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Hsieh YC, Chou LS, Lin CH, Wu HC, Li DJ, Tseng PT. Serum folate levels in bipolar disorder: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:305. [PMID: 31640634 PMCID: PMC6805488 DOI: 10.1186/s12888-019-2269-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/03/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a major psychiatric illness, however its physiopathology is unclear. The role of folate in the physiopathology of BD is controversial. We conducted this systematic review and meta-analysis to investigate the effect of folate in BD patients. METHODS We performed a thorough literature study of the PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov databases until December 21st, 2018. Random effects meta-analysis was conducted. RESULTS Six articles involving 481 patients with BD and 760 controls were included. The meta-analysis results suggested that serum folate levels in the patients with BD were significantly lower than those in the controls (Hedges' g = - 0.211, 95% confidence interval = - 0.391 to - 0.031, p = 0.021). CONCLUSION The current meta-analysis show it might be association between lower serum folate levels and patient with BD. However, we could not distinguish the potentially confounding effects of mood states on the folate levels. Further prospective studies including subjects with different mood states and possible physiopathology are warranted to investigate the association between folate deficiency and the etiology of BD.
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Affiliation(s)
- Yung-Chi Hsieh
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Rd., Lingya Dist, Kaohsiung City, 802 Taiwan
| | - Li-Shiu Chou
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Rd., Lingya Dist, Kaohsiung City, 802 Taiwan
| | - Ching-Hua Lin
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Rd., Lingya Dist, Kaohsiung City, 802 Taiwan
| | - Hung-Chi Wu
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Rd., Lingya Dist, Kaohsiung City, 802 Taiwan
| | - Dian-Jeng Li
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Rd., Lingya Dist, Kaohsiung City, 802, Taiwan.
| | - Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan. .,Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan.
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Wang HR, Jung YE, Chung SK, Hong J, Ri Kang N, Kim MD, Bahk WM. Prevalence and correlates of bipolar spectrum disorder comorbid with ADHD features in nonclinical young adults. J Affect Disord 2017; 207:175-180. [PMID: 27723541 DOI: 10.1016/j.jad.2016.09.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/20/2016] [Accepted: 09/27/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND We investigate the rate of bipolar spectrum disorder comorbid with ADHD features using two screening instruments, the Mood Disorder Questionnaire (MDQ) and the Wender Utah Rating Scale (WURS), in a nonclinical young adult population. METHODS College and graduate students aged 18 years or older from four universities in Korea were selected. Comorbidity was defined as both MDQ positivity and WURS positivity. To look for a trend in clinical characteristics according to the severity of the comorbid condition, we used the Jonckheere-Terpstra test and the linear-by-linear association test. We performed ordinal logistic regression analysis to identify predictors associated with the studied comorbid condition. RESULTS A total of 1948 subjects were included in the study, and 15 (0.8%) of them were found to have the comorbid condition defined as both MDQ positivity and WURS positivity. As the severity of the comorbid condition increased, we saw trends of lower socioeconomic status, higher history of suicidality, higher history of self-mutilating behavior, higher history of parental abuse or abuse by other people, more severe depression, and more severe problematic alcohol use. The ordinal regression analysis showed that history of parental abuse, depression, and problematic alcohol use predicted the comorbid condition. LIMITATIONS We did not use standardized diagnostic tools for case findings. CONCLUSION The condition of comorbid bipolar spectrum disorder with ADHD features had a notable prevalence of 0.8% in a nonclinical young adult sample. This comorbid condition was found to be related with serious clinical phenomenology.
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Affiliation(s)
- Hee Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, 10, 63(yuksam)-ro, Yeongdeungpo-gu, Seoul, Korea
| | - Young-Eun Jung
- Department of Psychiatry, School of Medicine, Jeju National University, #15 Aran 13gil, Jeju 63241, Korea
| | - Sang-Keun Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Jeongwan Hong
- Department of Psychiatry, Iksan Hospital, Iksan, Korea
| | - Na Ri Kang
- Department of Psychiatry, School of Medicine, Jeju National University, #15 Aran 13gil, Jeju 63241, Korea
| | - Moon-Doo Kim
- Department of Psychiatry, School of Medicine, Jeju National University, #15 Aran 13gil, Jeju 63241, Korea.
