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Veronese N, Solimando L, Bolzetta F, Maggi S, Fiedorowicz JG, Gupta A, Fabiano N, Wong S, Boyer L, Fond G, Dragioti E, Dominguez LJ, Barbagallo M, Romagnoli S, Bellelli G, Solmi M. Interventions to prevent and treat delirium: An umbrella review of randomized controlled trials. Ageing Res Rev 2024; 97:102313. [PMID: 38677599 DOI: 10.1016/j.arr.2024.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
Delirium is a common condition across different settings and populations. The interventions for preventing and managing this condition are still poorly known. The aim of this umbrella review is to synthesize and grade all preventative and therapeutic interventions for delirium. We searched five databases from database inception up to March 15th, 2023 and we included meta-analyses of randomized controlled trials (RCTs) to decrease the risk of/the severity of delirium. From 1959 records after deduplication, we included 59 systematic reviews with meta-analyses, providing 110 meta-analytic estimates across populations, interventions, outcomes, settings, and age groups (485 unique RCTs, 172,045 participants). In surgery setting, for preventing delirium, high GRADE evidence supported dexmedetomidine (RR=0.53; 95%CI: 0.46-0.67, k=13, N=3988) and comprehensive geriatric assessment (OR=0.46; 95%CI=0.32-0.67, k=3, N=496) in older adults, dexmedetomidine in adults (RR=0.33, 95%CI=0.24-0.45, k=7, N=1974), A2-adrenergic agonists after induction of anesthesia (OR= 0.28, 95%CI= 0.19-0.40, k=10, N=669) in children. High certainty evidence did not support melatonergic agents in older adults for delirium prevention. Moderate certainty supported the effect of dexmedetomidine in adults and children (k=4), various non-pharmacological interventions in adults and older people (k=4), second-generation antipsychotics in adults and mixed age groups (k=3), EEG-guided anesthesia in adults (k=2), mixed pharmacological interventions (k=1), five other specific pharmacological interventions in children (k=1 each). In conclusion, our work indicates that effective treatments to prevent delirium differ across populations, settings, and age groups. Results inform future guidelines to prevent or treat delirium, accounting for safety and costs of interventions. More research is needed in non-surgical settings.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy.
| | - Luisa Solimando
- Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy
| | - Francesco Bolzetta
- Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria), 3 "Serenissima", Dolo-Mirano District, Dolo, Venice, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Jess G Fiedorowicz
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Ottawa, Ontario,Canada
| | - Arnav Gupta
- College of Public Health, Kent State University, Kent, OH, United States; Department of Medicine, University of Calgary, Calgary, AB, United States
| | - Nicholas Fabiano
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ, CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Marseille, France; FondaMental Fondation, Créteil, France
| | - Guillaume Fond
- AP-HM, Aix-Marseille Univ, CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Marseille, France; FondaMental Fondation, Créteil, France
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping 581 85, Sweden; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina 45500, Greece
| | - Ligia J Dominguez
- Faculty of Medicine and Surgery, Kore University of Enna, Enna 94100, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy; Acute Geriatric Unit, IRCCS San Gerardo, Monza 20900, Italy
| | - Marco Solmi
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Ottawa, Ontario,Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Alrfooh A, Casten LG, Richards JG, Wemmie JA, Magnotta VA, Fiedorowicz JG, Michaelson J, Williams AJ, Gaine ME. Investigating the relationship between DNA methylation, genetic variation, and suicide attempt in bipolar disorder. medRxiv 2024:2024.04.03.24305263. [PMID: 38633806 PMCID: PMC11023653 DOI: 10.1101/2024.04.03.24305263] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Individuals with bipolar disorder are at increased risk for suicide, and this can be influenced by a range of biological, clinical, and environmental risk factors. Biological components associated with suicide include DNA modifications that lead to changes in gene expression. Common genetic variation and DNA methylation changes are some of the most frequent types of DNA findings associated with an increased risk for suicidal behavior. Importantly, the interplay between genetic predisposition and DNA methylation patterns is becoming more prevalent in genetic studies. We hypothesized that DNA methylation patterns in specific loci already genetically associated with suicide would be altered in individuals with bipolar disorder and a history of suicide attempt. To test this hypothesis, we searched the literature to identify common genetic variants (N=34) previously associated with suicidal thoughts and behaviors in individuals with bipolar disorder. We then created a customized sequencing panel that covered our chosen genomic loci. We profiled DNA methylation patterns from blood samples collected from bipolar disorder participants with suicidal behavior (N=55) and without suicidal behavior (N=51). We identified seven differentially methylated CpG sites and five differentially methylated regions between the two groups. Additionally, we found that DNA methylation changes in MIF and CACNA1C were associated with lethality or number of suicide attempts. Finally, we identified three meQTLs in SIRT1 , IMPA2 , and INPP1 . This study illustrates that DNA methylation is altered in individuals with bipolar disorder and a history of suicide attempts in regions known to harbor suicide-related variants.
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Harrison LD, Dumicho AY, Eddeen AB, Tanuseputro P, Kendall CE, Fiedorowicz JG, Rosic T, Fernando SM, McNaughton CD, Corace K, Kurdyak P, Beckerleg W, Webber C, Gardner W, Sood M, Myran DT. Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol. Acad Emerg Med 2024; 31:220-229. [PMID: 38097531 DOI: 10.1111/acem.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND METHODS We conducted a population-based, retrospective cohort study of first-time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with nonalcohol ED visits between 2009 and 2015 using standardized all-cause mortality ratios (age, sex, income, and rurality). We described the cause of death for AYA and examined the association between clinical factors and mortality rates in the alcohol cohort using proportional hazard models. RESULTS A total of 71,776 AYA had a first-time ED visit due to alcohol (56.1% male, mean age 20.7 years) between 2009 and 2015, representing 3.3% of the 2,166,838 AYA with an ED visit in this time period. At 1 year, there were 2396 deaths, 248 (10.3%) following an ED visit related to alcohol. First-time alcohol ED visits were associated with a threefold higher risk in mortality at 1 year (0.35% vs. 0.10%, adjusted hazard ratio [aHR] 3.07, 95% confidence interval [CI] 2.69-3.51). Mortality was associated with age 25-29 years (aHR 3.88, 95% CI 2.56-5.86), being male (aHR 1.98, 95% CI 1.49-2.62), having a history of mental health or substance use (aHR 3.22, 95% CI 1.64-6.32), cause of visit being withdrawal/dependence (aHR 2.81, 95% CI 1.96-4.02), and having recurrent ED visits (aHR 1.97, 95% CI 1.27-3.05). Trauma (42.7%), followed by poisonings from drugs other than opioids (38.3%), and alcohol (28.6%) were the most common contributing causes of death. CONCLUSION Incident ED visits due to alcohol in AYA are associated with a high risk of 1-year mortality, especially in young adults, those with concurrent mental health or substance use disorders, and those with a more severe initial presentation. These findings may help inform the need and urgency for follow-up care in this population.
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Affiliation(s)
- Lyndsay D Harrison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Asnake Y Dumicho
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Primary Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Lamont Primary Health Care Research Centre, Riverside Campus Family Health Team, Ottawa, Ontario, Canada
| | - Jess G Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Tea Rosic
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
| | - Candace D McNaughton
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
| | - Kim Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kurdyak
- ICES Central, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Weiwei Beckerleg
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - William Gardner
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Manish Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
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Fabiano N, Gupta A, Wong S, Tran J, Mohammad IY, Bal S, Fiedorowicz JG, Firth J, Stubbs B, Vancampfort D, Schuch FB, Carr LJ, Shorr R, Cortese S, Manchia M, Hartman CA, Høye A, Fusar-Poli P, Koyanagi A, Vieta E, Nielsen RE, Holt RI, Correll CU, Du Rietz E, Taipale H, Lehto K, Larrson H, Nordentoft M, Dragioti E, Skonieczna-Żydecka K, Solmi M. Physical activity, suicidal ideation, suicide attempt and death among individuals with mental or other medical disorders: A systematic review of observational studies. Neurosci Biobehav Rev 2024; 158:105547. [PMID: 38246231 DOI: 10.1016/j.neubiorev.2024.105547] [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] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
A growing body of research has demonstrated the potential role for physical activity as an intervention across mental and other medical disorders. However, the association between physical activity and suicidal ideation, attempts, and deaths has not been systematically appraised in clinical samples. We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, EMBASE, and PsycINFO for observational studies investigating the influence of physical activity on suicidal behavior up to December 6, 2023. Of 116 eligible full-text studies, seven (n = 141691) were included. Depression was the most frequently studied mental condition (43%, k = 3), followed by chronic pain as the most common other medical condition (29%, k = 2). Two case-control studies examined suicide attempts and found an association between physical activity and a reduced frequency of such attempts. However, in studies examining suicidal ideation (k = 3) or suicide deaths (k = 2), no consistent associations with physical activity were observed. Overall, our systematic review found that physical activity may be linked to a lower frequency of suicide attempts in non-prospective studies involving individuals with mental disorders.
