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Corponi F, Li BM, Anmella G, Mas A, Pacchiarotti I, Valentí M, Grande I, Benabarre A, Garriga M, Vieta E, Lawrie SM, Whalley HC, Hidalgo-Mazzei D, Vergari A. Automated mood disorder symptoms monitoring from multivariate time-series sensory data: getting the full picture beyond a single number. Transl Psychiatry 2024; 14:161. [PMID: 38531865 DOI: 10.1038/s41398-024-02876-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Mood disorders (MDs) are among the leading causes of disease burden worldwide. Limited specialized care availability remains a major bottleneck thus hindering pre-emptive interventions. MDs manifest with changes in mood, sleep, and motor activity, observable in ecological physiological recordings thanks to recent advances in wearable technology. Therefore, near-continuous and passive collection of physiological data from wearables in daily life, analyzable with machine learning (ML), could mitigate this problem, bringing MDs monitoring outside the clinician's office. Previous works predict a single label, either the disease state or a psychometric scale total score. However, clinical practice suggests that the same label may underlie different symptom profiles, requiring specific treatments. Here we bridge this gap by proposing a new task: inferring all items in HDRS and YMRS, the two most widely used standardized scales for assessing MDs symptoms, using physiological data from wearables. To that end, we develop a deep learning pipeline to score the symptoms of a large cohort of MD patients and show that agreement between predictions and assessments by an expert clinician is clinically significant (quadratic Cohen's κ and macro-average F1 score both of 0.609). While doing so, we investigate several solutions to the ML challenges associated with this task, including multi-task learning, class imbalance, ordinal target variables, and subject-invariant representations. Lastly, we illustrate the importance of testing on out-of-distribution samples.
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Affiliation(s)
- Filippo Corponi
- School of Informatics, University of Edinburgh, Edinburgh, UK.
| | - Bryan M Li
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Ariadna Mas
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Antoni Benabarre
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Stephen M Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Heather C Whalley
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Generation Scotland, Institute for Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, c. Villarroel, 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Antonio Vergari
- School of Informatics, University of Edinburgh, Edinburgh, UK
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Giménez-Palomo A, Guitart-Mampel M, Roqué G, Sánchez E, Borràs R, Meseguer A, García-García FJ, Tobías E, Valls-Roca L, Anmella G, Valentí M, Olivier L, de Juan O, Ochandiano I, Andreu H, Radua J, Verdolini N, Berk M, Vieta E, Garrabou G, Roca J, Alsina-Restoy X, Pacchiarotti I. Aerobic capacity and mitochondrial function in bipolar disorder: a longitudinal study during acute phases and after clinical remission. Front Psychiatry 2024; 15:1386286. [PMID: 38596629 PMCID: PMC11002204 DOI: 10.3389/fpsyt.2024.1386286] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Background Aerobic capacity has shown to predict physical and mental health-related quality of life in bipolar disorder (BD). However, the correlation between exercise respiratory capacity and mitochondrial function remains understudied. We aimed to assess longitudinally intra-individual differences in these factors during mood episodes and remission in BD. Methods This study included eight BD patients admitted to an acute psychiatric unit. Incremental cardiopulmonary exercise test (CPET) was conducted during acute episodes (T0), followed by constant work rate cycle ergometry (CWRCE) to evaluate endurance time, oxygen uptake at peak exercise (VO2peak) and at the anaerobic threshold. The second test was repeated during remission (T1). Mitochondrial respiration rates were assessed at T0 and T1 in peripheral blood mononuclear cells. Results Endurance time, VO2peak, and anaerobic threshold oxygen consumption showed no significant variations between T0 and T1. Basal oxygen consumption at T1 tended to inversely correlate with maximal mitochondrial respiratory capacity (r=-0.690, p=0.058), and VO2peak during exercise at T1 inversely correlated with basal and minimum mitochondrial respiration (r=-0.810, p=0.015; r=-0.786, p=0.021, respectively). Conclusions Our preliminary data showed that lower basal oxygen consumption may be linked to greater mitochondrial respiratory capacity, and maximum oxygen uptake during the exercise task was associated with lower basal mitochondrial respiration, suggesting that lower oxygen requirements could be associated with greater mitochondrial capacity. These findings should be replicated in larger samples stratified for manic and depressive states.
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Affiliation(s)
- Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Mariona Guitart-Mampel
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and Centro de Investigación en Red de Enfermedades Raras (CIBERER), Catalonia, Spain
| | - Gemma Roqué
- Pneumology Department (ICR), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Ester Sánchez
- Pneumology Department (ICR), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Roger Borràs
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Meseguer
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Josep García-García
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and Centro de Investigación en Red de Enfermedades Raras (CIBERER), Catalonia, Spain
| | - Esther Tobías
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and Centro de Investigación en Red de Enfermedades Raras (CIBERER), Catalonia, Spain
| | - Laura Valls-Roca
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and Centro de Investigación en Red de Enfermedades Raras (CIBERER), Catalonia, Spain
| | - Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Marc Valentí
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Luis Olivier
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Oscar de Juan
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Iñaki Ochandiano
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Helena Andreu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Joaquim Radua
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, Orygen, The University of Melbourne, Melbourne, Australia
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Glòria Garrabou
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and Centro de Investigación en Red de Enfermedades Raras (CIBERER), Catalonia, Spain
| | - Josep Roca
- Pneumology Department (ICR), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Xavier Alsina-Restoy
- Pneumology Department (ICR), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
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Salmerón S, Ochandiano I, Andreu H, Olivier L, de Juan O, Fernández-Plaza T, Bracco L, Colomer L, Barrio P, Valentí M, Giménez-Palomo A, Vieta E, Pacchiarotti I. Cannabis withdrawal and manic episodes: Three cases of an unknown trigger for bipolar disorder. Bipolar Disord 2024. [PMID: 38508861 DOI: 10.1111/bdi.13425] [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] [Indexed: 03/22/2024]
Affiliation(s)
- Sergi Salmerón
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Iñaki Ochandiano
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Helena Andreu
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Olivier
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Oscar de Juan
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Tabatha Fernández-Plaza
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lorenzo Bracco
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciencies, University of Barcelona, Barcelona, Spain
- Department of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica en Red de Salud Metal (CIBERSAM), Institut de Salud Carlos III, Madrid, Spain
| | - Lluc Colomer
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pablo Barrio
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciencies, University of Barcelona, Barcelona, Spain
- Department of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Addictive Behaviours Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marc Valentí
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciencies, University of Barcelona, Barcelona, Spain
- Department of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica en Red de Salud Metal (CIBERSAM), Institut de Salud Carlos III, Madrid, Spain
| | - Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciencies, University of Barcelona, Barcelona, Spain
- Department of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica en Red de Salud Metal (CIBERSAM), Institut de Salud Carlos III, Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciencies, University of Barcelona, Barcelona, Spain
- Department of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica en Red de Salud Metal (CIBERSAM), Institut de Salud Carlos III, Madrid, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciencies, University of Barcelona, Barcelona, Spain
- Department of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica en Red de Salud Metal (CIBERSAM), Institut de Salud Carlos III, Madrid, Spain
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4
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de Juan O, Mas A, Giménez-Palomo A, Gil-Badenes J, Ilzarbe L, Colomer L, Andreu H, Bueno L, Olivier L, Estévez B, Fernández-Plaza T, Tardón-Senabre L, Arbelo N, Valentí M, Gomes da Costa S, Pujol-Fontrodona G, Vieta E, Pacchiarotti I. Catatonic postpartum paternal depression as a first debut of a bipolar disorder: a case report. Int Clin Psychopharmacol 2024; 39:113-116. [PMID: 37729655 DOI: 10.1097/yic.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 09/22/2023]
Abstract
Paternal postpartum depression (PD) is considered an affective disorder that affects fathers during the months following childbirth. Interestingly, it has been observed that during these months the chances of a male parent suffering from depression are double that for a non-parent male counterpart. We present the case of a 34-year-old man with no relevant medical history in who, overlapping her daughter's birth, several depressive symptoms emerged, such as fatigue, lack of concentration, sleeping disturbances and abandonment of care of the newborn. Prior to consultation, patient refused to eat and open his eyes, and his speech became progressively more parsimonious until reaching mutism. The patient was diagnosed with a severe depressive disorder with catatonia. Given the lack of improvement with pharmacological treatment and due to the evidence of electroconvulsive therapy (ECT)'s effectiveness on patients with catatonia, acute ECT treatment was indicated and started. It should be noted that PD is an important entity to consider in our differential diagnosis of young parents who present a depressive episode. Few cases of relatively young patients presenting with such clinical presentation have been described and, although this case presents some of the characteristics described in the epidemiology of PD, other clinical aspects are not typical of this entity. Informed consent was obtained from the patient for the purpose of publication.
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Affiliation(s)
- Oscar de Juan
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Albert Mas
- Institute of Neurosciences (UBNeuro)
- Department of Neurology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
| | - Joaquín Gil-Badenes
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III
| | - Lídia Ilzarbe
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
| | - Lluc Colomer
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Helena Andreu
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Laura Bueno
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Luis Olivier
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Beatriz Estévez
- Department of Psychiatry. Hospital Universitario Puerta de Hierro, Madrid
| | - Tábatha Fernández-Plaza
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Laia Tardón-Senabre
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
| | - Néstor Arbelo
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III
| | - Susana Gomes da Costa
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
| | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain
- Institute of Neurosciences (UBNeuro)
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III
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5
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Anmella G, Mas A, Sanabra M, Valenzuela-Pascual C, Valentí M, Pacchiarotti I, Benabarre A, Grande I, De Prisco M, Oliva V, Fico G, Giménez-Palomo A, Bastidas A, Agasi I, Young AH, Garriga M, Corponi F, Li BM, de Looff P, Vieta E, Hidalgo-Mazzei D. Electrodermal activity in bipolar disorder: Differences between mood episodes and clinical remission using a wearable device in a real-world clinical setting. J Affect Disord 2024; 345:43-50. [PMID: 37865347 DOI: 10.1016/j.jad.2023.10.125] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Bipolar disorder (BD) lacks objective measures for illness activity and treatment response. Electrodermal activity (EDA) is a quantitative measure of autonomic function, which is altered in manic and depressive episodes. We aimed to explore differences in EDA (1) inter-individually: between patients with BD on acute mood episodes, euthymic states and healthy controls (HC), and (2) intra-individually: longitudinally within patients during acute mood episodes of BD and after clinical remission. METHODS A longitudinal observational study. EDA was recorded using a research-grade wearable in patients with BD during acute manic and depressive episodes and at clinical remission. Euthymic BD patients and HC were recorded during a single session. We compared EDA parameters derived from the tonic (mean EDA, mEDA) and phasic components (EDA peaks per minute, pmEDA, and EDA peaks mean amplitude, pmaEDA). Inter- and intra-individual comparisons were computed respectively with ANOVA and paired t-tests. RESULTS 49 patients with BD (15 manic, 9 depressed, and 25 euthymic), and 19 HC were included. Patients with bipolar depression showed significantly reduced mEDA (p = 0.003) and pmEDA (p = 0.001), which increased to levels similar to euthymia or HC after clinical remission (mEDA, p = 0.011; pmEDA, p < 0.001; pmaEDA, p < 0.001). Manic patients showed no differences compared to euthymic patients and HCs, but a significant reduction of tonic and phasic EDA parameters after clinical remission (mEDA, p = 0.035; pmEDA, p = 0.004). LIMITATIONS Limited sample size, high inter-individual variability of EDA parameters, limited comparability to previous studies and non-adjustment for medication. CONCLUSION EDA ecological monitoring might provide several opportunities for early detection of depressive symptoms, and might aid at assessing early response to treatments in mania and bipolar depression.