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, 10, 63(yuksam)-ro, Yeongdeungpo-gu, Seoul, Korea.
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Rajizadeh A, Mozaffari-Khosravi H, Yassini-Ardakani M, Dehghani A. Effect of magnesium supplementation on depression status in depressed patients with magnesium deficiency: A randomized, double-blind, placebo-controlled trial. Nutrition 2016; 35:56-60. [PMID: 28241991 DOI: 10.1016/j.nut.2016.10.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/01/2016] [Accepted: 10/09/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effect of magnesium supplementation on the depression status of depressed patients suffering from magnesium deficiency. METHODS Sixty depressed people suffering from hypomagnesemia participated in this trial. The individuals were randomly categorized into two groups of 30 members; one receiving two 250-mg tablets of magnesium oxide (MG) daily and the other receiving placebo (PG) for 8 wk. The Beck Depression Inventory-II was conducted and the concentration of serum magnesium was measured. RESULTS At the end of intervention, 88.5% of the MG and 48.1% of the PG (P = 0.002) had a normal level of magnesium. The mean changes of serum magnesium were significantly different across the two groups. After the intervention, the mean Beck score significantly declined. However, in the MG, this reduction was more significant than in the PG (P = 0.02), so that the mean changes in this group experienced 15.65 ± 8.9 reduction, but in the PG, it declined by 10.40 ± 7.9. CONCLUSIONS Daily consumption of 500 mg magnesium oxide tablets for ≥8 wk by depressed patients suffering from magnesium deficiency leads to improvements in depression status and magnesium levels. Therefore, assessment of the magnesium serum and resolving this deficiency positively influence the treatment of depressed patients.
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Affiliation(s)
- Afsaneh Rajizadeh
- Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hassan Mozaffari-Khosravi
- Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mojtaba Yassini-Ardakani
- Department of General Psychiatry, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Dehghani
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Gumus F, Buzlu S, Cakir S. Effectiveness of individual psychoeducation on recurrence in bipolar disorder; a controlled study. Arch Psychiatr Nurs 2015; 29:174-9. [PMID: 26001717 DOI: 10.1016/j.apnu.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/09/2015] [Accepted: 01/16/2015] [Indexed: 12/19/2022]
Abstract
This research was conducted as an controlled experimental study which aimed to determine the effectiveness of individual psychoeducation program on recurrence rate during 1year follow up period. The study included eighty-two patients who had been diagnosed with bipolar disorder. There were no hospitalizations in intervention group, while 7.3% of control patients experienced hospitalizations; recurrence rates were 18.9% in the intervention group patients and 34.1% in the control group patients, but statistical significant difference between the groups was not found. Four sessions of individual psychoeducation may have some positive effects but seem to be ineffective for preventing recurrences in patients with bipolar disorder during one year prospective follow up.
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Affiliation(s)
- Funda Gumus
- Diyarbakır Atatürk School of Health Services, Dicle University, Diyarbakır, Turkey.
| | - Sevim Buzlu
- Florence Nightingale Nursing Faculty, Department of Mental Health and Psychiatric Nursing, Istanbul University, Istanbul, Turkey.
| | - Sibel Cakir
- Istanbul Medical School, Department of Psychiatry, Mood Disorders Unit, Istanbul University, Istanbul, Turkey.
