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Kalcev G, Scano A, Orrù G, Primavera D, Cossu G, Nardi AE, Carta MG. Is a Genetic Variant associated with Bipolar Disorder Frequent in People without Bipolar Disorder but with Characteristics of Hyperactivity and Novelty Seeking? Clin Pract Epidemiol Ment Health 2023; 19:e174501792303280. [PMID: 37916199 PMCID: PMC10351339 DOI: 10.2174/17450179-v19-e230419-2022-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 11/03/2023]
Abstract
Objective The objective is to verify whether a genetic condition associated with bipolar disorder (BD) is frequent in old adults adapted to their environment, without BD, but with aptitudes for hyperactivity and novelty seeking (H/NS). Methods In this cross-sectional study, the study sample included healthy elderly people (40 participants, aged 60 or older) living in an urban area and recruited from a previous study on physical exercise and active aging, who were compared with 21 old adults with BD from the same area. The genetic methodology consisted of blood sampling, DNA extraction, real-time PCR jointly with FRET probes, and the SANGER sequencing method. The genetic variant RS1006737 of CACNA1C, found to be associated with bipolar disorder diagnosis, was investigated. Results The frequency of the RS1006737 genetic variant in the study group (H/NS) is not higher than in the BD group and is statistically significantly higher than in all the control groups found in the literature. However, the familiarity for BD is higher in old adults with BD than in the H/NS sample without BD. The risk of BD in the family (also considering those without BD but with family members with BD) is not associated with the presence of the genetic variant examined. Conclusion The study suggests that the gene examined is associated with characteristics of hyperactivity rather than just BD. Nevertheless, choosing to participate in an exercise program is an excessively general way to identify H/NS. The next step would be to identify the old adults with well-defined H/NS features with an adequate tool.
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Affiliation(s)
- Goce Kalcev
- Department of Innovation Sciences and Technology, University of Cagliari, Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Germano Orrù
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Azienda Regionale della Salute (ARES, Sardegna), Medio Campidano, University of Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (Ipub), Federal University of Rio De Janeiro (Ufrj), Rio De Janeiro, Brazil
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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2
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Kalcev G, Cossu G, Preti A, Littera MT, Frau S, Primavera D, Zaccheddu R, Matza V, Ermellino M, Pintus E, Carta MG. Development and Validation of the Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA). Clin Pract Epidemiol Ment Health 2023; 19:e174501792303281. [PMID: 37916197 PMCID: PMC10351347 DOI: 10.2174/17450179-v19-e230419-2022-50] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 11/03/2023]
Abstract
Objective This paper illustrates the preliminary psychometric properties of the Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA), aimed at measuring adaptive characteristics of hyperactivity and goal pursuit in older adults. Methods The 12-item scale was administered to a sample of 120 subjects (older adults) between February 2022 and June 2022. The reliability of AHGA was measured using Cronbach's alpha, and factor structure was established using parallel analysis (PA) and principal component analysis (PCA). Convergent validity was tested against the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). Results All included subjects have an average age of 74.1±5.1 years. AHGA reliability was good (Cronbach's alpha: 0.713 [95%CI: 0.630 to 0.783]). Factor analysis suggested two main components: goal achievement and hyperactivity, which explained 41% of the variance in the data. The results support the convergent validity of the scale: AHGA measures adaptive characteristics of hyperactivity and goal pursuit, in contrast to BRIAN, which measures pathological characteristics. Conclusion The reported findings represent an innovative approach to hyperthymic features by embracing a broader spectrum concept that conceptualizes the potential transition between pathological and adaptive aspects as a continuum.
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Affiliation(s)
- Goce Kalcev
- Department of Innovation Sciences and Technologies at the University of Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Stèphanie Frau
- Department of Psychology, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Azienda Regionale della Salute (ARES, Sardegna), Medio Campidano, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Elisa Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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3
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Scano A, Kalcev G, Piras M, Fais S, Cossu G, Gonzalez CIA, Carta MG, Orrù G. Usefulness of salivary sampling for the molecular detection of a
genetic variant associated with bipolar disorders. J Public Health Res 2023; 12:22799036221146915. [PMID: 36967730 PMCID: PMC10037733 DOI: 10.1177/22799036221146915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/05/2022] [Indexed: 03/25/2023] Open
Abstract
Under certain conditions, the hyperthymic temperament traits associated with an
increased risk of developing bipolar disorders may in fact produce adaptive
responses. The purpose of this study is to see if the type of biological
material used for genetic analysis (saliva or blood) affects the detection of
mutations in the CACNA1C (RS1006737) gene. The first experimental group
consisted of Sardinian migrants (“volunteers”) in South American and European
megacities. The second experimental group consisted of older healthy subjects
with hyperactivity and novelty-seeking characteristics from Cagliari, Italy. The
genetic procedure included DNA extraction, real-time PCR, and the Sanger method.
Nonetheless, the authors believe that saliva is the most appropriate biological
material, given its many advantages. In contrast to blood, saliva can be
collected by any type of healthcare provider after following a few simple
instructions.
