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Katz D, Petersen T, Rabideau DJ, Stark A, Pintro K, Alvarez-Hernandez A, Stancroff N, Deng Y, Albury E, Kuperberg M, George N, Amado S, Temes C, Nierenberg AA, Sylvia L. A trial of prolonged exposure therapy for outpatients with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). J Affect Disord 2024; 344:432-439. [PMID: 37802328 DOI: 10.1016/j.jad.2023.10.004] [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: 05/23/2023] [Revised: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Bipolar disorder and posttraumatic stress disorder (PTSD) commonly co-occur, but no treatment guidelines exist for this population. Prolonged exposure (PE) is a well-established and efficacious treatment for PTSD, untested in patients with comorbid bipolar disorder. The current study evaluates the feasibility and preliminary efficacy of PE for patients with bipolar disorder and PTSD. METHODS Participants were enrolled in PE and completed assessments of PTSD symptoms, suicidality, state and trait anxiety, depression, and mania at baseline, Sessions 5 and 10, and at 6-months post-treatment. RESULTS 32 patients enrolled in this study, with 75 % (24/32) completing all ten PE sessions and 50 % completing 6-month follow-up assessments. PTSD symptoms decreased from baseline to Session 10 and continued to decrease throughout the follow-up period. Suicidality, measured by implicit associations between self and death, showed a similar pattern of decrease over treatment and follow-up periods. Suicidal thinking and depressive symptoms decreased from baseline through Session 10 and rebounded slightly, remaining below baseline at 6-months follow-up. State and trait anxiety increased initially through Session 5 but then decreased and remained stable. Mania scores remained stable at all assessment periods. LIMITATIONS The study is limited by a small sample size and absence of a control condition. Criterion A trauma was not required, limiting generalizability, and there was significant attrition at follow-up. CONCLUSIONS These findings suggest that PE is a feasible and preliminarily efficacious treatment for patients with bipolar disorder and comorbid PTSD, and support the conduct of a fully powered efficacy of PE for this comorbidity.
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Affiliation(s)
- Douglas Katz
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States.
| | - Timothy Petersen
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Dustin J Rabideau
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Abigail Stark
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Kedie Pintro
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Noah Stancroff
- Massachusetts General Hospital, Boston, MA, United States
| | - Yunfeng Deng
- Massachusetts General Hospital, Boston, MA, United States
| | - Evan Albury
- Massachusetts General Hospital, Boston, MA, United States
| | - Maya Kuperberg
- Tel Aviv University, Israel; Beer Yaakov-Ness Ziona Mental Health Center, Israel
| | - Nevita George
- Massachusetts General Hospital, Boston, MA, United States
| | - Selen Amado
- Massachusetts General Hospital, Boston, MA, United States
| | - Christina Temes
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Louisa Sylvia
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
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2
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Palmer-Cooper EC, Woods C, Richardson T. The relationship between dysfunctional attitudes, maladaptive perfectionism, metacognition and symptoms of mania and depression in bipolar disorder: The role of self-compassion as a mediating factor. J Affect Disord 2023; 341:265-274. [PMID: 37633530 DOI: 10.1016/j.jad.2023.08.117] [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: 03/27/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Maladaptive cognitions appear to be associated with the severity of mood symptoms in bipolar disorder (BD), but findings are mixed and generally cross-sectional in design. METHOD This study (n = 331) explored the associations between maladaptive cognitions and mood symptoms in BD over time (3 months), and the potential mediating effect of self-compassion cross-sectionally. Dysfunctional attitudes, maladaptive perfectionism and maladaptive metacognitions were explored separately with depressive and manic symptoms, and with current mood state in BD. RESULTS The results showed maladaptive metacognitions to be the only significant predictor of depression at 3-month follow-up (β = 0.31, p < .001), with no relationship to mania over time. Cross-sectionally, self-compassion partially mediated the relationship between all maladaptive cognitions and depression, with higher dysfunctional cognitions and lower self-compassion predicting increased severity of depressive symptoms. Only the relationship between dysfunctional attitudes and mania was partially mediated by self-compassion, however, the relationship was weak and suggestive that higher self-compassion predicted increased mania. LIMITATIONS The study duration limited the possible analysis. Future longitudinal research is needed. Also, the study sample was not representative of the clinical population, making results less generalisable. Additionally, limited significant findings regarding manic symptoms supports the need for further research into active cognitions during this phase of BD. CONCLUSIONS Maladaptive metacognitions were predictive of future depression severity, therefore, further exploration of metacognitive therapy for BD should be explored. Furthermore, self-compassion was shown to partially mediate the relationship between negative cognitions and mood, therefore further exploration of compassion-based therapies for BD is needed.