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Bae SO, Kim MD, Lee JG, Seo JS, Won SH, Woo YS, Seok JH, Kim W, Kim SJ, Min KJ, Jon DI, Shin YC, Bahk WM, Yoon BH. Is it useful to use the Korean version of the mood disorder questionnaire for assessing bipolar spectrum disorder among Korean college students? Asia Pac Psychiatry 2014; 6:170-8. [PMID: 23857742 DOI: 10.1111/appy.12026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 11/18/2012] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The purpose of this study was to assess the usefulness of the Korean version of the Mood Disorder Questionnaire (K-MDQ) as a screening tool for the identification of bipolar spectrum disorder (BSD) among Korean college students. METHODS The sample of 1,020 college students was stratified to reflect geographical differences among the students. The K-MDQ and an epidemiological survey were administered between November 2006 and February 2007. To validate the K-MDQ as a screening tool for BSD, the Korean version of the Bipolar Spectrum Diagnostic Scale (K-BSDS) and the Structured Clinical Interview for DSM-IV (SCID) were also administered. RESULTS The rates satisfying MDQ criterion 1, and all three MDQ criteria, were 55.5% and 2.3%, respectively. According to the K-BSDS, 59.9% of the sample met the criteria for BSD using a threshold of 10, while no statistical differences were observed among subgroups. When we examined the diagnostic agreement between K-MDQ and K-BSDS, 79.5% of students who met MDQ criterion 1 were also positive on the BSDS. Sixteen (21.6%) of the 74 students who participated in the SCID interview were diagnosed with BSD. DISCUSSION Although the K-MDQ is a useful tool to assess BSD among inpatients and outpatients, it does not appear useful as a screening tool to detect BSD among college students.
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Affiliation(s)
- Seung Oh Bae
- Department of Psychiatry, Gwangju Mirae Hospital, Gwangju, Korea
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Battle CL, Weinstock LM, Howard M. Clinical correlates of perinatal bipolar disorder in an interdisciplinary obstetrical hospital setting. J Affect Disord 2014; 158:97-100. [PMID: 24655772 PMCID: PMC4070876 DOI: 10.1016/j.jad.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pregnancy and the postpartum period can be destabilizing for women with bipolar disorder (BD), and treatment decisions particularly complex. Yet, to date, relatively little research has focused on perinatal BD. METHOD Following IRB approval, trained raters reviewed clinical records of 334 women who had sought treatment at a specialized partial hospitalization program serving perinatal women, including demographic, clinical, and treatment history information as noted in each patient׳s chart by treating providers. RESULTS Slightly over 10% of the perinatal sample was diagnosed with Bipolar I, Bipolar II, or Bipolar NOS Disorder. In addition, 26% of the sample, regardless of diagnostic status, reported recent, abnormally elevated mood persisting 4 or more days. Compared to women with other Axis I disorders, women with a BD diagnosis were more likely to report a substance abuse history, prior suicide attempts, and more extensive psychiatric histories, including greater use of pharmacotherapy. Pregnant women with BD were more likely to take psychotropic medications prenatally, and postpartum women with BD reported higher rates of birth complications and difficulty breastfeeding. LIMITATIONS This research is limited by use of retrospective data, and utilization of self-report and clinician diagnosis, rather than structured interviews. CONCLUSION Even in the context of a partial hospital sample with high levels of symptoms and impairment, the clinical features of perinatal women with BD stand out as markedly more severe in comparison to those of women seeking care for other perinatal psychiatric conditions. Risk for suicide, substance abuse, and difficulties in the mother-child relationship are concerns.
