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Bransfield RC, Goud Gadila SK, Kursawe LJ, Dwork AJ, Rosoklija G, Horn EJ, Cook MJ, Embers ME. Late-stage borreliosis and substance abuse. Heliyon 2024; 10:e31159. [PMID: 38779029 PMCID: PMC11108998 DOI: 10.1016/j.heliyon.2024.e31159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Background Infectious diseases can contribute to substance abuse. Here, a fatal case of borreliosis and substance abuse is reported. This patient had a history of multiple tick bites and increasing multisystem symptoms, yet diagnosis and treatment were delayed. He experimented with multiple substances including phencyclidine (PCP), an N-methyl-d-aspartate (NMDA) receptor antagonist that opposes NMDA agonism caused by Borrelia infection. During PCP withdrawal, he committed one homicide, two assaults, and suicide. Methods Brain tissue was obtained from autopsy and stained for microglial activation and quinolinic acid (QA). Immunoflouresence (IFA) and fluorescence in situ hybridization (FISH) were used to identify the presence of pathogens in autopsy tissue. Results Autopsy tissue evaluation demonstrated Borrelia in the pancreas by IFA and heart by IFA and FISH. Activated microglia and QA were found in the brain, indicating neuroinflammation. It is postulated that PCP withdrawal may exacerbate symptoms produced by Borrelia-induced biochemical imbalances in the brain. This combination may have greatly increased his acute homicidal and suicidal risk. Patient databases also demonstrated the risk of homicide or suicide in patients diagnosed with borreliosis and confirmed multiple symptoms in these patients, including chronic pain, anxiety, and anhedonia. Conclusions Late-stage borreliosis is associated with multiple symptoms that may contribute to an increased risk of substance abuse and addictive disorders. More effective diagnosis and treatment of borreliosis, and attention to substance abuse potential may help reduce associated morbidity and mortality in patients with borreliosis, particularly in endemic areas.
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Affiliation(s)
- Robert C. Bransfield
- Rutgers-RWJ Medical School, Piscataway, NJ, USA. Hackensack Meridian Health-School of Medicine, Nutley, NJ, USA
| | - Shiva Kumar Goud Gadila
- Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA, USA
| | - Laura J. Kursawe
- Charité – Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andrew J. Dwork
- Department of Psychiatry, Columbia University, New York, NY, United States. Division of Molecular Imaging and Neuropathology, New York, USA
- State Psychiatric Institute, New York, NY, USA
- Macedonian Academy of Sciences and Arts, Skopje, Macedonia
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Gorazd Rosoklija
- State Psychiatric Institute, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | | | | | - Monica E. Embers
- Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA, USA
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Koning E, McDonald A, Bambokian A, Gomes FA, Vorstman J, Berk M, Fabe J, McIntyre RS, Milev R, Mansur RB, Brietzke E. The concept of "metabolic jet lag" in the pathophysiology of bipolar disorder: implications for research and clinical care. CNS Spectr 2023; 28:571-580. [PMID: 36503605 DOI: 10.1017/s1092852922001195] [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] [Indexed: 12/14/2022]
Abstract
Bipolar disorder (BD) is a potentially chronic mental disorder marked by recurrent depressive and manic episodes, circadian rhythm disruption, and changes in energetic metabolism. "Metabolic jet lag" refers to a state of shift in circadian patterns of energy homeostasis, affecting neuroendocrine, immune, and adipose tissue function, expressed through behavioral changes such as irregularities in sleep and appetite. Risk factors include genetic variation, mitochondrial dysfunction, lifestyle factors, poor gut microbiome health and abnormalities in hunger, satiety, and hedonistic function. Evidence suggests metabolic jet lag is a core component of BD pathophysiology, as individuals with BD frequently exhibit irregular eating rhythms and circadian desynchronization of their energetic metabolism, which is associated with unfavorable clinical outcomes. Although current diagnostic criteria lack any assessment of eating rhythms, technological advancements including mobile phone applications and ecological momentary assessment allow for the reliable tracking of biological rhythms. Overall, methodological refinement of metabolic jet lag assessment will increase knowledge in this field and stimulate the development of interventions targeting metabolic rhythms, such as time-restricted eating.
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Affiliation(s)
- Elena Koning
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alexandra McDonald
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alexander Bambokian
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jacob Vorstman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Jennifer Fabe
- Department of Neurology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, The Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roumen Milev
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, ON, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry and Pharmacology, University of Toronto, The Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Elisa Brietzke
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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3
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Michel M, Hariz AJ, Chevreul K. Association of mental disorders with costs of somatic admissions in France. L'ENCEPHALE 2023; 49:453-459. [PMID: 35973851 DOI: 10.1016/j.encep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mentally ill patients have worse health outcomes when they suffer from somatic conditions compared to other patients. The objective of this study was to assess the association of mental illness with hospital inpatient costs for somatic reasons. METHODS All adult inpatient stays for somatic reasons in acute care hospitals between 2009 and 2013 were included using French exhaustive hospital discharge databases. Total inpatient costs were calculated from the all-payer perspective and compared in patients with and without a mental disorder. Only patients who had been admitted at least once for a mental disorder (either full-time or part-time) were considered to be mentally ill in this study. Generalized linear models with and without interaction terms studied the factors associated with hospital inpatient costs. RESULTS 17,728,424 patients corresponding to 37,458,810 admissions were included. 1,163,972 patients (6.57%) were identified as having a mental illness. A previous full-time or part-time admission for a mental disorder significantly increased hospital inpatient costs (+32.64%, 95%CI=1.3243-1.3284). Interaction terms found an increased impact of mental disorders on costs in patients with low socio-economic status, as well as in men, patients aged between 45 and 60, and patients with a cardiovascular disease or diabetes. CONCLUSION Mentally ill patients have higher hospital costs than non-mentally ill patients. Improving curative and preventive treatments in those patients could improve their health and decrease the burden on healthcare systems.
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Affiliation(s)
- M Michel
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France.
| | - A J Hariz
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France
| | - K Chevreul
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France
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Cardiometabolic and endocrine comorbidities in women with bipolar disorder: A systematic review. J Affect Disord 2023; 323:841-859. [PMID: 36538952 DOI: 10.1016/j.jad.2022.12.023] [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: 09/09/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bipolar Disorder (BD) is known to be equally distributed among males and females. The well-documented increased risk of medical comorbidities in patients with BD, in comparison to BD patients without medical comorbidities, shows a negative impact on the course of illness. There is some evidence suggesting that women with BD have higher psychiatric and medical comorbidities in comparison to men with BD, however there is no evidence in comparison to women without BD or other major psychiatric illness. These comorbidities, along with various psychosocial factors, are known to affect the course of BD. METHODS We aimed to systematically review the literature on cardiovascular, metabolic and endocrine comorbidities in women with BD in comparison to men with BD and control women. A comprehensive search of electronic databases including PubMed, PsycINFO, Embase, and SCOPUS was conducted, and a total of 61 identified studies were included in this review. RESULTS Women with BD had higher rates of cardiovascular risk factors/mortality, diabetes mellitus II and thyroid disorders compared to women in the general population. In comparison to men with BD, women with BD had comparable cardiovascular risk but higher prevalence of metabolic and thyroid disorders. LIMITATIONS Gender specific data was limited in multiple studies. CONCLUSIONS Results present a need for gender-specific screening and interventions for various medical comorbidities in patients with BD.
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Ralat SI, Rodríguez-Gómez J. The RAS-24: Development and validation of an adherence-to-medication scale for severe mental illness patients. J Clin Transl Sci 2023; 7:e94. [PMID: 37125053 PMCID: PMC10130847 DOI: 10.1017/cts.2023.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Several studies have found that most patients with severe mental illness (SMI) and comorbid (physical) conditions are partially or wholly nonadherent to their medication regimens. Nonadherence to treatment is a serious concern, affecting the successful management of patients with SMIs. Psychiatric disorders tend to worsen and persist in nonadherent patients, worsening their overall health. The study described herein aimed to develop and validate a scale (the Ralat Adherence Scale) to measure nonadherence behaviors in a culturally sensitive way. Materials and Methods Guided by a previous study that explored the primary reasons for nonadherence in Puerto Rican patients, we developed a pool of 147 items linked to the concept of adherence. Nine experts reviewed the meaning, content, clarity, and relevance of the individual items, and a content validity ratio was calculated for each one. Forty items remained in the scale's first version. This version was administered to 160 patients (21-60 years old). All the participants had a diagnosis of bipolar disorder, major depressive disorder, or schizoaffective disorder. The STROBE checklist was used as the reporting guideline. Results The scale had very good internal consistency (Cronbach's alpha = 0.812). After a factor analysis, the scale was reduced to 24 items; the new scale had a Cronbach's alpha of 0.900. Conclusions This adherence scale is a self-administered instrument with very good psychometric properties; it has yielded important information about nonadherence behaviors. The scale can help health professionals and researchers to assess patient adherence or nonadherence to a medication regimen.
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Affiliation(s)
- Sandra I. Ralat
- Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Address for correspondence: Sandra I. Ralat, PhD, Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, Puerto Rico.
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Ringen PA, Lund-Stenvold E, Andreassen OA, Gaarden TL, Hartberg CB, Johnsen E, Myklatun S, Osnes K, Sørensen K, Sørensen K, Vaaler A, Tonstad S, Engh JA, Høye A. Quality of clinical management of cardiometabolic risk factors in patients with severe mental illness in a specialist mental health care setting. Nord J Psychiatry 2022; 76:602-609. [PMID: 35200088 DOI: 10.1080/08039488.2022.2039288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Cardiometabolic disease in patients with severe mental illness is a major cause of shortened life expectancy. There is sparse evidence of real-world clinical risk prevention practice. We investigated levels of assessments of cardiometabolic risk factors and risk management interventions in patients with severe mental illness in the Norwegian mental health service according to an acknowledged international standard. METHODS We collected data from 264 patients residing in six country-wide health trusts for: (a) assessments of cardiometabolic risk and (b) assessments of levels of risk reducing interventions. Logistic regressions were employed to investigate associations between risk and interventions. RESULTS Complete assessments of all cardiometabolic risk variables were performed in 50% of the participants and 88% thereof had risk levels requiring intervention according to the standard. Smoking cessation advice was provided to 45% of daily smokers and 4% were referred to an intervention program. Obesity was identified in 62% and was associated with lifestyle interventions. Reassessment of psychotropic medication was done in 28% of the obese patients. Women with obesity were less likely to receive dietary advice, and use of clozapine or olanzapine reduced the chances for patients with obesity of getting weight reducing interventions. CONCLUSIONS Nearly nine out of the ten participants were identified as being at cardiometabolic high risk and only half of the participants were adequately screened. Women with obesity and patients using antipsychotics with higher levels of cardiometabolic side effects had fewer adequate interventions. The findings underscore the need for standardized recommendations for identification and provision of cardiometabolic risk reducing interventions in all patients with severe mental illness.
