Clinical Correlates of False Positive Assignment in Bipolar Screening Measures Across Psychiatric Diagnoses among Patients without Bipolar Disorder

Does the Dysregulation of Social Rhythms Syndrome (DYMERS) be Considered an Essential Component of Panic Disorders?

This editorial explores the role of hyperactivity and social rhythm dysregulation in bipolar disorder (BD) and related syndromes. Social Rhythm Dysregulation Syndrome (DYMERS) is proposed as a common vulnerability across various disorders, including panic disorder (PD), attention deficit hyperactivity disorder, and post-traumatic stress disorder. A study conducted on a sample of elderly individuals participating in an active aging study investigated whether individuals with PD exhibit higher biological rhythm dysregulation compared to those without PD. The sample, consisting of 119 individuals, revealed that those with a lifetime PD diagnosis scored significantly higher on the dysregulation of biological rhythms scale compared to those without panic disorder. A higher prevalence of depressive episodes was found in individuals with PD at the time of the interview. Notably, a small sample of elderly individuals with panic disorder, voluntarily selected for a physical exercise trial, showed a significantly higher level of dysregulation of social rhythms compared to those without panic disorder. This study opens a debate on the accuracy of paper and pencil screening tests for bipolar disorders, especially regarding false positives in individuals with panic disorder. Our hypothesis is that DYMERS could be a shared vulnerability substrate for various disorders, serving as a basis for bipolar onset in the presence of a hyperactivity profile, even with genetic features. The data collected from older adults suggest that social rhythm dysregulation is a typical feature of PD, regardless of the coexistence of a depressive episode. While the study has limitations due to a small sample size, the findings warrant careful analysis and suggest the need for larger-scale replication studies. If confirmed, the dysregulation of rhythms and its association with depressive disorders highlight a significant area of vulnerability for serious psychopathological disorders, emphasizing the importance of extending research to younger populations.

Is there a 'bipolar iceberg' in UK primary care psychological therapy services?

BACKGROUND

Improving Access to Psychological Therapies (IAPT) is a primary care therapy service commissioned by England's National Health Service (NHS) for people with unipolar depression and anxiety-related disorders. Its scope does not extend to 'severe mental illness', including bipolar disorders (BD), but evidence suggests there is a high BD prevalence in ostensibly unipolar major depressive disorder (uMDD) samples. This study aimed to indicate the prevalence and characteristics of people with BD in a naturalistic cohort of IAPT patients.

METHODS

371 participants were assessed before initiating therapy. Participants were categorised by indicated diagnoses: BD type-I (BD-I) or type-II (BD-II) as defined using a DSM diagnostic interview, bipolar spectrum (BSp, not meeting diagnostic criteria but exceeding BD screening thresholds), lifetime uMDD or other. Information about psychiatric history and co-morbidities was examined, along with symptoms before and after therapy.

RESULTS

368 patients provided sufficient data to enable classification. 10% of participants were grouped as having BD-I, 20% BD-II, 40% BSp, 25% uMDD and 5% other. BD and uMDD participants had similar demographic characteristics, but patients meeting criteria for BD-I/BD-II had more complex psychiatric presentations. All three 'bipolar' groups had particularly high rates of anxiety disorders. IAPT therapy receipt was comparable between groups, as was therapy response (F9704 = 1.113, p = 0.351).

CONCLUSIONS

Notwithstanding the possibility that bipolar diathesis was overestimated, findings illustrate a high prevalence of BD in groups of people notionally with uMDD or anxiety. As well as improving the detection of BD, further substantive investigation is required to establish whether individuals affected by BD should be eligible for primary care psychological intervention.

Association of Resting Heart Rate and Heart Rate Variability With Proximal Suicidal Risk in Patients With Diverse Psychiatric Diagnoses

Objectively measurable biomarkers have not been applied for suicide risk prediction. Resting heart rate (HR) and heart rate variability (HRV) showed potential as trans-diagnostic markers associated with suicide. This study aimed to investigate the associations of resting HR and HRV on proximal suicide risk in patients with diverse psychiatric diagnoses. This chart review study used the medical records of psychiatric patients who visited the outpatient clinic at an academic tertiary hospital. A total of 1,461 patients with diverse psychiatric diagnoses was included in the analysis. Proximal suicide risk was measured using the Mini-International Neuropsychiatric Interview (MINI) suicidal score. Linear regression analyses with the MINI suicidal score as a dependent variable and binary logistic regression analyses with moderate-to-high suicide risk (MINI suicidal risk score ≥6) as a dependent variable were conducted to explore the effects of resting HR and HRV parameters on acute suicide risk after adjusting for age, sex, presence of major depressive disorder (MDD) and bipolar disorder (BD), severity of depression and anxiety severity. We found that 55 (34.6%) patients in the MDD group, 40 (41.7%) in the BD group and 36 (3.9%) in the others group reported moderate-to-high suicide risk. Linear regression analysis revealed that both resting HR and root-mean-square of successive difference (RMSSD) had significant associations with the MINI suicidal score (P = 0.037 with HR, P = 0.003 with RMSSD). In logistic regression, only RMSSD showed a significant association with moderate-to-high suicide risk (P = 0.098 with HR, P = 0.019 with RMSSD), which remained significant in subgroup analysis with patients who reported any suicide-related symptom (MINI suicidal score >0; n = 472; P = 0.017 with HR, P = 0.012 with RMSSD). Our study findings suggest the potential for resting HR and RMSSD as biomarkers for proximal suicide risk prediction. Further research with longitudinal evaluation is needed to confirm our study findings.