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Affiliation(s)
- Emma C Palmer-Cooper
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Chloe Woods
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Thomas Richardson
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
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3
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Hochheimer M, Glick JL, Garrison-Desany H, Huhn AS. Transgender individuals are at higher risk for suicidal ideation and preparation than cisgender individuals in substance use treatment. Front Psychiatry 2023; 14:1225673. [PMID: 37779622 PMCID: PMC10535091 DOI: 10.3389/fpsyt.2023.1225673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction This study describes the differences and similarities in mental health, substance use, and substance use treatment outcomes between people presenting for SUD treatment who identified as transgender and those who identified as cisgender men or women. Methods We compared 64 individuals who self-identified as transgender and presented for SUD treatment to samples of cisgender men and women (separately) matched based on propensity scores which were created based on sociodemographic factors known to influence both the nature of substance use and patterns of treatment engagement including age, education, race, stable housing, and employment status. Comparisons were made using χ2 tests and t-tests in over 150 variables collected at treatment intake regarding physical and mental health, substance use patterns, events that led to treatment, reasons for seeking treatment, and treatment outcomes. Results The transgender sample endorsed six of the seven suicide-related items more often than at least one of the cisgender-matched samples. Furthermore, the transgender sample remained in treatment significantly longer (M = 32.3, SD = 22.2) than the cisgender male sample (M = 19.5, SD = 26.1, t = 2.17, p = 0.03). Discussion This study is a first step into understanding gender minority population experiences during SUD treatment. While there was no significant difference between the cisgender and transgender samples on most variables, there was an elevated prevalence of suicidal ideation and behaviors in the transgender sample, which warrants further investigation.
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Affiliation(s)
- Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Henri Garrison-Desany
- Department of Social and Behavioral Science, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | - Andrew S. Huhn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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4
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Ouali U, Zgueb Y, Jouini L, Aissa A, Jomli R, Ouertani A, Omrani A, Nacef F, Carta MG, Preti A. Accuracy of the Arabic HCL - 32 and MDQ in detecting patients with bipolar disorder. BMC Psychiatry 2023; 23:70. [PMID: 36703141 PMCID: PMC9878752 DOI: 10.1186/s12888-023-04529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Studies about the two most used and validated instruments for the early detection of Bipolar Disorder (BD), the 32 - item Hypomania Checklist (HCL - 32) and the Mood Disorder Questionnaire (MDQ), are scarce in non-Western countries. This study aimed to explore the reliability, factor structure, and criterion validity of their Arabic versions in a sample of Tunisian patients diagnosed with mood disorders. METHODS The sample included 59 patients with BD, 86 with unipolar Major Depressive Disorder (MDD) and 281 controls. Confirmatory factor analysis was applied to show that a single global score was an appropriate summary measure of the screeners in the sample. Receiver Operating Characteristic analysis was used to assess the capacity of the translated screeners to distinguish patients with BD from those with MDD and controls. RESULTS Reliability was good for both tools in all samples. The bifactor implementation of the most reported two-factor model had the best fit for both screeners. Both were able to distinguish patients diagnosed with BD from putatively healthy controls, and equally able to distinguish patients diagnosed with BD from patients with MDD. CONCLUSION Both screeners work best in excluding the presence of BD in patients with MDD, which is an advantage in deciding whether or not to prescribe an antidepressant.
