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Menculini G, Steardo L, Sciarma T, D'Angelo M, Lanza L, Cinesi G, Cirimbilli F, Moretti P, Verdolini N, De Fazio P, Tortorella A. Sex Differences in Bipolar Disorders: Impact on Psychopathological Features and Treatment Response. Front Psychiatry 2022; 13:926594. [PMID: 35757228 PMCID: PMC9226371 DOI: 10.3389/fpsyt.2022.926594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sex differences were demonstrated in bipolar disorders (BD) concerning epidemiological, clinical, and psychopathological characteristics, but consensus is lacking. Moreover, data concerning the influence of sex on treatment response in BD is contrasting. The present cross-sectional study aimed to analyze sex differences in a population of BD subjects, with specific focus on psychopathological features and treatment response. MATERIALS AND METHODS Subjects diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th version (DSM-5) were recruited. Socio-demographic and clinical characteristics were collected. The Hamilton Rating Scale for Depression, the Mania Rating Scale (MRS), the brief version of the Temperament Evaluation of Memphis, Pisa and San Diego-Münster version (briefTEMPS-M), and the Barratt Impulsiveness Scale-11 items (BIS-11) were used for psychopathological assessment. Treatment response was appraised with the Alda Scale. We performed bivariate analyses to compare socio-demographic, clinical, and psychopathological characteristics between men and women (p < 0.05). A logistic regression was run to analyze features that were significantly associated with female sex. RESULTS Among the recruited 219 BD subjects, 119 (54.3%) were females. Women had a lower scholarity (p = 0.015) and were less frequently employed (p = 0.001). As for psychopathological features, a higher MRS total score (p < 0.001) was detected among women, as well as higher BIS-11 total score (p = 0.040), and briefTEMPS-M score for anxious temperament (p = 0.006). Men showed higher prevalence of DSM-5 mixed features (p = 0.025), particularly during a depressive episode (p = 0.014). Women reported longer duration of untreated illness (DUI) (p < 0.001). There were no sex differences in the Alda Scale total score when considering the whole sample, but this was significantly higher among men (p = 0.030) when evaluating subjects treated with anticonvulsants. At the logistic regression, female sex was positively associated with longer DUI (p < 0.001; OR 1.106, 95% CI 1.050-1.165) and higher MRS total score (p < 0.001; OR 1.085, 95% CI 1.044-1.128) and negatively associated with employment (p = 0.003; OR 0.359, 95% CI 0.185-0.698) and DSM-5 mixed features (p = 0.006; OR 0.391, 95% CI 0.200-0.762). CONCLUSIONS The clinical presentation of BD may differ depending on sex. The severity of BD should not be neglected among women, who may also display worse treatment response to anticonvulsants.
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Affiliation(s)
- Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Tiziana Sciarma
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Martina D'Angelo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Laura Lanza
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gianmarco Cinesi
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Federica Cirimbilli
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Patrizia Moretti
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Norma Verdolini
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Zhang T, Guo L, Li R, Wang F, Yang WM, Yang JB, Cui ZQ, Zhou CH, Chen YH, Yu H, Peng ZW, Tan QR. Alterations of Plasma Lipids in Adult Women With Major Depressive Disorder and Bipolar Depression. Front Psychiatry 2022; 13:927817. [PMID: 35923457 PMCID: PMC9339614 DOI: 10.3389/fpsyt.2022.927817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Lipidomics has been established as a potential tool for the investigation of mental diseases. However, the composition analysis and the comparison of the peripheral lipids regarding adult women with major depressive depression (MDD) or bipolar depression (BPD) has been poorly addressed. In the present study, age-matched female individuals with MDD (n = 28), BPD (n = 22) and healthy controls (HC, n = 25) were enrolled. Clinical symptoms were assessed and the plasma samples were analyzed by comprehensive lipid profiling based on liquid chromatography-mass spectrometry (LC/MS). We found that the composition of lipids was remarkably changed in the patients with MDD and BPD when compared to HC or compared to each other. Moreover, we identified diagnostic potential biomarkers comprising 20 lipids that can distinguish MDD from HC (area under the curve, AUC = 0.897) and 8 lipids that can distinguish BPD from HC (AUC = 0.784), as well as 13 lipids were identified to distinguish MDD from BPD with moderate reliability (AUC = 0.860). This study provides further understanding of abnormal lipid metabolism in adult women with MDD and BPD and may develop lipid classifiers able to effectively discriminate MDD from BPD and HC.