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Affiliation(s)
- Alessandra Scano
- Department of Surgical Sciences,
University of Cagliari, Cagliari, Italy
- Alessandra Scano, Department of Surgical
Sciences, University of Cagliari, Via Ospedale, 46, 09124 Cagliari, Italy.
| | - Goce Kalcev
- International PhD in Innovation
Sciences and Technology, University of Cagliari, Cagliari, Italy
| | - Martina Piras
- International PhD in Innovation
Sciences and Technology, University of Cagliari, Cagliari, Italy
| | - Sara Fais
- Department of Surgical Sciences,
University of Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and
Public Health, University of Cagliari, Cagliari, Italy
| | | | - Mauro Giovanni Carta
- Department of Medical Sciences and
Public Health, University of Cagliari, Cagliari, Italy
| | - Germano Orrù
- Department of Surgical Sciences,
University of Cagliari, Cagliari, Italy
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4
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Edmiston EK, Fournier JC, Chase HW, Bertocci MA, Greenberg T, Aslam HA, Lockovich J, Graur S, Bebko G, Forbes EE, Stiffler R, Phillips ML. Assessing Relationships Among Impulsive Sensation Seeking, Reward Circuitry Activity, and Risk for Psychopathology: A Functional Magnetic Resonance Imaging Replication and Extension Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:660-668. [PMID: 31862347 PMCID: PMC7202969 DOI: 10.1016/j.bpsc.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND High trait impulsive sensation seeking (ISS), the tendency to engage in behavior without forethought and to seek out new or extreme experiences, is a transdiagnostic risk factor for externalizing and mood disorders, particularly bipolar disorder. We published a positive association between trait ISS and reward expectancy-related activity in the left ventrolateral prefrontal cortex (L vlPFC) and the ventral striatum. We aimed to replicate this finding and extend it by testing for mediation effects of ISS on relationships between reward expectancy-related activity and measures denoting hypomania. METHODS A transdiagnostic sample of 127 adults, 18 to 25 years of age, completed a card-guessing functional magnetic resonance imaging task as well as measures of ISS (inattention, motor impulsivity, fun seeking, positive and negative urgency) and the Moods Spectrum as a measure of hypomania. An original sample of 98 was included for confirmatory and mediation analyses. RESULTS We replicated a positive relationship between reward expectancy-related L vlPFC activity and negative urgency, an ISS component (β = .28, t = 2.44, p = .0169). We combined these data with the original sample, confirming this finding (β = .27, t = 2.41, p = .0184). Negative urgency statistically mediated the relationship between reward expectancy-related L vlPFC activity and Moods Spectrum factors associated with hypomania. No other associations between ISS measures and reward expectancy-related activity were replicated. CONCLUSIONS We replicated findings showing that reward expectancy-related L vlPFC activity is a biomarker for negative urgency, the tendency to react with frustration during distressing conditions. Negative urgency also statistically mediated the relationship between L vlPFC activity and measures indicative of hypomanic symptoms.
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Affiliation(s)
- E Kale Edmiston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Jay C Fournier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michele A Bertocci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tsafrir Greenberg
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Haris A Aslam
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeanette Lockovich
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Simona Graur
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Genna Bebko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richelle Stiffler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Too Much of a Good Thing: A Neuro-Dynamic Personality Model Explaining Engagement and Its Protective Inhibition. ADVANCES IN MOTIVATION AND ACHIEVEMENT 2016. [DOI: 10.1108/s0749-742320160000019012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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6
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Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders. PSYCHIATRY JOURNAL 2016; 2016:5839181. [PMID: 27190984 PMCID: PMC4852112 DOI: 10.1155/2016/5839181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/01/2016] [Accepted: 03/14/2016] [Indexed: 11/17/2022]
Abstract
Sexual behavior over the past year of 32 outpatients with Bipolar disorder is compared to that of 44 Comparison patients that had never had an episode of affective illness. Subjects were outpatients treated with drugs and psychotherapy in routine office practice. Differences in sexual behavior between the two groups as a whole were minimal, but meaningful differences emerged when subgroups were compared. Compared to control men, Bipolar men had had more partners in the last year and were more likely to have had sex without condoms. Compared to Bipolar females, Bipolar males had more sex partners, had more sex with strangers, and were more likely to have engaged in homosexual behavior. Even so, some patients in the Comparison group also had engaged in risky sexual behavior. They had failed to use condoms and had had sex with strangers and prostitutes during the previous year.
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7
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Parker RD, Lõhmus L, Valk A, Mangine C, Rüütel K. Outcomes associated with anxiety and depression among men who have sex with men in Estonia. J Affect Disord 2015; 183:205-9. [PMID: 26025366 DOI: 10.1016/j.jad.2015.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/03/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence supports that gay, lesbian, and transgender populations are at increased risk for mental health problems. The current study was conducted to estimate the prevalence of anxiety and depressive symptoms and related factors among men who have sex with men (MSM) in Estonia. This is the only known study of its type in the Eastern European region. METHODS In 2013, an Internet-based survey was conducted among men who have sex with men, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. RESULTS 265 MSM completed the questionnaire (median age 31 years, 90% Estonian, 71% from the capital; 73% employed full-time, 42% with at least college education; 44% in a steady relationship; 72% gay, 23% bisexual; 23% reported illegal drug use in the last 12 months). One third met criteria for problem drinking and depressive symptoms with one quarter for anxiety symptoms. Suicidality was 44% reported lifetime suicidal thoughts and 11% with at least one suicide attempt. LIMITATIONS The study instruments, EST-Q and CAGE, only measure symptoms and are not diagnostic tests. A non-random sample which could possibly include persons with easier internet access. Self-reported data and cross-sectional study design are prone to issues with recall bias and temporality. CONCLUSIONS With demonstrated high rates of anxiety, depression, drinking, and drug use among MSM which is consistent with similar studies in Western countries, further research could help determine effective MSM focused interventions to address the broad spectrum of issues among MSM.