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Affiliation(s)
- Uta Ouali
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010, La Manouba, Tunisia. .,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia. .,Research Laboratory LR18SP03, Tunis, Tunisia.
| | - Lamia Jouini
- grid.418149.10000 0000 8631 6364Centre de Compétences en Psychiatrie et Psychothérapie, Pôle de Psychiatrie et Psychothérapie, Hôpital du Valais (HVS)- Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Amina Aissa
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Rabaa Jomli
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Abdelhafidh Ouertani
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Adel Omrani
- Tunisian Bipolar Forum, Erable Médical Cabinet 324, Tunis, Tunisia
| | - Fethi Nacef
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Mauro G. Carta
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- grid.7605.40000 0001 2336 6580Department of Neuroscience, University of Turin, Turin, Italy
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5
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McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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Affiliation(s)
- Roger S. McIntyre
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada,Department of PharmacologyUniversity of TorontoTorontoONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Ross J. Baldessarini
- Harvard Medical SchoolBostonMAUSA,International Consortium for Bipolar & Psychotic Disorders ResearchMcLean HospitalBelmontMAUSA,Mailman Research CenterMcLean HospitalBelmontMAUSA
| | - Michael Bauer
- University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of MedicineDeakin UniversityGeelongVICAustralia,Orygen, National Centre of Excellence in Youth Mental HealthCentre for Youth Mental Health, University of MelbourneMelbourneVICAustralia
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | | | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Heinz Grunze
- Allgemeinpsychiatrie OstKlinikum am WeissenhofWeinsbergGermany,Paracelsus Medical Private University NurembergNurembergGermany
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research CenterPsychiatric Center CopenhagenCopenhagenDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - David J. Miklowitz
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los Angeles (UCLA) Semel InstituteLos AngelesCAUSA
| | - Gordon Parker
- School of PsychiatryUniversity of New South WalesSydneyNSWAustralia
| | - Robert M. Post
- School of Medicine & Health SciencesGeorge Washington UniversityWashingtonDCUSA,Bipolar Collaborative NetworkBethesdaMDUSA
| | - Alan C. Swann
- Department of PsychiatryBaylor College of MedicineHoustonTXUSA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural SciencesStanford School of Medicine and VA Palo Alto Health Care SystemPalo AltoCAUSA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamUK
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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6
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Abstract
Bipolar disorder (BD) affects approximately 2% of U.S. adults and is the most costly mental health condition for commercial insurers nationwide. Rates of BD are elevated among persons with depression, anxiety disorders, and substance use disorders-conditions frequently seen by primary care clinicians. In addition, antidepressants can precipitate manic or hypomanic symptoms or rapid cycling in persons with undiagnosed BD. Thus, screening in these high-risk groups is indicated. Effective treatments exist, and many can be safely and effectively administered by primary care clinicians.
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Affiliation(s)
- Mark S Bauer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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7
