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Takami Lageborn C, Zhou M, Boman M, Sjölander A, Larsson H, D'Onofrio BM, Pettersson E, Lichtenstein P, Landén M. Childhood and adolescence outcomes in offspring to parents with bipolar disorder: the impact of lifetime parental comorbidity, parental sex, and bipolar subtype. J Child Psychol Psychiatry 2024. [PMID: 38527491 DOI: 10.1111/jcpp.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Offspring of parents with bipolar disorder have increased risks of their own psychopathology. However, a large-scale survey of psychiatric, somatic, and adverse social outcomes up to adulthood, which could aid in prioritizing and tailoring prevention, is lacking. It also remains to clarify how risks are modified by other parental factors. METHODS Swedish population registers were linked to compare offspring having (N = 24,788) and not having (N = 247,880) a parent with bipolar disorder with respect to psychiatric diagnoses and psychotropic medication, birth-related and somatic conditions, social outcomes, accidents, suicide attempts, and mortality. Individuals were followed until age 18. We estimated the influence of lifetime parental psychiatric comorbidity, bipolar disorder subtype, and sex on outcomes. RESULTS Children of parents with bipolar disorder had 2-3 times higher risks of all psychiatric diagnoses, except for bipolar disorder, for which the risk was 11-fold. Significantly increased risks were also found for several somatic conditions, low school grades, criminal behavior, victimization, accidents, and suicidal behavior. Adjusting for lifetime parental psychiatric comorbidity attenuated most associations. Offspring of a parent with bipolar disorder type 2 had statistically significantly higher risks of attention deficit hyperactivity disorder, respiratory tract conditions, and accidents compared with offspring of a parent with bipolar disorder type 1. Offspring of mothers with bipolar disorder had higher risks of several psychiatric diagnoses, respiratory tract conditions, low school grades, and accidents compared with offspring of fathers with bipolar disorder. Having two parents with bipolar disorder entailed the highest risks of psychiatric outcomes in offspring. CONCLUSIONS Early intervention and family support are particularly warranted for the offspring of a parent with bipolar disorder in the presence of lifetime parental psychiatric comorbidity, when the parent has bipolar disorder type 2, or when the mother or both parents have bipolar disorder.
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Affiliation(s)
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Coello K, Mäkinen IJO, Kjærstad HL, Faurholt-Jepsen M, Miskowiak KW, Poulsen HE, Vinberg M, Kessing LV. Oxidation of DNA and RNA in young patients with newly diagnosed bipolar disorder and relatives. Transl Psychiatry 2024; 14:81. [PMID: 38331875 PMCID: PMC10853262 DOI: 10.1038/s41398-024-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Excessive oxidative stress-generated nucleoside damage seems to play a key role in bipolar disorder (BD) and may present a trait phenomenon associated with familial risk and is one of the putative mechanisms explaining accelerated atherosclerosis and premature cardiovascular diseases (CVD) in younger patients with BD. However, oxidative stress-generated nucleoside damage has not been studied in young BD patients and their unaffected relatives (UR). Therefore, we compared oxidative stress-generated damage to DNA and RNA in young patients newly diagnosed with BD, UR, and healthy control individuals (HC). Systemic oxidative stress-generated DNA and RNA damage levels were compared by analyzing urinary levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine and 8-oxo-7,8-dihydroguanosine in participants aged 15-25 years, including 133 patients newly diagnosed with BD, 57 UR, and 83 HC. Compared with HC, damage to DNA was 21.8% higher in BD patients (B = 1.218, 95% CI = 1.111-1.335, p = <0.001) and 22.5% higher in UR (B = 1.225, 95% CI = 1.090-1.377, p = <0.002), while damage to RNA was 14.8% higher in BD patients (B = 1.148, 95% CI = 1.082-1.219, p = <0.001) and 14.0% higher in UR (B = 1.140, 95% CI = 1.055-1.230, p = < 0.001) in models adjusted for sex and age after correction for multiple comparison. Levels did not differ between patients with BD and UR. Our findings support higher oxidative stress-generated nucleoside damage being a trait phenomenon in BD associated with familial risk and highlight the importance of early diagnosis and treatment to prevent illness progression and development of premature CVD.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark.
| | - Ilari Jaakko Olavi Mäkinen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital North Zealand Hillerød, Hillerød, Denmark
- Research Unit, Copenhagen University Hospital North Zealand Hillerød, Hillerød, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Abstract
OBJECTIVES Paediatric bipolar disorder - bipolar disorder occurring in prepubertal children - is a diagnosis subject to considerable controversy. Whilst historically considered to be very rare, proponents since the 1990s have argued that mania can present differently in children and, as such, is much more common than previously thought. Such proposals raise questions about the validity of proposed phenotypes and potential risks of iatrogenic harm. METHODS I critically examine the construct of paediatric bipolar disorder using Robins and Guze's (1970, American Journal of Psychiatry126, 983-987) influential criteria for the validity of a psychiatric diagnosis. I review, in turn, evidence relating to its clinical description, delimitation from other conditions, follow-up studies, family studies, laboratory studies, and treatment response. RESULTS Across domains, existing research highlights significant challenges establishing the diagnosis. This includes significant heterogeneity in operationalising criteria for children; variable or poor inter-rater reliability; difficulty distinguishing paediatric bipolar disorder from other conditions; large differences in rates of diagnosis between the United States of America and other countries; limited evidence of continuity with adult forms; and a lack of evidence for proposed paediatric phenotypes in children at genetic high-risk of the condition. Laboratory and treatment studies are limited, but also do not provide support for the construct. CONCLUSIONS Evidence for the more widespread existence of paediatric bipolar disorder and its various proposed phenotypes remains weak. The ongoing popularity of the diagnosis, most evident in America, may reflect social pressures and broader limitations in psychiatric nosology. The uncertainty around the diagnosis highlights the need for careful longitudinal assessment of children potentially affected.
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4
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Bäckström B, Rask O, Knutsson J. Adolescent and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorders: An Open Trial and Individual Trajectories Study in Routine Psychiatric Care. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01504-1. [PMID: 36849847 DOI: 10.1007/s10578-023-01504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/01/2023]
Abstract
Psychosocial treatments improve outcome in Pediatric bipolar disorder (PBD), but few are developed specifically for adolescents and none has been evaluated in Europe. This study evaluates family-focused cognitive-behavioral therapy for adolescents (ages 13-18) with PBD in routine psychiatric care in Sweden, adapted for teenagers in a European setting from the Child and Family-Focused Cognitive Behavioral Therapy for PBD (ages 8-12) developed in the US. In a repeated-measure open trial, psychosocial functioning, depression, skills and knowledge about PBD, and family climate were assessed at pre-treatment, post-treatment, and after 6 months. Assessments were made by adolescents (n = 45), parents (n = 61) and clinicians. Both group statistics and individual trajectories are reported. Psychosocial function, as rated by parents and clinicians, improved at post-treatment, and parents reported less mania and improved family climate at post-treatment. Both parents and adolescents reported improved skills and knowledge. Most results after treatment showed medium effect sizes. Significant improvements were seen in most individual trajectories, however no change and even deterioration was observed in some. The present trial shows that AFF-CBT is well accepted and associated with improved psychosocial function in adolescents and improved skills and knowledge about PBD in adolescents and their parents. Regarding mood symptoms and family climate the results showed more individual variability, indicating that adjustments in delivery of the treatment according to the unique patient could be of importance. AFF-CBT seems to be a valuable addition to pharmacological treatments in PBD.
