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Langfus JA, Chen YL, Janos JA, Youngstrom JK, Findling RL, Youngstrom EA. Psychometric Properties and Clinical Utility of CBCL and P-GBI Sleep Items in Children and Adolescents. J Clin Child Adolesc Psychol 2023:1-18. [PMID: 37972333 PMCID: PMC11096265 DOI: 10.1080/15374416.2023.2272965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Sleep is crucial to overall health, playing a complex role in a wide range of mental health concerns in children and adults. Nevertheless, clinicians may not routinely assess sleep problems due to lack of awareness or limitations such as cost or time. Scoring sleep-related items embedded on broader scales may help clinicians get more out of tools they are already using. The current study explores evidence of reliability, validity, and clinical utility of sleep-related items embedded on two caregiver-report tools: the Child Behavior Checklist (CBCL) and Parent General Behavior Inventory (P-GBI). METHOD Youth aged 5-18 years and their parents were recruited from both an academic medical center (N = 759) and an urban community health center (N = 618). Caregivers completed the CBCL and P-GBI as part of a more comprehensive outpatient evaluation. Exploratory factor analyses, multi-group confirmatory factor analyses, and graded response models evaluated dimensionality, reliability, and invariance across samples. Correlations and receiver operating characteristic curve analyses probed associations with diagnostic and demographic variables. RESULTS Two subscales emerged for each itemset. Across both samples, P-GBI sleep subscales were more reliable and consistent than CBCL sleep subscales, showed greater coverage of sleepiness and insomnia constructs, were better at discriminating individuals within a wider range of sleep complaints, and showed significant correlation with mood disorder diagnoses. CONCLUSIONS The P-GBI sleep items provide a brief, reliable measure for assessing distinct dimensions of sleep complaints and detecting mood symptoms or diagnoses related to the youth's sleep functioning, making them a useful addition to clinical practice.
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Affiliation(s)
- Joshua A. Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yen-Ling Chen
- Department of Psychology, University of Nevada, Las Vegas, NV
| | - Jessica A. Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer K. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert L. Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Helping Give Away Psychological Science, 501c3
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Kamali M, Pegg S, Janos JA, Bobo WV, Brody B, Gao K, Ketter TA, McElroy SL, McInnis MG, Rabideau DJ, Reilly-Harrington NA, Shelton RC, Sylvia LG, Tohen M, Nierenberg A. Illness stage and predominant polarity in bipolar disorder: Correlation with burden of illness and moderation of treatment outcome. J Psychiatr Res 2021; 140:205-213. [PMID: 34118638 PMCID: PMC8319086 DOI: 10.1016/j.jpsychires.2021.05.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
Bipolar disorder often follows a set progression best described in stages where advanced stages are associated with poorer outcomes. Bipolar disorder is also often characterized by a predominance of episode polarity, where some individuals experience more depressive episodes (termed predominant depressive polarity) while others experience more hypo/manic episodes (termed predominant hypo/manic polarity). We examined the associations between staging and predominant polarity with measures of illness burden and treatment outcome utilizing data from a six-month comparative effectiveness trial of lithium and quetiapine in bipolar disorder (Bipolar CHOICE). We used number of self-reported lifetime mood (depressive and hypo/manic) episodes as a proxy for staging and ratio of depressive to manic episodes to define predominant polarity. Polarity and staging were correlated with several measures of burden of illness. Childhood abuse was correlated with more lifetime mood episodes, while more depressive episodes and depressive polarity were correlated with more anxiety disorder comorbidity. Depressive polarity was also correlated with more past trials of psychotropics, particularly antidepressants. However, neither staging nor predominant polarity moderated the randomized treatment effect of lithium vs. quetiapine. Number of depressive episodes in the past year was identified as a potential predictor of overall worse treatment outcome, regardless of medication condition. In conclusion, though staging and predominant episode polarity correlated with several measures of illness burden, they were not associated with differential treatment outcomes. This could be because many of our patients presented for treatment at advanced stages of illness and further highlights the need for early intervention in bipolar disorder.
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Affiliation(s)
- Masoud Kamali
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States.
| | - Samantha Pegg
- Department of Psychology and Human Development, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, United States.
| | - Jessica A. Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 East Cameron Avenue, Chapel Hill, NC 27599, United States
| | - William V. Bobo
- Department of Psychiatry & Psychology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States
| | - Benjamin Brody
- Department of Psychiatry, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10065, United States.
| | - Keming Gao
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, United States.
| | - Terence A. Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States
| | - Susan L. McElroy
- Lindner Center of HOPE, University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street, Cincinnati, OH 45219, United States
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Dustin J. Rabideau
- Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA 02114, United States,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Noreen A. Reilly-Harrington
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Richard C. Shelton
- Department of Psychiatry, University of Alabama at Birmingham School of Medicine, 1720 2nd Avenue S, Birmingham, AL 35294, United States
| | - Louisa G. Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, 2400 Tucker Avenue NE, Albuquerque, NM, 87106, United States.
| | - Andrew Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States.
