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Sokolov AV, Schiöth HB. Decoding depression: a comprehensive multi-cohort exploration of blood DNA methylation using machine learning and deep learning approaches. Transl Psychiatry 2024; 14:287. [PMID: 39009577 PMCID: PMC11250806 DOI: 10.1038/s41398-024-02992-y] [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: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/17/2024] Open
Abstract
The causes of depression are complex, and the current diagnosis methods rely solely on psychiatric evaluations with no incorporation of laboratory biomarkers in clinical practices. We investigated the stability of blood DNA methylation depression signatures in six different populations using six public and two domestic cohorts (n = 1942) conducting mega-analysis and meta-analysis of the individual studies. We evaluated 12 machine learning and deep learning strategies for depression classification both in cross-validation (CV) and in hold-out tests using merged data from 8 separate batches, constructing models with both biased and unbiased feature selection. We found 1987 CpG sites related to depression in both mega- and meta-analysis at the nominal level, and the associated genes were nominally related to axon guidance and immune pathways based on enrichment analysis and eQTM data. Random forest classifiers achieved the highest performance (AUC 0.73 and 0.76) in CV and hold-out tests respectively on the batch-level processed data. In contrast, the methylation showed low predictive power (all AUCs < 0.57) for all classifiers in CV and no predictive power in hold-out tests when used with harmonized data. All models achieved significantly better performance (>14% gain in AUCs) with pre-selected features (selection bias), with some of the models (joint autoencoder-classifier) reaching AUCs of up to 0.91 in the final testing regardless of data preparation. Different algorithmic feature selection approaches may outperform limma, however, random forest models perform well regardless of the strategy. The results provide an overview over potential future biomarkers for depression and highlight many important methodological aspects for DNA methylation-based depression profiling including the use of machine learning strategies.
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Affiliation(s)
- Aleksandr V Sokolov
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden.
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Peralta D, Janda L, García de Jalón E, Moreno-Izco L, Sánchez-Torres AM, Cuesta MJ, Peralta V. Long-term diagnostic stability, predictors of diagnostic change, and time until diagnostic change of first-episode psychosis: a 21-year follow-up study. Psychol Med 2024; 54:1329-1338. [PMID: 37987188 DOI: 10.1017/s0033291723003173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Although diagnostic instability in first-episode psychosis (FEP) is of major concern, little is known about its determinants. This very long-term follow-up study aimed to examine the diagnostic stability of FEP diagnoses, the baseline predictors of diagnostic change and the timing of diagnostic change. METHODS This was a longitudinal and naturalistic study of 243 subjects with FEP who were assessed at baseline and reassessed after a mean follow-up of 21 years. The diagnostic stability of DSM-5 psychotic disorders was examined using prospective and retrospective consistencies, logistic regression was used to establish the predictors of diagnostic change, and survival analysis was used to compare time to diagnostic change across diagnostic categories. RESULTS The overall diagnostic stability was 47.7%. Schizophrenia and bipolar disorder were the most stable diagnoses, with other categories having low stability. Predictors of diagnostic change to schizophrenia included a family history of schizophrenia, obstetric complications, developmental delay, poor premorbid functioning in several domains, long duration of untreated continuous psychosis, spontaneous dyskinesia, lack of psychosocial stressors, longer duration of index admission, and poor early treatment response. Most of these variables also predicted diagnostic change to bipolar disorder but in the opposite direction and with lesser effect sizes. There were no significant differences between specific diagnoses regarding time to diagnostic change. At 10-year follow-up, around 80% of the diagnoses had changed. CONCLUSIONS FEP diagnoses other than schizophrenia or bipolar disorder should be considered as provisional. Considering baseline predictors of diagnostic change may help to enhance diagnostic accuracy and guide therapeutic interventions.
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Affiliation(s)
- David Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Paljärvi T, Tiihonen J, Lähteenvuo M, Tanskanen A, Fazel S, Taipale H. Mortality in psychotic depression: 18-year follow-up study. Br J Psychiatry 2023; 222:37-43. [PMID: 36250518 PMCID: PMC10895511 DOI: 10.1192/bjp.2022.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the role of co-occurring psychiatric disorders in mortality associated with psychotic depression is limited. AIMS To estimate the risk of cause-specific mortality in psychotic depression compared with severe non-psychotic depression while controlling for comorbid psychiatric disorders. METHOD This cohort study used routine data from nationwide health registers in Finland. Eligible participants had their first diagnosis for psychotic depression or for severe non-psychotic depression between the years 2000 and 2018, had no pre-existing diagnoses for schizophrenia spectrum disorders or bipolar disorder, and were aged 18-65 years at the index diagnosis. Causes of death were defined by ICD-10 codes. The follow-up time was up to 18 years. RESULTS We included 19 064 individuals with incident psychotic depression and 90 877 individuals with incident non-psychotic depression. Half (1199/2188) of the deaths in those with psychotic depression occurred within 5 years from the index diagnosis and the highest relative risk was during the first year after the diagnosis. Compared with individuals with non-psychotic depression, those with psychotic depression had a higher risk of all-cause mortality (adjusted hazard ratio, aHR = 1.59, 95% CI 1.48-1.70), suicides (aHR = 2.36, 95% CI 2.11-2.64) and fatal accidents (aHR 1.63, 95% CI 1.26-2.10) during the subsequent 5-year period after the index diagnosis. CONCLUSIONS Psychotic symptoms markedly added to the mortality risk associated with severe depression after controlling for psychiatric comorbidity. Prompt treatment and enhanced monitoring for psychotic symptoms is warranted in all patients with severe depression to prevent deaths because of suicides and other external causes.
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Affiliation(s)
- Tapio Paljärvi
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; and Department of Psychiatry, Oxford University, Warneford Hospital, UK
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; and Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; and Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Seena Fazel
- Department of Psychiatry, Oxford University, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and School of Pharmacy, University of Eastern Finland, Finland
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Employing biochemical biomarkers for building decision tree models to predict bipolar disorder from major depressive disorder. J Affect Disord 2022; 308:190-198. [PMID: 35439462 DOI: 10.1016/j.jad.2022.03.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Conventional biochemical parameters may have predictive values for use in clinical identification between bipolar disorder (BD) and major depressive disorder (MDD). METHODS This study enrolled 2470 hospitalized patients with BD (n = 1333) or MDD (n = 1137) at reproductive age from 2009 to 2018 in China. We extracted 8 parameters, uric acid (UA), direct bilirubin (DBIL), indirect bilirubin (IDBIL), lactic dehydrogenase (LDH), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), high-density lipoprotein (HDL) and prealbumin of male, patients and 12 parameters, UA, DBIL, IBIL, LDH, FT3, TSH, glutamic-pyruvic transaminase (GPT), white blood cell (WBC), alkaline phosphatase (ALP), fasting blood glucose (FBG), triglyceride and low-density lipoprotein (LDL) of female patients. Backward stepwise multivariate regression analysis and the Chi-Square Automatic Interaction Detection (CHAID) segmentation analysis via SPSS Decision Tree were implemented to define the discrimination of BD and MDD. RESULTS DBIL was extracted as the first splitting variable, with LDH and IBIL as the second, TSH and prealbumin as the third in the model of male patients (p-value < .05). For the model of female patients, DBIL was also extracted as the first splitting variable, with UA, LDH, and IBIL as the second, triglyceride and FT3 as the third (p-value < .05). The predictive accuracies of the Decision Tree and multiple logistic regression models were similar (74.9% vs 76.9% in males; 74.4% vs 79.5% in females). CONCLUSIONS This study suggests the value of the Decision Tree models, which employ biochemical parameters as diagnostic predictors for BD and MDD. The CHAID Decision Tree identified that patients with concomitantly increased LDH, IBIL, and decreased DBIL could be in the group that showed the highest risk of being diagnosed as BD.
