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Morgan C, Ashcroft DM, Chew-Graham CA, Sperrin M, Webb RT, Francis A, Scott J, Yung AR. Identifying prior signals of bipolar disorder using primary care electronic health records: a nested case-control study. Br J Gen Pract 2024:BJGP.2022.0286. [PMID: 38325893 PMCID: PMC10877620 DOI: 10.3399/bjgp.2022.0286] [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: 06/01/2022] [Accepted: 04/24/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Bipolar disorders are serious mental illnesses, yet evidence suggests that the diagnosis and treatment of bipolar disorder can be delayed by around 6 years. AIM To identify signals of undiagnosed bipolar disorder using routinely collected electronic health records. DESIGN AND SETTING A nested case-control study conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. 'Cases' were adult patients with incident bipolar disorder diagnoses between 1 January 2010 and 31 July 2017. METHOD The patients with bipolar disorder (the bipolar disorder group) were matched by age, sex, and registered general practice to 20 'controls' without recorded bipolar disorder (the control group). Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events before the index (diagnosis) date. RESULTS There were 2366 patients with incident bipolar disorder diagnoses and 47 138 matched control patients (median age 40 years and 60.4% female: n = 1430/2366 with bipolar disorder and n = 28 471/47 138 without). Compared with the control group, the bipolar disorder group had a higher incidence of diagnosed depressive, psychotic, anxiety, and personality disorders and escalating self-harm up to 10 years before a bipolar disorder diagnosis. Sleep disturbance, substance misuse, and mood swings were more frequent among the bipolar disorder group than the control group. The bipolar disorder group had more frequent face-to-face consultations, and were more likely to miss multiple scheduled appointments and to be prescribed ≥3 different psychotropic medication classes in a given year. CONCLUSION Psychiatric diagnoses, psychotropic prescriptions, and health service use patterns might be signals of unreported bipolar disorder. Recognising these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment, and initiation of appropriate treatments.
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Affiliation(s)
- Catharine Morgan
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, NIHR Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | | | - Matthew Sperrin
- School of Health Sciences, Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, NIHR Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Roger T Webb
- Centre for Mental Health & Risk, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, NIHR Greater Manchester Patient Safety Research Collaboration, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Anya Francis
- Centre for Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Mental Health, Université de Paris, Paris, France; Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Research Translation, Deakin University, Geelong, Australia; emeritus professor of psychiatry, Centre for Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Messer T, Lammers G, Müller-Siecheneder F, Schmidt RF, Latifi S. Substance abuse in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Res 2017; 253:338-350. [PMID: 28419959 DOI: 10.1016/j.psychres.2017.02.067] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/11/2017] [Accepted: 02/12/2017] [Indexed: 12/25/2022]
Abstract
By considering the debilitating outcome of co-occurring of bipolar disorder (BD) and substance abuse, determination of risk factors of substance use disorders (SUD: abuse or dependence of drugs and/or alcohol) is essential to identify the susceptible patients. The purpose of this study was to clarify the major determinant factors of SUD among adults with BD by reviewing the relevant literature. We systematically searched electronic databases including PubMed (MEDLINE), EMBASE, OVID, Cochrane and Scopus for human studies addressing the co-existence of bipolar disorder and SUD. All potential published papers up to September 2016 have been reviewed. The statistical analysis was performed using Comprehensive Meta-analysis version 2. Male gender (Odds ratio: 2.191 (95% CI: 1.121-4.281), P 0.022), number of manic episodes (P: 0.001) and previous history of suicidality (Odds ratio: 1.758 (95% CI: 1.156-2.674), P: 0.008) were associated to SUD in patients with BD. SUD was not related to age, subtype of BD, hospitalization and co-existence of anxiety disorders or psychotic symptoms. SUD affects many aspects of BD regarding clinical course, psychopathology and prognosis. Our study demonstrates that male gender, history of higher number of manic episodes and suicidality are associated to higher susceptibility to SUD. Thus, assignment of more intensive therapeutic interventions should be considered in patients with increased risk of drug abuse to prevent development of SUD.
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Affiliation(s)
- Thomas Messer
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany
| | - Gero Lammers
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany
| | | | - Raluca-Florela Schmidt
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany
| | - Sahar Latifi
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany.
