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Yamamoto T, Sakurai K, Watanabe M, Sakuma I, Kanahara N, Shiina A, Hasegawa T, Watanabe H, Iyo M, Ishibashi R. Cyclothymic Temperament is Associated with Poor Medication Adherence and Disordered Eating in Type 2 Diabetes Patients: A Case-Control Study. Diabetes Ther 2021; 12:2611-2624. [PMID: 34331669 PMCID: PMC8384994 DOI: 10.1007/s13300-021-01121-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Poor medication adherence and disordered eating are major self-care problems in patients with type 2 diabetes that worsen glycemic control and increase the risk of developing severe diabetes complications. Affective temperament, which remains mostly unchanged throughout life, is speculated to predict poor treatment response and high comorbidity. The aim of this study was to explore the link between affective temperament and poor glycemic control due to insufficient self-care. METHODS This single-center case-control study involved 77 outpatients divided into the 'poor glycemic control' group (n = 52) and the 'better glycemic control' group (n = 25) based on their mean glycated hemoglobin (HbA1c) levels over the past 12 months. All participants underwent one-on-one interviews during which they completed the following psychometric questionnaires: (1) the Mini-International Neuropsychiatric Interview 5.0.0; (2) the Temperament Evaluation of Memphis, Pisa, and San Diego Auto-questionnaire; (3) a researcher-designed single question for assessing subclinical stress-induced overeating; and (4) the Morisky Medication Adherence Scale. The difference between two continuous independent variables was determined using Student's t test. Discrete variables were compared using the Chi-square (χ2) or Fisher's exact test. Multiple testing corrections were performed using the false discovery rate. RESULTS Those outpatients in the poor glycemic control group exhibited significantly more stress-induced overeating (χ2 = 1.14, q statistic = 0.040) and poor medication adherence (t = 3.70, q = 0.034) than those in the better glycemic control group. However, there were no significant differences between the two groups in terms of affective temperaments, clinical eating disorders, or diabetes-specific distress. Patients with stress-induced overeating (t = - 2.99, p = 0.004) and poor medication adherence (t = - 4.34, p = 0.000) exhibited significantly higher scores for cyclothymic temperament than their counterparts. CONCLUSION Cyclothymic temperament is significantly associated with disordered eating and/or poor medication adherence in patients with type 2 diabetes and is possibly linked to poor glycemic control.
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Affiliation(s)
- Tetsuya Yamamoto
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Kimitsu Chuo Hospital, Sakurai 1010, Kisarazu, Chiba, 292-0822, Japan
- Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Kenichi Sakurai
- Department of Nutrition and Metabolic Medicine, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Masahiro Watanabe
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Ikki Sakuma
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuhisa Kanahara
- Center for Forensic Mental Health, Chiba University, Chiba, Japan
- Department of Psychiatry, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Japan
| | - Akihiro Shiina
- Center for Forensic Mental Health, Chiba University, Chiba, Japan
- Department of Psychiatry, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Japan
| | - Tadashi Hasegawa
- Department of Psychiatry, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Japan
| | | | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Japan
| | - Ryoichi Ishibashi
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Kimitsu Chuo Hospital, Sakurai 1010, Kisarazu, Chiba, 292-0822, Japan.
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.