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Ahti J, Kieseppä T, Suvisaari J, Suokas K, Holm M, Wegelius A, Ahola-Olli A, Häkkinen K, Kampman O, Lähteenvuo M, Paunio T, Tiihonen J, Tuulio-Henriksson A, Isometsä E. Differences in psychosocial functioning between psychotic disorders in the Finnish SUPER study. Schizophr Res 2022; 244:10-17. [PMID: 35537381 DOI: 10.1016/j.schres.2022.04.008] [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: 12/20/2021] [Revised: 03/16/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psychotic disorders differ in their impact on psychosocial functioning. However, few studies have directly compared psychosocial functioning and its determinants between schizophrenia, schizoaffective disorder (SAD), bipolar disorder (BD), and major depressive disorder with psychotic features (psychotic MDD). OBJECTIVE We compared rates of independent living, employment, marriage, and having children between these diagnostic groups in a large national sample of participants with psychotic disorders in Finland. METHODS A cross-sectional substudy of participants (N = 9148) aged 18 to 65 years in the Finnish SUPER study, recruited nationwide from health- and social care settings and with advertisements. Psychosis diagnoses, age of onset, and hospitalizations were collected from healthcare registers. Participants were interviewed for psychosocial functioning. Associations of age of onset, hospitalizations, gender, and education with psychosocial functioning were analyzed using logistic regression models. RESULTS Of participants, 13.8% were employed or studying, 72.0% living independently and 32.5% had children. Overall, BD was associated with best, SAD and psychotic MDD with intermediate, and schizophrenia with worst level of psychosocial functioning. Greatest differences were found in independent living (OR 4.06 for BD vs. schizophrenia). In multivariate models, gender and number of hospitalizations predicted employment, marriage, and independent living in all diagnostic categories, and age of onset in some diagnostic categories. CONCLUSIONS Level of functioning and psychosocial outcomes differed markedly between psychotic disorders, particularly in independent living. Outcomes were worst for schizophrenia and best for BD. Across all psychotic disorders, female gender and lifetime number of hospitalizations had strong independent associations with marriage, employment, and independent living.
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Affiliation(s)
- Johan Ahti
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kimmo Suokas
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Tampere University Hospital, Tampere, Finland; Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland
| | - Minna Holm
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Asko Wegelius
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Ari Ahola-Olli
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Stanley Center for Psychiatric Research, The Broad Institute of MIT (Massachusetts Institute of Technology) and Harvard, Cambridge, MA, USA; Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Katja Häkkinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Olli Kampman
- Tampere University Hospital, Tampere, Finland; Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland; Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Tiina Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | | | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland.
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Zhu Y, Ji H, Niu Z, Liu H, Wu X, Yang L, Wang Z, Chen J, Fang Y. Biochemical and Endocrine Parameters for the Discrimination and Calibration of Bipolar Disorder or Major Depressive Disorder. Front Psychiatry 2022; 13:875141. [PMID: 35795028 PMCID: PMC9251015 DOI: 10.3389/fpsyt.2022.875141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Conventional biochemical indexes may have predictive values in clinical identification between bipolar disorder (BD) and major depressive disorder (MDD). METHODS This study included 2,470 (BD/MDD = 1,333/1,137) hospitalized patients in Shanghai as training sets and 2,143 (BD/MDD = 955/1,188) in Hangzhou as test sets. A total of 35 clinical biochemical indexes were tested, including blood cells, immuno-inflammatory factors, liver enzymes, glycemic and lipid parameters, and thyroid and gonadal hormones. A stepwise analysis of a multivariable logistic regression was performed to build a predictive model to identify BD and MDD. RESULTS Most of these biochemical indexes showed significant differences between BD and MDD groups, such as white blood cell (WBC) in the hematopoietic system, uric acid (UA) in immuno-inflammatory factors, direct bilirubin (DBIL) in liver function, lactic dehydrogenase (LDH) in enzymes, and fasting blood glucose (FBG) and low-density lipoprotein (LDL) in glucolipid metabolism (p-values < 0.05). With these predictors for discrimination, we observed the area under the curve (AUC) of the predictive model to distinguish between BD and MDD to be 0.772 among men and 0.793 among women, with the largest AUC of 0.848 in the luteal phase of women. The χ2 values of internal and external validation for male and female datasets were 2.651/10.264 and 10.873/6.822 (p-values < 0.05), respectively. The AUCs of the test sets were 0.696 for males and 0.707 for females. CONCLUSION Discrimination and calibration were satisfactory, with fair-to-good diagnostic accuracy and external calibration capability in the final prediction models. Female patients may have a higher differentiability with a conventional biochemical index than male patients. TRIAL REGISTRATION ICTRP NCT03949218. Registered on 20 November 2018. Retrospectively registered. https://www.clinicaltrials.gov/ct2/show/NCT03949218?id=NCT03949218&rank=1.