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Affiliation(s)
- R David Parker
- West Virginia University, School of Public Health, Morgantown, WV, USA.
| | - Liilia Lõhmus
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia
| | - Anti Valk
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia
| | - Cara Mangine
- West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Kristi Rüütel
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia
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8
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Lara DR, Bisol LW, Ottoni GL, de Carvalho HW, Banerjee D, Golshan S, Akiskal K, Akiskal HS. Validation of the "rule of three", the "red sign" and temperament as behavioral markers of bipolar spectrum disorders in a large sample. J Affect Disord 2015; 183:195-204. [PMID: 26021969 DOI: 10.1016/j.jad.2015.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/04/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Akiskal proposed the "rule of three" for behavioral indicators with high specificity for bipolarity in patients with major depression episodes. We evaluated these distinctive behaviors in controls and subjects with major depression or bipolar disorder. METHODS data was collected in the BRAINSTEP project with questions on general behaviors, style and talents. Univariate analysis was first conducted in 36,742 subjects and confirmatory multivariate analysis in further 34,505 subjects (22% with a mood disorder). Odds ratios were calculated adjusting for age. RESULTS Univariate analysis showed that 29 behavioral markers differentiated bipolar subjects from those with unipolar depression. The most robust differences in those with bipolarity (ORs >4) were ≥3 religion changes, ≥3 marriages, cheating the partner regularly, having ≥60 lifetime sexual partners, pathological love, heavy cursing, speaking ≥3 foreign languages, having ≥2 apparent tattoos, circadian dysregulation and high debts. Most behaviors were expressed in a minority of patients (usually around 5-30%) and usually the "rule of three" was the best numerical marker to distinguish those with bipolarity. However, multivariate analysis confirmed 11 of these markers for differentiating bipolar disorder from unipolar depression (reversed circadian rhythm and high debts for both genders, ≥3 provoked car accidents and talent for poetry in men, and frequent book reading, ≥3 religion changes, ≥60 sexual partners, pathological love ≥2 times, heavy cursing and extravagant dressing style in women). LIMITATIONS Self-report data collection only. CONCLUSIONS These behavioral markers should alert the clinician to perform a thorough investigation of bipolarity in patients presenting with a depressive episode.
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Affiliation(s)
- Diogo R Lara
- Faculdade de Biociências, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Luísa W Bisol
- Serviço de Psiquiatria, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo L Ottoni
- Serviço de Psiquiatria, Hospital Presidente Vargas, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Dipavo Banerjee
- International Mood Center, La Jolla, CA USA and Paris, France
| | - Shahrokh Golshan
- Department of Psychiatry, University of California at San Diego, USA
| | - Kareen Akiskal
- International Mood Center, La Jolla, CA USA and Paris, France
| | - Hagop S Akiskal
- Department of Psychiatry, University of California at San Diego, USA
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9
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The relationship between temperament and sexual orientation. J Affect Disord 2015; 175:379-84. [PMID: 25678170 DOI: 10.1016/j.jad.2015.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/17/2014] [Accepted: 01/15/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The relationship between temperament and sexual orientation has been poorly characterized. We have used the Affective and Emotional Composite Temperament (AFECT) model to evaluate this association in a large population sample. METHODS Data from 16,571 subjects between 21 and 45 years old (mean age=29.1±6.3 yrs, 69.4% females) was collected anonymously through Internet in Brazil. RESULTS Regarding affective temperaments, male cyclothymics and dysphorics had the lowest percentage of people with heterosexual orientation and the highest percentages of people with bisexual and homosexual orientations. The opposite profile was observed in hyperthymic and euthymic types. Among females, the volatile, cyclothymic, apathetic, disinhibited and euphoric types were less often observed in people with "pure" heterosexual orientation and more often in people with bisexual orientation. In men only, homosexuality was more common among the depressive, cyclothymic and dyphorics temperaments. Emotional trait analysis showed that heterosexual subjects differed statistically from all other groups by having higher scores of coping and stability and lower scores of sensitivity and desire. Overall, the effect sizes were small to moderate, with the largest differences between "pure" heterosexuals and people with bisexual orientation, particularly in women. Subjects with heterosexual orientation who have had homosexual experience and those with homosexual orientation presented intermediate scores. LIMITATIONS Cross-sectional design, lack of potentially important covariates (e.g., maltreatment) and data collected by Internet only. CONCLUSION Externalized and unstable traits were associated mainly with bisexuality. The group of heterosexuals with homosexual fantasies or experiences offers a new approach for the study of sexual orientation.
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10
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Abstract
Elucidating the true structure of depression is necessary if we are to advance our understanding and treatment options. Central to the issue of structure is whether depression represents discrete types or occurs on a continuum. Nature almost universally operates on the basis of continuums, whereas human perception favors discrete categories. This reality might be formalized into a 'continuum principle': natural phenomena tend to occur on a continuum, and any instance of hypothesized discreteness requires unassailable proof. Research evidence for discrete types falls far short of this standard, with most evidence supporting a continuum. However, quantitative variation can yield qualitative differences as an emergent property, fostering the appearance of discreteness. Depression as a continuum is best characterized by duration and severity dimensions, with the latter understood in terms of depressive inhibition. In the absence of some degree of cognitive, emotional, social, and physical inhibition, depression should not be diagnosed. Combining the dimensions of duration and severity provides an optimal way to characterize the quantitative and related qualitative aspects of depression and to describe the overall degree of dysfunction. The presence of other symptom types occurs when anxiety, hypomanic/manic, psychotic, and personality continuums interface with the depression continuum.