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Lesiewska N, Kamińska A, Junik R, Michalewicz M, Myszkowski B, Borkowska A, Bieliński M. Affective Temperament and Glycemic Control - The Psychological Aspect of Obesity and Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:4981-4991. [PMID: 35002270 PMCID: PMC8722534 DOI: 10.2147/dmso.s342185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/09/2021] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Affective temperament shows innate predisposition to affective disorders and has been studied in patients with type 2 diabetes mellitus (T2DM) and obesity. Studies describing connections between depressive disorders, obesity and T2DM, show a bidirectional way in which these disorders affect each other. Given that obesity, depression, and T2DM are still growing health problems of our times, the improvement of therapeutic strategies is required. The aim of our study was to evaluate affective temperament in obese individuals with T2DM and pre-diabetes and to investigate the correlations between affective temperaments and glycemic control. MATERIALS AND METHODS The study enrolled 185 obese individuals (146 females; 39 males) who were diagnosed with pre-diabetes, diabetes or without any carbohydrate disorder. For affective temperament evaluation, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was utilized; for glycemic control, the assessment of hemoglobin A1c (HbA1c) was performed. RESULTS We did not observe any significant differences of affective temperament between studied groups. In the group of patients with diabetes, depressive, cyclothymic and anxious temperaments positively correlated with HbA1c values indicating worse glycemic control. Inversly, hyperthymic dimension showed negative correlation with HbA1c values. CONCLUSION Affective temperaments may affect glycemic control in obese individuals with carbohydrate disorders. Individuals with stronger expression of cyclothymic, depressive and anxious temperaments may need more medical aid for better self-management. Hence, TEMPS-A is an easy and useful tool which may significantly improve the compliance in obese patients with carbohydrate disorders.
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Affiliation(s)
- Natalia Lesiewska
- Chair and Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Correspondence: Natalia Lesiewska Tel/Fax +48 52 585 37 03 Email
| | - Anna Kamińska
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Magdalena Michalewicz
- Department of Pulmonology, Allergology and Pulmonological Oncology, Military Clinical Hospital No. 10 with Policlinic in Bydgoszcz, Bydgoszcz, Poland
| | - Bartłomiej Myszkowski
- Department of Obstetrics, Women’s Diseases and Oncological Gynecology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Alina Borkowska
- Chair and Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Maciej Bieliński
- Chair and Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
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Albert U, De Ronchi D, Maina G, Pompili M. Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review. Curr Neuropharmacol 2020; 17:681-696. [PMID: 29929465 PMCID: PMC7059158 DOI: 10.2174/1570159x16666180620155941] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported. OBJECTIVE To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD. METHODS We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality. RESULTS In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness. CONCLUSION Overall, suicidality appears a relevant phenomenon in OCD.
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Affiliation(s)
- Umberto Albert
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Hamidian S, Pourshahbaz A, Bozorgmehr A, Ananloo ES, Dolatshahi B, Ohadi M. How obsessive-compulsive and bipolar disorders meet each other? An integrative gene-based enrichment approach. Ann Gen Psychiatry 2020; 19:31. [PMID: 32411272 PMCID: PMC7211339 DOI: 10.1186/s12991-020-00280-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/11/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The novel approaches to psychiatric classification assume that disorders, contrary to what was previously thought, are not completely separate phenomena. In this regard, in addition to symptom-based criteria, disturbances are also considered on the basis of lower level components. With this viewpoint, identifying common biochemical markers would be beneficial in adopting a comprehensive strategy for prevention, diagnosis and treatment. MAIN BODY One of the problematic areas in clinical settings is the coexistence of both obsessive-compulsive disorder (OCD) and bipolar disorder (BD) that is challenging and difficult to manage. In this study, using a system biologic approach we aimed to assess the interconnectedness of OCD and BD at different levels. Gene Set Enrichment Analysis (GSEA) method was used to identify the shared biological network between the two disorders. The results of the analysis revealed 34 common genes between the two disorders, the most important of which were CACNA1C, GRIA1, DRD2, NOS1, SLC18A1, HTR2A and DRD1. Dopaminergic synapse and cAMP signaling pathway as the pathways, dopamine binding and dopamine neurotransmitter receptor activity as the molecular functions, dendrite and axon part as the cellular component and cortex and striatum as the brain regions were the most significant commonalities. SHORT CONCLUSION The results of this study highlight the role of multiple systems, especially the dopaminergic system in linking OCD and BD. The results can be used to estimate the disease course, prognosis, and treatment choice, particularly in the cases of comorbidity. Such perspectives, going beyond symptomatic level, help to identify common endophenotypes between the disorders and provide diagnostic and therapeutic approaches based on biological in addition to the symptomatic level.