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Affiliation(s)
- Yuncheng Zhu
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, China.,Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Ji
- Division of Psychiatry, Shanghai Changning Mental Health Center, Shanghai, China
| | - Zhiang Niu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongmei Liu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohui Wu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Yang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, China
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Donaldson KR, Larsen EM, Jonas K, Tramazzo S, Perlman G, Foti D, Mohanty A, Kotov R. Mismatch negativity amplitude in first-degree relatives of individuals with psychotic disorders: Links with cognition and schizotypy. Schizophr Res 2021; 238:161-169. [PMID: 34695710 PMCID: PMC9235539 DOI: 10.1016/j.schres.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/12/2023]
Abstract
Mismatch negativity (MMN) amplitude is reliably reduced in psychotic disorders. While several studies have examined this effect in first-degree relatives of individuals with schizophrenia, few have sought to quantify deficits in relatives of individuals with other psychotic disorders. While some conclude that, compared to healthy subjects, first-degree relatives of schizophrenia show reduced MMN, others contradict this finding. Furthermore, though MMN is often shown to be associated with cognitive impairments and clinical symptoms in psychotic disorders, to our knowledge no studies have sought to fully examine these relationships in studies of first-degree relatives. The present study sought to clarify the extent of MMN amplitude reductions in a large sample of siblings of individuals with diverse psychotic disorders (n = 67), compared to probands with psychosis (n = 221) and never psychotic comparison subjects (n = 251). We further examined associations of MMN amplitude with cognition and schizotypal symptoms across these groups. We found that MMN amplitude was intact in siblings compared to probands. MMN amplitude was associated with cognition and schizotypal symptoms dimensionally across levels of familial risk. The present results imply that MMN reductions do not reflect genetic risk for psychotic disorders per se, and instead emerge as a result of, or in conjunction with, clinical features associated with psychosis. Such findings carry important implications for the utility of MMN amplitude as an indicator of inherited risk, and suggest that this component may be best conceptualized as an endophenotype for clinical symptoms and cognitive impairments, rather than risk for psychosis per se.
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Affiliation(s)
| | - Emmett M. Larsen
- Stony Brook University Department of Psychology, Stony Brook, NY
| | - Katherine Jonas
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY
| | - Sara Tramazzo
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY
| | - Greg Perlman
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY
| | - Dan Foti
- Purdue University Department of Psychological Sciences, West Lafayette, IN
| | - Aprajita Mohanty
- Stony Brook University Department of Psychology, Stony Brook, NY
| | - Roman Kotov
- Stony Brook Medicine, Psychiatry Department, Stony Brook, NY, United States of America.
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Wang MQ, Wang RR, Hao Y, Xiong WF, Han L, Qiao DD, He J. Clinical characteristics and sociodemographic features of psychotic major depression. Ann Gen Psychiatry 2021; 20:24. [PMID: 33771161 PMCID: PMC8004453 DOI: 10.1186/s12991-021-00341-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Psychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research. METHODS This study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0-2/9, F33.0-2/9), and SZ (F20-20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method. RESULTS PMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019-2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168-1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492-0.741), were more often divorced (OR 3.087, 95% CI 1.168-10.096), had a younger age of onset (OR 0.934, 95% CI 0.914-0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492-0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267-0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD. CONCLUSIONS PMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.
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Affiliation(s)
- Meng-Qi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No 11, Bei San Huan East Road, Chaoyang District, Beijing, 100029, China
| | - Ran-Ran Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No 11, Bei San Huan East Road, Chaoyang District, Beijing, 100029, China
| | - Yu Hao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No 11, Bei San Huan East Road, Chaoyang District, Beijing, 100029, China
| | - Wei-Feng Xiong
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No 11, Bei San Huan East Road, Chaoyang District, Beijing, 100029, China
| | - Ling Han
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No 11, Bei San Huan East Road, Chaoyang District, Beijing, 100029, China
| | - Dong-Dong Qiao
- Shandong Provincial Mental Health Hospital, No 49, Wenhua East Road, Jinan, 250014, Shandong, China.
| | - Juan He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No 11, Bei San Huan East Road, Chaoyang District, Beijing, 100029, China.
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Bingham KS, Dawson DR, Mulsant BH, Banerjee S, Flint AJ. Relationships Among History of Psychosis, Cognition and Functioning in Later-Life Remitted Major Depression. Am J Geriatr Psychiatry 2021; 29:144-155. [PMID: 32665079 DOI: 10.1016/j.jagp.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/11/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study tested the hypotheses that, in older adults with remitted major depression, a history of psychotic features and poorer neuropsychological performance would be independently associated with poorer everyday functioning, but that neuropsychological performance would explain more of the variance in functioning than history of psychotic features. METHODS This cross-sectional study included 73 patients aged 50 years or older with remitted psychotic major depression or nonpsychotic major depression. The dependent variables were subjective and objective measures of function. The independent variables were history of psychotic features during one or more major depressive episodes in the previous 10 years and neuropsychological performance. Linear regression models examined the association of independent variables with function, controlling for pertinent covariates. Effect sizes were calculated for the magnitude of difference in function between the patient participants and an age- and gender-matched nonpsychiatric group, and distribution of functioning scores were compared between groups. RESULTS In separate models, history of psychotic features and poorer processing speed, executive function, and verbal learning were independently associated with poorer participant-reported functioning and performance-based functioning. However, the association of psychotic features with functioning was no longer statistically significant when tested in the same models as neuropsychological measures. Effect sizes of the difference in functioning between patients and the nonpsychiatric group were significantly larger for the remitted psychotic than the remitted nonpsychotic depression group; functioning scores were more heterogeneous in the remitted psychotic depression group. CONCLUSION Patients with remitted psychotic depression exhibit greater, and clinically important, impairment in everyday functioning than those with remitted nonpsychotic depression. Neuropsychological impairment appears to contribute to this relationship.
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Affiliation(s)
- Kathleen S Bingham
- Department of Psychiatry, University of Toronto (KSB, BHM, AJF), Toronto, ON; Centre for Mental Health, University Health Network (KSB, AJF), Toronto, ON.
| | - Deirdre R Dawson
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, University of Toronto (DRD), Toronto, ON; Rotman Research Institute (DRD), Baycrest, Toronto, ON
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto (KSB, BHM, AJF), Toronto, ON; Centre for Addiction and Mental Health (BHM), Toronto, ON
| | - Samprit Banerjee
- Department. of Biostatistics and Epidemiology, Weill Cornell Medical College (SB), New York, NY
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto (KSB, BHM, AJF), Toronto, ON; Centre for Mental Health, University Health Network (KSB, AJF), Toronto, ON
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Li H, Huang Y, Wu F, Lang X, Zhang XY. Prevalence and related factors of suicide attempts in first-episode and untreated Chinese Han outpatients with psychotic major depression. J Affect Disord 2020; 270:108-113. [PMID: 32339099 DOI: 10.1016/j.jad.2020.03.093] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Major depressive depression (MDD) is often accompanied by suicidal behavior. Increasing evidence shows that MDD patients display psychotic symptoms. However, the relationship between psychotic symptoms and suicide attempt in MDD has not been reported. Therefore, this study was to identify the prevalence and associated factors of suicide attempts in first-episode and untreated Chinese Han outpatients comorbid with psychotic major depression (PMD). METHODS 1718 first-episode and untreated MDD outpatients were assessed with Positive Symptom Scale of Positive and Negative Syndrome Scale (PANSS), the 17-item Hamilton Depression Scale, Hamilton Anxiety Scale, and clinical global impression of severity scale (CGI-S). Some glycolipid metabolism and thyroid hormone parameters were measured. RESULTS In MDD patients, the percentage of PMD was 10.0%. The incidence of attempted suicide in PMD patients was 51.5%, which was more than 3 times higher than that in non-PMD patients (16.7%). In PMD patients, compared to non-attempters, suicide attempters were older, had a longer course of disease, scored higher on all scales, as well as had higher levels of thyroid stimulating hormone (TSH), thyroid peroxidases antibody, anti-thyroglobulin and blood glucose. PANSS positive symptom, CGI, diastolic blood pressure and TSH were independently associated with suicide attempts of PMD. CONCLUSIONS PMD patients have a higher prevalence of suicide attempt than non-PMD patients. Some demographic and clinical parameters are relevant factors for suicide attempt in PMD patients.