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Affiliation(s)
- Ting Zhang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Lin Guo
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Rui Li
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Fei Wang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Wen-Mao Yang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Jia-Bin Yang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Zhi-Quan Cui
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Cui-Hong Zhou
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yi-Huan Chen
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Huan Yu
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zheng-Wu Peng
- Department of Psychiatry, Chang'an Hospital, Xi'an, China.,Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Qing-Rong Tan
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
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3
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Hypomanic symptoms in early pregnancy: prevalence and associated factors. Arch Womens Ment Health 2021; 24:463-471. [PMID: 33094351 DOI: 10.1007/s00737-020-01078-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.
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Auger N, Potter BJ, Healy-Profitós J, He S, Schnitzer ME, Paradis G. Mood disorders in pregnant women and future cardiovascular risk. J Affect Disord 2020; 266:128-134. [PMID: 32056866 DOI: 10.1016/j.jad.2020.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/14/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The link between mood disorders and cardiovascular disease in women is unclear. We studied the association of mood disorders around pregnancy with the future risk of cardiovascular disease. METHODS We analyzed a cohort of 1,028,109 women who were pregnant between 1989 and 2012 in Quebec, Canada. We identified women hospitalized for bipolar disorder or depression before, during, or in the 5 years after delivery, and tracked them over time to identify cardiovascular hospitalizations up to 23 years later. We calculated the incidence of cardiovascular hospitalization per 1,000 person-years, and used Cox regression to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association with mood disorders. RESULTS Incidence of cardiovascular events was higher for bipolar disorder (4.4 per 1,000 person-years) and depression (4.2 per 1,000) than no mental illness (1.8 per 1,000). Compared with no mental disorder, bipolar disorder was associated with 3.0 times the risk of cardiovascular disease (95% CI 1.92-4.73), and depression with 2.3 times the risk (95% CI 1.34-3.99). The risk of cardiovascular disease was elevated for bipolar hospitalization before pregnancy (HR 2.42, 95% CI 1.90-3.09), during pregnancy (HR 3.78, 95% CI 2.32-6.17), in the first year postpartum (HR 2.20, 95% CI 1.54-3.12), and 1-5 years postpartum (HR 2.42, 95% CI 2.04-2.86). Similar associations were found for depression. LIMITATIONS We could only assess mood disorders that required hospitalization, and certain covariates might be underreported. CONCLUSIONS Women with bipolar disorder or depression before, during, or after pregnancy may benefit from early prevention of cardiovascular disease.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Brian J Potter
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Division of Cardiology, Department of Medicine, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Siyi He
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Mireille E Schnitzer
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Gilles Paradis
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Solé E, Roca A, Torres A, Hernández AS, Fernández N, Díaz CN, Vieta E, Garcia-Esteve L. Obstetric complications in bipolar disorder: Psychiatric factors and the risk of caesarean section. Eur Neuropsychopharmacol 2020; 32:47-55. [PMID: 31911063 DOI: 10.1016/j.euroneuro.2019.12.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
Bipolar Disorder (BD) is a chronic psychiatric condition with somatic morbidity that requires continuous mood stabilizing treatment to prevent relapses. Pregnant women with BD have shown an increased rate of caesarean section (C-Section) in comparison with women without BD. Because specific differentiated profiles between mothers with BD that require C-Section and those that do not require C-Section have not been largely discussed, we aim to explore the risk factors associated with the type of delivery in pregnant women with BD. A prospective cohort study was conducted at the Perinatal Mental Health Unit. 100 pregnant women with BD were followed throughout their pregnancy by obstetric and psychiatric services at the same hospital. The cohort was developed in order to compare psychiatric and obstetric outcomes between women with BD that required C-Section (N = 40) versus women that did not require C-Section (N = 60). Final regression models showed an increased risk for obstetric complications during labour (OR 4,52, 95% CI 1,66-12,29), higher rates of hypothyroidism (OR 3,73, 95% CI 1,04-13,73) and treatment with lithium + antidepressant (OR 4,24, 95% CI 1,34-13,40) amongst the C-Section group when compared to the non-C-Section group. In our sample, women with BD treated with lithium plus antidepressant, with hypothyroidism and without obstetric complications have a 70,5% probability of C-Section. In conclusion, psychopharmacology and thyroid function might help understanding which women with BD will have more probability of C-Section. The implementation of more targeted interventions in selected patients might be useful to avoid complications during delivery.