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Affiliation(s)
- Beata Bäckström
- Department of Psychosis and Bipolar Disorders, Clinic for Child and Adolescent Psychiatry, Skane University Hospital, Region Skane, Lovisastigen 13, 22185, Lund, Sweden.
| | - Olof Rask
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Jens Knutsson
- Department of Psychology, Lund University, Lund, Sweden
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5
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Sher L. Testosterone and Suicidal Behavior in Bipolar Disorder. Int J Environ Res Public Health 2023; 20:2502. [PMID: 36767867 PMCID: PMC9915214 DOI: 10.3390/ijerph20032502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Bipolar disorder is associated with suicidal behavior. The risk of suicide for individuals with bipolar disorder is up to 20-30 times larger than that of the general population. Considerable evidence suggests that testosterone may play a role in the pathophysiology of suicidal behavior in both men and women with bipolar disorder and other psychiatric conditions. Testosterone has complex effects on psychological traits. It affects mood and behavior, including interactions with other people. Testosterone regulates pro-active and re-active aspects of aggression. Probably, both high and low levels of testosterone may contribute to the neurobiology of suicide in various patient populations. The effects of endogenous and exogenous testosterone on suicidality in patients with bipolar disorder need further investigation. The aim of this commentary article is to provide a commentary on the author's work on the topic, summarize the literature on testosterone, bipolar disorder, and suicide, and encourage future research on this poorly studied topic.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; ; Tel.: +1-718-584-9000
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
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6
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McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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Affiliation(s)
- Roger S. McIntyre
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada,Department of PharmacologyUniversity of TorontoTorontoONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Ross J. Baldessarini
- Harvard Medical SchoolBostonMAUSA,International Consortium for Bipolar & Psychotic Disorders ResearchMcLean HospitalBelmontMAUSA,Mailman Research CenterMcLean HospitalBelmontMAUSA
| | - Michael Bauer
- University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of MedicineDeakin UniversityGeelongVICAustralia,Orygen, National Centre of Excellence in Youth Mental HealthCentre for Youth Mental Health, University of MelbourneMelbourneVICAustralia
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | | | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Heinz Grunze
- Allgemeinpsychiatrie OstKlinikum am WeissenhofWeinsbergGermany,Paracelsus Medical Private University NurembergNurembergGermany
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research CenterPsychiatric Center CopenhagenCopenhagenDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - David J. Miklowitz
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los Angeles (UCLA) Semel InstituteLos AngelesCAUSA
| | - Gordon Parker
- School of PsychiatryUniversity of New South WalesSydneyNSWAustralia
| | - Robert M. Post
- School of Medicine & Health SciencesGeorge Washington UniversityWashingtonDCUSA,Bipolar Collaborative NetworkBethesdaMDUSA
| | - Alan C. Swann
- Department of PsychiatryBaylor College of MedicineHoustonTXUSA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural SciencesStanford School of Medicine and VA Palo Alto Health Care SystemPalo AltoCAUSA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamUK
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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7
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Barton J, Mio M, Timmins V, Mitchell RHB, Goldstein BI. Prevalence and correlates of childhood-onset bipolar disorder among adolescents. Early Interv Psychiatry 2022; 17:385-393. [PMID: 35702036 DOI: 10.1111/eip.13335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/06/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
AIM Early-onset bipolar disorder (BD) is associated with a more severe illness as well as a number of clinical factors among adults. Early-onset can be categorized as childhood- (age < 13) or adolescent- (age ≥ 13) onset, with the two displaying different clinical profiles. We set out to examine differences in clinical, and familial characteristics among adolescents with childhood- versus adolescent-onset BD. METHODS The study included 195 adolescents with BD, ages 14-18 years. Age of onset was determined retrospectively by self-report. Participants completed the semi-structured K-SADS-PL diagnostic interviews along with self-reported dimensional scales. Analyses examined between-group differences for clinical and familial variables. Variables associated with age of onset at p < 0.1 in univariate analyses were evaluated in a logistic regression model. RESULTS Approximately one-fifth of participants had childhood-onset BD (n = 35; 17.9%). A number of clinical and familial factors were significantly associated with childhood-onset BD. However, there were no significant differences in depressive and manic symptom severity. In multivariate analyses, the variables most strongly associated with childhood-onset were police contact, and family history of suicidal ideation. Smoking and psychiatric hospitalization were associated with adolescent-onset. CONCLUSIONS In this large clinical sample of adolescents with BD, one-fifth reported childhood-onset BD. Correlates of childhood-onset generally aligned with those observed in the literature. Future research is warranted to better understand the genetic and environmental implications of high familial loading of psychopathology associated with childhood-onset, and to integrate age-related treatment and prevention strategies.
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Affiliation(s)
- Jessica Barton
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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8
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Post RM, Leverich GS, McElroy SL, Kupka R, Suppes T, Altshuler LL, Nolen WA, Frye MA, Keck PE, Grunze H, Rowe M. Are personality disorders in bipolar patients more frequent in the US than Europe? Eur Neuropsychopharmacol 2022; 58:47-54. [PMID: 35227977 DOI: 10.1016/j.euroneuro.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Bipolar patients in the United States (US) compared to those from the Netherlands and Germany (here abbrev. as "Europe") have more Axis I comorbidities and more poor prognosis factors such as early onset and psychosocial adversity in childhood. We wished to examine whether these differences also extended to Axis II personality disorders (PDs). METHODS 793 outpatients with bipolar disorder diagnosed by SCID gave informed consent for participating in a prospective longitudinal follow up study with clinician ratings at each visit. They completed detailed patient questionnaires and a 99 item personality disorder inventory (PDQ-4). US versus European differences in PDs were examined in univariate analyses and then logistic regressions, controlling for severity of depression, age, gender, and other poor prognosis factors. RESULTS In the univariate analysis, 7 PDs were more prevalent in the US than in Europe, including antisocial, avoidant, borderline, depressive, histrionic, obsessive compulsive, and schizoid PDs. In the multivariate analysis, the last 4 of these PDs remained independently greater in the US than Europe. CONCLUSIONS Although limited by use of self report and other potentially confounding factors, multiple PDs were more prevalent in the US than in Europe, but these preliminary findings need to be confirmed using other methodologies. Other poor prognosis factors are prevalent in the US, including early age of onset, more childhood adversity, anxiety and substance abuse comorbidity, and more episodes and rapid cycling. The interactions among these variables in relationship to the more adverse course of illness in the US than in Europe require further study.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Chevy Chase, MD, United States.