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Affiliation(s)
- Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Arnav Gupta
- Department of Medicine, University of Calgary, Calgary, AB, Canada; College of Public Health, Kent State University, Kent, OH, United States
| | - Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason Tran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Shan Bal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Brendon Stubbs
- EXI, People's Mission Hall, Whitechapel Road, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil; Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile; Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas J Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09124 Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax NS B3H 4R2, Canada
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulationn (ICPE), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anne Høye
- Department of Psychiatry, UiT The Arctic University of Norway, Tromsø, Norway; Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - René Ernst Nielsen
- Aalborg University Hospital, Department of Psychiatry, Aalborg, Denmark; Aalborg University, Aalborg, Denmark
| | - Richard Ig Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, UK; Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christoph U Correll
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany; The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Henrik Larrson
- Department of Medical Sciences, Örebro Universitet, Örebro, Sweden
| | - Merete Nordentoft
- Core-Copenhagen Research Center for Mental Health, Copenhagen University Hospital, Denmark
| | - Elena Dragioti
- Research Laboratory of Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece; Pain and Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden
| | | | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
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Kim MS, Kim JY, Song YS, Hong S, Won HH, Kim WJ, Kwon Y, Ha J, Fiedorowicz JG, Solmi M, Shin JI, Park S, Rosenthal RJ. Association of bariatric surgery with indicated and unintended outcomes: An umbrella review and meta-analysis for risk-benefit assessment. Obes Rev 2024; 25:e13670. [PMID: 38049310 DOI: 10.1111/obr.13670] [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: 10/27/2022] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 12/06/2023]
Abstract
Bariatric surgery can cause numerous functional changes to recipients, some of which are unintended. However, a systematic evaluation of wide-angled health benefits and risks following bariatric surgery has not been conducted. We systematically evaluated published systematic reviews of randomized controlled trials and observational studies reporting the association between bariatric surgery and health outcomes. We performed subgroup analyses by surgery type and sensitivity analysis, excluding gastric band. Thirty systematic reviews and 82 meta-analyzed health outcomes were included in this review. A total of 66 (80%) health outcomes were significantly associated with bariatric surgery, of which 10 were adverse outcomes, including suicide, fracture, gastroesophageal reflux after sleeve gastrectomy, and neonatal morbidities. The other 56 outcomes were health benefits including new-onset diabetes mellitus (DM) (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.19-0.79), hypertension (OR = 0.36; 95% CI = 0.33-0.40), dyslipidemia (OR = 0.33; 95% CI = 0.14-0.81), cancers (OR = 0.65; 95% CI = 0.53-0.80), cardiovascular diseases (CVDs), and women's health. Surgery is associated with reductions in all-cause mortality and death due to cancer, DM, and CVD. Bariatric surgery has both beneficial and harmful effects on a broader than expected array of patients' health outcomes. An expansion of the indication for bariatric surgery could be discussed to include a broader population with metabolic vulnerabilities.
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Affiliation(s)
- Min Seo Kim
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong Yeob Kim
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Yong Shin Song
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seokwon Hong
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Won Jun Kim
- Gangneung Prison Medical Department, Ministry of Justice, Seoul, Republic of Korea
| | - Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, Republic of Korea
- Centre for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Centre for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jae Il Shin
- Department of Pediatrics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, Republic of Korea
- Centre for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida, USA
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Fiedorowicz JG, Merranko JA, Goldstein TR, Hower H, Iyengar S, Hafeman DM, Hunt JI, Strober M, Keller MB, Goldstein BI, Diler RS, Siddiqi S, Birmaher B. Validation of a youth suicide risk calculator in an adult sample with bipolar disorder. J Affect Disord 2024; 347:278-284. [PMID: 38007103 PMCID: PMC11022308 DOI: 10.1016/j.jad.2023.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/08/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) conveys the highest risk of suicide of all mental disorders. We sought to externally validate a risk calculator (RC) of suicide attempts developed in youth with BD from the Course and Outcome of Bipolar Youth (COBY) study in an adult sample. METHODS A prospective cohort of adults with BD from the National Institute of Mental Health Collaborative Depression Study (CDS; N = 427; mean (+/- SD) age at intake (36 +/- 13 years)) was secondarily analyzed to validate the COBY RC for one-year risk of suicide attempts/deaths. Nine of the ten predictor variables from the COBY RC were available in the CDS and used: age, age of mood disorder onset, first and second (partial) degree family history of suicide, history of psychotic symptoms, substance use disorder, prior suicide attempt, socioeconomic status, and non-suicidal self-injury (prospectively, incompletely at baseline). RESULTS Over a mean (SD) follow-up of 19 (10) years, 29 % of the CDS sample attempted suicide. The RC predicted suicide attempts/deaths over one-year follow-up with an area under the receiver operating characteristic curve (AUC) of 0.78 (95 % CI 0.75-0.80). The RC performed slightly better in those with a younger age of mood disorder onset. LIMITATIONS Clinical samples may limit generalizability; the RC does not assess more acute suicide risk. CONCLUSIONS One-year risk of suicide attempts/deaths can be predicted with acceptable accuracy in youth and adults with BD, comparable to commonly used RCs to predict cardiovascular risk. This RC may help identify higher-risk individuals with BD for personalized treatment and research. https://cobysuicideattemptsrc.shinyapps.io/Shiny.
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Affiliation(s)
- Jess G Fiedorowicz
- Departments of Psychiatry and Epidemiology, The University of Ottawa, 75 Laurier Ave. East, Ottawa, ON K1N 6N5, Canada.
| | - John A Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, 230 S. Bouquet St., Pittsburgh, PA 15213, USA
| | - Danella M Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Jeffrey I Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, University of Miami, 1120 NW 14(th) St., Miami, FL 33136, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, CAMH, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Sara Siddiqi
- Departments of Psychiatry and Epidemiology, The University of Ottawa, 75 Laurier Ave. East, Ottawa, ON K1N 6N5, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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Fiedorowicz JG, Mikocka-Walus A. Journal of Psychosomatic Research 2023 year in review. J Psychosom Res 2024; 177:111619. [PMID: 38413330 DOI: 10.1016/j.jpsychores.2024.111619] [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: 02/29/2024]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Psychiatry, School of Public Health and Epidemiology, Brain & Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Antonina Mikocka-Walus
- School of Psychology & Centre for Social and Early Emotional Development, Deakin University Geelong, Melbourne, Victoria, Australia
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Mirza S, Lima CNC, Del Favero-Campbell A, Rubinstein A, Topolski N, Cabrera-Mendoza B, Kovács EHC, Blumberg HP, Richards JG, Williams AJ, Wemmie JA, Magnotta VA, Fiedorowicz JG, Gaine ME, Walss-Bass C, Quevedo J, Soares JC, Fries GR. Blood epigenome-wide association studies of suicide attempt in adults with bipolar disorder. Transl Psychiatry 2024; 14:70. [PMID: 38296944 PMCID: PMC10831084 DOI: 10.1038/s41398-024-02760-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Suicide attempt (SA) risk is elevated in individuals with bipolar disorder (BD), and DNA methylation patterns may serve as possible biomarkers of SA. We conducted epigenome-wide association studies (EWAS) of blood DNA methylation associated with BD and SA. DNA methylation was measured at >700,000 positions in a discovery cohort of n = 84 adults with BD with a history of SA (BD/SA), n = 79 adults with BD without history of SA (BD/non-SA), and n = 76 non-psychiatric controls (CON). EWAS revealed six differentially methylated positions (DMPs) and seven differentially methylated regions (DMRs) between BD/SA and BD/non-SA, with multiple immune-related genes implicated. There were no epigenome-wide significant differences when BD/SA and BD/non-SA were each compared to CON, and patterns suggested that epigenetics differentiating BD/SA from BD/non-SA do not differentiate BD/non-SA from CON. Weighted gene co-methylation network analysis and trait enrichment analysis of the BD/SA vs. BD/non-SA contrast further corroborated immune system involvement, while gene ontology analysis implicated calcium signalling. In an independent replication cohort of n = 48 BD/SA and n = 47 BD/non-SA, fold changes at the discovery cohort's significant sites showed moderate correlation across cohorts and agreement on direction. In both cohorts, classification accuracy for SA history among individuals with BD was highest when methylation at the significant CpG sites as well as information from clinical interviews were combined, with an AUC of 88.8% (CI = 83.8-93.8%) and 82.1% (CI = 73.6-90.5%) for the combined epigenetic-clinical classifier in the discovery and replication cohorts, respectively. Our results provide novel insight to the role of immune system functioning in SA and BD and also suggest that integrating information from multiple levels of analysis holds promise to improve risk assessment for SA in adults with BD.
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Affiliation(s)
- Salahudeen Mirza
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Institute of Child Development, University of Minnesota, 55455, Minneapolis, MN, USA
- Department of Psychiatry, Yale School of Medicine, 06510, New Haven, CT, USA
| | - Camila N C Lima
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
| | - Alexandra Del Favero-Campbell
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
| | - Alexandre Rubinstein
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
| | - Natasha Topolski
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | | | - Emese H C Kovács
- Department of Neuroscience and Pharmacology, The University of Iowa, 51 Newton Rd, 52242, Iowa City, IA, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 06510, New Haven, CT, USA
| | - Jenny Gringer Richards
- Department of Radiology, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Aislinn J Williams
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
| | - John A Wemmie
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
- Department of Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Vincent A Magnotta
- Department of Radiology, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Jess G Fiedorowicz
- University of Ottawa Brain and Mind Research Institute, Ottawa Hospital Research Institute, 501 Smyth, K1H 8L6, Ottawa, ON, Canada
| | - Marie E Gaine
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
- Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, 180 South Grand Ave, 52242, Iowa City, IA, USA
| | - Consuelo Walss-Bass
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
- Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, 1941 East Rd, 77054, Houston, TX, USA
| | - Jair C Soares
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
| | - Gabriel R Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA.
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA.
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA.
- Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, 1941 East Rd, 77054, Houston, TX, USA.