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Affiliation(s)
- Eva Solé
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Bipolar and Depressives Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Alba Roca
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
| | - Anna Torres
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
| | - Ana Sandra Hernández
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Noemí Fernández
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Carmen Naranjo Díaz
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressives Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
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6
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Rosso G, Aragno E, Mehanović E, Di Salvo G, Maina G. Age at Menarche in Women With Bipolar Disorder: Correlation With Clinical Features and Peripartum Episodes. Front Psychiatry 2020; 11:00851. [PMID: 33033479 PMCID: PMC7509456 DOI: 10.3389/fpsyt.2020.00851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is related to reproductive cycles. However, findings on putative correlation between age at menarche and course of BD are particularly scarce and conflicting. The aim of the present study is to analyze the relationship between age at menarche and characteristics of BD, including comorbid medical conditions and peripartum mood episodes. METHODS The study sample consists of 288 women with BD type I, II, or not otherwise specified (NOS). Age at menarche was both considered as a continuous variable and categorized into three groups: early menarche (≤11 years), normal menarche (12-14 years), and late menarche (≥15 years). The study focused on two sets of comparisons, by age at menarche and women with vs. without children. Spearman correlation matrix was produced to calculate correlations between the variables of interest. Socio-demographic and clinical characteristics between early, normal and late menarche, and women with vs. without children were examined through descriptive statistics. Finally, adjusted logistic regression analysis was run to examine the association between variables. RESULTS Out of 288 women included in the study, 21.5% had early menarche, 55.6% had normal, and 22.9% had late menarche. Women with early menarche had higher rates of metabolic syndrome compared to women with normal menarche even after adjustment for age. The subgroup of women with children does not present clinical differences compared to women without children except a lower rate of psychiatric comorbidities. At least one mood episode with peripartum onset occurred in 29.6% of the women with children. After controlling for confounding variables, women with late menarche were associated with lower probability of BD peripartum episodes compared to women with normal menarche. CONCLUSION Age at menarche may be related to specific characteristics of women with BD. The results deserve to be deepened in further studies.
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Affiliation(s)
- Gianluca Rosso
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Elena Aragno
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Emina Mehanović
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Gabriele Di Salvo
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Giuseppe Maina
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Torino, Italy
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Zengin Eroglu M, Lus MG. Impulsivity, Unplanned Pregnancies, and Contraception Among Women with Bipolar Disorder. Neuropsychiatr Dis Treat 2020; 16:407-414. [PMID: 32103960 PMCID: PMC7012326 DOI: 10.2147/ndt.s238887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Impulsivity is one of the principal symptoms of bipolar and related disorders (BD). Unsafe sex and unplanned pregnancies are serious problems in clinical practice. The aim of this study was to investigate impulsivity levels, contraception methods, and levels of planned pregnancies among women with bipolar and related disorders (WBD). METHODS Fifty-eight euthymic women with BD (bipolar disorder type I, II, or other) were matched by education levels with a control group of 59 healthy women. Data about their demographic, clinical-Barratt Impulsiveness Scale (BIS-11), Hamilton Depression Rating Scale, and Young Mania Rating Scale scores-and reproductive health features were obtained and compared between the groups. RESULTS No difference was found regarding BIS-11 (total, nonplanning, motor, and attentional subscales) scores between the WBD and control groups. The overall rate of contraception use was higher in WBD (96.6%), but they generally preferred "traditional" methods (i.e., withdrawal and calendar). The total rate of unplanned pregnancies in WBD was 49.52%. Rate of unplanned pregnancies in WBD was significantly different from women without bipolar disorder (49.52% vs 15.04%). DISCUSSION Levels of impulsivity in euthymic WBD under treatment were similar to those of healthy women in the control sample. WBD paid attention to contraception although they usually used traditional methods. The findings indicate that most WBD use contraception, yet the contraception is potentially ineffective especially if WBD have more unplanned pregnancies. The provision of an effective contraception method in WBD is suggested for all clinicians, in order to prevent sexually transmitted diseases and unplanned pregnancies, and thus protect the health of both mother and fetus.