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Affiliation(s)
- Cynthia L. Battle
- Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior,Butler Hospital Psychosocial Research Program,Women & Infants’ Hospital of Rhode Island Department of Medicine
| | - Lauren M. Weinstock
- Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior,Butler Hospital Psychosocial Research Program
| | - Margaret Howard
- Women & Infants’ Hospital of Rhode Island Department of Medicine
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Lachaine J, Beauchemin C, Mathurin K, Gilbert D, Beillat M. Cost-effectiveness of asenapine in the treatment of bipolar disorder in Canada. BMC Psychiatry 2014; 14:16. [PMID: 24450548 PMCID: PMC3905654 DOI: 10.1186/1471-244x-14-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bipolar disorder (BPD) is prevalent and is associated with a significant economic burden. Asenapine, the first tetracyclic antipsychotic approved in Canada for the treatment of BPD, has shown a comparable efficacy profile to other atypical antipsychotics. In addition, it is associated with a favourable metabolic profile and minimal weight gain potential. This study aimed to assess the economic impact of asenapine compared to olanzapine in the treatment of BPD in Canada. METHODS A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with olanzapine. The decision tree takes into account the occurrence of extrapyramidal symptoms (EPS), the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases (CHDs), and stroke. Analyses were conducted from both a Canadian Ministry of Health (MoH) and a societal perspective over a five-year time horizon with yearly cycles. RESULTS In the treatment of BPD, asenapine is a dominant strategy over olanzapine from both a MoH and a societal perspective. In fact, asenapine is associated with lower costs and more quality-adjusted life years (QALYs). Results of the probabilistic sensitivity analysis indicated that asenapine remains a dominant strategy in 99.2% of the simulations, in both a MoH and a societal perspective, and this result is robust to the many deterministic sensitivity analyses performed. CONCLUSIONS This economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine in the treatment of BPD in Canada.
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Affiliation(s)
- Jean Lachaine
- Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada.
| | - Catherine Beauchemin
- Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada
| | - Karine Mathurin
- Faculty of Pharmacy, University of Montreal, Station Centre-ville, PO Box 6128, H3C 3 J7 Montreal, Quebec, Canada
| | - Dominique Gilbert
- Market Access and Health Outcomes, Lundbeck Canada Inc., Montreal, Quebec, Canada
| | - Maud Beillat
- Health Economics and HTA, Lundbeck S.A.S., Issy-Les-Moulineaux, France
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Problematic boundaries in the diagnosis of bipolar disorder: the interface with borderline personality disorder. Curr Psychiatry Rep 2013; 15:422. [PMID: 24254199 DOI: 10.1007/s11920-013-0422-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. The most studied question on the relationship between BPD and bipolar disorder is their diagnostic concordance. Across studies approximately 10 % of patients with BPD had bipolar I disorder and another 10 % had bipolar II disorder. Likewise, approximately 20 % of bipolar II patients were diagnosed with BPD, though only 10 % of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is, nonetheless, diagnosed in the absence of the other in the vast majority of cases (80-90 %). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are more commonly diagnosed in patients with BPD than is bipolar disorder. Studies comparing patients with BPD and bipolar disorder find significant differences on a range of variables. These findings challenge the notion that BPD is part of the bipolar spectrum. While a substantial literature has documented problems with the under-recognition and under-diagnosis of bipolar disorder, more recent studies have found evidence of bipolar disorder over-diagnosis and that BPD is a significant contributor to over-diagnosis. Re-conceptualizing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, diagnostic criteria for bipolar disorder as a type of test, rather than the final word on diagnosis, shifts the diagnostician from thinking solely whether a patient does or does not have a disorder to considering the risks of false-positive and false-negative diagnoses, and the ease by which each type of diagnostic error can be corrected by longitudinal observation.
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Sylvia LG, Friedman ES, Kocsis JH, Bernstein EE, Brody BD, Kinrys G, Kemp DE, Shelton RC, McElroy SL, Bobo WV, Kamali M, McInnis MG, Tohen M, Bowden CL, Ketter TA, Deckersbach T, Calabrese JR, Thase ME, Reilly-Harrington NA, Singh V, Rabideau DJ, Nierenberg AA. Association of exercise with quality of life and mood symptoms in a comparative effectiveness study of bipolar disorder. J Affect Disord 2013; 151:722-727. [PMID: 23993440 DOI: 10.1016/j.jad.2013.07.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Individuals with bipolar disorder lead a sedentary lifestyle associated with worse course of illness and recurrence of symptoms. Identifying potentially modifiable predictors of exercise frequency could lead to interventions with powerful consequences on the course of illness and overall health. METHODS The present study examines baseline reports of exercise frequency of bipolar patients in a multi-site comparative effectiveness study of a second generation antipsychotic (quetiapine) versus a classic mood stabilizer (lithium). Demographics, quality of life, functioning, and mood symptoms were assessed. RESULTS Approximately 40% of participants reported not exercising regularly (at least once per week). Less frequent weekly exercise was associated with higher BMI, more time depressed, more depressive symptoms, and lower quality of life and functioning. In contrast, more frequent exercise was associated with experiencing more mania in the past year and more current manic symptoms. LIMITATIONS Exercise frequency was measured by self-report and details of the exercise were not collected. Analyses rely on baseline data, allowing only for association analyses. Directionality and predictive validity cannot be determined. Data were collected in the context of a clinical trial and thus, it is possible that the generalizability of the findings could be limited. CONCLUSION There appears to be a mood-specific relationship between exercise frequency and polarity such that depression is associated with less exercise and mania with more exercise in individuals with bipolar disorder. This suggests that increasing or decreasing exercise could be a targeted intervention for patients with depressive or mood elevation symptoms, respectively.