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Affiliation(s)
- Petter A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Lund-Stenvold
- Department of Clinical Medicine, UiT The Arctic University of Norway and Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ole A Andreassen
- NORMENT Centre of Excellence, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torfinn L Gaarden
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilie B Hartberg
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Johnsen
- NORMENT Centre of Excellence, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Silje Myklatun
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Osnes
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Sørensen
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Sørensen
- Division of Mental Health, Østmarka, St Olav's University Hospital, Trondheim, Norway
| | - Arne Vaaler
- Department of acute psychiatry, St. Olavs University Hospital and Department of Mental Health, NTNU, Trondheim, Norway
| | - Serena Tonstad
- Section for Preventive Cardiology Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - John A Engh
- Division of Mental health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway and Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
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7
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Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:918-933. [PMID: 36007991 DOI: 10.1016/j.jacc.2022.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
People with severe mental illness, consisting of schizophrenia, bipolar disorder, and major depression, have a high burden of modifiable cardiovascular risk behaviors and conditions and have a cardiovascular mortality rate twice that of the general population. People with acute and chronic cardiovascular disease are at a higher risk of developing mental health symptoms and disease. There is emerging evidence for shared etiological factors between severe mental illness and cardiovascular disease that includes biological, genetic, and behavioral mechanisms. This state-of-the art review will describe the relationship between severe mental illness and cardiovascular disease, explore the factors that lead to poor cardiovascular outcomes in people with severe mental illness, propose strategies to improve the cardiovascular health of people with severe mental illness, and present areas for future research focus.
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8
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Levin JB, Moore DJ, Depp C, Montoya JL, Briggs F, Rahman M, Stange KC, Einstadter D, Weise C, Conroy C, Yala J, Radatz E, Sajatovic M. Using mHealth to improve adherence and reduce blood pressure in individuals with hypertension and bipolar disorder (iTAB-CV): study protocol for a 2-stage randomized clinical trial. Trials 2022; 23:539. [PMID: 35768875 PMCID: PMC9244195 DOI: 10.1186/s13063-022-06449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease in individuals with mental health conditions such as bipolar disorder is highly prevalent and often poorly managed. Individuals with bipolar disorder face significant medication adherence barriers, especially when they are prescribed multiple medications for other health conditions including hypertension. Poor adherence puts them at a disproportionate risk for poor health outcomes. As such, there is a need for effective interventions to improve hypertension medication adherence, particularly in patients that struggle with adherence due to mental health comorbidity. METHODS This 5-year project uses a 2-stage randomized controlled trial design to evaluate a brief, practical adherence intervention delivered via interactive text messaging (iTAB-CV) along with self-monitoring of medication taking, mood, and home blood pressure (N = 100) compared to self-monitoring alone (N = 100). Prior to randomization, all participants will view an educational video that emphasizes the importance of medication for the treatment of hypertension and bipolar disorder. Those randomized to the texting intervention will receive daily text messages with predetermined content to address 11 salient domains as well as targeted customized messages for 2 months. This group will then be re-randomized to receive either a high (gradual taper from daily to weekly texts) or low booster (weekly texts) phase for an additional 2 months. All participants will be monitored for 52 weeks. The primary outcomes are systolic blood pressure and adherence to antihypertensive medication as determined by a self-reported questionnaire and validated with an automated pill-monitoring device. Secondary outcomes include adherence to bipolar disorder medications, psychiatric symptoms, health status, self-efficacy for medication-taking behavior, illness beliefs, medication attitudes, and habit strength. DISCUSSION This study specifically targets blood pressure and mental health symptom control in people with bipolar and includes implementation elements in the study design intended to inform future scale-up. Promising pilot data and a theoretical model, which views sustained medication-taking behavior in the context of habit formation, suggests that this remotely delivered intervention may help advance care for this high-risk population and is amenable to both scale up and easy adaptation for other groups with poor medication adherence. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov ( NCT04675593 ) on December 19, 2020.
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Affiliation(s)
- Jennifer B Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Ave. 7th floor, Cleveland, OH, 44106, USA. .,Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. .,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - David J Moore
- HIV Neurobehavioral Research Program (HNRP), Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Colin Depp
- HIV Neurobehavioral Research Program (HNRP), Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Stein Institute for Research on Aging, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jessica L Montoya
- HIV Neurobehavioral Research Program (HNRP), Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA.,Department of Medicine, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Celeste Weise
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Carla Conroy
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joy Yala
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ethan Radatz
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Ave. 7th floor, Cleveland, OH, 44106, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Wilson CA, Newham J, Rankin J, Ismail K, Simonoff E, Reynolds RM, Stoll N, Howard LM. Systematic review and meta-analysis of risk of gestational diabetes in women with preconception mental disorders. J Psychiatr Res 2022; 149:293-306. [PMID: 35320739 DOI: 10.1016/j.jpsychires.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
There is a well-established bidirectional association between Type 2 diabetes and mental disorder and emerging evidence for an increased risk of perinatal mental disorder in women with gestational diabetes (GDM). However, the relation between mental disorder prior to pregnancy and subsequent risk of GDM remains relatively unexplored. This is a systematic review and meta-analysis of the risk of GDM in women with a range of preconception mental disorders. Peer-reviewed literature measuring odds of GDM and preconception mood, anxiety, psychotic and eating disorders was systematically reviewed. Risk of bias was assessed using a checklist. Two independent reviewers were involved. 22 observational studies met inclusion criteria; most were retrospective cohorts from English speaking, high income countries. 14 studies were at high risk of bias. There was evidence for an increased risk of GDM in women with schizophrenia (pooled OR 2.44; 95% CI 1.17,5.1; 5 studies) and a reduced risk of GDM in women with anorexia nervosa (pooled OR 0.63; 95% CI 0.49,0.80; 5 studies). There was some limited evidence of an increased risk in women with bipolar disorder. There was no evidence for an association with preconception depression or bulimia nervosa on meta-analysis. There were insufficient studies on anxiety disorders for meta-analysis. This review indicates that there is not a significant risk of GDM associated with many preconception mental disorders but women with psychotic disorders represent a group uniquely vulnerable to GDM. Early detection and management of GDM could improve physical and mental health outcomes for these women and their children.
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Affiliation(s)
- Claire A Wilson
- Section of Women's Mental Health, PO31 King's College London, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK.
| | - James Newham
- Faculty of Health and Life Sciences, Sutherland Building, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK
| | - Judith Rankin
- Institute of Health and Society, Baddiley-Clark Building, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - Khalida Ismail
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK; Department of Psychological Medicine, Weston Education Centre, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK; Department of Child and Adolescent Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Nkasi Stoll
- Department of Psychological Medicine, Weston Education Centre, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Louise M Howard
- Section of Women's Mental Health, PO31 King's College London, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK
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10
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Winterton A, Bettella F, de Lange AMG, Haram M, Steen NE, Westlye LT, Andreassen OA, Quintana DS. Oxytocin-pathway polygenic scores for severe mental disorders and metabolic phenotypes in the UK Biobank. Transl Psychiatry 2021; 11:599. [PMID: 34824196 PMCID: PMC8616952 DOI: 10.1038/s41398-021-01725-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Oxytocin is a neuromodulator and hormone that is typically associated with social cognition and behavior. In light of its purported effects on social cognition and behavior, research has investigated its potential as a treatment for psychiatric illnesses characterized by social dysfunction, such as schizophrenia and bipolar disorder. While the results of these trials have been mixed, more recent evidence suggests that the oxytocin system is also linked with cardiometabolic conditions for which individuals with severe mental disorders are at a higher risk for developing. To investigate whether the oxytocin system has a pleiotropic effect on the etiology of severe mental illness and cardiometabolic conditions, we explored oxytocin's role in the shared genetic liability of schizophrenia, bipolar disorder, type-2 diabetes, and several phenotypes linked with cardiovascular disease and type 2 diabetes risk using a polygenic pathway-specific approach. Analysis of a large sample with about 480,000 individuals (UK Biobank) revealed statistically significant associations across the range of phenotypes analyzed. By comparing these effects to those of polygenic scores calculated from 100 random gene sets, we also demonstrated the specificity of many of these significant results. Altogether, our results suggest that the shared effect of oxytocin-system dysfunction could help partially explain the co-occurrence of social and cardiometabolic dysfunction in severe mental illnesses.
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Affiliation(s)
- Adriano Winterton
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Francesco Bettella
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ann-Marie G de Lange
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Marit Haram
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Daniel S Quintana
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway.
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway.
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11
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Genetic variants associated with cardiometabolic abnormalities during treatment with selective serotonin reuptake inhibitors: a genome-wide association study. THE PHARMACOGENOMICS JOURNAL 2021; 21:574-585. [PMID: 33824429 DOI: 10.1038/s41397-021-00234-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are prescribed both to patients with schizophrenia and bipolar disorder. Previous studies have shown associations between SSRI treatment and cardiometabolic alterations. The aim of the present study was to investigate genetic variants associated with cardiometabolic adverse effects in patients treated with SSRIs in a naturalistic setting, using a genome-wide cross-sectional approach in a genetically homogeneous sample. We included and genotyped 1981 individuals with schizophrenia or bipolar disorder, of whom 1180 had information available on the outcomes low-density lipoprotein cholesterol (LDL-cholesterol), high-density lipoprotein cholesterol (HDL-cholesterol), triglycerides, and body mass index (BMI) and investigated interactions between SNPs and SSRI use (N = 246) by conducting a genome-wide GxE analysis. We report 13 genome-wide significant interaction effects of SNPs and SSRI serum concentrations on LDL-cholesterol, HDL-cholesterol, and BMI, located in four distinct genomic loci. This study provides new insight into the pharmacogenetics of SSRI but warrants replication in independent populations.
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12
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Nilsson NH, Bendix M, Öhlund L, Widerström M, Werneke U, Maripuu M. Increased Risks of Death and Hospitalization in Influenza/Pneumonia and Sepsis for Individuals Affected by Psychotic Disorders, Bipolar Disorders, and Single Manic Episodes: A Retrospective Cross-Sectional Study. J Clin Med 2021; 10:jcm10194411. [PMID: 34640430 PMCID: PMC8509221 DOI: 10.3390/jcm10194411] [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] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/28/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022] Open
Abstract
Individuals with severe mental disorders (SMDs) such as psychotic disorders, bipolar disorders, and single manic episodes have increased mortality associated with COVID-19 infection. We set up a population-based study to examine whether individuals with SMD also had a higher risk of hospitalization and death from other infectious conditions. Anonymized and summarized data from multiple Swedish patient registers covering the entire Swedish population were supplied by the Swedish National Board of Health and Welfare. The frequencies of hospitalizations and deaths associated with influenza/pneumonia and sepsis in individuals with SMD were compared with the rest of the population during 2018–2019. Possible contributing comorbidities were also examined, of which diabetes, cardiovascular disease, chronic lung disease, and hypertension were chosen. A total of 7,780,727 individuals were included in the study; 97,034 (1.2%) cases with SMD and 7,683,693 (98.8%) controls. Individuals with SMD had increased risk of death associated with influenza/pneumonia (OR = 2.06, 95% CI [1.87–2.27]) and sepsis (OR = 1.61, 95% CI [1.38–1.89]). They also had an increased risk of hospitalization associated with influenza/pneumonia (OR = 2.12, 95% CI [2.03–2.20]) and sepsis (OR = 1.89, 95% CI [1.75–2.03]). Our results identify a need for further evaluation of whether these individuals should be included in prioritized risk groups for vaccination against infectious diseases other than COVID-19.