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Affiliation(s)
- Meliha Zengin Eroglu
- Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Uskudar-Istanbul 34668, Turkey
| | - Melek Gözde Lus
- Department of Child and Adolescent Psychiatry, Haydarpasa Numune Training and Research Hospital, Uskudar-Istanbul 34668, Turkey
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8
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Ragazan DC, Eberhard J, Berge J. Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study. Front Psychiatry 2020; 11:598946. [PMID: 33262715 PMCID: PMC7688467 DOI: 10.3389/fpsyt.2020.598946] [Citation(s) in RCA: 4] [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: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006-2014. Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables. Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56-84%), carbamazepine by 44% (18-62%), aripiprazole by 29% (13-42%), and valproate by 23% (11-33%); whereas among males, ziprasidone by 65% (41-79%). Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes.
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Affiliation(s)
- Dragos C Ragazan
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Vancouver Coastal Health Authority, University of British Columbia Hospital Detwiller Pavilion, Vancouver, BC, Canada
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden
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9
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Voinsky I, McCarthy MJ, Shekhtman T, Kelsoe JR, Gurwitz D. SCN11A mRNA levels in female bipolar disorder PBMCs as tentative biomarker for distinct patient sub-phenotypes. Drug Dev Res 2019; 80:1128-1135. [PMID: 31498915 DOI: 10.1002/ddr.21598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 01/12/2023]
Abstract
Bipolar disorder (BD) is a complex neuropsychiatric disorder characterized by recurrent mania and depression episodes and requiring lifelong treatment with mood stabilizing drugs. Several lines of evidence, including with BD patient iPSC-derived neurons, suggest that neuronal hyperexcitability may underlie the key clinical symptoms of BD. Indeed, higher mRNA levels of SCN11A, coding for the voltage-gated sodium channel NaV 1.9 implicated in nociception, were detected in iPSC-derived neurons from BD patients, and were normalized by in vitro lithium. Here we studied SCN11A expression in peripheral blood mononuclear cells (PBMCs) from well-phenotyped female BD patients and controls and evaluated their association with several clinical sub-phenotypes. We observed higher mRNA levels of SCN11A in PBMCs from female BD patients with no records of alcohol dependence (p = .0050), no records of psychosis (p = .0097), or no records of suicide attempts (p = .0409). A trend was observed for higher SCN11A expression (FD = 1.91; p = .052) in BD PBMCs compared with controls. Datamining of published postmortem gene expression datasets indicated higher SCN11A expression in dorsolateral prefrontal cortex and orbitofrontal cortex tissues from BD patients compared with controls. Higher phenotype-associated expression levels in PBMC from BD patients were also observed for ID2 (alcohol dependence, suicide attempts) and HDGFRP3 (seasonal BD pattern). Our findings suggest that higher PBMC SCN11A expression levels may be associated with certain behavioral BD sub-phenotypes, including lack of alcohol dependence and psychosis, among BD patients. The NaV 1.9 voltage-gated sodium channel thus deserves consideration as a tentative phenotype modifier in BD.
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Affiliation(s)
- Irena Voinsky
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla, California.,VA San Diego Healthcare System, San Diego, California
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - David Gurwitz
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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10
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Solé E, Torres A, Roca A, Hernández AS, Roda E, Sureda B, Martin-Santos R, Vieta E, Garcia-Esteve L. Obstetric complications in bipolar disorder: The role of mental health disorders in the risk of caesarean section. J Affect Disord 2019; 252:458-463. [PMID: 31004826 DOI: 10.1016/j.jad.2019.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies' health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population. METHODS A case-control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section. RESULTS Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4-1,6). Case group had more somatic illness (SI) without treatment (P<, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P<, 001), obstetric complications during labour (P<,001), and SI with and without treatment (P<,001 and P=,007, respectively) were higher in women that required C- section. CONCLUSION Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.