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain.
| | - Ariadna Mas
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Miriam Sanabra
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Clàudia Valenzuela-Pascual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Marc Valentí
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Antoni Benabarre
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Iria Grande
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Michele De Prisco
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Vincenzo Oliva
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Anna Bastidas
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Agasi
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Allan H Young
- Centre for Affective Disorders (CfAD), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Marina Garriga
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | | | - Bryan M Li
- School of informatics, University of Edinburgh, UK
| | - Peter de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Fivoor, Science and Treatment Innovation, Expert centre "De Borg", Den Dolder, the Netherlands
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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6
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Giménez-Palomo A, Guitart-Mampel M, Meseguer A, Borràs R, García-García FJ, Tobías E, Valls L, Alsina-Restoy X, Roqué G, Sánchez E, Roca J, Anmella G, Valentí M, Bracco L, Andreu H, Salmerón S, Colomer L, Radua J, Verdolini N, Berk M, Vieta E, Garrabou G, Pacchiarotti I. Reduced mitochondrial respiratory capacity in patients with acute episodes of bipolar disorder: Could bipolar disorder be a state-dependent mitochondrial disease? Acta Psychiatr Scand 2024; 149:52-64. [PMID: 38030136 DOI: 10.1111/acps.13635] [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: 08/18/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and recurrent disease characterized by acute mood episodes and periods of euthymia. The available literature postulates that a biphasic dysregulation of mitochondrial bioenergetics might underpin the neurobiology of BD. However, most studies focused on inter-subject differences rather than intra-subject variations between different mood states. To test this hypothesis, in this preliminary proof-of-concept study, we measured in vivo mitochondrial respiration in patients with BD during a mood episode and investigated differences compared to healthy controls (HC) and to the same patients upon clinical remission. METHODS This longitudinal study recruited 20 patients with BD admitted to our acute psychiatric ward with a manic (n = 15) or depressive (n = 5) episode, and 10 matched HC. We assessed manic and depressive symptoms using standardized psychometric scales. Different mitochondrial oxygen consumption rates (OCRs: Routine, Leak, electron transport chain [ETC], Rox) were assessed during the acute episode (T0) and after clinical remission (T1) using high-resolution respirometry at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system in one million of peripheral blood mononuclear cells (PMBC). Specific OCRs were expressed as mean ± SD in picomoles of oxygen per million cells. Significant results were adjusted for age, sex, and body mass index. RESULTS The longitudinal analysis showed a significant increase in the maximal oxygen consumption capacity (ETC) in clinical remission (25.7 ± 16.7) compared to the acute episodes (19.1 ± 11.8, p = 0.025), and was observed separately for patients admitted with a manic episode (29.2 ± 18.9 in T1, 22.3 ± 11.9 in T0, p = 0.076), and at a trend-level for patients admitted with a depressive episode (15.4 ± 3.9 in T1 compared to 9.4 ± 3.2 in T0, p = 0.107). Compared to HC, significant differences were observed in ETC in patients with a bipolar mood episode (H = 11.7; p = 0.003). Individuals with bipolar depression showed lower ETC than those with a manic episode (t = -3.7, p = 0.001). Also, significant differences were observed in ETC rates between HC and bipolar depression (Z = 1.000, p = 0.005). CONCLUSIONS Bioenergetic and mitochondrial dysregulation could be present in both manic and depressive phases in BD and, importantly, they may restore after clinical remission. These preliminary results suggest that mitochondrial respiratory capacity could be a biomarker of illness activity and clinical response in BD. Further studies with larger samples and similar approaches are needed to confirm these results and identify potential biomarkers in different phases of the disease.
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Affiliation(s)
- Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Mariona Guitart-Mampel
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and CIBERER, Barcelona, Spain
| | - Ana Meseguer
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Roger Borràs
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Josep García-García
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and CIBERER, Barcelona, Spain
| | - Esther Tobías
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and CIBERER, Barcelona, Spain
| | - Laura Valls
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and CIBERER, Barcelona, Spain
| | | | - Gemma Roqué
- Pneumology Department, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Ester Sánchez
- Pneumology Department, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Josep Roca
- Pneumology Department, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Marc Valentí
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Lorenzo Bracco
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Helena Andreu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Sergi Salmerón
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Lluc Colomer
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Joaquim Radua
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Norma Verdolini
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
| | - Glòria Garrabou
- Inherited Metabolic Diseases and Muscular Disorders Research Lab, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Department-Hospital Clinic of Barcelona and CIBERER, Barcelona, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Spain
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7
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Andreu H, Olivier L, Giménez-Palomo A, Roson-Fernandez C, Bueno L, de Juan Ó, Bartolomé I, Ilzarbe L, Tardón-Senabre L, Fernández-Plaza T, Arbelo N, Valentí M, Gil-Badenes J, Macau E, Pujol-Fontrodona G, Colomer L, Vieta E, Pacchiarotti I. Neuropsychiatric symptoms in a patient under cystic fibrosis transmembrane conductance regulator modulators treatment: a case report. Int Clin Psychopharmacol 2023; 38:402-405. [PMID: 37767628 DOI: 10.1097/yic.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 09/29/2023]
Abstract
In recent times, some research has focused on the study of potential treatments for cystic fibrosis (CF), such as cystic fibrosis transmembrane conductance regulator (CFTR) modulators. These treatments have been reported to produce neuropsychiatric symptoms in a few patients, even though there is still no clear correlation nor underlying mechanism proposed. We present the case of a 23-year-old woman with CF and no previous psychiatric history who was admitted to our inpatient psychiatric unit presenting a wide range of neuropsychiatric symptoms, such as disorganized speech, bizarre poses or persecutory delusional ideation, after going under CFTR modulators treatment. After several diagnostic tests, other possible organic causes were ruled out. Multiple antipsychotic treatments were tested during her admission, with poor tolerance and scarce response. Finally, symptomatic remission was only observed after electroconvulsive therapy was initiated. The final diagnostic hypothesis was unspecified psychosis. This case highlights the relevance of considering the possibility of neuropsychiatric symptoms appearing in patients under CFTR modulators treatment.
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Affiliation(s)
- Helena Andreu
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | - Luis Olivier
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
| | - Carmen Roson-Fernandez
- Psychiatry Department, Hospital Naval, Complexo Universitario de Ferrol (CHUF), Ferrol, A Coruña
| | - Laura Bueno
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | - Óscar de Juan
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | - Inés Bartolomé
- Neurology Department, Institute of Neuroscience, Hospital Clínic, University of Barcelona, CIBERNED, IDIBAPS, Barcelona, Catalonia
| | - Lidia Ilzarbe
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | | | | | - Néstor Arbelo
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | | | - Elisabet Macau
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | | | - Lluc Colomer
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Instituto Carlos III, Madrid, Spain
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8
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Solé B, Bonnín CM, Radua J, Montejo L, Hogg B, Jimenez E, Reinares M, Valls E, Varo C, Pacchiarotti I, Valentí M, Garriga M, Torres I, Martínez-Arán A, Vieta E, Torrent C. Long-term outcome predictors after functional remediation in patients with bipolar disorder - CORRIGENDUM. Psychol Med 2023; 53:5886. [PMID: 37278316 DOI: 10.1017/s0033291723001538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- B Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C M Bonnín
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Radua
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - L Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Hogg
- Centre Fórum Research Unit, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Reinares
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Valls
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Varo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Garriga
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Torres
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martínez-Arán
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Torrent
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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9
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Bioque M, Mac-Dowell KS, Font C, Meseguer A, Macau E, Garcia-Orellana M, Valentí M, Leza JC, Bernardo M. Acute effects of a session of electroconvulsive therapy on brain-derived neurotrophic factor plasma levels. Span J Psychiatry Ment Health 2023; 16:137-142. [PMID: 32674992 DOI: 10.1016/j.rpsm.2020.05.011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/29/2020] [Accepted: 05/22/2020] [Indexed: 11/15/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are neurotrophins that play critical roles in brain neuronal function. Previous studies have established the association between BDNF and NGF signaling and severe mental disorders, but changes in BDNF plasma levels and electroconvulsive therapy (ECT) response are controversial. The aim of his study was to explore the acute effects of a single session of ECT on these neurotrophins signaling. Plasma levels of BDNF and NGF and their tyrosine kinase-type receptors expression in peripheral blood mononuclear cells (PBMCs) were determined before and two hours after a single ECT session in 30 subjects with a severe mental disorder. Two hours after an ECT session we found a statistically significant decrease of BDNF plasma levels (p=0.007). We did not find significant acute effects on NGF plasma levels or receptors expression in PBMCs. We found a significant inverse correlation between the time of convulsion and BDNF plasma levels decrease (r=-0.041, p=0.024). We have identified a decrease in BDNF plasma levels after 2h of a single ECT session. These results indicate the interest for future research in the role of neurotrophins in the response and safety of ECT.
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Affiliation(s)
- Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Departament de Medicina, Universitat de Barcelona, Spain.
| | - Karina S Mac-Dowell
- Department of Pharmacology & Toxicology, Faculty of Medicine, Universidad Complutense de Madrid University, Instituto de Investigación Hospital 12 de Octubre (i+12), IUIN; CIBERSAM, Spain
| | - Cristina Font
- Department of Pharmacology & Toxicology, Faculty of Medicine, Universidad Complutense de Madrid University, Instituto de Investigación Hospital 12 de Octubre (i+12), IUIN; CIBERSAM, Spain
| | - Ana Meseguer
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona; CIBERSAM, Spain
| | - Elisabet Macau
- Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Garcia-Orellana
- Anesthesiolgy Department, Hospital Clínic de Barcelona, Barcelona; Universitat de Barcelona, Barcelona, Spain
| | - Marc Valentí
- Barcelona Bipolar Disorder Program, Psychatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan C Leza
- Department of Pharmacology & Toxicology, Faculty of Medicine, Universidad Complutense de Madrid University, Instituto de Investigación Hospital 12 de Octubre (i+12), IUIN; CIBERSAM, Spain.
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Departament de Medicina, Universitat de Barcelona, Spain
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10
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Anmella G, Corponi F, Li BM, Mas A, Sanabra M, Pacchiarotti I, Valentí M, Grande I, Benabarre A, Giménez-Palomo A, Garriga M, Agasi I, Bastidas A, Cavero M, Fernández-Plaza T, Arbelo N, Bioque M, García-Rizo C, Verdolini N, Madero S, Murru A, Amoretti S, Martínez-Aran A, Ruiz V, Fico G, De Prisco M, Oliva V, Solanes A, Radua J, Samalin L, Young AH, Vieta E, Vergari A, Hidalgo-Mazzei D. Exploring digital biomarkers of illness activity in mood episodes: hypotheses generating and model development study. JMIR Mhealth Uhealth 2023; 11:e45405. [PMID: 36939345 DOI: 10.2196/45405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Depressive and manic episodes within bipolar disorder (BD) and major depressive disorder (MDD) involve altered mood, sleep, and activity alongside physiological alterations that wearables can capture. OBJECTIVE We explored whether physiological wearable data could predict: (aim 1) the severity of an acute affective episode at the intra-individual level, (aim 2) the polarity of an acute affective episode and euthymia among different individuals. Secondarily, we explored which physiological data were related to the prior predictions, generalization across patients, and associations between affective symptoms and physiological data. METHODS We conducted a prospective exploratory observational study including patients with BD and MDD on acute affective episodes (manic, depressed, and mixed) whose physiological data were recorded with a research-grade wearable (Empatica E4) across three consecutive timepoints (acute, response, and remission of episode). Euthymic patients and healthy controls (HC) were recorded during a single session (∼48 hours). Manic and depressive symptoms were assessed with standardized psychometric scales. Physiological wearable data included the following channels: acceleration (ACC), temperature (TEMP), blood volume pulse (BVP), heart rate (HR), and electrodermal activity (EDA). For data pre-processing, invalid physiological data were removed using a rule-based filter, channels were time-aligned at 1 second time units and then segmented window lengths of 32 seconds, since those parameters showed the best performances. We developed deep learning predictive models, assessed channels' individual contribution using permutation feature importance analysis, and computed physiological data to psychometric scales' items normalized mutual information (NMI). We present a novel fully automated method for analysis of physiological data from a research-grade wearable device, including a rule-based filter for invalid data and a viable supervised learning pipeline for time-series analyses. RESULTS 35 sessions (1,512 hours) from 12 patients (manic, depressed, mixed, and euthymic) and 7 HC (age 39.7±12.6; 31.6% female) were analyzed. (aim 1) The severity of mood episodes was predicted with moderate (62%-85%) accuracies. (aim 2) The polarity of episodes was predicted with moderate (70%) accuracy. The most relevant features for the former tasks were ACC, EDA, and HR. Kendall W showed fair agreement (0.383) in feature importance across classification tasks. Generalization of the former models were of overall low accuracy, with better results for the intra-individual models. "Increased motor activity" was associated with ACC (NMI>0.55), "aggressive behavior" with EDA (NMI=1.0), "insomnia" with ACC (NMI∼0.6), "motor inhibition" with ACC (NMI∼0.75), and "psychic anxiety" with EDA (NMI=0.52). CONCLUSIONS Physiological data from wearables show potential to identify mood episodes and specific symptoms of mania and depression quantitatively, both in BD and MDD. Motor activity and stress-related physiological data (EDA and HR) stand out as potential digital biomarkers for predicting mania and depression respectively. These findings represent a promising pathway towards personalized psychiatry, in which physiological wearable data could allow early identification and intervention of mood episodes. CLINICALTRIAL
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Affiliation(s)
- Gerard Anmella
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Filippo Corponi
- School of informatics, University of Edinburgh, UK., Edinburgh, GB
| | - Bryan M Li
- School of informatics, University of Edinburgh, UK., Edinburgh, GB
| | - Ariadna Mas
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Miriam Sanabra
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Isabella Pacchiarotti
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Marc Valentí
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Iria Grande
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Antoni Benabarre
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Anna Giménez-Palomo
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Marina Garriga
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Isabel Agasi
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Anna Bastidas
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Myriam Cavero
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | | | - Néstor Arbelo
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Miquel Bioque
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Clemente García-Rizo
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Norma Verdolini
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Santiago Madero
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Andrea Murru
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Silvia Amoretti
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Anabel Martínez-Aran
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Victoria Ruiz
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Giovanna Fico
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Michele De Prisco
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Vincenzo Oliva
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Barcelona, ES
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Barcelona, ES
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France., Clermont-Ferrand, FR
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom., London, GB
| | - Eduard Vieta
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
| | - Antonio Vergari
- School of informatics, University of Edinburgh, UK., Edinburgh, GB
| | - Diego Hidalgo-Mazzei
- Hospital Clínic de Barcelona, Villarroel St., 170, 08036 Barcelona, Spain., Barcelona, ES
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11
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Fico G, Oliva V, De Prisco M, Giménez-Palomo A, Sagué-Vilavella M, Gomes-da-Costa S, Garriga M, Solé E, Valentí M, Fanelli G, Serretti A, Fornaro M, Carvalho AF, Vieta E, Murru A. The U-shaped relationship between parental age and the risk of bipolar disorder in the offspring: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2022; 60:55-75. [PMID: 35635997 DOI: 10.1016/j.euroneuro.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 03/27/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/06/2023]
Abstract
Parenthood age may affect the risk for the development of different psychiatric disorders in the offspring, including bipolar disorder (BD). The present systematic review and meta-analysis aimed to appraise the relationship between paternal age and risk for BD and to explore the eventual relationship between paternal age and age at onset of BD. We searched the MEDLINE, Scopus, Embase, PsycINFO online databases for original studies from inception, up to December 2021. Random-effects meta-analyses were conducted. Sixteen studies participated in the qualitative synthesis, of which k = 14 fetched quantitative data encompassing a total of 13,424,760 participants and 217,089 individuals with BD. Both fathers [adjusted for the age of other parent and socioeconomic status odd ratio - OR = 1.29(95%C.I. = 1.13-1.48)] and mothers aged ≤ 20 years [(OR = 1.23(95%C.I. = 1.14-1.33)] had consistently increased odds of BD diagnosis in their offspring compared to parents aged 25-29 years. Fathers aged ≥ 45 years [adjusted OR = 1.29 (95%C.I. = 1.15-1.46)] and mothers aged 35-39 years [OR = 1.10(95%C.I. = 1.01-1.19)] and 40 years or older [OR = 1.2(95% C.I. = 1.02-1.40)] likewise had inflated odds of BD diagnosis in their offspring compared to parents aged 25-29 years. Early and delayed parenthood are associated with an increased risk of BD in the offspring. Mechanisms underlying this association are largely unknown and may involve a complex interplay between psychosocial, genetic and biological factors, and with different impacts according to sex and age range. Evidence on the association between parental age and illness onset is still tentative but it points towards a possible specific effect of advanced paternal age on early BD-onset.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain; Department of Neuroscience, Section of Psychiatry, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Eva Solé
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele Fornaro
- Department of Neuroscience, Section of Psychiatry, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Andre F Carvalho
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Vic., Australia 6 Perinatal Health Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Deakin University, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain.