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Affiliation(s)
- Niklas Harry Nilsson
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, 90736 Umeå, Sweden; (N.H.N.); (M.B.)
| | - Marie Bendix
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, 90736 Umeå, Sweden; (N.H.N.); (M.B.)
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
| | - Louise Öhlund
- Division of Psychiatry, Sunderby Research Unit, Department of Clinical Sciences, Umeå University, 90736 Umeå, Sweden; (L.Ö.); (U.W.)
| | - Micael Widerström
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden;
| | - Ursula Werneke
- Division of Psychiatry, Sunderby Research Unit, Department of Clinical Sciences, Umeå University, 90736 Umeå, Sweden; (L.Ö.); (U.W.)
| | - Martin Maripuu
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, 90736 Umeå, Sweden; (N.H.N.); (M.B.)
- Correspondence:
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13
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Minhas S, Patel JR, Malik M, Hana D, Hassan F, Khouzam RN. Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness. Curr Probl Cardiol 2021; 47:100959. [PMID: 34358587 DOI: 10.1016/j.cpcardiol.2021.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/30/2021] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.
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Affiliation(s)
| | - Jay R Patel
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Maira Malik
- Department of Internal Medicine, East Tennessee State University, TN
| | - David Hana
- Department of Internal Medicine, West Virginia University, Morgantown, WV
| | - Fatima Hassan
- University of Tennessee Health Science Center, Memphis, TN
| | - Rami N Khouzam
- Interventional Cardiology, University of Tennessee Health Science Center, Memphis, TN; Cardiology Fellowship, University of Tennessee Health Science Center, Memphis, TN; Cardiac Cath Labs, Methodist University Hospital, Memphis, TN
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14
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Guidara W, Messedi M, Maalej M, Naifar M, Khrouf W, Grayaa S, Maalej M, Bonnefont-Rousselot D, Lamari F, Ayadi F. Plasma oxysterols: Altered level of plasma 24-hydroxycholesterol in patients with bipolar disorder. J Steroid Biochem Mol Biol 2021; 211:105902. [PMID: 33901658 DOI: 10.1016/j.jsbmb.2021.105902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Abstract
Cholesterol and its oxygenated metabolites, including oxysterols, are intensively investigated as potential players in the pathophysiology of brain disorders. Altered oxysterol levels have been described in patients with numerous neuropsychiatric disorders. Recent studies have shown that Bipolar disorder (BD) is associated with the disruption of cholesterol metabolism. The present study was aimed at investigating the profile of oxysterols in plasma, their ratio to total cholesterol and their association with clinical parameters in patients with BD. Thirty three men diagnosed with BD and forty healthy controls matched for age and sex were included in the study. Oxysterol levels were measured by isotope-dilution ultra-performance liquid chromatography-tandem mass spectrometry. Significantly higher levels were observed for cholestane-3β,5α,6β-triol, 27-hydroxycholesterol (27-OHC) and Cholestanol in patients with BD. The concentration of 24-hydroxycholesterol (24-OHC) was significantly lower in patients compared to controls. 24-OHC was also negatively correlated to MAS subscale score (r =-0.343; p = 0.049). In patients, 24-OHC was inversely correlated with age (r = -0.240; p = 0.045). Multivariate analysis found that BD acute decompensation was independently related to the rise in plasma 24-OHC (p = 0.002; OR = 0.966, 95 % CI [0.945 - 0.987]). However, the 24-OHC assay relevance as a biomarker of this disease deserves further investigation in other studies.
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Affiliation(s)
- Wassim Guidara
- Laboratory of Research "Molecular Basis of Human Diseases", LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
| | - Meriam Messedi
- Laboratory of Research "Molecular Basis of Human Diseases", LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Manel Maalej
- Psychiatry C-department, University of Sfax & Hédi Chaker Hospital, Sfax, Tunisia
| | - Manel Naifar
- Laboratory of Research "Molecular Basis of Human Diseases", LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia; Laboratory of Biochemistry, University of Sfax & Habib Bourguiba Hospital, Sfax, Tunisia
| | - Walid Khrouf
- AP-HP, Sorbonne University, La Pitié-Salpêtrière University Hospital, Department of Metabolic Biochemistry, Paris, France
| | - Sahar Grayaa
- Laboratory of Research "Molecular Basis of Human Diseases", LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Mohamed Maalej
- Psychiatry C-department, University of Sfax & Hédi Chaker Hospital, Sfax, Tunisia
| | - Dominique Bonnefont-Rousselot
- AP-HP, Sorbonne University, La Pitié-Salpêtrière University Hospital, Department of Metabolic Biochemistry, Paris, France; UTCBS, U1267 Inserm, UMR 8258 CNRS, Université de Paris, Paris, France
| | - Foudil Lamari
- AP-HP, Sorbonne University, La Pitié-Salpêtrière University Hospital, Department of Metabolic Biochemistry, Paris, France
| | - Fatma Ayadi
- Laboratory of Research "Molecular Basis of Human Diseases", LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia; Laboratory of Biochemistry, University of Sfax & Habib Bourguiba Hospital, Sfax, Tunisia
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15
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Sud D, Laughton E, McAskill R, Bradley E, Maidment I. The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review. Syst Rev 2021; 10:92. [PMID: 33789745 PMCID: PMC8015120 DOI: 10.1186/s13643-021-01586-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. METHODS A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. RESULTS A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. CONCLUSIONS Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086411.
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Affiliation(s)
- Dolly Sud
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eileen Laughton
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Robyn McAskill
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Eleanor Bradley
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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16
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Cuellar-Barboza AB, Cabello-Arreola A, Winham SJ, Colby C, Romo-Nava F, Nunez NA, Morgan RJ, Gupta R, Bublitz JT, Prieto ML, De Filippis EA, Lopez-Jimenez F, McElroy SL, Biernacka JM, Frye MA, Veldic M. Body mass index and blood pressure in bipolar patients: Target cardiometabolic markers for clinical practice. J Affect Disord 2021; 282:637-643. [PMID: 33445086 DOI: 10.1016/j.jad.2020.12.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/07/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the association between cardiometabolic markers and bipolar disorder (BD), examining the impact of sex and cardiometabolic medication use, from a large case-control biorepository of more than 1300 participants. PATIENTS AND METHODS Recruited from July 2009 through September 2017, cardiometabolic markers were harvested from electronic health records (EHR) of participants (n=661) from the Mayo Clinic Individualized Medicine Biobank for Bipolar Disorder and Mayo Clinic Biobank age-sex-matched controls (n=706). Markers were compared between cases and controls using logistic regression, stratified by sex, adjusting for cardiometabolic medications and current smoking status. We studied the effect of psychotropics in case-only analyses. RESULTS The mean age of the sample was 52.5 ± 11.6 years and 55% were female. BD patients had higher rates of smoking, but lower utilization of lipid-lowering medication compared with controls. After adjustment, BD was associated with obesity [Odds ratio (CI) 1.62 (1.22-2.15)], elevated systolic blood pressure (SBP) [2.18 (1.55-3.06)] and elevated triglycerides [1.58 (1.13-2.2)]. When stratified by sex, obesity [1.8 (1.23-2.66)] and systolic blood pressure [2.32 (1.46-3.7)] were associated with BD females compared to female controls; however, only systolic blood pressure [2.04 (1.23-3.42)] was associated with male bipolars compared to male controls. Psychotropics were marginally associated with mean BMI, abnormal triglycerides, and HbA1c. LIMITATIONS EHR cross-sectional data CONCLUSION: To our knowledge, this is the largest case controlled study to date to explore the association between cardiometabolic markers and bipolar disorder adjusting for utilization of cardiometabolic medication. Identification of significant, non-laboratory based cardiometabolic markers that are associated with increased risk of major cardiovascular adverse events in patients with bipolar disorder, underscores, both the utility and importance of risk monitoring that can be easily done in community mental health centers.
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Affiliation(s)
- Alfredo B Cuellar-Barboza
- Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Stacey J Winham
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Colin Colby
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, Ohio; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Robert J Morgan
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Ruchi Gupta
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Joshua T Bublitz
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Miguel L Prieto
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota; Department of Psychiatry, Facultad de Medicina, Universidad de los Andes, Santiago, Chile; Mental Health Service, Clínica Universidad de los Andes, Santiago, Chile; Center for Biomedical Research and Innovation, Universidad de los Andes, Santiago, Chile
| | | | | | - Susan L McElroy
- Lindner Center of HOPE, Mason, Ohio; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joanna M Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota.
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17
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Lv Q, Hu Q, Zhang W, Huang X, Zhu M, Geng R, Cheng X, Bao C, Wang Y, Zhang C, He Y, Li Z, Yi Z. Disturbance of Oxidative Stress Parameters in Treatment-Resistant Bipolar Disorder and Their Association With Electroconvulsive Therapy Response. Int J Neuropsychopharmacol 2020; 23:207-216. [PMID: 31967315 PMCID: PMC7177162 DOI: 10.1093/ijnp/pyaa003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective option for treatment-resistant bipolar disorder (trBD). However, the mechanisms of its effect are unknown. Oxidative stress is thought to be involved in the underpinnings of BD. Our study is the first, to our knowledge, to report the association between notable oxidative stress parameters (superoxide dismutase [SOD], glutathione peroxidase [GSH-Px], catalase [CAT], and malondialdehyde [MDA]) levels and ECT response in trBD patients. METHODS A total 28 trBD patients and 49 controls were recruited. Six-week ECT and naturalistic follow-up were conducted. SOD, GSH-Px, CAT, and MDA levels were measured by enzyme-linked immunosorbent assay, and the 17-item Hamilton Depression Rating Scale and Young Mania Rating Scale were administered at baseline and the end of the 6th week. MANCOVA, ANCOVA, 2 × 2 ANCOVA, and a multiple regression model were conducted. RESULTS SOD levels were lower in both trBD mania and depression (P = .001; P = .001), while GSH-Px (P = .01; P = .001) and MDA (P = .001; P = .001) were higher in both trBD mania and depression compared with controls. CAT levels were positively associated with 17-item Hamilton Depression Rating Scale scores in trBD depression (radjusted = 0.83, P = .005). MDA levels in trBD decreased after 6 weeks of ECT (P = .001). Interestingly, MDA levels decreased in responders (P = .001) but not in nonresponders (P > .05). CONCLUSIONS Our study indicates that decreased SOD could be a trait rather than a state in trBD. Oxidative stress levels are associated with illness severity and ECT response. This suggests that the mechanism of oxidative stress plays a crucial role in the pathophysiology of trBD.