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Bouchard K, Liu PP, Dautenhahn K, Fiedorowicz JG, Afrin J, Dans M, McGuinty C, Tulloch H. Cardiology professionals' views of social robots in augmenting heart failure patient care. Eur Heart J Digit Health 2024; 5:69-76. [PMID: 38264699 PMCID: PMC10802821 DOI: 10.1093/ehjdh/ztad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 01/25/2024]
Abstract
Aims Social robots are arriving to the modern healthcare system. Whether patients with heart failure, a prevalent chronic disease with high health and human costs would derive benefit from a social robot intervention has not been investigated empirically. Diverse healthcare provider's perspectives are needed to develop an acceptable and feasible social robot intervention to be adopted for the clinical benefit of patients with heart failure. Using a qualitative research design, this study investigated healthcare providers' perspectives of social robot use in heart failure patient care. Methods and results Interdisciplinary healthcare providers from a tertiary care cardiac hospital completed a structured individual interview and a supplemental questionnaire. The framework method was used to analyse the qualitative data. Respondents (n = 22; saturation was reached with this sample; 77% female; 52% physicians) were open to using social robots to augment their practice, particularly with collecting pertinent data and providing patient and family education and self-management prompts, but with limited responsibility for direct patient care. Prior to implementation, providers required robust evidence of: value-added beyond current remote patient monitoring devices, patient and healthcare provider partnerships, streamlined integration into existing practice, and capability of supporting precision medicine goals. Respondents were concerned that social robots did not address and masked broader systemic issues of healthcare access and equity. Conclusion The adoption of social robots is a viable option to assist in the care of patients with heart failure, albeit in a restricted capacity. The results inform the development of a social robotic intervention for patients with heart failure, including improving social robot efficiencies and increasing their uptake, while protecting patients' and providers' best interest.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Peter P Liu
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Kerstin Dautenhahn
- Faculty of Engineering, University of Waterloo, 200 University Ave W., Waterloo, N2L 3G1 ON, Canada
| | - Jess G Fiedorowicz
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
- Department of Mental Health, The Ottawa Hospital/Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, K1H 8L6 ON, Canada
| | - Jenifar Afrin
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Michael Dans
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
| | - Caroline McGuinty
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
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10
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Harmata GIS, Barsotti EJ, Casten LG, Fiedorowicz JG, Williams A, Shaffer JJ, Richards JG, Sathyaputri L, Schmitz SL, Christensen GE, Long JD, Gaine ME, Xu J, Michaelson JJ, Wemmie JA, Magnotta VA. Cerebellar morphological differences and associations with extrinsic factors in bipolar disorder type I. J Affect Disord 2023; 340:269-279. [PMID: 37562560 PMCID: PMC10529949 DOI: 10.1016/j.jad.2023.08.018] [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: 01/04/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The neural underpinnings of bipolar disorder (BD) remain poorly understood. The cerebellum is ideally positioned to modulate emotional regulation circuitry yet has been understudied in BD. Literature suggests differences in cerebellar activity and metabolism in BD, however findings on structural differences remain contradictory. Potential reasons include combining BD subtypes, small sample sizes, and potential moderators such as genetics, adverse childhood experiences (ACEs), and pharmacotherapy. METHODS We collected 3 T MRI scans from participants with (N = 131) and without (N = 81) BD type I, as well as blood and questionnaires. We assessed differences in cerebellar volumes and explored potentially influential factors. RESULTS The cerebellar cortex was smaller bilaterally in participants with BD. Polygenic propensity score did not predict any cerebellar volumes, suggesting that non-genetic factors may have greater influence on the cerebellar volume difference we observed in BD. Proportionate cerebellar white matter volumes appeared larger with more ACEs, but this may result from reduced ICV. Time from onset and symptom burden were not associated with cerebellar volumes. Finally, taking sedatives was associated with larger cerebellar white matter and non-significantly larger cortical volume. LIMITATIONS This study was cross-sectional, limiting interpretation of possible mechanisms. Most of our participants were White, which could limit the generalizability. Additionally, we did not account for potential polypharmacy interactions. CONCLUSIONS These findings suggest that external factors, such as sedatives and childhood experiences, may influence cerebellum structure in BD and may mask underlying differences. Accounting for such variables may be critical for consistent findings in future studies.
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Affiliation(s)
- Gail I S Harmata
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Department of Radiology, The University of Iowa, United States
| | - Ercole John Barsotti
- Department of Psychiatry, The University of Iowa, United States; Department of Epidemiology, The University of Iowa, United States
| | - Lucas G Casten
- Department of Psychiatry, The University of Iowa, United States; Interdisciplinary Graduate Program in Genetics, The University of Iowa, United States
| | - Jess G Fiedorowicz
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Department of Psychiatry, University of Ottawa, Canada
| | - Aislinn Williams
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States
| | - Joseph J Shaffer
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Department of Radiology, The University of Iowa, United States; Department of Biosciences, Kansas City University, United States
| | | | | | | | - Gary E Christensen
- Department of Electrical and Computer Engineering, The University of Iowa, United States; Department of Radiation Oncology, The University of Iowa, United States
| | - Jeffrey D Long
- Department of Psychiatry, The University of Iowa, United States; Department of Biostatistics, The University of Iowa, United States
| | - Marie E Gaine
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Department of Pharmaceutical Sciences and Experimental Therapeutics (PSET), College of Pharmacy, The University of Iowa, United States
| | - Jia Xu
- Department of Radiology, The University of Iowa, United States
| | - Jake J Michaelson
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Interdisciplinary Graduate Program in Genetics, The University of Iowa, United States
| | - John A Wemmie
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Department of Molecular Physiology and Biophysics, The University of Iowa, United States; Department of Neurosurgery, The University of Iowa, United States; Veterans Affairs Medical Center, Iowa City, United States
| | - Vincent A Magnotta
- Department of Psychiatry, The University of Iowa, United States; Iowa Neuroscience Institute, The University of Iowa, United States; Department of Radiology, The University of Iowa, United States; Department of Biomedical Engineering, The University of Iowa, United States.
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11
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Myran DT, Harrison LD, Pugliese M, Solmi M, Anderson KK, Fiedorowicz JG, Perlman CM, Webber C, Finkelstein Y, Tanuseputro P. Transition to Schizophrenia Spectrum Disorder Following Emergency Department Visits Due to Substance Use With and Without Psychosis. JAMA Psychiatry 2023; 80:1169-1174. [PMID: 37755727 PMCID: PMC10535000 DOI: 10.1001/jamapsychiatry.2023.3582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 06/13/2023] [Accepted: 07/28/2023] [Indexed: 09/28/2023]
Abstract
Importance Episodes of substance-induced psychosis are associated with increased risk of developing a schizophrenia spectrum disorder. However, there are limited data on the transition risk for substance use without psychosis. Objectives To quantify the risk of transition to schizophrenia spectrum disorder following an incident emergency department (ED) visit for (1) substance-induced psychosis and (2) substance use without psychosis and to explore factors associated with transition. Design, Settings, and Participants A population-based retrospective cohort study (January 2008 to March 2022) of all individuals, aged 14 to 65 years, in Ontario, Canada, with no history of a psychotic disorder. Individuals with incident ED visits for substance use with and without psychosis were compared with members of the general population. Main Outcomes and Measures Transition to schizophrenia spectrum disorder using a chart-validated algorithm. Associations between ED visits for substance use and subsequent transition were estimated using cause-specific hazard models. Results The study included 9 844 497 individuals, aged 14 to 65 years (mean [SD] age, 40.2 [14.7] years; 50.2% female) without a history of psychosis. There were 407 737 individuals with an incident ED visit for substance use, of which 13 784 (3.4%) ED visits were for substance-induced psychosis. Individuals with substance-induced psychosis were at a 163-fold (age- and sex-adjusted hazard ratio [aHR], 163.2; 95% CI, 156.1-170.5) increased risk of transitioning, relative to the general population (3-year risk, 18.5% vs 0.1%). Individuals with an ED visit for substance use without psychosis had a lower relative risk of transitioning (aHR, 9.8; 95% CI, 9.5-10.2; 3-year risk, 1.4%), but incurred more than 3 times the absolute number of transitions (9969 vs 3029). Cannabis use had the highest transition risk among visits with psychosis (aHR, 241.6; 95% CI, 225.5-258.9) and the third-highest risk among visits without psychosis (aHR, 14.3; 95% CI, 13.5-15.2). Younger age and male sex were associated with a higher risk of transition, and the risk of male sex was greater in younger compared with older individuals, particularly for cannabis use. Conclusions and Relevance The findings of this cohort study suggest that ED visits for substance use were associated with an increased risk of developing a schizophrenia spectrum disorder. Although substance-induced psychoses had a greater relative transition risk, substance use without psychosis was far more prevalent and resulted in a greater absolute number of transitions. Several factors were associated with higher transition risk, with implications for counseling and early intervention.
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Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Lyndsay D. Harrison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marco Solmi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Kelly K. Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- ICES Western, London, Ontario, Canada
| | - Jess G. Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Neurosciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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12
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Luu B, Gupta A, Fabiano N, Wong S, Fiedorowicz JG, Fidler L, Shorr R, Solmi M. Influence of pulmonary rehabilitation on symptoms of anxiety and depression in interstitial lung disease: A systematic review of randomized controlled trials. Respir Med 2023; 219:107433. [PMID: 37863339 DOI: 10.1016/j.rmed.2023.107433] [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: 06/02/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Interstitial lung diseases (ILDs) cause fibrosis of lung parenchyma, leading to impaired quality of life, dyspnea, and functional decline. Individuals with ILD experience a high prevalence of anxiety and depression. Recent research has demonstrated pulmonary rehabilitation (PR) alleviates symptoms of anxiety and depression in those with COPD. RESEARCH QUESTION What is the influence of PR on symptoms of anxiety and depression in individuals with ILD? STUDY DESIGN We conducted a PRISMA-2020-compliant systematic review of randomized controlled trials (RCTs) investigating PR's effect on anxiety and depression in patients with ILD. We searched MEDLINE, EMBASE, Cochrane, and PsycINFO from inception until April 3, 2023. A narrative synthesis was conducted where a quantitative approach was not feasible. RESULTS Five RCTs (n = 281) were included. Idiopathic pulmonary fibrosis (IPF) was the most common type of ILD (k = 3). One study reported clinically-significant improvements in symptoms of anxiety among patients with IPF, and two studies for symptoms of depression among patients with sarcoidosis. Dropout rates were similar between intervention and control groups. All studies were at a high risk of bias. INTERPRETATION Pulmonary rehabilitation is not detrimental to anxiety or depression for patients with ILD, and may improve symptoms of anxiety in IPF and depression in sarcoidosis. However, no conclusion can be drawn from available evidence, which is limited by heterogeneous populations/interventions, sample sizes and unexpectedly low prevalences of clinically-significant anxiety or depression. Further adequately powered RCTs that focus on anxiety and depressive symptoms as primary outcomes are needed.