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Affiliation(s)
- Eva Solé
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain; Bipolar Disorder Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Anna Torres
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Alba Roca
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Ana Sandra Hernández
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ester Roda
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Bàrbara Sureda
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Rocío Martin-Santos
- Vulnerability, Psychopathology and Gender research group, Generalitat de Catalunya, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender research group, Generalitat de Catalunya, Catalonia, Spain
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11
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Rabelo-da-Ponte FD, Pessoa Gomes JM, Torres NL, Barbosa JIC, de Andrade GM, Macedo D, Ceppi B. Behavioral, affective, and cognitive alterations induced by individual and combined environmental stressors in rats. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 41:289-296. [PMID: 30892378 PMCID: PMC6804305 DOI: 10.1590/1516-4446-2018-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether exposing rats to individual or combined environmental stressors triggers endophenotypes related to mood and anxiety disorders, and whether this effect depends on the nature of the behavior (i.e., innate or learned). METHODS We conducted a three-phase experimental protocol. In phase I (baseline), animals subjected to mixed schedule of reinforcement were trained to press a lever with a fixed interval of 1 minute and a limited hold of 3 seconds. On the last day of phase I, an open-field test was performed and the animals were divided into four experimental groups (n=8/group). In phase II (repeated stress), each group was exposed to either hot air blast (HAB), paradoxical sleep deprivation (PSD) or both (HAB+PSD group) on alternate days over a 10-day period. Control group animals were not exposed to stressors. In phase III (post-stress evaluation), behavior was analyzed on the first (short-term effects), third (mid-term effects), and fifth (long-term effects) days after repeated stress. RESULTS The PSD group presented operant hyperactivity, the HAB group presented spontaneous hypoactivity and anxiety, and the HAB+PSD group presented spontaneous hyperactivity, operant hypoactivity, impulsivity, loss of interest, and cognitive impairment. CONCLUSION A combination of environmental stressors (HAB and PSD) may induce endophenotypes related to bipolar disorder.
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Affiliation(s)
| | | | - Nathércia Lima Torres
- Departamento de Psicologia, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | | | - Geanne Matos de Andrade
- Laboratório de Neurociências e Comportamento, Departamento de Fisiologia e Farmacologia, UFC, Fortaleza, CE, Brazil
| | - Danielle Macedo
- Laboratório de Neurofarmacologia, Departamento de Fisiologia e Farmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, UFC, Fortaleza, CE, Brazil.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Ribeirão Preto, SP, Brazil
| | - Bruno Ceppi
- Laboratório de Neurociências e Comportamento, Departamento de Fisiologia e Farmacologia, UFC, Fortaleza, CE, Brazil
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Syan SK, Smith M, Frey BN, Remtulla R, Kapczinski F, Hall GBC, Minuzzi L. Resting-state functional connectivity in individuals with bipolar disorder during clinical remission: a systematic review. J Psychiatry Neurosci 2018; 43:298-316. [PMID: 30125243 PMCID: PMC6158027 DOI: 10.1503/jpn.170175] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/21/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Bipolar disorder is chronic and debilitating. Studies investigating resting-state functional connectivity in individuals with bipolar disorder may help to inform neurobiological models of illness. METHODS We conducted a systematic review with the following goals: to summarize the literature on resting-state functional connectivity in bipolar disorder during clinical remission (euthymia) compared with healthy controls; to critically appraise the literature and research gaps; and to propose directions for future research. We searched PubMed/MEDLINE, Embase, PsycINFO, CINAHL and grey literature up to April 2017. RESULTS Twenty-three studies were included. The most consistent finding was the absence of differences in resting-state functional connectivity of the default mode network (DMN), frontoparietal network (FPN) and salience network (SN) between people with bipolar disorder and controls, using independent component analysis. However, 2 studies in people with bipolar disorder who were positive for psychosis history reported DMN hypoconnectivity. Studies using seed-based analysis largely reported aberrant resting-state functional connectivity with the amygdala, ventrolateral prefrontal cortex, cingulate cortex and medial prefrontal cortex in people with bipolar disorder compared with controls. Few studies used regional homogeneity or amplitude of low-frequency fluctuations. LIMITATIONS We found heterogeneity in the analysis methods used. CONCLUSION Stability of the DMN, FPN and SN may reflect a state of remission. Further, DMN hypoconnectivity may reflect a positive history of psychosis in patients with bipolar disorder compared with controls, highlighting a potentially different neural phenotype of psychosis in people with bipolar disorder. Resting-state functional connectivity changes between the amygdala, prefrontal cortex and cingulate cortex may reflect a neural correlate of subthreshold symptoms experienced in bipolar disorder euthymia, the trait-based pathophysiology of bipolar disorder and/or a compensatory mechanism to maintain a state of euthymia.
