthymic temperament, endurance and rhythmicity may provide buffers against procrastination.ConclusionsCyclothymic temperament is an important predictor of procrastination. Emotional reactivity significantly mediated between cy-clothymic temperament and procrastination. Hyperthymic temperament, endurance and rhythmicity may provide a buffer against procrastination.
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Pisano S, Senese VP, Bravaccio C, Santangelo P, Milone A, Masi G, Catone G. Cyclothymic-hypersensitive temperament in youths: Refining the structure, the way of assessment and the clinical significance in the youth population. J Affect Disord 2020; 271:272-278. [PMID: 32479326 DOI: 10.1016/j.jad.2020.03.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/15/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although a better understanding of the prodromes of affective disorders in youth has important clinical and research implications, empirical data are still unconclusive. Cyclothymic-hypersensitive temperament (CHT) has been linked to both depression and bipolarity, as well as to suicidality. Its conceptualization is still debated, as well as a comprehensive, psychometrically sound way of assessment. METHODS factor structure, reliability, measurement invariance, convergent and divergent validity of the previously published CHT questionnaire (a youth version derived from Temperament Evaluation in Memphis Pisa and San Diego (TEMPS) was assessed in a school-based sample of 2959 students aged from 10 to 14 years (mean age = 11.8 ± 0.97 years). Furthermore, accuracy, sensitivity and specificity were calculated for a new cut-off score related to the presence of general psychopathology symptoms. RESULTS CHT is better conceptualized in a two-correlated factors model, a moodiness/hypersensitiveness factor, more associated with internalizing symptoms, and an impulsiveness/emotional dysregulation factor, more associated with externalizing symptoms. The revised 22-items version of the CHT questionnaire with a cut-off score of 15 for females and 17 for males results accurate, sensitive and specific enough for the recognition of cyclothymic adolescents with clinical symptoms. LIMITATION the cross sectional design and the self-report nature of the measures limit the findings. DISCUSSION Cyclothymic-hypersensitive temperament is a relevant concept in the realm of affective disorder and can be reliably assessed in youths. It may describe youths with the coexistence of both internalizing and externalizing symptoms that can be difficult to diagnose with a DSM perspective.
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Affiliation(s)
- Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy; Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | | | - Carmela Bravaccio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Pia Santangelo
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Gennaro Catone
- Department of Educational, Psychological and Communication Sciences, Suor Orsola Benincasa, Naples, Italy
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Fernandes LA, Borja Santos N. A commentary on "Risk of bipolar disorder in patients with polycystic ovary syndrome". J Affect Disord 2020; 270:83-84. [PMID: 32275224 DOI: 10.1016/j.jad.2020.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Luís Afonso Fernandes
- Department of Mental Health, Hospital Prof. Doutor Fernando Fonseca, E.P.E., IC 19 Venteira, 2720-276 Amadora, Portugal.
| | - Nuno Borja Santos
- Department of Mental Health, Hospital Prof. Doutor Fernando Fonseca, E.P.E., IC 19 Venteira, 2720-276 Amadora, Portugal
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Palagini L, Miniati M, Caruso D, Massa L, Novi M, Pardini F, Salarpi G, Pini S, Marazziti D, Etain B, Riemann D. Association between affective temperaments and mood features in bipolar disorder II: The role of insomnia and chronobiological rhythms desynchronization. J Affect Disord 2020; 266:263-272. [PMID: 32056887 DOI: 10.1016/j.jad.2020.01.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bipolar disorders are complex disorders involving the interaction of multiple factors. Affective temperaments, insomnia, and chronobiological rhythms desynchronization may all contribute to bipolar disorder. Since there is a paucity of research examining this topic we aimed to study how they are interrelated and collectively associated with clinical features of bipolar disorder. METHOD One-hundred patients with Bipolar Disorder type II depressive episode with and without mixed features were recruited and compared. Subjects were evaluated with SCID -5, the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), the Insomnia Severity Index (ISI), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) while evaluating depressive (Beck Depression Inventory-BDI-II) and manic (Young Mania Rating Scale-YMRS) symptoms. Logistic regression and mediation analyses were conducted. RESULTS Subjects with mixed features showed a higher scores in both insomnia and chronobiological rhythms scores. When considering affective temperaments not only depressive, cyclothymic and irritable temperaments predicted mood symptoms but also insomnia (depressive symptoms O.R. 4.17, p = 0.043) and chronobiological sleep de-synchronization (manic symptoms O.R. 8.69, p = 0.001). Insomnia symptoms and chronobiological alterations mediated the association between affective temperaments and mood symptoms. LIMITATIONS the cross-sectional design limited any causal interpretation. CONCLUSION Subjects with mixed features showed a greater severity of insomnia and chronobiological rhythm de-synchronization compared to subjects without. Insomnia and chronobiological alterations may contribute to mood disorders together with affective temperaments in a complex interplay also mediating their effect on mood. Preventive strategies for bipolars should also act on the dysregulation of sleep and circadian rhythms.