| | | | - Susan L McElroy
- Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - Ralph Kupka
- VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Trisha Suppes
- 11 Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and V.A. Palo Alto Health Care System Palo Alto, CA V.A, United States
| | - Lori L Altshuler
- UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, United States
| | - Willem A Nolen
- Universitair Medisch Centrum Groningen (UMCG), Groningen, the Netherlands
| | - Mark A Frye
- Professor of Psychiatry, Mayo Clinic, Rochester, MI, United States
| | - Paul E Keck
- Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States; Professor of Psychiatry & Neuroscience, University of Cincinnati College of Medicine Cincinnati, OH, President-CEO Lindner Center of HOPE Mason, OH, United States
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall & Paracelsus Medical University Nuremberg, Germany
| | - Michael Rowe
- Biostatistician Bipolar Collaborative Network, Chevy Chase, MD, United States
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9
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Amini A, Aghabozorg Afjeh SS, Boshehri B, Hamednia S, Mashayekhi P, Omrani MD. The Relationship between rs534654 Polymorphism in TMEM165 Gene and Increased Risk of Bipolar Disorder Type 1. Int J Mol Cell Med 2021; 10:162-165. [PMID: 34703799 PMCID: PMC8496248 DOI: 10.22088/ijmcm.bums.10.2.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
Bipolar disorder (BD) is a major health care concern worldwide. There are some reports showing an association between genes and their variants involved in circadian rhythm; clock and clock related genes function and development of BD in patients. Therefore, the aim of this study was to investigate the possible association of rs534654 variant on TMEM165 (transmembrane protein 165) gene with the risk of BD. Genotyping of the rs534654 was carried out using the tetra primers- amplification refractory mutation system-PCR (4P-ARMS-PCR) method in 203 patients with BD type 1 and their healthy and normal counterpart. The frequency of the G and A alleles of rs534654 polymorphism was 53% and 47%, respectively in patients. Genotype frequency in patients in comparison with control subjects was 5.4% vs 2.5% for the AA homozygous; 11.3% vs 80.8% for the GG homozygous; and 83.3% vs 16.7% for the heterozygous AG. Statistical analysis showed a significant difference in frequencies between the control and patient groups (P = 0.001). Based on this finding, it is possible to conclude that the impairment in the rs534654 single nucleotide polymorphism in TMEM165 gene is associated with the risk of BD development.
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Affiliation(s)
| | | | - Behzad Boshehri
- Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
| | - Safar Hamednia
- Department of Psychiatry, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Mir Davood Omrani
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Post RM, Grunze H. The Challenges of Children with Bipolar Disorder. Medicina (Kaunas) 2021; 57:medicina57060601. [PMID: 34207966 PMCID: PMC8230664 DOI: 10.3390/medicina57060601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023]
Abstract
Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.
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Affiliation(s)
- Robert M. Post
- School of Medicine, George Washington University, Washington, DC 20052, USA
- Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA
- Correspondence:
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Campus ZfPG, 74523 Schwäbisch Hall, Germany;
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
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11
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Abstract
OBJECTIVE Bipolar disorder (BD) is a chronic mental health disorder with significant morbidity and mortality. Age at onset (AAO) may be a key variable in delineating more homogeneous subgroups of BD patients. However, no known research has systematically assessed how BD age-at-onset subgroups should be defined. METHODS We systematically searched the following databases: Cochrane Central Register of Controlled Trials, PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Proquest Dissertations and Theses, Google Scholar and BIOSIS Previews. Original quantitative English language studies investigating AAO in BD were sought. RESULTS A total of 9454 unique publications were identified. Twenty-one of these were included in data analysis (n = 22981 BD participants). Fourteen of these studies (67%, n = 13626 participants) found a trimodal AAO distribution: early-onset (µ = 17.3, σ = 1.19, 45% of sample), mid-onset (µ = 26.0, σ = 1.72, 35%), and late-onset (µ = 41.9, σ = 6.16, 20%). Five studies (24%, n = 1422 participants) described a bimodal AAO distribution: early-onset (µ = 24.3, σ = 6.57, 66% of sample) and late-onset (µ = 46.3, σ = 14.15, 34%). Two studies investigated cohort effects on BD AAO and found that when the sample was not split by cohort, a trimodal AAO was the winning model, but when separated by cohort a bimodal distribution fit the data better. CONCLUSIONS We propose that the field conceptualises bipolar disorder age-at-onset subgroups as referring broadly to life stages. Demarcating BD AAO groups can inform treatment and provide a framework for future research to continue to investigate potential mechanisms of disease onset.
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Affiliation(s)
- Sorcha Bolton
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK
| | - Jeremy Warner
- University of Oxford Medical SchoolJohn Radcliffe HospitalOxfordUK
| | - Eli Harriss
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - John Geddes
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - Kate E. A. Saunders
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
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12
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Sandstrom A, Perroud N, Alda M, Uher R, Pavlova B. Prevalence of attention-deficit/hyperactivity disorder in people with mood disorders: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:380-391. [PMID: 33528847 DOI: 10.1111/acps.13283] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) in mood disorders is associated with unfavorable outcomes, including more frequent mood episodes, and increased risk of suicide. The reported prevalence of ADHD in individuals with mood disorders varies widely. METHODS We searched PsycInfo and PubMed for articles published before September 21st , 2020, using search terms for ADHD and mood disorders. We included original data on the prevalence of ADHD in individuals with bipolar disorder (BD) or major depressive disorder (MDD). We estimated the prevalence of ADHD, by developmental period and disorder using random-effects meta-analyses. We also compared the rate of ADHD in people with MDD and BD, and with and without mood disorders. RESULTS Based on 92 studies including 17089 individuals, prevalence of ADHD in BD is 73% (95% CI 66-79) in childhood, 43% (95% CI 35-50) in adolescence, and 17% (95% CI 14-20) in adulthood. Data from 52 studies with 16897 individuals indicated that prevalence of ADHD in MDD is 28% (95% CI 19-39) in childhood, 17% (95% CI 12-24) in adolescence, and 7% (95% CI 4-11) in adulthood. ADHD was three times more common in people with mood disorders compared to those without and 1.7 times more common in BD compared to MDD. CONCLUSION People with mood disorders are at a significant risk for ADHD. ADHD should be assessed and treated in individuals with BD and MDD. Comprehensive assessment strategies are needed to address challenges of diagnosing ADHD alongside mood disorders.