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Affiliation(s)
- Brandon Luu
- Department of Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Arnav Gupta
- Department of Internal Medicine, University of Calgary, Calgary, AB, Canada; College of Public Health, Kent State University, Kent, OH, United States
| | - Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, OH, Canada
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lee Fidler
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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13
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Fiedorowicz JG, Guthrie E, Löwe B. Seryan Atasoy, 2023 EAPM Elsevier Young Investigator Award recipient, on stability of somatic symptoms. J Psychosom Res 2023; 173:111497. [PMID: 37743219 DOI: 10.1016/j.jpsychores.2023.111497] [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: 09/26/2023]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Bernd Löwe
- University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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14
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Mirza S, de Carvalho Lima CN, Del Favero-Campbell A, Rubinstein A, Topolski N, Cabrera-Mendoza B, Kovács EH, Blumberg HP, Richards JG, Williams AJ, Wemmie JA, Magnotta VA, Fiedorowicz JG, Gaine ME, Walss-Bass C, Quevedo J, Soares JC, Fries GR. Blood epigenome-wide association studies of suicide attempt in adults with bipolar disorder. medRxiv 2023:2023.07.20.23292968. [PMID: 37546994 PMCID: PMC10402220 DOI: 10.1101/2023.07.20.23292968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Suicide attempt (SA) risk is elevated in individuals with bipolar disorder (BD), and DNA methylation patterns may serve as possible biomarkers of SA. We conducted epigenome-wide association studies (EWAS) of blood DNA methylation associated with BD and SA. DNA methylation was measured at > 700,000 positions in a discovery cohort of n = 84 adults with BD with a history of SA (BD/SA), n = 79 adults with BD without history of SA (BD/non-SA), and n = 76 non-psychiatric controls (CON). EWAS revealed six differentially methylated positions (DMPs) and seven differentially methylated regions (DMRs) between BD/SA and BD/non-SA, with multiple immune-related genes implicated. There were no epigenome-wide significant differences when BD/SA and BD/non-SA were each compared to CON, and patterns suggested that epigenetics differentiating BD/SA from BD/non-SA do not differentiate BD/non-SA from CON. Weighted gene co-methylation network analysis and trait enrichment analysis of the BD/SA vs. BD/non-SA contrast further corroborated immune system involvement, while gene ontology analysis implicated calcium signalling. In an independent replication cohort of n = 48 BD/SA and n = 47 BD/non-SA, fold-changes at the discovery cohort's significant sites showed moderate correlation across cohorts and agreement on direction. In both cohorts, classification accuracy for SA history among individuals with BD was highest when methylation at the significant CpG sites as well as information from clinical interviews were combined, with an AUC of 88.8% (CI = 83.8-93.8%) and 82.1% (CI = 73.6-90.5%) for the combined epigenetic-clinical predictor in the discovery and replication cohorts, respectively. Our results provide novel insight to the role of immune system functioning in SA and BD and also suggest that integrating information from multiple levels of analysis holds promise to improve risk assessment for SA in adults with BD.
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Affiliation(s)
- Salahudeen Mirza
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Institute of Child Development, University of Minnesota, 55455 Minneapolis, Minnesota, USA
| | - Camila N. de Carvalho Lima
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
| | - Alexandra Del Favero-Campbell
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
| | - Alexandre Rubinstein
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
| | - Natasha Topolski
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
| | | | - Emese H.C. Kovács
- Department of Neuroscience and Pharmacology, The University of Iowa, 51 Newton Rd, 52242 Iowa City, Iowa, USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, 06510 New Haven, Connecticut, USA
| | - Jenny Gringer Richards
- Department of Radiology, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
| | - Aislinn J. Williams
- Department of Psychiatry, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
- Iowa Neuroscience Institute, The University of Iowa. 169 Newton Rd, 52242 Iowa City, Iowa USA
| | - John A. Wemmie
- Department of Psychiatry, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
- Iowa Neuroscience Institute, The University of Iowa. 169 Newton Rd, 52242 Iowa City, Iowa USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - Vincent A. Magnotta
- Department of Radiology, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
- Department of Psychiatry, The University of Iowa. 200 Hawkins Dr, 52242 Iowa City, Iowa, USA
| | - Jess G. Fiedorowicz
- University of Ottawa Brain and Mind Research Institute, Ottawa Hospital Research Institute. 501 Smyth, K1H 8L6, Ottawa, Ontario, Canada
| | - Marie E. Gaine
- Iowa Neuroscience Institute, The University of Iowa. 169 Newton Rd, 52242 Iowa City, Iowa USA
- Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, 180 South Grand Ave, 52242, Iowa City, Iowa, USA
| | - Consuelo Walss-Bass
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, Texas, USA
| | - Jair C. Soares
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, Texas, USA
| | - Gabriel R. Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054 Houston, Texas, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054 Houston, Texas, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, Texas, USA
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Bauer M, Glenn T, Achtyes ED, Alda M, Agaoglu E, Altınbaş K, Andreassen OA, Angelopoulos E, Ardau R, Aydin M, Ayhan Y, Baethge C, Bauer R, Baune BT, Balaban C, Becerra-Palars C, Behere AP, Behere PB, Belete H, Belete T, Belizario GO, Bellivier F, Belmaker RH, Benedetti F, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Brady C, Cabrera J, Cappucciati M, Castro AMP, Chen WL, Cheung EYW, Chiesa S, Crowe M, Cuomo A, Dallaspezia S, Del Zompo M, Desai P, Dodd S, Etain B, Fagiolini A, Fellendorf FT, Ferensztajn-Rochowiak E, Fiedorowicz JG, Fountoulakis KN, Frye MA, Geoffroy PA, Gitlin MJ, Gonzalez-Pinto A, Gottlieb JF, Grof P, Haarman BCM, Harima H, Hasse-Sousa M, Henry C, Hoffding L, Houenou J, Imbesi M, Isometsä ET, Ivkovic M, Janno S, Johnsen S, Kapczinski F, Karakatsoulis GN, Kardell M, Kessing LV, Kim SJ, König B, Kot TL, Koval M, Kunz M, Lafer B, Landén M, Larsen ER, Lenger M, Licht RW, Lopez-Jaramillo C, MacKenzie A, Madsen HØ, Madsen SAKA, Mahadevan J, Mahardika A, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Martini J, Martiny K, Mashima Y, McLoughlin DM, Meesters Y, Melle I, Meza-Urzúa F, Mikolas P, Mok YM, Monteith S, Moorthy M, Morken G, Mosca E, Mozzhegorov AA, Munoz R, Mythri SV, Nacef F, Nadella RK, Nakanotani T, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Ouali U, Pantovic-Stefanovic M, Pariwatcharakul P, Petite J, Petzold J, Pfennig A, Ruiz YP, Pinna M, Pompili M, Porter RJ, Quiroz D, Rabelo-da-Ponte FD, Ramesar R, Rasgon N, Ratta-Apha W, Ratzenhofer M, Redahan M, Reddy MS, Reif A, Reininghaus EZ, Richards JG, Ritter P, Rybakowski JK, Sathyaputri L, Scippa AM, Simhandl C, Smith D, Smith J, Stackhouse PW, Stein DJ, Stilwell K, Strejilevich S, Su KP, Subramaniam M, Sulaiman AH, Suominen K, Tanra AJ, Tatebayashi Y, Teh WL, Tondo L, Torrent C, Tuinstra D, Uchida T, Vaaler AE, Vieta E, Viswanath B, Yoldi-Negrete M, Yalcinkaya OK, Young AH, Zgueb Y, Whybrow PC. Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder. Int J Bipolar Disord 2023; 11:22. [PMID: 37347392 DOI: 10.1186/s40345-023-00303-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample. METHODS Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001. RESULTS The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger. CONCLUSION UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Eric D Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Esen Agaoglu
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kürsat Altınbaş
- Department of Psychiatry, Selcuk University Faculty of Medicine, Mazhar Osman Mood Center, Konya, Turkey
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elias Angelopoulos
- Department of Psychiatry, National and Capodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Raffaella Ardau
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Memduha Aydin
- Department of Psychiatry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Yavuz Ayhan
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ceylan Balaban
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt Am Main, Frankfurt Am Main, Germany
| | | | - Aniruddh P Behere
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA
| | - Prakash B Behere
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, India
| | - Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gabriel Okawa Belizario
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique, Hôpitaux de Paris, INSERM UMR-S1144, Université Paris Cité, Fondation FondaMental, Paris, France
| | - Robert H Belmaker
- Division of Psychiatry, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Francesco Benedetti
- University Vita-Salute San Raffaele, Milan, Italy
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Yuly Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Şule Bicakci
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Department of Psychiatry, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Thomas D Bjella
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Conan Brady
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Jorge Cabrera
- Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile
| | | | - Angela Marianne Paredes Castro
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Wei-Ling Chen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | | | - Silvia Chiesa
- Department of Mental Health and Substance Abuse, Piacenza, Italy
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Sara Dallaspezia
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Pratikkumar Desai
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Seetal Dodd
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique, Hôpitaux de Paris, INSERM UMR-S1144, Université Paris Cité, Fondation FondaMental, Paris, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | | | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat, Claude Bernard, 75018, Paris, France
- GHU Paris, Psychiatry and Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- Université de Paris, NeuroDiderot, Inserm, FHU I2D2, 75019, Paris, France
| | - Michael J Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ana Gonzalez-Pinto
- BIOARABA, Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - John F Gottlieb
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa and the Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Mathias Hasse-Sousa
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Chantal Henry
- Department of Psychiatry, GHU Paris Psychiatrie and Neurosciences, Université de Paris, F-75014, F-75006, Paris, France
| | - Lone Hoffding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Josselin Houenou
- Université Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, APHP, Mondor Univ Hospitals, Fondation FondaMental, F-94010, Créteil, France
- Université Paris Saclay, CEA, Neurospin, F-91191, Gif-Sur-Yvette, France
| | | | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Maja Ivkovic
- Clinic for Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sven Janno
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - Simon Johnsen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - Flávio Kapczinski
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gregory N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Seong Jae Kim
- Department of Psychiatry, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Barbara König
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - Timur L Kot
- Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia
| | - Michael Koval
- Neuroscience Program, Michigan State University, East Lansing, MI, USA
| | - Mauricio Kunz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik R Larsen
- Mental Health Department Odense, University Clinic and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Rasmus W Licht
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carlos Lopez-Jaramillo
- Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alan MacKenzie
- Forensic Psychiatry, University of Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Agustine Mahardika
- Department of Psychiatry, Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Mirko Manchia
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Monica Martinez-Cengotitabengoa
- Osakidetza, Basque Health Service, BioAraba Health Research Institute, University of the Basque Country, Bilbao, Spain
- The Psychology Clinic of East Anglia, Norwich, UK
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaus Martiny
- Psychiatric Centre Copenhagen, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Yuki Mashima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Declan M McLoughlin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Ybe Meesters
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fátima Meza-Urzúa
- Department of Child and Adolescent Psychiatry Und Psychotherapy, SHG Klinikum, Idar-Oberstein, Germany
| | - Pavol Mikolas
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yee Ming Mok
- Department of Mood and Anxiety Disorders, Institute of Mental Health, Singapore City, Singapore