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Affiliation(s)
- Qinyu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiongyue Hu
- Qingdao Mental Health Center, Qingdao, China
| | | | - Xinxin Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minghuan Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Geng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Cheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenxi Bao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingyi Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongguang He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zezhi Li
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence: Zezhi Li, MD, PhD, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 1630 Dongfang Road, 200127 Shanghai, China (); and Zhenghui Yi, MD, PhD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai 200030, China ()
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence: Zezhi Li, MD, PhD, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 1630 Dongfang Road, 200127 Shanghai, China (); and Zhenghui Yi, MD, PhD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai 200030, China ()
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18
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Ralat SI, Barrios RI. THE MANAGEMENT OF CARDIOVASCULAR DISEASE RISK FACTORS IN BIPOLAR DISORDER PATIENTS IN PRIMARY HEALTHCARE SETTINGS. REVISTA PUERTORRIQUENA DE PSICOLOGIA 2020; 31:62-78. [PMID: 34221244 PMCID: PMC8249201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Accumulating evidence supports the association between cardiovascular disease (CVD) risk factors and bipolar disorder (BD). CVD is the leading cause of morbidity and mortality in patients with bipolar disorder. However, there is a need to study the management of the risk factors in the primary healthcare context. This narrative review aims to appraise the different approaches of care that have been used in the management of these patients to address CVD risk factors in primary care. We reviewed articles from PubMed, Science Direct and other studies cited in the articles found. The keywords used for this review included "bipolar," "bipolar disorder," "cardiovascular" or "metabolic syndrome," "screening," "primary care," and "integrative" or "integrated care model" or "collaborative care model." This review includes studies published over a period of 48 months (January 2016 through December 2019). We identified 128 articles, removing two duplicates. From them, 115 articles are excluded based on the inclusion/exclusion criteria leaving eleven relevant articles. Upon full-text review, six studies were excluded. The final studies included are five. We used the study-quality assessment tools from the National Heart, Lung, and Blood Institute to assess the quality of the articles found. CVD risk factors in patients with BD and forms of other severe mental illness (SMI) are often underdetected. Primary healthcare providers need to identify these risk factors in the management of these patients to determine and recommend appropriate strategies.
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Affiliation(s)
- Sandra I. Ralat
- Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Rossana I. Barrios
- Conrado F. Asenjo Library, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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19
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Naderyan Fe'li S, Yassini Ardekani SM, Fallahzadeh H, Dehghani A. Metabolic syndrome and 10-year risk of cardiovascular events among schizophrenia inpatients treated with antipsychotics. Med J Islam Repub Iran 2019; 33:97. [PMID: 31696091 PMCID: PMC6825382 DOI: 10.34171/mjiri.33.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background: The metabolic syndrome is highly prevalent among patients with schizophrenia. This study was conducted to determine the prevalence of metabolic syndrome and the risk of cardiovascular disease in the next 10 years among schizophrenic patients. Methods: This cross sectional study was performed on 100 Iranian patients with schizophrenia in 2016. The prevalence of metabolic syndrome was determined by adult treatment panel III criteria, and 10-year cardiovascular risk was calculated by Framingham Risk Score. SPSS software was used to perform statistical analysis. Chi-square and Fisher's exact or extended Fisher's exact tests were used to compare dichotomous variables. Also, Mann-Whitney U test was applied to compare the quantitative variables. Significance level was considered to be less than or equal to 0.05. Results: In this study, 83 participants (83%) were male and 17 (17%) were female. The prevalence of metabolic syndrome was 27% (21.7% in males and 52.9% in females, p=0.015). Among all components of metabolic syndrome, low HDL-C in men and abdominal obesity in females were the most common disorders. Based on Framingham Risk Score, 76%, 16%, and 8% of patients had low, intermediate, and high level of risk, respectively. A significant difference was observed between the level of risk among participants with and without metabolic syndrome (p=0.042). Conclusion: In this study, patients with schizophrenia showed a high prevalence of metabolic syndrome, but most of them had low risk of developing cardiovascular disease. These results suggest regular screening and early interventions to modify the risk factors of metabolic syndrome.
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Affiliation(s)
- Shadi Naderyan Fe'li
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Hosein Fallahzadeh
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Dehghani
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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20
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Morris G, Puri BK, Walker AJ, Maes M, Carvalho AF, Bortolasci CC, Walder K, Berk M. Shared pathways for neuroprogression and somatoprogression in neuropsychiatric disorders. Neurosci Biobehav Rev 2019; 107:862-882. [PMID: 31545987 DOI: 10.1016/j.neubiorev.2019.09.025] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/13/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022]
Abstract
Activated immune-inflammatory, oxidative and nitrosative stress (IO&NS) pathways and consequent mitochondrial aberrations are involved in the pathophysiology of psychiatric disorders including major depression, bipolar disorder and schizophrenia. They offer independent and shared contributions to pathways underpinning medical comorbidities including insulin resistance, metabolic syndrome, obesity and cardiovascular disease - herein conceptualized as somatoprogression. This narrative review of human studies aims to summarize relationships between IO&NS pathways, neuroprogression and somatoprogression. Activated IO&NS pathways, implicated in the neuroprogression of psychiatric disorders, affect the pathogenesis of comorbidities including insulin resistance, dyslipidaemia, obesity and hypertension, and by inference, metabolic syndrome. These conditions activate IO&NS pathways, exacerbating neuroprogression in psychiatric disorders. The processes whereby proinflammatory cytokines, nitrosative and endoplasmic reticulum stress, NADPH oxidase isoforms, PPARγ inactivation, SIRT1 deficiency and intracellular signalling pathways impact lipid metabolism and storage are considered. Through associations between body mass index, chronic neuroinflammation and FTO expression, activation of IO&NS pathways arising from somatoprogression may contribute to neuroprogression. Early evidence highlights the potential of adjuvants targeting IO&NS pathways for treating somatoprogression and neuroprogression.
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Affiliation(s)
- Gerwyn Morris
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Basant K Puri
- Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Adam J Walker
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Chiara C Bortolasci
- Deakin University, CMMR Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia
| | - Ken Walder
- Deakin University, CMMR Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia; Deakin University, CMMR Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
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21
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Onyeka IN, Collier Høegh M, Nåheim Eien EM, Nwaru BI, Melle I. Comorbidity of Physical Disorders Among Patients With Severe Mental Illness With and Without Substance Use Disorders: A Systematic Review and Meta-Analysis. J Dual Diagn 2019; 15:192-206. [PMID: 31164045 DOI: 10.1080/15504263.2019.1619007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Physical disorders in patients with severe mental illness (SMI) are common and they tend to be underdiagnosed by clinicians, which might lead to negative treatment outcomes. The presence of substance use disorders could further aggravate the situation. There are existing systematic reviews on physical disorders among individuals with SMI in general but none of these previous reviews stratified their findings by substance use disorder status. This study aimed to synthesize the evidence on the frequency of comorbid physical disorders among patients with SMI with or without substance use disorders. Methods: We searched for studies published in English between 1988 and 2017 in MEDLINE, Embase, CINAHL, PsycINFO, Global Health, Web of Science, Scopus, WHO Global Health Library (Global Index Medicus), Google Scholar, OpenGrey, the Grey Literature Report, Cochrane Library, International Standardized Randomized Controlled Trial Number Registry, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Australian and New Zealand Clinical Trials Registry, and PROSPERO. There was no geographical restriction and the target population was adults (≥18 years) with diagnosed SMI including schizophrenia, bipolar disorder, and other psychotic illnesses. The outcome of interest was physical disorder. Results: A total of 6,994 records were retrieved. Only 30 papers (representing 24 studies) met our inclusion criteria and 13 studies were included in the meta-analysis. The prevalence of most of the reported physical disorders was higher in SMI patients with substance use disorders than in those without substance use disorders. When ranked according to pooled prevalence level, hypertension (35.6%), tardive dyskinesia (35.4%), and hepatitis C (26.9%) were the most prevalent physical disorders among SMI patients with substance use disorders. For SMI patients without substance use disorders, hypertension (32.5%), tardive dyskinesia (25.1%), and endocrine disease (19.0%) were more common. Estimates for diabetes (7.5% vs. 7.5%) and cardiovascular diseases (11.8% vs. 11.3%) were similar across groups. Conclusions: Physical disorders among SMI patients vary by substance use disorder status. Clinicians managing SMI in patients should screen for physical disorders and substance use disorders and provide treatment or referral. Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42017072286.
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Affiliation(s)
- Ifeoma N Onyeka
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital , Belfast , UK
| | - Margrethe Collier Høegh
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway
| | | | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.,Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg , Gothenburg , Sweden
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway
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22
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Al-Seddik G, Hachem D, Haddad C, Hallit S, Salameh P, Nabout R, Zoghbi M. Cardiovascular events in hospitalised patients with schizophrenia: a survival analysis. Int J Psychiatry Clin Pract 2019; 23:106-113. [PMID: 30741069 DOI: 10.1080/13651501.2018.1545910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To evaluate the occurrence of cardiovascular (CV), cerebrovascular events and mortality rates, and compare the predictive ability of two scores, Framingham Risk Score (FRS) and Atherosclerotic Cardiovascular Disease (ASCVD), of detecting a cardiovascular event in a cohort of schizophrenic patients. Methods: A cohort of 329 hospitalised schizophrenic patients is being monitored since 1 January 2013. Patients' file review was performed to detect the CV events of interest. Results: Out of the 329 patients with schizophrenia, with a mean study follow-up of 41.07 ± 12.55 months, 29 cardiovascular events were recorded; of those events, we recorded 4 myocardial infarction, 1 stroke, 6 heart failure and 18 cardiovascular deaths. The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance (RR = 1.90, p = .078). Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival (RR = 3.35, p = .005). Conclusion: The ASCVD items should be included in the medical assessment in any patient with severe mental illness. Key points The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance. Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival. The ASCVD items should be included in the medical assessment in any patient with severe mental illness.
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Affiliation(s)
- Ghina Al-Seddik
- a Faculty of Sciences , Lebanese University , Beirut , Lebanon
| | - Dory Hachem
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon
| | - Chadia Haddad
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon
| | - Souheil Hallit
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon.,d Faculty of Medicine and Medical Sciences , Holy Spirit University , Kaslik , Lebanon.,e INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie , Beirut , Lebanon
| | - Pascale Salameh
- c Faculty of Pharmacy , Lebanese University , Beirut , Lebanon.,e INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie , Beirut , Lebanon.,f Faculty of Medicine , Lebanese University , Beirut , Lebanon
| | - Rita Nabout
- a Faculty of Sciences , Lebanese University , Beirut , Lebanon
| | - Marouan Zoghbi
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon.,g Faculty of Medicine , Saint-Joseph University , Beirut , Lebanon
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23
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Nielsen RE, Kugathasan P, Straszek S, Jensen SE, Licht RW. Why are somatic diseases in bipolar disorder insufficiently treated? Int J Bipolar Disord 2019; 7:12. [PMID: 31055668 PMCID: PMC6500513 DOI: 10.1186/s40345-019-0147-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/23/2019] [Indexed: 12/27/2022] Open
Abstract
Background Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of findings in studies on patients diagnosed with other severe mental disorders. Main body The existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel findings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specific cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases. Conclusion It is surprising and of major concern that patients with bipolar disorder have not benefitted from the significant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.