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Horton EG, Luna N, Malloy T. Associations Between Spirituality, Meaning in Life, and Depressive Disorders Among a Sample of Individuals in Treatment for Substance-Use Disorders. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2016. [DOI: 10.1080/19349637.2016.1159941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 513] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Treatment Motivation Predicts Substance Use Treatment Retention Across Individuals with and Without Co-Occurring Mental Illness. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9510-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mulder CL, Ruud T, Bahler M, Kroon H, Priebe S. The availability and quality across Europe of outpatient care for difficult-to-engage patients with severe mental illness: a survey among experts. Int J Soc Psychiatry 2014; 60:304-10. [PMID: 23680763 DOI: 10.1177/0020764013485941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As many patients with severe mental illness (SMI) who have complex needs are difficult to engage, outreach mental health services are needed to engage them into treatment. The extent to which these services exist in large European cities is unknown. METHODS Experts in 29 European countries were sent a structured questionnaire containing two case vignettes of difficult-to-engage patients (a first-episode psychosis patient and a homeless chronic schizophrenia patient). The type and quality of outpatient care was assessed and related to several national indices. RESULTS The questionnaire was returned by experts from 22 countries (76%) representing 92% of the EU population. Six countries (21%) had a systematic method for detecting difficult-to-engage patients. The most important route whereby such patients entered the mental health system was through informal care; the most important reasons for entering it were the level of psychiatric symptoms, nuisance and violence. Assertive outreach was available in nine countries (41%), with coverage ranging from a few teams (sometimes for a specific target group) to most of the country. The case vignettes showed that outpatient care for these difficult-to-engage patients varied widely. In seven (30%) of the 22 countries, a hospital would take no action if such patients who had been admitted voluntarily discharged themselves prematurely. On a scale of 0-10, the experts' mean scores regarding the quality of outpatient care for patients with SMI in general were 5.2 (SD = 1.9) and 3.2 (SD = 2.2) in difficult-to-engage ones. Explorative analyses showed that the quality of outpatient care for difficult-to-engage patients was associated with gross national income and the number of psychiatrists per capita. CONCLUSIONS Outpatient mental health services for difficult-to-engage SMI patients varied widely among European countries; experts judged their overall quality to be poor. It is now important to achieve consensus on a minimum European standard for the quality of care for such patients.
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Affiliation(s)
- Cornelis L Mulder
- 1Epidemiological and Social Psychiatric Research institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
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Hodgkin D, Volpe-Vartanian J, Merrick EL, Horgan CM, Nierenberg AA, Frank RG, Lee S. Customization in prescribing for bipolar disorder. HEALTH ECONOMICS 2012; 21:653-668. [PMID: 21506194 PMCID: PMC3164906 DOI: 10.1002/hec.1737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/18/2011] [Accepted: 03/14/2011] [Indexed: 05/30/2023]
Abstract
For many disorders, patient heterogeneity requires physicians to customize their treatment to each patient's needs. We test for the existence of customization in physicians' prescribing for bipolar disorder, using data from a naturalistic clinical effectiveness trial of bipolar disorder treatment (STEP-BD), which did not constrain physician prescribing. Multinomial logit is used to model the physician's choice among five combinations of drug classes. We find that our observed measure of the patient's clinical status played only a limited role in the choice among drug class combinations, even for conditions such as mania that are expected to affect class choice. However, treatment of a patient with given characteristics differed widely depending on which physician was seen. The explanatory power of the model was low. There was variation within each physician's prescribing, but the results do not suggest a high degree of customization in physicians' prescribing, based on our measure of clinical status.
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Affiliation(s)
- Dominic Hodgkin
- Institute for Behavioral Health, Heller School of Social Policy & Management, Brandeis University, Waltham, MA 02454, USA.
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Motivationsbehandlung für Patienten mit der Doppeldiagnose Psychose und Sucht. DER NERVENARZT 2011; 83:888-96. [DOI: 10.1007/s00115-011-3331-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic. Compr Psychiatry 2009; 50:100-7. [PMID: 19216885 PMCID: PMC2746444 DOI: 10.1016/j.comppsych.2008.06.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 06/12/2008] [Accepted: 06/19/2008] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Subjective experience of illness is a critical component of treatment adherence in populations with bipolar disorder (BPD). This cross-sectional analysis examined clinical and subjective variables in relation to adherence in 140 individuals with BPD receiving treatment with mood-stabilizing medication. METHODS Nonadherence was defined as missing 30% or more of medication on the Tablets Routine Questionnaire, a self-reported measure of medication treatment adherence. Adherent and nonadherent groups were compared on measures of attitudes toward illness and treatment including the Attitudes toward Mood Stabilizers Questionnaire, the Insight and Treatment Attitudes Questionnaire, the Rating of Medication Influences, and the Multidimensional Health Locus of Control Scale. RESULTS Except for substance abuse comorbidity, adherent individuals (n = 113, 80.7%) did not differ from nonadherent individuals (n = 27, 19.3%) on clinical variables. However, nonadherent individuals had reduced insight into illness, more negative attitudes toward medications, fewer reasons for adherence, and more perceived reasons for nonadherence compared with adherent individuals. The strongest attitudinal predictors for nonadherence were difficulties with medication routines (odds ratio = 2.2) and negative attitudes toward drugs in general (odds ratio = 2.3). LIMITATIONS Results interpretation is limited by cross-sectional design, self-report methodology, and sample size. CONCLUSIONS Comorbid substance abuse, negative attitudes toward mood-stabilizing medication, and difficulty managing to take medication in the context of one's daily schedule are primary determinants of medication treatment adherence. A patient-centered collaborative model of care that addresses negative attitudes toward medication and difficulty coping with medication routines may be ideally suited to address individual adherence challenges.
