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Anmella G, Meehan A, Ashton M, Mohebbi M, Fico G, Ng CH, Maes M, Berk L, Prisco MD, Singh AB, Malhi GS, Berk M, Dodd S, Hidalgo-Mazzei D, Grande I, Pacchiarotti I, Murru A, Vieta E, Dean OM. Exploring Clinical Subgroups of Participants with Major Depressive Disorder that may Benefit from Adjunctive Minocycline Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:33-44. [PMID: 38247410 PMCID: PMC10811397 DOI: 10.9758/cpn.23.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 01/23/2024]
Abstract
Objective : To explore illness-related factors in patients with major depressive disorder (MDD) recipients of adjunctive minocycline (200 mg/day) treatment. The analysis included participants experiencing MDD from a 12-week, double blind, placebo-controlled, randomized clinical trial (RCT). Methods : This is a sub-analysis of a RCT of all 71 participants who took part in the trial. The impact of illness chronicity (illness duration and number of depressive episodes), systemic illness (endocrine, cardiovascular and obesity), adverse effects and minocycline were evaluated as change from baseline to endpoint (12-week) using ANCOVA. Results : There was a consistent but statistically non-significant trend on all outcomes in favour of the use of adjunctive minocycline for participants without systemic illness, less illness chronicity, and fewer adverse effects. Conclusion : Understanding the relationship between MDD and illness chronicity, comorbid systemic illness, and adverse effects, can potentially better characterise those individuals who are more likely to respond to adjunctive anti-inflammatory medications.
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Alcy Meehan
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Melanie Ashton
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Deakin University, Faculty of Health, Biostatistics Unit, Geelong, VIC, Australia
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Chee H. Ng
- The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Lesley Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Michele De Prisco
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Ajeet B. Singh
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Gin S. Malhi
- Department of Psychiatry, Northern Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
- Academic Department of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Seetal Dodd
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Iria Grande
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Andrea Murru
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
| | - Olivia M. Dean
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
- Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
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2
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Biazus TB, Beraldi GH, Tokeshi L, Rotenberg LDS, Dragioti E, Carvalho AF, Solmi M, Lafer B. All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry 2023; 28:2508-2524. [PMID: 37491460 PMCID: PMC10611575 DOI: 10.1038/s41380-023-02109-9] [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: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality. RESULTS Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. CONCLUSION Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.
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Affiliation(s)
- Taís Boeira Biazus
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Schizophrenia Research Program (Projesq), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tokeshi
- Consultation Liaison, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luísa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 58185, Linköping, Sweden
| | - André F Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Sylvia LG, Tovey RE, Katz D, Boccagno C, Stromberg AR, Peters AT, Temes CM, Gold AK, Mow J, Puvanich N, Albury EA, Stephan NJ, Faria CM, Nierenberg AA, Kamali MP. A New Treatment Program: Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). J Psychiatr Pract 2023; 29:176-188. [PMID: 37185884 DOI: 10.1097/pra.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is complicated by a dynamic, chronic course along with multiple comorbid psychiatric and medical conditions, making it challenging for clinicians to treat and patients to thrive. To efficiently manage the complexity of BD and help patients recover, we developed a Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). The purpose of this paper is to describe how we developed this clinic and the lessons we learned. METHODS We developed FITT-BD by integrating strategies from stepped care, collaborative care, and learning health care systems. We describe the rationale, details, and lessons learned in developing FITT-BD. RESULTS By integrating stepped care, collaborative care, and a learning health care system approach, FITT-BD aims to reduce barriers to care, leverage the expertise of a multidisciplinary treatment team, ensure patient-centeredness, and use assessments to inform and continuously improve outcomes in real time. We learned that there are challenges in the creation of a web-based application that tracks the treatment of patients within a network of hospitals. CONCLUSIONS The success of FITT-BD will be determined by the degree to which it can increase treatment access, improve treatment adherence, and help individuals with BD achieve their treatment goals. We expect that FITT-BD will improve outcomes in the context of ongoing clinical care. PUBLIC HEALTH SIGNIFICANCE The treatment of BD is challenging and complex. We propose a new treatment model for BD: FITT-BD. We expect that this program will be a patient-centered approach that improves outcomes in the context of ongoing clinical care for patients with BD.
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Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders. Eur Neuropsychopharmacol 2022; 61:60-70. [PMID: 35810585 DOI: 10.1016/j.euroneuro.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022]
Abstract
Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.
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Scott J, Morton E, Michalak EE, Murray G. An epidemiological study of externally determined and self-identified mental and physical disability across the spectrum of bipolar disorders. J Affect Disord 2021; 294:597-604. [PMID: 34332361 DOI: 10.1016/j.jad.2021.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Studies exploring disability in bipolar disorder (BD) have primarily assessed clinical samples of full-threshold BD-I and BD-II alongside so-called objective criteria such as unemployment or receipt of government disability payments. This study extends research on disability by examining externally determined and self-identified disability in a community sample and by including subthreshold BD (BDS). METHODS Data were extracted from the USA Collaborative Psychiatric Epidemiology Surveys about individuals who met recognized criteria for BD-I, BD-II and BDS who had completed self-ratings of physical and mental disability, comorbidities, and health risk factors (e.g., obesity). Rates of disability were estimated, and logistic regression analyses were used to determine demographic and clinical variables associated with externally determined and self-identified of disability. RESULTS Of 408 individuals who met eligibility criteria (BD-I = 100; BD-II=104; BDS=204), 35% met criteria for externally determined disability, about 40% self-reported mental disability and about 23% self-reported physical disability. The odds were three-fold (Odds Ratio (OR): 3.05; 95% Confidence Intervals (CI): 1.69, 5.53) that someone with self-identified physical disability would meet criteria for externally determined disability, but associations with mental disability were non-significant (OR: 1.06; 95% CI: 0.63, 1.80). Regression analyses demonstrated that mental disability was associated with being a current or past smoker and physical disability was associated with BD-I. LIMITATIONS the adequacy of the assessments of disability and definition of BDS can be questioned. CONCLUSIONS Future clinical and community studies need to consider both externally determined and self-identified disability across the entire Bd spectrum.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle, UK.
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Victoria, Australia.
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Beunders AJM, Kok AAL, Kosmas PC, Beekman ATF, Sonnenberg CM, Schouws SNTM, Kupka RW, Stek ML, Dols A. Physical comorbidity in Older-Age Bipolar Disorder (OABD) compared to the general population - a 3-year longitudinal prospective cohort study. J Affect Disord 2021; 288:83-91. [PMID: 33845328 DOI: 10.1016/j.jad.2021.03.057] [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: 12/07/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to examine the accumulation of chronic physical diseases in Older-Age Bipolar Disorder (OABD) as well as in individuals from the general aging population over a 3-year period. METHODS This prospective longitudinal study compared 101 patients with OABD receiving outpatient care (DOBi cohort) with 2545 individuals from the general aging population (LASA cohort). The presence of eight major chronic diseases was asked at baseline and 3-year follow-up. Total number of diseases was the main outcome measure. Self-rated health (SRH, scale 1-5) was examined as a secondary outcome. Multilevel linear modelling of change was performed to estimate and test the observed change in both samples. RESULTS At baseline, the number of chronic diseases was lower (b= -0.47, p<0.01) and self-rated health comparable (b=0.27, p=0.13) in DOBi than in LASA. Over 3 years the number of chronic diseases increased faster in DOBi than in LASA (b=0.51 versus b=0.35, p(interaction)=0.03). When corrected for employment, depressive symptoms, waist circumference, smoking, and alcohol use, this difference was no longer significant. SRH decreased faster in DOBi than in LASA (b=-0.24 versus b=-0.02, p(interaction)=0.04). LIMITATIONS Information on chronic diseases was collected using self-report. CONCLUSIONS A faster accumulation of chronic physical diseases and a faster decline in health perception was observed in OABD than in participants from the general population. The observed differences could partly be attributed to baseline differences in psychosocial, lifestyle, and health behaviour factors. Our findings urgently call for the use of integrated care in BD.
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Affiliation(s)
- Alexandra J M Beunders
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Almar A L Kok
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Panagiotis C Kosmas
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Caroline M Sonnenberg
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sigfried N T M Schouws
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Max L Stek
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Annemiek Dols
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Menculini G, Verdolini N, Brufani F, Pierotti V, Cirimbilli F, Di Buò A, Spollon G, De Giorgi F, Sciarma T, Tortorella A, Moretti P. Comorbidities, Depression Severity, and Circadian Rhythms Disturbances as Clinical Correlates of Duration of Untreated Illness in Affective Disorders. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:459. [PMID: 34066782 PMCID: PMC8150538 DOI: 10.3390/medicina57050459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Affective disorders, namely bipolar (BDs) and depressive disorders (DDs) are characterized by high prevalence and functional impairment. From a dimensional point of view, BDs and DDs can be considered as psychopathological entities lying on a continuum. A delay in treatment initiation might increase the burden associated with affective disorders. The aim of this study is to analyze the correlates of a long duration of untreated illness (DUI) in these conditions. Materials and Methods: Subjects with BDs and DDs, both in- and outpatients, were recruited. Long DUI was defined according to previous research criteria as >2 years for BDs or >1 year for DDs. Socio-demographic, clinical and psychopathological characteristics of the recruited subjects were collected. Bivariate analyses were performed to compare subjects with a long and short DUI (p < 0.05). Results: In our sample (n = 61), 34.4% of subjects presented a long DUI. A long DUI was significantly associated with longer overall illness duration (p = 0.022) and a higher rate of psychiatric (p = 0.048) and physical comorbidities (p = 0.023). As for psychopathological features, depressive symptoms were more severe in the long DUI subgroup, as demonstrated by a higher score at the Clinical Global Impression-severity of depression (p = 0.012) item and at the anxiety/depression factor of the Positive and Negative Syndrome Scale (p = 0.041). Furthermore, subjects with a long DUI displayed more severe disruption of circadian rhythms, as evaluated by the Biological Rhythms Interview for Assessment in Neuropsychiatry total (p = 0.044) and social domain (p = 0.005) scores and by the Hamilton Depression Rating Scale diurnal variation items (18a: p = 0.029, 18b: p = 0.047). Conclusions: A long DUI may underpin higher clinical severity, as well as worse illness course and unfavorable prognosis in affective disorders. Intervention strategies targeting comorbidities, depressive symptoms and circadian rhythms may decrease disease burden in subjects with a long DUI.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, 08036 Barcelona, Spain;
| | - Francesca Brufani
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Valentina Pierotti
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Federica Cirimbilli
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Santa Maria Della Misericordia Hospital, 06132 Perugia, Italy; (F.C.); (F.D.G.)
| | - Agata Di Buò
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Giulio Spollon
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Filippo De Giorgi
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Santa Maria Della Misericordia Hospital, 06132 Perugia, Italy; (F.C.); (F.D.G.)
| | - Tiziana Sciarma
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
| | - Patrizia Moretti
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (F.B.); (V.P.); (A.D.B.); (G.S.); (T.S.); (A.T.)
