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Zhang X, Cheng X, Chen J, Sun J, Yang X, Li W, Chen L, Mao Y, Liu Y, Zeng X, Ye B, Yang C, Li X, Cao L. Distinct global brain connectivity alterations in depressed adolescents with subthreshold mania and the relationship with processing speed: Evidence from sBEAD Cohort. J Affect Disord 2024; 357:97-106. [PMID: 38657768 DOI: 10.1016/j.jad.2024.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Bipolar disorder (BD) is a progressive condition. Investigating the neuroimaging mechanisms in depressed adolescents with subthreshold mania (SubMD) facilitates the early identification of BD. However, the global brain connectivity (GBC) patterns in SubMD patients, as well as the relationship with processing speed before the onset of full-blown BD, remain unclear. METHODS The study involved 72 SubMD, 77 depressed adolescents without subthreshold mania (nSubMD), and 69 gender- and age-matched healthy adolescents (HCs). All patients underwent a clinical follow-up ranging from six to twelve months. We calculated the voxel-based graph theory analysis of the GBC map and conducted the TMT-A test to measure the processing speed. RESULTS Compared to HCs and nSubMD, SubMD patients displayed distinctive GBC index patterns: GBC index decreased in the right Medial Superior Frontal Gyrus (SFGmed.R)/Superior Frontal Gyrus (SFG) while increased in the right Precuneus and left Postcentral Gyrus. Both patient groups showed increased GBC index in the right Inferior Temporal Gyrus. An increased GBC value in the right Supplementary Motor Area was exclusively observed in the nSubMD-group. There were opposite changes in the GBC index in SFGmed.R/SFG between two patient groups, with an AUC of 0.727. Additionally, GBC values in SFGmed.R/SFG exhibited a positive correlation with TMT-A scores in SubMD-group. LIMITATIONS Relatively shorter follow-up duration, medications confounding, and modest sample size. CONCLUSION These findings suggest that adolescents with subthreshold BD have specific impairments patterns at the whole brain connectivity level associated with processing speed impairments, providing insights into early identification and intervention strategies for BD.
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Affiliation(s)
- Xiaofei Zhang
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong province 510000, PR China
| | - Xiaofang Cheng
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Jianshan Chen
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Jiaqi Sun
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Xiaoyong Yang
- Department of Psychiatry, Guangzhou Medical University, Guangdong province 510300, PR China
| | - Weiming Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Lei Chen
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Yimiao Mao
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Yutong Liu
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Xuanlin Zeng
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Biyu Ye
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Chanjuan Yang
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China
| | - Xuan Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China.
| | - Liping Cao
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong province 510300, PR China.
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2
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de Azevedo Cardoso T, Kochhar S, Torous J, Morton E. Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions. JMIR Ment Health 2024; 11:e58631. [PMID: 38557724 PMCID: PMC11019420 DOI: 10.2196/58631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Bipolar disorder (BD) impacts over 40 million people around the world, often manifesting in early adulthood and substantially impacting the quality of life and functioning of individuals. Although early interventions are associated with a better prognosis, the early detection of BD is challenging given the high degree of similarity with other psychiatric conditions, including major depressive disorder, which corroborates the high rates of misdiagnosis. Further, BD has a chronic, relapsing course, and the majority of patients will go on to experience mood relapses despite pharmacological treatment. Digital technologies present promising results to augment early detection of symptoms and enhance BD treatment. In this editorial, we will discuss current findings on the use of digital technologies in the field of BD, while debating the challenges associated with their implementation in clinical practice and the future directions.
