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Hsu JH, Wu CH, Lin ECL, Chen PS. MoodSensing: A smartphone app for digital phenotyping and assessment of bipolar disorder. Psychiatry Res 2024; 334:115790. [PMID: 38401488 DOI: 10.1016/j.psychres.2024.115790] [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: 08/14/2023] [Revised: 01/29/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Daily life tracking has proven to be of great help in the assessment of patients with bipolar disorder. Although there are many smartphone apps for tracking bipolar disorder, most of them lack academic verification, privacy policy and long-term maintenance. METHODS Our developed app, MoodSensing, aims to collect users' digital phenotyping for assessment of bipolar disorder. The data collection was approved by the Institutional Review Board. This study collaborated with professional clinicians to ensure that the app meets both clinical needs and user experience requirements. Based on the collected digital phenotyping, deep learning techniques were applied to forecast participants' weekly HAM-D and YMRS scale scores. RESULTS In experiments, the data collected by our app can effectively predict the scale scores, reaching the mean absolute error of 0.84 and 0.22 on the scales. The statistical data also demonstrate the increase in user engagement. CONCLUSIONS Our analysis reveals that the developed MoodSensing app can not only provide a good user experience, but also the recorded data have certain discriminability for clinical assessment. Our app also provides relevant policies to protect user privacy, and has been launched in the Apple Store and Google Play Store.
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Affiliation(s)
- Jia-Hao Hsu
- Department of Computer Science and Information Engineering, National Cheng Kung University, Taiwan
| | - Chung-Hsien Wu
- Department of Computer Science and Information Engineering, National Cheng Kung University, Taiwan.
| | | | - Po-See Chen
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Taiwan
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Rabinowitz J, Young RC, Yavorsky C, Williams JBW, Sedway J, Marino P, Matteo C, Mahableshwarkar A, Kott A, Hefting N, Engler J, Brady C. Consistency checks to improve measurement with the Young Mania Rating Scale ( YMRS). J Affect Disord 2024; 345:24-31. [PMID: 37865349 DOI: 10.1016/j.jad.2023.10.098] [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: 05/31/2023] [Revised: 09/22/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Mitigating rating inconsistency can improve measurement fidelity and detection of treatment response. METHODS The International Society for CNS Clinical Trials and Methodology convened an expert Working Group that developed logical consistency (LC) checks for ratings of the Young Mania Rating Scale (YMRS), which is widely used in studies of mood and bipolar disorders. LC and statistical outlier-response pattern checks (SC) were applied to 63,228 YMRS administrations from 14 clinical trials evaluating treatments for bipolar disorder. Checks were also applied to Monte Carlo-simulated data as a proxy for their use under conditions of inconsistency. RESULTS 42 LC flags were developed, and four SC flags were created from the data set (n = 14). Almost 20 % of the rating administrations had at least one LC flag, 6.7 % had two or more, 1.7 % had three or more; 17.3 % percent of the administrations had at least one SC flag and 4.6 % percent had two or more. Overall, 31 % of administrations had at least one flag of any type, 12.1 % had two or more and 5.3 % had three or more. In acute antimanic treatment trials (n = 10) there were more flags of any type compared to relapse prevention trials (n = 4). LIMITATIONS Flagged ratings may represent less-common presentations assessed correctly. CONCLUSIONS Using established methods, we illustrate development and application of consistency flags for YMRS ratings. Applying flags and mitigation during trials may improve the value of YMRS data, help focus attention on rater training, and improve reliability and validity of trial data.