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Mariano A, Di Lorenzo G, Jannini TB, Santini R, Bertinelli E, Siracusano A, Niolu C. Medical Comorbidities in 181 Patients With Bipolar Disorder vs. Schizophrenia and Related Psychotic Disorders: Findings From a Single-Center, Retrospective Study From an Acute Inpatients Psychiatric Unit. Front Psychiatry 2021; 12:702789. [PMID: 34658948 PMCID: PMC8517081 DOI: 10.3389/fpsyt.2021.702789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Medical comorbidities (MCs) represent a significant burden in terms of more frequent hospitalizations and overall lower life expectancy among people with severe mental disorders, such as schizophrenia and related psychotic disorders (SZ) and bipolar disorder (BD). The present article aims to compare the prevalence of MCs and to examine the associated characteristics as marital status, job occupation, level of education, and living arrangements, between BD and SZ patients. Methods: One-hundred-eight-one patients with MCs (85/47% had BD and 96/53% had SZ) were recruited retrospectively from the Acute Inpatients Psychiatry Unit of Policlinico Tor Vergata, Rome, between January-2017 and December-2020. MCs were: cardiovascular diseases (CVD), bacterial infections, mycoses, viral diseases, neoplasms, musculoskeletal, respiratory tract, urological and male genital, gynecological, neurological, gastrointestinal, metabolic syndrome, nutritional, and metabolic diseases. Results: BD had more MC than SZ (36.2 vs. 28.2%, respectively, p = 0.04). CVD and metabolic MC were more common among BD (51.8 vs.34.4%; 51.8 vs.35.3%; p = 0.018; p = 0.039; respectively), while viral diseases were more frequent in SZ (13.5 vs.3.5%, p = 0.035). Hypertension was common in both psychiatric illnesses (81.8% BD vs. 65.6% SZ, p = 0.18). Obesity was the most frequent metabolic disease in both BD and SZ (75% BD vs. 73.5% SZ, p = 0.91), followed by diabetes mellitus (52.3% BD vs. 55.9% SZ, p = 0.93), metabolic syndrome (54.5% BD vs. 47.1% SZ, p = 0.67) and dysthyroidism (47.7% BD vs. 25.7% SZ, p = 0.093). After performing a binary logistic regression analysis, only two MCs showed a statistically significant association: patients with SZ had an OR of 2.01 [CI 95% (1.00-4.01)] for CVD compared to BD; on the other hand, patients with BD had an OR of 16.57 [CI 95% (3.58-76.77)] for gynecological diseases compared to SZ patients. Conclusions: MCs are common among people with severe mental illness, especially CVD and metabolic diseases, highlighting the need for a more collaborative relationship between general medical providers and psychiatrists.
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Affiliation(s)
- Antonella Mariano
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy.,IRCCS - Fondazione Santa Lucia, Rome, Italy
| | - Tommaso B Jannini
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Santini
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bertinelli
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
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9
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Gomes FA, Magalhães PV, Magee T, Brietzke E, Kunz M, Kapczinski F. Clinical correlates of high burden of general medical comorbidities in patients with bipolar disorder. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Olmert T, Cooper JD, Han SYS, Barton-Owen G, Farrag L, Bell E, Friend LV, Ozcan S, Rustogi N, Preece RL, Eljasz P, Tomasik J, Cowell D, Bahn S. A Combined Digital and Biomarker Diagnostic Aid for Mood Disorders (the Delta Trial): Protocol for an Observational Study. JMIR Res Protoc 2020; 9:e18453. [PMID: 32773373 PMCID: PMC7445599 DOI: 10.2196/18453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Mood disorders affect hundreds of millions of people worldwide, imposing a substantial medical and economic burden. Existing diagnostic methods for mood disorders often result in a delay until accurate diagnosis, exacerbating the challenges of these disorders. Advances in digital tools for psychiatry and understanding the biological basis of mood disorders offer the potential for novel diagnostic methods that facilitate early and accurate diagnosis of patients. Objective The Delta Trial was launched to develop an algorithm-based diagnostic aid combining symptom data and proteomic biomarkers to reduce the misdiagnosis of bipolar disorder (BD) as a major depressive disorder (MDD) and achieve more accurate and earlier MDD diagnosis. Methods Participants for this ethically approved trial were recruited through the internet, mainly through Facebook advertising. Participants were then screened for eligibility, consented to participate, and completed an adaptive digital questionnaire that was designed and created for the trial on a purpose-built digital platform. A subset of these participants was selected to provide dried blood spot (DBS) samples and undertake a World Health Organization World Mental Health Composite International Diagnostic Interview (CIDI). Inclusion and exclusion criteria were chosen to maximize the safety of a trial population that was both relevant to the trial objectives and generalizable. To provide statistical power and validation sets for the primary and secondary objectives, 840 participants were required to complete the digital questionnaire, submit DBS samples, and undertake a CIDI. Results The Delta Trial is now complete. More than 3200 participants completed the digital questionnaire, 924 of whom also submitted DBS samples and a CIDI, whereas a total of 1780 participants completed a 6-month follow-up questionnaire and 1542 completed a 12-month follow-up questionnaire. The analysis of the trial data is now underway. Conclusions If a diagnostic aid is able to improve the diagnosis of BD and MDD, it may enable earlier treatment for patients with mood disorders. International Registered Report Identifier (IRRID) DERR1-10.2196/18453
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Affiliation(s)
- Tony Olmert
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jason D Cooper
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Sung Yeon Sarah Han
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | | | - Sureyya Ozcan
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Nitin Rustogi
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Rhian L Preece
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Pawel Eljasz
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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11
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Remission and recurrence in bipolar disorder: The data from health outcomes and patient evaluations in bipolar disorder (HOPE-BD) study. J Affect Disord 2020; 268:150-157. [PMID: 32174473 DOI: 10.1016/j.jad.2020.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The HOPE-BD was a naturalistic study established to follow individuals in Canada seeking treatment for bipolar disorder (BD). The study aimed to examine the course of BD and describe how clinical and sociodemographic factors are associated with outcomes. METHODS Individuals with BD had their clinical data recorded at enrolment and were naturalistically treated. Participant were followed for up to four years, and visits occurred at least once every three months. We investigated the longitudinal outcomes with logistic, Cox, and quantile regressions. RESULTS Among the 354 participants, 57.3% had BD type I. Depression as first episode, younger ages at onset and older ages of the first professional help predicted longer delays in correct diagnosis. Among the symptomatic patients at baseline, the median time to remission was 10.9 months. Comorbid alcohol use disorder and the severity of baseline depressive symptoms predicted longer times to remission. Among the euthymic participants, the median time to recurrence was 14.5 months. History of anxiety disorder and younger ages at onset predicted shorter times to recurrence. Baseline depression scores predicted recurrence in euthymic patients. LIMITATIONS We did not investigate the predictors of each polarity. Our findings may not apply to individuals followed in non-specialised outpatient services. CONCLUSION Our study reinforces the necessity of early diagnosis and interventions, as well as the importance of treating depressive symptoms and comorbidities.
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12
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Costa MH, Kunz M, Nierenberg AA, Deckersbach T, Berk M, Magalhaes PVS. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:245-252. [PMID: 31958979 PMCID: PMC7385420 DOI: 10.1177/0706743719900460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The potential of clozapine in severe bipolar disorder is suggested by its
efficacy in refractory schizophrenia, but the evidence is limited thus far.
This report utilizes data from the standard care pathway of the Systematic
Treatment Enhancement Program to examine the clinical impact of clozapine in
bipolar disorder, comparing it to two groups, one that received olanzapine
and an additional group that received neither drug. Method: A total of 4,032 outpatients were available for this analysis. Groups for
longitudinal analyses are based on the medication used at each visit.
Outcomes assessed were clinical status, symptoms subscales,
hospitalizations, and death. We utilized mixed models and generalized
estimating equations to adjust for baseline differences and investigate
longitudinal differences in symptoms, clinical status, and hospitalization
rates between groups. Results: During the study, 1.1% (n = 43) of the patients used
clozapine at any time. Those on clozapine had significantly fewer manic and
depressive symptoms during follow-up as compared with those on neither
clozapine nor olanzapine, while those on olanzapine had more symptoms. The
use of clozapine was not associated with an increased risk of
hospitalization. No deaths were recorded for clozapine group during the
trial. Conclusions: Although prescribed to very few patients, the impact of clozapine was
notable, with fewer symptoms in patients who had more severe illnesses at
baseline. Clozapine could prove to be as successful an intervention for
late-stage bipolar disorder as it has been in schizophrenia.