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Affiliation(s)
- Taiane de Azevedo Cardoso
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- JMIR Publications, Toronto, ON, Canada
| | | | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emma Morton
- School of Psychological Sciences, Monash University, Clayton, Australia
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3
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Walsh CG, Ripperger MA, Hu Y, Sheu YH, Lee H, Wilimitis D, Zheutlin AB, Rocha D, Choi KW, Castro VM, Kirchner HL, Chabris CF, Davis LK, Smoller JW. Development and multi-site external validation of a generalizable risk prediction model for bipolar disorder. Transl Psychiatry 2024; 14:58. [PMID: 38272862 PMCID: PMC10810911 DOI: 10.1038/s41398-023-02720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Bipolar disorder is a leading contributor to disability, premature mortality, and suicide. Early identification of risk for bipolar disorder using generalizable predictive models trained on diverse cohorts around the United States could improve targeted assessment of high risk individuals, reduce misdiagnosis, and improve the allocation of limited mental health resources. This observational case-control study intended to develop and validate generalizable predictive models of bipolar disorder as part of the multisite, multinational PsycheMERGE Network across diverse and large biobanks with linked electronic health records (EHRs) from three academic medical centers: in the Northeast (Massachusetts General Brigham), the Mid-Atlantic (Geisinger) and the Mid-South (Vanderbilt University Medical Center). Predictive models were developed and valid with multiple algorithms at each study site: random forests, gradient boosting machines, penalized regression, including stacked ensemble learning algorithms combining them. Predictors were limited to widely available EHR-based features agnostic to a common data model including demographics, diagnostic codes, and medications. The main study outcome was bipolar disorder diagnosis as defined by the International Cohort Collection for Bipolar Disorder, 2015. In total, the study included records for 3,529,569 patients including 12,533 cases (0.3%) of bipolar disorder. After internal and external validation, algorithms demonstrated optimal performance in their respective development sites. The stacked ensemble achieved the best combination of overall discrimination (AUC = 0.82-0.87) and calibration performance with positive predictive values above 5% in the highest risk quantiles at all three study sites. In conclusion, generalizable predictive models of risk for bipolar disorder can be feasibly developed across diverse sites to enable precision medicine. Comparison of a range of machine learning methods indicated that an ensemble approach provides the best performance overall but required local retraining. These models will be disseminated via the PsycheMERGE Network website.
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Affiliation(s)
- Colin G Walsh
- Vanderbilt University Medical Center Health System, Nashville, TN, USA.
| | | | - Yirui Hu
- Geisinger Health System, Danville, PA, USA
| | - Yi-Han Sheu
- Massachusetts General-Brigham Health System, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hyunjoon Lee
- Vanderbilt University Medical Center Health System, Nashville, TN, USA
| | - Drew Wilimitis
- Vanderbilt University Medical Center Health System, Nashville, TN, USA
| | | | | | - Karmel W Choi
- Massachusetts General-Brigham Health System, Boston, MA, USA
| | - Victor M Castro
- Massachusetts General-Brigham Health System, Boston, MA, USA
| | | | | | - Lea K Davis
- Vanderbilt University Medical Center Health System, Nashville, TN, USA
| | - Jordan W Smoller
- Massachusetts General-Brigham Health System, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
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4
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Rabelo-da-Ponte FD, Marchionatti LE, Watts D, Roza TH, Amoretti S, Barros FC, Wehrmeister FC, Gonçalves H, B Menezes AM, Kunz M, Kapczinski F, Passos IC. Premorbid intelligence quotient and school failure as risk markers for bipolar disorder and major depressive disorder. J Psychiatr Res 2024; 169:160-165. [PMID: 38039690 DOI: 10.1016/j.jpsychires.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
Mood disorders significantly impact global health, with MDD ranking as the second leading cause of disability in the United States and BD ranking 18th. Despite their prevalence and impact, the relationship between premorbid intelligence and the subsequent development of BD and MDD remains inconclusive. This study investigates the potential of premorbid Intelligence Quotient (IQ) and school failure frequency as risk factors for Bipolar Disorder (BD) and Major Depressive Disorder (MDD) in a birth cohort setting. We analyze data from the Pelotas population-based birth cohort study, comprising 3580 participants aged 22, who had no prior mood disorder diagnoses. Utilizing regression models and accounting for potential confounders, we assess the impact of IQ and school failure, measured at age 18, on the emergence of BD and MDD diagnoses at age 22, using individuals without mood disorders as comparators. Results reveal that lower IQ (below 70) at 18 is associated with an increased risk of BD (Adjusted Odds Ratio [AOR] 1.75, 95%CI: 1.00-3.09, p < 0.05), while higher IQ (above 120) is linked to MDD (AOR 2.16, 95%CI: 1.24-3.75, p < 0.001). Moreover, an elevated number of school failures is associated with increased BD risk (AOR 1.23, 95%CI: 1.11-1.41, p < 0.001), particularly for BD type 1 (AOR 1.36, 95% CI: 1.17-1.58, p < 0.001). These findings offer insights into the distinct premorbid intellectual characteristics of BD and MDD and contribute to a deeper understanding of their developmental trajectories, potentially informing the development of risk assessment tools for mood disorders.
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Affiliation(s)
- Francisco Diego Rabelo-da-Ponte
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Lauro Estivalete Marchionatti
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil.
| | - Devon Watts
- Department of Psychiatry, Harvard Medical School, USA; Center for Precision Psychiatry, Massachusetts General Hospital, USA.
| | - Thiago Henrique Roza
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil.