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Affiliation(s)
- Sajedeh Hamidian
- 1Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Abbas Pourshahbaz
- 1Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ali Bozorgmehr
- 2Iran Psychiatric Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Esmaeil Shahsavand Ananloo
- 3Department of Psychosomatic, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Behrooz Dolatshahi
- 1Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Mina Ohadi
- 4Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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Sakalli Kani A, Aksoy Poyraz C, Poyraz BC, Bayar MR, Akin E, Kose S. The role of affective temperaments and chronotype in pharmacotherapy response in patients with obsessive-compulsive disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1391157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ayse Sakalli Kani
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - B. Cağrı Poyraz
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - M. Reha Bayar
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry, University of Texas Medical School of Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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Abstract
PURPOSE OF REVIEW The review focused on associations between temperament dimensions and clinical features in different anxiety disorders, likewise in obsessive-compulsive disorder in clinical samples of adults. A literature search was conducted in the Medline and PsycINFO databases covering the years 2010-2016. A systematic review and grading of the level of evidence for an association between temperament dimension scores and clinical features in each disorder were performed. RECENT FINDINGS Twenty papers reporting 18 different studies were included. Five of the papers focused on panic disorder (PD), five on social anxiety disorder (SAD), three on post-traumatic stress disorder (PTSD), one on generalized anxiety disorder (GAD), three on obsessive-compulsive disorder (OCD), and an additional three papers on several anxiety disorders. The review consolidates the finding that trait anxiety, especially as assessed by Cloninger's model or the five-factor model, is a phenomenon common to all anxiety disorders and OCD. More follow-up studies including large samples are needed to differentiate the dimensional profiles of trait anxiety in specific disorders.
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Affiliation(s)
- Olli Kampman
- Faculty of Medicine and Life Sciences, University of Tampere, PO Box 100, 33014, Tampere, FI, Finland. .,Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland.
| | - Merja Viikki
- Faculty of Medicine and Life Sciences, University of Tampere, PO Box 100, 33014, Tampere, FI, Finland.,Tampere City Mental Health Center, Tampere, Finland
| | - Esa Leinonen
- Faculty of Medicine and Life Sciences, University of Tampere, PO Box 100, 33014, Tampere, FI, Finland.,Department of Psychiatry, Tampere University Hospital, Tampere, Finland
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Saraf G, Paul I, Viswanath B, Narayanaswamy JC, Math SB, Reddy YCJ. Bipolar disorder comorbidity in patients with a primary diagnosis of OCD. Int J Psychiatry Clin Pract 2017; 21:70-74. [PMID: 27646489 DOI: 10.1080/13651501.2016.1233344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is considered to be a common comorbid condition in subjects with obsessive-compulsive disorder (OCD), but there is limited literature on the prevalence of BD and its clinical correlates in those with a primary diagnosis of OCD. METHODS We studied the prevalence of BD in a sample of consecutively registered outpatients attending a specialty OCD clinic in India over a period of 13 months. One hundred and seventy-one patients with a primary diagnosis of OCD were assessed systematically using structured and semi-structured instruments. RESULTS The prevalence of lifetime BD in OCD was 4%. The OCD + BD group had an episodic course of OCD and higher rate of lifetime suicide attempts. CONCLUSIONS BD may not be as highly prevalent in OCD as reported in literature. Those with OCD seem to have only a marginally higher risk for developing BD than the general population. A diagnosis of BD seems to have a pathoplastic effect on the course of OCD. Patients with OCD-BD comorbidity have to be specifically assessed for suicide risk.