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
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12
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Anmella G, Mas A, Pacchiarotti I, Fernández T, Bastidas A, Agasi I, Garriga M, Verdolini N, Arbelo N, Nicolás D, Ruiz V, Valentí M, Murru A, Vieta E, Solanes A, Corponi F, Li B, Hidalgo-Mazzei D. The TIMEBASE Study: IdenTifying dIgital bioMarkers of illnEss activity in BipolAr diSordEr. Preliminary results. Eur Psychiatry 2022. [PMCID: PMC9566946 DOI: 10.1192/j.eurpsy.2022.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Mood episodes in bipolar disorder (BD) are still identified with subjective retrospective reports and scales. Digital biomarkers, such as actigraphy, heart rate variability, or ElectroDermal activity (EDA) have demonstrated their potential to objectively capture illness activity.
Objectives
To identify physiological digital signatures of illness activity during acute episodes of BD compared to euthymia and healthy controls (HC) using a novel wearable device (Empatica´s E4).
Methods
A pragmatic exploratory study. The sample will include 3 independent groups totalizing 60 individuals: 36 BD inpatients admitted due to severe acute episodes of mania (N=12), depression (N=12), and mixed features (N=12), will wear the E4-device at four timepoints: the acute phase (T0), treatment response (T1), symptoms remission (T2) and during euthymia (T3; outpatient follow-up). 12 BD euthymic outpatients and 12 HC will be asked to wear the E4-device once. Data pre-processing included average downsampling, channel time-alignment in 2D segments, 3D-array stacking of segments, and random shuffling for training/validation sets. Finally, machine learning algorithms will be applied.
Results
A total of 10 patients and 5 HC have been recruited so far. The preliminary results follow the first differences between the physiological digital biomarkers between manic and depressive episodes. 3 fully connected layers with 32 hidden units, ectified linear activation function (ReLU) activation, 25% dropout rate, significantly differentiated a manic from a depressive episode at different timepoints (T0, T1, T2).
Conclusions
New wearables technologies might provide objective decision-support parameters based on digital signatures of symptoms that would allow tailored treatments and early identification of symptoms.
Disclosure
No significant relationships.
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Ilzarbe L, Ilzarbe D, Gil J, Valentí M, De Juan O, Arbelo N, Llach C, Bioque M. Atrial fibrillation debut following first electroconvulsive therapy combined with venlafaxine: a case report and a literature review. Eur Psychiatry 2022. [PMCID: PMC9565946 DOI: 10.1192/j.eurpsy.2022.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Cardiovascular events (CVE) are infrequent adverse effects in patients receiving electroconvulsive therapy (ECT). Nonetheless, it constitutes a threat for patient’s life and may compromise continuing ECT. Objectives To describe a case of acute-onset atrial fibrillation under combined therapy with ECT and venlafaxine. Methods We present a 76-year-old man diagnosed of delusional disorder and without any previous CVE, who was hospitalized in our acute psychiatric unit by major depressive episode with psychotic symptoms resistant to pharmacological treatment (valproic-acid 100mg/d, haloperidol 6mg/d, venlafaxine 300mg/d). ECT was initiated presenting atrial fibrillation after first session of ECT, requiring amiodarone and anticoagulant treatment for stabilization. Second session of ECT was delayed for three-weeks, worsening the psychiatric symptoms. Haloperidol was discontinued initiating lurasidone with better cardiovascular profile. Results
CVE occur in 2% of the patients receiving ECT, being acute arrhythmia the most frequent one. Among them, few cases of atrial fibrillation (AF) under ECT have been reported. It has been hypothesised that initial vagal response followed by catecholamine surge secondary to ECT could facilitate the development of AF. In addition venlafaxine, an antidepressant drug, may also predispose to arrhythmia in high-risk individuals. High doses of venlafaxine (>300mg/d) combined with ECT have been related with an increment of CVE. Conclusions Although clinically effective for the treatment of major depression disorder, combined therapy of ECT and venlafaxine could precipitate the start of a CVE in genetically susceptible individuals. Therefore, identify and clarify potential risk factors other than previous history of CVE is critical to reduce morbidity and mortality in these patients. Disclosure No significant relationships.
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14
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Cavero M, Planas T, Goikolea J, Lens S, Bartrés C, Colomer L, García C, Valentí M, Ruiz V, Rivas Y, Benabarre A, Catalan R, Masana G, Colom J, Forns X, Martin-Santos R, Mariño Z. Screnning of viral hepatitis in mental disorder patients: Psiqui-Clinic Programme. Eur Psychiatry 2022. [PMCID: PMC9567413 DOI: 10.1192/j.eurpsy.2022.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The WHO would increase diagnosis and treatment of viral hepatitis in the world by 2030, based on the high efficacy of direct-acting-antivirals against HCV, extended vaccination programs in HBC, and epidemiological data. Diagnostic of HCV/HBV infection has been simplified by point-of-care (POC) devices (cheap/easy-to-use/interprete/qick-results), detecting anti-HCV-antibodies or HBV-antigen in capillary blood at the patients´site. The current seroprevalence of viral hepatitis B/C in general population in Spain is 0.5%/1% and would be higher (3-17%) in people with severe-mental-disorder due to risk factors and traditionally less access to health care. Objectives To design a screening protocol for HCV eradication and HBV-detection, and risk factors among severe-mental-disorder patients in a CommunityMentalHealthCenter. To guarantee equal access to viral hepatitis screening and therapy among this population. Methods Outpatients visited along one-year who accepts participate. Using POC-device for qualitative detection of anti-HCV-antibodies (Quickview-of-Lumiquick-Diagnostics®)/HBsAG (Abbott-Rapid-Diagnostics®). Socio-demographic data; mental disorder(ICD-10); HCV/HBV risk-factors; Neurotoxicity-scale (mood/cognition/sleep/gastrointestinal/sickness/motor); SF-12; Patient-satisfaction. Subjects with positive HCV/HBV POC-test will have a on-site venopuncture to assess hemograme/liver tests, and HCV-RNA (Cobas-TaqMan-RocheDiagnostics)/HBsAg-ELISA (Atellica-Siemens). In positive HCV-RNA (active infection) the psychiatric-team will inform the hepatology-team for non-invasive liver fibrosis assessment and DAA prescription. The patient will receive 8-12-weeks on-site treatment, and assessed (Neurotoxicity/SF-12).HCV cure will be confirmed by HCV-RNA in blood. Chronic-cases will be managed at Hepatology-Unit. Results We will present the results of the implementation of the programme and their ability to detect viral-hepatitis-positive cases among patients with severe-mental-disorders and to treat them effectively. Conclusions Our results may support the generalisation of the programme in among CMHC’s. Disclosure No significant relationships.
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15
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Montejo L, Jiménez E, Solé B, Murru A, Arbelo N, Benabarre A, Valentí M, Clougher D, Rodríguez MA, Borràs R, Martínez-Arán A, Vieta E, Bonnín CDM, Torrent C. Identifying neurocognitive heterogeneity in Older Adults with Bipolar Disorder: a cluster analysis. J Affect Disord 2022; 298:522-531. [PMID: 34788686 DOI: 10.1016/j.jad.2021.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cognitive profiles of BD patients show a demonstrated heterogeneity among young and middle-aged patients, but this issue has not yet deeply explored in Older Adults with bipolar disorder (OABD). The aim of the present study was to analyze cognitive variability in a sample of OABD. METHODS A total of 138 OABD patients and 73 healthy controls were included in this study. A comprehensive neuropsychological assessment was administered. We performed a k-means cluster analysis method based on the neurocognitive performance to detect heterogeneous subgroups. Demographic, clinical, cognitive and functional variables were compared. Finally, univariate logistic regressions were conducted to detect variables associated with the severity of the cognitive impairment. RESULTS We identified three distinct clusters based on the severity of cognitive impairment: (1) a preserved group (n = 58; 42%) with similar cognitive performance to HC, (2) a group showing mild cognitive deficits in all cognitive domains (n = 64; 46%) and, finally, (3) a group exhibiting severe cognitive impairment (n = 16; 12%). Older age, late onset, higher number of psychiatric admissions and lower psychosocial functioning were associated with the greatest cognitive impairment. Lower age, more years of education and higher estimated IQ were associated with a preserve cognitive functioning. LIMITATIONS The small sample size of the severely impaired group. CONCLUSIONS Cognitive heterogeneity remains at late-life bipolar disorder. Demographic and specific illness factors are related to cognitive dysfunction. Detecting distinct cognitive subgroups may have significant clinical implications for tailoring specific intervention strategies adapted to the level of the impairment and also to prevent cognitive decline.
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Affiliation(s)
- Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Néstor Arbelo
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic of Barcelona, Department of Medicine, Neuroscience Institute, Barcelona, Catalonia, Spain
| | - Antonio Benabarre
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Derek Clougher
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Manuel Arturo Rodríguez
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Roger Borràs
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Caterina Del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carla Torrent
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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16
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Solé B, Bonnín CM, Radua J, Montejo L, Hogg B, Jimenez E, Reinares M, Valls E, Varo C, Pacchiarotti I, Valentí M, Garriga M, Torres I, Martínez-Arán A, Vieta E, Torrent C. Long-term outcome predictors after functional remediation in patients with bipolar disorder. Psychol Med 2022; 52:314-322. [PMID: 32539879 DOI: 10.1017/s0033291720001968] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD. METHODS A total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature. RESULTS The regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model. CONCLUSIONS Results suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.