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Affiliation(s)
- Marta H Costa
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauricio Kunz
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Orygen, The Centre of Excellence in Youth Mental Health, Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia
| | - Pedro V S Magalhaes
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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13
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Rubensson A, Salzmann‐Erikson M. A document analysis of how the concept of health is incorporated in care plans when using the nursing diagnosis classification system (
NANDA
‐I) in relation to individuals with bipolar disorder. Scand J Caring Sci 2019; 33:986-994. [DOI: 10.1111/scs.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anton Rubensson
- Ward 53, Inpatient Care Unit for Patients with Bipolar Disorder Section for Affective Disorders Northern Stockholm Psychiatry Stockholm Sweden
| | - Martin Salzmann‐Erikson
- Department of Health and Caring Sciences Faculty of Health and Occupational Studies University of Gävle Gävle Sweden
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14
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Gut microbiota and bipolar disorder: a review of mechanisms and potential targets for adjunctive therapy. Psychopharmacology (Berl) 2019; 236:1433-1443. [PMID: 31041459 DOI: 10.1007/s00213-019-05248-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Abstract
There is increasing evidence that connections formed between microbiome, the gut, and the brain play a role in health and well-being. Non-pharmaceutical targets for management of mood disorders, such as bipolar disorder, are relatively under-researched. At the same time, it is clear that there is an intimate connection between psychiatry and gastrointestinal health. Here, we have discussed various comorbid conditions associated with bipolar disorders such as inflammation, irritable bowel disease and antibiotic induced mania with importance to demonstrate possible involvement of the gut microbiota. Gut microbiota-targeted preclinical and clinical interventions have demonstrated enhancement in various psychological conditions. Further in this review, we explore links between bipolar disorder, inflammation and gut microbiome with a focus on dietary, pro- and pre-biotic interventions as potential adjuvant therapies for use in the management of mood disorders such as bipolar disorder.
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15
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Pereira CS, Padoan CS, Garcia LF, Patusco L, Magalhães PVS. Barriers and facilitators perceived by people with bipolar disorder for the practice of exercise: a qualitative study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:1-8. [PMID: 30994778 DOI: 10.1590/2237-6089-2017-0069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 05/10/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Exercising regularly has benefits for people with bipolar disorder. Nevertheless, as a group, these patients tend to be less physically active than the general population and little is known from the viewpoint of the patients about the barriers and facilitators to such a practice. OBJECTIVE To know the barriers and facilitators perceived by people with bipolar disorder for the practice of exercise. METHODS This study had a descriptive, qualitative, exploratory nature. The investigation method used for data collection was a semi-structured in-depth interview, using grounded theory as theoretical framework. RESULTS The data analysis generated two main areas of interest: adherence to regular physical exercise (barriers and facilitators) and the participants' exercise history and perception of disease management, as described below. The main findings were: most of our sample did not exercise regularly, nor knew how exercise can positively influence their disorder; with regard to adherence to physical exercise, the presence of symptoms and stigma were the most important barriers to the practice of physical exercise. Social support, especially from family and friends, could be a facilitator to the practice of exercise. CONCLUSIONS Even considering the limitations for generalization of qualitative and exploratory studies, understanding perceived barriers and facilitators for the practice of exercise among people who suffer with bipolar disorder may contribute to the promotion of activities in which people with mental illness can participate.
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Affiliation(s)
| | | | | | - Lucas Patusco
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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16
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Serafim SD, da Ponte FDR, Lima FM, Martins DS, Rosa AR, Kunz M. Effects of deep breathing in patients with bipolar disorder. Perspect Psychiatr Care 2019; 55:119-125. [PMID: 30189115 DOI: 10.1111/ppc.12325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/30/2018] [Accepted: 08/12/2018] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Our aim was to evaluate the effects of deep breathing exercises in subjects with bipolar disorder. DESIGN AND METHODS This was an open-label, uncontrolled clinical trial with three assessments: preintervention, postintervention, and follow-up. FINDINGS The Hamilton Anxiety Rating Scale, BECK-A, Hamilton Depression Rating Scale, and Young Mania Rating Scale had significant preintervention, postintervention, and follow-up differences. The results indicated that the deep breathing protocol was effective in reducing anxiety levels in patients with bipolar disorder. The deep breathing protocol has no negative side effects and might be applied to decrease anxiety symptoms in individuals with bipolar disorder. PRACTICE IMPLICATIONS The results provide direction for providing quality care that reduces anxiety levels in patients with bipolar disorder.
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Affiliation(s)
- Silvia D Serafim
- Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.,Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Francisco D R da Ponte
- Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.,Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Flavia M Lima
- Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.,Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Dayane S Martins
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Adriane R Rosa
- Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.,Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maurício Kunz
- Postgraduate Program: Psychiatry and Behavioral Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.,Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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17
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Abstract
PURPOSE OF REVIEW Bipolar disorder (BD) medical comorbidity presents significant clinical and public health concerns with serious impact on health. The aim of this article is to present an updated narrative review of original research articles (case control, longitudinal cohort, and cross-sectional studies) and meta-analyses published in English language journals from January 2013 to May 2017 focusing on general medical comorbidity in BD, including the added risks of iatrogenic factors relevant to the treatment of BD. RECENT FINDINGS We found numerous patterns of association between BD and various medical disorders involving multiple organ systems. One pattern indicated reciprocal increase in the rate of each comorbid condition, such as an increased rate of BD in asthma or migraine, and likewise an increase in the rate of asthma or migraine in patients with BD. A second pattern was a predominantly unidirectional increase in the rate of BD in patients with certain medical disorders, such as multiple sclerosis or cerebellar diseases. A third pattern was a predominantly unidirectional increased rate of medical disorders in patients with BD. One study suggested the potential involvement of genetic mechanisms for the association between BD and migraine. Most of the studies had cross-sectional or retrospective designs, and many relied on analysis of large administrative databases inviting multiple potential biases. Our review highlights the association between BD and a variety of medical disorders. Further research is needed to elucidate the potential underlying etiopathological mechanisms that contribute to observed comorbidities. The results of this review also emphasize the need for comprehensive screening for medical disorders in BD and for adoption of an integrated model of care to address these complex comorbidities.
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Affiliation(s)
- Aktriti Sinha
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Anam Shariq
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Khaled Said
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Abhinav Sharma
- Homewood Health Center, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
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18
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Aguglia A, Signorelli MS, Albert U, Maina G. The Impact of General Medical Conditions in Obsessive-Compulsive Disorder. Psychiatry Investig 2018; 15:246-253. [PMID: 29475243 PMCID: PMC5900370 DOI: 10.30773/pi.2017.06.17.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/04/2017] [Accepted: 06/17/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The co-occurrence of general medical conditions (GMCs) and major psychiatric disorders is well documented. The aim of this study was to assess the prevalence of GMCs in patients with a primary diagnosis of obsessive-compulsive disorder (OCD) and, secondly, to investigate which clinical variables are associated with the presence of a GMC. METHODS Subjects with a primary diagnosis of OCD were included. Socio-demographic and clinical characteristics were collected. GMCs were classified using the ICD-10 and grouped according to the Cumulative Illness Rating Scale (CIRS) in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The association between the presence of GMCs and demographic/clinical variables of OCD was investigated. RESULTS A total of 162 patients with OCD were included. 78 (48.1%) patients had at least one comorbid GMC. Most frequent GMCs were endocrine/metabolic diseases (25.9%), followed by upper/lower gastrointestinal (20.5%) and cardio-vascular diseases (13.6%). The presence of a GMC was significantly associated with female gender, older age, duration of untreated illness (DUI), and absence of physical activity. CONCLUSION Patients with OCD have high rates of comorbid GMCs. A longer DUI is associated with having at least one GMCs; this might be due to the long-lasting adoption of unhealthy lifestyles, not counterbalanced by appropriate treatment and psychoeducation.
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Affiliation(s)
- Andrea Aguglia
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Psychiatric Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, AOU Policlinico Hospital, University of Catania, Catania, Italy
| | - Umberto Albert
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Psychiatric Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giuseppe Maina
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Psychiatric Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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19
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Exclusion criteria and generalizability in bipolar disorder treatment trials. Contemp Clin Trials Commun 2018; 9:130-134. [PMID: 29696235 PMCID: PMC5898491 DOI: 10.1016/j.conctc.2018.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/22/2018] [Accepted: 01/26/2018] [Indexed: 12/15/2022] Open
Abstract
Objective The current paper reviews the English-language research on exclusion criteria in bipolar disorder treatment trials and discusses how study samples compare to the general bipolar patient population. Methods & Results: Across 8 identified studies of exclusion criteria and their impact, between 55% and 96% of people with bipolar disorder would be excluded from treatment research. The number of exclusion criteria varies across bipolar disorder treatment research, with one study estimate of a median of 7 criteria used across studies. The criteria that excluded the greatest number of potential participants were comorbid substance use disorder, suicidal risk, and comorbid medical conditions. Both studies that compared treatment responses among participants who met and did not meet exclusion criteria found no statistically significant differences. Conclusions Most potential participants are excluded from outcome research, which creates challenges for recruitment and limits generalizability of study findings. Common exclusionary practices lead to unrepresentative samples that limit generalizability and reduce the confidence of clinicians that findings can be translated to front-line practice with bipolar disorder patients.