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Affiliation(s)
- Brad Bowins
- Centre for Theoretical Research in Psychiatry and Clinical Psychology, Toronto, Ont., Canada
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11
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Carta MG, Massidda D, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Calò S, Pollice R, Fortezzo A, Akiskal H. Comparing factor structure of the Mood Disorder Questionnaire (MDQ): In Italy sexual behavior is euphoric but in Asia mysterious and forbidden. J Affect Disord 2014; 155:96-103. [PMID: 24238869 DOI: 10.1016/j.jad.2013.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders. In this work, we studied the item response pattern of the MDQ in the Italian population and compared the results with those of the validation of the MDQ in Asian studies (Chinese and Korean), analyzing similarities and differences among the populations studied. METHODS The sample was made up of 2278 participants, distributed as follows: 56.6% females, 50.8% living in the north-central Italy, and 33.7% living in rural areas. The factor analysis was run on the matrix of tetrachoric correlations. The psychometric properties of the MDQ were also studied using the Rasch logistic model. RESULTS The parallel analysis found two significant components. The first includes symptoms referring to acceleration, danger and irritability as risky behaviors, social interaction problems and mental flow. The second includes symptoms referring to self-confidence and energy. With respect to the Korean/Chinese results, the Italian sample, item 11 ("much more sex"), appears related to self-confidence and energy, while in Asia it is connected with items expressing risky behaviors and irritability. LIMITATIONS Differences in the frequency of comorbid disorders in Asian and Italian populations should be considered. The results should be confirmed and compared with those of other populations. CONCLUSIONS Cultural differences appear to be associated with a different symptomatic expression of bipolar spectrum disorders. Future research will investigate the role of gene-environment interaction in the genesis of these differences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Audrey Fortezzo
- International Mood Center, University of California, San Diego, USA
| | - Hagop Akiskal
- International Mood Center, University of California, San Diego, USA
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12
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Noto MN, de Souza Noto C, de Jesus DR, Zugman A, Mansur RB, Berberian AA, Leclerc E, McIntyre RS, Correll CU, Brietzke E. Recognition of bipolar disorder type I before the first manic episode: challenges and developments. Expert Rev Neurother 2014; 13:795-806; quiz 807. [DOI: 10.1586/14737175.2013.811132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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13
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Affiliation(s)
- Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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14
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Abstract
There is considerable debate over whether bipolar and related disorders that share common signs and symptoms, but are currently defined as distinct clinical entities in DSM-IV and ICD-10, may be better characterized as falling within a more broadly defined "bipolar spectrum". With a spectrum view in mind, the possibility of broadening the diagnosis of bipolar disorder has been proposed. This paper discusses some of the rationale for an expanded diagnostic scheme from both clinical and research perspectives in light of potential drawbacks. The ultimate goal of broadening the diagnosis of bipolar disorder is to help identify a common etiopathogenesis for these conditions to better guide treatment. To help achieve this goal, bipolar researchers have increasingly expanded their patient populations to identify objective biological or endophenotypic markers that transcend phenomenological observation. Although this approach has and will likely continue to produce beneficial results, the upcoming DSM-IV and ICD-10 revisions will place increasing scrutiny on psychiatry's diagnostic classification systems and pressure to re-evaluate our conceptions of bipolar disorder. However, until research findings can provide consistent and converging evidence as to the validity of a broader diagnostic conception, clinical expansion to a dimensional bipolar spectrum should be considered with caution.
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Affiliation(s)
- STEPHEN M. STRAKOWSKI
- Division of Bipolar Disorders Research, Department
of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin
Way, Cincinnati, OH 45267-0559, USA
| | - DAVID E. FLECK
- Division of Bipolar Disorders Research, Department
of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin
Way, Cincinnati, OH 45267-0559, USA
| | - MARIO MAJ
- Department of Psychiatry, University of Naples
SUN, Naples, Italy
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15
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Manning JS. Tools to improve differential diagnosis of bipolar disorder in primary care. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12:17-22. [PMID: 20628502 DOI: 10.4088/pcc.9064su1c.03] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Among patients seen in a primary care setting for depressive and/or anxiety symptoms, 20% to 30% are estimated to have bipolar disorder. Although relatively common in primary care settings, bipolar disorder is still underrecognized, primarily due to misdiagnosis as unipolar depression. Patients often seek treatment when they are depressed but uncommonly present with mania or hypomania, the specific markers of bipolar spectrum disorders. An awareness of the prevalence, characteristics, and predictors of bipolar disorder can help the primary care physician to properly differentiate between bipolar depression and unipolar depression. Completing a differential diagnosis of bipolar disorder requires obtaining a comprehensive patient history that investigates symptom phenomenology and associated features, family history, longitudinal course of illness, and prior treatment response. In addition to the clinical interview, the Mood Disorder Questionnaire and the World Health Organization Composite International Diagnostic Interview 3.0 can be useful tools for evaluating patients for bipolar disorder. Screening patients at risk for bipolar disorder will help to avoid the use of unproductive or possibly even harmful treatments.
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Affiliation(s)
- J Sloan Manning
- Department of Family Medicine, University of North Carolina, Chapel Hill, and the Moses Cone Family Practice Residency and private practice, Greensboro, North Carolina
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16
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Culpepper L. The role of primary care clinicians in diagnosing and treating bipolar disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12:4-9. [PMID: 20628500 DOI: 10.4088/pcc.9064su1c.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Because many patients with bipolar disorder seek treatment in primary care practices, physicians in these settings need to be able to diagnose bipolar disorder and common psychiatric and medical comorbidities and to initiate and manage treatment. Unfortunately, bipolar disorder is often underrecognized. The most common symptoms in patients with bipolar disorder are depressive, but these patients may also have anxiety, mood swings, sleep problems, irritability, difficulty concentrating, relationship issues, alcohol- or drug-related problems, and infections. Social and family history and screening tools can help clarify diagnosis. The goal of treatment should be recovery, but periodic relapse and medication nonadherence should be expected. Primary care physicians should decide what level of intervention their practices can support. To manage these patients effectively, practices may need to train office staff, set up monitoring and follow-up systems, establish links with referral and community support services, develop therapeutic alliances with patients, and provide psychoeducation for patients and significant others. Receiving comprehensive psychiatric and medical care and support can be life-changing for patients with bipolar disorder and their families.