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Affiliation(s)
- Gayatri Saraf
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Imon Paul
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Biju Viswanath
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Janardhanan C Narayanaswamy
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Suresh Bada Math
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Y C Janardhan Reddy
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
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Ozdemiroglu F, Sevincok L, Sen G, Mersin S, Kocabas O, Karakus K, Vahapoglu F. Comorbid obsessive-compulsive disorder with bipolar disorder: A distinct form? Psychiatry Res 2015; 230:800-5. [PMID: 26561371 DOI: 10.1016/j.psychres.2015.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 08/09/2015] [Accepted: 11/02/2015] [Indexed: 12/24/2022]
Abstract
We examined whether the patients with Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) comorbidity may represent a distinct form of BD. The subjects diagnosed with BD (n=48), OCD (n=61), and BD with OCD (n=32) were compared in terms of several socio-demographic and clinical characteristics. Previous history of suicidal attempts was more likely to be higher in BD-OCD group compared to the other two groups. A more episodic course of OCD, higher rates of rapid cycling, and the seasonality were found in BD-OCD patients. The frequency of bipolar II and NOS subtypes was more prevalent in patients with BD-OCD than in OCD patients. The first diagnosed illness was BD in the majority of BD-OCD cases. It was found that first affective episode was major depression in half of BD-OCD patients. Age at onset of BD was found to be earlier in BD-OCD group compared to pure BD patients. Bipolarity may not have a specific effect on the phenomenology of OC symptoms. The episodic course of OCD, seasonality, rapid cycling, earlier onset of BD, and impulsivity in BD-OCD patients may be indicative for a distinct form of BD.
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Affiliation(s)
| | - Levent Sevincok
- Adnan Menderes University Department of Psychiatry, Aydın, Turkey.
| | - Gulnur Sen
- Adnan Menderes University Department of Psychiatry, Aydın, Turkey
| | - Sanem Mersin
- Adnan Menderes University Department of Psychiatry, Aydın, Turkey
| | - Oktay Kocabas
- Adnan Menderes University Department of Psychiatry, Aydın, Turkey
| | - Kadir Karakus
- Adnan Menderes University Department of Psychiatry, Aydın, Turkey
| | - Fatih Vahapoglu
- Adnan Menderes University Department of Psychiatry, Aydın, Turkey
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Albert U, Manchia M, Tortorella A, Volpe U, Rosso G, Carpiniello B, Maina G. Admixture analysis of age at symptom onset and age at disorder onset in a large sample of patients with obsessive-compulsive disorder. J Affect Disord 2015; 187:188-96. [PMID: 26339929 DOI: 10.1016/j.jad.2015.07.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A number of studies tested for the presence of different homogeneous subgroups of obsessive-compulsive disorder (OCD) patients depending on the age at onset (AAO). However, none of the various thresholds of AAO have been validated. No study examined whether age at symptoms onset (ASO) and age at disorder onset (ADO) each define specific and diverse OCD subgroups. METHODS We used normal distribution mixture analysis in a sample of 483 OCD patients to test whether we could identify subgroups of patients according to the AAO. We tested whether ASO and ADO had different distributions and identified different subgroups of OCD patients, and whether clinical correlates had similar patterns of associations with patients subgroups identified with ASO or ADO. RESULTS The mixture analysis showed a trimodal distribution for ASO (mean ASO: 6.9 years for the early onset, 14.99 years for the intermediate onset, and 27.7 years for the late onset component), and confirmed a bimodal distribution for ADO (mean ADO: 18.0 and 29.5 years). Significant differences in the clinical profile of the subgroups emerged, particularly when identified using ASO. LIMITATIONS Limitations of our study are the retrospective investigation of AAO, and the fact that our sample may not represent the OCD population, as we enrolled patients referring to a tertiary center specialized in the treatment of OCD. Our findings need to be confirmed in community samples. Another limitation is the lack of information on medication status at enrollment. CONCLUSIONS Age at symptom onset and ADO showed distinct patterns of distributions. Similarly, phenotypic delineation was specific for ASO and ADO identified subgroups. Accurate clinical and biological profiling of ADO and ASO subgroups might show distinct genetic liabilities, ultimately leading to better nosological models and possibly to improved treatment decision making of OCD patients.
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Affiliation(s)
- Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, Anxiety and Mood Disorders Unit, University of Turin, Italy Via Cherasco 11, 10126 Torino, Italy.