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20
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Yapici Eser H, Kacar AS, Kilciksiz CM, Yalçinay-Inan M, Ongur D. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry 2018; 9:229. [PMID: 29997527 PMCID: PMC6030835 DOI: 10.3389/fpsyt.2018.00229] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/11/2018] [Indexed: 12/23/2022] Open
Abstract
Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence. Method: We searched PubMed to access relevant articles published until September 2015, using the keywords "Bipolar disorder" or "Affective Psychosis" or "manic depressive" separately with "generalized anxiety," "panic disorder," "social phobia," "obsessive compulsive," and "anxiety." Variables for associated features and prevalence of anxiety disorders were carefully extracted. Results: Lifetime any anxiety disorder comorbidity in BD was 40.5%; panic disorder (PD) 18.1%, generalized anxiety disorder (GAD) 13.3%, social anxiety disorder (SAD) 13.5% and obsessive compulsive disorder (OCD) 9.7%. Current any anxiety disorder comorbidity in BD is 38.2%; GAD is 15.2%, PD 13.3%, SAD 11.7%, and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38% and 34%, PD was 15% and 15%, GAD was 14% and 16.6%, SAD was 8% and 13%, OCD was 8% and 10%, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31% and 37%, PD was 9% and 13%, GAD was 8% and 12%, SAD was 7% and 11%, and OCD was 8% and 7%, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD-SAD comorbidity. History of psychotic features significantly affected current PD and GAD. Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.
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Affiliation(s)
- Hale Yapici Eser
- School of Medicine, Koç University, Sariyer, Turkey.,Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Anil S Kacar
- Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Can M Kilciksiz
- School of Medicine, Koç University, Sariyer, Turkey.,Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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21
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Baba H. Importance of managing physical conditions in the acute phase for people with psychiatric disorders. Psychiatry Clin Neurosci 2017; 71:662. [PMID: 28975724 DOI: 10.1111/pcn.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Hajime Baba
- Department of Psychiatry & Behavioral Science, Juntendo Graduate School of Medicine, Tokyo, Japan
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Pregnancy and bipolar disorder: the risk of recurrence when discontinuing treatment with mood stabilisers: a systematic review. Acta Neuropsychiatr 2017; 29:259-266. [PMID: 27852343 DOI: 10.1017/neu.2016.60] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Bipolar disorder in pregnancy may be difficult to treat. The dilemma is whether the women should continue medication throughout pregnancy, and maybe accept a minor risk to harm their unborn child, or discontinue medication and increase the risk of recurrence, which can lead to maternal morbidity, thereby endangering themselves and their foetus. Design and methods In September 2016, three electronic search databases; PubMed, Scopus and PsycInfo, were used searching for clinical trials concerning this question. Eight clinical trials concerning risk of recurrence after discontinuation of medication in pregnancy were included. RESULTS There is no consensus concerning the risk of discontinuation of medication during pregnancy among bipolar women. The evidence from the trials included underscore that there seem to be a group of pregnant women who are stable despite they are not receiving mood stabilisers during pregnancy. Besides, there is a group of more severe and more unstable bipolar disorders that seem to benefit of a more close monitoring, support and prophylactic medication during pregnancy and postpartum period to prevent recurrence. CONCLUSION For the more stable bipolar women we recommend a well planned and more slowly discontinuation of medication before pregnancy. For the unplanned pregnancies it is important to consider the possibility of a more slowly discontinuation. For the more severe conditions of bipolar disorder, it is important to secure a close monitoring of medication. As the risk of postpartum relapse is high, medication may be started soon after delivery.
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Hosang GM, Fisher HL, Uher R, Cohen-Woods S, Maughan B, McGuffin P, Farmer AE. Childhood maltreatment and the medical morbidity in bipolar disorder: a case-control study. Int J Bipolar Disord 2017; 5:30. [PMID: 28879470 PMCID: PMC5587525 DOI: 10.1186/s40345-017-0099-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/14/2017] [Indexed: 12/31/2022] Open
Abstract
Background Childhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Emerging evidence suggests that a history of childhood maltreatment is linked to the comorbidity between medical illnesses and mood disorders. However, existing studies on bipolar disorder have not yet explored the specific influence of child neglect and have not included comparisons with individuals without mood disorders (controls). This study aimed to extend the existing literature by examining the differential influence of child abuse and child neglect on medical morbidity in a sample of bipolar cases and controls. Methods The study included 72 participants with bipolar disorder and 354 psychiatrically healthy controls (average age of both groups was 48 years), who completed the Childhood Trauma Questionnaire, and were interviewed regarding various medical disorders. Results A history of any type of childhood maltreatment was significantly associated with a diagnosis of any medical illness (adjusted OR = 6.28, 95% confidence intervals 1.70–23.12, p = 0.006) and an increased number of medical illnesses (adjusted OR = 3.77, 95% confidence intervals 1.34–10.57, p = 0.012) among adults with bipolar disorder. Exposure to child abuse was more strongly associated with medical disorders than child neglect. No association between childhood maltreatment and medical morbidity was detected among controls. Conclusions To summarise, individuals with bipolar disorder who reported experiencing maltreatment during childhood, especially abuse, were at increased risk of suffering from medical illnesses and warrant greater clinical attention.
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Affiliation(s)
- Georgina M Hosang
- Psychology Department, Goldsmiths, University of London, Lewisham Way, London, SE14 6NW, UK.
| | - Helen L Fisher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
| | - Sarah Cohen-Woods
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Barbara Maughan
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Peter McGuffin
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Anne E Farmer
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Dell'Osso B, Grancini B, Vismara M, De Cagna F, Maggi M, Molle M, Cremaschi L, Miller S, Ketter TA, Altamura AC. Age at onset in patients with bipolar I and II disorder: a comparison of large sample studies. J Affect Disord 2016; 201:57-63. [PMID: 27177297 DOI: 10.1016/j.jad.2016.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/14/2016] [Accepted: 04/11/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bipolar Disorder (BD) is a leading cause of disability worldwide and factors contributing to its burden include chronic relapsing course, comorbidity, suicide risk, and early age at onset (AAO). In particular, recent investigation has shown that BD onset may occur earlier than previously believed, even though whether BDI and II are different in such regard is still debated. Reduced samples may, moreover, limit the confidence in the published studies, with geographic issues, in turn, representing potentially conditioning factors. The present review was aimed to select and analyze large sample studies comparing AAO in BDI vs II patients. METHODS A PubMed literature search was performed, considering English-written articles published up to December 2015, comparing AAO in BDI vs II patients with sample size≥100 subjects per group. RESULTS Seventeen studies were considered suitable for revision, with 8 studies reporting statistically significant differences and 9 not. Among studies reporting statistically significant differences, mostly conducted in Europe, 6 showed an earlier AAO in BDI, while 2 in BDII subjects. LIMITATIONS Only studies with large samples included, considering AAO as a continuous variable, and providing a comparison between the bipolar subtypes. CONCLUSIONS Our findings suggest that AAO per se does not seem to reliably differentiate BDI from BDII patients and that such variable should likely be investigated in the context of other clinical characteristics, in order to assess its overall influence over BD course. Geographic factors may, in turn, play a potential role with future investigation warranted to further explore this specific issue.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA.
| | - Benedetta Grancini
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Vismara
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca De Cagna
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Maggi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Molle
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shefali Miller
- Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - Terence A Ketter
- Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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25
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Hsu JH, Chien IC, Lin CH. Increased risk of chronic liver disease in patients with bipolar disorder: A population-based study. Gen Hosp Psychiatry 2016; 42:54-9. [PMID: 27638973 DOI: 10.1016/j.genhosppsych.2016.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the prevalence and incidence of chronic liver disease in patients with bipolar disorder. METHODS We used a random sample of 766,427 subjects aged ≥18 years from the National Health Research Institute database in the year 2005. Subjects with at least one primary diagnosis of bipolar disorder in 2005 were identified. Patients with a primary or secondary diagnosis of chronic liver disease were also defined. We compared the prevalence and associated factors of chronic liver disease between patients with bipolar disorder and the general population in 2005. We also compared the incidence of chronic liver disease in patients with bipolar disorder and the general population from 2006 to 2010. RESULTS The prevalence of chronic liver disease in patients with bipolar disorder (13.9%) was 2.68 times higher than that of the general population (5.8%) in 2005. The average annual incidence of chronic liver disease in patients with bipolar disorder from 2006 to 2010 was also higher than that of the general population (2.95% vs. 1.73%; risk ratio: 1.71; 95% confidence interval: 1.46-2.01). CONCLUSIONS Patients with bipolar disorder had a significantly higher prevalence and incidence of chronic liver disease than those in the general population, and younger patients with bipolar disorder have a much higher prevalence and incidence than those in the general population. Male sex, second-generation antipsychotic or antidepressant use, and hyperlipidemia were associated factors for chronic liver disease in patients with bipolar disorder.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Ministry of Health and Welfare, Chiayi City, Taiwan
| | - I-Chia Chien
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan; Department of Public Health & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Heng Lin
- Taichung Veteran General Hospital, Taichung, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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26
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Prieto ML, Ryu E, Jenkins GD, Batzler A, Nassan MM, Cuellar-Barboza AB, Pathak J, McElroy SL, Frye MA, Biernacka JM. Leveraging electronic health records to study pleiotropic effects on bipolar disorder and medical comorbidities. Transl Psychiatry 2016; 6:e870. [PMID: 27529678 PMCID: PMC5022084 DOI: 10.1038/tp.2016.138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 05/13/2016] [Accepted: 06/15/2016] [Indexed: 01/27/2023] Open
Abstract
Patients with bipolar disorder (BD) have a high prevalence of comorbid medical illness. However, the mechanisms underlying these comorbidities with BD are not well known. Certain genetic variants may have pleiotropic effects, increasing the risk of BD and other medical illnesses simultaneously. In this study, we evaluated the association of BD-susceptibility genetic variants with various medical conditions that tend to co-exist with BD, using electronic health records (EHR) data linked to genome-wide single-nucleotide polymorphism (SNP) data. Data from 7316 Caucasian subjects were used to test the association of 19 EHR-derived phenotypes with 34 SNPs that were previously reported to be associated with BD. After Bonferroni multiple testing correction, P<7.7 × 10(-5) was considered statistically significant. The top association findings suggested that the BD risk alleles at SNP rs4765913 in CACNA1C gene and rs7042161 in SVEP1 may be associated with increased risk of 'cardiac dysrhythmias' (odds ratio (OR)=1.1, P=3.4 × 10(-3)) and 'essential hypertension' (OR=1.1, P=3.5 × 10(-3)), respectively. Although these associations are not statistically significant after multiple testing correction, both genes have been previously implicated with cardiovascular phenotypes. Moreover, we present additional evidence supporting these associations, particularly the association of the SVEP1 SNP with hypertension. This study shows the potential for EHR-based analyses of large cohorts to discover pleiotropic effects contributing to complex psychiatric traits and commonly co-occurring medical conditions.