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Biomedical Network Research Centre on Mental Health (CIBERSAM), 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
| | | | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Ana Maria B Menezes
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Maurício Kunz
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Flávio Kapczinski
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil; Neuroscience Graduate Program, McMaster University, Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil.
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Feng Y, Song J, Lin G, Qian H, Feng L, Wang Z, Wen J, Wang C, Wang J, Li P, Gao Z, Wang X, Hu X. Can neurological soft signs and neurocognitive deficits serve as a combined endophenotype for Han Chinese with bipolar disorder? Int J Methods Psychiatr Res 2023; 32:e1970. [PMID: 37038344 DOI: 10.1002/mpr.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Bipolar disorder's (BD) potential endophenotypes include neurological soft signs (NSS) and neurocognitive disorders (ND). Few research, meanwhile, has coupled NSS and ND as combined endophenotypes of BD. OBJECT This study intends to investigate NSS and ND and compare their differences in euthymic patients with bipolar disorder (EBP), their unaffected first-degree relatives (FDR), and healthy controls (HC). Additionally, search for potential endophenotypic subprojects of NSS and ND and construct and verify a composite endophenotypic. METHODS The subjects were all Han Chinese and consisted of 86 EBP, 81 FDR, and 81HC. Cambridge Neurological Inventory and MATRICSTM Consensus Cognitive Battery tested NSS and ND independently. RESULTS All three groups displayed a trapezoidal distribution of NSS levels and cognitive abnormalities, with EBP having the most severe NSS levels and cognitive deficits, followed by FDR and HC. Among them, motor coordination in NSS and Information processing speed (IPS), Verbal learning (VL), and Working memory (WM) in neurocognitive function are consistent with the traits of the endophenotype of BD. The accuracy in differentiating EBP and HC or FDRs and HC was higher when these items were combined as predictor factors than in differentiating EBP and FDR. CONCLUSION These results provide more evidence that motor coordination, IPS, VL, and WM may be internal characteristics of bipolar disease. When these characteristics are combined into a complex endophenotype, it may be possible to distinguish BD patients and high-risk groups from normal populations.
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Affiliation(s)
- Yingying Feng
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Jia Song
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Guorong Lin
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Hong Qian
- Division of Child Healthcare, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Feng
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Zongqin Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Juan Wen
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Chengchen Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Jiayuan Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Peifu Li
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Zuohui Gao
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xiaoli Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xiaohua Hu
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
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Kapczinski F, Montezano BB, de Azevedo Cardoso T. Latent bipolar disorder. Lancet 2023; 401:2109. [PMID: 37355285 DOI: 10.1016/s0140-6736(23)00402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/16/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Flávio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8P 3R2, Canada; Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Porto Alegre, Brazil.
| | - Bruno Braga Montezano
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Taiane de Azevedo Cardoso
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8P 3R2, Canada
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Buckley V, Young AH, Smith P. Child and adolescent anxiety as a risk factor for bipolar disorder: A systematic review of longitudinal studies. Bipolar Disord 2023; 25:278-288. [PMID: 36949612 DOI: 10.1111/bdi.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVES Several studies have suggested that anxiety disorders in childhood and adolescence often precede the onset of bipolar disorder. We therefore systematically reviewed the relationship between child and adolescent anxiety and later bipolar disorder. METHODS Online databases (Medline [for Ovid], EMBASE and PsychINFO) were searched for original, peer-reviewed studies examining the relationship between child and adolescent anxiety and later bipolar disorder. Studies in both community samples and bipolar offspring samples were included. RESULTS A total of 16 studies were included in the review. The results were broadly consistent and revealed that child and adolescent anxiety disorders are associated with later bipolar disorder in community samples. In bipolar offspring, child and adolescent anxiety disorders are a marker of increased risk and predict the onset of bipolar disorder and other major mood disorders. CONCLUSIONS There is evidence that anxiety disorders in childhood and adolescence increase the risk of later bipolar disorder. Anxiety disorders may be a useful target for early intervention in those at high-risk of bipolar disorder.