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Affiliation(s)
- Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - XiaoE Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiang Yang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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11
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Zhou Y, Li Z, Wang Y, Huang H, Chen W, Dong L, Wu J, Chen J, Miao Y, Qi L, Zhang S, Lang X, Zhang X. Prevalence and clinical correlates of psychotic depression in first-episode and drug-naïve outpatients with major depressive disorder in a Chinese Han population. J Affect Disord 2020; 263:500-506. [PMID: 31759662 DOI: 10.1016/j.jad.2019.10.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few systemic studies of psychotic depression (PD) have been conducted in first-episode and drug-naïve (FEDN) patients. This study was to examine the prevalence of PD and its clinical correlates in a large sample of FEDN outpatients with major depressive disorder (MDD) in a Chinese Han population, which to our best knowledge has not been studied. METHODS In this cross-sectional study, a total of 1718 FEDN MDD outpatients were recruited. All patients were rated on the positive symptom subscale of the Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms, the 17-item Hamilton Depression Rating Scale (HAMD-17) for depression and Hamilton Anxiety Rating Scale (HAMA) for anxiety. RESULTS The prevalence of PD was 10.0% (171/1718) in MDD patients. Compared to the non-PD patients, PD patients had significantly older age, lower educational levels, higher anxiety symptom score and were more likely to attempt suicide. Further logistic regression analysis indicated that PD was associated with older age, suicide attempt and comorbid anxiety (all p < 0.05). Multiple regression analyses showed that both HAMD and HAMA total scores were significantly associated with PANSS positive symptom subscale score. LIMITATIONS Our cross-sectional study design does not show a direct causal relationship between psychiatric symptoms and related factors in patients with MDD. CONCLUSIONS Our results suggest a high prevalence of PD in MDD patients in the acute early stage in a Chinese Han population, which is associated with demographic variables and clinical symptoms.
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Affiliation(s)
- Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Zezhi Li
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Yijun Wang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Huiteng Huang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Wencai Chen
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ling Dong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jiang Wu
- Wuhan Youfu Hospital, Wuhan, China
| | - Jing Chen
- Wuhan Youfu Hospital, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ying Miao
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ling Qi
- Wuhan Youfu Hospital, Wuhan, China; School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, 430023, China
| | - Shufang Zhang
- Wuhan Youfu Hospital, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Xiaoe Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Abstract
Mood disorders, including major depression and mania, can present with psychotic features. In youth psychotic-like phenomena such as "seeing faces in the dark" or "hearing noises" are fairly common. Rates of lifetime psychotic symptoms are much higher than rates of psychosis during a "current" episode of mania or depression in youth. Psychotic phenomena can be mood congruent or incongruent. A detailed mental status examination and clinical history include questioning to ensure the informants understand the questions being asked. There are interviews that structure how questions are asked, and rating scales that help anchor severity and quality of the mood episode.
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Affiliation(s)
- Gabrielle A Carlson
- Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Putnam Hall - South Campus, 101 Nichols Road, Stony Brook, NY 11794, USA
| | - Caroly Pataki
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, 546 16th Street, Los Angeles, CA 90402, USA.
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13
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Coryell W. Impact, Diagnosis, Phenomenology, and Biology. Handb Exp Pharmacol 2019; 250:3-33. [PMID: 31004226 DOI: 10.1007/164_2018_156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This section provides summaries of the epidemiology, phenomenology, nosology, and the suspected biological substrates of the depressive disorders. It particularly emphasizes the historical evolution of the pertinent diagnostic constructs and the prognostic import both of the various diagnostic groupings and of the individual symptoms and symptom clusters.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
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14
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Jääskeläinen E, Juola T, Korpela H, Lehtiniemi H, Nietola M, Korkeila J, Miettunen J. Epidemiology of psychotic depression - systematic review and meta-analysis. Psychol Med 2018; 48:905-918. [PMID: 28893329 DOI: 10.1017/s0033291717002501] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. We performed a systematic review and meta-analyses on epidemiology, especially incidence and prevalence, risk factors, and outcomes of PD. A systematic search to identify potentially relevant studies was conducted using four electronic databases and a manual search. The search identified 1764 unique potentially relevant articles, the final study included 99 articles. We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. Onset age of PD was earlier than that of NPD in younger samples, but later in older samples. There were no differences in gender distribution in PD v. NPD, but higher proportion of females was found in PD than in SZ or in psychotic bipolar disorder (PBD). Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. Outcomes of PD were mostly worse when compared with NPD, but better compared with SZ and schizoaffective disorder. The outcome compared with PBD was relatively similar, and somewhat varied depending on the measure of the outcome. Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.
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Affiliation(s)
- E Jääskeläinen
- Center for Life Course Health Research,University of Oulu,Finland
| | - T Juola
- Center for Life Course Health Research,University of Oulu,Finland
| | - H Korpela
- Center for Life Course Health Research,University of Oulu,Finland
| | - H Lehtiniemi
- Center for Life Course Health Research,University of Oulu,Finland
| | - M Nietola
- Psychiatric Department,University of Turku and Turku University Hospital,Finland
| | - J Korkeila
- Psychiatric Department,University of Turku and Satakunta Hospital District,Finland
| | - J Miettunen
- Center for Life Course Health Research,University of Oulu,Finland
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15
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Kim YK, Na KS. Application of machine learning classification for structural brain MRI in mood disorders: Critical review from a clinical perspective. Prog Neuropsychopharmacol Biol Psychiatry 2018. [PMID: 28648568 DOI: 10.1016/j.pnpbp.2017.06.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mood disorders are a highly prevalent group of mental disorders causing substantial socioeconomic burden. There are various methodological approaches for identifying the underlying mechanisms of the etiology, symptomatology, and therapeutics of mood disorders; however, neuroimaging studies have provided the most direct evidence for mood disorder neural substrates by visualizing the brains of living individuals. The prefrontal cortex, hippocampus, amygdala, thalamus, ventral striatum, and corpus callosum are associated with depression and bipolar disorder. Identifying the distinct and common contributions of these anatomical regions to depression and bipolar disorder have broadened and deepened our understanding of mood disorders. However, the extent to which neuroimaging research findings contribute to clinical practice in the real-world setting is unclear. As traditional or non-machine learning MRI studies have analyzed group-level differences, it is not possible to directly translate findings from research to clinical practice; the knowledge gained pertains to the disorder, but not to individuals. On the other hand, a machine learning approach makes it possible to provide individual-level classifications. For the past two decades, many studies have reported on the classification accuracy of machine learning-based neuroimaging studies from the perspective of diagnosis and treatment response. However, for the application of a machine learning-based brain MRI approach in real world clinical settings, several major issues should be considered. Secondary changes due to illness duration and medication, clinical subtypes and heterogeneity, comorbidities, and cost-effectiveness restrict the generalization of the current machine learning findings. Sophisticated classification of clinical and diagnostic subtypes is needed. Additionally, as the approach is inevitably limited by sample size, multi-site participation and data-sharing are needed in the future.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea.