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Affiliation(s)
- Sabrina K Syan
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Mara Smith
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Benicio N Frey
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Raheem Remtulla
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Flavio Kapczinski
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Geoffrey B C Hall
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
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13
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Risk of sexual transmitted infection following bipolar disorder: a nationwide population-based cohort study. Oncotarget 2018; 9:17533-17542. [PMID: 29707127 PMCID: PMC5915135 DOI: 10.18632/oncotarget.24780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background Bipolar disorder is a severe mental disorder associated with functional and cognitive impairment. Numerous studies have investigated associations between sexually transmitted infections (STIs) and psychiatric illnesses. However, the results of these studies are controversial. Objective We explored the association between bipolar disorder and the subsequent development of STIs, including human immunodeficiency virus infection; primary, secondary, and latent syphilis; genital warts; gonorrhea; chlamydial infection; and trichomoniasis. Results The bipolar cohort consisted of 1293 patients, and the comparison cohort consisted of 5172 matched control subjects without bipolar disorder. The incidence of subsequent STIs (hazard ratio (HR) = 2.23, 95% confidence interval (CI) 1.68-2.96) was higher among the patients with bipolar disorder than in the comparison cohort. Furthermore, female gender is a risk factor for acquisition of STIs (HR = 2.36, 95% CI 1.73-4.89) among patients with bipolar disorder. For individual STIs, the results indicated that the patients with bipolar disorder exhibited a markedly higher risk for subsequently contracting syphilis, genital warts, and trichomoniasis. Conclusions Bipolar disorder might increase the risk of subsequent newly diagnosed STIs, including syphilis, genital warts, and trichomoniasis. Clinicians should pay particular attention to STIs in patients with bipolar disorder. Patients with bipolar disorder, especially those with a history of high-risk sexual behaviors, should be routinely screened for STIs. Methods We identified patients who were diagnosed with bipolar disorder in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without bipolar disorder who were matched with the bipolar cohort according to age and gender. The occurrence of subsequent new-onset STIs was evaluated in both cohorts.
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Syan SK, Minuzzi L, Smith M, Allega OR, Hall GB, Frey BN. Resting state functional connectivity in women with bipolar disorder during clinical remission. Bipolar Disord 2017; 19:97-106. [PMID: 28258639 DOI: 10.1111/bdi.12469] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Periods of euthymia in bipolar disorder (BD) serve as a valuable time to study trait-based pathophysiology. The use of resting state functional connectivity (Rs-FC) can aid in the understanding of BD pathophysiology free of task or mood state biases. The present study investigated two unexplored areas of Rs-FC research in bipolar remission: (i) Rs-FC in women, controlling for the potential influence of premenstrual symptoms, and (ii) the use of both independent component analysis (ICA) and seed-based analysis (SBA) to investigate Rs-FC. METHODS We investigated Rs-FC of the default mode network, meso-paralimbic network and fronto-parietal network in a sample of 32 euthymic women with BD and 36 age-matched controls during the mid-follicular phase of their menstrual cycle. Rs-FC was assessed with ICA and SBA using the posterior cingulate cortex (PCC), amygdala and dorsolateral prefrontal cortex (dlPFC) as seed points for their respective resting state networks. RESULTS In BD, compared to controls, SBAs revealed increased coupling between the PCC and the angular gyrus (P=.002, false discovery rate [FDR]-corrected) and between the right dlPFC and the brainstem (P=.03, FDR-corrected). In BD only, PCC-angular gyrus coupling was correlated with anxiety symptoms. Group differences in Rs-FC using ICA did not survive multiple comparisons. CONCLUSIONS Negative findings from whole-brain ICA Rs-FC may reflect a state of clinical remission in BD. Heightened activation between the PCC and the angular gyrus and between the dlPFC and the brainstem may reflect (i) an abnormal trait integration of affective information during clinical remission and/or (ii) an adaptive compensatory mechanism required for clinical stabilization.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Luciano Minuzzi
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Olivia R Allega
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Geoffrey Bc Hall
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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16