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Affiliation(s)
- Vanessa Buckley
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, DeCrespigny Park, London, SE5 8AF, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, DeCrespigny Park, London, SE5 8AF, UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, DeCrespigny Park, London, SE5 8AF, UK
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8
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Walsh CG, Ripperger MA, Hu Y, Sheu YH, Wilimitis D, Zheutlin AB, Rocha D, Choi KW, Castro VM, Kirchner HL, Chabris CF, Davis LK, Smoller JW. Development and Multi-Site External Validation of a Generalizable Risk Prediction Model for Bipolar Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.21.23286251. [PMID: 36865341 PMCID: PMC9980254 DOI: 10.1101/2023.02.21.23286251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Bipolar disorder is a leading contributor to disability, premature mortality, and suicide. Early identification of risk for bipolar disorder using generalizable predictive models trained on diverse cohorts around the United States could improve targeted assessment of high risk individuals, reduce misdiagnosis, and improve the allocation of limited mental health resources. This observational case-control study intended to develop and validate generalizable predictive models of bipolar disorder as part of the multisite, multinational PsycheMERGE Consortium across diverse and large biobanks with linked electronic health records (EHRs) from three academic medical centers: in the Northeast (Massachusetts General Brigham), the Mid-Atlantic (Geisinger) and the Mid-South (Vanderbilt University Medical Center). Predictive models were developed and validated with multiple algorithms at each study site: random forests, gradient boosting machines, penalized regression, including stacked ensemble learning algorithms combining them. Predictors were limited to widely available EHR-based features agnostic to a common data model including demographics, diagnostic codes, and medications. The main study outcome was bipolar disorder diagnosis as defined by the International Cohort Collection for Bipolar Disorder, 2015. In total, the study included records for 3,529,569 patients including 12,533 cases (0.3%) of bipolar disorder. After internal and external validation, algorithms demonstrated optimal performance in their respective development sites. The stacked ensemble achieved the best combination of overall discrimination (AUC = 0.82 - 0.87) and calibration performance with positive predictive values above 5% in the highest risk quantiles at all three study sites. In conclusion, generalizable predictive models of risk for bipolar disorder can be feasibly developed across diverse sites to enable precision medicine. Comparison of a range of machine learning methods indicated that an ensemble approach provides the best performance overall but required local retraining. These models will be disseminated via the PsycheMERGE Consortium website.
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9
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Fijtman A, Clausen A, Kauer-Sant'Anna M, Morey R. Trauma history in veterans with bipolar disorder and its impact on suicidality. J Psychiatr Res 2023; 157:119-126. [PMID: 36463626 DOI: 10.1016/j.jpsychires.2022.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Veterans are at increased risk for exposure to trauma, developing serious mental illnesses, and death by suicide. History of trauma correlates with worsening outcomes in patients with bipolar disorder. This study investigated associations between trauma exposure (type and timing) and suicide attempt in Veterans with bipolar disorder. METHODS One hundred six Veterans with a diagnosis of bipolar disorder and 815 Veterans with no psychiatric history (age rage = 20-72 years old) completed a clinical questionnaire, the Beck Scale for Suicide Ideation, and the Traumatic Live Events Questionnaire. Multinomial logistic regressions investigated correlations between diagnosis, time of trauma (before, during, or after the military), trauma type (attack, illness, accident, child violence, child sexual abuse, and adult sexual abuse), and suicide attempt. RESULTS Seventy-five Veterans with bipolar disorder had comorbid PTSD. Controlling for PTSD, Veterans with bipolar disorder had a higher prevalence of trauma including physical assault [odds ratio (OR) = 2.85; 95% confidence interval (CI) = 1.39-5.86] and child sexual trauma (OR = 2.89; CI = 1.38-6.05). Veterans with bipolar disorder who endorsed previous suicide attempts (n = 42) had significantly higher levels of exposure to childhood trauma (OR = 5.69; CI = 1.84-17.62). CONCLUSIONS Results support incorporating history of previous trauma exposure when assessing Veterans at risk for bipolar disorder. Especially, trauma characterized as attack and childhood sexual abuse. Particular attention should be given to Veterans with bipolar disorder and exposure to trauma during childhood, which may be associated with increased risk of suicidality.
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Affiliation(s)
- Adam Fijtman
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 3643 N. Roxboro St, Durham, NC, 27704, USA.
| | - Ashley Clausen
- St. Vincent Hospital, Department of Behavioral Health, 2900 12th Ave N, Billings, MT, 59101, USA.
| | - Marcia Kauer-Sant'Anna
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.
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- Durham VA Medical Center, 508 Fulton St. Durham, NC. 27705, USA
| | - Rajendra Morey
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 3643 N. Roxboro St, Durham, NC, 27704, USA; Durham VA Medical Center, 508 Fulton St. Durham, NC. 27705, USA.
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10
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Abstract
OBJECTIVES A number of staging models have been generated for the bipolar disorders, which include pre-onset as well as post-onset stages. Some models propose treatments for those at the pre-onset stage, a recommendation which is critiqued here. METHODS Several exemplar staging models are overviewed, and a critique is provided. RESULTS The critique argues against intervention at a pre-onset stage, in light of there being limited risk factors, unquantified sensitivity and specificity data for most putative onset illness risk factors, and thus there is the risk of overtreatment. Also, it is possible that many of the recommended interventions for those at risk of a bipolar disorder may have general non-specific benefits for those at risk. CONCLUSIONS While retaining a pre-onset phase in the staging model, it would appear wiser for it to not be populated with recommended interventions until they have a firmer empirical base.