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Affiliation(s)
- Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
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Kornreich C, Dan B, Vandriette Y. Suicidal risk in a patient receiving tamoxifen treatment for breast cancer. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 20694123 DOI: 10.4088/pcc.09l00828blu] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Vöhringer P. Tamizaje en trastornos bipolares: experiencia chilena. Medwave 2010. [DOI: 10.5867/medwave.2010.07.4620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Antioxidant-like effects and protective action of transcranial magnetic stimulation in depression caused by olfactory bulbectomy. Neurochem Res 2010; 35:1182-7. [PMID: 20428940 DOI: 10.1007/s11064-010-0172-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2010] [Indexed: 12/23/2022]
Abstract
We studied the effects of transcranial magnetic stimulation (TMS, 60 Hz and 0.7 mT for 4 h/day for 14 days) on oxidative and cell damage caused by olfactory bulbectomy (OBX) in Wistar rats. The levels of lipid peroxidation products and caspase-3 were enhanced by OBX, whereas it prompted a reduction in reduced glutathione (GSH) content and antioxidative enzymes activities. The treatment with TMS reverted towards normality the biomarkers indicative of oxidative stress and apoptosis. In conclusion, our data show that TMS induced a protection against cell and oxidative damage induced by OBX, as well as they support the hypothesis that oxidative stress may play an important role in depression.
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Besnier N, Fakra E, Kaladjian A, Adida M, Maurel M, Azorin JM. [Depressive onset episode of bipolar disorder: clinical and prognostic considerations]. Encephale 2010; 36 Suppl 1:S18-22. [PMID: 20141803 DOI: 10.1016/s0013-7006(10)70005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Both retrospective and high-risk individuals prospective studies show that a high percentage of patients experience one or more depressive episodes previous the diagnosis of bipolar disorder. Depressive onset bipolar disorders begin earlier than the ones with a manic onset, have a higher duration, a chronic course with frequent recurrences, a depressive dominant polarity, a higher lifetime rate of suicidal behaviour, less psychotic symptoms and more rapid cycling. A relation between frequent rapid cycling and previous prescription of antidepressants was suggested but not rigorously demonstrated. Thus, a high percentage of patients presenting a first depressive episode will later develop bipolar disorder. Several risk factors of bipolarity have been identified and might be detected during each depressive episode by using standardised evaluations and family interviews, if necessary. Among them, an early age at first episode, frequent recurrences, a family history of bipolar disorder, atypical features and hypomanic symptoms are particularly associated with the subsequent development of a bipolar disorder. The impact of a high risk of bipolarity on drug prescription is unclear ; however, one can strongly recommend to intensifying clinical monitoring and to proposing adjunctive psychoeducation.
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Affiliation(s)
- N Besnier
- Pôle de Psychiatrie Adultes, CHU Sainte Marguerite, 13009 Marseille.
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Miniati M, Rucci P, Benvenuti A, Frank E, Buttenfield J, Giorgi G, Cassano G. Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse. J Psychiatr Res 2010; 44:302-9. [PMID: 19800634 PMCID: PMC2836419 DOI: 10.1016/j.jpsychires.2009.09.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 08/28/2009] [Accepted: 09/08/2009] [Indexed: 11/29/2022]
Abstract
Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: 'depressivemood' (15.6+/-4.9 vs. 13.5+/-5.4; p<0.004), 'psychomotorretardation' (11.7+/-4.5 vs. 9.6+/-4.7; p<0.001), 'drugandillness-relateddepression' (1.3+/-1.3 vs. 0.6+/-1.0; p<0.0001), and 'neurovegetativesymptoms' (8.3+/-2.6 vs. 6.9+/-2.9; p<0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67days, log-rank test, p=0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms.
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Affiliation(s)
- M. Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - P. Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A. Benvenuti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - E. Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - J. Buttenfield
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - G. Giorgi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - G.B. Cassano
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
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Abstract
In the DSM-IV-TR, specific impulse control disorders not elsewhere classified (ICD) have been designated following four principles: (1) through the addition of an adjective that emphasizes the aberrant character of an otherwise normal behaviour (e.g., pathological gambling); (2) by means of metaphors (such as in intermittent explosive disorder); (3) according to the presumably quintessential nature of their main signs and symptoms, such as impulsive (e.g., impulse control disorders not elsewhere classified), compulsive (e.g., compulsive shopping), or addictive (e.g., internet addiction); or (4) using Greek suffix mania (e.g., kleptomania, pyromania, and trichotillomania). Given this flagrant inconsistency, we argue that time has come to adopt a less arbitrary way of describing these disorders, at least until it becomes clearer whether they are really impulsive, compulsive or addictive or if the preoccupation with this distinction is valid. In keeping with DSM's emphasis on descriptive phenomenology rather than on unsupported theory, a less biased terminology is in order. Therefore, we would like to suggest: (1) the substitution of the term ICD by the more neutral expression 'volitional disorders not elsewhere classified'; (2) the use of the classical Greek suffix mania, already present in some DSM-IV-TR ICDs, as the main naming principle to be adopted in the DSM-V; and (3) the creation of compulsive, impulsive, and mixed subtypes of the 'volitional disorders not elsewhere classified', since they are beginning to be validated by treatment trials.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil.
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Bisol LW, Lara DR. Low-dose quetiapine for patients with dysregulation of hyperthymic and cyclothymic temperaments. J Psychopharmacol 2010; 24:421-4. [PMID: 18838499 DOI: 10.1177/0269881108097715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with hyperthymic and cyclothymic temperaments often develop symptoms that fail to meet diagnostic criteria for bipolar disorders. These patients can be conceived as having bipolar disorder NOS (not otherwise specified), a bipolar spectrum disorder, cyclothymic disorder or cluster B personality traits. Here, we describe four of these patients with mild to moderate symptoms affecting mood, behaviour, emotional reactivity and sleep. Treatment with low-dose quetiapine (25-75 mg/day at night) lead to sustained symptom remission. Two of them were on quetiapine monotherapy. Such low doses occupy a minority of D2 and 5-HT2 receptors, which may nevertheless be of therapeutic value in mild cases. Alternatively, other mechanisms more likely to occur at low doses, such as antagonism of H1, alpha(1B)-adrenergic and other serotonin receptors, as well as reduction cortisol secretion, may be involved in the therapeutic efficacy of quetiapine.