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Affiliation(s)
- B Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C M Bonnín
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Radua
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - L Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Hogg
- Centre Fórum Research Unit, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Reinares
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Valls
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Varo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Garriga
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Torres
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martínez-Arán
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Torrent
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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17
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Suquet J, Godo-Pla L, Valentí M, Ferràndez L, Verdaguer M, Poch M, Martín MJ, Monclús H. Assessing the effect of catchment characteristics to enhanced coagulation in drinking water treatment: RSM models and sensitivity analysis. Sci Total Environ 2021; 799:149398. [PMID: 34375875 DOI: 10.1016/j.scitotenv.2021.149398] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/09/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Coagulation is the main process for removing natural organic matter (NOM), considered to be the major disinfection by-products (DBPs) precursor in drinking water production. In this work, k-means clusters analysis were used to classify influent waters from two different surface drinking water treatment plants (DWTPs) located in the Mediterranean region. From this, enhanced coagulation models based on response surface methodology (RSM) were then developed to optimise coagulation at two water catchments (river and reservoir). The cluster analysis classified the water quality of the raw waters into two groups related to baseline and peak organic loads. The developed enhanced coagulation models were based on the turbidity, total organic carbon (TOC) and UV254 removals. Sensitivity analysis applied to the models (after predictors selection) determined the factors relative individual contributions for each DWTP scenario. Then, profile plots for enhanced coagulation were studied to identify the optimal levels for each case. Models mean R2 were 0.85 and 0.86 in baseline and 0.85 and 0.84 in peak scenario for river and reservoir catchments, respectively. Results of this study indicate that the surface water quality variation in river DWTP is seasonal and is expressed by an increase of turbidity, while in the reservoir DWTP is related to extreme weather events showing high levels of dissolved organic load (TOC and UV254). During baseline cases, where raw waters present low levels of organics, the three factors optimal adjustment should be ensured to optimise coagulation. Then, during peak scenarios, where influent waters present high organics, the optimal for enhanced coagulation relies on the correct adjustment of Cd. The presented work provides models for drinking water production aimed to propose the optimum conditions for enhanced coagulation, considering the influent water characteristics under different weather conditions.
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Affiliation(s)
- J Suquet
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - Ll Godo-Pla
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - M Valentí
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - L Ferràndez
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - M Verdaguer
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - M Poch
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - M J Martín
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain
| | - H Monclús
- LEQUIA, Institute of the Environment, Universitat de Girona. C/Maria Aurèlia Capmany, 69, E-17003 Girona, Catalonia, Spain.
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18
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Solanes A, Palau P, Fortea L, Salvador R, González-Navarro L, Llach CD, Valentí M, Vieta E, Radua J. Biased accuracy in multisite machine-learning studies due to incomplete removal of the effects of the site. Psychiatry Res Neuroimaging 2021; 314:111313. [PMID: 34098248 DOI: 10.1016/j.pscychresns.2021.111313] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/04/2020] [Revised: 04/24/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023]
Abstract
Brain MRI researchers conducting multisite studies, such as within the ENIGMA Consortium, are very aware of the importance of controlling the effects of the site (EoS) in the statistical analysis. Conversely, authors of the novel machine-learning MRI studies may remove the EoS when training the machine-learning models but not control them when estimating the models' accuracy, potentially leading to severely biased estimates. We show examples from a toy simulation study and real MRI data in which we remove the EoS from both the "training set" and the "test set" during the training and application of the model. However, the accuracy is still inflated (or occasionally shrunk) unless we further control the EoS during the estimation of the accuracy. We also provide several methods for controlling the EoS during the estimation of the accuracy, and a simple R package ("multisite.accuracy") that smoothly does this task for several accuracy estimates (e.g., sensitivity/specificity, area under the curve, correlation, hazard ratio, etc.).
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Affiliation(s)
- Aleix Solanes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Pol Palau
- FIDMAG Research Foundation, Barcelona, Spain; CASM Benito Menni Granollers-Hospital General de Granollers, Barcelona, Spain
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Research Foundation, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cristian Daniel Llach
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Marc Valentí
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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19
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Gomes-da-Costa S, Marx W, Corponi F, Anmella G, Murru A, Pons-Cabrera MT, Giménez-Palomo A, Gutiérrez-Arango F, Llach CD, Fico G, Kotzalidis GD, Verdolini N, Valentí M, Berk M, Vieta E, Pacchiarotti I. Lithium therapy and weight change in people with bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 134:104266. [PMID: 34265322 DOI: 10.1016/j.neubiorev.2021.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023]
Abstract
Lithium remains the gold standard maintenance treatment for Bipolar Disorder (BD). However, weight gain is a side effect of increasing relevance due to its metabolic implications. We conducted a systematic review and meta-analysis aimed at summarizing evidence on the use of lithium and weight change in BD. We followed the PRISMA methodology, searching Pubmed, Scopus and Web of Science. From 1003 screened references, 20 studies were included in the systematic review and 9 included in the meta-analysis. In line with the studies included in the systematic review, the meta-analysis revealed that weight gain with lithium was not significant, noting a weight increase of 0.462 Kg (p = 0158). A shorter duration of treatment was significantly associated with more weight gain. Compared to placebo, there were no significant differences in weight gain. Weight gain was significantly lower with lithium than with active comparators. This work reveals a low impact of lithium on weight change, especially compared to some of the most widely used active comparators. Our results could impact clinical decisions.
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Affiliation(s)
- Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Filippo Corponi
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Maria Teresa Pons-Cabrera
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Felipe Gutiérrez-Arango
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Cristian Daniel Llach
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Georgios D Kotzalidis
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain.
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
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20
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Macau E, Valero R, Gil-Badenes J, Valentí M, Baeza I, Pacchiarotti I, Bioque M. Totally Implantable Venous-Access Device in Maintenance Electroconvulsive Therapy: A Retrospective Case Series. J ECT 2021; 37:e9-e12. [PMID: 34029306 DOI: 10.1097/yct.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an effective and safe treatment of certain severe mental disorders, but there are some barriers to the implementation of continuation/maintenance ECT courses in some cases. Repeated difficulties in achieving intravenous access before each session may contribute to premature ECT discontinuation. The placement of a totally implantable venous-access device (TIVAD) could be an alternative to overcome these difficulties in certain subjects. METHODS For the present study we retrospectively identified all patients treated with continuation/maintenance ECT in our facilities during a 13-year period to which a TIVAD was implanted, paying attention to specific factors related to clinical characteristics, treatment course, and ECT technique. RESULTS We identified a TIVAD in 16 (3.33%) of 481 patients receiving ECT in our unit, of whom 87.5% were female. Half of the cases met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for schizophrenia, 6 for bipolar disorder, and 2 for major depression disorder. Age of the study cases ranged from 17 to 87 years. A total of 1957 ECT sessions were registered in this group of cases during the observation period. Patients had undergone a mean of 124.06 ± 132.41 ECT sessions before the TIVAD was implanted, with the device mean time of utilization being 5.39 ± 3.46 years. In 2 cases, the device was removed after ECT discontinuation. Few incidents associated with the implantation and operation of the TIVAD were registered, comparable to the use of this device in other clinical contexts. CONCLUSIONS This case series suggest that a TIVAD placement can be an effective and safe solution for patients in continuation/maintenance ECT courses with difficult intravenous access. Future studies will need to carefully monitor the benefit and the potential complications of TIVAD placement in patients undergoing continuation/maintenance ECT programs.
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Affiliation(s)
| | | | - Joaquín Gil-Badenes
- Barcelona Clínic Schizophrenia Unit, Bipolar and Depressive Disorders Unit, Neuroscience Institute, Hospital Clínic de Barcelona
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21
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Fortea L, Albajes-Eizagirre A, Yao YW, Soler E, Verdolini N, Hauson AO, Fortea A, Madero S, Solanes A, Wollman SC, Serra-Blasco M, Wise T, Lukito S, Picó-Pérez M, Carlisi C, Zhang J, Pan P, Farré-Colomés Á, Arnone D, Kempton MJ, Soriano-Mas C, Rubia K, Norman L, Fusar-Poli P, Mataix-Cols D, Valentí M, Via E, Cardoner N, Solmi M, Shin JI, Vieta E, Radua J. Focusing on Comorbidity-A Novel Meta-Analytic Approach and Protocol to Disentangle the Specific Neuroanatomy of Co-occurring Mental Disorders. Front Psychiatry 2021; 12:807839. [PMID: 35115973 PMCID: PMC8805083 DOI: 10.3389/fpsyt.2021.807839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In mental health, comorbidities are the norm rather than the exception. However, current meta-analytic methods for summarizing the neural correlates of mental disorders do not consider comorbidities, reducing them to a source of noise and bias rather than benefitting from their valuable information. OBJECTIVES We describe and validate a novel neuroimaging meta-analytic approach that focuses on comorbidities. In addition, we present the protocol for a meta-analysis of all major mental disorders and their comorbidities. METHODS The novel approach consists of a modification of Seed-based d Mapping-with Permutation of Subject Images (SDM-PSI) in which the linear models have no intercept. As in previous SDM meta-analyses, the dependent variable is the brain anatomical difference between patients and controls in a voxel. However, there is no primary disorder, and the independent variables are the percentages of patients with each disorder and each pair of potentially comorbid disorders. We use simulations to validate and provide an example of this novel approach, which correctly disentangled the abnormalities associated with each disorder and comorbidity. We then describe a protocol for conducting the new meta-analysis of all major mental disorders and their comorbidities. Specifically, we will include all voxel-based morphometry (VBM) studies of mental disorders for which a meta-analysis has already been published, including at least 10 studies. We will use the novel approach to analyze all included studies in two separate single linear models, one for children/adolescents and one for adults. DISCUSSION The novel approach is a valid method to focus on comorbidities. The meta-analysis will yield a comprehensive atlas of the neuroanatomy of all major mental disorders and their comorbidities, which we hope might help develop potential diagnostic and therapeutic tools.
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Affiliation(s)
- Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Yuan-Wei Yao
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Edu Soler
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Norma Verdolini
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, Barcelona, Spain
| | - Alexander O Hauson
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA, United States.,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Adriana Fortea
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain.,Psychiatric and Psychology Service, Hospital Clinic, Barcelona, Spain
| | - Santiago Madero
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Aleix Solanes
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Scott C Wollman
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA, United States
| | - Maria Serra-Blasco
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychology, Abat Oliba CEU ("Centro de Estudios Universitarios") University, Barcelona, Spain.,Programa E-Health ICOnnecta't, Institut Català d'Oncologia, Barcelona, Spain
| | - Toby Wise
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Maria Picó-Pérez
- Live and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center - Braga, Braga, Portugal
| | - Christina Carlisi
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - JinTao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - PingLei Pan
- Department of Neurology, Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Affiliated Yancheng Hospital of Southeast University, Yancheng, China
| | - Álvar Farré-Colomés
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Danilo Arnone
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Matthew J Kempton
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Carles Soriano-Mas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Luke Norman
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,The Social and Behavioral Research Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD, United States
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Marc Valentí
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, Barcelona, Spain.,Psychiatric and Psychology Service, Hospital Clinic, Barcelona, Spain
| | - Esther Via
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Narcis Cardoner
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, United Kingdom.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jae I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, Barcelona, Spain.,Psychiatric and Psychology Service, Hospital Clinic, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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22
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Gil-Badenes J, Valero R, Valentí M, Macau E, Bertran MJ, Claver G, Bioque M, Baeza I, Bastidas Salvadó A, Lombraña Mencia M, Pacchiarotti I, Bernardo M, Vieta E. Electroconvulsive therapy protocol adaptation during the COVID-19 pandemic. J Affect Disord 2020; 276:241-248. [PMID: 32697705 PMCID: PMC7361096 DOI: 10.1016/j.jad.2020.06.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, electroconvulsive therapy units have had to confront challenges such as the infectious hazard due to aerosol-generating ventilation, or the lack of staff and material resources. Our objective was to elaborate a protocol to make ECT during the COVID-19 pandemic a safer procedure for patients and professionals. METHODS A multidisciplinary workgroup (including mental health, anesthesia, preventive medicine, and occupational risk professionals) was formed in the Hospital Clínic de Barcelona, in March 2020. A core group conducted a review of the scientific literature and healthcare organizations' guidelines and wrote a protocol draft. Then, a discussion with the workgroup was made until consensus was reached. The protocol has been continuously updated. Discussions were made by group e-mailing and video conferencing. RESULTS The protocol includes the following main areas: (1) ECT unit's structural and functional considerations; (2) SARS-CoV-2 screening protocol; (3) ECT clinical practice adaptation (personal protective equipment, airway management, recovery room, and maintenance of the facilities); (4) management of COVID-19 cases; and (5) protocol assessment. LIMITATIONS The literature review was not systematic; the consensus was not based on a structured methodology. For other ECT units, local advisories may not be valid, and resource shortages (such as anesthetist availability, or the lack of respirators and PCR tests) may impede or prevent their implementation. CONCLUSIONS During the COVID-19 pandemic, ECT should continue to be advocated as an essential medical procedure. It is recommended that each ECT unit develop its own protocol. This proposal may be used as a reference.