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Sylvia LG, Janos JA, Pegg SL, Montana RE, Gold AK, Bianchi M, Nierenberg AA. Pilot Study of a Brief Sleep Intervention for Suicidal Ideation in Bipolar Disorder. J Psychiatr Pract 2021; 27:109-114. [PMID: 33656816 PMCID: PMC7935402 DOI: 10.1097/pra.0000000000000528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated the feasibility and acceptability of a brief sleep intervention and sleep monitoring device in bipolar disorder (BD), as well as the intervention's effectiveness in reducing suicidal ideation through improved sleep quality and duration. METHODS Participants (N=13) with BD received 4 sessions of cognitive-behavioral therapy for sleep disturbance and completed assessments of the intervention and sleep device acceptability, mood, suicidal ideation, and sleep at pretreatment and posttreatment. RESULTS Feasibility and acceptability of the intervention were high at both pretreatment and posttreatment and did not significantly change by the intervention's conclusion, although participants reported being significantly more likely to recommend the intervention to others at posttreatment. The sleep device was easy to understand, wear, and did not interfere with participants' sleep. Suicidal ideation and depressive symptoms significantly decreased from pretreatment to posttreatment (P<0.05). There were small, but not significant, improvements in the percentage of time spent in stable sleep and total average nightly sleep. CONCLUSION The potential of this intervention for reducing suicidal ideation and improving sleep is promising, but future research is warranted.
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Sylvia LG, Pegg SL, Dufour SC, Janos JA, Bernstein EE, Chang WC, Hall NE, Ellard KK, Nierenberg AA, Deckersbach T. Pilot study of a lifestyle intervention for bipolar disorder: Nutrition exercise wellness treatment (NEW Tx). J Affect Disord 2019; 250:278-283. [PMID: 30875669 PMCID: PMC7676479 DOI: 10.1016/j.jad.2019.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) are more likely than the general population to develop risk factors associated with cardiovascular disease, one of the leading causes of morbidity and mortality in this clinical population. To address this disproportionate medical burden, we developed Nutrition Exercise and Wellness Treatment (NEW Tx), a lifestyle intervention for individuals with BD. METHODS In this study, participants were randomized to NEW Tx (n = 19) or a treatment as usual waitlist (n = 19). We examine the intervention's efficacy to improve the physical and psychological outcomes of individuals with BD. Assessors were blind to participant condition throughout study duration. RESULTS The NEW Tx group reported increased weekly exercise duration and overall functioning, and decreased depression and illness severity over the study duration. However, only improvements in functioning were significantly greater in the NEW Tx group than in the control group. There were no group differences in weight loss or mood symptoms over the study duration. LIMITATIONS Limitations to this study include lack of objective measurement of exercise and a small and relatively homogeneous sample. CONCLUSIONS These data suggest that a manualized lifestyle intervention for BD may not be ideal to improve lifestyle changes in this clinical population. Further research is needed to pilot personalized approaches to creating a healthy lifestyle in BD.
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Affiliation(s)
- Louisa G Sylvia
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Samantha L Pegg
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Steven C Dufour
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Jessica A Janos
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Emily E Bernstein
- Harvard University, Department of Psychology, 33 Kirkland Street, Cambridge, MA 02138, United States
| | - Weilynn C Chang
- McLean Hospital, Gunderson Residence, 115 Mill Street, Belmont, MA 02478, United States
| | - Nathan E Hall
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard University, Department of Biostatistics, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Kristen K Ellard
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Thilo Deckersbach
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
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Nierenberg AA, Ghaznavi SA, Sande Mathias I, Ellard KK, Janos JA, Sylvia LG. Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1 Alpha as a Novel Target for Bipolar Disorder and Other Neuropsychiatric Disorders. Biol Psychiatry 2018; 83:761-769. [PMID: 29502862 DOI: 10.1016/j.biopsych.2017.12.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022]
Abstract
Peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1 alpha) is a protein that regulates metabolism and inflammation by activating nuclear receptors, especially the family of peroxisome proliferator-activated receptors (PPARs). PGC-1 alpha and PPARs also regulate mitochondrial biogenesis, cellular energy production, thermogenesis, and lipid metabolism. Brain energy metabolism may also be regulated in part by the interaction between PGC-1 alpha and PPARs. Because neurodegenerative diseases (Huntington's disease, Parkinson's disease, and amyotrophic lateral sclerosis) and bipolar disorder have been associated with dysregulated mitochondrial and brain energy metabolism, PGC-1 alpha may represent a potential drug target for these conditions. The purpose of this article is to review the physiology of PGC-1 alpha, PPARs, and the role of PPAR agonists to target PGC-1 alpha to treat neurodegenerative diseases and bipolar disorder. We also review clinical trials of repurposed antidiabetic thiazolidines and anti-triglyceride fibrates (PPAR agonists) for neurodegenerative diseases and bipolar disorder. PGC-1 alpha and PPARs are innovative potential targets for bipolar disorder and warrant future clinical trials.
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Affiliation(s)
- Andrew A Nierenberg
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Sharmin A Ghaznavi
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Isadora Sande Mathias
- Acadêmica da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Kristen K Ellard
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Louisa G Sylvia
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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