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Affiliation(s)
- Luísa W Bisol
- Departamento de Bioquímica, ICBS - UFRGS, Porto Alegre, Brazil
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Túnez I, Drucker-Colín R, Montilla P, Peña J, Jimena I, Medina FJ, Tasset I. Protective effect of nicotine on oxidative and cell damage in rats with depression induced by olfactory bulbectomy. Eur J Pharmacol 2009; 627:115-8. [PMID: 19887066 DOI: 10.1016/j.ejphar.2009.10.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 09/24/2009] [Accepted: 10/14/2009] [Indexed: 01/29/2023]
Abstract
We evaluated the effects of nicotine on cell and oxidative damage caused by olfactory bulbectomy (OBX). The rats were divided into seven groups as follows: i) control; ii) vehicle (6% ethanol); iii) treated with nicotine; iv) sham operated; v) olfactory bulbectomy (OBX); vi) OBX+vehicle; and vii) OBX+Nic. The OBX was performed using the trepanation of frontal bone. The olfactory bulbs were cut and removed without damage to the frontal cortex. Two weeks after surgery nicotine was administered chronically once daily for 14 days, intraperitoneally (i.p.) in doses of 1.5 mg/kg, two weeks after surgery. OBX caused an increase in lipid peroxidation products and caspase-3 but prompted a reduction in reduced glutathione (GSH) content and antioxidative enzyme activity. All these changes were reverted by treatment of nicotine (14 days). In conclusions: i) OBX induces oxidative stress and cell death by apoptosis; and ii) nicotine presents antidepressant and antioxidant effect. All these findings suggest that nicotine would be a therapeutic tool for depression, although more studies are needed in this area to define the appropriate treatment regime.
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Affiliation(s)
- Isaac Túnez
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Córdoba, Avda. Menendez Pidal s/n, 14004-Córdoba, Spain.
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25
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Miniati M, Rucci P, Benvenuti A, Frank E, Buttenfield J, Giorgi G, Cassano GB. Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse. J Psychiatr Res 2009. [PMID: 19800634 DOI: 10.1016/j.jpsychires] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: 'depressivemood' (15.6+/-4.9 vs. 13.5+/-5.4; p<0.004), 'psychomotorretardation' (11.7+/-4.5 vs. 9.6+/-4.7; p<0.001), 'drugandillness-relateddepression' (1.3+/-1.3 vs. 0.6+/-1.0; p<0.0001), and 'neurovegetativesymptoms' (8.3+/-2.6 vs. 6.9+/-2.9; p<0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67days, log-rank test, p=0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms.
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Affiliation(s)
- M Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy
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26
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Hypomanic personality traits: A multi-method exploration of their association with normal and abnormal dimensions of personality. JOURNAL OF RESEARCH IN PERSONALITY 2009. [DOI: 10.1016/j.jrp.2009.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cassano G, Benvenuti A, Miniati M, Calugi S, Mula M, Maggi L, Rucci P, Fagiolini A, Perris F, Frank E. The factor structure of lifetime depressive spectrum in patients with unipolar depression. J Affect Disord 2009; 115:87-99. [PMID: 18947882 PMCID: PMC3387569 DOI: 10.1016/j.jad.2008.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/07/2008] [Accepted: 09/09/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND While previous attempts to elucidate the factor structure of depression tended to agree on a central focus on depressed mood, other factors were not replicated across studies. By examining data from a large number of items covering the range of depressive symptoms, the aim of the present study is to contribute to the identification of the structure of depression on a lifetime perspective. METHODS The study sample consisted of 598 patients with unipolar depression who were administered the Mood Spectrum Self-Report (lifetime version) in Italian (N=415) or English (N=183). In addition to classical exploratory factor analysis using tetrachoric correlation coefficients, an IRT-based factor analysis approach was adopted to analyze the data on 74 items of the instrument that explore cognitive, mood and energy/activity features associated with depression. RESULTS Six factors were identified, including 'Depressive Mood', 'Psychomotor Retardation', 'Suicidality', 'Drug/Illness related depression', 'Psychotic Features' and 'Neurovegetative Symptoms', accounting overall for 48.3% of the variance of items. LIMITATIONS Clinical information on onset of depression and duration of illness is available only for 350 subjects. Therefore, differences between sites can only be partially accounted using available data. CONCLUSIONS Our study confirms the central role of depressed mood, psychomotor retardation and suicidality and identifies the factors 'Drug/Illness related depression', 'Psychotic features' and the neurovegetative dysregulation not captured by the instruments most frequently used in previous studies. The identification of patients with specific profiles on multiple factors may be useful in achieving greater precision in neuroimaging studies and in informing treatment selection.
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Affiliation(s)
- G.B. Cassano
- Corresponding author. Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, via Roma 67 - 56100 Pisa, Italy. Tel.: +39 050 835419; fax: +39 050 21581. (G.B. Cassano)
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Commonalities and differences in characteristics of persons at risk for narcissism and mania. JOURNAL OF RESEARCH IN PERSONALITY 2008; 42:1427-1438. [PMID: 20376289 DOI: 10.1016/j.jrp.2008.06.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Clinicians have long noted overlap in some of the key features of narcissism and bipolar disorder, including excessively high goals and impulsivity. In addition, empirical findings consistently document high levels of comorbidity between the two conditions. To better understand the similarities and differences in psychological qualities associated with mania- and narcissism-related vulnerabilities, we administered to 233 undergraduates a broad range of measures pertaining to goals and affects (both their experience and their dysregulation) and impulsivity. As hypothesized, tendencies toward both narcissism and hypomania related to elevations on measures of affective and goal dysregulation. In addition, hypomania tendencies were related to higher impulsivity, but that association did not appear for narcissistic tendencies. Results highlight key commonalities and differences between those at risk for mania versus narcissism. Future research should examine these relationships in clinically diagnosed samples.