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy Via Liguria 13, 09127 Cagliari, Italy; Department of Pharmacology, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College St, Halifax, Nova Scotia, Canada B3H 4R2
| | | | - Umberto Volpe
- Department of Psychiatry, University of Naples SUN, Napoli, Italy
| | - Gianluca Rosso
- Department of Mental Health, "San Luigi-Gonzaga" Hospital, University of Turin, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano (To), Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy Via Liguria 13, 09127 Cagliari, Italy
| | - Giuseppe Maina
- Department of Mental Health, "San Luigi-Gonzaga" Hospital, University of Turin, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano (To), Italy
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Amerio A, Stubbs B, Odone A, Tonna M, Marchesi C, Ghaemi SN. The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2015; 186:99-109. [PMID: 26233320 DOI: 10.1016/j.jad.2015.06.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. METHODS A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). LIMITATIONS Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. CONCLUSIONS This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups.
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Affiliation(s)
- A Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - B Stubbs
- School of Health and Social Care, University of Greenwich, London, UK.
| | - A Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - M Tonna
- Department of Mental Health, Local Health Service, Parma, Italy.
| | - C Marchesi
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy.
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA.
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11
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Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. J Affect Disord 2015; 183:119-33. [PMID: 26005206 DOI: 10.1016/j.jad.2015.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 12/16/2022]
Abstract
Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities.
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Tonna M, Amerio A, Ottoni R, Paglia F, Odone A, Ossola P, De Panfilis C, Ghaemi SN, Marchesi C. The clinical meaning of obsessive-compulsive symptoms in bipolar disorder and schizophrenia. Aust N Z J Psychiatry 2015; 49:578-9. [PMID: 25688121 DOI: 10.1177/0004867415572010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Andrea Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Rebecca Ottoni
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - Francesca Paglia
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - Anna Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Paolo Ossola
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA
| | - Carlo Marchesi
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
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13
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Pallanti S, Grassi G. Pharmacologic treatment of obsessive-compulsive disorder comorbidity. Expert Opin Pharmacother 2014; 15:2543-52. [DOI: 10.1517/14656566.2014.964208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Pombo S, Figueira ML, da Costa NF, Ismail F, Yang G, Akiskal K, Akiskal H. The burden of cyclothymia on alcohol dependence. J Affect Disord 2013; 151:1090-6. [PMID: 24091304 DOI: 10.1016/j.jad.2013.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. METHODS A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. RESULTS Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. LIMITATIONS Correlational study CONCLUSIONS CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.
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Affiliation(s)
- Samuel Pombo
- Psychiatric Service and Medical Psychology from Santa Maria Universitary Hospital of Lisbon, Portugal.
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15
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Fistikçi N, Hacioğlu M, Erek Ş, Tabo A, Erten E, Güler AS, Kalkan M, Saatçioğlu Ö. Differences in Affective Temperaments in Anxiety Disorders: Comparison of Panic Disorder and Obsessive Compulsive Disorder. Noro Psikiyatr Ars 2013; 50:337-343. [PMID: 28360567 DOI: 10.4274/npa.y6464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/18/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION In this study, probable differences in affective temperament among anxiety disorders were investigated via a comparison of panic disorder (PD) and obsessive-compulsive disorder (OCD). METHOD 44 patients with OCD and 42 patients with PD, who were admitted to Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery outpatient clinics with complaints of OCD and PD and were diagnosed according to DSM IV criteria, were consecutively included in the study after informed consent was taken. A sociodemographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory, Panic and Agoraphobia Scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the temperament evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were given to the patients. PD and OCD patients were compared in terms of affective temperament characteristics. RESULTS Mean age, educational status and gender distribution of OCD and PD patients were similar (p>0.05). Dominant depressive temperament was more prominent in OCD group than in PD group (p=0.021). Hyperthymic temperament scores were higher in PD group than in OCD group (p=0.002). Dominant hyperthymic temperament was not encountered in either group. CONCLUSION Dominant depressive temperament was more prominent in OCD group whereas hyperthymic temperament scores were higher in PD group. These findings should be evaluated in studies with larger sample sizes.