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Affiliation(s)
- Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Moller CI, Davey CG, Badcock PB, Wrobel AL, Cao A, Murrihy S, Sharmin S, Cotton SM. Correlates of suicidality in young people with depressive disorders: A systematic review. Aust N Z J Psychiatry 2022; 56:910-948. [PMID: 35362327 DOI: 10.1177/00048674221086498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. METHOD Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. RESULTS We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. CONCLUSION Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.
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Affiliation(s)
- Carl I Moller
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Paul B Badcock
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anna L Wrobel
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alice Cao
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sean Murrihy
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Sonia Sharmin
- Department of Occupational Therapy, Social Work and Social Policy, La Trobe University, Bundoora, VIC, Australia
- Research and Evaluation, Take Two, Berry Street, Eaglemont, VIC, Australia
- Department of Public Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
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12
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Passos IC, Ballester P, Rabelo-da-Ponte FD, Kapczinski F. Precision Psychiatry: The Future Is Now. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:21-25. [PMID: 33757313 PMCID: PMC8807995 DOI: 10.1177/0706743721998044] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Rio Grande do Sul, Brazil.,Department of Psychiatry, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Ballester
- Neuroscience Graduate Program, 3710McMaster University, Hamilton, Ontario, Canada
| | - Francisco Diego Rabelo-da-Ponte
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Rio Grande do Sul, Brazil.,Department of Psychiatry, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Ontario, Canada
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13
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Lalli M, Brouillette K, Kapczinski F, de Azevedo Cardoso T. Substance use as a risk factor for bipolar disorder: A systematic review. J Psychiatr Res 2021; 144:285-295. [PMID: 34710665 DOI: 10.1016/j.jpsychires.2021.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Detecting substance use as a predictor of bipolar disorder (BD) is important for clinicians to perform accurate and early diagnosis, as well as better manage the treatment of individuals with BD. The aim of this systematic review was to describe whether substance use is a predictor of BD. A literature search was conducted using the following databases: PubMed, PsycINFO, and Embase. All eligible studies published up to February 9, 2021 were included. This systematic review included 22 studies. We found that 66.7% of the studies assessing overall substance use found that overall substance use was a risk factor for BD. Regarding the specific substances assessed, cannabis use was described as a risk factor for BD in 55.6% of the studies, nonmedical use of prescription medications was a risk factor for BD in 50% of the studies, nicotine was found as a risk factor for BD in 50% of the studies, and alcohol use was described as a risk factor for BD in 42.9% of the studies assessing it. Only one study assessed whether cocaine use was a risk factor for BD and found a significant association. Interestingly, some studies suggested that the greater frequency of cannabis use was associated with greater risk to develop BD or hypomanic/manic symptoms. In conclusion, there is evidence supporting that substance use is a risk factor for BD. Importantly, when assessing the risk factors for BD related to psychoactive substance use, special attention should be given for the frequency of cannabis use.
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Affiliation(s)
- Mikayla Lalli
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Khadija Brouillette
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Graduate Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Taiane de Azevedo Cardoso
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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14
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Risk factors for new-onset bipolar disorder in a community cohort: A five-year follow up study. Psychiatry Res 2021; 303:114109. [PMID: 34284307 DOI: 10.1016/j.psychres.2021.114109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/15/2022]
Abstract
The aim of this study was to assess the risk factors for new-onset Bipolar Disorder (BD) in a community sample of young adults. This is a prospective cohort study including a population-based sample of young adults aged between 18-24 years. The baseline took place from 2007 to 2009, and 1560 subjects were included. Five years after, 1244 individuals were re-evaluated (79.7% retention). Substance abuse/dependence was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and mental disorders were assessed using the Mini International Neuropsychiatric Interview 5.0 (MINI) at both waves. The cumulative incidence of BD in five years was 4.6%. There was no significant association between sociodemographic factors and BD incidence. Tobacco, cannabis, cocaine/crack, other substances abuse/dependence increased the relative risk for BD. Depressive, anxiety, post-traumatic stress disorders, and the suicide risk increased the relative risk to BD. Depressive episode was the strongest risk factor for BD, followed by other mental disorders and substance abuse/dependence in a probabilistic community sample of young adults. Preventive actions in mental health directed at the non-clinical population are needed for early detection and better management of BD.
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