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Affiliation(s)
| | - Robert C Young
- Dept. of Psychiatry, Weil Cornell Medical College, New York, NY 10065, USA
| | | | - Janet B W Williams
- Columbia University Department of Psychiatry, c/o 2466 Westlake Ave N., #19, Seattle, WA 98109, USA
| | - Jan Sedway
- WCG Clinical Endpoint Solutions, 5000 Centregreen Way, Suite 200, Cary, NC 27513, USA
| | - Patricia Marino
- Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Christopher Matteo
- TPS Global, 1777 Sentry Parkway West, Suite 100, Building 17, Blue Bell, PA 19422, USA
| | | | - Alan Kott
- Signant Health, Slezská 2127/13, 120 00 Prague 2, Czech Republic
| | | | - Jenicka Engler
- Cronos Clinical Consulting Services, Inc., an IQVIA business, 201 S Main St, Lambertville, NJ 08530, USA
| | - Chris Brady
- WCG Clinical Endpoint Solutions, 5000 Centregreen Way, Suite 200, Cary, NC 27513, USA
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Sharpley AL, Williams C, Holder AA, Godlewska BR, Singh N, Shanyinde M, MacDonald O, Cowen PJ. A phase 2a randomised, double-blind, placebo-controlled, parallel-group, add-on clinical trial of ebselen (SPI-1005) as a novel treatment for mania or hypomania. Psychopharmacology (Berl) 2020; 237:3773-3782. [PMID: 32909076 PMCID: PMC7683468 DOI: 10.1007/s00213-020-05654-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE Lithium is an effective prophylactic and anti-manic treatment in bipolar disorder; however, its use is declining through perceived poor tolerance and toxicity. Lithium inhibits inositol monophosphatase (IMPase), a probable key therapeutic mechanism. The anti-inflammatory drug, ebselen, also inhibits IMPase and appears well-tolerated and safe. OBJECTIVES To assess the efficacy of adjunctive ebselen in mania using the Young Mania Rating Scale (YMRS) (primary outcome) and the Altman Self-Rating Mania (ASRM) Scale and Clinical Global Impression-Severity Scale (CGI-S) among the secondary outcomes. METHODS Randomised, double-blind, placebo-controlled, parallel-group trial conducted between October 2017 and June 2019, at Oxford Health NHS Foundation Trust. Pharmacy-controlled randomisation was computer-generated, with full allocation concealment. In/outpatients (n = 68) aged 18-70, experiencing mania or hypomania, were assigned to 3 weeks ebselen (600 mg bd) (n = 33) or placebo (n = 35). Participants received usual clinical care and psychotropic medication. RESULTS Ebselen was numerically, but not statistically, superior to placebo in lowering scores on the YMRS (adjusted mean difference and 95% confidence interval, - 1.71 (- 5.34 to 1.91), p = 0.35) and ASRM (- 1.36 (- 3.75 to 1.17), p = 0.29). However, scores on the CGI-S were significantly lower at week 3 in ebselen-treated participants (adjusted mean difference, - 0.58 (- 1.14 to - 0.03), p = 0.04). A post hoc analysis excluding patients taking concomitant valproate treatment magnified the difference between ebselen and placebo on the YMRS. Adverse events were comparable between groups, and mild. CONCLUSIONS Ebselen merits further investigation where concomitant psychotropic medication is better controlled and participants taking valproate are excluded. If effective, ebselen's superior tolerance and safety could make it a useful alternative to lithium. TRIAL REGISTRATION Trial Registry: www.clinicaltrials.gov , Identifier: NCT03013400.
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Affiliation(s)
- Ann L Sharpley
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Clare Williams
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Adele A Holder
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Beata R Godlewska
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nisha Singh
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Milensu Shanyinde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla MacDonald
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Zhang Y, Ma X, Liang S, Yu W, He Q, Zhang J, Bian Y. Social cognition and interaction training (SCIT) for partially remitted patients with bipolar disorder in China. Psychiatry Res 2019; 274:377-382. [PMID: 30852431 DOI: 10.1016/j.psychres.2019.03.002] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/03/2019] [Accepted: 03/03/2019] [Indexed: 12/20/2022]
Abstract
Bipolar disorder (BD) is associated with functional impairment. Social Cognition and Interaction Training (SCIT) has been shown to be feasible and effective at improving social functioning in patients with schizophrenia. We aimed to explore the association between SCIT and improvements in the clinical symptoms and functioning of partially remitted patients with BD in China. Seventy-four BD patients were randomly assigned to the SCIT and psychoeducation (Control) groups. All subjects participated in group interventions weekly for 8 weeks. Furthermore, the participants were administered the Young Mania Rating Scale (YMRS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Function Assessment Short Test (FAST) and neurocognitive measures at baseline and after eight weeks. There were no differences in demographics, the HDRS-17, YRMS, and FAST scores or neurocognitive measures between the groups at baseline (p>0.05). The repeated-measures analysis revealed that SCIT resulted in greater improvement in the HDRS, YMRS, and FAST scores (including six domains) (p<0.01) and two neurocognitive measures (p<0.05) compared to psychoeducation. Our findings suggest that SCIT is a feasible and promising intervention for the clinical symptoms and functioning of partially remitted patients with BD. Further longitudinal studies are needed to observe the long-term impact of SCIT on emotional and functional improvement in these patients.