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Syan SK, Minuzzi L, Smith M, Costescu D, Allega OR, Hall GBC, Frey BN. Brain Structure and Function in Women with Comorbid Bipolar and Premenstrual Dysphoric Disorder. Front Psychiatry 2017; 8:301. [PMID: 29367847 PMCID: PMC5768056 DOI: 10.3389/fpsyt.2017.00301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hormonal fluctuations associated with female reproductive life events may precipitate or worsen affective episodes in women with bipolar disorder (BD). Previous studies have shown that women with BD report higher rates of premenstrual dysphoric disorder (PMDD) than controls. Further, bipolar women who report premenstrual worsening of mood display a worse course of their bipolar illness. Despite this, the neural correlates of comorbid BD and PMDD have not been investigated. METHODOLOGY Eighty-five [CTRL, n = 25; PMDD, n = 20; BD, n = 21; BD with comorbid PMDD (BDPMDD), n = 19], regularly cycling women, not on hormonal contraception, underwent two MRI scans: during their mid-follicular and late luteal menstrual phases. We investigated resting-state functional connectivity (Rs-FC), cortical thickness, and subcortical volumes of brain regions associated with the pathophysiology of BD and PMDD between groups, in the mid-follicular and late luteal phases of the menstrual cycle. All BD subjects were euthymic for at least 2 months prior to study entry. RESULTS Women in the BDPMDD group displayed greater disruption in biological rhythms and more subthreshold depressive and anxious symptoms through the menstrual cycle compared to other groups. Rs-FC was increased between the L-hippocampus and R-frontal cortex and decreased between the R-hippocampus and R-premotor cortex in BDPMDD vs. BD (FDR-corrected, p < 0.05). Cortical thickness analysis revealed decreased cortical thickness of the L-pericalcarine, L-superior parietal, R-middle temporal, R-rostral middle frontal, and L-superior frontal, as well as increased cortical thickness of the L-superior temporal gyri in BDPMDD compared to BD. We also found increased left-caudate volume in BDPMDD vs. BD (pCORR < 0.05). CONCLUSION Women with BD and comorbid PMDD display a distinct clinical and neurobiological phenotype of BD, which suggests differential sensitivity to endogenous hormones.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Dustin Costescu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Olivia R Allega
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Geoffrey B C Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Rusner M, Berg M, Begley C. Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy Childbirth 2016; 16:331. [PMID: 27793111 PMCID: PMC5084442 DOI: 10.1186/s12884-016-1127-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/22/2016] [Indexed: 01/08/2023] Open
Abstract
Background Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy. Methods An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared. Results The search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities. Discussion Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis. Conclusions It is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1127-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Brämhultsvägen 53, SE-501 82, Borås, Sweden. .,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
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Fitelson E, McGibbon C. Evaluation and Management of Behavioral Health Disorders in Women: An Overview of Major Depression, Bipolar Disorder, Anxiety Disorders, and Sleep in the Primary Care Setting. Obstet Gynecol Clin North Am 2016; 43:231-46. [PMID: 27212090 DOI: 10.1016/j.ogc.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Providers of obstetric and gynecologic care are often the most commonly seen medical providers for adult women, providing primary and reproductive care. Even where psychiatric care is readily available, obstetricians/gynecologists are frequently the front line for recognition, education, and initial management of many mental health problems. In settings where psychiatric treatment is a more scarce resource, obstetricians/gynecologists often are responsible for ongoing treatment of these disorders. This review focuses on the impact of the female reproductive life cycle on the presentation and management of some of the most common behavioral health problems in women: major depression, bipolar disorder, anxiety disorders, and primary sleep disorders.
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Affiliation(s)
- Elizabeth Fitelson
- The Women's Program, Columbia University Department of Psychiatry, 710 West 168th Street, 12th Floor, New York, NY 10032, USA.
| | - Cheryl McGibbon
- The Women's Program, Columbia University Department of Psychiatry, 710 West 168th Street, 12th Floor, New York, NY 10032, USA
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Weis JR, Greene JA. Mental Health in Pregnant Adolescents: Focus on Psychopharmacology. J Pediatr 2016; 169:297-304. [PMID: 26616248 DOI: 10.1016/j.jpeds.2015.10.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/24/2015] [Accepted: 10/21/2015] [Indexed: 11/19/2022]
Affiliation(s)
- J Rebecca Weis
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Early Childhood Mental Health, Bellevue Hospital Center, New York, NY.
| | - Judy A Greene
- Department of Psychiatry, New York University School of Medicine, New York, NY; Women's Mental Health, Bellevue Hospital Center, New York, NY
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Mittal L, Wichman CL, Byatt N. Bipolar Disorder in Pregnancy and Breast-Feeding: A Practical Guide for the General Psychiatrist. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20150803-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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