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16
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Gournellis R, Tournikioti K, Touloumi G, Thomadakis C, Michalopoulou PG, Christodoulou C, Papadopoulou A, Douzenis A. Psychotic (delusional) depression and suicidal attempts: a systematic review and meta-analysis. Acta Psychiatr Scand 2018; 137:18-29. [PMID: 29178463 DOI: 10.1111/acps.12826] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It still remains unclear whether psychotic features increase the risk of suicidal attempts in major depressive disorder. Thus, we attempted, through a systematic review coupled with a meta-analysis, to elucidate further whether unipolar psychotic depression (PMD) compared to non-PMD presents higher levels of suicidal attempts. METHOD A systematic search was conducted in PubMed, EMBASE, PsycINFO as well as in various databases of the so-called gray literature for all studies providing data on suicidal attempts in PMD compared to non-PMD, and the results were then subjected to meta-analysis. RESULTS Twenty studies met our inclusion criteria, including in total 1,275 PMD patients and 5,761 non-PMD patients. An elevated risk for suicide attempt for PMD compared to non-PMD patients was found: The total (lifetime) fixed-effects pooled OR was 2.11 (95% CI: 1.81-2.47), and the fixed-effects pooled OR of the five studies of the acute phase of the disorder was 1.93 (95% CI: 1.33-2.80). This elevated risk of suicidal attempt for PMD patients remained stable across all age groups of adult patients. CONCLUSION Despite data inconsistency and clinical heterogeneity, this systematic review and meta-analysis showed that patients with PMD are at a two-fold higher risk, both during lifetime and in acute phase, of committing a suicidal attempt than patients with non-PMD.
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Affiliation(s)
- R Gournellis
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - K Tournikioti
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - G Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - P G Michalopoulou
- Cognition, Schizophrenia, Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Christodoulou
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - A Papadopoulou
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - A Douzenis
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
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17
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Gournellis R, Tournikioti K, Touloumi G, Thomadakis C, Michalopoulou PG, Michopoulos I, Christodoulou C, Papadopoulou A, Douzenis A. Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis. Ann Gen Psychiatry 2018; 17:39. [PMID: 30258483 PMCID: PMC6150953 DOI: 10.1186/s12991-018-0207-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides. METHODS A systematic search was conducted in Scopus, PubMed, and "gray literature" for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields. RESULTS Nine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04-1.40). In a sub-analysis excluding a very large study (weight = 86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16-2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD's suicide risk. The lack of accurate diagnosis at the time of suicide, PMD's diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations. CONCLUSIONS The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients' suicidality constitutes a supreme priority.
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Affiliation(s)
- Rossetos Gournellis
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Kalliopi Tournikioti
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Giota Touloumi
- 2Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Thomadakis
- 2Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiota G Michalopoulou
- 3Cognition, Schizophrenia, Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Ioannis Michopoulos
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Christos Christodoulou
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Athanasia Papadopoulou
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Athanasios Douzenis
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
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18
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Kessing LV, Willer I, Andersen PK, Bukh JD. Rate and predictors of conversion from unipolar to bipolar disorder: A systematic review and meta-analysis. Bipolar Disord 2017; 19:324-335. [PMID: 28714575 DOI: 10.1111/bdi.12513] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/31/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES For the first time to present a systematic review and meta-analysis of the conversion rate and predictors of conversion from unipolar disorder to bipolar disorder. METHODS A systematic literature search up to October 2016 was performed. For the meta-analysis, we only included studies that used survival analysis to estimate the conversion rate. RESULTS A total of 31 studies were identified, among which 11 used survival analyses, including two register-based studies. The yearly rate of conversion to bipolar disorder decreased with time from 3.9% in the first year after study entry with a diagnosis of unipolar disorder to 3.1% in years 1-2, 1.0% in years 2-5 and 0.8% in years 5-10. A total of eight risk factors were evaluated comprising gender, age at onset of unipolar disorder, number of depressive episodes, treatment resistance to antidepressants, family history of bipolar disorder, the prevalence of psychotic depression, the prevalence of chronic depression, and severity of depression. It was not possible to identify risk factors that were consistently or mainly confirmed to predict conversion across studies. CONCLUSIONS The conversion rate from unipolar to bipolar disorder decreases with time. It was not possible to identify predictors of conversion that were consistently or mainly confirmed across studies, which may be due to variations in methodology across studies.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Department O and University of Copenhagen, Copenhagen, Denmark
| | - Inge Willer
- Psychiatric Center Copenhagen, Department O and University of Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jens Drachman Bukh
- Psychiatric Center Copenhagen, Department O and University of Copenhagen, Copenhagen, Denmark
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19
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Cui X, Niu W, Kong L, He M, Jiang K, Chen S, Zhong A, Li W, Lu J, Zhang L. Can lncRNAs be indicators for the diagnosis of early onset or acute schizophrenia and distinguish major depressive disorder and generalized anxiety disorder?-A cross validation analysis. Am J Med Genet B Neuropsychiatr Genet 2017; 174:335-341. [PMID: 28371072 DOI: 10.1002/ajmg.b.32521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/09/2016] [Indexed: 11/09/2022]
Abstract
Depression and anxiety are apparent symptoms in the early onset or acute phase of schizophrenia (SZ), which complicate timely diagnosis and treatment. It is imperative to seek an indicator to distinguish schizophrenia from depressive and anxiety disorders. Using lncRNA microarray profiling and RT-PCR, three up-regulated lncRNAs in SZ, six down-regulated lncRNAs in major depressive disorder (MDD), and three up-regulated lncRNAs in generalized anxiety disorder (GAD) had been identified as potential biomarkers. All the lncRNAs were, then, cross-validated in 40 SZ patients, 40 MDD patients, 40 GAD patients, and 40 normal controls. Compared with controls, three up-regulated SZ lncRNAs had a significantly down-regulated expression in GAD, and no remarkable differences existed between MDD and the controls. Additionally, the six down-regulated MDD lncRNAs were expressed in an opposite fashion in SZ, and the expression of the three up-regulated GAD lncRNAs were significantly different between SZ and GAD. These results indicate that the expression patterns of the three up-regulated SZ lncRNAs could not be completely replicated in MDD and GAD, and vice versa. Thus, these three SZ lncRNAs seem to be established as potential indicators for diagnosis of schizophrenia and distinguishing it from MDD and GAD. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Xuelian Cui