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Muthukumaran Moorthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Enrica Mosca
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Starlin V Mythri
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Assam, 788727, India
| | - Fethi Nacef
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ravi K Nadella
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Takako Nakanotani
- Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - René Ernst Nielsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Adel Omrani
- Tunisian Bipolar Forum, Érable Médical Cabinet 324, Lac 2, Tunis, Tunisia
| | - Yamima Osher
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uta Ouali
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | | | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Joanne Petite
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Johannes Petzold
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Marco Pinna
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Danilo Quiroz
- Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile
| | | | - Raj Ramesar
- SA MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular, Medicine, University of Cape Town, Cape Town, South Africa
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Maria Redahan
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Jenny Gringer Richards
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Leela Sathyaputri
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Angela M Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - Christian Simhandl
- Bipolar Zentrum Wiener Neustadt, Sigmund Freud Privat Universität, Vienna, Austria
| | - Daniel Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - José Smith
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Paul W Stackhouse
- Science Directorate/Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA
| | - Dan J Stein
- Department of Psychiatry, MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Kellen Stilwell
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Kuan-Pin Su
- College of Medicine, China Medical University (CMU), Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirsi Suominen
- Department of Social Services and Health Care, Psychiatry, City of Helsinki, Helsinki, Finland
| | - Andi J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Yoshitaka Tatebayashi
- Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Leonardo Tondo
- McLean Hospital-Harvard Medical School, Boston, MA, USA
- Mood Disorder Lucio Bini Centers, Cagliari e Rome, Italy
| | - Carla Torrent
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Daniel Tuinstra
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Takahito Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Arne E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Maria Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
| | - Oguz Kaan Yalcinkaya
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yosra Zgueb
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Ewald VAM, Purnell JR, Bruss JE, Barsotti EJ, Aldine AS, Mahachi KG, Wemmie JA, Magnotta VA, Boes AD, Parker KL, Fiedorowicz JG. Posterior Fossa Sub-Arachnoid Cysts Observed in Patients with Bipolar Disorder: a Retrospective Cohort Study. Cerebellum 2023; 22:370-378. [PMID: 35568792 PMCID: PMC9659668 DOI: 10.1007/s12311-022-01408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Posterior fossa arachnoid cysts (PFACs) are rare congenital abnormalities observed in 0.3 to 1.7% of the population and are traditionally thought to be benign. While conducting a neuroimaging study investigating cerebellar structure in bipolar disorder, we observed a higher incidence of PFACs in bipolar patients (5 of 75; 6.6%) compared to the neuronormative control group (1 of 54; 1.8%). In this report, we detail the cases of the five patients with bipolar disorder who presented with PFACs. Additionally, we compare neuropsychiatric measures and cerebellar volumes of these patients to neuronormative controls and bipolar controls (those with bipolar disorder without neuroanatomical abnormalities). Our findings suggest that patients with bipolar disorder who also present with PFACs may have a milder symptom constellation relative to patients with bipolar disorder and no neuroanatomical abnormalities. Furthermore, our observations align with prior literature suggesting an association between PFACs and psychiatric symptoms that warrants further study. While acknowledging sample size limitations, our primary aim in the present work is to highlight a connection between PFACs and BD-associated symptoms and encourage further study of cerebellar abnormalities in psychiatry.
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Affiliation(s)
- Victόria A Müller Ewald
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
| | - Jessica R Purnell
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
| | - Joel E Bruss
- Department of Neurology, The University of Iowa, Iowa City, IA, USA
| | - Ercole J Barsotti
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - Amro S Aldine
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kurayi G Mahachi
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - John A Wemmie
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
| | - Vincent A Magnotta
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Aaron D Boes
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
- Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
| | - Krystal L Parker
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA.
| | - Jess G Fiedorowicz
- Brain and Mind Institute, University of Ottawa, The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Saleem A, Harmata G, Jain S, Voss MW, Fiedorowicz JG, Williams AJ, Shaffer JJ, Richards JG, Barsotti EJ, Sathyaputri L, Schmitz SL, Christensen GE, Long JD, Xu J, Wemmie JA, Magnotta VA. Functional connectivity of the cerebellar vermis in bipolar disorder and associations with mood. Front Psychiatry 2023; 14:1147540. [PMID: 37215681 PMCID: PMC10196126 DOI: 10.3389/fpsyt.2023.1147540] [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: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose Studies of the neural underpinnings of bipolar type I disorder have focused on the emotional control network. However, there is also growing evidence for cerebellar involvement, including abnormal structure, function, and metabolism. Here, we sought to assess functional connectivity of the cerebellar vermis with the cerebrum in bipolar disorder and to assess whether connectivity might depend on mood. Methods This cross-sectional study enrolled 128 participants with bipolar type I disorder and 83 control comparison participants who completed a 3 T magnetic resonance imaging (MRI) study, which included anatomical as well as resting state Blood Oxygenation Level Dependent (BOLD) imaging. Functional connectivity of the cerebellar vermis to all other brain regions was assessed. Based on quality control metrics of the fMRI data, 109 participants with bipolar disorder and 79 controls were included in the statistical analysis comparing connectivity of the vermis. In addition, the data was explored for the potential impacts of mood, symptom burden, and medication in those with bipolar disorder. Results Functional connectivity between the cerebellar vermis and the cerebrum was found to be aberrant in bipolar disorder. The connectivity of the vermis was found to be greater in bipolar disorder to regions involved in motor control and emotion (trending), while reduced connectivity was observed to a region associated with language production. In the participants with bipolar disorder, past depression symptom burden affected connectivity; however, no effects of medication were observed. Functional connectivity between the cerebellar vermis and all other regions revealed an inverse association with current mood ratings. Conclusion Together the findings may suggest that the cerebellum plays a compensatory role in bipolar disorder. The proximity of the cerebellar vermis to the skull may make this region a potential target for treatment with transcranial magnetic stimulation.
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Affiliation(s)
- Arshaq Saleem
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Gail Harmata
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Shivangi Jain
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Michelle W. Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Jess G. Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | | | - Joseph J. Shaffer
- Department of Radiology, University of Iowa, Iowa City, IA, United States
- Department of Biosciences, Kansas City University, Kansas City, MO, United States
| | | | | | - Leela Sathyaputri
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Embracing the World, Elburn, IL, United States
| | - Samantha L. Schmitz
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, United States
| | - Gary E. Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, United States
| | - Jeffrey D. Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Department of Biostatistics, University of Iowa, Iowa City, IA, United States
| | - Jia Xu
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - John A. Wemmie
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Veterans Affairs Medical Center, Iowa City, IA, United States
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Vincent A. Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, United States
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
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18
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Fiedorowicz JG. Looking across the interprofessional bridge. J Psychosom Res 2023:111341. [PMID: 37156693 DOI: 10.1016/j.jpsychores.2023.111341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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19
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Lima CNC, Kovács EHC, Mirza S, Del Favero-Campbell A, Diaz AP, Quevedo J, Argue BMR, Richards JG, Williams A, Wemmie JA, Magnotta VA, Fiedorowicz JG, Soares JC, Gaine ME, Fries GR. Association between the epigenetic lifespan predictor GrimAge and history of suicide attempt in bipolar disorder. Neuropsychopharmacology 2023; 48:954-962. [PMID: 36878995 PMCID: PMC10156727 DOI: 10.1038/s41386-023-01557-9] [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: 11/16/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Bipolar disorder (BD) has been previously associated with premature mortality and aging, including acceleration of epigenetic aging. Suicide attempts (SA) are greatly elevated in BD and are associated with decreased lifespan, biological aging, and poorer clinical outcomes. We investigated the relationship between GrimAge, an epigenetic clock trained on time-to-death and associated with mortality and lifespan, and SA in two independent cohorts of BD individuals (discovery cohort - controls (n = 50), BD individuals with (n = 77, BD/SA) and without (n = 67, BD/non-SA) lifetime history of SA; replication cohort - BD/SA (n = 48) and BD/non-SA (n = 47)). An acceleration index for the GrimAge clock (GrimAgeAccel) was computed from blood DNA methylation (DNAm) and compared between groups with multiple general linear models. Differences in epigenetic aging from the discovery cohort were validated in the independent replication cohort. In the discovery cohort, controls, BD/non-SA, and BD/SA significantly differed on GrimAgeAccel (F = 5.424, p = 0.005), with the highest GrimAgeAccel in BD/SA (p = 0.004, BD/SA vs. controls). Within the BD individuals, BD/non-SA and BD/SA differed on GrimAgeAccel in both cohorts (p = 0.008) after covariate adjustment. Finally, DNAm-based surrogates revealed possible involvement of plasminogen activator inhibitor 1, leptin, and smoking pack-years in driving accelerated epigenetic aging. These findings pair with existing evidence that not only BD, but also SA, may be associated with an accelerated biological aging and provide putative biological mechanisms for morbidity and premature mortality in this population.
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Affiliation(s)
- Camila N C Lima
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
| | - Emese H C Kovács
- Department of Neuroscience and Pharmacology, The University of Iowa, 51 Newton Rd, 52242, Iowa City, IA, USA
| | - Salahudeen Mirza
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
- Institute of Child Development, University of Minnesota, 51 E River Rd, 55455, Minneapolis, MN, USA
| | - Alexandra Del Favero-Campbell
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
| | - Alexandre Paim Diaz
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 6767 Bertner Ave, 77030, Houston, TX, USA
| | - Benney M R Argue
- Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, 180 South Grand Ave, 52242, Iowa City, IA, USA
| | - Jenny Gringer Richards
- Department of Radiology, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Aislinn Williams
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
| | - John A Wemmie
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Vincent A Magnotta
- Department of Radiology, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
- Department of Psychiatry, The University of Iowa, 200 Hawkins Dr, 52242, Iowa City, IA, USA
| | - Jess G Fiedorowicz
- University of Ottawa Brain and Mind Research Institute, Ottawa Hospital Research Institute, 501 Smyth, K1H 8L6, Ottawa, ON, Canada
| | - Jair C Soares
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 6767 Bertner Ave, 77030, Houston, TX, USA
| | - Marie E Gaine
- Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, 180 South Grand Ave, 52242, Iowa City, IA, USA
- Iowa Neuroscience Institute, The University of Iowa, 169 Newton Rd, 52242, Iowa City, IA, USA
| | - Gabriel R Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA.