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Affiliation(s)
- René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark.
| | - Pirathiv Kugathasan
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - Sune Straszek
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
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24
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Mohamed MO, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas MA. Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations. Can J Cardiol 2019; 35:821-830. [PMID: 31292080 DOI: 10.1016/j.cjca.2019.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI). METHODS All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes. RESULTS Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively). CONCLUSION Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Saeed Farooq
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Nishat Siddiqui
- Nevill Hall Hospital, Aneurin Bevan University Health Board, Wales, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ritu Thamman
- Department of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
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25
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Rødevand L, Steen NE, Elvsåshagen T, Quintana DS, Reponen EJ, Mørch RH, Lunding SH, Vedal TSJ, Dieset I, Melle I, Lagerberg TV, Andreassen OA. Cardiovascular risk remains high in schizophrenia with modest improvements in bipolar disorder during past decade. Acta Psychiatr Scand 2019; 139:348-360. [PMID: 30697685 DOI: 10.1111/acps.13008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE While CVD risk has decreased in the general population during the last decade, the situation in patients with schizophrenia (SCZ) and bipolar disorder (BD) is unknown. METHODS We compared CVD risk factors in patients with SCZ and BD recruited from 2002-2005 (2005 sample, N = 270) with patients recruited from 2006-2017 (2017 sample, N = 1011) from the same catchment area in Norway. The 2017 sample was also compared with healthy controls (N = 922) and the general population (N range = 1285-4587, Statistics Norway) from the same area and period. RESULTS Patients with SCZ and BD in the 2017 sample had significantly higher level of most CVD risk factors compared to healthy controls and the general population. There was no significant difference in the prevalence of CVD risk factors in SCZ between the 2005 and 2017 samples except a small increase in glucose in the 2017 sample. There were small-to-moderate reductions in hypertension, obesity, total cholesterol, low-density lipoprotein, systolic and diastolic blood pressure in the BD 2017 sample compared to the 2005 sample. CONCLUSION Despite major advances in health promotion during the past decade, there has been no reduction in the level of CVD risk factors in patients with SCZ and modest improvement in BD.
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Affiliation(s)
- L Rødevand
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - N E Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - D S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E J Reponen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R H Mørch
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S H Lunding
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T S J Vedal
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - I Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - I Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T V Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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26
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Impaired Glucose Metabolism in Bipolar Patients: The Role of Psychiatrists in Its Detection and Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071132. [PMID: 30934836 PMCID: PMC6480108 DOI: 10.3390/ijerph16071132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/12/2022]
Abstract
Bipolar patients have a higher risk of type 2 diabetes and obesity, which are associated with cardiovascular diseases as the leading cause of death in this group. Additionally, there is growing evidence that impaired glucose metabolism in bipolar patients is associated with rapid cycling, poor response to mood stabilizers and chronic course of illness. The aim of the study was to assess the prevalence of type 2 diabetes and other types of impaired glucose metabolism in bipolar patients along with an evaluation of the Fasting Triglycerides and Glucose Index (TyG) as a method of the insulin sensitivity assessment. The analysis of fasting glycemia, insulinemia and lipid profile in euthymic bipolar patients was performed, and the Homeostasis model assessment for insulin resistance (HOMA-IR) and TyG were computed. Type 2 diabetes was observed in 9% and insulin resistance with HOMA-IR in 48% of patients. The TyG and HOMA-IR indices were correlated (p < 0.0001), the TyG index value of 4.7 had the highest sensitivity and specificity for insulin resistance detection. The usefulness of TyG in the recognition of insulin resistance in bipolar patients was suggested. The significant role of psychiatrists in the detection and management of impaired glucose metabolism in bipolar patients was presented.
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27
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Steardo L, Fabrazzo M, Sampogna G, Monteleone AM, D'Agostino G, Monteleone P, Maj M. Impaired glucose metabolism in bipolar patients and response to mood stabilizer treatments. J Affect Disord 2019; 245:174-179. [PMID: 30391773 DOI: 10.1016/j.jad.2018.10.360] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/15/2018] [Accepted: 10/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Metabolic dysfunctions in patients with bipolar disorder (BD) are critical factors that interfere with outcome, but only one study evaluated the influence of glucose dysmetabolism on the response to treatment with lithium. We aimed to investigate the potential impact of glucose metabolic status on clinical characteristics of BD patients and their response to treatment with different mood stabilizers in monotherapy or in combination. METHODS 45 BD patients with insulin resistance (IR) or type 2 diabetes mellitus (DM2) and 46 patients with normal glucose metabolism, treated with mood stabilizers for at least one year were assessed by diagnostic and rating instruments. Their clinical characteristics were compared and an ordinal logistic regression model was adopted to identify possible predictors of response to mood stabilizer treatments. RESULTS Compared to patients with normal glucose metabolism, BD patients with impaired glucose metabolism showed a worse clinical presentation of their psychiatric illness and a worse response to mood stabilizers. Ordinal logistic regression analysis evidenced that impaired glucose metabolism was the only predictor of poor response to mood stabilizers (OR 4.3; 95% CI: 1.7-11.1; p < 0.002). LIMITATIONS Cross-sectional design and the relatively small sample size, are the main limitations of our study. CONCLUSIONS Our findings expand literature data suggesting that BD patients with impaired glucose metabolism are at a greater risk of not responding to lithium as well as to different mood stabilizer treatments.
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Affiliation(s)
- Luca Steardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessio M Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia D'Agostino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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28
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Ferns G. Cause, consequence or coincidence: The relationship between psychiatric disease and metabolic syndrome. TRANSLATIONAL METABOLIC SYNDROME RESEARCH 2018. [DOI: 10.1016/j.tmsr.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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29
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Kocakaya H, Batmaz S, Demir O, Songur E, Celikbas Z. Metabolic syndrome in bipolar disorder: prevalence, demographics and clinical correlates in individuals with bipolar I, bipolar II, and healthy controls. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0101-60830000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Sedat Batmaz
- Gaziosmanpasa University School of Medicine, Turkey
| | - Osman Demir
- Gaziosmanpasa University School of Medicine, Turkey
| | - Emrah Songur
- Ankara Kecioren Training and Research Hospital, Turkey
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30
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McCarthy MJ, Korelova O, Demodena A, Kelsoe JR. A common genetic variant in CACNA1C predicts heart rate in patients with bipolar disorder. Psychiatry Res 2018; 263:294-295. [PMID: 29395250 DOI: 10.1016/j.psychres.2018.01.032] [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: 07/28/2017] [Revised: 12/13/2017] [Accepted: 01/14/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Michael J McCarthy
- VA San Diego Healthcare System, Psychiatry Service MC116A, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego Department of Psychiatry MC116A, La Jolla, CA 92093, USA.
| | - Olga Korelova
- University of California, San Diego Department of Psychiatry MC116A, La Jolla, CA 92093, USA.
| | - Anna Demodena
- VA San Diego Healthcare System, Psychiatry Service MC116A, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego Department of Psychiatry MC116A, La Jolla, CA 92093, USA.
| | - John R Kelsoe
- VA San Diego Healthcare System, Psychiatry Service MC116A, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego Department of Psychiatry MC116A, La Jolla, CA 92093, USA.
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31
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Wazen GLL, Gregório ML, Kemp AH, Godoy MFD. Heart rate variability in patients with bipolar disorder: From mania to euthymia. J Psychiatr Res 2018; 99:33-38. [PMID: 29407285 DOI: 10.1016/j.jpsychires.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/23/2017] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
Abstract
Bipolar Disorder (BD) is characterized by the occurrence of mania alternating with euthymia. The aim of the present study was to investigate the impact of BD on the autonomic nervous system, as indicated by heart rate variability (HRV). The study was registered in the Clinical Trials Registration (NCT01272518). Nineteen hospitalized, male patients (age: 34.0 ± 12.3 years) with type I BD were assessed during mania and at discharge on euthymia. HRV data were collected during 20- minutes in supine position at rest, on spontaneous breathing, using the Polar RS 800 CX frequencymeter. HRV measures included variables in time, frequency and non-linear domains. Psychiatric conditions were evaluated by the Mini International Neuropsychiatric Interview (MINI) and the Bech-Rafaelsen mania scale (BRMS). Time domain measures of RMSSD (Cohen's d = 0.668) and pNN50 (Cohen's d = 0.688) increased from first to second assessments. The high-frequency component (HFms2) also increased (Cohen's d = 0.586), while the LF/HF ratio decreased (Cohen's d = 0.785). Non-linear domain measures including the SD1 component (Cohen's d = 0.668), and the SD1/SD2 ratio (Cohen's d = 1.2934) extracted from the Poincare plot analysis increased from first to second assessment. The variables Lmean (Cohen's d = 0.9627), Lmax (Cohen's d = 1.2164), REC% (Cohen's d = 1.0595) and EntShannon (Cohen's d = 1.0607) were higher in mania. By contrast, ApEn (Cohen's d = 0.995) and EntSample (Cohen's d = 1.189) were less during mania, all reflecting ANS improvement. Findings are interpreted in the context of recently published models relating to neurovisceral integration across the continuum of time, and the implications for the future health and wellbeing of patients are considered.
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Affiliation(s)
- Guilherme Luiz Lopes Wazen
- Department of Psychiatry and Medical Psychology of São José do Rio Preto Medical School, Famerp, São José do Rio Preto, São Paulo, Brazil.
| | - Michele Lima Gregório
- Transdisciplinary Nucleus for Chaos and Complexity Studies (NUTECC), São José do Rio Preto Medical School, Famerp, São José do Rio Preto, São Paulo, Brazil
| | - Andrew Haddon Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom; Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil; School of Psychology, University of Sydney, Sydney, Australia
| | - Moacir Fernandes de Godoy
- Transdisciplinary Nucleus for Chaos and Complexity Studies (NUTECC), São José do Rio Preto Medical School, Famerp, São José do Rio Preto, São Paulo, Brazil; Department of Cardiology and Cardiovascular Surgery of São José do Rio Preto Medical School, Famerp, São Paulo, Brazil.
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Blixen C, Sajatovic M, Moore DJ, Depp C, Cushman C, Cage J, Barboza M, Eskew L, Klein P, Levin JB. Patient Participation in the Development of a Customized M-Health Intervention to Improve Medication Adherence in Poorly Adherent Individuals with Bipolar Disorder (BD) and Hypertension (HTN). ACTA ACUST UNITED AC 2018; 4:25-35. [PMID: 30410985 DOI: 10.5430/ijh.v4n1p25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective Individuals living with bipolar disorder (BD) have poorer management of chronic medical conditions such as hypertension (HTN), and worse treatment adherence than the general population. The study objective was to obtain information from patients with both BD and HTN that would inform the development of an m-Health intervention to improve medication adherence for poorly adherent individuals living with both these chronic illnesses. Methods Focus group methodology was used to collect information from 13 participants on perceived barriers and facilitators to BD and HTN medication adherence, as well as feedback on the demonstration and use of a bidirectional text messaging system for medication reminders. Focus groups were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Results Forgetfulness was the most frequently mentioned barrier to taking antihypertensive medications, and decisions about taking them were often influenced by BD mood fluctuations and the burden of having to take "too many pills" for both chronic illnesses. Participants' feedback about the use of a text-messaging system to help with medication adherence for BD and HTN was very positive, and their suggestions for modification were incorporated into a more customized system for testing in a Phase 2 trial. Conclusions Our findings indicate that patient engagement in the development of an m-health intervention has the potential to improve adherence with both BD and HTN medications in individuals with known sub-optimal adherence. Patient engagement in health care is essential if we are to optimize patient outcomes.