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Affiliation(s)
- Andrea Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Nader Perroud
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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13
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Grunze H, Suppes T, Keck PE, Nolen WA. 25 Years of the International Bipolar Collaborative Network (BCN). Int J Bipolar Disord 2021; 9:13. [PMID: 33811284 PMCID: PMC8019011 DOI: 10.1186/s40345-020-00218-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Stanley Foundation Bipolar Treatment Outcome Network (SFBN) recruited more than 900 outpatients from 1995 to 2002 from 4 sites in the United States (US) and 3 in the Netherlands and Germany (abbreviated as Europe). When funding was discontinued, the international group of investigators continued to work together as the Bipolar Collaborative Network (BCN), publishing so far 87 peer-reviewed manuscripts. On the 25th year anniversary of its founding, publication of a brief summary of some of the major findings appeared appropriate. Important insights into the course and treatment of adult outpatients with bipolar disorder were revealed and some methodological issues and lessons learned will be discussed. RESULTS The illness is recurrent and pernicious and difficult to bring to a long-term remission. Virtually all aspects of the illness were more prevalent in the US compared to Europe. This included vastly more patients with early onset illness and those with more psychosocial adversity in childhood; more genetic vulnerability; more anxiety and substance abuse comorbidity; more episodes and rapid cycling; and more treatment non-responsiveness. CONCLUSIONS The findings provide a road map for a new round of much needed clinical treatment research studies. They also emphasize the need for the formation of a new network focusing on child and youth onset of mood disorders with a goal to achieve early precision diagnostics for intervention and prevention in attempting to make the course of bipolar illness more benign.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, 5415 W Cedar Lane, Ste 201-B, Bethesda, 20814, MD, USA.
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA.
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Ralph Kupka
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry& Psychology, Mayo Clinic, Rochester, MN, USA
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall GmbH & Paracelsus Medical University, Nuremberg, Germany.
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paul E Keck
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Lindner Center of HOPE, Mason, OH, USA
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
INTRODUCTION Few animal models address the characteristics of the longitudinal course of bipolar disorder. However, behavioral sensitization (to recurrent stressors and psychomotor stimulants) and kindling of seizures both provide clues to mechanisms in the progressive course of bipolar disorder. METHODS We describe aspects of bipolar illness that show sensitization and kindling-like increases reactivity to the recurrence of stressors, mood episodes, and bouts of substance abuse. Mechanisms of these events and clinical implications for treatment are discussed. RESULTS Early life stress is a risk factor for the development of episodes of unipolar depression and bipolar disorder and the acquisition of substance abuse. Initial affective episodes are often triggered by the recurrence of psychosocial stressors in adulthood, but after many episodes have occurred, episodes may also begin to emerge spontaneously in a kindling-like progression. More prior episodes are associated with faster recurrences, dysfunction, disability, frontal cortical abnormalities, cognitive impairment, shorter telomeres, treatment refractoriness, and an increased risk of a diagnosis of dementia in old age. Sensitization to stressors, episodes, and substances of abuse each appear driven by epigenetic mechanisms and their accumulation on DNA, histones, and microRNA. Patients with bipolar illness in the USA are more ill than those from Europe and experience more sensitization to stressors, episodes, substance abuse, as well as more genetic vulnerability across four generations. DISCUSSION The sensitization and kindling models highlight the importance of early intervention and prevention in order to limit or halt the downhill progression of bipolar disorder and its multiple comorbidities toward treatment refractoriness. Clinical data support this conclusion as well but have not been sufficient to change practice in the direction of early intervention. It is hoped that a better understanding of sensitization and kindling-like mechanisms will add neurobiological rationales for the importance of prevention and sustained prophylactic intervention in rendering bipolar disorder a more benign illness.
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Affiliation(s)
- Robert M Post
- Clinical Professor of Psychiatry, George Washington University School of Medicine, Bipolar Collaborative Network, Bethesda, MD, USA.
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15
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Post RM. A shocking deficit in bipolar disorder treatment research funding. Bipolar Disord 2020; 22:864-865. [PMID: 32989875 DOI: 10.1111/bdi.13010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Robert M Post
- Department of Psychiatry, George Washington University School of Medicine, Bethesda, MD, USA
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16
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Post RM, Leverich GS, McElroy S, Kupka R, Suppes T, Altshuler L, Nolen W, Frye M, Keck P, Grunze H, Rowe M. Relationship of comorbid personality disorders to prospective outcome in bipolar disorder. J Affect Disord 2020; 276:147-151. [PMID: 32697693 DOI: 10.1016/j.jad.2020.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
Introduction There is a high incidence of Axis II personality disorders (PDs) in patients with bipolar illness, but their influence on the prospectively measured course of bipolar disorder has been less well explicated. Methods 392 outpatients with bipolar disorder gave informed consent, completed the PDQ4 99 item personality disorder rating, and where clinically rated during at least one year of prospective naturalistic treatment. They were classified as Well on admission (N = 64) or Responders (N = 146) or Non-responders (N = 182) to treatment for at least six months. Results Patients who were positive for PDs were very infrequently represented in the category of Well on admission. In addition, patients with borderline, depressive, and schizoid PDs were significantly more likely to be Non-responders compared to Responders upon prospective naturalistic treatment in the network. Conclusions Patients with bipolar disorder and comorbid PDs were in general less likely to be Well from treatment in the community at network entry or to be a Responder to prospective treatment in the network. Therapeutic approaches to patients with PDs deserve specific study in an attempt to achieve a better long-term course of bipolar disorder.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, United States.
| | | | - Susan McElroy
- Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Trisha Suppes
- 11 Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and V.A. Palo Alto Health Care System Palo Alto, CA, United States
| | - Lori Altshuler
- UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, United States
| | - Willem Nolen
- Universitair Medisch Centrum Groningen (UMCG), Groningen, the Netherlands
| | - Mark Frye
- Mayo Clinic, Rochester, MI, United States
| | - Paul Keck
- University of Cincinnati College of Medicine Cincinnati, Lindner Center of HOPE Mason, OH, United States
| | - Heinz Grunze
- Chefarzt, Allgemein Psychiatrie Ost am Klinikum am Weissenhof, Privat-Dozent der PMU Nürnberg, Germany
| | - Michael Rowe
- Biostatistician Bipolar Collaborative Network, Bethesda, MD, United States
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17
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Nolen WA. Double jeopardy in the United States: Early onset bipolar disorder and treatment delay. Psychiatry Res 2020; 292:113274. [PMID: 32731080 DOI: 10.1016/j.psychres.2020.113274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Evidence is emerging that early onset bipolar disorder and the duration of the delay to first treatment are both risk factors for poor treatment outcome. We report on the incidence and implications of these two risk factors in patients from the United States (US) versus Europe. METHODS Age of onset and age at first treatment for depression or mania was assessed in 967 outpatients with bipolar disorder who gave informed consent for participation and filling out a detailed questionnaire. Age at onset and treatment delay were compared in the 675 patients from the US and 292 from the Netherlands and Germany (abbreviated as Europe). Both were then graphed and analyzed. RESULTS Age of onset of bipolar disorder was earlier in the US than in Europeans by an average of 6-7 years with similar results in those with first onsets of depression or of mania. Delay to first treatment was strongly inversely related to age of onset and was twice as long in the US than in Europe, and especially different for mania in adolescents. The longer delay to treatment in the US was not solely due to earlier age of onset. CONCLUSIONS Treatment delay is a remedial risk factor and could be shortened with better recognition of the higher incidence of early onset bipolar disorder in the US, which also associated with more genetic and environmental vulnerability factors compared to Europe. New treatment and research initiatives are needed to address these liabilities so that children with bipolar achieve more positive long-term outcomes.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA.