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Newman LA, Darling J, McGaughy J. Atomoxetine reverses attentional deficits produced by noradrenergic deafferentation of medial prefrontal cortex. Psychopharmacology (Berl) 2008; 200:39-50. [PMID: 18568443 PMCID: PMC10719959 DOI: 10.1007/s00213-008-1097-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 02/01/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND The majority of studies assessing executive function in attention deficit disorder (ADD) have shown deficits in attentional set shifting using either the Wisconsin card sorting task or the intra-dimensional/extra-dimensional set-shifting task (ID/ED). Damage to the prefrontal cortex in humans, primates, and rodents impairs extra-dimensional (ED) shifts. Noradrenergic depletion of the medial prefrontal cortex in rats is sufficient to impair attentional set shifting. Atomoxetine, a selective norepinephrine (NE) re-uptake inhibitor, is hypothesized to produce beneficial effects in patient with ADD by augmenting NE release in prefrontal cortex. MATERIALS AND METHODS We assessed the effects of systemic administration of atomoxetine (0.0, 0.1, 0.3, and 0.9 mg/kg/ml) in normal and noradrenergically lesioned (NE-LX) rats on attentional-set shifts. We replicated findings showing NE-LX rats are selectively impaired on the ED shifts but not reversals or other discriminations. RESULTS Atomoxetine remediated the attentional set-shifting impairments in NE-LX rats but impaired ED performance of non-lesioned rats. DISCUSSION Though atomoxetine is neurochemically selective, it is not wholly specific at doses >0.3 mg/kg. All doses of the drug were similar in their efficacy in reversing the ED deficit, but the effectiveness of the 0.1 mg/kg dose supports the hypothesis that increases in prefrontal NE alone are sufficient to improve attention in NE-LX rats. Moreover, the detrimental effects of the drug in non-lesioned rats support the hypothesis that optimal levels of NE in prefrontal cortex are critical to attentional set shifting with both supra- and sub-optimal levels producing attentional impairments.
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Affiliation(s)
- Lori A Newman
- Department of Psychology, University of New Hampshire, Conant Hall, Durham, NH 03824, USA
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[Management of comorbid bipolar disorder and alcohol dependence]. Presse Med 2008; 37:1132-7. [PMID: 18296020 DOI: 10.1016/j.lpm.2007.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 09/18/2007] [Accepted: 09/18/2007] [Indexed: 11/24/2022] Open
Abstract
Recent studies confirm the clear association between bipolar disorders and alcohol abuse and dependence. Lifetime prevalence of disorders associated with alcohol abuse or dependence appears to be 3 to 4 times higher in patients with bipolar disorders than in the general population. Lifetime prevalence of mood disorders in alcohol-dependent subjects is approximately 10 times higher than in the general population. Despite the strength of this association, there is little information about specific management that takes into account both disorders and their interaction. One study shows that valproate may reduce excessive alcohol consumption in bipolar alcohol-dependent patients, especially because of its stabilizing and anticonvulsant effects. Based on this study, the American Psychiatry Association (APA) recently suggested the use of valproate in the treatment of patients with comorbid bipolar disorder and alcohol dependence.
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Watts M. High expressed emotion, severe mental illness and substance use disorder. ACTA ACUST UNITED AC 2007; 16:1259-62. [DOI: 10.12968/bjon.2007.16.20.27572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Malcolm Watts
- School of Health, Park Campus, University of Northampton, Northampton
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San L, Arranz B, Martinez-Raga J. Antipsychotic drug treatment of schizophrenic patients with substance abuse disorders. Eur Addict Res 2007; 13:230-43. [PMID: 17851245 DOI: 10.1159/000104886] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM In recent years, there has been a growing interest in developing adequate treatments for patients with a diagnosis of schizophrenia and a comorbid substance use disorder (SUD). In the present paper we aim to critically review published reports on the use of conventional and second-generation antipsychotics in the treatment of patients with schizophrenia and comorbid SUD, to provide clinicians with a clearer view of the pharmacological treatment of this highly prevalent dual diagnosis based upon the evidence arising from the scientific literature. METHODS A search of the relevant literature from Medline, PsycLIT and EMBASE databases, included in the Science Citation Index, and available up to November 2006 was conducted using the terms: 'schizophrenia', 'substance use disorder' and 'antipsychotics'. RESULTS While research on the use of conventional antipsychotics has remained limited, the majority of studies suggest the effectiveness of second-generation antipsychotics, particularly clozapine, for patients with schizophrenia and a comorbid substance use disorder. CONCLUSION In the absence of randomized controlled trials that could provide more reliable information, clinical decisions may need to rely on indirect data provided by the increasing number of case reports, open trials and retrospective studies showing a decrease in cigarette smoking, alcohol, cocaine or cannabis use and an improvement of overall psychiatric symptoms.
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Affiliation(s)
- Luis San
- Department of Psychiatry, Hospital San Rafael, Barcelona, Spain.
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