- Department of Health Care, Changzhou Maternal and Child Health Care Hospital Affiliated With Nanjing Medical University, Changzhou, People's Republic of China
| | - Wei Niu
- Department of Rehabilitation, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Lingming Kong
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Mingjun He
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Kunhong Jiang
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Shengdong Chen
- Department of Neurology, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Aifang Zhong
- Clinical Laboratory, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Wanshuai Li
- Gopath Diagnostic Laboratory Co. Ltd., No. 801, Changzhou, People's Republic of China
| | - Jim Lu
- Gopath Diagnostic Laboratory Co. Ltd., No. 801, Changzhou, People's Republic of China.,Gopath Laboratories LLC, 1351 Barclay Blvd, Buffalo Grove, Illinois
| | - Liyi Zhang
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of the Chinese People's Liberation Army, Changzhou, People's Republic of China
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20
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Ratheesh A, Davey C, Hetrick S, Alvarez-Jimenez M, Voutier C, Bechdolf A, McGorry PD, Scott J, Berk M, Cotton SM. A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder. Acta Psychiatr Scand 2017; 135:273-284. [PMID: 28097648 DOI: 10.1111/acps.12686] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Some people with major depressive disorder (MDD) may be at a pre-onset stage for bipolar disorder (BD), where early identification or prevention efforts may be feasible. We aimed to identify rates and characteristics predictive of transition to BD in prospective follow-up studies of people with MDD. METHODS Using a systematic search strategy, we identified studies with a diagnostic ascertainment of MDD and BD of an adequate standard, and where the minimum length of follow-up was 6 months. We examined the incidence and point prevalence of BD and the pooled odds ratios (OR) for baseline predictors. RESULTS From 5554 unique publications, 56 were included. Nearly a quarter of adults (22.5%) and adolescents with MDD followed up for a mean length of 12-18 years developed BD, with the greatest risk of transition being in the first 5 years. The meta-analysis identified that transition from MDD to BD was predicted by family history of BD (OR = 2.89, 95% CI: 2.01-4.14, N = 7), earlier age of onset of depression (g = -0.33, SE = 0.05, N = 6) and presence of psychotic symptoms (OR = 4.76, 95% CI: 1.79-12.66, N = 5). CONCLUSIONS Participants with the identified risk factors merit closer observation and may benefit from prevention efforts, especially if outcomes broader than BD are considered.
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Affiliation(s)
- A Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - C Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - S Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - M Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - C Voutier
- Royal Melbourne Hospital Library, Melbourne, Vic., Australia
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charite Universitätsmedizin, Berlin, Germany
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - J Scott
- University of Newcastle, Newcastle upon Tyne, UK
| | - M Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic.,Florey Institute of Neuroscience and Mental Health, Parkville, Vic.,Impact Strategic Research Centre, Deakin University, Geelong, Vic, Australia
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
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Purper-Ouakil D, Porfirio MC, Le Strat Y, Falissard B, Gorwood P, Masi G. What do childhood attention deficit/hyperactivity symptoms in depressed adults tell us about the bipolar spectrum? Psychiatry Res 2017; 249:244-251. [PMID: 28126580 DOI: 10.1016/j.psychres.2016.12.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/15/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to establish if adult patients with major depressive disorder (MDD) and childhood Attention Deficit/Hyperactivity disorder (ADHD) symptoms would be more frequently within the bipolar spectrum than depressed patients without childhood ADHD. METHODS This study was carried out in outpatients recruited by psychiatrists in private practice, with 3963 participants being included in the final sample. Clinicians filled out questionnaires about current depressive symptoms in their patients, lifetime bipolar symptoms, global assessment of functioning and parental history of both major depression and bipolar disorder. Patients assessed current level of anxiety and depressive symptoms and antecedents of childhood ADHD symptoms. RESULTS Depressed adults with significant childhood ADHD symptoms had a specific pattern of their major depressive episode compared to depressed patients without such symptoms. Subjects with childhood ADHD symptoms were more likely to report lifetime symptoms of mania/hypomania and to have a parent with type I or II bipolar disorder. The developmental trajectories of familial risk for lifetime bipolar symptoms showed that parental bipolar disorder influenced lifetime bipolar symptoms both through a direct pathway and an indirect pathway involving childhood ADHD symptoms. Childhood ADHD and number of depressive symptoms both made direct contributions to lifetime bipolar symptoms.
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Affiliation(s)
- D Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, Montpellier, France.
| | - M C Porfirio
- Unit of Child Neurology and Psychiatry of "Tor Vergata", University of Rome, Italy
| | - Y Le Strat
- AP-HP Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, France; INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France
| | - B Falissard
- INSERM U1178, Maison de Solenn, Paris, France
| | - P Gorwood
- INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France; CMME Saint Anne Hospital, Hôpital Sainte-Anne (Paris-Descartes University), France
| | - G Masi
- Stella Maris Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Watanabe SY, Numata S, Iga JI, Kinoshita M, Umehara H, Ishii K, Ohmori T. Gene expression-based biological test for major depressive disorder: an advanced study. Neuropsychiatr Dis Treat 2017; 13:535-541. [PMID: 28260899 PMCID: PMC5328599 DOI: 10.2147/ndt.s120038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Recently, we could distinguished patients with major depressive disorder (MDD) from nonpsychiatric controls with high accuracy using a panel of five gene expression markers (ARHGAP24, HDAC5, PDGFC, PRNP, and SLC6A4) in leukocyte. In the present study, we examined whether this biological test is able to discriminate patients with MDD from those without MDD, including those with schizophrenia and bipolar disorder. PATIENTS AND METHODS We measured messenger ribonucleic acid expression levels of the aforementioned five genes in peripheral leukocytes in 17 patients with schizophrenia and 36 patients with bipolar disorder using quantitative real-time polymerase chain reaction (PCR), and we combined these expression data with our previous expression data of 25 patients with MDD and 25 controls. Subsequently, a linear discriminant function was developed for use in discriminating between patients with MDD and without MDD. RESULTS This expression panel was able to segregate patients with MDD from those without MDD with a sensitivity and specificity of 64% and 67.9%, respectively. CONCLUSION Further research to identify MDD-specific markers is needed to improve the performance of this biological test.