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Ralph Kupka
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, the Netherlands
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MI, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall gmbH, & Paracelsus Medical University, Nuremberg, Germany
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Willem A Nolen
- University Medical Center, University of Groningen, Groningen, the Netherlands
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18
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Mendez I, Castro-Fornieles J, Lera-Miguel S, Picado M, Borras R, Cosi S, Valenti M, Santamarina P, Font E, Romero S. Functional Impairment and Clinical Correlates in Adolescents with Bipolar Disorder Compared to Healthy Controls. A Case-control Study. J Can Acad Child Adolesc Psychiatry 2020; 29:149-164. [PMID: 32774398 PMCID: PMC7391870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 03/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Evidence shows that most adolescents with bipolar disorder (BD) achieve syndromic recovery after being referred to specialized treatment. However, functional recovery is reached in less than 50% of those cases. METHOD Descriptive cross-sectional case-control study, based on a clinical sample of 44 BD patients aged 12-19, matched by age and sex with 44 healthy controls (HC). Psychopathology was ascertained using the KSADS-PL, in addition to the clinical scales. Information about previous academic performance was included, as well as functional outcome based on the Children's Global Assessment Functioning Scale (CGAS). Previous exposure to stressful experiences was assessed using the Schedule for Stressful Life Events (SLES). All analyses were performed using either conditional or stepwise logistic regression models. RESULTS Once they have become stabilized, and even after controlling for socio-demographic differences, BD patients were associated with lower levels of functionality [OR 0.65 (0.46, 0.93), p=0.02], and worse performance at school [OR 0.03 (0.01, 0.67), p=0.03] compared with HC. Persistent sub-syndromal psychosis showed the strongest negative correlation with functionality (rho=-0.65, -0.57 for BD and HC respectively; p<0.001). Although BD was associated with more stressful life events, this association did not remain significant in the multivariate models. LIMITATIONS The small sample size limits our ability to detect differences between groups, and between BD subtypes. CONCLUSIONS Even when early detection and intervention is provided, BD has a significant impact on functioning and academic performance. It is important to address persistent sub-threshold symptoms and to emphasize the social and rehabilitative components of treatment.
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Affiliation(s)
- Iria Mendez
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
- Institute d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERSAM, Institute Carlos III, Spain
| | - Sara Lera-Miguel
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Marisol Picado
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Roger Borras
- Institute d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sandra Cosi
- Research Center for Behavior Assessment, Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Marc Valenti
- CIBERSAM, Institute Carlos III, Spain
- Department of Adult Psychiatry and Psychology, Clínic Hospital, Barcelona, Spain
| | - Pilar Santamarina
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Elena Font
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
- CIBERSAM, Institute Carlos III, Spain
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Post RM, Rowe M, Kaplin DB, Findling R. Preliminary evaluation of the utility of parental ratings in a Child Network. Psychiatry Res 2020; 290:112908. [PMID: 32480114 DOI: 10.1016/j.psychres.2020.112908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Children in the US have a high incidence of psychiatric disorders, but the symptoms of these illnesses are often poorly recognized and treated. We thus created a Child Network for parents of children aged 2-12 to rate their child on a weekly basis on a secure website so that longitudinal ratings could be easily visualized. METHODS After giving informed consent, parents filled out: a one-time questionnaire and a 97 item Child Checklist; and then rated the severity of depression, anxiety, ADHD, oppositional behavior, and mania each week. The new Checklist ratings were correlated with the 23 previous validated in adults (the M-3), and symptom burden was compared with diagnoses received in the community. RESULTS The 23 item M-3 ratings were highly correlated with the more extensive Child Checklist. Symptom severity also corresponded to diagnoses received in the community. An example of the longitudinal weekly ratings of a child with a dysphoric mania is also presented. CONCLUSIONS The convergence of scores on the adult and child portions of the Child Checklist and the ease of visualization of symptoms and response to treatment suggest the utility of the ratings in the Child Network.
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Affiliation(s)
- Robert M Post
- Clinical Professor of Psychiatry, George Washington University School of Medicine, Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA.
| | - Michael Rowe
- Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA
| | - Dana B Kaplin
- Sr. Clinical Research Program Manager, Clinical Trials Group, Department of Radiation Oncology and Molecular Radiation Sciences, 1550 Orleans Street, CRBll, 4M53, Baltimore, MD 21287, USA
| | - Robert Findling
- Chair, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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Post RM, Goldstein BI, Birmaher B, Findling RL, Frey BN, DelBello MP, Miklowitz DJ. Toward prevention of bipolar disorder in at-risk children: Potential strategies ahead of the data. J Affect Disord 2020; 272:508-520. [PMID: 32553395 PMCID: PMC8986089 DOI: 10.1016/j.jad.2020.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/03/2020] [Accepted: 03/05/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite the well-documented negative impact of untreated bipolar illness, approaches to early intervention in childhood-onset bipolar and related disorders are not well delineated. METHODS We reviewed the extant treatment literature on children at high risk for bipolar disorder, with definitions based on family history, childhood adversity, and prodromal symptoms. RESULTS A panoply of approaches have been described, but most interventions are based on an inadequate database to support their routine implementation. We classify early stage interventions as a function of their safety and tolerability with the hope that these might generate more rigorous study and a stronger database. LIMITATIONS Critics may rightly argue that identifying viable treatment methods is premature given our lack of ability to reliably predict illness trajectory in very young children. However, many of the psychosocial and pharmacological interventions we present could have nonspecific positive effects across a variety of symptoms, syndromes, and diagnoses, further enhancing the rationale for more rigorous study. CONCLUSIONS Early stage interventions have the potential to improve functioning in prodromal illness and exert long-term positive effects on the course of illness. Many of the safest interventions deserve consideration for implementation and dissemination studies.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Professor of Psychiatry George Washington Medical School, Bethesda, MD, Washington, DC, United States.
| | - Benjamin I Goldstein
- Departments of Psychiatry and Pharmacology, University of Toronto; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Canada
| | - Boris Birmaher
- University of Pittsburgh School of Medicine, Psychiatry Research Pathway, United States
| | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Melissa P DelBello
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David J Miklowitz
- Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Dinnissen M, Dietrich A, van der Molen JH, Verhallen AM, Buiteveld Y, Jongejan S, Troost PW, Buitelaar JK, Hoekstra PJ, van den Hoofdakker BJ. Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence. Eur Child Adolesc Psychiatry 2020; 29:1717-27. [PMID: 32052173 DOI: 10.1007/s00787-020-01488-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/01/2020] [Indexed: 12/23/2022]
Abstract
Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.