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Affiliation(s)
- M L Prieto
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile
| | - E Ryu
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - G D Jenkins
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - A Batzler
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M M Nassan
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - A B Cuellar-Barboza
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - J Pathak
- Division of Health Informatics, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - S L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - M A Frye
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - J M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
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Peters AT, Shesler LW, Sylvia L, da Silva Magalhaes PV, Miklowitz DJ, Otto MW, Frank E, Berk M, Dougherty DD, Nierenberg AA, Deckersbach T. Medical burden, body mass index and the outcome of psychosocial interventions for bipolar depression. Aust N Z J Psychiatry 2016; 50:667-77. [PMID: 26590023 DOI: 10.1177/0004867415616694] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Individuals with bipolar disorder experience a disproportionately high incidence of medical co-morbidity and obesity. These health-related problems are a barrier to recovery from mood episodes and have been linked with unfavorable responses to pharmacological treatment. However, little is known about whether and how these characteristics affect responses to adjunctive psychotherapy. METHOD Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy plus pharmacotherapy with collaborative care (a three-session psycho-educational intervention) plus pharmacotherapy. We conducted a post-hoc analysis to evaluate whether medical burden and body mass index predicted and/or moderated the likelihood of recovery and time until recovery from a depressive episode among patients in the two treatments. RESULTS Participants who had medical co-morbidity and body mass index data constituted 199 of the 293 patients in the original Systematic Treatment Enhancement Program for Bipolar Disorder trial. Higher medical burden predicted a lower likelihood of recovery from depression in both treatment conditions (odds ratio = 0.89), but did not moderate responses to intensive psychotherapy vs collaborative care. Intensive psychotherapy yielded superior recovery rates for individuals of normal body mass index (odds ratio= 2.39) compared with collaborative care, but not among individuals who were overweight or obese. CONCLUSION Medical co-morbidity and body weight impacts symptom improvement and attention to this co-morbidity may inform the development of more personalized treatments for bipolar disorder.
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Affiliation(s)
- Amy T Peters
- University of Illinois at Chicago, Chicago, IL, USA
| | - Leah W Shesler
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | | | | | | | - Ellen Frank
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Berk
- Deakin University, Melbourne, VIC, Australia University of Melbourne, Melbourne, VIC, Australia
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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28
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Jeon HJ, Baek JH, Ahn YM, Kim SJ, Ha TH, Cha B, Moon E, Kang HJ, Ryu V, Cho CH, Heo JY, Kim K, Lee HJ. Review of Cohort Studies for Mood Disorders. Psychiatry Investig 2016; 13:265-76. [PMID: 27247592 PMCID: PMC4878960 DOI: 10.4306/pi.2016.13.3.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 12/28/2022] Open
Abstract
This paper aimed to review currently available cohort studies of subjects with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD). Using the PubMed and KoreaMed databases, we reviewed eight major cohort studies. Most studies recruited participants with MDD and BD separately, so direct comparison of factors associated with diagnostic changes was difficult. Regular and frequent follow-up evaluations utilizing objective mood ratings and standardized evaluation methods in a naturalistic fashion are necessary to determine detailed clinical courses of mood disorders. Further, biological samples should also be collected to incorporate clinical findings in the development of new diagnostic and therapeutic approaches. An innovative cohort study that can serve as a platform for translational research for treatment and prevention of mood disorders is critical in determining clinical, psychosocial, neurobiological and genetic factors associated with long-term courses and consequences of mood disorders in Korean patients.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences & Technology, Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Ha
- Department of Psychiatry, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University College of Medicine, Gwangju, Republic of Korea
| | - Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Mansur RB, Rizzo LB, Santos CM, Asevedo E, Cunha GR, Noto MN, Pedrini M, Zeni M, Cordeiro Q, McIntyre RS, Brietzke E. Adipokines, metabolic dysfunction and illness course in bipolar disorder. J Psychiatr Res 2016; 74:63-9. [PMID: 26748249 DOI: 10.1016/j.jpsychires.2015.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/27/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022]
Abstract
Replicated evidence indicates that individuals with BD are differentially affected by metabolic comorbidities and that its occurrence is a critical mediator and/or moderator of BD outcomes. This study aimed to explore the role of adipokines on bipolar disorder (BD) course and its relationship with metabolic comorbidities (i.e. type 2 diabetes mellitus, obesity). We measured plasma levels of adiponectin and leptin, as well as anthropometric and metabolic parameters of 59 patients with BD and 28 healthy volunteers. Our results showed that, in female participants, adiponectin was lower in individuals with BD, relative to healthy controls (p = 0.017). In the BD population, adiponectin levels were correlated with fasting glucose (r = -0.291, p = 0.047), fasting insulin (r = -0.332, p = 0.023), C-peptide (r = 0.040, p = 0.040), homeostatic model assessment-insulin resistance (r = -0.411, p = 0.004), HDL (r = 0.508, p < 0.001), VLDL (r = -0.395, p = 0.005) and triglycerides (r = -0.310, p = 0.030). After adjustment for age, gender and BMI, individuals with BD and low adiponectin levels (i.e. < 7.5 μg/ml), had a higher number of mood episodes (p < 0.001), lower number of psychiatric hospitalizations (p = 0.007), higher depressive symptoms (p < 0.001) and lower levels of functioning (p = 0.020). In conclusion, adiponectin levels, either directly or as a proxy of metabolic dysfunction, is independently associated with an unfavorable course of illness in BD.
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Affiliation(s)
- Rodrigo B Mansur
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
| | - Lucas B Rizzo
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Department of Psychiatry, Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Camila M Santos
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Elson Asevedo
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Graccielle R Cunha
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariane N Noto
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Vila Maria Outpatient Clinic in São Paulo, Brazil
| | - Mariana Pedrini
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maiara Zeni
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Quirino Cordeiro
- Department of Psychiatry, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Dysregulation of the NF-κB pathway as a potential inducer of bipolar disorder. J Psychiatr Res 2015; 70:18-27. [PMID: 26424419 DOI: 10.1016/j.jpsychires.2015.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 11/20/2022]
Abstract
A century of investigations enhanced our understanding of bipolar disorder although it remains a complex multifactorial disorder with a mostly unknown pathophysiology and etiology. The role of the immune system in this disorder is one of the most controversial topics in genetic psychiatry. Though inflammation has been consistently reported in bipolar patients, it remains unclear how the immunologic process influences the disorder. One of the core components of the immune system is the NF-κB pathway, which plays an essential role in the development of innate and adaptive immunity. Remarkably, the NF-κB pathway received only little attention in bipolar studies, as opposed to studies of related psychiatric disorders where immune dysregulation has been proposed to explain the neurodegeneration in patient conditions. If immune dysregulation can also explains the neurodegeneration in bipolar disorder, it will underscore the role of the immune system in the chronicity and pathophysiology of the disorder and may promote personalized therapeutic strategies. This is the first review to summarize the current knowledge of the pathophysiological functions of NF-κB in bipolar disorder.
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Jackson JG, Diaz FJ, Lopez L, de Leon J. A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disord 2015; 17:575-97. [PMID: 26238269 DOI: 10.1111/bdi.12319] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/31/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Worldwide studies were combined to examine two hypotheses: (i) bipolar disorder is associated with smoking behaviors, compared with the general population; and (ii) smoking behavior prevalences in bipolar disorder are intermediate between those in major depressive disorder and those in schizophrenia. METHODS Combined analyses used 56 articles on adults obtained from a PubMed search or the senior author's article collection. Odds ratios (ORs) and their 95% confidence intervals (CIs) compared current smoking, heavy smoking among current smokers, smoking cessation in ever smokers, and ever smoking in bipolar disorder versus control groups. RESULTS The combined OR was 3.5 (CI: 3.39-3.54) in 51 current smoking studies of bipolar disorder versus the general population from 16 countries. More limited data provided an OR = 0.34 (CI: 0.31-0.37) for smoking cessation and an OR = 3.6 (CI: 3.30-3.80) for ever smoking. The combined OR was 0.76 (CI: 0.74-0.79) for current smoking in bipolar disorder versus schizophrenia in 20 studies from ten countries. Ever smoking may be lower in bipolar disorder than in schizophrenia (OR = 0.83, CI: 0.75-0.91). The OR was 2.05 (CI: 2.00-2.10) for current smoking in bipolar disorder versus major depression in 18 studies from seven countries. Ever smoking may be higher (OR = 1.5, CI: 1.40-1.70) and smoking cessation lower (OR = 0.51, CI: 0.45-0.59) in bipolar disorder than in major depression. CONCLUSIONS Increased current smoking in bipolar disorder versus the general population reflected increased ever smoking (initiation) and decreased smoking cessation. Smoking behavior frequencies in bipolar disorder may be between those in depressive disorder and schizophrenia, with schizophrenia showing the highest severity level.