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Cerimele JM, Russo J, Bauer AM, Hawrilenko M, Pyne JM, Dalack GW, Kroenke K, Unützer J, Fortney JC. The Patient Mania Questionnaire (PMQ-9): a Brief Scale for Assessing and Monitoring Manic Symptoms. J Gen Intern Med 2022; 37:1680-1687. [PMID: 34145517 PMCID: PMC9130397 DOI: 10.1007/s11606-021-06947-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measurement-based care is an effective clinical strategy underutilized for bipolar disorder partly due to lacking a widely adopted patient-reported manic symptom measure. OBJECTIVE To report development and psychometric properties of a brief patient-reported manic symptom measure. DESIGN Secondary analysis of data collected in a randomized effectiveness trial comparing two treatments for 1004 primary care patients screening positive for bipolar disorder and/or PTSD. PARTICIPANTS Two analytic samples included 114 participants with varied diagnoses and test-retest data, and 179 participants with psychiatrist-diagnosed bipolar disorder who had two or more assessments with the nine-item Patient Mania Questionnaire-9 [PMQ-9]). MAIN MEASURES Internal and test-retest reliability, concurrent validity, and sensitivity to change were assessed. Minimally important difference (MID) was estimated by standard error of measurement (SEM) and by standard deviation (SD) effect sizes. KEY RESULTS The PMQ-9 had high internal reliability (Cronbach's alpha = 0.88) and test-retest reliability (0.85). Concurrent validity correlation with manic symptom measures was high for the Internal State Scale-Activation Subscale (0.70; p<0.0001), and lower for the Altman Mania Rating Scale (0.26; p=0.007). Longitudinally, PMQ-9 was completed at 1511 clinical encounters in 179 patients with bipolar disorder. Mean PMQ-9 score at first and last encounters was 14.5 (SD 6.5) and 10.1 (SD 7.0), a 27% decrease in mean score during treatment, suggesting sensitivity to change. A point estimate of the MID was approximately 3 points (range of 2-4). CONCLUSIONS The PMQ-9 demonstrated excellent test-retest reliability, concurrent validity, internal consistency, and sensitivity to change and was widely used and acceptable to patients and clinicians in a pragmatic clinical trial. Combined with the Patient Health Questionnaire-9 (PHQ-9) measure of depressive symptoms this brief measure could inform measurement-based care for individuals with bipolar disorder in primary care and mental health care settings given its ease of administration and familiar self-report response format.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jeffrey M Pyne
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gregory W Dalack
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kurt Kroenke
- Center for Health Services and Outcomes Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
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8
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Stahl K, Adorjan K, Anderson-Schmidt H, Budde M, Comes AL, Gade K, Heilbronner M, Kalman JL, Klöhn-Saghatolislam F, Oraki Kohshour M, Papiol S, Reich-Erkelenz D, Schaupp SK, Schulte EC, Senner F, Vogl T, Wiltfang J, Reininghaus E, Falkai P, Schulze TG, Bickeböller H, Heilbronner U. Stability over time of scores on psychiatric rating scales, questionnaires and cognitive tests in healthy controls. BJPsych Open 2022; 8:e55. [PMID: 35232513 PMCID: PMC8935911 DOI: 10.1192/bjo.2022.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Case-only longitudinal studies are common in psychiatry. Further, it is assumed that psychiatric ratings and questionnaire results of healthy controls stay stable over foreseeable time ranges. For cognitive tests, improvements over time are expected, but data for more than two administrations are scarce. AIMS We comprehensively investigated the longitudinal course for trends over time in cognitive and symptom measurements for severe mental disorders. Assessments included the Trail Making Tests, verbal Digit Span tests, Global Assessment of Functioning, Inventory of Depressive Symptomatology, the Positive and Negative Syndrome Scale, and the Young Mania Rating Scale, among others. METHOD Using the data of control individuals (n = 326) from the PsyCourse study who had up to four assessments over 18 months, we modelled the course using linear mixed models or logistic regression. The slopes or odds ratios were estimated and adjusted for age and gender. We also assessed the robustness of these results using a longitudinal non-parametric test in a sensitivity analysis. RESULTS Small effects were detected for most cognitive tests, indicating a performance improvement over time (P < 0.05). However, for most of the symptom rating scales and questionnaires, no effects were detected, in line with our initial hypothesis. CONCLUSIONS The slightly but consistently improved performance in the cognitive tests speaks of a test-unspecific positive trend, while psychiatric ratings and questionnaire results remain stable over the observed period. These detectable improvements need to be considered when interpreting longitudinal courses. We therefore recommend recruiting control participants if cognitive tests are administered.