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Affiliation(s)
- Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy.
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Danila Caruso
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Lucia Massa
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Martina Novi
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Francesco Pardini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Gianluca Salarpi
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
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Brancati GE, Barbuti M, Pallucchini A, Cotugno B, Schiavi E, Hantouche EG, Perugi G. Reactivity, Intensity, Polarity and Stability questionnaire (RIPoSt-40) assessing emotional dysregulation: Development, reliability and validity. J Affect Disord 2019; 257:187-194. [PMID: 31301622 DOI: 10.1016/j.jad.2019.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/06/2019] [Accepted: 07/04/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Emotional dysregulation (ED) is a heterogenous construct with great relevance in psychiatric research and clinical practice. In the present study, we validated a 40-items version of the Reactivity, Intensity, Polarity and Stability questionnaire (RIPoSt-40), a self-report measure of ED. METHODS A non-clinical sample (N = 396) and two clinical samples of patients with cyclothymia (N = 120) and ADHD (N = 54) were recruited. Items were selected and subscales were derived based on inter-item correlations and PCA with promax rotation in the non-clinical sample. Test-retest reliability was assessed in a subsample (N = 60). Internal consistency and concurrent validity with TEMPS-M factors were evaluated in each sample. The three groups results were compared to ascertain discriminant validity. RESULTS Four subscales were identified as measures of affective instability, emotional impulsivity, negative and positive emotionality. The first three subscales also sum up to a negative ED score comprising thirty items. Measures of reliability (test-retest r = 0.71-0.84) and internal consistency (Cronbach's α = 0.72-0.95) were generally high. Concurrent validity was supported by correlations with TEMPS-M factors. Discriminant validity was significant (p < 0.001) with cyclothymic and ADHD patients showing higher scores for each subscale, except for positive emotionality. LIMITATIONS The non-clinical sample was recruited through a web-survey and mainly included young and highly educated subjects. Mood and anxiety comorbidity of the clinical samples were not taken into consideration. CONCLUSION RIPoSt-40 questionnaire has proved to be a valid, reliable and useful tool to assess ED both in clinical and non-clinical contexts.
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Affiliation(s)
- Giulio E Brancati
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Sant'Anna School of Advanced Studies, Pisa, Italy.
| | - Margherita Barbuti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Biagio Cotugno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Schiavi
- Azienda Ospedaliera Universitaria Pisana, Pisa Italy
| | - Elie G Hantouche
- Centre des Troubles Anxieux et de l'Humeur, Anxiety & Mood Center, 89 Boulevard de Courcelles 75008, Paris, France
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Cattaneo CI, Ressico FV, Pallucchini A, Perugi G. Commentary on chronic mood instability: Bipolar, borderline or both? Bipolar Disord 2019; 21:460-461. [PMID: 30888723 DOI: 10.1111/bdi.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Giulio Perugi
- Clinica Psichiatrica, Dipartimento di Medicina, Sperimentale University of Pisa, Pisa, Toscany, Italy
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Fico G, Caivano V, Zinno F, Carfagno M, Steardo LJ, Sampogna G, Luciano M, Fiorillo A. Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E390. [PMID: 31331102 PMCID: PMC6681298 DOI: 10.3390/medicina55070390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory, revised version (TCI-R). The sample was divided into two groups on the basis of a positive history for suicidal attempts and the suicidal group was further divided into two subgroups according to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamental characteristics are associated with violent suicide attempts, suggesting the importance of affective temperaments in the clinical management of patients with BPI.