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Affiliation(s)
| | - Francisco J Diaz
- Department of Biostatistics, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Lucelly Lopez
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, University of Kentucky, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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Stertz L, Fries GR, Rosa AR, Kauer-Sant'anna M, Ferrari P, Paz AVC, Green C, Cunha ÂBM, Dal-Pizzol F, Gottfried C, Kapczinski F. Damage-associated molecular patterns and immune activation in bipolar disorder. Acta Psychiatr Scand 2015; 132:211-7. [PMID: 25891376 DOI: 10.1111/acps.12417] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Immune activation in bipolar disorder (BD) has been frequently reported. Damage-associated molecular patterns (DAMPs) are key players in the immune activation reaction. The aim of this study was to assess DAMP levels in drug-free patients with BD during acute episodes. METHOD Serum levels of a predetermined set of DAMPs were assessed in drug-free patients with BD (n = 20) during an acute mood episode. We also included two control groups: healthy subjects, used as a negative control (n = 20); and patients with sepsis, used as a positive control for severe immune activation (n = 20). RESULTS Multivariate analysis using generalized linear mixed model indicated that all DAMPs differed as a function of group membership after controlling for age and addressing multiplicity (P < 0.0006 for all comparisons). Follow-up analyses showed higher levels in BD subjects of circulating cell-free (ccf) nuclear (n)DNA (P = 0.02), HSP70 (P = 0.03) and HSP90α (P = 0.02) as compared to healthy subjects. Also, patients with BD showed lower levels of ccf nDNA (P = 0.04), HSP60 (P = 0.03), HSP70 (P = 0.01), and HSP90α (P = 0.002) as compared to patients with sepsis and higher levels of ccf mitochondrial DNA (P < 0.0001). CONCLUSION The present findings may be linked to the inflammatory activity previously described among patients with BD and may help in the development of more targeted and personalized treatments for patients under acute episodes of BD.
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Affiliation(s)
- L Stertz
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, BRA.,Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Sciences, Center for Molecular Psychiatry, University of Texas Health Science Center, Houston, TX, USA
| | - G R Fries
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, BRA.,Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - A R Rosa
- Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pharmacology, Basic Science Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M Kauer-Sant'anna
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, BRA.,Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - P Ferrari
- Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - A V C Paz
- Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - C Green
- Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Â B M Cunha
- Department of Pharmacology, Basic Science Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Neuropsychiatry, Centro de Ciências da Saude, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - F Dal-Pizzol
- Laboratorio de FisiopatologiaExperimental, Unidade Academica de Ciencias da Saude, Universidade do Extremo Sul Catarinense, Criciuma, SC, USA
| | - C Gottfried
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, BRA
| | - F Kapczinski
- Bipolar Disorder Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Sciences, Center for Molecular Psychiatry, University of Texas Health Science Center, Houston, TX, USA
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34
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Panizzutti B, Gubert C, Schuh AL, Ferrari P, Bristot G, Fries GR, Massuda R, Walz J, Rocha NP, Berk M, Teixeira AL, Gama CS. Increased serum levels of eotaxin/CCL11 in late-stage patients with bipolar disorder: An accelerated aging biomarker? J Affect Disord 2015; 182:64-9. [PMID: 25973785 DOI: 10.1016/j.jad.2014.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/04/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is commonly comorbid with many medical disorders including atopy, and appears characterized by progressive social, neurobiological, and functional impairment associated with increasing number of episodes and illness duration. Early and late stages of BD may present different biological features and may therefore require different treatment strategies. Consequently, the aim of this study was to evaluate serum levels of eotaxin/CCL11, eotaxin-2/CCL24, IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α, IFNγ, BDNF, TBARS, carbonyl, and GPx in a sample of euthymic patients with BD at early and late stages compared to controls. METHODS Early-stage BD patients, 12 late-stage patients, and 25 controls matched for sex and age were selected. 10mL of peripheral blood was drawn from all subjects by venipuncture. Serum levels of BDNF, TBARS, carbonyl content, glutathione-peroxidase activity (GPx), cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α and IFNγ), and chemokines (eotaxin/CCL11 and eotaxin-2/CCL24) were measured. RESULTS There were no demographic differences between patients and controls. No significant differences were found for any of the biomarkers, except chemokine eotaxin/CCL11, whose serum levels were higher in late-stage patients with BD when compared to controls (p=0.022; Mann-Whitney U test). LIMITATIONS Small number of subjects and use of medication may have influenced in our results. CONCLUSION The present study suggests a link between biomarkers of atopy and eosinophil function and bipolar disorder. These findings are also in line with progressive biological changes partially mediated by inflammatory imbalance, a process referred to as neuroprogression.
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Affiliation(s)
- B Panizzutti
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, UFRGS, Porto Alegre, Brazil.
| | - C Gubert
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Brazil
| | - A L Schuh
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - P Ferrari
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, UFRGS, Porto Alegre, Brazil
| | - G Bristot
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - G R Fries
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Brazil
| | - R Massuda
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, UFRGS, Porto Alegre, Brazil; Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - J Walz
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, UFRGS, Porto Alegre, Brazil; Centro Universitário UNILASALLE, Canoas, Brazil
| | - N P Rocha
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
| | - M Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - A L Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
| | - C S Gama
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, UFRGS, Porto Alegre, Brazil
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Prieto ML, McElroy SL, Hayes SN, Sutor B, Kung S, Bobo WV, Fuentes ME, Cuellar-Barboza AB, Crow S, Ösby U, Chauhan M, Westman J, Geske JR, Colby CL, Ryu E, Biernacka JM, Frye MA. Association between history of psychosis and cardiovascular disease in bipolar disorder. Bipolar Disord 2015; 17:518-27. [PMID: 26062406 DOI: 10.1111/bdi.12302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/09/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. METHODS This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. RESULTS In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08). CONCLUSIONS The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.
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Affiliation(s)
- Miguel L Prieto
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.,Departamento de Psiquiatría, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sharonne N Hayes
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bruce Sutor
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Simon Kung
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA
| | - William V Bobo
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Manuel E Fuentes
- Department of Psychiatry, Facultad de Medicina Clínica Alemana/Universidad del Desarrollo, Santiago, Chile
| | | | - Scott Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Urban Ösby
- Department of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Mohit Chauhan
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jeanette Westman
- Department of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer R Geske
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Colin L Colby
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Joanna M Biernacka
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Mark A Frye
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA
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36
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Jakobsson J, Bjerke M, Sahebi S, Isgren A, Ekman CJ, Sellgren C, Olsson B, Zetterberg H, Blennow K, Pålsson E, Landén M. Monocyte and microglial activation in patients with mood-stabilized bipolar disorder. J Psychiatry Neurosci 2015; 40:250-8. [PMID: 25768030 PMCID: PMC4478058 DOI: 10.1503/jpn.140183] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bipolar disorder is associated with medical comorbidities that have been linked to systemic inflammatory mechanisms. There is, however, limited evidence supporting a role of neuroinflammation in bipolar disorder. Here we tested whether microglial activation and associated tissue remodelling processes are related to bipolar disorder by analyzing markers in cerebrospinal fluid (CSF) and serum from patients and healthy controls. METHODS Serum was sampled from euthymic patients with bipolar disorder and healthy controls, and CSF was sampled from a large subset of these individuals. The levels of monocyte chemoattractant protein-1 (MCP-1), YKL-40, soluble cluster of differentiation 14 (sCD14), tissue inhibitor of metalloproteinases-1 (TIMP-1) and tissue inhibitor of metalloproteinases-2 (TIMP-2), were measured, and we adjusted comparisons between patients and controls for confounding factors. RESULTS We obtained serum samples from 221 patients and 112 controls and CSF samples from 125 patients and 87 controls. We found increased CSF levels of MCP-1 and YKL-40 and increased serum levels of sCD14 and YKL-40 in patients compared with controls; these differences remained after controlling for confounding factors, such as age, sex, smoking, blood-CSF barrier function, acute-phase proteins and body mass index. The CSF levels of MCP-1 and YKL-40 correlated with the serum levels, whereas the differences between patients and controls in CSF levels of MCP-1 and YKL-40 were independent of serum levels. LIMITATIONS The cross-sectional study design precludes conclusions about causality. CONCLUSION Our results suggest that both neuroinflammatory and systemic inflammatory processes are involved in the pathophysiology of bipolar disorder. Importantly, markers of immunological processes in the brain were independent of peripheral immunological activity.
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Affiliation(s)
- Joel Jakobsson
- Correspondence to: Joel Jakobsson, Sahlgrenska University hospital, Blå Stråket 15, floor 3, SE-413 45 Gothenburg, Sweden;
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Trevizol F, Roversi K, Dias V, Roversi K, Barcelos R, Kuhn F, Pase C, Golombieski R, Veit J, Piccolo J, Pochmann D, Porciúncula L, Emanuelli T, Rocha J, Bürger M. Cross-generational trans fat intake facilitates mania-like behavior: Oxidative and molecular markers in brain cortex. Neuroscience 2015; 286:353-63. [DOI: 10.1016/j.neuroscience.2014.11.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/15/2014] [Accepted: 11/30/2014] [Indexed: 01/01/2023]
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Peters A, Sylvia LG, da Silva Magalhães PV, Miklowitz DJ, Frank E, Otto MW, Hansen NS, Dougherty DD, Berk M, Nierenberg AA, Deckersbach T. Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Psychol Med 2014; 44:3455-67. [PMID: 25066366 PMCID: PMC4620042 DOI: 10.1017/s0033291714000804] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy. METHOD Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. RESULTS Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes. CONCLUSIONS Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.