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Affiliation(s)
- Nurhan Fistikçi
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of 3 Psychiatry, İstanbul, Turkey
| | - Münevver Hacioğlu
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of 3 Psychiatry, İstanbul, Turkey
| | - Şakire Erek
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of 3 Psychiatry, İstanbul, Turkey
| | - Abdülkadir Tabo
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of Neurosis, İstanbul, Turkey
| | - Evrim Erten
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of 3 Psychiatry, İstanbul, Turkey
| | | | - Murat Kalkan
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of 3 Psychiatry, İstanbul, Turkey
| | - Ömer Saatçioğlu
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology education and Research Hospital, Clinic of 3 Psychiatry, İstanbul, Turkey
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16
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Albert U, Aguglia A, Chiarle A, Bogetto F, Maina G. Metabolic syndrome and obsessive-compulsive disorder: a naturalistic Italian study. Gen Hosp Psychiatry 2013; 35:154-9. [PMID: 23158675 DOI: 10.1016/j.genhosppsych.2012.10.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/30/2012] [Accepted: 10/03/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The increased risk for metabolic syndrome (MetS) in individuals with schizophrenia and bipolar disorder has been documented. No study examined MetS in patients with obsessive-compulsive disorder (OCD), despite the fact that a great proportion of them are treated with antipsychotic addition. The aim of our study was to investigate the prevalence and the sociodemographic and clinical correlates of MetS in an Italian sample of patients with OCD. METHOD Subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, OCD and a Yale-Brown Obsessive-Compulsive Scale score ≥ 16 were included. Sociodemographic and clinical characteristics, current and lifetime pharmacological treatments, lifestyle information, and comorbidity for cardiovascular diseases and diabetes were collected. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III modified criteria. RESULTS We enrolled 104 patients with OCD. MetS was present in 21.2% (95% confidence interval: 13.7%-30.3%) of the sample. Abdominal obesity was present in 36.5%, hypertension in 42.3%, high triglycerides in 23.1%, low high-density lipoprotein cholesterol levels in 22.1% and fasting hyperglycemia in 4.8% of the sample. MetS was associated with cigarette smoking (duration of cigarette smoking), absence of physical activity, a higher body mass index and a greater proportion of obesity. Among pharmacological treatments, MetS was associated with the duration of the exposure (lifetime) to antipsychotics. CONCLUSIONS This is the first study that examined the prevalence and correlates of MetS in a sample of patients with OCD. Our cross-sectional evaluation found a prevalence of MetS higher than those reported in the Italian general population, although the confidence interval encompasses the general population estimate reported. Patients with OCD on antipsychotic treatment are particularly at risk for MetS and should be carefully monitored for metabolic abnormalities and cardiovascular complications.
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Affiliation(s)
- Umberto Albert
- Department of Neurosciences, Anxiety and Mood Disorders Unit, University of Turin, Italy, Via Cherasco 11-10126 Torino, Italy.
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Friborg O, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. J Affect Disord 2013; 145:143-55. [PMID: 22999891 DOI: 10.1016/j.jad.2012.07.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/02/2012] [Accepted: 07/05/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. METHODS A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. RESULTS The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity. LIMITATIONS Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong. CONCLUSIONS The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5.
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Affiliation(s)
- Oddgeir Friborg
- Faculty of Health Sciences, Department of Psychology, University of Tromsø, Norway.