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Affiliation(s)
- Joaquín Gil-Badenes
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Catalonia, Spain,Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Catalonia, Spain,Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain
| | - Ricard Valero
- Department of Anaesthesiology, Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Catalonia, Spain,Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Elisabet Macau
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain
| | - Maria Jesús Bertran
- Preventive Medicine and Epidemiology Department, Hospital Clínic de Barcelona, Catalonia, Spain,Clínic Institute of Medicine and Dermatology (ICMiD), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain
| | - Gerard Claver
- Occupational Health Services, Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Catalonia, Spain,Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Anna Bastidas Salvadó
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - María Lombraña Mencia
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Catalonia, Spain,Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Catalonia, Spain,Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain,Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain,Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain,University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Catalonia, Spain; Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, Catalonia, Spain; Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalonia, Spain; Hospital Clínic de Barcelona, 170 Villarroel St., 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain; University of Barcelona, 08036 Barcelona, Catalonia, Spain.
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23
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Pacchiarotti I, Kotzalidis GD, Murru A, Mazzarini L, Rapinesi C, Valentí M, Anmella G, Gomes-da-Costa S, Gimenez A, Llach C, Perugi G, Vieta E, Verdolini N. Mixed Features in Depression: The Unmet Needs of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Psychiatr Clin North Am 2020; 43:59-68. [PMID: 32008688 DOI: 10.1016/j.psc.2019.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 12/16/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition introduced the specifier "with mixed features" including 3 or more nonoverlapping typical manic symptoms during a major depressive episode in bipolar disorder type I or II or unipolar major depressive disorder. Excluding overlapping excitatory symptoms, which are frequently observed in mixed depression, leaves many patients with mixed depression undiagnosed. As a consequence, alternative diagnostic criteria have been proposed, claiming for the inclusion in the rubric of mixed features the following symptoms: psychomotor agitation, mood lability, and aggressiveness. A deeper diagnostic reconsideration of mixed features in depression should be provided by the new nosologic classification systems.
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Affiliation(s)
- Isabella Pacchiarotti
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Giorgio D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea University Hospital, UOC Psichiatria, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Andrea Murru
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Lorenzo Mazzarini
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea University Hospital, UOC Psichiatria, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Chiara Rapinesi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea University Hospital, UOC Psichiatria, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Marc Valentí
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Gerard Anmella
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Susana Gomes-da-Costa
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Anna Gimenez
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Cristian Llach
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Eduard Vieta
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain.
| | - Norma Verdolini
- Barcelona Bipolar and Depressive Disorders Program, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, Barcelona, Catalonia 08036, Spain
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24
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Giménez A, Pacchiarotti I, Gil J, Murru A, Gomes SP, Pinzón JE, Anmella G, Gómez-Ramiro M, Verdolini N, Valentí M, Goikolea JM, Vieta E. Adverse outcomes during pregnancy and major congenital malformations in infants of patients with bipolar and schizoaffective disorders treated with antiepileptic drugs: a systematic review. Psychiatr Pol 2019; 53:223-244. [DOI: 10.12740/pp/105906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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25
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Pacchiarotti I, Tiihonen J, Kotzalidis GD, Verdolini N, Murru A, Goikolea JM, Valentí M, Aedo A, Vieta E. Long-acting injectable antipsychotics (LAIs) for maintenance treatment of bipolar and schizoaffective disorders: A systematic review. Eur Neuropsychopharmacol 2019; 29:457-470. [PMID: 30770235 DOI: 10.1016/j.euroneuro.2019.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 11/16/2018] [Revised: 01/09/2019] [Accepted: 02/02/2019] [Indexed: 01/08/2023]
Abstract
Long-Acting Injectable Antipsychotics (LAIs) are used to overcome non-compliance in psychoses, mainly schizophrenia spectrum disorders. We aimed to summarize available evidence of studies comparing the efficacy of LAIs to placebo or oral medications for Bipolar Disorder (BD) and/or Schizoaffective Disorder (SAD). We searched six databases from inception to 28-March-2018, using the strategy: long-acting antipsychotics AND (bipolar disorder OR schizoaffective disorder OR mania OR manic OR bipolar depression). We included peer-reviewed double-blind comparisons of LAIs for any clinical outcome occurrence in BD, or open mirror studies with same prospective as retrospective assessment periods. We excluded studies reporting on mixed schizophrenia/SAD populations without reporting results separately. The pooled records amounted to 642. After duplicate removal and inclusion/exclusion criteria application, we included 15 studies, 6 double-blind and 9 open, 13 assessing BD and 2 SAD. Depot neuroleptics prevented manic, but not depressive recurrences and may worsen depressive symptoms. Risperidone long-acting injectable was found to be effective in protecting from any mood/manic symptom compared to placebo, but not from depressive recurrences. Add-on or monotherapy paliperidone palmitate in SAD patients protected from psychotic, depressive, and manic symptoms. In patients with BD-I with a manic episode at study enrolment, aripiprazole monohydrate significantly delayed time to recurrence of manic episodes without inducing depressive episodes. LAIs are effective and well-tolerated maintenance treatments for BD and SAD. They showed better efficacy in preventing mania than depression. LAIs may be first-line for BD-I and SAD patients with a manic predominant polarity and with non-adherence problems.
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Affiliation(s)
- Isabella Pacchiarotti
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Norma Verdolini
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalunya, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Andrea Murru
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain
| | - José Manuel Goikolea
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain
| | - Marc Valentí
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain
| | - Alberto Aedo
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain; Unidad de Trastorno Afectivo Bipolar, Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st., Barcelona, Catalunya, Spain.
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26
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Goikolea JM, Dima D, Landín-Romero R, Torres I, DelVecchio G, Valentí M, Amann BL, Bonnín CM, McKenna PJ, Pomarol-Clotet E, Frangou S, Vieta E. Multimodal Brain Changes in First-Episode Mania: A Voxel-Based Morphometry, Functional Magnetic Resonance Imaging, and Connectivity Study. Schizophr Bull 2019; 45:464-473. [PMID: 29672741 PMCID: PMC6403052 DOI: 10.1093/schbul/sby047] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/16/2022]
Abstract
BACKGROUND Brain structural and functional changes in bipolar disorder (BD) are well-established findings, but it is uncertain whether these changes are already present in first episode mania (FEM). METHODS We compared 31 FEM subjects, with 31 healthy individuals matched for age, sex, and premorbid IQ. Whole-brain voxel-wise morphometry, functional magnetic resonance imaging during the n-back task, and a functional connectivity analysis were performed. RESULTS There were no volumetric differences between the 2 groups. During the 2-back task, FEM patients did not perform differently from controls and activated similar regions, but they showed less deactivation in the ventromedial prefrontal cortex (vmPFC), the anterior hub of the default mode network (DMN). They showed preserved functional connectivity between the vmPFC and other regions of the DMN, but increased connectivity with the superior frontal gyrus. CONCLUSIONS The absence of volumetric changes in FEM patients suggests that these changes could be related to progression of the illness. On the other hand, the failure of deactivation of the anterior hub of the DMN is present from the onset of the illness and may represent a core pathophysiological feature of BD.
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Affiliation(s)
- José M Goikolea
- Barcelona Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City University London, London, UK,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Ramón Landín-Romero
- FIDMAG Germanes Hospitalàries Research Foundation, Benito Menni Complex Assistencial en Salut Mental, CIBERSAM, Barcelona, Catalonia, Spain
| | - Imma Torres
- Barcelona Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Marc Valentí
- Barcelona Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Benedikt L Amann
- FIDMAG Germanes Hospitalàries Research Foundation, Benito Menni Complex Assistencial en Salut Mental, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina Mar Bonnín
- Barcelona Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Benito Menni Complex Assistencial en Salut Mental, CIBERSAM, Barcelona, Catalonia, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Benito Menni Complex Assistencial en Salut Mental, CIBERSAM, Barcelona, Catalonia, Spain
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eduard Vieta
- Barcelona Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,To whom correspondence should be addressed; Bipolar Disorder Program, Clinical Institute of Neuroscience, Hospital Clinic of Barcelona, Villarroel, 170, 08036 Barcelona, Spain; tel: +34-93-227-5401; fax: +34-93-227-9228, e-mail:
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27
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Bonnín CM, Martínez-Arán A, Reinares M, Valentí M, Solé B, Jiménez E, Montejo L, Vieta E, Rosa AR. Thresholds for severity, remission and recovery using the functioning assessment short test (FAST) in bipolar disorder. J Affect Disord 2018; 240:57-62. [PMID: 30053684 DOI: 10.1016/j.jad.2018.07.045] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/07/2018] [Accepted: 07/15/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite its importance, no distinction between none, mild, moderate and severe functional impairment is available. Categorization of functional impairment could help to better assess randomized controlled trials (RCT) and to study the correlates of functional impairment according to severity. The Functional Assessment Short Test (FAST) is one of the most widely used measures of functional impairment in bipolar disorder and related conditions, but to date no severity cut-offs have been determined for their use in clinical research and practice. METHOD FAST and Global Functioning Assessment (GAF) ratings from 65 euthymic outpatients with bipolar disorder at the Hospital Clínic in Barcelona were analyzed. A linear regression was computed using the FAST as the independent variable and the GAF as the dependent variable. Cut-offs scores for the FAST were estimated taking into account the GAF scores as a reference. RESULTS Linear regression analysis with GAF scores as the dependent variable yielded the following equation: GAF score = 91,41-1,031 * FAST score. The cut-off scores for the FAST scale derived from this equation were as follows: scores from 0 to 11 included patients with no impairment. Scores from 12 to 20, represented the category of mild impairment. Moderate impairment comprised scores from 21 to 40. Finally, scores above 40 represent severe functional impairment. Further, the 4 × 4 cross-tabulation resulted in a significant association of FAST and GAF severity gradation: (Chi2 = 95,095; df = 9; p < 0,001). Chance-corrected agreement was κ = 0,65 (p < 0.001). LIMITATIONS In the absence of a better alternative, the GAF, a broad clinical measure, was used as gold standard for establishing FAST categories according to severity. CONCLUSION The categorization of functional impairment in four categories based on empirical data shows that 12, 20 and 40 represent clinically meaningful cut-offs of the FAST for mild, moderate, and severe functional impairment and for functional recovery, remission, and improvement. The proposed categories are suitable to be further implemented in clinical studies and RCTs.
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Affiliation(s)
- C M Bonnín
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martínez-Arán
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - M Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - L Montejo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - A R Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Pharmacology, Postgraduate Program in Pharmacology and Therapeutics and Postgraduate Program in Psychiatry and Behavior Science, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Bonnín CM, Yatham LN, Michalak EE, Martínez-Arán A, Dhanoa T, Torres I, Santos-Pascual C, Valls E, Carvalho AF, Sánchez-Moreno J, Valentí M, Grande I, Hidalgo-Mazzei D, Vieta E, Reinares M. Psychometric properties of the well-being index (WHO-5) spanish version in a sample of euthymic patients with bipolar disorder. J Affect Disord 2018; 228:153-159. [PMID: 29248821 DOI: 10.1016/j.jad.2017.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 07/13/2017] [Revised: 10/18/2017] [Accepted: 12/03/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The concept of well-being which focuses on positive emotions has received increased research attention. However, a consensus definition of this term is lacking. The Well-Being Index scale (WHO-5) is a generic, self-report scale that contains five Likert-type items to evaluate psychological well-being. This construct may provide a relevant outcome in bipolar disorder (BD) research and care beyond the rating of mood symptoms. Thus, in the current study, the psychometric properties of the WHO-5 Spanish version were assessed in a sample of euthymic patients with BD. METHODS Patients with BD- I and BD-II and healthy controls completed the Well-Being Index (WHO-5) together with an assessment of depressive (Hamilton Depression Rating Scale-17; HAM-D) and manic symptoms (Young Mania Rating Scale; YMRS); and a measure of psychosocial functioning (Functioning Assessment Short Test; FAST). Internal consistency reliability was measured through Cronbach's alpha. Test-retest reliability was calculated comparing the WHO-5 total score at baseline and after 10 days of the first administration. To assess the structure of the scale, a principal component analysis (PCA) was carried out. Correlations between the WHO-5, HAM-D, YMRS and FAST were calculated. Finally, a t-test for independent samples was applied to compare the WHO-5 total score in the patient and control groups. RESULTS A total of 104 patients with BD and 40 healthy controls were included in this study. A Chronbach's alpha of 0.83 indicated acceptable internal consistency. A paired sample t-test revealed no significant differences between WHO-5 total score at baseline and at follow-up (tn = - 0.72; df = 15; p = 0.48). The PCA provided a single factor solution that accounted for 59.74% of the variation in WHO-5. Test-retest reliability was high (r = 0.83; p < 0.001). Moderate negative correlations were observed between the WHO-5 total score, the FAST (r = - 0.46.; p < 0.001) and the HAM-D (r = - 0.68; p < 0.001), but not with the YMRS (r = - 0.07; p = 0.42). Finally, significant differences were found when comparing the WHO-5 total score between patient and healthy controls (t = 5.1; df = 147; p < 0.001). LIMITATIONS some limitations include the lack of a comparator scale to test for validity construct and the small sample size in the test-retest reliability CONCLUSIONS: The WHO-5 shows an acceptable reliability index and measures a unitary construct in a Spanish population of euthymic patients with BD.