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Affiliation(s)
- A. Peters
- University of Illinois at Chicago, Chicago, IL, USA
| | - L. G. Sylvia
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - E. Frank
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - D. D. Dougherty
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M. Berk
- Deakin University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - A. A. Nierenberg
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - T. Deckersbach
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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39
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The prevalence and burden of bipolar depression. J Affect Disord 2014; 169 Suppl 1:S3-11. [PMID: 25533912 DOI: 10.1016/s0165-0327(14)70003-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bipolar disorder is characterized by debilitating episodes of depression and mood elevation (mania or hypomania). For most patients, depressive symptoms are more pervasive than mood elevation or mixed symptoms, and thus have been reported in individual studies to impose a greater burden on affected individuals, caregivers, and society. This article reviews and compiles the literature on the prevalence and burden of syndromal as well as subsyndromal presentations of depression in bipolar disorder patients. METHODS The PubMed database was searched for English-language articles using the search terms "bipolar disorder," "bipolar depression," "burden," "caregiver burden," "cost," "costs," "economic," "epidemiology," "prevalence," "quality of life," and "suicide." Search results were manually reviewed, and relevant studies were selected for inclusion as appropriate. Additional references were obtained manually from reviewing the reference lists of selected articles found by computerized search. RESULTS In aggregate, the findings support the predominance of depressive symptoms compared with mood elevation/mixed symptoms in the course of bipolar illness, and thus an overall greater burden in terms of economic costs, functioning, caregiver burden, and suicide. LIMITATIONS This review, although comprehensive, provides a study-wise aggregate (rather than a patient-wise meta-analytic) summary of the relevant literature on this topic. CONCLUSION In light of its pervasiveness and prevalence, more effective and aggressive treatments for bipolar depression are warranted to mitigate its profound impact upon individuals and society. Such studies could benefit by including metrics not only for mood outcomes, but also for illness burden.
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40
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Prieto M, Cuéllar-Barboza A, Bobo W, Roger V, Bellivier F, Leboyer M, West C, Frye M. Risk of myocardial infarction and stroke in bipolar disorder: a systematic review and exploratory meta-analysis. Acta Psychiatr Scand 2014; 130:342-53. [PMID: 24850482 PMCID: PMC5023016 DOI: 10.1111/acps.12293] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the evidence on and estimate the risk of myocardial infarction and stroke in bipolar disorder. METHOD A systematic search using MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and bibliographies (1946 - May, 2013) was conducted. Case-control and cohort studies of bipolar disorder patients age 15 or older with myocardial infarction or stroke as outcomes were included. Two independent reviewers extracted data and assessed quality. Estimates of effect were summarized using random-effects meta-analysis. RESULTS Five cohort studies including 13 115 911 participants (27 092 bipolar) were included. Due to the use of registers, different statistical methods, and inconsistent adjustment for confounders, there was significant methodological heterogeneity among studies. The exploratory meta-analysis yielded no evidence for a significant increase in the risk of myocardial infarction: [relative risk (RR): 1.09, 95% CI 0.96-1.24, P = 0.20; I(2) = 6%]. While there was evidence of significant study heterogeneity, the risk of stroke in bipolar disorder was significantly increased (RR 1.74, 95% CI 1.29-2.35; P = 0.0003; I(2) = 83%). CONCLUSION There may be a differential risk of myocardial infarction and stroke in patients with bipolar disorder. Confidence in these pooled estimates was limited by the small number of studies, significant heterogeneity and dissimilar methodological features.
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Affiliation(s)
- M.L. Prieto
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA,Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile
| | - A.B. Cuéllar-Barboza
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA,Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México
| | - W.V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - V.L. Roger
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - F. Bellivier
- Psychiatric Department, APHP Hôpital F. Widal, Paris, France,INSERM, UMR-S1144,FondaMenta Foundation
| | - M. Leboyer
- FondaMenta Foundation,Faculté de Médecine, Université Paris Est,INSERM, U955, Psychiatrie Génétique,Département de Psychiatrie, Hôpital H. Mondor-A. Chenevier, Créteil, France
| | - C.P. West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M.A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
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41
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Kapczinski F, Magalhães PVS, Balanzá-Martinez V, Dias VV, Frangou S, Gama CS, Gonzalez-Pinto A, Grande I, Ha K, Kauer-Sant'Anna M, Kunz M, Kupka R, Leboyer M, Lopez-Jaramillo C, Post RM, Rybakowski JK, Scott J, Strejilevitch S, Tohen M, Vazquez G, Yatham L, Vieta E, Berk M. Staging systems in bipolar disorder: an International Society for Bipolar Disorders Task Force Report. Acta Psychiatr Scand 2014; 130:354-63. [PMID: 24961757 DOI: 10.1111/acps.12305] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We discuss the rationale behind staging systems described specifically for bipolar disorders. Current applications, future directions and research gaps in clinical staging models for bipolar disorders are outlined. METHOD We reviewed the literature pertaining to bipolar disorders, focusing on the first episode onwards. We systematically searched data on staging models for bipolar disorders and allied studies that could inform the concept of staging. RESULTS We report on several dimensions that are relevant to staging concepts in bipolar disorder. We consider whether staging offers a refinement to current diagnoses by reviewing clinical studies of treatment and functioning and the potential utility of neurocognitive, neuroimaging and peripheral biomarkers. CONCLUSION Most studies to date indicate that globally defined late-stage patients have a worse overall prognosis and poorer response to standard treatment, consistent with patterns for end-stage medical disorders. We believe it is possible at this juncture to speak broadly of 'early'- and 'late'-stage bipolar disorder. Next steps require further collaborative efforts to consider the details of preillness onset and intermediary stages, and how many additional stages are optimal.
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Affiliation(s)
- F Kapczinski
- National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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42
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Assies J, Mocking RJT, Lok A, Ruhé HG, Pouwer F, Schene AH. Effects of oxidative stress on fatty acid- and one-carbon-metabolism in psychiatric and cardiovascular disease comorbidity. Acta Psychiatr Scand 2014; 130:163-80. [PMID: 24649967 PMCID: PMC4171779 DOI: 10.1111/acps.12265] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in severe psychiatric disorders (depression, schizophrenia). Here, we provide evidence of how the effects of oxidative stress on fatty acid (FA) and one-carbon (1-C) cycle metabolism, which may initially represent adaptive responses, might underlie comorbidity between CVD and psychiatric disorders. METHOD We conducted a literature search and integrated data in a narrative review. RESULTS Oxidative stress, mainly generated in mitochondria, is implicated in both psychiatric and cardiovascular pathophysiology. Oxidative stress affects the intrinsically linked FA and 1-C cycle metabolism: FAs decrease in chain length and unsaturation (particularly omega-3 polyunsaturated FAs), and lipid peroxidation products increase; the 1-C cycle shifts from the methylation to transsulfuration pathway (lower folate and higher homocysteine and antioxidant glutathione). Interestingly, corresponding alterations were reported in psychiatric disorders and CVD. Potential mechanisms through which FA and 1-C cycle metabolism may be involved in brain (neurocognition, mood regulation) and cardiovascular system functioning (inflammation, thrombosis) include membrane peroxidizability and fluidity, eicosanoid synthesis, neuroprotection and epigenetics. CONCLUSION While oxidative-stress-induced alterations in FA and 1-C metabolism may initially enhance oxidative stress resistance, persisting chronically, they may cause damage possibly underlying (co-occurrence of) psychiatric disorders and CVD. This might have implications for research into diagnosis and (preventive) treatment of (CVD in) psychiatric patients.
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Affiliation(s)
- J Assies
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, Amsterdam
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43
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Kelly T. A favorable risk-benefit analysis of high dose thyroid for treatment of bipolar disorders with regard to osteoporosis. J Affect Disord 2014; 166:353-8. [PMID: 24981132 DOI: 10.1016/j.jad.2014.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/11/2014] [Indexed: 12/14/2022]
Abstract
High dose thyroid hormone has been in use since the 1930s for the treatment of affective disorders. Despite numerous papers showing benefit, the lack of negative trials and its inclusion in multiple treatment guidelines, high dose thyroid has yet to find wide spread use. The major objection to the use of high dose thyroid is the myth that it causes osteoporosis. This paper reviews the literature surrounding the use of high dose thyroid, both in endocrinology and in psychiatry. High dose thyroid does not appear to be a significant risk factor for osteoporosis while other widely employed psychiatric medications do pose a risk. Psychiatrists are uniquely qualified to do the risk-benefit analyses of high dose thyroid for the treatment of the bipolar I, bipolar II and bipolar NOS. Other specialties do not have the requisite knowledge of the risks of alterative medications or of the mortality and morbidity of the bipolar disorders to do a full risk benefit analysis.
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Affiliation(s)
- Tammas Kelly
- Psychiatry and Behavioral Sciences George Washington University, The Depression & Bipolar Clinic of Colorado, USA.
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44
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Liu X, Zhang T, He S, Hong B, Chen Z, Peng D, Wu Y, Wen H, Lin Z, Fang Y, Jiang K. Elevated serum levels of FGF-2, NGF and IGF-1 in patients with manic episode of bipolar disorder. Psychiatry Res 2014; 218:54-60. [PMID: 24793757 DOI: 10.1016/j.psychres.2014.03.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/15/2014] [Accepted: 03/29/2014] [Indexed: 01/17/2023]
Abstract
Multiple neurotrophic and/or growth factors, recently nominated as "angioneurins", play the key roles in mood modulation and neuroplasticity, and their dysfunction might be involved in the pathophysiology and treatment of mood disorders. We examined serum levels of vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF)-2, nerve growth factor (NGF) and insulin-like growth factor (IGF)-1 in 70 drug-naïve or drug-free patients with manic episode of bipolar disorder and 50 healthy controls, using the enzyme-linked immunosorbent assay (ELISA) method. The results showed that mean serum levels of VEGF, FGF-2, NGF and IGF-1 were 168.13±225.61pg/ml, 279.09±378.62pg/ml, 61.38±171.67pg/ml and 162.01±72.00ng/ml in patients, and 140.80±143.71pg/ml, 275.46±235.29pg/ml, 36.34±15.14pg/ml and 138.90±80.11ng/ml in healthy controls, respectively. Serum levels of FGF-2, NGF and IGF-1 in patients were significantly higher than those in healthy controls, though there was no statistical difference in serum VEGF level between two groups. Moreover, serum NGF level in patients was significantly correlated with duration of disorder and times of previous manic episodes. We conclude that the increase of serum FGF-2, NGF and IGF-1 levels in manic state of bipolar disorder may be associated with their compensatory roles of neuroprotection and angiogenesis, and these angioneurins may be involved in the pathophysiology of bipolar disorder.