- Center of Excellence in Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Rd, 77054, Houston, TX, USA.
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 6767 Bertner Ave, 77030, Houston, TX, USA.
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin, 77030, Houston, TX, USA.
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20
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Fiani D, Campbell H, Solmi M, Fiedorowicz JG, Calarge CA. Impact of antidepressant use on the autonomic nervous system: A meta-analysis and systematic review. Eur Neuropsychopharmacol 2023; 71:75-95. [PMID: 37075594 DOI: 10.1016/j.euroneuro.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
Changes in cardiac autonomic nervous system (ANS) regulation observed in psychiatric disorders may be mitigated by antidepressants. We meta-analyzed and systematically reviewed studies examining antidepressants' effects on ANS outcomes, including heart rate variability (HRV). We conducted a PRISMA/MOOSE-compliant search of PubMed and Scopus until March 28th, 2022. We included randomized placebo-controlled trials (RCTs) and pre-post studies, regardless of diagnosis. We pooled results in random-effects meta-analyses, pooling homogeneous study designs and outcomes. We conducted sensitivity analyses and assessed quality of included studies. Thirty studies could be meta-analyzed. Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with a reduction in the square root of the mean-squared difference between successive R-R intervals (RMSSD) (SMD= -0.48) and skin conductance response (SMD= -0.55) in RCTs and with a significant increase in RMSSD in pre-post studies (SMD=0.27). In pre-post studies, tricyclic antidepressants (TCAs) were associated with a significant decrease in several HRV outcomes while agomelatine was associated with a significant increase in high frequency power (SMD= 0.14). In conclusion, SSRIs reduce skin conductance response but have no or inconclusive effects on other ANS outcomes, depending on study design. TCAs reduce markers of parasympathetic function while agomelatine might have the opposite effect. Studies are needed to investigate the impact of SSRIs on the recovery of cardiac ANS regulation after acute myocardial infarction, and the effects of newer antidepressants.
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Affiliation(s)
- Dimitri Fiani
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Hannah Campbell
- Duke Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, United States
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jess G Fiedorowicz
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Chadi A Calarge
- Menninger Department of Psychiatry and Behavioral Sciences, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
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21
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Goldstein BI, Fiedorowicz JG. The Vascular - Bipolar Link. J Affect Disord 2023; 332:201-202. [PMID: 37024016 DOI: 10.1016/j.jad.2023.04.001] [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: 04/08/2023]
Affiliation(s)
- Benjamin I Goldstein
- Departments of Psychiatry and Pharmacology, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Jess G Fiedorowicz
- Departments of Psychiatry and Epidemiology, The University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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22
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Fiedorowicz JG, Mikocka-Walus A. Journal of psychosomatic research 2022 year in review. J Psychosom Res 2023; 167:111204. [PMID: 36863892 DOI: 10.1016/j.jpsychores.2023.111204] [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: 03/04/2023]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Psychiatry, School of Public Health and Epidemiology, Brain & Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Antonina Mikocka-Walus
- School of Psychology & Centre for Social and Early Emotional Development, Deakin University Geelong, Melbourne, Victoria, Australia
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23
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Fabiano N, Mikocka-Walus A, Fiedorowicz JG. Format less, publish more with flexible formatting. J Psychosom Res 2023; 168:111228. [PMID: 36918331 DOI: 10.1016/j.jpsychores.2023.111228] [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: 03/16/2023]
Affiliation(s)
- Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, Brain & Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.
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Fabiano N, Gupta A, Fiedorowicz JG, Firth J, Stubbs B, Vancampfort D, Schuch FB, Carr LJ, Solmi M. Dr Amir Mohammadamini
The effect of exercise on suicidal behaviors: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2023; 330:355-366. [PMID: 36871911 DOI: 10.1016/j.jad.2023.02.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Although exercise may positively impact those with mental or other medical illnesses, there is a lack of understanding on how it influences suicidal ideation or risk. METHODS We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, EMBASE, Cochrane, and PsycINFO from inception to June 21, 2022. Randomized controlled trials (RCTs) investigating exercise and suicidal ideation in subject with mental or physical conditions were included. Random-effects meta-analysis was conducted. The primary outcome was suicidal ideation. We assessed bias of studies with risk of bias tool 2. RESULTS We identified 17 RCTs encompassing 1021 participants. Depression was the most included condition (71 %, k = 12). Mean follow up was 10.0 weeks (SD = 5.2). Post-intervention suicidal ideation (SMD = -1.09, CI -3.08-0.90, p = 0.20, k = 5) was not significantly different between exercise and control groups. Suicide attempts were significantly reduced in participants randomized to exercise interventions as compared to inactive controls (OR = 0.23, CI 0.09-0.67, p = 0.04, k = 2). Fourteen studies (82 %) were at high risk of bias. LIMITATIONS This meta-analysis is limited by few, and underpowered and heterogenous studies. CONCLUSION Overall, our meta-analysis did not find a significant decrease in suicidal ideation or mortality between exercise and control groups. However, exercise did significantly decrease suicide attempts. Results should be considered preliminary, and more and larger studies assessing suicidality in RCTs testing exercise are needed.
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Affiliation(s)
- Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Arnav Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; College of Public Health, Kent State University, Kent, OH, United States
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Lucas J Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Saleem A, Harmata G, Jain S, Voss MW, Fiedorowicz JG, Williams A, Shaffer JJ, Richards JG, Barsotti EJ, Sathyaputri L, Schmitz SL, Christensen GE, Long JD, Xu J, Wemmie JA, Magnotta VA. Functional Connectivity of the Cerebellar Vermis in Bipolar Disorder and Associations with Mood. bioRxiv 2023:2023.02.02.526878. [PMID: 36778335 PMCID: PMC9915674 DOI: 10.1101/2023.02.02.526878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose Studies of the neural underpinnings of bipolar type I disorder have focused on the emotional control network. However, there is also growing evidence for cerebellar involvement, including abnormal structure, function, and metabolism. Here, we sought to assess functional connectivity of the cerebellum with the cerebrum in bipolar disorder and to assess whether any effects might depend on mood. Methods This cross-sectional study enrolled 128 participants with bipolar type I disorder and 83 control comparison participants who completed a 3T MRI scan, which included anatomical imaging as well as resting state BOLD imaging. Functional connectivity of the cerebellar vermis to all other brain regions was assessed. Based on quality control metrics of the fMRI data, 109 participants with bipolar disorder and 79 controls were used to in the statistical analysis comparing connectivity of the vermis as well as associations with mood. Potential impacts of medications were also explored. Results Functional connectivity of the cerebellar vermis in bipolar disorder was found to differ significantly between brain regions known to be involved in the control of emotion, motor function, and language. While connections with emotion and motor control areas were significantly stronger in bipolar disorder, connection to a region associated language production was significantly weaker. In the participants with bipolar disorder, ratings of depression and mania were inversely associated with vermis functional connectivity. No effect of medications on these connections were observed. Conclusion Together the findings suggest cerebellum may play a compensatory role in bipolar disorder and when it can no longer fulfill this role, depression and mania develop. The proximity of the cerebellar vermis to the skull may make this region a potential target for treatment with transcranial magnetic stimulation.
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Affiliation(s)
- Arshaq Saleem
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Gail Harmata
- Department of Radiology, University of Iowa, Iowa City, IA, 52242
| | - Shivangi Jain
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Michelle W. Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Jess G. Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, Ottawa ON Canada K1H 8L6
| | - Aislinn Williams
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242
| | | | | | | | - Leela Sathyaputri
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Samantha L. Schmitz
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Gary E. Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242,Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242
| | - Jeffrey D. Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242,Department of Biostatistics, University of Iowa, Iowa City, IA, 52242
| | - Jia Xu
- Department of Radiology, University of Iowa, Iowa City, IA, 52242
| | - John A. Wemmie
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242,Veterans Affairs Medical Center, Iowa City, Iowa, USA,Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA,Department of Neurosurgery, University of Iowa, Iowa City, IA, 52242
| | - Vincent A. Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, 52242,Department of Psychiatry, University of Iowa, Iowa City, IA, 52242,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242
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Adviento BA, Regan EA, Make BJ, Han MK, Foreman MG, Iyer AS, Bhatt SP, Kim V, Bon J, Soler X, Kinney GL, Hanania NA, Lowe KE, Holm KE, Yohannes AM, Shinozaki G, Hoth KF, Fiedorowicz JG. Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort. Chest 2023; 163:292-302. [PMID: 36167120 PMCID: PMC10083129 DOI: 10.1016/j.chest.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/11/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. RESEARCH QUESTION Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? STUDY DESIGN AND METHODS We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time-varying covariates and other causes of death as a competing risk. RESULTS The cohort was 47% female and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [HR], 6.44; 95% CI, 2.64-15.67), use of sedative/hypnotics (HR, 2.33; 95% CI, 1.24-4.38), and dyspnea (HR, 2.23; 95% CI, 1.34-3.70). Lower risk was associated with older age (per-decade HR, 0.45; 95% CI, 0.31-0.67), higher BMI (HR, 0.95; 95% CI, 0.91-0.99), and African-American race (HR, 0.41; 95% CI, 0.23-0.74). Severity of airflow limitation (FEV % predicted) was not associated with suicide risk. INTERPRETATION In this well-characterized cohort of individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.
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Affiliation(s)
- Brigid A Adviento
- Department of Psychiatry, University of Iowa, Iowa City, IA; Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Elizabeth A Regan
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, CO
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Marilyn G Foreman
- Pulmonary and Critical Care Medicine Division, Morehouse School of Medicine, Atlanta, GA
| | - Anand S Iyer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Xavier Soler
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Katherine E Lowe
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kristen E Holm
- Division of Neurology and Behavioral Health, National Jewish Health, Denver, CO; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Gen Shinozaki
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA.
| | - Jess G Fiedorowicz
- Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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27
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Nikolitch K, Saraf G, Solmi M, Kroenke K, Fiedorowicz JG. Fire and Darkness: On the Assessment and Management of Bipolar Disorder. Med Clin North Am 2023; 107:31-60. [PMID: 36402499 DOI: 10.1016/j.mcna.2022.04.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bipolar disorder is characterized by recurrent mood episodes, affecting 1% to 2% of the population. Although its defining features are manic and hypomanic episodes, its course is dominated by depressive syndromes. Diagnosis can be challenging owing to symptom overlap with other disorders. Management goals include early and complete remission of acute episodes and the prevention of relapse between episodes. We present an overview of bipolar disorder and its subtypes, including algorithms and suggestions for screening, assessment, and treatment.