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Affiliation(s)
- C M Bonnín
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - L N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - E E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Martínez-Arán
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - T Dhanoa
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - I Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Santos-Pascual
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Valls
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A F Carvalho
- Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - J Sánchez-Moreno
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Grande
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - D Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - M Reinares
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Garrido JM, Sánchez-Moreno J, Vázquez M, Hidalgo D, Valentí M, Goikolea JM, Benabarre A, Ylla A, Grande I, Vieta E, Trilla A. Evaluation of Patient Satisfaction in a State Reference Center of Bipolar Disorder. J Behav Health Serv Res 2017; 46:319-329. [DOI: 10.1007/s11414-017-9561-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Alonso-Lana S, Valentí M, Romaguera A, Sarri C, Sarró S, Rodríguez-Martínez A, Goikolea JM, Amann BL, Maristany T, Salvador R, Vieta E, McKenna PJ, Pomarol-Clotet E. Brain functional changes in first-degree relatives of patients with bipolar disorder: evidence for default mode network dysfunction. Psychol Med 2016; 46:2513-2521. [PMID: 27334766 DOI: 10.1017/s0033291716001148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Relatively few studies have investigated whether relatives of patients with bipolar disorder show brain functional changes, and these have focused on activation changes. Failure of de-activation during cognitive task performance is also seen in the disorder and may have trait-like characteristics since it has been found in euthymia. METHOD A total of 20 euthymic patients with bipolar disorder, 20 of their unaffected siblings and 40 healthy controls underwent functional magnetic resonance imaging during performance of the n-back working memory task. An analysis of variance (ANOVA) was fitted to individual whole-brain maps from each set of patient-relative-matched pair of controls. Clusters of significant difference among the groups were used as regions of interest to compare mean activations/de-activations between them. RESULTS A single cluster of significant difference among the three groups was found in the whole-brain ANOVA. This was located in the medial prefrontal cortex, a region of task-related de-activation in the healthy controls. Both the patients and their siblings showed significantly reduced de-activation compared with the healthy controls in this region, but the failure was less marked in the relatives. CONCLUSIONS Failure to de-activate the medial prefrontal cortex in both euthymic bipolar patients and their unaffected siblings adds to evidence for default mode network dysfunction in the disorder, and suggests that it may act as a trait marker.
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Affiliation(s)
- S Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
| | - M Valentí
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic,University of Barcelona,IDIBAPS,Barcelona,Spain
| | - A Romaguera
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
| | - C Sarri
- Benito Menni Complex Assistencial en Salut Mental,Barcelona,Spain
| | - S Sarró
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
| | | | - J M Goikolea
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic,University of Barcelona,IDIBAPS,Barcelona,Spain
| | - B L Amann
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
| | - T Maristany
- Hospital Sant Joan de Déu Infantil,Barcelona,Spain
| | - R Salvador
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
| | - E Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),Madrid,Spain
| | - P J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
| | - E Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation,Barcelona,Spain
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Hidalgo-Mazzei D, Mateu A, Reinares M, Murru A, Del Mar Bonnín C, Varo C, Valentí M, Undurraga J, Strejilevich S, Sánchez-Moreno J, Vieta E, Colom F. Psychoeducation in bipolar disorder with a SIMPLe smartphone application: Feasibility, acceptability and satisfaction. J Affect Disord 2016; 200:58-66. [PMID: 27128358 DOI: 10.1016/j.jad.2016.04.042] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [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: 03/01/2016] [Revised: 04/11/2016] [Accepted: 04/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND During the last fifteen years, the possibility of delivering psychoeducation programs through Internet-based platforms have been explored. Studies evaluating those programs have shown good to acceptable retention rates. In this context, we developed a smartphone application (SIMPLe) collecting information about mood symptoms and offering personalized psychoeducation messages. The main aims of this study were to evaluate the feasibility, acceptability and satisfaction of the smartphone application. METHODS The study was conducted from March to August 2015. Participation in the study was proposed to a consecutive sample of adult patients attending an outpatient mental health clinic. Sociodemographic data, clinical and functional assessments alongside smartphone ownership and uses were collected at baseline and at 3 months' follow-up. A 5 item Likert-scale satisfaction questionnaire was also employed. RESULTS 51 participants were initially enrolled in the study, 36 (74%) remained actively using the application after 3 months. The whole sample interacted with the application a mean of 77 days (SD=26.2). During these days they completed 88% of the daily tests. Over 86% of the participants agreed that the experience using the application was satisfactory. LIMITATIONS The diversity of smartphones operating systems led to a moderate, although representative, sample number. Additionally, the subjective data reporting, narrow time frame of use and stability of the patients could have affected the results. CONCLUSIONS The results confirm that this particular intervention is feasible and represent a satisfactory and acceptable instrument for the self-management of bipolar disorder as an add-on to the usual treatment but future clinical trials must still probe its efficacy.
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Affiliation(s)
- Diego Hidalgo-Mazzei
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ainoa Mateu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Andrea Murru
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina Del Mar Bonnín
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cristina Varo
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Marc Valentí
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Juan Undurraga
- Department of Psychiatry, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Early Intervention Program, Instituto Psiquiátrico "Dr Horwitz Barak", Santiago, Chile
| | - Sergio Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
| | - José Sánchez-Moreno
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Francesc Colom
- Mental Health Group, IMIM-Hospital del Mar, Barcelona, Catalonia, Spain
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Valentí M, Pacchiarotti I, Undurraga J, Bonnín CM, Popovic D, Goikolea JM, Torrent C, Hidalgo-Mazzei D, Colom F, Vieta E. Risk factors for rapid cycling in bipolar disorder. Bipolar Disord 2015; 17:549-59. [PMID: 25682854 DOI: 10.1111/bdi.12288] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Received: 06/19/2014] [Accepted: 10/23/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical factors associated with the development of rapid cycling, as well as to elucidate the role of antidepressants. METHODS The present study (NCT01503489) is a prospective, naturalistic cohort study conducted in a sample of 289 patients diagnosed with bipolar disorder followed and treated for up to 14 years. The patients were divided into two groups on the basis of the development of a rapid cycling course (n = 48) or no development of such a course (n = 241), and compared regarding sociodemographic, clinical, and outcome variables. RESULTS Among the 289 patients, 48 (16.6%) developed a rapid cycling course during the follow-up. Several differences were found between the two groups, but after performing Cox regression analysis, only atypical depressive symptoms (p = 0.001), age at onset (p = 0.015), and number of suicide attempts (p = 0.030) persisted as significantly associated with the development of a rapid cycling course. CONCLUSIONS The development of rapid cycling during the course of bipolar disorder is associated with a tendency to chronicity, with a poorer outcome, and with atypical depressive symptomatology. Our study also suggests that the development of rapid cycling is associated with a higher use of antidepressants.
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Affiliation(s)
- Marc Valentí
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Juan Undurraga
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.,Department of Psychiatry, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - C Mar Bonnín
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Dina Popovic
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - José M Goikolea
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carla Torrent
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Colom
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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León-Caballero J, Pacchiarotti I, Murru A, Valentí M, Colom F, Benach B, Pérez V, Dalmau J, Vieta E. Bipolar disorder and antibodies against the N-methyl-d-aspartate receptor: A gate to the involvement of autoimmunity in the pathophysiology of bipolar illness. Neurosci Biobehav Rev 2015; 55:403-12. [PMID: 26014349 DOI: 10.1016/j.neubiorev.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/04/2015] [Accepted: 05/11/2015] [Indexed: 01/15/2023]
Abstract
The high prevalence of comorbidity between bipolar disorder (BD) and other medical conditions, including autoimmune diseases, supports the hypothesis of the nature of BD as a biological illness category. Hence, an immune dysregulation process may play an important role in the development of at least certain subtypes of BD. Increasing evidence also suggests that the N-methyl-d-aspartate receptor (NMDAR) may be relevant in the pathophysiology of BD. A possible key mechanism underlying the physiopathology of certain autoimmune diseases that may present with affective symptoms might be the production of anti-NMDAR auto-antibodies (auto-Abs). The best characterized autoimmune anti-NMDAR disease is the anti-NMDAR encephalitis. It has been found that 4% of these patients present isolated, mostly affective, psychiatric manifestations during their illness. An interesting suggestion emerged from this overview is that the same mechanisms that trigger affective symptoms in patients with increased anti-NMDAR auto-Abs levels could be involved in the physiopathology of at least a subgroup of BD. Future studies are needed to characterize the relationship between anti-NMDAR auto-Abs and BD.
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Affiliation(s)
- J León-Caballero
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Universidad Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - F Colom
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Benach
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - V Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Universidad Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - J Dalmau
- Catalan Institution for Research and Advanced Studies (ICREA), IDIBAPS, University of Barcelona; Department of Neurology, University of Pennsylvania
| | - E Vieta
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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Sarró S, Madre M, Fernández-Corcuera P, Valentí M, Goikolea JM, Pomarol-Clotet E, Berk M, Amann BL. Transcultural adaption and validation of the Spanish version of the Bipolar Depression Rating Scale (BDRS-S). J Affect Disord 2015; 172:110-5. [PMID: 25451403 DOI: 10.1016/j.jad.2014.10.009] [Citation(s) in RCA: 9] [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: 09/18/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Bipolar Depression Rating Scale (BDRS) arguably better captures symptoms in bipolar depression especially depressive mixed states than traditional unipolar depression rating scales. The psychometric properties of the Spanish adapted version, BDRS-S, are reported. METHODS The BDRS was translated into Spanish by two independent psychiatrists fluent in English and Spanish. After its back-translation into English, the BDRS-S was administered to 69 DSMI-IV bipolar I and II patients who were recruited from two Spanish psychiatric hospitals. The Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS) were concurrently administered. 42 patients were reviewed via video by four psychiatrists blind to the psychopathological status of those patients. In order to assess the BDRS-S intra-rater or test-retest validity, 22 subjects were assessed by the same investigator performing two evaluations within five days. RESULTS The BDRS-S had a good internal consistency (Cronbach׳s α=0.870). We observed strong correlations between the BDRS-S and the HDRS (r=0.874) and MADRS (r=0.854) and also between the mixed symptom cluster score of the BDRS-S and the YMRS (r=0.803). Exploratory factor analysis revealed a three factor solution: psychological depressive symptoms cluster, somatic depressive symptoms cluster and mixed symptoms cluster. LIMITATIONS A relatively small sample size for a 20-item scale. CONCLUSIONS The BDRS-S provides solid psychometric performance and in particular captures depressive or mixed symptoms in Spanish bipolar patients.
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Affiliation(s)
- Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, CIBERSAM, Barcelona, Spain
| | - Mercè Madre
- FIDMAG Germanes Hospitalàries Research Foundation, CIBERSAM, Barcelona, Spain; Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain
| | - Paloma Fernández-Corcuera
- FIDMAG Germanes Hospitalàries Research Foundation, CIBERSAM, Barcelona, Spain; Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain
| | - Marc Valentí
- Bipolar Disorders Program, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - José M Goikolea
- Bipolar Disorders Program, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, School of Medicine, Australia; Orygen Youth Health Research Centre, Florey Institute for Neuroscience and Mental Health and, Department of Psychiatry, University of Melbourne, Australia
| | - Benedikt L Amann
- FIDMAG Germanes Hospitalàries Research Foundation, CIBERSAM, Barcelona, Spain.