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Affiliation(s)
- Yong Zhang
- Tianjin Anding Hospital, Tianjin 300222, China.
| | - Xiaojuan Ma
- Tianjin Medical College, Tianjin 300222, China
| | | | - Wenwen Yu
- Tianjin Anding Hospital, Tianjin 300222, China
| | | | - Jian Zhang
- Tianjin Anding Hospital, Tianjin 300222, China
| | - Yanhui Bian
- Tianjin Anding Hospital, Tianjin 300222, China
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Dal Mas C, Carvalho MS, Marins LA, Yonamine CM, Cordeiro Q, McIntyre RS, Mansur RB, Brietzke E, Hayashi MAF. Oligopeptidases activity in bipolar disorder: Ndel1 and angiotensin I converting enzyme. J Affect Disord 2019; 244:67-70. [PMID: 30321766 DOI: 10.1016/j.jad.2018.10.001] [Citation(s) in RCA: 5] [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: 02/02/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Abnormal activity of two enzymes relevant to neurodevelopment, namely nuclear-distribution element-like 1 (Ndel1) and angiotensin I-converting enzyme (ACE), was reported in individuals with schizophrenia; to our knowledge, these oligopeptidases were never measured in bipolar disorder (BD). AIMS Evaluate the enzyme activity of Ndel1 and ACE in euthymic individuals with BD type 1 which was compare to healthy control (HC) group. METHODS Ndel1 and ACE activities were assessed in the serum of individuals with BD type 1 according to DSM-IV criteria (n = 70) and a HC group (n = 34). The possible differences between BD type 1 and HC groups were evaluated using Analysis of Covariance (ANCOVA), and the results were adjusted for age, gender and body mass index. RESULTS We observed a positive correlation between Ndel1 activity and the total YMRS score in BD group (p = 0.030) and a positive correlation between ACE activity and Ham-D score (p = 0.047). ANCOVA analysis showed lower Ndel1 activity in BDs compared to HCs. Interestingly, we did not observe between-groups differences in ACE activity, despite the recognized correlation of ACE activity levels with cognitive functions, also described to be worsened in psychiatric patients. CONCLUSION Oligopeptidases, especially Ndel1, which has been strongly correlated with neurodevelopment and brain formation, are potentially a good new target in the study of the neurobiology of BD. LIMITATIONS The relatively small sample size did not permit to examine the cause-effect relationship of clinical dimensions of BD and the enzymatic activity.
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Affiliation(s)
- Caroline Dal Mas
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), Rua 3 de maio 100, Ed. INFAR, 3rd floor, CEP 04044-020 São Paulo, Brazil
| | - Michelle S Carvalho
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), Rua 3 de maio 100, Ed. INFAR, 3rd floor, CEP 04044-020 São Paulo, Brazil
| | - Lucas A Marins
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), Rua 3 de maio 100, Ed. INFAR, 3rd floor, CEP 04044-020 São Paulo, Brazil
| | - Camila M Yonamine
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), Rua 3 de maio 100, Ed. INFAR, 3rd floor, CEP 04044-020 São Paulo, Brazil
| | - Quirino Cordeiro
- Department of Psychiatry, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3rd floor, Vila Clementino, CEP 04039-032 São Paulo, Brazil.
| | - Mirian A F Hayashi
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), Rua 3 de maio 100, Ed. INFAR, 3rd floor, CEP 04044-020 São Paulo, Brazil.
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Targum SD, Pendergrass JC, Lee S, Loebel A. Ratings surveillance and reliability in a study of major depressive disorder with subthreshold hypomania (mixed features). Int J Methods Psychiatr Res 2018; 27:e1729. [PMID: 29943445 PMCID: PMC6877125 DOI: 10.1002/mpr.1729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/16/2018] [Accepted: 05/31/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Site-independent ratings surveillance assessed ratings reliability in a clinical trial. METHODS Inter-rater reliability was assessed at the screen visit in a 6-week, double-blind, placebo-controlled study of lurasidone for the treatment of major depressive disorder (MDD) with subthreshold hypomanic ("mixed") symptoms (clinicaltrials.gov NCT01421134). Site-based Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) interviews were paired with 184 site-independent ratings derived from audio-digital recordings. RESULTS The paired MADRS and YMRS scores were highly correlated (r = 0.708 and 0.885, respectively) and generated minimal scoring discordance. The surveillance program identified 14 MADRS scores (7.6% of this sample) that were below the study entry criterion (MADRS ≥26) and resulted in screen failure. When present, paired scoring discordance was associated with symptom severity, interview length, interview quality, and the level of patient cooperation. Higher severity scores (MADRS ≥40 and YMRS ≥15) were associated with greater paired scoring discordance. Further, MADRS scores <30 and short MADRS interviews conducted in ≤12 min revealed significantly more pairs of discordant outliers (p = 0.04 and 0.009, respectively). CONCLUSIONS The findings suggest that MDD patients with mixed features can be reliably assessed, that paired site-based and site-independent assessments were generally concordant, and that ratings surveillance may reinforce ratings precision.