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Affiliation(s)
- Shin-Ya Watanabe
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
| | - Shusuke Numata
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime
| | - Makoto Kinoshita
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
| | - Hidehiro Umehara
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
| | - Kazuo Ishii
- Department of Applied Biological Science, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
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Control-related frontal-striatal function is associated with past suicidal ideation and behavior in patients with recent-onset psychotic major mood disorders. J Affect Disord 2015; 188:202-9. [PMID: 26363618 DOI: 10.1016/j.jad.2015.08.049] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/16/2015] [Accepted: 08/21/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Suicide is highly-prevalent in major mood disorders, yet it remains unclear how suicidal ideation and suicidal behavior relate to brain functions, especially those that support control processes. We evaluated how prefrontal cortex (PFC) activity during goal-representation (an important component of cognitive control) relates to past suicidal ideation and behavior in patients with psychotic major mood disorders. METHOD 30 patients with recent-onset of either DSM-IV-TR-defined bipolar disorder type I (n=21) or major depressive disorder (n=9) with psychotic features, but neither in a major mood episode nor acutely psychotic at study, were evaluated for past suicidal ideation and behavior (Columbia Suicide Severity Rating Scale) and functional MRI during cognitive control task performance. Group-level regression models of brain activation accounted for current depression, psychosis and trait impulsivity. RESULTS Intensity of past suicidal ideation was associated with higher control-related activation in right-hemisphere regions including the ventrolateral PFC (VLPFC) and orbitofrontal cortex, rostral insula, and dorsal striatum. Among those with past suicidal ideation (n=16), past suicidal behavior (n=8) was associated with higher control-related activation in right-hemisphere regions including VLPFC, rostrolateral PFC, and frontal operculum/rostral insula; and relatively lower activity in midline parietal regions, including cuneus and precuneus. LIMITATIONS The sample size of subjects with past suicidal behavior was modest, and all subjects were taking psychotropic medication. CONCLUSIONS This study provides unique evidence that in early-course psychotic major mood disorders, suicidal ideation and behavior histories directly relate to PFC-based circuit function in support of cognitive control.
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Castro VM, Minnier J, Murphy SN, Kohane I, Churchill SE, Gainer V, Cai T, Hoffnagle AG, Dai Y, Block S, Weill SR, Nadal-Vicens M, Pollastri AR, Rosenquist JN, Goryachev S, Ongur D, Sklar P, Perlis RH, Smoller JW. Validation of electronic health record phenotyping of bipolar disorder cases and controls. Am J Psychiatry 2015; 172:363-72. [PMID: 25827034 PMCID: PMC4441333 DOI: 10.1176/appi.ajp.2014.14030423] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study was designed to validate use of electronic health records (EHRs) for diagnosing bipolar disorder and classifying control subjects. METHOD EHR data were obtained from a health care system of more than 4.6 million patients spanning more than 20 years. Experienced clinicians reviewed charts to identify text features and coded data consistent or inconsistent with a diagnosis of bipolar disorder. Natural language processing was used to train a diagnostic algorithm with 95% specificity for classifying bipolar disorder. Filtered coded data were used to derive three additional classification rules for case subjects and one for control subjects. The positive predictive value (PPV) of EHR-based bipolar disorder and subphenotype diagnoses was calculated against diagnoses from direct semistructured interviews of 190 patients by trained clinicians blind to EHR diagnosis. RESULTS The PPV of bipolar disorder defined by natural language processing was 0.85. Coded classification based on strict filtering achieved a value of 0.79, but classifications based on less stringent criteria performed less well. No EHR-classified control subject received a diagnosis of bipolar disorder on the basis of direct interview (PPV=1.0). For most subphenotypes, values exceeded 0.80. The EHR-based classifications were used to accrue 4,500 bipolar disorder cases and 5,000 controls for genetic analyses. CONCLUSIONS Semiautomated mining of EHRs can be used to ascertain bipolar disorder patients and control subjects with high specificity and predictive value compared with diagnostic interviews. EHRs provide a powerful resource for high-throughput phenotyping for genetic and clinical research.
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Affiliation(s)
- Victor M. Castro
- Partners Research Information Systems and Computing, Oregon Health & Science University, Portland, OR
| | - Jessica Minnier
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR
| | - Shawn N. Murphy
- Partners Research Information Systems and Computing, Oregon Health & Science University, Portland, OR
- Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Isaac Kohane
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA
| | | | - Vivian Gainer
- Partners Research Information Systems and Computing, Oregon Health & Science University, Portland, OR
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Alison G. Hoffnagle
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
| | - Yael Dai
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
| | - Stefanie Block
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
| | - Sydney R. Weill
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
| | - Mireya Nadal-Vicens
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alisha R. Pollastri
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - J. Niels Rosenquist
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Sergey Goryachev
- Partners Research Information Systems and Computing, Oregon Health & Science University, Portland, OR
| | | | - Pamela Sklar
- Division of Psychiatric Genomics, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roy H. Perlis
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Duffy A. Toward a comprehensive clinical staging model for bipolar disorder: integrating the evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:659-66. [PMID: 25702367 PMCID: PMC4304586 DOI: 10.1177/070674371405901208] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe key findings relating to the natural history and heterogeneity of bipolar disorder (BD) relevant to the development of a unitary clinical staging model. Currently proposed staging models are briefly discussed, highlighting complementary findings, and a comprehensive staging model of BD is proposed integrating the relevant evidence. METHOD A selective review of key published findings addressing the natural history, heterogeneity, and clinical staging models of BD are discussed. RESULTS The concept of BD has broadened, resulting in an increased spectrum of disorders subsumed under this diagnostic category. Different staging models for BD have been proposed based on the early psychosis literature, studies of patients with established BD, and prospective studies of the offspring of parents with BD. The overarching finding is that there are identifiable sequential clinical phases in the development of BD that differ in important ways between classical episodic and psychotic spectrum subtypes. In addition, in the context of familial risk, early risk syndromes add important predictive value and inform the staging model for BD. CONCLUSIONS A comprehensive clinical staging model of BD can be derived from the available evidence and should consider the natural history of BD and the heterogeneity of subtypes. This model will advance both early intervention efforts and neurobiological research.
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Affiliation(s)
- Anne Duffy
- Campus Alberta Innovates Program Professor in Youth Mental Health, Medical Director Mood Disorders Program, Department of Psychiatry, University of Calgary, Calgary, Alberta
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Gournellis R, Oulis P, Howard R. Psychotic major depression in older people: a systematic review. Int J Geriatr Psychiatry 2014; 29:789-96. [PMID: 25191689 DOI: 10.1002/gps.4065] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to systematically review available evidence relevant to the following issues: (1) whether psychotic major depression (PMD) in older people differs in overall severity from non-PMD, besides the presence of psychotic symptoms; (2) whether it constitutes a distinct clinical entity from non-PMD; and (3) whether it differs from PMD in younger adults. DESIGN A computerized MEDLINE, PsycINFO and the entire Cochrane Library search has been performed in June 2013 for prospective controlled studies investigating PMD features in older people. RESULTS Thirty-five relevant studies were identified. PMD in older people compared with non-PMD has been shown to present with overall more severe depressive symptomatology, more psychomotor disturbance, more guilt feelings, more depressive episodes with psychosis, worse prognosis, more severe executive dysfunction associated with frontal lobe atrophy, and lower serum dopamine β-hydroxylase activity. No differences in the efficacy of an antidepressant plus antipsychotic combination versus antidepressant monotherapy in the acute treatment as well as in the maintenance treatment were found. PMD in older patients is characterized by more somatic complaints and delusions of hypochondriacaland impending disaster content and by a lower comorbidity with anxiety disorders compared with PMD in younger adults. CONCLUSIONS Psychotic major depression in older people is associated with higher severity in most clinically important key features than in non-PMD. However, available evidence is still insufficient for the conclusive elucidation of its nosological status. Finally, the differences between PMD in older and younger patients can be attributed to biological and psychosocial changes of old age.