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Abstract
Atypical antipsychotics have been used to treat patients with schizophrenia for many years, but now there is increasing evidence of their utility in the treatment of mood disorders. In the past few years, several atypical agents have received regulatory approval for use in mania. The evidence shows that atypical antipsychotics are effective in the treatment of manic symptoms, either alone or in combination with traditional mood stabilizers, such as lithium and divalproex. Although emerging data indicate that atypical antipsychotics will be a promising addition to those therapies that are currently available for managing patients during the maintenance phase of bipolar illness, their potential in the long-term management of bipolar disorder remains to be fully explored. Aripiprazole is a recently released antipsychotic medication that differs from other atypical antipsychotic agents by its mode of action as a dopamine D2 partial agonist. It is administered orally and has a long half-life. Randomized studies have demonstrated the efficacy of aripiprazole compared with placebo in the treatment of acute relapse of schizophrenia and schizoaffective disorder, maintenance treatment of schizophrenia, treatment of acute mania, and prevention of manic relapse in patients who responded to the drug during a manic episode. Further studies are ongoing in bipolar and unipolar depression. Aripiprazole is generally well tolerated compared with other antipsychotic medications, although commonly reported side effects include extrapyramidal symptoms and motoric activation similar to akathisia. Further studies and postmarketing data will be helpful in providing additional information regarding the comparative safety, efficacy and tolerability of aripiprazole in the treatment of affective disorders.
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Affiliation(s)
- Margarita García-Amador
- Clinical Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain.
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Olazarán J, López-Álvarez J, Agüera-Ortiz L, Valentí M, Zea-Sevilla MA, González B, León-Salas B, Dobato JL, Rábano A. Brain Donation by Proxy: Are There Predictors in Neurodegenerative Dementia? J Prev Alzheimers Dis 2014; 1:151-159. [PMID: 29251742 DOI: 10.14283/jpad.2014.28] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the frequency and predictors of brain donation by relatives in patients with neurodegenerative dementia. DESIGN Database review and quantitative analysis. SETTING The Alzheimer Center Reina Sofia Foundation (ACRSF), a center devoted to the care and research of patients with neurodegenerative dementia. PARTICIPANTS Patients with signed consent for participation in the ACRSF research program. MEASUREMENTS A set of 38 demographic, clinical, and social variables related to patient and closest relative, which were collected by the ACRSF multidisciplinary team upon patient admission. RESULTS Admission data were available for 198 patients who entered the ACRSF research program; 85 of them (42.9%) died during follow-up. Mean age (SD) at admission was 82.3 (6.8) years and 80.8% of the patients were female. Family link between patient and closest relative was spouse or partner (12.0%), son or daughter (74.9%), or other link (13.1%). Brain was obtained from 56 patients (65.9%). Consent by legal representative and patient's depressive symptoms were more frequent in the donors (p<0.05, corrected) and trend was observed for more aberrant motor symptoms in the donors (p<0.05, uncorrected). CONCLUSION A high rate of brain donation was achieved, probably due to the unique characteristics of the ACRSF and consent for research policy. Wish of alleviating suffering, as well as general interest in dementia research, possibly exerted an influence in brain donation. More research is needed to ascertain the values, motivations, and circumstances that may lead to brain donation by proxy in neurodegenerative dementia.
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Affiliation(s)
- J Olazarán
- Javier Olazarán, Unidad de Investigación Proyecto Alzheimer, Center Reina Sofía Foundation - CIEN Foundation,, Valderrebollo 5, 28031 Madrid (Spain), Tel.: 00 34 913852200, Fax: 00 34 913852118, E-mail:
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Pacchiarotti I, Bond DJ, Baldessarini RJ, Nolen WA, Grunze H, Licht RW, Post RM, Berk M, Goodwin GM, Sachs GS, Tondo L, Findling RL, Youngstrom EA, Tohen M, Undurraga J, González-Pinto A, Goldberg JF, Yildiz A, Altshuler LL, Calabrese JR, Mitchell PB, Thase ME, Koukopoulos A, Colom F, Frye MA, Malhi GS, Fountoulakis KN, Vázquez G, Perlis RH, Ketter TA, Cassidy F, Akiskal H, Azorin JM, Valentí M, Mazzei DH, Lafer B, Kato T, Mazzarini L, Martínez-Aran A, Parker G, Souery D, Ozerdem A, McElroy SL, Girardi P, Bauer M, Yatham LN, Zarate CA, Nierenberg AA, Birmaher B, Kanba S, El-Mallakh RS, Serretti A, Rihmer Z, Young AH, Kotzalidis GD, MacQueen GM, Bowden CL, Ghaemi SN, Lopez-Jaramillo C, Rybakowski J, Ha K, Perugi G, Kasper S, Amsterdam JD, Hirschfeld RM, Kapczinski F, Vieta E. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013; 170:1249-62. [PMID: 24030475 PMCID: PMC4091043 DOI: 10.1176/appi.ajp.2013.13020185] [Citation(s) in RCA: 436] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. METHOD An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. RESULTS There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. CONCLUSIONS Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
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Pacchiarotti I, Nivoli AMA, Mazzarini L, Kotzalidis GD, Sani G, Koukopoulos A, Scott J, Strejilevich S, Sánchez-Moreno J, Murru A, Valentí M, Girardi P, Vieta E, Colom F. The symptom structure of bipolar acute episodes: in search for the mixing link. J Affect Disord 2013; 149:56-66. [PMID: 23394711 DOI: 10.1016/j.jad.2013.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/11/2013] [Accepted: 01/11/2013] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The nature of mixed mood episodes is still a matter of controversy amongst experts. Currently, the approach to this syndrome is mainly categorical and very restrictive. The factor-structure of bipolar mood episodes has not been studied yet. We performed a dimensional analysis of the structure of bipolar episodes aimed at identifying a factor deconstructing mixed episodes; furthermore, we analyzed correlations of factors emerging from the factorial analysis of the Brief Psychiatric Rating Scale (BPRS) with Temperament Evaluation of Memphis-Pisa-Paris-San Diego (TEMPS-A) and predominant polarity. METHOD 187 consecutive bipolar I inpatients hospitalized for DSM-IV-TR acute mood episodes (depressive, manic or mixed) underwent a standardized assessment, including the 24-item Brief Psychiatric Rating Scale (BPRS 4.0), the 21-item Hamilton Depression Rating Scale (HDRS-21), the Young Mania Rating Scale (YMRS) and the TEMPS-A. Principal factor analysis was performed on BPRS-24 items. RESULTS This analysis revealed five factors corresponding to "psychosis", "euphoric mania", "mixity", "dysphoria" and "inhibited depression", capturing 71.89% of the rotated variance. The mixity factor was characterized by higher rates of suicidal ideation, more mixed episodes, higher frequencies of antidepressant (AD) use, depressive predominant polarity and anxious temperament. DISCUSSION The factor-structure of the BPRS in inpatients with bipolar I disorder with an acute episode of any type is pentafactorial; one factor identified is the mixity factor, which is independent from other factors and characterized by anxiety and motor hyperactivity and by the absence of motor retardation. Our results should prompt reconsideration of proposals for DSM-5 diagnostic criteria for the mixed features specifier. Limitations of the study include the relative small sample, the absence of drug-naïve patients and the use of rating scales no specific for mixed states.
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Affiliation(s)
- Isabella Pacchiarotti
- Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) nomenclature for the co-occurrence of manic and depressive symptoms (mixed states) has been revised in the new DSM-5 version to accommodate a mixed categorical-dimensional concept. The new classification will capture subthreshold non-overlapping symptoms of the opposite pole using a "with mixed features" specifier to be applied to manic episodes in bipolar disorder I (BD I), hypomanic, and major depressive episodes experienced in BD I, BD II, bipolar disorder not otherwise specified, and major depressive disorder. The revision will have a substantial impact in several fields: epidemiology, diagnosis, treatment, research, education, and regulations. The new concept is data-driven and overcomes the problems derived from the extremely narrow definition in the DSM-IV-TR. However, it is unclear how clinicians will deal with the possibility of diagnosing major depression with mixed features and how this may impact the bipolar-unipolar dichotomy and diagnostic reliability. Clinical trials may also need to address treatment effects according to the presence or absence of mixed features. The medications that are effective in treating mixed episodes per the DSM-IV-TR definition may also be effective in treating mixed features per the DSM-5, but new studies are needed to demonstrate it.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorder Programme, Institute of Neuroscience, University of Barcelona Hospital Clínic, IDIBAPS, CIBERSAM, C/Villarroel 170, Barcelona 08036, Catalonia, Spain.
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Nivoli AMA, Colom F, Pacchiarotti I, Murru A, Scott J, Valentí M, Mazzarini L, Del Mar Bonnin C, Sánchez-Moreno J, Serretti A, Vieta E. Treatment strategies according to clinical features in a naturalistic cohort study of bipolar patients: a principal component analysis of lifetime pharmacological and biophysic treatment options. Eur Neuropsychopharmacol 2013; 23:263-75. [PMID: 22939529 DOI: 10.1016/j.euroneuro.2012.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of patients with bipolar disorder (BD) is complex and psychiatrists often have to change treatment strategies. However, available data do not provide information about the most frequent patterns of treatment strategies prescribed in clinical practice and clinical/socio-demographic factors of drugs prescription. OBJECTIVE The aims of this study were: (1) to identify specific patterns of life-time treatment strategies in a representative sample of bipolar patients; (2) to assess consistency with guidelines recommendations; and (3) to investigate clinical/socio-demographic of patients. METHODS Six-hundred and four BD I and II out-patients were enrolled in a naturalistic cohort study at the Barcelona Bipolar Disorders Program, in a cross-sectional analysis. A principal component analysis was applied to group psychotropic drugs into fewer underlying clusters which represent patterns of treatment strategies more frequently adopted in the life-time naturalistic treatment of BD. RESULTS Three main factors corresponding to three main prescription patterns were identified, which explained about 60% of cases, namely, Factor 1 (21.1% of common variance), defined the "antimanic stabilisation package" including treatments with antimanic mechanism of action in predominantly manic-psychotic BD I patients; Factor 2 (20.4%), "antidepressive stabilisation package" that grouped predominantly depressed patients, and Factor 3 (16.4%) defined the "anti-bipolar II package", including antidepressant monotherapy in BD II patients with depressive predominant polarity, melancholic features and higher rates of suicide behaviours. CONCLUSIONS This study identified three patterns of lifetime treatment strategies in three specific and different groups of naturalistically treated bipolar patients.
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Affiliation(s)
- Alessandra M A Nivoli
- Bipolar Disorder Program, Institute of Clinical Neuroscience, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036, Barcelona, Catalonia, Spain
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Goikolea JM, Colom F, Torres I, Capapey J, Valentí M, Undurraga J, Grande I, Sanchez-Moreno J, Vieta E. Lower rate of depressive switch following antimanic treatment with second-generation antipsychotics versus haloperidol. J Affect Disord 2013; 144:191-8. [PMID: 23089129 DOI: 10.1016/j.jad.2012.07.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Treatment of acute mania with second-generation antipsychotics has been claimed to involve a lower risk of switch to depression than haloperidol. However, clinical guidelines clearly state that this is not a proven fact. METHODS Meta-analysis of double-blind randomized controlled trials in acute mania, comparing rates of switch to depression with atypical antipsychotics and with haloperidol. Search was conducted in MEDLINE and CENTRAL databases (last search: September 2011). RESULTS 8 randomized clinical trials fulfilled inclusion criteria. 2 of them were excluded because of low methodological quality or lack of data. 5 second-generation antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone) were compared to haloperidol. In the mixed effects model the Risk Ratio for depressive switch was 0.71 (0.52, 0.96) favouring atypical antipsychotics. In the random effects model the difference did not reach statistical significance. In the heterogeneity analysis, exclusion of an outlying aripiprazole trial yielded a Risk Ratio of 0.58 (0.42, 0.82) with a non-significant heterogeneity test. Although no atypical antipsychotic was individually significantly superior to haloperidol, a trend could be seen favouring olanzapine (RR=0.56 [0.29, 1.08]), quetiapine (RR=0.36 [0.10, 1.33]), and ziprasidone (RR=0.51 [0.22, 1.18]). LIMITATIONS All trials were industry supported, with some variability in dosage of haloperidol. Switch to depression was not the primary outcome of the trials. Heterogeneity could be explained as a lack of class-effect for atypicals. CONCLUSIONS Treating acute mania with atypicals is associated to 42% less risk of switch to depression than with haloperidol. Nevertheless, caution should be taken when considering this a class effect, as only olanzapine, quetiapine, and ziprasidone may show a better profile.