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18
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Rosso G, Albert U, Asinari GF, Bogetto F, Maina G. Stressful life events and obsessive-compulsive disorder: clinical features and symptom dimensions. Psychiatry Res 2012; 197:259-64. [PMID: 22370150 DOI: 10.1016/j.psychres.2011.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/20/2011] [Accepted: 10/05/2011] [Indexed: 01/15/2023]
Abstract
The potential role of stressful life events (SLEs) in the genesis of obsessive-compulsive disorder (OCD) has been suggested by several authors, but whether the number or the severity or the type of SLEs preceding the onset of OCD has a triggering effect is unclear. Further, sociodemographic and clinical features of OCD preceded by SLEs, and the relationship between type of SLEs and type of obsessive-compulsive symptomatology remain mainly unexplored. The aims of this study were to compare the clinical features of OCD with and without SLEs preceding it and to examine the relationship between type of SLEs and OCD symptom dimensions. The number and type of SLEs which occurred before the onset of OCD were determined in 329 patients: the raters had to decide whether an occurrence 12 months before the onset of OCD would fit any of the 61 items on Paykel's list, and each event reported was carefully investigated in order to determine the exact time of occurrence. At least one event preceded the onset of OCD in 200 patients (60.8%), and this was significantly associated with female gender, abrupt onset of the disorder and somatic obsessions. Moreover, LogReg Analysis identified three specific traumatic events ("hospitalization of a family member", "major personal physical illness", "loss of personally valuable object") significantly associated with a symptom dimension (symmetry obsessions, repeating, ordering/arranging, counting, and checking compulsions). Additional evidence regarding the association among SLE-preceded OCD, female gender, somatic obsessions and symmetry/ordering symptoms should be obtained to advance the understanding of OCD.
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Timpano KR, Rubenstein LM, Murphy DL. Phenomenological features and clinical impact of affective disorders in OCD: a focus on the bipolar disorder and OCD connection. Depress Anxiety 2012; 29:226-33. [PMID: 22109969 PMCID: PMC3322278 DOI: 10.1002/da.20908] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/02/2011] [Accepted: 09/18/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Given the general population prevalence rates of obsessive compulsive disorder (OCD) and the affective disorders, one would expect the co-occurrence of these syndromes to be rare. Yet findings by our group and others have revealed extremely high rates of comorbidity in OCD with both depressive disorders (DD; 50%) and bipolar disorder (BPD; 10%). The current investigation sought to further clarify the role affective disorder comorbidity-particularly that with BPD-may play in the clinical expression of OCD. METHOD A total of 605 individuals with OCD were evaluated with the Structured Clinical Interview for DSM-IV. The sample included three groups: BPD (bipolar I or II; N = 79, 13.1%), DD (major depression or dysthymia; N = 388, 64.1%), and NAD (no affective disorder comorbidity; N = 138, 22.8%). Group-wise comparisons were conducted on comorbidity patterns, impairment measures, and clinical features of OCD. RESULTS Analyses revealed a graded severity pattern, with the BPD group as the most severe, followed by the DD group, and finally the NAD group. Severity was reflected by the total number of Axis I disorders (P<.01), the number of psychiatric hospitalizations (P<.001), impairment measures (Ps<.05), and OCD symptoms (P<.01). It is worth noting that the impairment and OCD symptom severity findings were not attributable to the higher level of nonmood disorder comorbidities in the BPD and DD groups. RESULTS Those individuals with comorbid affective disorders, particularly BPD, represent a clinically severe group compared to those without such comorbidity. Clarifying the phenomenological features of OCD-affective disorder comorbidity has important etiological and treatment implications.
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Pallanti S, Grassi G, Sarrecchia ED, Cantisani A, Pellegrini M. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Front Psychiatry 2011; 2:70. [PMID: 22203806 PMCID: PMC3243905 DOI: 10.3389/fpsyt.2011.00070] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/21/2011] [Indexed: 12/15/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder affecting approximately 1-3% of the population. OCD is probably an etiologically heterogeneous condition. Individuals with OCD frequently have additional psychiatric disorders concomitantly or at some time during their lifetime. Recently, some authors proposed an OCD sub-classification based on comorbidity. An important issue in assessing comorbidity is the fact that the non-response to treatment often involves the presence of comorbid conditions. Non-responsive patients are more likely to meet criteria for comorbid axis I or axis II disorders and the presence of a specific comorbid condition could be a distinguishing feature in OCD, with influence on the treatment adequacy and outcome.
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Affiliation(s)
- Stefano Pallanti
- Department of Psychiatry, Mount Sinai School of Medicine New York, NY, USA
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