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Sher L. Early-onset bipolar disorder and suicide. Asian J Psychiatr 2020; 47:101854. [PMID: 31726423 DOI: 10.1016/j.ajp.2019.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Oswalt SB, Lederer AM, Chestnut-Steich K, Day C, Halbritter A, Ortiz D. Trends in college students' mental health diagnoses and utilization of services, 2009-2015. J Am Coll Health 2020; 68:41-51. [PMID: 30355071 DOI: 10.1080/07448481.2018.1515748] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/22/2018] [Accepted: 08/18/2018] [Indexed: 05/21/2023]
Abstract
Objective: To examine changes in diagnoses/treatment for 12 mental health (MH) conditions, previous use of campus MH services, and willingness to seek MH services in the future. Participants: ACHA-NCHA II participants from 2009 to 2015 (n = 454,029). Methods: Hierarchical binary logistic regression with step 1 controlling for demographics and step 2 considering time. Results: Time was significant except for bipolar disorder, bulimia, and schizophrenia with increases for all conditions except substance abuse. Anxiety (OR = 1.68), panic attacks (OR = 1.61), and ADHD (OR = 1.40) had the highest odd ratios. Use of MH services at current institution (OR = 1.30) and willingness to utilize services in the future (OR = 1.37) also increased over time. Conclusions: Based on a national sample, self-reported diagnoses/treatment of several MH conditions are increasing among college students. This examination of a variety of MH issues can aid college health professionals to engage institutional stakeholders regarding the resources needed to support college students' MH.
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Affiliation(s)
- Sara B Oswalt
- Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, San Antonio, TX, USA
- American College Health Association Health Promotion Section Research Committee, Silver Spring, MD, USA
| | - Alyssa M Lederer
- American College Health Association Health Promotion Section Research Committee, Silver Spring, MD, USA
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Kimberly Chestnut-Steich
- American College Health Association Health Promotion Section Research Committee, Silver Spring, MD, USA
- Student Affairs, West Chester University of Pennsylvania, West Chester, PA, USA
| | - Carol Day
- American College Health Association Health Promotion Section Research Committee, Silver Spring, MD, USA
- Health Education Services, Georgetown University, Washington, DC, USA
| | - Ashlee Halbritter
- American College Health Association Health Promotion Section Research Committee, Silver Spring, MD, USA
- Campus Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Dugeidy Ortiz
- American College Health Association Health Promotion Section Research Committee, Silver Spring, MD, USA
- Wellness and Education Program, Lehman College, New York, NY, USA
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Frahm Laursen M, Valentin JB, Licht RW, Correll CU, Nielsen RE. Longitudinal outcomes in pediatric- and adult-onset bipolar patients compared to healthy and schizophrenia controls. Bipolar Disord 2019; 21:514-524. [PMID: 31069923 DOI: 10.1111/bdi.12793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Comparing outcomes of bipolar disorder (BD) with schizophrenia (SCZ) and psychiatrically healthy controls (PHC), contrasting pediatric-onset with adult-onset disorders. METHODS A nationwide cohort study, including patients with an incident diagnosis of BD or SCZ registered in the Danish National Patient Registry and corresponding PHCs. Outcomes were (a) duration of hospitalization, (b) psychiatric admissions, (c) psychiatric outpatient contacts, (d) bone-fracture-related healthcare contacts, (e) self-harm-related healthcare contacts (including suicide and non-suicidal self-injuries), and (f) criminal charges. Incidence rate ratios (IRRs), adjusted for age at first psychiatric contact, substance abuse and parental psychiatric illness, were calculated, comparing pediatric-onset BD (5-17 years) and adult-onset BD (18-39 years) with age- and sex-matched SCZ patients and PHC. RESULTS Pediatric-onset BD (n = 349) performed better than 1:1-matched pediatric-onset SCZ (n = 349) on all six outcomes (IRR = 0.30 for self-harm-related contacts (P < 0.001) to IRR = 0.86 for criminal charges (P = 0.05). Similar, but less pronounced results were observed comparing 1:1-matched adult-onset BD (n = 5515) with adult-onset SCZ (n = 5515) IRR = 0.58 for psychiatric outpatient contact (P < 0.001) to IRR = 0.93 for criminal charges (P < 0.001), except for more bone-fracture-related contacts in adult-onset BD (IRR = 1.13, P < 0.01). Comparing pediatric-onset BD (n = 365) to 1:3-matched PHC (n = 1095), only self-harm-related contacts differed significantly (IRR = 2.80, P < 0.001). Conversely, comparing adult-onset BD (n = 6005) with 1:3-matched PHC (n = 18 015), self-harm-related contacts (IRR = 16.68, P < 0.001), bone fractures (IRR = 1.74, P < 0.001), and criminal charges (IRR = 2.03, P < 0.001) were more common in BD. CONCLUSION BD was associated with poorer outcomes than PHC, but better outcomes than SCZ. Furthermore, outcomes were more favorable in pediatric-onset BD when indirectly contrasted to adult-onset BD.
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Affiliation(s)
- Mathilde Frahm Laursen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan B Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus W Licht
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christoph U Correll
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York City, New York, USA.,Hofstra Northwell School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - René E Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Research and Treatment Program for Bipolar Disorder, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
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Parry P, Allison S, Bastiampillai T. The geography of a controversial diagnosis: A bibliographic analysis of published academic perspectives on 'paediatric bipolar disorder'. Clin Child Psychol Psychiatry 2019; 24:529-545. [PMID: 30905170 DOI: 10.1177/1359104519836700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The hypothesis that bipolar disorder presents before puberty with atypical mania has proved to be controversial. Published academic perspectives on the validity of Paediatric Bipolar Disorder (PBD) appear to vary between the United States and the rest of the world. METHODS We examined the perspectives of articles citing four seminal articles. The citing articles were grouped as either supportive or non-supportive of the PBD hypothesis, and the perspectives of the articles by US authors were compared with those by non-US authors. RESULTS There were 787 citing articles commenting on PBD, mostly published in US-based journals. Most authors were affiliated with several US institutions. Among the 624 articles with US authorship, the majority (83%) supported PBD. Of the 163 articles by non-US authors, most (60%) supported the traditional view that bipolar disorders are rare before mid-adolescence. Published academic perspectives in favour of the PBD hypothesis are mostly concentrated in several US institutions. CONCLUSION There is majority support for PBD among citing articles from the United States, whereas the traditional perspective predominates in articles from most other countries.