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Affiliation(s)
- J M Goikolea
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Undurraga J, Baldessarini RJ, Valentí M, Pacchiarotti I, Tondo L, Vázquez G, Vieta E. Bipolar depression: clinical correlates of receiving antidepressants. J Affect Disord 2012; 139:89-93. [PMID: 22406337 DOI: 10.1016/j.jad.2012.01.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The efficacy and tolerability of antidepressants (ADs) to treat or avoid episodes of depression in bipolar disorder (BPD) patients as well as reasons for using them remain unresolved. METHODS We analyzed patient-characteristics and outcomes of episodes of acute major depression among 290 adult, DSM-IV BPD patients (71% type-I, 52% women) at the Hospital Clinic of Barcelona; 80% were given an AD and 20% were not; 80% of both groups also received mood-stabilizers. We evaluated factors associated with AD-treatment using bivariate analyses and multiple logistic-regression modeling. RESULTS Factors associated with AD-use by multivariate modeling ranked: [a] more years ill, [b] depressive first-lifetime episode, [c] more depressions/year, [d] melancholic index episode, and [e] less affective illness in first-degree relatives. Within 8weeks, depression improved by ≥50%, less often among BPD patients given an AD (64.4%; 38.6% without switching into hypo/mania) than not (82.1%; 78.6% without switching). CONCLUSIONS Use of ADs to treat acute BP-depression was very common and associated with a more severe clinical history. Mood-switching was prevalent with AD-treatment even with mood-stabilizers present.
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Affiliation(s)
- Juan Undurraga
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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Valentí M, Pacchiarotti I, Bonnín CM, Rosa AR, Popovic D, Nivoli AMA, Goikolea JM, Murru A, Undurraga J, Colom F, Vieta E. Risk factors for antidepressant-related switch to mania. J Clin Psychiatry 2012; 73:e271-6. [PMID: 22401488 DOI: 10.4088/jcp.11m07166] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/11/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Treatment of bipolar depression with antidepressants is strongly debated on the basis of the methodologically poor and insufficient data supporting their use and the widely held belief that antidepressants can induce new episodes of abnormal mood elevation or accelerate the rate of cycling. The present study aimed at identifying clinical risk factors for switch into hypomania, mania, or mixed states, within 8 weeks after introduction of an antidepressant or after increasing its dosage, in a prospective, longitudinal design. METHOD 221 consecutive DSM-IV-TR depressed bipolar I and II disorder patients were treated with antidepressants, which were added to previously prescribed mood stabilizers and/or atypical antipsychotics. No patient was on antidepressant monotherapy. The patients were enrolled from October 2005 through January 2010. The primary outcome was the assessment of switch to mania or hypomania within 8 weeks after the introduction or dose increase of an antidepressant. Both groups were compared with analysis of variance and χ² procedures. RESULTS Treatment-emergent affective switch was detected in 54 patients (24.4%) (switch group) while 167 patients (75.6%) (nonswitch group) did not experience a treatment-related switch. The main clinical differences significantly associated with the occurrence of an antidepressant-related switch, after performing logistic regression analysis, were higher rate of previous switches (P < .001) in the switch versus the nonswitch group, lower rate of responses to antidepressants (P < .001) in the switch versus the nonswitch group, and earlier age at onset (P = .026) in the switch versus the nonswitch group. DISCUSSION Bipolar patients with an earlier age at onset and an illness course characterized by lower rate of response to antidepressants and higher rate of switches into mania or hypomania were found to be the ones with higher switch risk. Nevertheless, a greater number of previous antidepressant exposures was not associated with the occurrence of an antidepressant-associated switch. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01503489.
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Affiliation(s)
- Marc Valentí
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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Rosa AR, Reinares M, Amann B, Popovic D, Franco C, Comes M, Torrent C, Bonnín CM, Solé B, Valentí M, Salamero M, Kapczinski F, Vieta E. Six-month functional outcome of a bipolar disorder cohort in the context of a specialized-care program. Bipolar Disord 2011; 13:679-86. [PMID: 22085481 DOI: 10.1111/j.1399-5618.2011.00964.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A marked disparity between functional recovery and symptomatic improvement has been demonstrated in bipolar disorder. However, most of the previous studies have been conducted in the United States, and there is little prospective research from Europe on this topic. The main objective of the present six-month follow-up study was to assess functioning in a sample of Spanish bipolar disorder patients following an acute episode or subsyndromal state. Additionally, we also evaluated the sensitivity to change of the Functioning Assessment Short Test (FAST). METHODS A total of 97 bipolar disorder patients with syndromal (n = 59) or subsyndromal (n = 38) symptoms were evaluated using the 17-item Hamilton Depression Rating Scale and Young Mania Rating Scale. The FAST was the primary measure to assess multiple areas of psychosocial functioning. Functioning was evaluated at four different time periods: baseline, 21 days, three months, and six months. RESULTS A significant improvement in global functioning was found in the whole sample over the six-month period, as indicated by a reduction of FAST total score (mean ± standard deviation) from 39.97 ± 15.10 to 30.65 ± 16.93 (F = 36.104, p = 0.0001). This was also evident in all areas of functioning studied. However, only 26.4% of remitted patients (n = 42) achieved functional recovery, while 79.6% of the total sample (N = 97) experienced clinical remission of acute symptoms. CONCLUSIONS Although many patients presented syndromal recovery, only a minority of them achieved favorable functioning in multiple areas, even after specialized mental health care. Furthermore, the FAST scale was sensitive to detect minimal changes in functioning in both short (21 days) and long (6 months) periods, which may be relevant to the use of this scale in clinical trials.
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Affiliation(s)
- Adriane R Rosa
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Pacchiarotti I, Valentí M, Bonnin CM, Rosa AR, Murru A, Kotzalidis GD, Nivoli AMA, Sánchez-Moreno J, Vieta E, Colom F. Factors associated with initial treatment response with antidepressants in bipolar disorder. Eur Neuropsychopharmacol 2011; 21:362-9. [PMID: 21056928 DOI: 10.1016/j.euroneuro.2010.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/15/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Controversy in antidepressant (AD) use in bipolar depression relies in its potential induction of mood switches and ineffectiveness. Responders to acute AD add-on treatment maintain response with continued treatment, whilst partial/non-responders fail to reach remission despite continuation treatment. We aimed to identify response predictors to acute AD addition in bipolar depression in order to optimize treatment choice in bipolar depression and avoid unnecessary AD exposure of people unlikely to respond. METHODS Two hundred and twenty-one DSM-IV-TR depressed bipolar - type I and II - patients were treated with AD on an observational study. AD response was defined as an at least 50% drop from baseline of their HDRS17 score after 8weeks of treatment. One hundred and thirty-eight patients (138, 62.4%) fulfilled response criteria (RI) whilst 83 patients (37.6%) did not (NRI). In all cases AD therapy was on top of previously prescribed stabilizers and/or atypical antipsychotics. RESULTS RI patients were more likely to have had previous response to ADs, whereas NRI had a higher number of previous mood switches with ADs during past depressive episodes. Psychotic symptoms were more frequent amongst RI, whilst lifetime history of atypical depression was more frequent amongst NRI. NRI had more total, depressive, and hypomanic, but not manic or mixed, episodes in the past than RI. Analyzed through a logistic regression, higher previous response to ADs and lower rate of past hypomanic episodes in RI were the variables explaining intergroups (RI vs. NRI) differences. DISCUSSION Taking into account the proper caution in the use of Ads in bipolar disorder, there is a subgroup of bipolar patients who might benefit from adjunctive Ads. Looking at specific clinical factors during the course of the illness could help physicians in deciding whether to use an antidepressant in a bipolar depressed patient already treated with mood stabilizers.
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Valentí M, Pacchiarotti I, Rosa AR, Bonnín CM, Popovic D, Nivoli AMA, Murru A, Grande I, Colom F, Vieta E. Bipolar mixed episodes and antidepressants: a cohort study of bipolar I disorder patients. Bipolar Disord 2011; 13:145-54. [PMID: 21443568 DOI: 10.1111/j.1399-5618.2011.00908.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to elucidate the factors associated with the occurrence of mixed episodes, characterized by the presence of concomitant symptoms of both affective poles, during the course of illness in bipolar I disorder patients treated with an antidepressant, as well as the role of antidepressants in the course and outcome of the disorder. METHOD We enrolled a sample of 144 patients followed for up to 20 years in the referral Barcelona Bipolar Disorder Program and compared subjects who had experienced at least one mixed episode during the follow-up (n=60) with subjects who had never experienced a mixed episode (n=84) regarding clinical variables. RESULTS Nearly 40% of bipolar I disorder patients treated with antidepressants experienced at least one mixed episode during the course of their illness; no gender differences were found between two groups. Several differences regarding clinical variables were found between the two groups, but after performing logistic regression analysis, only suicide attempts (p<0.001), the use of serotonin norepinephrine reuptake inhibitors (p=0.041), switch rates (p=0.010), and years spent ill (p=0.022) were significantly associated with the occurrence of at least one mixed episode during follow-up. CONCLUSIONS The occurrence of mixed episodes is associated with a tendency to chronicity, with a poorer outcome, a higher number of depressive episodes, and greater use of antidepressants, especially serotonin norepinephrine reuptake inhibitors.
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Affiliation(s)
- Marc Valentí
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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Pacchiarotti I, Valentí M, Colom F, Rosa AR, Nivoli AMA, Murru A, Sánchez-Moreno J, Vieta E. Differential outcome of bipolar patients receiving antidepressant monotherapy versus combination with an antimanic drug. J Affect Disord 2011; 129:321-6. [PMID: 20817267 DOI: 10.1016/j.jad.2010.07.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/30/2010] [Accepted: 07/30/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite antidepressants are widely used in treating bipolar depression, there is much debate about their utility and their potential dangers, involving mood switches and suicidality. Our hypothesis was that the pattern of initial antidepressant prescription, i.e., alone (AM) or in combination with stabilizers (AC) might impact the long-term outcome of patients with bipolar disorder (BP). We aimed to test this hypothesis and to identify outcome measures that could be predicted by initial AM or AC treatment in patients with BP. METHODS We included 95 patients with DSM-IV BP from a pool of 138 patients following a BP program. Patients were rated for initial AM vs. AC treatment when they were first seen in primary care and subdivided into two groups accordingly. Differences in their clinical course were sought investigating course both retrospectively and prospectively (mean follow-up 10 years). Primary outcome measures comprised suicidality and switch rate. RESULTS There were significantly more patients who switched in the AM group than in the AC group. The number of suicide attempts was higher in the AM group. Significance was retained after performing logistic regression. LIMITATIONS Sample size was small and severe BP patients might be overrepresented in this sample. DISCUSSION Initial AM treatment of patients subsequently diagnosed as BP may entrain a course characterized by higher proneness to switch and suicidal behaviour. Accurate initial diagnosis of bipolar depression should prompt combined treatment with antimanic drugs.
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Affiliation(s)
- Isabella Pacchiarotti
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
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Valentí M, Morer A, Lázaro ML, Bernardo M, Castro-Fornieles J. [Repeated transcranial magnetic stimulation in children and adolescents]. Rev Neurol 2010; 50:230-234. [PMID: 20198595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS To gather the knowledge that currently exist on transcranial magnetic stimulation applied in children and adolescents, as well as its possible future therapeutic applications in disorders that have so far shown more chances of being effective. DEVELOPMENT First, we provide a general review of the history of the technique, from its early days until the present day, and we also highlight the studies in the literature that refer to the harmlessness of the technique by referring to histological studies where no pathological changes were found. We then focus on the repeated mode, which is the technique that is most widely used for therapeutic purposes, both in adults and in children and adolescents, despite the fact that its frequency of use is clearly lower than that of other modes. We centre our attention on the disorders in which the technique has been applied, the ones that to date have been most successful (therapeutically speaking), the subjective experiences of the patients themselves and the side effects that they have suffered. CONCLUSIONS Further studies need to be conducted on the use of repeated transcranial magnetic stimulation to treat different neurological and psychiatric disorders in children and adolescents, especially in diseases like depression and obsessive-compulsive disorder.
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Affiliation(s)
- Marc Valentí
- Hospital Clinic i Provincial de Barcelona, 08036 Barcelona, Espana
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Valentí M, Morer A, Lázaro ML, Bernardo M, Castro Fornieles J. Estimulación magnética transcraneal repetitiva en niños y adolescentes. Rev Neurol 2010. [DOI: 10.33588/rn.5004.2007595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- Marc Valentí
- Child and Adolescent Psychiatry Department, Institut de Neurociències. Hospital Clínic i Provincial de Barcelona, CIBER-SAM, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Child and Adolescent Psychiatry Department, Institut de Neurociències. Hospital Clínic i Provincial de Barcelona, CIBER-SAM, Barcelona, Spain
| | - María Luisa Lázaro
- Child and Adolescent Psychiatry Department, Institut de Neurociències. Hospital Clínic i Provincial de Barcelona, CIBER-SAM, Barcelona, Spain
| | - Gisela Sugrañes
- Child and Adolescent Psychiatry Department, Institut de Neurociències. Hospital Clínic i Provincial de Barcelona, CIBER-SAM, Barcelona, Spain
| | - Inmaculada Baeza
- Child and Adolescent Psychiatry Department, Institut de Neurociències. Hospital Clínic i Provincial de Barcelona, CIBER-SAM, Barcelona, Spain
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