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Affiliation(s)
| | | | - Sang Lee
- Bracket Global, LLC, Boston, Massachusetts, USA
| | - Antony Loebel
- Sunovion Pharmaceuticals, Fort Lee, New Jersey, USA.,Sunovion Pharmaceuticals, Marlborough, Massachusetts, USA
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Abstract
OBJECTIVES To evaluate the effect of psychosis on prognosis as measured by the course of a manic episode, symptoms severity and time to remission and identify existing differences in positive and negative symptoms between psychotic and non-psychotic patients. STUDY DESIGN 40 bipolar patients presenting with a diagnosis of acute mania were enrolled (18 psychotic patients and 22 non-psychotic patients) in this cross-sectional study. Subjects were required to complete two self-reported questionnaires, the Young Mania Rating Scale (YMRS) for manic symptoms, and Positive and Negative Symptoms Scale (PANSS) for psychotic symptoms. Rating scales were administered at baseline and then again after three weeks of pharmacologic treatment. RESULTS There were no differences in socio-demographic characteristics between psychotic and non-psychotic subjects. Psychosis was associated with higher scores on the YMRS and PANSS (increased symptoms severity), compared to non-psychotic patients. Both groups demonstrated clinical improvement and remission, with scores amongst psychotic patients remaining higher. Groups were similar in symptomatology except with regards to psychotic symptoms (the content, insight, delusions, hallucinations, grandiosity, poor rapport and unusual thoughts). CONCLUSIONS Psychosis can be considered a severity index in bipolar disorder, with decreased severity and overall clinical improvement and remission taking place in response to pharmacotherapy.
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Affiliation(s)
- Elionor Nehme
- a Lebanese University , Faculty of Sciences , Beirut , Lebanon
| | - Sahar Obeid
- b Psychiatric Hospital of the Cross , Jal Eddib, Lebanon.,c Holy Spirit University , Faculty of Philosophy and Human Sciences , Kaslik , Lebanon.,d Lebanese University , Faculty of Pedagogy , Beirut , Lebanon
| | - Souheil Hallit
- b Psychiatric Hospital of the Cross , Jal Eddib, Lebanon.,e Lebanese University , Faculty of Pharmacy , Beirut , Lebanon.,f Saint Joseph University , Faculty of Pharmacy , Beirut , Lebanon.,g Holy Spirit University , Faculty of Medicine and Medical Sciences , Kaslik, Lebanon.,h INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie , Faculty of Public Health , Lebanese University , Beirut , Lebanon
| | - Chadia Haddad
- b Psychiatric Hospital of the Cross , Jal Eddib, Lebanon
| | - Wael Salame
- b Psychiatric Hospital of the Cross , Jal Eddib, Lebanon.,i Lebanese American University , Faculty of Medicine , Byblos , Lebanon
| | - Fouad Tahan
- a Lebanese University , Faculty of Sciences , Beirut , Lebanon.,b Psychiatric Hospital of the Cross , Jal Eddib, Lebanon
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Capote HA, Rainka M, Westphal ES, Beecher J, Gengo FM. Ropinirole in Bipolar Disorder: Rate of Manic Switching and Change in Disease Severity. Perspect Psychiatr Care 2018; 54:100-106. [PMID: 28105645 DOI: 10.1111/ppc.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/11/2016] [Revised: 11/01/2016] [Accepted: 11/25/2016] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To determine the effects of ropinirole on manic switching and disease severity in bipolar disorder. DESIGN AND METHODS A cross-sectional survey was conducted in 23 bipolar depressed patients using ropinirole combination therapy (Young Mania Rating Scale [YMRS], Bipolar Inventory of Symptoms Scale [BISS]). Retrospective Clinical Global Impression of Change (CGI-C) and CGI-S (Severity) were captured via chart review. FINDINGS One patient (4.3%) experienced induction of mania (YMRS). All patients responded or partially responded to ropinirole (CGIs). YMRS and BISS mania scores were correlated. PRACTICE IMPLICATIONS Ropinirole has a low rate of manic switching and significantly reduces bipolar depression severity.