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Affiliation(s)
- Carol Blixen
- Department of Psychiatry, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, Department of Psychiatry; University Hospitals Cleveland Medical Center; Neurological and Behavioral Outcomes Center, Cleveland, Ohio, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Colin Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Clint Cushman
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jamie Cage
- School of Social Work, Virginia Commonwealth University, Virginia, USA
| | - Marina Barboza
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland State University, Cleveland, Ohio, USA
| | - Logan Eskew
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland State University, Cleveland, Ohio, USA
| | - Peter Klein
- Department of Psychiatry, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, Cleveland, Ohio, USA
| | - Jennifer B Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine, Department of Psychiatry; University Hospitals Cleveland Medical Center; Neurological and Behavioral Outcomes Center, Cleveland, Ohio, USA
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Goldstein BI. Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities. Can J Cardiol 2017; 33:1565-1576. [DOI: 10.1016/j.cjca.2017.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
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Fornaro M, Solmi M, Veronese N, De Berardis D, Buonaguro EF, Tomasetti C, Perna G, Preti A, Carta MG. The burden of mood-disorder/cerebrovascular disease comorbidity: essential neurobiology, psychopharmacology, and physical activity interventions. Int Rev Psychiatry 2017; 29:425-435. [PMID: 28681620 DOI: 10.1080/09540261.2017.1299695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardio-vascular diseases (CVDs) and CVD-related disorders (including cerebrovascular diseases; CBVDs) are a major public health concern as they represent the leading cause of mortality and morbidity in developed countries. Patients with CVDs and CBVDs co-morbid with mood disorders, especially bipolar disorder (BD) and major depressive disorder (MDD), suffer reduced quality-of-life and significant disability adjusted for years of life and mortality. The relationship between CVDs/CBVDs and mood disorders is likely to be bidirectional. Evidence for shared genetic risk of pathways involved in stress reaction, serotonin or dopamine signalling, circadian rhythms, and energy balance was reported in genome-wide association studies. There is some evidence of a neuroprotective effect of various antidepressants, which may be boosted by physical exercise, especially by aerobic ones. Patients with CVDs/CBVDs should be routinely attentively evaluated for the presence of mood disorders, with tools aimed at detecting both symptoms of depression and of hypomania/mania. Behavioural lifestyle interventions targeting nutrition and exercise, coping strategies, and attitudes towards health should be routinely provided to patients with mood disorders, to prevent the risk of CVDs/CBVDs. A narrative review of the evidence is herein provided, focusing on pharmacological and physical therapy interventions.
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Affiliation(s)
- Michele Fornaro
- a Department of Neuroscience, Reproductive Science and Odontostomatology , School of Medicine 'Federico II' Naples , Naples , Italy.,b Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , NY , USA
| | - Marco Solmi
- c Neuroscience Department , University of Padua , Padua , Italy.,d Institute for Clinical Research and Education in Medicine, I.R.E.M , Padua , Italy
| | - Nicola Veronese
- d Institute for Clinical Research and Education in Medicine, I.R.E.M , Padua , Italy.,e Department of Medicine (DIMED), Geriatrics Division , University of Padova , Padova , Italy
| | - Domenico De Berardis
- f Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini' , Teramo , Italy
| | - Elisabetta Filomena Buonaguro
- a Department of Neuroscience, Reproductive Science and Odontostomatology , School of Medicine 'Federico II' Naples , Naples , Italy
| | - Carmine Tomasetti
- a Department of Neuroscience, Reproductive Science and Odontostomatology , School of Medicine 'Federico II' Naples , Naples , Italy
| | - Giampaolo Perna
- g Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , Netherlands.,h Department of Clinical Neurosciences, FoRiPsi , Hermanas Hospitalarias-Villa San Benedetto Menni Hospital , Albese con Cassano , Como , Italy.,i Department of Psychiatry and Behavioural Sciences, Leonard Miller School of Medicine , University of Miami , Miami , FL , USA
| | - Antonio Preti
- j Center of Liaison Psychiatry and Psychosomatics , University Hospital, University of Cagliari , Monserrato , Cagliari , Italy
| | - Mauro Giovanni Carta
- k Department of Public Health, Clinical and Molecular Medicine , University of Cagliari , Monserrato , Cagliari , Italy
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Eap CB. Personalized prescribing: a new medical model for clinical implementation of psychotropic drugs. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27757065 PMCID: PMC5067148 DOI: 10.31887/dcns.2016.18.3/ceap] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The use of pharmacogenetic tests was already being proposed in psychiatry in the early 2000s because genetic factors were known to influence drug pharmacokinetics and pharmacodynamics. However, sufficient levels of evidence to justify routine use have been achieved for only a few tests (eg, major histocompatibility complex, class I, B, allele 1502 [HLA-B*1502] for carbamazepine in epilepsy and bipolar disorders); many findings are too preliminary or, when replicated, of low clinical relevance because of a small effect size. Although drug selection and dose adaptation according to cytochrome P450 genotypes are sound, a large number of patients need to be genotyped in order to prevent one case of severe side effect and/or nonresponse. The decrease in cost for genetic analysis shifts the cost: benefit ratio toward increasing use of pharmacogenetic tests. However, they have to be combined with careful clinical evaluations and other tools (eg, therapeutic drug monitoring and phenotyping) to contribute to the general aim of providing the best care for psychiatric patients.
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Affiliation(s)
- Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland; School of Pharmacy, Department of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Earley W, Durgam S, Lu K, Debelle M, Laszlovszky I, Vieta E, Yatham LN. Tolerability of cariprazine in the treatment of acute bipolar I mania: A pooled post hoc analysis of 3 phase II/III studies. J Affect Disord 2017; 215:205-212. [PMID: 28343051 DOI: 10.1016/j.jad.2017.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Atypical antipsychotics have broad-spectrum efficacy against core symptoms of acute mania/mixed states in bipolar disorder; however, they are associated with clinically significant adverse effects (AEs). METHODS This post hoc analysis evaluated the safety and tolerability of the atypical antipsychotic cariprazine in the treatment of adult patients with acute manic/mixed episodes of bipolar I disorder. Data were taken from three 3-week randomized, double-blind, placebo-controlled, flexible-dose trials of cariprazine 3-12mg/d. Patient subgroups categorized by modal daily dose (3-6mg/d; 9-12mg/d) were used to assess dose response. RESULTS The pooled safety population comprised 1065 patients (placebo=442; cariprazine 3-6mg/d=263; cariprazine 9-12mg/d=360). More cariprazine- than placebo-treated patients reported double-blind treatment-emergent AEs; the overall AE incidence was similar among cariprazine-dose groups. AEs reported in ≥5% of cariprazine patients overall with at least twice the incidence of placebo were akathisia, extrapyramidal symptoms, restlessness, and vomiting. The incidence of SAEs was low and similar between the placebo- and cariprazine-treatment groups. Metabolic parameter changes were small and generally similar between cariprazine and placebo groups; mean increases in fasting glucose levels were greater with cariprazine (3-6mg/d=6.6mg/dL; 9-12mg/d=7.2mg/dL) than placebo (1.7mg/dL). Mean weight change was 0.54kg and 0.17kg for cariprazine and placebo, respectively; weight increase ≥7% was <3% in all treatment groups. Cariprazine was not associated with clinically meaningful changes in electrocardiogram parameters. LIMITATIONS Post hoc analysis, flexible-dose design, short trial duration. CONCLUSION Cariprazine was generally safe and well-tolerated in patients with manic/mixed episodes associated with bipolar I disorder.
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Affiliation(s)
| | | | | | | | | | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Fjukstad KK, Engum A, Lydersen S, Dieset I, Steen NE, Andreassen OA, Spigset O. Metabolic risk factors in schizophrenia and bipolar disorder: The effect of comedication with selective serotonin reuptake inhibitors and antipsychotics. Eur Psychiatry 2017; 48:71-78. [PMID: 29331603 DOI: 10.1016/j.eurpsy.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this observational study was to investigate the relationship between metabolic factors and use of selective serotonin reuptake inhibitors (SSRIs) combined with olanzapine, quetiapine or risperidone. METHODS Data from the Norwegian Thematically Organized Psychosis study, a cross-sectional study on 1301 patients with schizophrenia (n=868) or bipolar disorder (n=433), were analyzed. As exposure variables in the linear regression model were included the dose or serum concentration of SSRIs (n=280) and of olanzapine (n=398), quetiapine (n=234) or risperidone (n=128). The main outcome variables were levels of total cholesterol, low and high density lipoprotein (LDL and HDL) cholesterol, triglycerides and glucose. RESULTS One defined daily dose (DDD) per day of an SSRI in addition to olanzapine was associated with an increase in total cholesterol of 0.16 (CI 0.01 to 0.32) mmol/L (P=0.042) and an increase in LDL-cholesterol of 0.17 (CI 0.02 to 0.31) mmol/L (P=0.022). An SSRI serum concentration in the middle of the reference interval in addition to quetiapine was associated with an increase in total cholesterol of 0.39 (CI 0.10 to 0.68) mmol/L (P=0.011) and an increase in LDL-cholesterol of 0.29 (0.02 to 0.56) mmol/L (P=0.037). There were no such effects when combined with risperidone. CONCLUSIONS The findings indicate only minor deteriorations of metabolic variables associated with treatment with an SSRI in addition to olanzapine and quetiapine, and none when combined with risperidone. These results suggest that SSRIs can be used in combination with antipsychotics, and that the possible increase in cardiovascular risk is negligible.
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Affiliation(s)
- K K Fjukstad
- Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - A Engum
- Department of Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - S Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Trondheim, Norway
| | - I Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - N Eiel Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O Spigset
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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Quintana DS, Dieset I, Elvsåshagen T, Westlye LT, Andreassen OA. Oxytocin system dysfunction as a common mechanism underlying metabolic syndrome and psychiatric symptoms in schizophrenia and bipolar disorders. Front Neuroendocrinol 2017; 45:1-10. [PMID: 28049009 DOI: 10.1016/j.yfrne.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 12/24/2022]
Abstract
There is growing interest in using intranasal oxytocin (OT) to treat social dysfunction in schizophrenia and bipolar disorders (i.e., psychotic disorders). While OT treatment results have been mixed, emerging evidence suggests that OT system dysfunction may also play a role in the etiology of metabolic syndrome (MetS), which appears in one-third of individuals with psychotic disorders and associated with increased mortality. Here we examine the evidence for a potential role of the OT system in the shared risk for MetS and psychotic disorders, and its prospects for ameliorating MetS. Using several studies to demonstrate the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, we show that OT system dysfunction may be one common mechanism underlying MetS and psychotic disorders. Given the critical need to better understand metabolic dysregulation in these disorders, future OT trials assessing behavioural and cognitive outcomes should additionally include metabolic risk factor parameters.