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Patten SB, Paris J. The bipolar spectrum--a bridge too far? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:762-8. [PMID: 19087470 DOI: 10.1177/070674370805301108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies. METHODS The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. RESULTS In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. CONCLUSIONS Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta.
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Bourgeois ML. [Cadet Rousslell syndrome, the rule of three according to Akiskal in the shadow of bipolar depression]. Encephale 2008; 34:313-5. [PMID: 18922231 DOI: 10.1016/j.encep.2008.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Indexed: 11/30/2022]
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Abstract
Classification of any mental disorder is likely to have clinical utility only if it is based on a valid underlying model. The depressive disorders have long provoked debates as to whether a categorical or a dimensional model is all explanatory. This paper will argue that no single (categorical or dimensional) model is likely to be valid, and that a mix of models is required to classify, diagnose and shape management decisions for the mood disorders. After reviewing limitations to the dimensionally based official classificatory systems (DSM-IV and ICD-10), and noting some of the consequences, a set of alternative strategies is outlined. In essence, identifying syndromal 'fuzzy sets' from phenotypic and aetiological clustering, a model that occurs in the rest of medicine.
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Affiliation(s)
- Gordon Parker
- Black Dog Institute, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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Bowins B. Hypomania: a depressive inhibition override defense mechanism. J Affect Disord 2008; 109:221-32. [PMID: 18325598 DOI: 10.1016/j.jad.2008.01.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 01/17/2008] [Accepted: 01/24/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Evolutionary perspectives on bipolar disorders can further our understanding of the origins of these conditions, and assist clinicians in distinguishing normal from abnormal states. Hypomania is unique amongst bipolar conditions in that it seems to have beneficial aspects and can be difficult to diagnose, in contrast to full-blown mania and depression. A theoretical perspective regarding the evolution of hypomania as a defense mechanism is presented. METHOD Literature review focused on the fitness reducing aspects of depression and the fitness enhancing aspects of hypomania/mania. RESULTS Of all the adversity inherent in depression, inhibition of physical and mental activity-depressive inhibition-has the most detrimental consequences, and throughout our evolution would have significantly reduced fitness. It is proposed that hypomania evolved as a depressive inhibition override defense mechanism, typically operating in a short-term time frame, to restore physical and mental activity to fitness sustaining or enhancing levels. Over-activity and not mood enhancement enabled hypomania to function as a defense mechanism against the fitness reducing state of depressive inhibition. Contributing to depressive inhibition are the Behavioral Activation System (BAS) and the Behavioral Inhibition System (BIS), two basic motivational systems. Depressive inhibition consists to some extent of low BAS and high BIS. As human intelligence evolved cognitions inhibiting BAS and activating BIS became amplified, resulting in intensified depressive inhibition. LIMITATIONS A theoretical perspective. CONCLUSIONS Given its ability to override depressive inhibition hypomania might be viewed as a natural treatment as opposed to a problem to treat, producing maximal improvement in areas where functioning has suffered the most while typically enhancing social behavior.
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Affiliation(s)
- Brad Bowins
- University of Toronto Student Services, Psychiatry Service, Toronto, Ontario, Canada.
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McIntyre RS, McElroy SL, Konarski JZ, Soczynska JK, Wilkins K, Kennedy SH. Problem gambling in bipolar disorder: results from the Canadian Community Health Survey. J Affect Disord 2007; 102:27-34. [PMID: 17240457 DOI: 10.1016/j.jad.2006.12.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 09/22/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This investigation was undertaken to explore the prevalence and associated features of problem gambling amongst individuals with bipolar I disorder. METHODS The data for this analysis were procured from the Canadian Community Health Survey: Mental Health and Well-being (CCHS 1.2) conducted by Statistics Canada. Individuals screening positive for a lifetime (World Mental Health- Composite International Diagnostic Interview) WMH-CIDI-defined manic episode (i.e. bipolar I disorder) or depressive episode (i.e. major depressive disorder) and current (i.e. past 12-month) problem gambling were compared to the general population without these disorders. Past year problem gambling was operationalized with the Canadian Problem Gambling Index (CPGI). RESULTS The sample consisted of 36,984 individuals (> or = 15 years old); the weighted prevalence of problem gambling was significantly higher (6.3%) amongst the population with bipolar disorder as compared to the general population (2.0%, p<0.001) and those with major depressive disorder (2.5%, p<0.01). Compared to those without bipolar disorder, the odds of problem gambling for bipolar individuals were over twice as high (OR=2.3; 95% CI 1.4-3.7), even when controlling for potential confounders. Males also had higher odds of problem gambling (OR=1.8; 95% CI 1.4-2.3), as did individuals without post-secondary education (OR=1.4; 95% CI 1.1-1.8). Persons who were married/cohabiting had lowered odds of problem gambling, compared with those who were unmarried (OR=0.6; 95% CI 0.5-0.8). Comorbid alcohol dependence (OR=3.4; 95% CI 2.3-5.0) and illicit drug dependence (OR=2.6; 95% CI 1.1-6.2) each conferred an increased risk for problem gambling. Physical activity level (moderate to active) was associated with a decreased risk for problem gambling (OR=0.8; 95% CI 0.6-0.9). CONCLUSIONS Individuals with bipolar I disorder are differentially affected by problem gambling. Opportunistic screening for problem gambling is warranted, particularly in persons with comorbid alcohol or substance dependence.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Ramsley SE. Unipolar or bipolar depression? Improving diagnostic confidence with the adult patient. ACTA ACUST UNITED AC 2007; 19:172-8. [PMID: 17430538 DOI: 10.1111/j.1745-7599.2007.00214.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this article is to inform advanced practice nurses in primary care about the differential diagnosis of bipolar disorder (BD), when depression is identified in the adult patient. DATA SOURCES Selected research and clinical articles. CONCLUSIONS Adult patients with BD are much more likely to seek treatment for depression than for mania or hypomania. Recognition of BD is improved when the primary care clinician is alerted to the factors indicating bipolarity and utilizes available screening tools. IMPLICATIONS FOR PRACTICE Misdiagnosis of a bipolar spectrum disorder delays proper treatment and precludes adequate management both pharmacologically and psychotherapeutically.