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Affiliation(s)
- Horacio A Capote
- Director, Neuropsychiatry Division, Dent Neurologic Institute, Buffalo, New York, USA
| | - Michelle Rainka
- Clinical Pharmacist, Research Division, Dent Neurologic Institute, Buffalo, New York, USA
| | - Erica S Westphal
- Research Associate, Dent Neurologic Institute, Buffalo, New York, USA
| | - Jonathan Beecher
- Research Intern, Dent Neurologic Institute, Buffalo, New York, USA
| | - Francis M Gengo
- Director of Research Division, Dent Neurologic Institute, Buffalo, New York, USA
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Chen AT, Malmstrom T, Nasrallah HA. Allopurinol augmentation in acute mania: A meta-analysis of placebo-controlled trials. J Affect Disord 2018; 226:245-50. [PMID: 29017068 DOI: 10.1016/j.jad.2017.09.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/11/2017] [Accepted: 09/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Allopurinol is a xanthine oxidase inhibitor commonly used in the treatment of gout. Recent studies have also shown its promise as an adjunctive treatment for manic episodes in bipolar 1 disorder, possibly through mechanisms involving the purinergic pathway. However, its efficacy across studies has been inconsistent, so we conducted a meta-analysis of the published controlled studies with the goal of determining the efficacy profile of allopurinol as an adjunctive treatment for mania in bipolar disorder. METHODS An online search was conducted using PubMed for placebo-controlled, randomized, double-blind, clinical trials (RCTs) using the terms "allopurinol," "bipolar," "mania," "manic," and "YMRS" and a meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. RESULTS Five studies met the criteria for inclusion. Three of the five studies were inpatient treatments, one study was outpatient treatment, and one study had a mixture of both. All studies used allopurinol as an adjunct in treating acute mania in bipolar disorder subjects. Four of the studies showed efficacy in the primary outcome measure between allopurinol vs. placebo groups with significantly reduced YMRS scores while one showed no significant effect size between the allopurinol and placebo groups. The overall effect size for the four studies is d = 0.294. No significant difference in side effects were found between groups for any of the studies. CONCLUSION The data suggest that allopurinol may have some efficacy as an adjunct in reducing mania symptoms during acute manic episodes in patients with bipolar disorder. Adjunctive allopurinol efficacy may be related to the mood stabilizer used. Additional controlled trials with greater sample sizes, homogenous dosing, and consistent treatment modalities are needed to determine optimal clinical application.
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Chen WT, Huang TL, Tsai MC. Bcl-2 associated with severity of manic symptoms in bipolar patients in a manic phase. Psychiatry Res 2015; 225:305-8. [PMID: 25563670 DOI: 10.1016/j.psychres.2014.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/18/2014] [Accepted: 12/14/2014] [Indexed: 01/26/2023]
Abstract
B cell lymphoma protein-2 (Bcl-2) may contribute to the pathophysiology of bipolar disorder, and may be involved in the therapeutic action of anti-manic drugs. The aim of this study was to investigate serum levels of Bcl-2 in bipolar patients in a manic phase, and evaluate the Bcl-2 changes after treatment. We consecutively enrolled 23 bipolar inpatients in a manic phase and 40 healthy subjects; 20 bipolar patients were followed up with treatment. Serum Bcl-2 levels were measured with assay kits. All 20 patients were evaluated by examining the correlation between Bcl-2 levels and Young Mania Rating Scale (YMRS) scores, using Spearman׳s correlation coefficients. The serum Bcl-2 levels in bipolar patients in a manic phase were higher than in healthy subjects, but without a significant difference. The YMRS scores were significantly negatively associated with serum Bcl-2 levels (p=0.042). Bcl-2 levels of the 20 bipolar patients were measured at the end of treatment. Using the Wilcoxon Signed Rank test, we found no significant difference in the Bcl-2 levels of bipolar patients after treatment. Our results suggest that Bcl-2 levels might be an indicator of severity of manic symptoms in bipolar patients in a manic phase.