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Affiliation(s)
- Katharina Stahl
- Department of Genetic Epidemiology, University Medical Center Göttingen, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Heike Anderson-Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Ashley L Comes
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Katrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Maria Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; and International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | | | - Mojtaba Oraki Kohshour
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Thomas Vogl
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany; and German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany; and iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Austria
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA; and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heike Bickeböller
- Department of Genetic Epidemiology, University Medical Center Göttingen, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
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9
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Anýž J, Bakštein E, Dally A, Kolenič M, Hlinka J, Hartmannová T, Urbanová K, Correll CU, Novák D, Španiel F. Validity of the Aktibipo Self-rating Questionnaire for the Digital Self-assessment of Mood and Relapse Detection in Patients With Bipolar Disorder: Instrument Validation Study. JMIR Ment Health 2021; 8:e26348. [PMID: 34383689 PMCID: PMC8386400 DOI: 10.2196/26348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick, and scalable digital self-report measures that can also detect relapse are still not available for clinical care. OBJECTIVE In this study, we aim to validate the newly developed ASERT (Aktibipo Self-rating) questionnaire-a 10-item, mobile app-based, self-report mood questionnaire consisting of 4 depression, 4 mania, and 2 nonspecific symptom items, each with 5 possible answers. The validation data set is a subset of the ongoing observational longitudinal AKTIBIPO400 study for the long-term monitoring of mood and activity (via actigraphy) in patients with bipolar disorder (BD). Patients with confirmed BD are included and monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale [MADRS] and Young Mania Rating Scale [YMRS]). METHODS The content validity of the ASERT questionnaire was assessed using principal component analysis, and the Cronbach α was used to assess the internal consistency of each factor. The convergent validity of the depressive or manic items of the ASERT questionnaire with the MADRS and YMRS, respectively, was assessed using a linear mixed-effects model and linear correlation analyses. In addition, we investigated the capability of the ASERT questionnaire to distinguish relapse (YMRS≥15 and MADRS≥15) from a nonrelapse (interepisode) state (YMRS<15 and MADRS<15) using a logistic mixed-effects model. RESULTS A total of 99 patients with BD were included in this study (follow-up: mean 754 days, SD 266) and completed an average of 78.1% (SD 18.3%) of the requested ASERT assessments (completion time for the 10 ASERT questions: median 24.0 seconds) across all patients in this study. The ASERT depression items were highly associated with MADRS total scores (P<.001; bootstrap). Similarly, ASERT mania items were highly associated with YMRS total scores (P<.001; bootstrap). Furthermore, the logistic mixed-effects regression model for scale-based relapse detection showed high detection accuracy in a repeated holdout validation for both depression (accuracy=85%; sensitivity=69.9%; specificity=88.4%; area under the receiver operating characteristic curve=0.880) and mania (accuracy=87.5%; sensitivity=64.9%; specificity=89.9%; area under the receiver operating characteristic curve=0.844). CONCLUSIONS The ASERT questionnaire is a quick and acceptable mood monitoring tool that is administered via a smartphone app. The questionnaire has a good capability to detect the worsening of clinical symptoms in a long-term monitoring scenario.
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Affiliation(s)
- Jiří Anýž
- National Insitute of Mental Health, Klecany, Czech Republic
| | | | | | - Marián Kolenič
- National Insitute of Mental Health, Klecany, Czech Republic
| | | | - Tereza Hartmannová
- National Insitute of Mental Health, Klecany, Czech Republic.,Mindpax s.r.o, Prague, Czech Republic
| | - Kateřina Urbanová
- National Insitute of Mental Health, Klecany, Czech Republic.,Mindpax s.r.o, Prague, Czech Republic
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Novák
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Filip Španiel
- National Insitute of Mental Health, Klecany, Czech Republic
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10
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Skokou M, Asimakopoulou R, Andreopoulou O, Kolettis G, Perrou S, Gourzis P, Daskalaki S. Reliability, validity and psychometric properties of the Greek version of the Altman self rating mania scale. Compr Psychiatry 2021; 109:152243. [PMID: 34271257 DOI: 10.1016/j.comppsych.2021.152243] [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: 07/19/2020] [Revised: 03/17/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although self-rating mania scales have been developed, a lack of such instruments validated for the Greek population is noted. This study aims to examine the validity, reliability and psychometric properties of the Altman Self Rating Mania Scale (ASRM) adapted in Greek (G-ASRM). METHODS A sample of 86 consecutive inpatient and outpatient bipolar patients diagnosed by the DSM-5 criteria and 37 healthy controls were assessed by using the Young Mania Rating Scale (YMRS) and the Montgomery Asberg Depression Rating Scale (MADRS), and self-administered the G-ASRM. Factor analysis, test-retest analysis, measurement invariance tests, mean differences, Pearson's Correlation analysis and ROC analysis were used to confirm the validity of G-ASRM as a scale, test its reliability, study its psychometric properties in different subgroups and establish a cut-off value for indicating the presence of (hypo)mania in BD patients. Also, regression models were built to expose dependencies between YMRS and G-ASRM items. RESULTS Monofactoriality of the scale was verified, based on Exploratory Factor Analysis (EFA). Cronbach's alpha was 0.895. G-ASRM is highly correlated with YMRS (r = 0.856, p < 0.0005) and uncorrelated with MADRS (r = -0.051, p = 0.623). Test- retest r-coefficient was calculated at 0.85. The optimal cut-off score, set at ≥6 for (hypo)mania assessment, is in agreement with the results reported for the original version. Limitations of the study are that the scale was not normed on diagnostic groups other than bipolar, nor was it administered longitudinally, so as to assess its sensitivity to symptom changes overtime. CONCLUSION The G-ASRM can be validly and reliably used in the Greek population for the assessment of (hypo)mania in bipolar patients.