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Affiliation(s)
| | | | - James H Kocsis
- Weill Cornell Medical College of Cornell University, USA
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- Perelman School of Medicine at the University of Pennsylvania, USA
| | | | - Vivek Singh
- University of Texas Health Science Center at San Antonio, USA
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Sylvia LG, Peters AT, Deckersbach T, Nierenberg AA. Nutrient-based therapies for bipolar disorder: a systematic review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:10-9. [PMID: 23147067 DOI: 10.1159/000341309] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 06/22/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pharmacotherapy is the first line of treatment for bipolar disorder, but many patients continue to experience persistent subthreshold symptoms. Alternative adjunct treatments, including nutritional therapies, may have the potential to alleviate residual symptoms and improve the outcomes of standard pharmacotherapy. The aim of this paper is to critically review the current clinical evidence and mechanisms of action of nutrient-based therapies alone or in combination with commonly used pharmacotherapies for mania and bipolar depression. METHODS We conducted a Medline search for clinical trials conducted with humans, published in English from 1960 to 2012 using nutritional supplements such as n-3, chromium, inositol, choline, magnesium, folate and tryptophan alone or in combination with pharmacotherapies for the treatment of bipolar disorder. RESULTS Preliminary data yields conflicting but mainly positive evidence for the use of n-3 fatty acids and chromium in the treatment of bipolar depression. Limited evidence found that inositol may be helpful for bipolar depression, but larger sample sizes are needed. Preliminary randomized, controlled trials suggest that choline, magnesium, folate and tryptophan may be beneficial for reducing symptoms of mania. CONCLUSIONS Given the potential public health impact of identifying adjunct treatments that improve psychiatric as well as physical health outcomes, nutritional treatments appear promising for the management of bipolar disorder but require further study.
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Affiliation(s)
- Louisa G Sylvia
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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Sarris J, Lake J, Hoenders R. Bipolar Disorder and Complementary Medicine: Current Evidence, Safety Issues, and Clinical Considerations. J Altern Complement Med 2011; 17:881-90. [DOI: 10.1089/acm.2010.0481] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, Faculty of Medicine, The University of Melbourne, The Melbourne Clinic, Melbourne, Australia
- Swinburne University of Technology, Centre for Human Pyschopharmacology, Melbourne, Victoria, Australia
| | - James Lake
- Arizona Center for Integrative Medicine, Tucson, AZ
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12
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Sarris J, Mischoulon D, Schweitzer I. Adjunctive nutraceuticals with standard pharmacotherapies in bipolar disorder: a systematic review of clinical trials. Bipolar Disord 2011; 13:454-65. [PMID: 22017215 DOI: 10.1111/j.1399-5618.2011.00945.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Studies using augmentation of pharmacotherapies with nutraceuticals in bipolar disorder (BD) have been conducted and preliminary evidence in many cases appears positive. To date, however, no specialized systematic review of this area has been conducted. We present the first systematic review of clinical trials using nutrient-based nutraceuticals in combination with standard pharmacotherapies to treat BD. A subsequent aim of this report was to discuss posited underlying mechanisms of action. METHODS PubMed, CINAHL, Web of Science, and Cochrane Library databases, and grey literature were searched during mid-2010 for human clinical trials in English using nutraceuticals such as omega-3, N-acetyl cysteine (NAC), inositol, and vitamins and minerals, in combination with pharmacotherapies to treat bipolar mania and bipolar depression. A review of the results including an effect size analysis (Cohen's d) was subsequently conducted. RESULTS In treating bipolar depression, positive evidence with large effect