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Affiliation(s)
- Giovanna Fico
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy.
| | - Vito Caivano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Francesca Zinno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Luca Jr Steardo
- Department of Health Sciences, Psychiatric Unit, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro CZ, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
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The emergence of loss of efficacy during antidepressant drug treatment for major depressive disorder: An integrative review of evidence, mechanisms, and clinical implications. Pharmacol Res 2019; 139:494-502. [DOI: 10.1016/j.phrs.2018.10.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
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Conio B, Magioncalda P, Martino M, Tumati S, Capobianco L, Escelsior A, Adavastro G, Russo D, Amore M, Inglese M, Northoff G. Opposing patterns of neuronal variability in the sensorimotor network mediate cyclothymic and depressive temperaments. Hum Brain Mapp 2018; 40:1344-1352. [PMID: 30367740 DOI: 10.1002/hbm.24453] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
Affective temperaments have been described since the early 20th century and may play a central role in psychiatric illnesses, such as bipolar disorder (BD). However, the neuronal basis of temperament is still unclear. We investigated the relationship of temperament with neuronal variability in the resting state signal-measured by fractional standard deviation (fSD) of Blood-Oxygen-Level Dependent signal-of the different large-scale networks, that is, sensorimotor network (SMN), along with default-mode, salience and central executive networks, in standard frequency band (SFB) and its sub-frequencies slow4 and slow5, in a large sample of healthy subject (HC, n = 109), as well as in the various temperamental subgroups (i.e., cyclothymic, hyperthymic, depressive, and irritable). A replication study on an independent dataset of 121 HC was then performed. SMN fSD positively correlated with cyclothymic z-score and was significantly increased in the cyclothymic temperament compared to the depressive temperament subgroups, in both SFB and slow4. We replicated our findings in the independent dataset. A relationship between cyclothymic temperament and neuronal variability, an index of intrinsic neuronal activity, in the SMN was found. Cyclothymic and depressive temperaments were associated with opposite changes in the SMN variability, resembling changes previously described in manic and depressive phases of BD. These findings shed a novel light on the neural basis of affective temperament and also carry important implications for the understanding of a potential dimensional continuum between affective temperaments and BD, on both psychological and neuronal levels.
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Affiliation(s)
- Benedetta Conio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Magioncalda
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Martino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Shankar Tumati
- Brain and Mind Research Institute, Mind Brain Imaging and Neuroethics, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Laura Capobianco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Adavastro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniel Russo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Neurology, University of Genoa, Genoa, Italy.,Department of Neurology, Radiology, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Georg Northoff
- Brain and Mind Research Institute, Mind Brain Imaging and Neuroethics, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.,Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China.,Brain and Consciousness Research Centre, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Masi G, Milone A, Montesanto AR, Valente E, Pisano S. Non suicidal self-injury in referred adolescents with mood disorders and its association with cyclothymic-hypersensitive temperament. J Affect Disord 2018; 227:477-482. [PMID: 29156361 DOI: 10.1016/j.jad.2017.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/24/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non suicidal self-injuries (NSSIs) are deliberate self-harm behaviors without suicidal intent, usually starting in adolescence, with increasing rates of occurrence both in epidemiological and clinical samples. Several studies associated cyclothymic-hypersensitive temperament (CHT) with self-harm behaviors and suicidal risk. Aim of this study is to explore the association between NSSIs and CHT in a clinical sample of adolescents. We hypothesized that CHT may differentiate NSSI from non-NSSI adolescents with mood disorders, when other psychopathological features are controlled for. METHODS A consecutive sample of 89 adolescents with mood disorders were assessed for presence and phenomenology of NSSIs, CHT, demographics, comorbid categorical psychiatric diagnoses, dimensional psychopathology, impairment and previous suicide attempts. RESULTS NSSIs were reported in 52% of the sample, with higher rates in females and in bipolar disorder. Regression analyses showed that CHT, but not age, gender, bipolar vs depression diagnosis, functional impairment, was associated with NSSIs. DISCUSSION CHT may be in close association with NSSIs in adolescents with mood disorders. An assessment of CHT in adolescents referred for mood disorder may help to detect specific psychological features of NSSIs, which may improve diagnostic and treatment strategies. LIMITATIONS Given the cross-sectional design, a developmental relation between CHT and NSSIs cannot be determined. The small sample size and the selection bias of severely impaired patients limit the generalization of the results. More sophisticated measures of CHT may consent to explore other dimensions of the cyclothymic construct (i.e., emotional intensity, emotional reactivity, emotional stability, positive vs. negative emotions, interpersonal sensitivity, impulsivity).
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Anna Rita Montesanto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Elena Valente
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Simone Pisano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy.
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Sachs G, Erfurth A. Obsessive Compulsive and Related Disorders: From the Biological Basis to a Rational Pharmacological Treatment. Int J Neuropsychopharmacol 2017; 21:59-62. [PMID: 29087499 PMCID: PMC5795350 DOI: 10.1093/ijnp/pyx101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria,Correspondence: Gabriele Sachs, MD, PhD, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria ()
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, Vienna, Austria
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