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Affiliation(s)
- Peter Parry
- 1 School of Clinical Medicine - Children's Health Queensland Clinical Unit, University of Queensland, Australia.,2 College of Medicine and Public Health, Flinders University, Australia
| | - Stephen Allison
- 2 College of Medicine and Public Health, Flinders University, Australia
| | - Tarun Bastiampillai
- 2 College of Medicine and Public Health, Flinders University, Australia.,3 Mind and Brain Theme, South Australian Health and Medical Research Institute, Australia
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Van Meter A, Guinart D, Bashir A, Sareen A, Cornblatt BA, Auther A, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Cascio NL, Correll CU. Bipolar Prodrome Symptom Scale - Abbreviated Screen for Patients: Description and validation. J Affect Disord 2019; 249:357-365. [PMID: 30807937 DOI: 10.1016/j.jad.2019.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is no standard method for assessing symptoms of the prodrome to bipolar disorder (BD), which has limited progress toward early identification and intervention. We aimed to validate the Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P), a brief self-report derived from the validated, clinician-rated Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP), as a means to screen and identify people for whom further evaluation is indicated. METHOD Altogether, 134 participants (aged 12-18 years) were drawn from a study of the pre-syndromal stage of mood and psychotic disorders. All participants had chart diagnoses of a mood- or psychosis-spectrum disorder. Participants were interviewed with the BPSS-FP and completed measures of mania and non-mood psychopathology. Prior to being interviewed, patients completed the BPSS-AS-P. Scores on the BPSS-AS-P were determined by summing the severity and frequency ratings for each item. RESULTS BPSS-AS-P scores were highly reliable (Cronbach's alpha = 0.94) and correlated with the interview-based BPSS-FP Mania Symptom Index (r = 0.55, p < .0001). BPSS-AS-P scores had good convergent validity, correlating with the General Behavior Inventory-10M (r = 0.65, p < .0001) and Young Mania Rating Scale; r = 0.48, p < .0001). The BPSS-AS-P had good discriminant validity, not being correlated with scales measuring positive and negative symptoms of psychotic disorders (p-values = 0.072-0.667). LIMITATIONS Findings are limited by the cross-sectional nature of the study by the fact that the participants were all treatment-seeking. Future studies need to evaluate the predictive validity of the BPSS-AS-P for identifying those who develop BD in a community sample. CONCLUSION BPSS-AS-P has promise as a screening tool for people at risk for BD. Adopting the BPSS-AS-P would support the goal of characterizing the prodrome systematically in order to facilitate research and clinical care.
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Affiliation(s)
- Anna Van Meter
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Daniel Guinart
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Asjad Bashir
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Aditya Sareen
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Andrea Auther
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Ricardo E Carrión
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Maren Carbon
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain; Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark
| | - Susanne Walitza
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Miriam Gerstenberg
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Nella Lo Cascio
- Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
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Abstract
Does bipolar disorder exist in children? How common is childhood-onset bipolar disorder among adults? Are bipolar spectrum conditions relevant? Answers to these questions are key drivers of the design and interpretation of epidemiologic studies of pediatric bipolar disorder. In our commentary, we assert that Parry and colleagues have selectively attended to certain findings that support their thesis, while ignoring contradictory findings, and that they have assigned excessive meaning to relatively pedestrian methodologic limitations. Their singling out of the United States is done with criticism but without critical appraisal. We highlight the flawed logic and inferential leaps that sustain Parry et al's criticism despite contradictory information dating back over a century.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre
- Department of Psychiatry, University of Toronto Faculty of Medicine
| | - Robert M Post
- Bipolar Collaborative Network
- George Washington University School of Medicine
| | - Boris Birmaher
- Child and Adolescent Bipolar Spectrum Services, University of Pittsburgh Medical Center
- Department of Psychiatry, University of Pittsburgh School of Medicine
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Affiliation(s)
- Robert M Post
- George Washington University School of Medicine, Washington, DC.,Bipolar Collaborative Network, Bethesda, Maryland
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30
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Post RM, Leverich GS, McElroy S, Kupka R, Suppes T, Altshuler L, Nolen W, Frye M, Keck P, Grunze H, Hellemann G. Prevalence of axis II comorbidities in bipolar disorder: relationship to mood state. Bipolar Disord 2018; 20:303-312. [PMID: 29369448 DOI: 10.1111/bdi.12596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/09/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES A high incidence of Axis II personality disorders is described in patients with bipolar disorder; however, their relationship to mood state remains uncertain. METHODS A total of 966 outpatients with bipolar disorder gave informed consent and filled out the Personality Disorder Questionnaire, 4th edition (PDQ4) and a questionnaire on demographics and course of illness prior to Bipolar Treatment Outcome Network entry at average age 41 years. Patients were rated at each visit for depression on the Inventory of Depressive Symptoms-Clinician version (IDS-C) and for mania on the Young Mania Rating Scale (YMRS). In a subgroup, the PDQ4 was retaken during periods of depression and euthymia. RESULTS Patients met criteria for most personality disorders at a much higher rate when they took the PDQ4 while depressed compared to while euthymic, and scores were significantly related to the severity of depression (IDS) and of mania (YMRS) assessed within 2 weeks of taking the PDQ. Even when euthymic, more than quarter to half of the patients met criteria for a cluster A, B or C personality disorder. CONCLUSIONS A wide range of personality disorders occur in bipolar patients, but are highly dependent on filling out the form while depressed compared to while euthymic. How this relates to having a personality disorder assessed using a structured clinical interview remains to be tested. However, higher PDQ4 scores are related to an earlier age of onset of bipolar disorder and other factors portending a more difficult course of bipolar disorder, and the optimal treatment of these patients remains to be illuminated.
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Affiliation(s)
| | | | - Susan McElroy
- Linder Center of Hope, Mason, OH, USA
- Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam,, The Netherlands
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and V.A. Palo Alto Health Care System Palo Alto, Palo Alto, CA, USA
| | - Lori Altshuler
- UCLA Mood Disorders Research Program and West LA VA Medical Center, Los Angeles, CA, USA
| | - Willem Nolen
- Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands
| | - Mark Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | - Paul Keck
- Department of Psychiatry and Neuroscience, University of Cincinnati College of Medicine Cincinnati, Mason, OH, USA
- President-CEO Lindner Center of HOPE Mason, Mason, OH, USA
| | - Heinz Grunze
- Paracelsius Medical University, Salzburg, Austria
| | - Gerhard Hellemann
- Biostatistician UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, USA
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Kloosterboer SM, Schuiling-Veninga CCM, Bos JHJ, Kalverdijk LJ, Koch BCP, Dieleman GC, Hillegers MHJ, Dierckx B. Antipsychotics in Dutch Youth: Prevalence, Dosages, and Duration of Use from 2005 to 2015. J Child Adolesc Psychopharmacol 2018; 28:173-179. [PMID: 29641239 DOI: 10.1089/cap.2017.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives: The use of antipsychotic drugs by youth is associated with serious side effects, especially when prescribed in higher dosages and for a longer period. Despite this, little is known about recent trends in the dosages and duration of use of antipsychotic drugs in children and adolescents. The aim of this study was to describe trends in prevalence, incidence, dosages, duration of use, and preceding psychotropic medication in Dutch youth who had been prescribed antipsychotic drugs from 2005 to 2015. Methods: We analyzed 84,828 antipsychotic prescriptions of youths aged 0-19 years between 2005 and 2015, derived from a large Dutch community pharmacy-based prescription database (IADB.nl). Results: Since a peak of 9.8 users per 1000 youths in 2009, prevalence rates stabilized. Dosages in milligram per kilogram declined for the most frequently prescribed antipsychotic drugs during the study period. The median duration of use was 6.0 (95% CI 5.4-6.6) months. Boys used antipsychotic drugs significantly longer than girls, with a median of 6.9 (95% CI 6.1-7.7) versus 4.6 (95% CI 3.9-5.3) months (p < 0.01). Of the youths prescribed antipsychotics, 12.4% used them for at least 48 months. The majority of youths had used other psychotropic agents in the year before the start of an antipsychotic drug (62.4% in 2005 and 64.7% in 2015). Conclusions: Despite a stabilization of usage rates and decline in dosages and duration of use, one in eight youths still used antipsychotic drugs for 4 years or longer. A substantial share of youths may, therefore, be at high risk for serious side effects.