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Chen SL, Lee SY, Chang YH, Chen PS, Lee IH, Wang TY, Chen KC, Yang YK, Hong JS, Lu RB. Therapeutic effects of add-on low-dose dextromethorphan plus valproic acid in bipolar disorder. Eur Neuropsychopharmacol 2014; 24:1753-9. [PMID: 25262178 DOI: 10.1016/j.euroneuro.2014.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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] [Received: 04/30/2014] [Revised: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 12/24/2022]
Abstract
UNLABELLED Changes in inflammatory cytokines and dysfunction of the neurotrophic system are thought to be involved in the pathology of bipolar disorder (BP). We investigated whether inflammatory and neurotrophic factors were changed in BP. We also investigated whether treating BP with valproic acid (VPA) plus low-dose (30 or 60 mg/day) dextromethorphan (DM) is more effective than treating it with VPA only, and whether DM affects plasma cytokines and brain derived neurotrophic factor (BDNF) levels. In a 12-week, randomized, double-blind study, patients were randomly assigned to the VPA+DM30, VPA+DM60, or VPA+Placebo groups. The Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) were used to evaluate symptom severity, and ELISA to analyze plasma cytokine and BDNF levels. We recruited 309 patients with BP and 123 healthy controls. Before treatment, patients with BP had significantly higher plasma cytokine and lower plasma BDNF levels than did healthy controls. After treatment, HDRS and YMRS scores in each group showed significant improvement. Plasma cytokine levels tended to decline in all groups. Changes in plasma BDNF levels were significantly greater in the VPA+DM60 group than in the VPA+Placebo group. CONCLUSION patients with BP have a certain degree of systemic inflammation and BDNF dysfunction. Treatment with VPA plus DM (60 mg/day) provided patients with BP significantly more neurotrophic benefit than did VPA treatment alone.
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Affiliation(s)
- Shiou-Lan Chen
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veteran׳s General Hospital, Kaohsiung, Taiwan
| | - Yun-Hsuan Chang
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Po-See Chen
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - I-Hui Lee
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Behavioral Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Yun Wang
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kao-Ching Chen
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Kuang Yang
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Jau-Shyong Hong
- Laboratory of Toxicology and Pharmacology, NIH/NIEHS, Research Triangle Park, NC, USA
| | - Ru-Band Lu
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Center for Neuropsychiatric Research, National Health Research Institute, Miaoli, Taiwan.
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12
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Ayesa-Arriola R, Rodriguez-Sanchez JM, Gomez-Ruiz E, Roiz-Santiáñez R, Reeves LL, Crespo-Facorro B. No sex differences in neuropsychological performance in first episode psychosis patients. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:149-54. [PMID: 24075821 DOI: 10.1016/j.pnpbp.2013.09.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to verify whether male patients with psychosis have greater neurocognitive impairment than female patients at illness onset. METHOD Participants with a first episode of psychosis (74 women/86 men) and healthy controls (62 women/97 men) were assessed with an extensive neuropsychological test battery. RESULTS Women in the clinical group were older at illness onset and had achieved higher formal education than men. This trend was the same for the control group. The patient group presented with lower premorbid IQ compared to healthy controls, and performed below for most neuropsychological tests. Women scored higher than men on a test of verbal memory, whereas men scored higher than women on a test of reaction time, visual memory, and a planning task. There were no group-by-sex interactions for any of the neuropsychological tests. CONCLUSION The present study shows that at the onset of psychosis there are no differences between males and females in neuropsychological performance. The differential pattern of cognitive performance observed is similar to that in healthy males and females. Furthermore, females with a late onset of psychosis may represent a subgroup with specific visuospatial and problem solving impairments.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.
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13
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de Sousa RT, Uno M, Zanetti MV, Shinjo SMO, Busatto GF, Gattaz WF, Marie SKN, Machado-Vieira R. Leukocyte mitochondrial DNA copy number in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:32-5. [PMID: 24036318 DOI: 10.1016/j.pnpbp.2013.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 07/18/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Evidence supports the role for mitochondrial impairment in the pathophysiology of bipolar disorder (BD). BD has been associated with decreased mitochondrial electron transport chain activity and increased oxidative stress. Also, mitochondrial DNA (mtDNA) encodes mitochondrial electron transport chain proteins and has been associated with altered oxidative stress. Preclinical studies showed that lithium treatment increased mtDNA content, but no study has directly assessed mtDNA content in subjects with BD in vivo. Also, the effects of lithium treatment on mtDNA content have never been evaluated in humans. METHODS Leukocyte mtDNA content using real time-PCR was evaluated in subjects with BD (n=23) in a depressive episode (≥18 in the 21-item Hamilton Depression Rating Scale) before and after 6-week lithium treatment versus healthy controls (n=24). RESULTS mtDNA content showed no significant difference between subjects with BD at baseline and controls (p=0.46); also no difference was observed when comparing before and after lithium treatment. A trend for decreased mtDNA content was specifically observed in BD type I compared to controls and BD type II (p=0.05). Importantly, endpoint mtDNA copy number was significantly correlated with age. CONCLUSION In BD subjects who were younger, unmedicated and had a shorter duration of illness, no change was observed in mtDNA copy number. More studies with larger samples are warranted to evaluate mtDNA content changes in BD and its potential role as a treatment target, especially in BD type I and its association with aging.