sizes were found for NAC (d=1.04) and a chelated mineral and vitamin formula (d=1.70). On the outcome of bipolar mania, several nutraceuticals reduced mania with strong clinical effects: a chelated mineral formula (d=0.83), L-tryptophan (d=1.47), magnesium (d=1.44), folic acid (d=0.40), and branched-chain amino acids (d=1.60). Mixed, but mainly positive, evidence was found for omega-3 for bipolar depression, while no evidentiary support was found for use in mania. No significant effect on BD outcome scales was found for inositol (possibly due to small samples). CONCLUSIONS BD treatment outcomes may potentially be improved by additional use of certain nutraceuticals with conventional pharmacotherapies. However, caution should be extended in interpreting the large effects of several isolated studies, as they have not yet been replicated in larger trials.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, Faculty of Medicine, University of Melbourne, The Melbourne Clinic2 Salisbury Street, Richmond, Victoria 3121, Australia.
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Proudfoot JG, Parker GB, Benoit M, Manicavasagar V, Smith M, Gayed A. What happens after diagnosis? Understanding the experiences of patients with newly-diagnosed bipolar disorder. Health Expect 2009; 12:120-9. [PMID: 19538647 DOI: 10.1111/j.1369-7625.2009.00541.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Bipolar disorder is chronic condition involving episodes of both depression and elevated mood, associated with significant disability and high relapse rates. Recent estimates suggest a lifetime prevalence of 5%. Little is known about the subjective experiences of patients after receiving a diagnosis of bipolar disorder, and the impact of these experiences on patients' willingness and ability to work with their health professionals to find the most effective combination of treatments and to set up self-management plans. OBJECTIVE This paper describes a qualitative study exploring the experiences and difficulties faced by patients after they have received a diagnosis of bipolar disorder, as expressed online to expert patients trained to provide informed support. DESIGN Qualitative study. SETTING Online communication within a public health service setting. PARTICIPANTS Twenty-six participants with recently-diagnosed bipolar disorder communicated online with 'Informed Supporters', people who had been managing their bipolar disorder effectively for 2 years or more, as part of an online psycho-education programme. RESULTS Participants cited unwanted side-effects of medication, coping with unpleasant symptoms, positive and negative reactions to the diagnosis, identifying early warning signs and triggers of the illness, the loss of a sense of self, uncertainty about their future and stigma as issues of major importance after diagnosis. CONCLUSIONS Personal concerns and difficulties following diagnosis can undermine effective treatment, thwart self-management efforts and interfere with effective functioning. Such data are important for clinicians to take into account when they work in partnership with their patients to fine-tune treatments and help them set up self-management plans.
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Ghaemi SN, Bauer M, Cassidy F, Malhi GS, Mitchell P, Phelps J, Vieta E, Youngstrom E. Diagnostic guidelines for bipolar disorder: a summary of the International Society for Bipolar Disorders Diagnostic Guidelines Task Force Report. Bipolar Disord 2008; 10:117-28. [PMID: 18199230 DOI: 10.1111/j.1399-5618.2007.00556.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Diagnostic Guidelines Task Force of the International Society for Bipolar Disorders (ISBD) presents in this document and this special issue a summary of the current nosological status of bipolar illness, a discussion of possible revisions to current DSM-IV and ICD-10 definitions, an examination of the relevant literature, explication of areas of consensus and dissensus, and proposed definitions that might guide clinicians in the most valid approach to diagnosis of these conditions given the current state of our knowledge.
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Affiliation(s)
- S Nassir Ghaemi
- Bipolar Disorder Research Program, Department of Psychiatry, Emory University, Atlanta, GA 30322, USA.
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