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Affiliation(s)
- Sanne M Kloosterboer
- Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Jens H J Bos
- Department of Pharmacotherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Luuk J Kalverdijk
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Post RM. The New News about Lithium: An Underutilized Treatment in the United States. Neuropsychopharmacology 2018; 43:1174-1179. [PMID: 28976944 PMCID: PMC5854802 DOI: 10.1038/npp.2017.238] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/20/2022]
Abstract
Lithium use for the treatment of mood disorders remains quite low, particularly in the United States compared with some European countries. Mogens Schou pioneered the study of lithium for prophylaxis of the recurrent mood disorder and encouraged its greater use. In an effort to further address the appropriate role of this drug, the multiple assets of lithium beyond its well-known antimanic effect are reviewed, and a brief summary of its side effects is outlined. It appears that lithium has positive effects in depression and suicide prevention, cognition, and reducing the incidence of dementia. It increases the length of telomeres and has positive effects in prevention of some medical illnesses. Lithium side-effect burden, especially its association with end-stage renal disease, may be less than many have surmised. New data indicate the importance of long-term prophylaxis after a first manic episode to lessen episode recurrence, allow cognition to recover to normal, and prevent various aspects of illness progression. After a first manic episode, 1 year of randomized treatment with lithium was superior to that of quetiapine, suggesting the importance of having lithium in the treatment regimen. Given the highly recurrent and progressive course of bipolar disorder sometimes even in the face of conventional treatment, the role and enhanced use of lithium deserves reconsideration.
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Affiliation(s)
- Robert M Post
- George Washington University School of Medicine, Bipolar Collaborative Network, Bethesda, MD, USA,George Washington University School of Medicine, Bipolar Collaborative Network, 5415 W Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA, Tel: +1 301 530 8245, Fax: +1 301 530 8247, E-mail:
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Weeks G, Spratling R. Pediatric Bipolar Disorder: A Case Presentation and Discussion. J Pediatr Health Care 2018; 32:201-6. [PMID: 29126592 DOI: 10.1016/j.pedhc.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/03/2017] [Accepted: 09/07/2017] [Indexed: 11/21/2022]
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Abstract
INTRODUCTION A wide range of psychiatric disorders are common in young children, especially in those at high risk because of a parent with a unipolar or bipolar mood disorder in the United States. Yet in part because most children are seen in primary care, these illnesses are often not recognized or treated in a timely fashion. To begin to address this problem, we started the Child Network. METHODS The Child Network is for parents of children age 2-12 with mood or behavioral symptoms or at high risk for them. The parents rate the severity of symptoms of depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), oppositional behavior, and mania on a once a week basis on a secure website under a Johns Hopkins Intramural Review Board (IRB)-approved protocol. These ratings can then be printed out along with any treatments given to aide in visualization of symptom course. A demographics form, which includes diagnoses given to the child in the community, and a symptom checklist are filled out upon Network entry. We report on the retrospective diagnoses and prospective treatment of the first 65 parents to join the Network. RESULTS The most common diagnoses were anxiety disorders and ADHD followed by disruptive behavioral disorders and bipolar spectrum disorders. Prospective ratings of two or more consecutive weeks of moderate to severe rating in any of the five symptom domains paralleled these diagnoses given in the community. Atypical antipsychotics, anticonvulsant mood stabilizers, and medications for ADHD were among the most widely used drugs. An illustrated example of symptom course is presented. DISCUSSION Many children continued to show substantial symptom severity despite treatment with an average of 2.2 medications. The Child Network provides a useful longitudinal approach to visualize the course of symptoms, which should help lead to earlier and more effective treatment.
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Affiliation(s)
- Robert M Post
- 1 Department of Psychiatry, George Washington University School of Medicine , Washington, DC.,2 Bipolar Collaborative Network , Bethesda, Maryland
| | - Michael Rowe
- 2 Bipolar Collaborative Network , Bethesda, Maryland
| | - Dana Kaplan
- 3 Division of Child and Adolescent Psychiatry, Johns Hopkins Hospital/Bloomberg Children's Center , Baltimore, Maryland
| | - Robert Findling
- 3 Division of Child and Adolescent Psychiatry, Johns Hopkins Hospital/Bloomberg Children's Center , Baltimore, Maryland
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Berk M, Post R, Ratheesh A, Gliddon E, Singh A, Vieta E, Carvalho AF, Ashton MM, Berk L, Cotton SM, McGorry PD, Fernandes BS, Yatham LN, Dodd S. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry 2017; 16:236-244. [PMID: 28941093 PMCID: PMC5608827 DOI: 10.1002/wps.20441] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a) explore the current level of evidence supporting the descriptive staging of the syndromal pattern of bipolar disorder; b) describe preliminary attempts at validation; c) make recommendations for the direction of further studies; and d) provide a distillation of the potential clinical implications of staging in bipolar disorder within a broader transdiagnostic framework.
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Affiliation(s)
- Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia,Department of PsychiatryUniversity of MelbourneMelbourneAustralia,Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia,Florey Institute for Neuroscience and Mental HealthMelbourneAustralia
| | - Robert Post
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - Emma Gliddon
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Ajeet Singh
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Eduard Vieta
- Bipolar Disorders Program, Department of Psychiatry and PsychologyInstitute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Andre F. Carvalho
- Translational Psychiatry Research Group and Department of Clinical MedicineFaculty of Medicine, Federal University of CearáFortalezaBrazil,Institute for Clinical Research and Education in MedicinePaduaItaly
| | - Melanie M. Ashton
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Lesley Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia,Department of PsychiatryUniversity of MelbourneMelbourneAustralia
| | - Susan M. Cotton
- Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - Patrick D. McGorry
- Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - Brisa S. Fernandes
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia,Department of PsychiatryUniversity of MelbourneMelbourneAustralia,Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia
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