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Affiliation(s)
- Rafael T de Sousa
- Laboratory of Neuroscience, LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Brazil
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14
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Houenou J, d'Albis MA, Daban C, Hamdani N, Delavest M, Lepine JP, Vederine FE, Carde S, Lajnef M, Cabon C, Dickerson F, Yolken RH, Tamouza R, Poupon C, Leboyer M. Cytomegalovirus seropositivity and serointensity are associated with hippocampal volume and verbal memory in schizophrenia and bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:142-8. [PMID: 24083998 DOI: 10.1016/j.pnpbp.2013.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 08/27/2013] [Accepted: 09/07/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cytomegalovirus (CMV) is a member of the herpesviridae family that has a limbic and temporal gray matter tropism. It is usually latent in humans but has been associated with schizophrenia, bipolar disorder and cognitive deficits in some populations. Hippocampal decreased volume and dysfunction play a critical role in these cognitive deficits. We hypothesized that CMV seropositivity and serointensity would be associated with hippocampal volume and cognitive functioning in patients with schizophrenia or bipolar disorder. METHODS 102 healthy controls, 118 patients with bipolar disorder and 69 patients with schizophrenia performed the California Verbal Learning Test (CVLT) and had blood samples drawn to assess CMV IgG levels. A subgroup of 52 healthy controls, 31 patients with bipolar disorder and 27 patients with schizophrenia underwent T1 MRI for hippocampal volumetry. We analyzed the association between CMV serointensity and seropositivity with hippocampal volume. We also explored the correlation between CMV serointensity and seropositivity and CVLT scores. RESULTS In both patient groups but not in controls, higher CMV serointensity was significantly associated with smaller right hippocampal volume. Further, in the group of patients with schizophrenia but not bipolar disorder, CMV serointensity was negatively correlated with CVLT scores. CONCLUSION CMV IgG titers are associated with decreased hippocampal volume and poorer episodic verbal memory in patients with schizophrenia or bipolar disorder. The mechanism of this association warrants further exploration.
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Affiliation(s)
- J Houenou
- INSERM, U955, Equipe 15 "Psychiatrie Génétique", Créteil F-94000, France; Fondation Fondamental, Créteil F-94010, France; AP-HP, Groupe Henri Mondor - Albert Chenevier, Pôle de Psychiatrie, Créteil, F-94000, France; Neurospin, CEA Saclay, Gif-Sur-Yvette, France.
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Perugi G, Medda P, Reis J, Rizzato S, Giorgi Mariani M, Mauri M. Clinical subtypes of severe bipolar mixed states. J Affect Disord 2013; 151:1076-82. [PMID: 24074482 DOI: 10.1016/j.jad.2013.08.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of the present study was to identify different clinical subtypes in severe, treatment resistant bipolar mixed state (MS). METHOD The sample comprised 202 Bipolar I patients currently in MS referred for an Electro-convulsive Therapy (ECT) trial and evaluated in the first week of hospitalization and one week after the ECT course. Principal component factor analysis (PCA) followed by Varimax rotation was performed on 21 non-overlapping items selected from Hamilton rating-scale for depression (HAMD) and from Young mania rating-scale (YMRS) at baseline evaluation. Cluster subtypes derived from the factor scores were compared in clinical variables and final HAMD, YMRS, Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scores. RESULTS The principal-component analysis extracted 6 interpretable factors explaining 55.9% of the total variance. Cluster analysis identified four groups, including respectively 63 (31.2%) subjects with Agitated-Irritable Mixed-Depression, 59 (29.2%) with Psychotic Mixed-Mania, 17 (8.5%) with Anxious-Irritable-Psychotic Mixed-Mania, and 63 (31.2%) with Retarded-Psychotic Mixed-Depression. The four clusters were statistically distinct and did not show significant overlap in the main symptomatological presentation. Cluster subtypes reported differences in number of past mood episodes, duration of the current episode, suicide attempts, lifetime comorbidity with panic and eating disorders, baseline and final rating-scale scores and rate of remission after ECT trial. CONCLUSIONS Our study indicates that, at least in severe treatment resistant MS, multiple depressive and manic subtypes can be observed with substantial differences in terms of clinical presentation, course, associated comorbidities and treatment response.