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Affiliation(s)
- Maria Skokou
- Department of Psychiatry, University Hospital of Patras, Patras, Greece.
| | - Rafailia Asimakopoulou
- Department of Electrical and Computer Engineering, School of Engineering, University of Patras, Greece
| | - Ourania Andreopoulou
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, Greece.
| | | | - Sofia Perrou
- School of Medicine, University of Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, Greece.
| | - Sophia Daskalaki
- Department of Electrical and Computer Engineering, School of Engineering, University of Patras, Greece.
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11
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Ebner-Priemer UW, Mühlbauer E, Neubauer AB, Hill H, Beier F, Santangelo PS, Ritter P, Kleindienst N, Bauer M, Schmiedek F, Severus E. Digital phenotyping: towards replicable findings with comprehensive assessments and integrative models in bipolar disorders. Int J Bipolar Disord 2020; 8:35. [PMID: 33211262 PMCID: PMC7677415 DOI: 10.1186/s40345-020-00210-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 01/05/2023] Open
Abstract
Background Digital phenotyping promises to unobtrusively obtaining a continuous and objective input of symptomatology from patients’ daily lives. The prime example are bipolar disorders, as smartphone parameters directly reflect bipolar symptomatology. Empirical studies, however, have yielded inconsistent findings. We believe that three main shortcomings have to be addressed to fully leverage the potential of digital phenotyping: short assessment periods, rare outcome assessments, and an extreme fragmentation of parameters without an integrative analytical strategy. Methods To demonstrate how to overcome these shortcomings, we conducted frequent (biweekly) dimensional and categorical expert ratings and daily self-ratings over an extensive assessment period (12 months) in 29 patients with bipolar disorder. Digital phenotypes were monitored continuously. As an integrative analytical strategy, we used structural equation modelling to build latent psychopathological outcomes (mania, depression) and latent digital phenotype predictors (sleep, activity, communicativeness). Outcomes Combining gold-standard categorical expert ratings with dimensional self and expert ratings resulted in two latent outcomes (mania and depression) with statistically meaningful factor loadings that dynamically varied over 299 days. Latent digital phenotypes of sleep and activity were associated with same-day latent manic psychopathology, suggesting that psychopathological alterations in bipolar disorders relate to domains (latent variables of sleep and activity) and not only to specific behaviors (such as the number of declined incoming calls). The identification of latent psychopathological outcomes that dimensionally vary on a daily basis will enable to empirically determine which combination of digital phenotypes at which days prior to an upcoming episode are viable as digital prodromal predictors.
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Affiliation(s)
- Ulrich W Ebner-Priemer
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Karlsruhe, Germany. .,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Esther Mühlbauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas B Neubauer
- DIPF - Leibniz Institute for Research and Information in Education, Frankfurt, Germany
| | - Holger Hill
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Fabrice Beier
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philip S Santangelo
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim / Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Florian Schmiedek
- DIPF - Leibniz Institute for Research and Information in Education, Frankfurt, Germany.,Department of Psychology, Goethe University, Frankfurt, Germany
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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