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Affiliation(s)
- Xiaohua Liu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China.
| | - Tianhong Zhang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Shen He
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Bo Hong
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Zheng Chen
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Daihui Peng
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Yan Wu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Hui Wen
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Zhiguang Lin
- Biochemistry Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yiru Fang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
| | - Kaida Jiang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai 200030, PR China
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45
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Sachs GS, Peters AT, Sylvia L, Grunze H. Polypharmacy and bipolar disorder: what's personality got to do with it? Int J Neuropsychopharmacol 2014; 17:1053-61. [PMID: 24067291 DOI: 10.1017/s1461145713000953] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The majority of patients treated for bipolar disorder receive multiple psychotropic medications concurrently (polypharmacy), despite a lack of empirical evidence for any combination of three or more medications. Some patients benefit from the skillful management of a complex medication regimen, but iterative additions to a treatment regimen often do not lead to clinical improvement, are expensive, and can confound assessment of the underlying mood disorder. Given these potential problems of polypharmacy, this paper reviews the evidence supporting the use of multiple medications and seeks to identify patient personality traits that may put patients at a greater risk for ineffective complex chronic care. Patients with bipolar disorder (n = 89), ages 18 and older, were assessed on the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), and the NEO Five Factor Inventory (NEO-FFI), and completed a treatment history questionnaire to report psychotropic medication use. We found that patients with lower scores on openness had significantly more current psychotropic medications than patients with higher scores on openness (3.7 ± 1.9 vs. 2.8 ± 1.8, p < 0.05). Patients with the highest lifetime medication use had significantly lower extraversion (21.8 ± 8.9 vs. 25.4 ± 7.6, p < 0.05) and lower conscientiousness (21.9 ± 8.2 vs. 27.9 ± 8.2, p < 0.01) than those reporting lower lifetime medication use. Low levels of openness, extraversion, and conscientiousness may be associated with increased psychotropic medication use. Investigating the role of individual differences, such as patient personality traits, in moderating effective polypharmacy warrants future research.
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Affiliation(s)
- G S Sachs
- Massachusetts General Hospital,Boston, MA,USA
| | - A T Peters
- Massachusetts General Hospital,Boston, MA,USA
| | - L Sylvia
- Massachusetts General Hospital,Boston, MA,USA
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46
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Zendjidjian XY, Lodovighi MA, Richieri R, Guedj E, Boyer L, Dassa D, Lançon C. Resistant bipolar depressive disorder: case analysis of adjunctive transcranial magnetic stimulation efficiency in medical comorbid conditions. Bipolar Disord 2014; 16:211-3. [PMID: 24350675 DOI: 10.1111/bdi.12170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/17/2013] [Indexed: 01/19/2023]
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47
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Kuswanto CN, Sum MY, Yang GL, Nowinski WL, McIntyre RS, Sim K. Increased body mass index makes an impact on brain white-matter integrity in adults with remitted first-episode mania. Psychol Med 2014; 44:533-541. [PMID: 23731622 DOI: 10.1017/s0033291713000858] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obesity is increasingly prevalent in bipolar disorder (BD) but data about the impact of elevated body mass index (BMI) on brain white-matter integrity in BD are sparse. Based on extant literature largely from structural magnetic resonance imaging (MRI) studies, we hypothesize that increased BMI is associated with decreased fractional anisotropy (FA) in the frontal, temporal, parietal and occipital brain regions early in the course of BD. METHOD A total of 26 euthymic adults (12 normal weight and 14 overweight/obese) with remitted first-episode mania (FEM) and 28 controls (13 normal weight and 15 overweight/obese) matched for age, handedness and years of education underwent structural MRI and diffusion tensor imaging scans. RESULTS There are significant effects of diagnosis by BMI interactions observed especially in the right parietal lobe (adjusted F(1,48) = 5.02, p = 0.030), occipital lobe (adjusted F(1,48) = 10.30, p = 0.002) and temporal lobe (adjusted F(1,48) = 7.92, p = 0.007). Specifically, decreased FA is found in the right parietal (F(1,48) = 5.864, p = 0.023) and occipital lobes (F(1,48) = 4.397, p = 0.047) within overweight/obese patients compared with normal-weight patients with FEM. Compared with overweight/obese controls, decreased FA is observed in right parietal (F(1,48) = 6.708, p = 0.015), temporal (F(1,48) = 10.751, p = 0.003) and occipital (F(1,48) = 9.531, p = 0.005) regions in overweight/obese patients with FEM. CONCLUSIONS Our findings suggest that increased BMI affects temporo-parietal-occipital brain white-matter integrity in FEM. This highlights the need to further elucidate the relationship between obesity and other neural substrates (including subcortical changes) in BD which may clarify brain circuits subserving the association between obesity and clinical outcomes in BD.
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Affiliation(s)
- C N Kuswanto
- Research Department, Institute of Mental Health, Singapore
| | - M Y Sum
- Research Department, Institute of Mental Health, Singapore
| | - G L Yang
- Biomedical Imaging Laboratory, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
| | - W L Nowinski
- Biomedical Imaging Laboratory, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
| | - R S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - K Sim
- Research Department, Institute of Mental Health, Singapore
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48
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Pfaffenseller B, Fries GR, Wollenhaupt-Aguiar B, Colpo GD, Stertz L, Panizzutti B, Magalhães PVS, Kapczinski F. Neurotrophins, inflammation and oxidative stress as illness activity biomarkers in bipolar disorder. Expert Rev Neurother 2014; 13:827-42. [DOI: 10.1586/14737175.2013.811981] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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49
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Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. J Psychiatr Res 2014; 48:102-10. [PMID: 24139811 DOI: 10.1016/j.jpsychires.2013.09.014] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/16/2013] [Accepted: 09/19/2013] [Indexed: 11/22/2022]
Abstract
Even though individuals with psychiatric conditions have a prevalence of smoking approximately 2-4 times greater than the general population, surprisingly little evidence exists to inform an assessment of the full range of tobacco-related mortality in such populations. The current study aims to provide mortality estimates for conditions causally related to tobacco use among individuals hospitalized with a primary psychiatric diagnosis in California from 1990 to 2005. Restricting cases to those of individuals aged 35 or older at the mid-point of their follow-up period, we assembled cohorts of individuals with ICD-9 diagnoses of schizophrenia and related disorders ("schizophrenia"; n = 174,277), depressive disorders (n = 338,250), or bipolar disorder (n = 78,739). Inpatient records were linked to death-certificate data. We generated age-, sex-, and race-adjusted standardized mortality ratios (SMRs) for the 19 diseases identified by the Centers for Disease Control and Prevention as being causally linked to tobacco use. The SMRs for all tobacco-linked diseases combined were: schizophrenia, 2.45 (95% CI = 2.41-2.48); bipolar, 1.57 (95% CI = 1.53-1.62); and depression, 1.95 (95% CI = 1.93-1.98). Tobacco-related conditions comprised approximately 53% (23,620/44,469) of total deaths in the schizophrenia, 48% (6004/12,564) in the bipolar, and 50% (35,729/71,058) in the depression cohorts. Addressing tobacco use in psychiatric populations is a critical clinical and public-health concern, especially in light of the currently limited clinical attention devoted to tobacco use in these groups.
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50
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Zhang Y, Yang H, Yang S, Liang W, Dai P, Wang C, Zhang Y. Antidepressants for bipolar disorder: A meta-analysis of randomized, double-blind, controlled trials. Neural Regen Res 2013; 8:2962-74. [PMID: 25206617 PMCID: PMC4146170 DOI: 10.3969/j.issn.1673-5374.2013.31.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/25/2013] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To examine the efficacy and safety of short-term and long-term use of antidepressants in the treatment of bipolar disorder. DATA SOURCES A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords "bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder", AND "antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake inhibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent" were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsychotics in the experimental group were excluded. All analyses were conducted using Review Manager 5.1 provided by the Cochrane Collaboration. MAIN OUTCOME MEASURES The primary outcome was the response and switching to mania. The secondary outcomes included remission, discontinuation rate, and suicidality. RESULTS Among 5 001 treatment studies published, 14 double-blind randomized controlled trials involving 1 244 patients were included in the meta-analysis. Eleven short-term studies and three maintenance studies were included. Studies suggested that patients treated with antidepressants were not significantly more likely to achieve higher response and remission rates in the short-term or long-term treatment than patients treated with placebo and other medications. Antidepressants were not associated with an increased risk of discontinuation, relapse or suicidality. When one antidepressant was compared with another, no significant difference in efficacy and tolerability was found. CONCLUSION Existing evidence of efficacy does not support the short-term or long-term application of antidepressant therapy in patients with bipolar disorder, although the tolerability and safety of antidepressants have been generally acknowledged. There is a need for large-sample, double-blind, randomized controlled trials to elucidate the role of antidepressants in patients with different subcategories of bipolar disorder.
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Affiliation(s)
- Yingli Zhang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Psychological Counseling Center, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Huan Yang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Shichang Yang
- Department of Psychology, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Wei Liang
- Department of Clinical Psychology, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Ping Dai
- Sichuan University Library, Chengdu 610041, Sichuan Province, China
| | - Changhong Wang
- Psychological Counseling Center, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Yalin Zhang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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