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Affiliation(s)
- Daniel S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway.
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Torbjørn Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
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SayuriYamagata A, Brietzke E, Rosenblat JD, Kakar R, McIntyre RS. Medical comorbidity in bipolar disorder: The link with metabolic-inflammatory systems. J Affect Disord 2017; 211:99-106. [PMID: 28107669 DOI: 10.1016/j.jad.2016.12.059] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 12/23/2016] [Accepted: 12/31/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with chronic low-grade inflammation, several medical comorbidities and a decreased life expectancy. Metabolic-inflammatory changes have been postulated as one of the main links between BD and medical comorbidity, although there are few studies exploring possible mechanisms underlying this relationship. Therefore, the aims of the current narrative review were 1) synthesize the evidence for metabolic-inflammatory changes that may facilitate the link between medical comorbidity and BD and 2) discuss therapeutic and preventive implications of these pathways. METHODS The PubMed and Google Scholar databases were searched for relevant studies. RESULTS Identified studies suggested that there is an increased risk of medical comorbidities, such as autoimmune disorders, obesity, diabetes and cardiovascular disease in patients with BD. The association between BD and general medical comorbidities seems to be bidirectional and potentially mediated by immune dysfunction. Targeting the metabolic-inflammatory-mood pathway may potential yield improved outcomes in BD; however, further study is needed to determine which specific interventions may be beneficial. LIMITATIONS The majority of identified studies had cross-sectional designs, small sample sizes and limited measurements of inflammation. CONCLUSIONS Treatment and prevention of general medical comorbidities in mood disorders should include preferential prescribing of metabolically neutral agents and adjunctive lifestyle modifications including increased physical activity, improved diet and decreased substance abuse. In addition, the use of anti-inflammatory agents could be a relevant therapeutic target in future research.
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Affiliation(s)
- Ana SayuriYamagata
- University of São Paulo (USP), São Paulo, Brazil; Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Elisa Brietzke
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network (UHN), University of Toronto, Toronto, Canada
| | - Ron Kakar
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network (UHN), University of Toronto, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network (UHN), University of Toronto, Toronto, Canada.
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A Reexamination of Nonpsychiatric Medication Adherence in Individuals With Bipolar Disorder and Medical Comorbidities. J Nerv Ment Dis 2017; 205:182-187. [PMID: 27294318 PMCID: PMC5315686 DOI: 10.1097/nmd.0000000000000544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Individuals with bipolar disorder (BD) have high rates of nonadherence, medical illness, and premature mortality. This analysis reexamined correlates of poor adherence to nonpsychiatric medication in 73 patients with BD and medical comorbidities. The majority was female (74%) and African American (77%) with mean age of 48.08 (SD, 8.04) years, mean BD duration of 28.67 (SD, 10.24) years, mean years of education of 12.01 (SD, 1.87), and mean proportion of days with missed doses in past week of 43.25 (SD, 31.14). Sex, age, education, race, and living alone did not correlate with adherence. More BD medications and more severe psychiatric symptoms correlated with worse adherence. Specifically, poor adherence correlated with the retardation and vegetative factors of Montgomery-Åsberg Depression Rating Scale and affect factor of the Brief Psychiatric Rating Scale. Among poorly adherent patients with BD and medical comorbidities, the number of BD medications, tension/anxiety, and somatic symptoms of depression related to worse nonpsychiatric medication adherence.
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Steen NE, Aas M, Simonsen C, Dieset I, Tesli M, Nerhus M, Gardsjord E, Mørch R, Agartz I, Melle I, Vaskinn A, Spigset O, Andreassen OA. Serum concentrations of mood stabilizers are associated with memory, but not other cognitive domains in psychosis spectrum disorders; explorative analyses in a naturalistic setting. Int J Bipolar Disord 2016; 4:24. [PMID: 27858347 PMCID: PMC5145893 DOI: 10.1186/s40345-016-0067-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mood stabilizers like lithium and anticonvulsants are used in bipolar and related psychotic disorders. There is a lack of knowledge of the relationship of these medications and cognition in the psychosis spectrum. We studied the association between serum concentration of mood stabilizers and cognitive performance in a well-characterized sample of bipolar and schizophrenia spectrum disorders. METHODS Serum concentrations of valproate, lamotrigine, and lithium were analyzed for associations to performance on neuropsychological tests in six cognitive domains in individuals with bipolar disorder (n = 167) and in a combined sample of individuals with bipolar or schizophrenia spectrum disorders (n = 217). Linear regression with adjustments for gender, age, and symptom levels of depression, mania, and psychosis were applied for the association analyses. RESULTS There were negative associations between serum levels of valproate and short term delayed recall (bipolar: p = 0.043; combined: p = 0.044) and working memory (bipolar: p = 0.043). A positive association was suggested between serum level of lithium and working memory (bipolar: p = 0.039). There were no other significant relationships between serum levels of valproate, lamotrigine, or lithium and neuropsychological test performance in neither the bipolar disorder nor the combined group. CONCLUSIONS Serum levels of mood stabilizers were unrelated to cognitive performance in most domains, indicating that higher dose does not lead to broader cognitive impairments in bipolar and related psychotic disorder patients. However, worsened memory with increasing levels of valproate suggests cautious dosing of anticonvulsants, while increasing lithium level seems to be associated with improved memory. The findings should be interpreted with caution due to the explorative, naturalistic design.
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Affiliation(s)
- Nils Eiel Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Monica Aas
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Tesli
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Mari Nerhus
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend Gardsjord
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragni Mørch
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anja Vaskinn
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Fjukstad KK, Engum A, Lydersen S, Dieset I, Steen NE, Andreassen OA, Spigset O. Metabolic Abnormalities Related to Treatment With Selective Serotonin Reuptake Inhibitors in Patients With Schizophrenia or Bipolar Disorder. J Clin Psychopharmacol 2016; 36:615-620. [PMID: 27749681 PMCID: PMC5098465 DOI: 10.1097/jcp.0000000000000582] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the effect of selective serotonin reuptake inhibitors (SSRIs) on cardiovascular risk factors in patients with schizophrenia or bipolar disorder. METHOD We used data from a cross-sectional study on 1301 patients with schizophrenia or bipolar disorder, of whom 280 were treated with SSRIs. The primary outcome variable was the serum concentration of total cholesterol. Secondary outcome variables were low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, triglyceride and glucose levels, body mass index, waist circumference, and systolic and diastolic blood pressure. RESULTS After adjusting for potential confounders, an SSRI serum concentration in the middle of the reference interval was associated with an increase of the total cholesterol level by 14.56 mg/dL (95% confidence interval (CI) 5.27-23.85 mg/dL, P = 0.002), the LDL cholesterol level by 8.50 mg/dL (CI 0.22-16.77 mg/dL, P = 0.044), the triglyceride level by 46.49 mg/dL (CI 26.53-66.46 mg/dL, P < 0.001) and the occurrence of the metabolic syndrome by a factor of 2.10 (CI 1.21-3.62, P = 0.008). There were also significant associations between the SSRI dose and total cholesterol and LDL cholesterol levels. CONCLUSIONS This study is the first to reveal significant associations between SSRI use and metabolic abnormalities in patients with schizophrenia or bipolar disorder. Although the effects were statistically significant, alterations were small. Thus, the clinical impact of the findings is most likely limited.
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Affiliation(s)
- Katrine Kveli Fjukstad
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
| | - Anne Engum
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
| | - Stian Lydersen
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
| | - Ingrid Dieset
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
| | - Nils Eiel Steen
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
| | - Ole A. Andreassen
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
| | - Olav Spigset
- From the *Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger; †Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology; ‡Department of Psychiatry, St. Olavs University Hospital; §Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, Trondheim; ‖NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo; ¶Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen; and #Department of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway
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Keane BP, Silverstein SM, Wang Y, Roché MW, Papathomas TV. Seeing more clearly through psychosis: Depth inversion illusions are normal in bipolar disorder but reduced in schizophrenia. Schizophr Res 2016; 176:485-492. [PMID: 27344363 PMCID: PMC5026901 DOI: 10.1016/j.schres.2016.06.015] [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: 04/20/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 01/11/2023]
Abstract
Schizophrenia patients with more positive symptoms are less susceptible to depth inversion illusions (DIIs) in which concave objects appear as convex. It remains unclear, however, the extent to which this perceptual advantage uniquely characterizes the schizophrenia phenotype. To address the foregoing, we compared 30 bipolar disorder patients to a previously published sample of healthy controls (N=25) and schizophrenia patients (N=30). The task in all cases was to judge the apparent convexity of physically concave faces and scenes. Half of the concave objects were painted with realistic texture to enhance the convexity illusion and the remaining objects were untextured to reduce the illusion. Subjects viewed objects stereoscopically or via monocular motion parallax depth cues. For each group, DIIs were stronger with texture than without, and weaker with stereoscopic information than without, indicating a uniformly normal response to stimulus alterations across groups. Bipolar patients experienced DIIs more frequently than schizophrenia patients but as commonly as controls, irrespective of the face/scene category, texture, or viewing condition (motion/stereo). More severe positive and disorganized symptoms predicted reduced DIIs for schizophrenia patients and across all patients. These results suggest that people with schizophrenia, but not bipolar disorder, more accurately perceive object depth structure. Psychotic symptoms-or their accompanying neural dysfunction-may primarily drive the effect presumably through eroding the visual system's generalized tendency to construe unusual or ambiguous surfaces as convex. Because such symptoms are by definition more common in schizophrenia, DIIs are at once state-sensitive and diagnostically specific, offering a potential biomarker for the presence of acute psychosis.
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Affiliation(s)
- Brian P. Keane
- University Behavioral Health Care, Rutgers University, Piscataway, NJ 08854, USA,Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA,Center for Cognitive Science, Rutgers University, Piscataway, NJ 08854, USA,Corresponding author at: Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA. (B.P. Keane)
| | - Steven M. Silverstein
- University Behavioral Health Care, Rutgers University, Piscataway, NJ 08854, USA,Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA
| | - Yushi Wang
- University Behavioral Health Care, Rutgers University, Piscataway, NJ 08854, USA
| | - Matthew W. Roché
- University Behavioral Health Care, Rutgers University, Piscataway, NJ 08854, USA
| | - Thomas V. Papathomas
- Center for Cognitive Science, Rutgers University, Piscataway, NJ 08854, USA,Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
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44
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Levin JB, Krivenko A, Howland M, Schlachet R, Sajatovic M. Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review. CNS Drugs 2016; 30:819-35. [PMID: 27435356 DOI: 10.1007/s40263-016-0368-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical.