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Affiliation(s)
- Rossetos Gournellis
- Second Department of Psychiatry, Psychogeriatric Unit; University of Athens, Medical School, University General Hospital “Attikon”; Athens Greece
- Institute of Psychiatry; King's College; London SE5 8AF UK
| | - Panagiotis Oulis
- First Department of Psychiatry; University of Athens, Medical School, “Eginition” Hospital; Athens Greece
| | - Robert Howard
- Institute of Psychiatry; King's College; London SE5 8AF UK
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Kingston T, Scully PJ, Browne DJ, Baldwin PA, Kinsella A, Russell V, O'Callaghan E, Waddington JL. Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Psychol Med 2013; 43:2523-2533. [PMID: 23480983 DOI: 10.1017/s003329171300041x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions. METHOD The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency. RESULTS Over 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria. CONCLUSIONS CAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.
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Affiliation(s)
- T Kingston
- Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
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Smoller JW. Disorders and borders: psychiatric genetics and nosology. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:559-78. [PMID: 24132891 DOI: 10.1002/ajmg.b.32174] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/07/2013] [Indexed: 01/10/2023]
Abstract
Over the past century, the definition and classification of psychiatric disorders has evolved through a combination of historical trends, clinical observations, and empirical research. The current nosology, instantiated in the DSM-5 and ICD-10, rests on descriptive criteria agreed upon by a consensus of experts. While the development of explicit criteria has enhanced the reliability of diagnosis, the validity of the current diagnostic categories has been the subject of debate and controversy. Genetic studies have long been regarded as a key resource for validating the boundaries among diagnostic categories. Genetic epidemiologic studies have documented the familiality and heritability of clinically defined psychiatric disorders and molecular genetic studies have begun to identify specific susceptibility variants. At the same time, there is growing evidence from family, twin and genomic studies that genetic influences on psychiatric disorders transcend clinical boundaries. Here I review this evidence for cross-disorder genetic effects and discuss the implications of these findings for psychiatric nosology. Psychiatric genetic research can inform a bottom-up reappraisal of psychopathology that may help the field move beyond a purely descriptive classification and toward an etiology-based nosology.
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Affiliation(s)
- Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Sikich L. Diagnosis and evaluation of hallucinations and other psychotic symptoms in children and adolescents. Child Adolesc Psychiatr Clin N Am 2013; 22:655-73. [PMID: 24012079 DOI: 10.1016/j.chc.2013.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recognizing positive psychotic symptoms and their diagnostic context in youth is challenging. A large minority say they "hear things others do not hear," though they seldom present with complaints of hallucinations or delusions. Few have schizophrenia spectrum disorder, but many have other psychiatric disorders. Frequently, they have psychotic symptoms for an extended period before diagnosis. Clinicians should understand psychotic symptoms and their differential diagnoses. This article reviews the epidemiology, associated diagnoses, and prognosis of hallucinations and delusions in youth. Strategies for optimizing the clinical diagnostic interview, appropriate laboratory tests, indications for psychological testing, and rating scales are reviewed.
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Affiliation(s)
- Linmarie Sikich
- ASPIRE Program, University of North Carolina at Chapel Hill, CB 7167 UNC-CH, 2218 Nelson Highway, Suite 1, Chapel Hill, NC 27599-7167, USA.
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Abstract
The significance of psychosis has yet to be fully understood and research is complicated because psychosis is often a state rather than trait occurrence. In youth, psychoticlike phenomena are common. Rates of lifetime psychotic symptoms are higher than rates of psychosis during a current episode of mania or depression, at least in youth. Rates vary widely between studies. Hallucinations are also more common than delusions in youth. Psychotic phenomena can be mood congruent or incongruent. A good mental status examination requires close questioning. There are several interviews that structure how questions are asked, and rating scales that help anchor severity.
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Affiliation(s)
- Gabrielle A Carlson
- Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Putnam Hall, South Campus, Stony Brook, NY 11794-8790, USA.
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31
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Busatto GF. Structural and functional neuroimaging studies in major depressive disorder with psychotic features: a critical review. Schizophr Bull 2013; 39:776-86. [PMID: 23615813 PMCID: PMC3686460 DOI: 10.1093/schbul/sbt054] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The relationship between major depressive disorder with psychotic (MDDP) features and schizophrenia has long been recognized, and the neurobiological boundaries between these disorders can nowadays be investigated using neuroimaging techniques. This article provides a critical review of such studies, addressing how they support a dimensional approach to the nosology and pathophysiology of psychotic disorders. A proportion of neuroimaging studies carried out to date indicate that MDDP subjects display structural and functional abnormalities in some brain regions specifically implicated in the pathophysiology of mood disorders, such as the subgenual cingulate cortex. This reinforces the validity of the classification of MDDP in proximity to major depression without psychosis. There is some neuroimaging evidence that MDDP may be associated with additional brain abnormalities relative to nonpsychotic major depression although less prominently in comparison with findings from the neuroimaging literature on schizophrenia. Brain regions seen as critical both to emotional processing and to models of psychotic symptoms, such as the hippocampus, insula, and lateral prefrontal cortex, have been implicated in separate neuroimaging investigations of either schizophrenia or major depression, as well as in some studies that directly compared depressed patients with and without psychotic features. These brain regions are key targets for future studies designed to validate imaging phenotypes more firmly associated with MDDP, as well as to investigate the relationship between these phenotypes and possible etiological influences for MDDP.
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Affiliation(s)
- Geraldo F. Busatto
- Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; ,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), Universidade de São Paulo, São Paulo, Brazil,*To whom correspondence should be addressed; Rua Ovidio Pires Campos s/n, CEP 05403-010, São Paulo–SP, Brasil; tel: -55-11-26618132, fax: -55-11-30821015, e-mail:
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Ostergaard SD, Rothschild AJ, Uggerby P, Munk-Jørgensen P, Bech P, Mors O. Considerations on the ICD-11 classification of psychotic depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:135-44. [PMID: 22398817 DOI: 10.1159/000334487] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 10/09/2011] [Indexed: 11/19/2022]
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