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Szegedi A, Zhao J, McIntyre RS. Early improvement as a predictor of acute treatment outcome in manic or mixed episodes in bipolar-1 disorder: a pooled, post hoc analysis from the asenapine development program. J Affect Disord 2013; 150:745-52. [PMID: 23473546 DOI: 10.1016/j.jad.2013.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 07/30/2012] [Revised: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess whether early symptom improvement predicts later treatment outcome in acute manic/mixed episodes of bipolar I disorder using Young Mania Rating Scale (YMRS) or Clinical Global Impression scale, bipolar disorders (CGI-BP) assessments. METHODS Data were pooled from two 3-week randomized controlled studies with asenapine (ASE; n=372), olanzapine (OLA; n=391), or placebo (PL; n=197). Early improvement was defined as reduction of YMRS total scores (≥15%, ≥20%, ≥25%) or CGI-BP severity scores (≥1 point change) at days 2, 4, and 7. Treatment outcome at week 3 was defined as response (YMRS: ≥50% score reduction; CGI-BP severity: "minimally ill" or better) or remission (YMRS total score ≤12; CGI-BP severity: "not at all ill"). Odds ratios (ORs) and predictive performance statistics were calculated. RESULTS Early improvement occurred in a substantial percentage of patients and was associated with significantly increased ORs for response or remission. For ASE, results were significant as early as day 2 on all measures of YMRS and CGI-severity of mania assessment. For all treatments sensitivity and negative predictive values increased from days 2 to 7 for all YMRS and CGI-BP measures, while specificity values decreased. CONCLUSION In acute manic/mixed episodes, early improvement within 1 week of treatment was associated with significantly increased ORs of endpoint response or remission. While only a subset of early improvers reach the endpoint treatment goals, absence of improvement within week 1 of treatment initiation strongly predicts the unlikely success of subsequent treatment. Further, CGI-based predictors had predictive properties similar to those based on the YMRS scale.
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Hui C, Morcillo C, Russo DA, Stochl J, Shelley GF, Painter M, Jones PB, Perez J. Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis. Schizophr Res 2013; 148:175-80. [PMID: 23773297 PMCID: PMC3744805 DOI: 10.1016/j.schres.2013.05.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders, which may indicate that the focus of research in individuals at high risk (HR) for psychosis needs updating. In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers. METHOD Between February 2010 and September 2012 60 help-seeking HR individuals, aged 16-35, were recruited from CAMEO Early Intervention in Psychosis Service, Cambridgeshire, UK. Forty-five age- and gender-matched healthy volunteers were randomly recruited from the same geographical area. Sociodemographic, psychiatric morbidity, functioning and quality of life measures were compared between both groups. RESULTS HR individuals suffered a wide range of DSM-IV psychiatric disorders, mainly within the affective and anxiety diagnostic spectra. In comparison to healthy volunteers, young people at HR reported more suicidal ideation/intention, depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life. CONCLUSION The presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis. A HR mental state may be associated not only with an increased risk for psychosis, but also other psychiatric disorders. Our findings may have implications for the future implementation of therapeutic interventions that this population could benefit from.
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Affiliation(s)
- Christy Hui
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Carmen Morcillo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Debra A. Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Gillian F. Shelley
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Michelle Painter
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,Corresponding author at: Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EE, UK. Tel.: + 44 1223884360; fax: + 44 1223884362.
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Cazorla P, Zhao J, Mackle M, Szegedi A. Asenapine effects on individual Young Mania Rating Scale items in bipolar disorder patients with acute manic or mixed episodes: a pooled analysis. Neuropsychiatr Dis Treat 2013; 9:409-13. [PMID: 23569381 PMCID: PMC3616130 DOI: 10.2147/ndt.s38390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An exploratory post hoc analysis was conducted to evaluate the potential differential effects over time of asenapine and olanzapine compared with placebo on the eleven individual items comprising the Young Mania Rating Scale (YMRS) in patients with manic or mixed episodes in bipolar I disorder. METHODS Data were pooled from two 3-week randomized, controlled trials in which the eleven individual items comprising the YMRS were measured over 21 days. An analysis of covariance model adjusted by baseline value was used to test for differences in changes from baseline in YMRS scores between groups. RESULTS Each of the eleven individual YMRS item scores was significantly reduced compared with placebo at day 21. After 2 days of treatment, asenapine and olanzapine were superior to placebo for six of the YMRS items: disruptive/aggressive behavior, content, irritability, elevated mood, sleep, and speech. CONCLUSION Reduction in manic symptoms over 21 days was associated with a broad-based improvement across all symptom domains with no subset of symptoms predominating.
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