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Affiliation(s)
- Jennifer B Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA. .,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA.
| | - Anna Krivenko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Psychology, Cleveland State University, 2300 Chester Avenue, Cleveland, OH, 44115, USA
| | - Molly Howland
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rebecca Schlachet
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA.,Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
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45
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Pratt SI, Sargent J, Daniels L, Santos MM, Brunette M. Appeal of electronic cigarettes in smokers with serious mental illness. Addict Behav 2016; 59:30-4. [PMID: 27043170 DOI: 10.1016/j.addbeh.2016.03.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Up to 75% of people with serious mental illness (SMI) smoke, and most are highly dependent on nicotine, consuming more cigarettes per day than smokers without mental illness. Even with evidence-based treatment, relapses are common, resulting in high morbidity and early mortality from tobacco-related diseases. Electronic cigarettes (e-cigarettes) are theoretically safer because they deliver no tar or carbon monoxide; however, their appeal is largely untested in people with SMI. METHODS We enrolled 21 chronic smokers with SMI who had failed a quit attempt and were not engaged in cessation treatment. Research staff provided e-cigarettes and instructions on how to use them, and assessed participants weekly for 4weeks. RESULTS Of the enrolled participants, 19 completed weekly assessments. From baseline to the final study visit, mean self-reported use of combustible tobacco declined from 192 to 67cigarettes/week (t=3.62, df=17, p=0.005), confirmed by reduction in breath carbon monoxide from 27ppm to 15ppm (t=3.246, df=18, p=0.004). Use of e-cigarettes did not escalate over the 4weeks. Temporary and mild side effects, including dry/sore throat, nausea, dizziness, and cough, were reported by 58% of participants. End of trial ratings of enjoyment, satisfaction compared to regular cigarettes, and willingness to buy e-cigarettes were high (ranging from 3.82-4.51 on a 5-point scale). CONCLUSIONS Results of this study suggest that people with SMI may find e-cigarettes an appealing substitute for combustible cigarettes. We found no evidence of increasing nicotine dependence. Further randomized studies are needed to better assess e-cigarette appeal and toxicity.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
| | - James Sargent
- Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Luke Daniels
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Meghan M Santos
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Mary Brunette
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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46
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Fabrazzo M, Monteleone P, Prisco V, Perris F, Catapano F, Tortorella A, Monteleone AM, Steardo L, Maj M. Olanzapine Is Faster than Haloperidol in Inducing Metabolic Abnormalities in Schizophrenic and Bipolar Patients. Neuropsychobiology 2016; 72:29-36. [PMID: 26337616 DOI: 10.1159/000437430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 07/06/2015] [Indexed: 11/19/2022]
Abstract
The effects of olanzapine and haloperidol on metabolic parameters in bipolar patients have been evaluated much less comprehensively than in schizophrenic patients. Therefore, in this study, medical records of 343 schizophrenic and bipolar patients treated with haloperidol or olanzapine for 1 year were retrospectively reviewed and metabolic outcomes were evaluated. After 12 months of follow-up, 25.9% of patients showed ≥3 metabolic abnormalities with a point prevalence of 27.2% in the bipolar and 24.9% in the schizophrenic group: 22.0% of the schizophrenic patients treated with haloperidol and 29.8% of those treated with olanzapine achieved ≥3 metabolic alterations; in bipolar patients, these percentages were 15.8% of those treated with haloperidol and 37.8% of those treated with olanzapine (p < 0.0001). Significant changes were reported over time in fasting glucose, triglycerides and cholesterol blood levels, systolic and diastolic blood pressure, body weight, and BMI. Overall, a significant number of schizophrenic and bipolar patients treated with olanzapine showed ≥3 metabolic alterations in the first month of treatment when compared to those treated with haloperidol. Moreover, the number of olanzapine-treated patients developing metabolic changes in the first month was significantly higher in both diagnostic groups when compared to those who reached metabolic abnormal values in the subsequent 11 months. These data suggest that both antipsychotics could increase the metabolic risk in schizophrenic and bipolar patients with a higher prevalence in olanzapine-treated patients. On the other hand, olanzapine-treated patients seem to achieve metabolic abnormalities faster than haloperidol-treated subjects in both diagnostic groups.
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47
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Abstract
Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for stroke patients at high risk of suicide. We performed a careful search to identify articles and book chapters focused on this issue, selecting only English-language articles published from 1990 to 2014 that addressed the issue of suicide after stroke and its pharmacological management. We found 12 clinical trials that explored the relationship between stroke and suicidal ideation and/or suicidal plans and 11 investigating suicide as the cause of death after stroke. We identified stroke as a significant risk factor for both suicide and suicidal ideation, especially among younger adult depressed patients in all articles, providing further support for the association between post-stroke and suicidality. Suicide risk is particularly high in the first 5 years following stroke. Depression, previous mood disorder, prior history of stroke, and cognitive impairment were found to be the most important risk factors for suicide. Selective serotonin reuptake inhibitors (SSRIs) represent the treatment of choice for stroke survivors with suicide risk, and studies in rats have suggested that carbolithium is a promising treatment in these patients. Early identification and treatment of post-stroke depression may significantly reduce suicide risk in stroke patients.
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Levin JB, Aebi ME, Tatsuoka C, Cassidy KA, Sajatovic M. Adherence to Psychotropic and Nonpsychotropic Medication Among Patients With Bipolar Disorder and General Medical Conditions. Psychiatr Serv 2016; 67:342-5. [PMID: 26695494 PMCID: PMC4934383 DOI: 10.1176/appi.ps.201500010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study assessed the relationship between nonadherence to psychotropic and nonpsychotropic medications for 88 patients nonadherent to medication treatment for bipolar disorder. METHODS This descriptive study was part of a clinical trial promoting medication adherence. Nonadherence was defined as ≥ 20% of days with missed doses. RESULTS A majority of the sample was female and had type I bipolar disorder; 49% had hypertension, 39% had hyperlipidemia, and 69% smoked; average body mass index was 34, and 65% were obese. The median proportion of days with missed doses was 53.6% (interquartile ratio [IQR]=38.10%-73.40%) for psychotropic medications and 33.93% (IQR=13.81%-51.91%) for nonpsychotropic medications. There was a significant difference between nonadherence to psychotropic and nonpsychotropic medication for the past week (z=-4.11, p<.001) and past month (z=-4.19, p<.001). More global psychopathology was associated with nonpsychotropic nonadherence. CONCLUSIONS Psychotropic adherence was worse than nonpsychotropic adherence, yet both were poor. Improving adherence to cardiovascular medications is a reasonable pathway to improve cardiovascular health in this population.
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Affiliation(s)
- Jennifer B Levin
- Dr. Levin and Dr. Sajatovic are with the Department of Psychiatry and Dr. Tatsuoka is with the Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio (e-mail: ). Dr. Levin, Dr. Tatsuoka, and Dr. Sajatovic are also with the Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, where Ms. Aebi and Ms. Cassidy are with the Department of Psychiatry
| | - Michelle E Aebi
- Dr. Levin and Dr. Sajatovic are with the Department of Psychiatry and Dr. Tatsuoka is with the Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio (e-mail: ). Dr. Levin, Dr. Tatsuoka, and Dr. Sajatovic are also with the Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, where Ms. Aebi and Ms. Cassidy are with the Department of Psychiatry
| | - Curtis Tatsuoka
- Dr. Levin and Dr. Sajatovic are with the Department of Psychiatry and Dr. Tatsuoka is with the Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio (e-mail: ). Dr. Levin, Dr. Tatsuoka, and Dr. Sajatovic are also with the Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, where Ms. Aebi and Ms. Cassidy are with the Department of Psychiatry
| | - Kristin A Cassidy
- Dr. Levin and Dr. Sajatovic are with the Department of Psychiatry and Dr. Tatsuoka is with the Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio (e-mail: ). Dr. Levin, Dr. Tatsuoka, and Dr. Sajatovic are also with the Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, where Ms. Aebi and Ms. Cassidy are with the Department of Psychiatry
| | - Martha Sajatovic
- Dr. Levin and Dr. Sajatovic are with the Department of Psychiatry and Dr. Tatsuoka is with the Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio (e-mail: ). Dr. Levin, Dr. Tatsuoka, and Dr. Sajatovic are also with the Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, where Ms. Aebi and Ms. Cassidy are with the Department of Psychiatry
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49
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Leopold K, Reif A, Haack S, Bauer M, Bury D, Löffler A, Kittel-Schneider S, Pfeiffer S, Sauer C, Schwarz P, Pfennig A. Type 2 diabetes and pre-diabetic abnormalities in patients with bipolar disorders. J Affect Disord 2016; 189:240-5. [PMID: 26451510 DOI: 10.1016/j.jad.2015.09.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 08/17/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormalities in the glucose metabolism cause nervous and organic damage and are a cardiovascular risk factor. They could be a main cause for the increased morbidity and mortality rates found in patients with bipolar disorders. The exact prevalence of diabetes and pre-diabetic abnormalities, however, is not clear. METHODS 85 euthymic outpatients with bipolar disorders from two university hospitals in Germany underwent an oral glucose tolerance test, laboratory screening and clinical measurements. Socio-demographic data, medication, severity of illness, global functioning and life quality were assessed. RESULTS Diabetes mellitus was found in 7% of the patients, pre-diabetic abnormalities in 27%. The group of patients with abnormalities in the glucose metabolism had significantly lower quality of life and global functioning. Higher BMI, leptin, triglycerides and CRP levels significantly increased the likelihood for pre-diabetes/diabetes. LIMITATIONS The low sample size did only allow limited assessment of impact of medication on the results. No healthy controls were assessed. CONCLUSIONS One-third of the patients with bipolar disorders showed abnormalities in the glucose metabolism and this was associated with impaired global functioning and lower quality of life. Early detection and intervention strategies fitting the needs of patient with bipolar disorder are needed to improve both physical and mental health.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt/Main, Germany
| | - Sarah Haack
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Daniel Bury
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Germany
| | - Antje Löffler
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt/Main, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Peter Schwarz
- Department of Internal Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany.
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50
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Quintana DS, Westlye LT, Kaufmann T, Rustan ØG, Brandt CL, Haatveit B, Steen NE, Andreassen OA. Reduced heart rate variability in schizophrenia and bipolar disorder compared to healthy controls. Acta Psychiatr Scand 2016; 133:44-52. [PMID: 26371411 DOI: 10.1111/acps.12498] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite current diagnostic systems distinguishing schizophrenia (SZ) and bipolar disorder (BD) as separate diseases, emerging evidence suggests they share a number of clinical and epidemiological features, such as increased cardiovascular disease (CVD) risk. It is not well understood if poor cardiac autonomic nervous system regulation, which can be indexed non-invasively by the calculation of heart rate variability (HRV), contributes to these common CVD risk factors in both diseases. METHOD We calculated HRV in 47 patients with SZ, 33 patients with BD and 212 healthy controls. Measures of symptom severity were also collected from the patient groups. RESULTS Heart rate variability was significantly reduced in both these disorders in comparison with the healthy participants; however, there were no HRV differences between disorders. Importantly, these reductions were independent of the medication, age or body mass index effects. There was also preliminary evidence that patients with reduced HRV had increased overall and negative psychosis symptom severity regardless of SZ or BD diagnosis. CONCLUSION We suggest that HRV may provide a possible biomarker of CVD risk and symptom severity in severe mental illness. Thus, our results highlight the importance of cardiometabolic screening across SZ and bipolar spectrum disorders.
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Affiliation(s)
- D S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - L T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - T Kaufmann
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Ø G Rustan
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - C L Brandt
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - B Haatveit
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - N E Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway.,Drammen Outpatient Clinic, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, Oslo, Norway
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