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Abstract
Bipolar affective disorder is a recurrent, disabling, and potentially lethal illness that typically begins early in life. Although the disorder is defined by the manic and hypomanic episodes, for most people the depression episodes are the more virulent aspect of the illness. Specifically, the depressive episodes are more numerous, last longer, and are more difficult to treat than the manias, and depression is the principal cause of the illness's increased mortality due to suicide. For people with early-onset depression, predictors of subsequent bipolarity include a family history, psychotic features, and reverse neurovegetative features. Initial episodes of depression are commonly misdiagnosed, which often delays initiation of appropriate therapy and increases the likelihood of treatment with antidepressants alone. Unfortunately, the correct diagnosis is often not made until there has been a treatment-emergent affective switch. There are no treatments specifically approved for bipolar disorder in youth and, among antidepressants, only fluoxetine has received approved. When bipolarity is suspected, treatment with mood stabilizers, both conventional (i.e., lithium, valproate, and carbamazapine) and more recently classified (lamotrigine) and atypical antipsychotics should be prioritized. When antidepressants are indicated in combination with mood stabilizers, first choice options include bupropion and the selective serotonin reuptake inhibitors. Studies of adults indicate that several forms of focused psychotherapy may improve longer term outcomes.
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Affiliation(s)
- Michael E Thase
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15123-2593, USA.
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36
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Abstract
Bipolar affective disorder is a virulent illness with high rates of recurrence, disability, social impairment, and suicide. Although the manic or hypomanic episodes define the disorder, the depressions are more numerous and less responsive to treatment. As the initial depressive episodes are commonly misdiagnosed, initiation of therapy with mood stabilizers is often delayed, increasing the likelihood of treatment-emergent affective switches on antidepressant monotherapy. The empirical basis for selecting treatments for people with bipolar depression is weak, and only the combination of olanzapine and fluoxetine has received US Food and Drug Administration (FDA) approval. Conventional mood stabilizers are preferred for first-line therapies, although atypical antipsychotics are increasingly used, and FDA approval of quetiapine is pending. Antidepressants--particularly selective serotonin reuptake inhibitors and bupropion--are indicated when mood stabilizers are ineffective and for "breakthrough" depressions.
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Affiliation(s)
- Michael E Thase
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213-2593, USA.
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Abstract
Although bipolar affective disorder is defined by the history of manic or hypomanic episodes, depression is arguably a more important facet of the illness. Depressive episodes, on average, are more numerous and last longer than manic or hypomanic episodes, and most suicides occur during these periods. Misdiagnosis of major depressive disorder delays initiation of appropriate therapy, further worsening prognosis. Distinguishing features of bipolar depression include earlier age of onset, a family history of bipolar disorder, presence of psychotic or reverse neurovegetative features, and antidepressant-induced switching. Bipolar I depressions should initially be treated with a mood stabilizer (carbamazapine, divalproex, lamotrigine, lithium, or an atypical antipsychotic); antidepressant monotherapy is contraindicated. More severe or "breakthrough" episodes often require a concomitant antidepressant, such as bupropion or a selective serotonin reuptake inhibitor (SSRI). The first treatment specifically approved for bipolar depression is a combination of the SSRI fluoxetine and the atypical antipsychotic olanzapine. For refractory depressive episodes, venlafaxine, the monoamine oxidase inhibitor tranylcypromine, and ECT are most widely recommended. The optimal duration of maintenance antidepressant therapy has not been established empirically and, until better evidence-based guidelines are established, should be determined on a case-by-case basis.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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McElroy SL, Kotwal R, Keck PE, Akiskal HS. Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations? J Affect Disord 2005; 86:107-27. [PMID: 15935230 DOI: 10.1016/j.jad.2004.11.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 11/30/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND The co-occurrence of bipolar and eating disorders, though of major clinical and public health importance, remains relatively unexamined. METHODS In reviewing the literature on this comorbidity, we compared bulimia, anorexia nervosa, bulimia nervosa, binge eating disorders and bipolar disorders on phenomenology, course, family history, biology, and treatment response. RESULTS Epidemiological studies show an association between subthreshold bipolar disorder and eating disorders in adolescents, and between hypomania and eating disorders, especially binge eating behavior, in adults. Of the clinical studies, most show that patients with bipolar disorder have elevated rates of eating disorders, and vice versa. Finally, the phenomenology, course, comorbidity, family history, and pharmacologic treatment response of these disorders show considerable overlap on all of these parameters. In particular, on phenomenologic grounds--eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity and/or exercise--we find many parallels between bipolar and eating disorders. Overall, the similarities between these disorders were more apparent when examined in their spectrum rather than full-blown expressions. LIMITATIONS Despite an extensive literature on each of these disorders, studies examining their overlap across all these parameters are relatively sparse and insufficiently systematic. CONCLUSIONS Nonetheless, the reviewed literature leaves little doubt that bipolar and eating disorders--particularly bulimia nervosa and bipolar II disorder--are related. Although several antidepressants and mood stabilizers have shown promise for eating disorders, their clinical use when these disorders co-exist with bipolarity is still very much of an art. We trust that this review will stimulate more rigorous research in their shared putative underlying psychobiologic mechanisms which, in turn, could lead to more rational targeted treatments.
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Affiliation(s)
- Susan L McElroy
- Psychopharmacology Research Program, University of Cincinnati College of Medicine, P.O. Box 670559, 231 Bethesda Avenue, Cincinnati, OH 45267-0559, USA.
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