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Affiliation(s)
- Katerina Nikolitch
- Department of Psychiatry, The University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute, 501 Smyth Road, Box 400, Ottawa, ON K1H 8L6, Canada; Institute for Mental Health Research, Ottawa, Ontario, Canada
| | - Gayatri Saraf
- Department of Psychiatry, The University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute, 501 Smyth Road, Box 400, Ottawa, ON K1H 8L6, Canada
| | - Marco Solmi
- Department of Psychiatry, The University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute, 501 Smyth Road, Box 400, Ottawa, ON K1H 8L6, Canada; School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Kurt Kroenke
- Indiana University School of Medicine and Regenstrief Institute, 1101 W 10th St, Indianapolis, IN 46202, USA
| | - Jess G Fiedorowicz
- Department of Psychiatry, The University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute, 501 Smyth Road, Box 400, Ottawa, ON K1H 8L6, Canada; School of Epidemiology and Public Health, The University of Ottawa, Ottawa, Ontario, Canada.
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28
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Croatto G, Vancampfort D, Miola A, Olivola M, Fiedorowicz JG, Firth J, Alexinschi O, Gaina MA, Makkai V, Soares FC, Cavaliere L, Vianello G, Stubbs B, Fusar-Poli P, Carvalho AF, Vieta E, Cortese S, Shin JI, Correll CU, Solmi M. The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials. Mol Psychiatry 2023; 28:369-390. [PMID: 36138129 PMCID: PMC9493151 DOI: 10.1038/s41380-022-01770-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. METHODS Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). RESULTS Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). CONCLUSIONS Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.
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Affiliation(s)
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven University, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Alessandro Miola
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Miriam Olivola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | | | - Marcel A Gaina
- Institute of Psychiatry "Socola", Iasi, Romania
- Psychiatry, Department of Medicine III, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | | | | | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King's College London, London, UK
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- The Ottawa Hospital, Ottawa, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Psychosis Studies, King's College London, London, UK.
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
- Department of Psychiatry, University of Ottawa, Ontario, Canada.
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29
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Fiedorowicz JG, Kleinstäuber M, Lemogne C, Löwe B, Ola B, Sutin A, Wong S, Fabiano N, Tilburg MV, Mikocka-Walus A. Peer review as a measurable responsibility of those who publish: The peer review debt index. J Psychosom Res 2022; 161:110997. [PMID: 35952404 DOI: 10.1016/j.jpsychores.2022.110997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, USA
| | - Cédric Lemogne
- Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014 Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bola Ola
- Department of Behavioural Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Angelina Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, USA
| | - Stanley Wong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Fabiano
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Miranda Van Tilburg
- Marshall University, Joan C Edwards School of Medicine, Huntington, WV, USA; University of North Carolina, School of Medicine, Chapel Hill, NC, USA; University of Washington, School of Social Work, Seattle, WA, USA
| | - Antonina Mikocka-Walus
- School of Psychology & Centre for Social and Early Emotional Development, Deakin University Geelong, Melbourne, Victoria, Australia
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30
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Fabiano N, Wong S, Miller A, Liu Z, Fiedorowicz JG. Changes in Attitudes and Confidence in the Integration of Psychiatry in Other Areas of Medicine. Acad Psychiatry 2022; 46:593-598. [PMID: 35701712 DOI: 10.1007/s40596-022-01670-9] [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: 12/20/2021] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The authors describe how attitudes and confidence in the integration of psychiatry into other areas of medicine change over time during clinical clerkship in medical school. METHODS From January 2015 to December 2016, medical students from the University of Iowa were recruited for a prospective study of changes in the Attitudes and Confidence in the Integration of Psychiatry Scale (ACIP) scale. The survey instrument was completed before their psychiatry clerkship, after the clerkship, and at the end of the year following that and other clinical clerkships. Other information such as gender, time spent in clerkship, USMLE Step 1 score, and clerkship grades was also collected. RESULTS A total of 172 surveys were completed by 138 students. The ACIP score was significantly higher at the end of the participants' clinical clerkship (67.2 to 76.6; t=-7.72, p<0.0001). Of the two ACIP subscales, confidence increased significantly (25.6 to 33.3; t=-9.82, p<0.0001), but attitudes toward integration of psychiatry did not (41.7 to 43.4; t=-1.96, p=0.059). Similar findings were seen in the subset of 34 students for whom pre- and post-clerkship data could be matched. CONCLUSIONS At the end of their clinical clerkship, medical students feel more confident providing psychiatric care. The lack of significant increase in the ACIP scale's attitude subscale either demonstrates that attitude scores going into clerkship were already high and did not deteriorate, or highlights an area for clerkship curriculum development.
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Affiliation(s)
- Nicholas Fabiano
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stanley Wong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony Miller
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Zhuangzhuang Liu
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jess G Fiedorowicz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Clinical Epidemiology and Neuroscience Programs, Ottawa Hospital Research Institute, Ottawa, Canada.
- University of Ottawa Brain and Mind Research Institute, Ottawa, Canada.
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31
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Bauer M, Glenn T, Achtyes ED, Alda M, Agaoglu E, Altınbaş K, Andreassen OA, Angelopoulos E, Ardau R, Aydin M, Ayhan Y, Baethge C, Bauer R, Baune BT, Balaban C, Becerra-Palars C, Behere AP, Behere PB, Belete H, Belete T, Belizario GO, Bellivier F, Belmaker RH, Benedetti F, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Brady C, Cabrera J, Cappucciati M, Castro AMP, Chen WL, Cheung EYW, Chiesa S, Crowe M, Cuomo A, Dallaspezia S, Del Zompo M, Desai P, Dodd S, Etain B, Fagiolini A, Fellendorf FT, Ferensztajn-Rochowiak E, Fiedorowicz JG, Fountoulakis KN, Frye MA, Geoffroy PA, Gonzalez-Pinto A, Gottlieb JF, Grof P, Haarman BCM, Harima H, Hasse-Sousa M, Henry C, Høffding L, Houenou J, Imbesi M, Isometsä ET, Ivkovic M, Janno S, Johnsen S, Kapczinski F, Karakatsoulis GN, Kardell M, Kessing LV, Kim SJ, König B, Kot TL, Koval M, Kunz M, Lafer B, Landén M, Larsen ER, Lenger M, Lewitzka U, Licht RW, Lopez-Jaramillo C, MacKenzie A, Madsen HØ, Madsen SAKA, Mahadevan J, Mahardika A, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Martiny K, Mashima Y, McLoughlin DM, Meesters Y, Melle I, Meza-Urzúa F, Mok YM, Monteith S, Moorthy M, Morken G, Mosca E, Mozzhegorov AA, Munoz R, Mythri SV, Nacef F, Nadella RK, Nakanotani T, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Ouali U, Pantovic-Stefanovic M, Pariwatcharakul P, Petite J, Pfennig A, Ruiz YP, Pinna M, Pompili M, Porter R, Quiroz D, Rabelo-da-Ponte FD, Ramesar R, Rasgon N, Ratta-Apha W, Ratzenhofer M, Redahan M, Reddy MS, Reif A, Reininghaus EZ, Richards JG, Ritter P, Rybakowski JK, Sathyaputri L, Scippa ÂM, Simhandl C, Smith D, Smith J, Stackhouse PW, Stein DJ, Stilwell K, Strejilevich S, Su KP, Subramaniam M, Sulaiman AH, Suominen K, Tanra AJ, Tatebayashi Y, Teh WL, Tondo L, Torrent C, Tuinstra D, Uchida T, Vaaler AE, Vieta E, Viswanath B, Yoldi-Negrete M, Yalcinkaya OK, Young AH, Zgueb Y, Whybrow PC. Association between polarity of first episode and solar insolation in bipolar I disorder. J Psychosom Res 2022; 160:110982. [PMID: 35932492 PMCID: PMC7615104 DOI: 10.1016/j.jpsychores.2022.110982] [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: 12/22/2021] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth. METHODS Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer. RESULTS The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001). CONCLUSION Increased awareness and research into circadian dysfunction throughout the course of BD is warranted.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Eric D Achtyes
- Michigan State University College of Human Medicine, Division of Psychiatry & Behavioral Medicine, Grand Rapids, MI, USA; Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Esen Agaoglu
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kürşat Altınbaş
- Department of Psychiatry, Selcuk University Faculty of Medicine, Mazhar Osman Mood Center, Konya, Turkey
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elias Angelopoulos
- Department of Psychiatry, National and Capodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Raffaella Ardau
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Memduha Aydin
- Department of Psychiatry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Yavuz Ayhan
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ceylan Balaban
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Aniruddh P Behere
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA
| | - Prakash B Behere
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, India
| | - Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gabriel Okawa Belizario
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique - Hôpitaux de Paris, INSERM UMR-S1144, Université de Paris, FondaMental Foundation, Paris, France
| | - Robert H Belmaker
- Professor Emeritus of Psychiatry, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Francesco Benedetti
- University Vita-Salute San Raffaele, Milan, Italy; Psychiatry & Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Yuly Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Şule Bicakci
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Psychiatry, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Thomas D Bjella
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Conan Brady
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Jorge Cabrera
- Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile
| | | | - Angela Marianne Paredes Castro
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Wei-Ling Chen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | | | - Silvia Chiesa
- Department of Mental Health and Substance Abuse, Piacenza, Italy
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Sara Dallaspezia
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Seetal Dodd
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique - Hôpitaux de Paris, INSERM UMR-S1144, Université de Paris, FondaMental Foundation, Paris, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | | | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, F-75019 Paris, France
| | - Ana Gonzalez-Pinto
- BIOARABA. Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - John F Gottlieb
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa and the Department of Psychiatry, University of Toronto, Canada
| | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Mathias Hasse-Sousa
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Chantal Henry
- Department of Psychiatry, GHU Paris Psychiatrie & Neurosciences, F-75014, Paris France, Université de Paris, F-75006 Paris, France
| | - Lone Høffding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Josselin Houenou
- Université Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, APHP, Mondor Univ Hospitals, Fondation FondaMental, F-94010 Créteil, France; Université Paris Saclay, CEA, Neurospin, F-91191 Gif-sur-Yvette, France
| | | | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Maja Ivkovic
- University Clinical Center of Serbia, Clinic for Psychiatry, Belgrade, Serbia
| | - Sven Janno
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - Simon Johnsen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - Flávio Kapczinski
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gregory N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Seong Jae Kim
- Department of Psychiatry, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Barbara König
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - Timur L Kot
- Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia
| | - Michael Koval
- Department of Neuroscience, Michigan State University, East Lansing, MI, USA
| | - Mauricio Kunz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik R Larsen
- Mental Health Department Odense, University Clinic and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Rasmus W Licht
- Psychiatry - Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carlos Lopez-Jaramillo
- Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alan MacKenzie
- Forensic Psychiatry, University of Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Agustine Mahardika
- Department of Psychiatry, Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Mirko Manchia
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Monica Martinez-Cengotitabengoa
- Osakidetza, Basque Health Service, BioAraba Health Research Institute, University of the Basque Country, Spain; The Psychology Clinic of East Anglia, Norwich, United Kingdom
| | - Klaus Martiny
- Copenhagen University Hospitals, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Yuki Mashima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Declan M McLoughlin
- Dept of Psychiatry & Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Ybe Meesters
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fátima Meza-Urzúa
- Department of Child and Adolescent Psychiatry und Psychotherapy, SHG Klinikum, Idar-Oberstein, Germany
| | - Yee Ming Mok
- Department of Mood and Anxiety disorders, Institute of Mental Health, Singapore City, Singapore
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Muthukumaran Moorthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway; Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Enrica Mosca
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Starlin V Mythri
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Assam 788727, India
| | - Fethi Nacef
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ravi K Nadella
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Takako Nakanotani
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - René Ernst Nielsen
- Psychiatry - Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Adel Omrani
- Tunisian Bipolar Forum, Érable Médical Cabinet 324, Lac 2, Tunis, Tunisia
| | - Yamima Osher
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uta Ouali
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | | | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Joanne Petite
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Marco Pinna
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Danilo Quiroz
- Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile
| | | | - Raj Ramesar
- SA MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Maria Redahan
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Jenny Gringer Richards
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Leela Sathyaputri
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Ângela M Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - Christian Simhandl
- Bipolar Zentrum Wiener Neustadt, Sigmund Freud Privat Universität, Vienna, Austria
| | - Daniel Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - José Smith
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Paul W Stackhouse
- Science Directorate/Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA
| | - Dan J Stein
- Department of Psychiatry, MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Kellen Stilwell
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Kuan-Pin Su
- College of Medicine, China Medical University (CMU), Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirsi Suominen
- Department of Social Services and Health Care, Psychiatry, City of Helsinki, Helsinki, Finland
| | - Andi J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore
| | - Leonardo Tondo
- McLean Hospital-Harvard Medical School, Boston, MA, USA; Mood Disorder Lucio Bini Centers, Cagliari e Roma, Italy
| | - Carla Torrent
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Daniel Tuinstra
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Takahito Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Arne E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway; Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Maria Yoldi-Negrete
- Subdirección de Investigaciones Clínicas. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
| | - Oguz Kaan Yalcinkaya
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yosra Zgueb
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- 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
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- 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
| | - Marco Solmi
- 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
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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Fiedorowicz JG. Separate, combined, and intersectional effects of race, gender, and social class on mental health and psychosomatic outcomes. J Psychosom Res 2022; 158:110939. [PMID: 35580453 DOI: 10.1016/j.jpsychores.2022.110939] [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: 11/26/2022]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, Ontario, Canada; University of Ottawa Department of Psychiatry, School of Epidemiology and Public Health, Brain & Mind Research Institute Ottawa, Ontario, Canada.
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Rosson S, de Filippis R, Croatto G, Collantoni E, Pallottino S, Guinart D, Brunoni AR, Dell'Osso B, Pigato G, Hyde J, Brandt V, Cortese S, Fiedorowicz JG, Petrides G, Correll CU, Solmi M. Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review. Neurosci Biobehav Rev 2022; 139:104743. [PMID: 35714757 DOI: 10.1016/j.neubiorev.2022.104743] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 02/26/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear. METHODS We conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE. RESULTS We selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRADE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high-quality meta-analyses/low-quality RCTs), GRADE low. DISCUSSION Despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines. FUNDING None.
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Affiliation(s)
- Stella Rosson
- Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Neurosciences, University of Padua, Padua, Italy
| | - Renato de Filippis
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giovanni Croatto
- Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy; Department of Neurosciences, University of Padua, Padua, Italy
| | | | | | - Daniel Guinart
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mard'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil; Departamentos de Clínica Médica e Psiquiatria, Faculdade de Medicina da USP, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA; Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
| | - Giorgio Pigato
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Georgios Petrides
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Division of ECT, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK; Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany; Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada.
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Magnotta VA, Xu J, Fiedorowicz JG, Williams A, Shaffer J, Christensen G, Long JD, Taylor E, Sathyaputri L, Richards JG, Harmata G, Wemmie J. Metabolic abnormalities in the basal ganglia and cerebellum in bipolar disorder: A multi-modal MR study. J Affect Disord 2022; 301:390-399. [PMID: 35031333 PMCID: PMC8828710 DOI: 10.1016/j.jad.2022.01.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/03/2021] [Revised: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 12/21/2022]
Abstract
AIMS Bipolar type I disorder (BD) is characterized by severe mood swings and occurs in about 1% of the population. The mechanisms underlying the disorder remain unknown. Prior studies have suggested abnormalities in brain metabolism using 1H and 31P magnetic resonance spectroscopy (MRS). Supporting altered metabolism, in previous studies we found T1ρ relaxation times in the cerebellum were elevated in participants with BD. In addition, T1ρ relaxation times in the basal ganglia were lower in participants with BD experiencing depressed mood. Based on these findings, this study sought to probe brain metabolism with a focus of extending these assessments to the cerebellum. METHODS This study collected data from 64 participants with Bipolar type I disorder (BD) and 42 controls. Subjects were scanned at both 3T (anatomical, functional, and T1ρ imaging data) and 7T (31P and 1H spectroscopy). Regions of interest defined by the 1H MRS data were used to explore metabolic and functional changes in the cerebellar vermis and putamen. RESULTS Elevated concentrations of n-Acetyl-l-aspartate (NAA), glutamate, glutathione, taurine, and creatine were found in the cerebellar vermis along with decreased intra-cellular pH. Similar trends were observed in the right putamen for glutamate, creatine, and pH. We also observed a relationship between T1ρ relaxation times and mood in the putamen. We did not observe a significant effect of medications on these measures. LIMITATIONS The study was cross sectional in design and employed a naturalistic approach for assessing the impact of medications on the results. CONCLUSION This study supports prior findings of reduced pH in mitochondrial dysfunction in BD while also showing that these differences extend to the cerebellum.
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Affiliation(s)
- Vincent A Magnotta
- Department of Radiology, The University of Iowa, United States; Department of Psychiatry, The University of Iowa, United States; Department of Biomedical Engineering, The University of Iowa, United States.
| | - Jia Xu
- Department of Radiology, The University of Iowa, United States
| | | | | | - Joseph Shaffer
- Department of Radiology, The University of Iowa, United States; College of Biosciences, Kansas City University, United States
| | - Gary Christensen
- Department of Electrical and Computer Engineering, The University of Iowa, United States; Department of Radiation Oncology, The University of Iowa, United States
| | - Jeffrey D Long
- Department of Psychiatry, The University of Iowa, United States; Department of Biostatistics, The University of Iowa, United States
| | - Eric Taylor
- Department of Molecular Physiology and Biophysics, The University of Iowa, United States
| | | | | | - Gail Harmata
- Department of Psychiatry, The University of Iowa, United States
| | - John Wemmie
- Department of Psychiatry, The University of Iowa, United States; Department of Molecular Physiology and Biophysics, The University of Iowa, United States; Department of Neurosurgery, The University of Iowa, United States
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Lee EK, Morra A, Bazaid K, Bezzahou A, Simas K, Taplin C, Chun S, Fiedorowicz JG, Douglass AB. A week long "pep" talk - initial and 2-3-year longitudinal data on the Ottawa Psychiatry Enrichment Program (OPEP). BMC Med Educ 2022; 22:163. [PMID: 35264167 PMCID: PMC8906362 DOI: 10.1186/s12909-022-03216-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 02/16/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Recruitment to psychiatry as a career has been challenging in Canada and abroad despite the known shortage and increasing burden of psychiatric issues globally. Deterrents to choosing psychiatry as a career include its negative stigma and paucity of knowledge about the field. The study goal was to evaluate the Ottawa Psychiatry Enrichment Program (OPEP), a one-week extracurricular program about psychiatry as a career for 1st and 2nd year medical students. We hypothesized OPEP would improve students' attitudes towards psychiatry, and positive changes would be sustained 2-3 years later following their residency match. We hypothesized there would be a high recruitment of OPEP attendees to psychiatry programs. METHODS 1st and 2nd year medical students from Canada applied to OPEP. Attendees completed the Attitudes Towards Psychiatry Questionnaire (ATP-30) at three times: before OPEP (PreOPEP), after OPEP (PostOPEP) and after their Canadian Residency Matching Service (CaRMs) match 2-3 years later. OPEP ATP-30 scores were compared to third-year student ATP-30 scores before and after their psychiatry rotation. Data were analysed using Friedman non-parametric ANOVA and post hoc testing by either Wilcoxon rank sum test, Wilcoxon matched pairs signed rank test, or parametric Welch independent t-test as appropriate. Effect sizes of group mean differences were calculated using Cohen's "d". RESULTS Between 2017-2018, 29/53 Canadian applicants were selected for OPEP. 100%, 93.1% and 75.8% of OPEP students completed the PreOPEP, PostOPEP, and CaRMs ATP-30 surveys respectively. 43% of OPEP attendees matched to psychiatry. PostOPEP ATP-30 scores (mean = 133, median = 137, SD = 10.6) were significantly higher than PreOPEP ATP-30 (mean score = 121, median = 122, SD = 9.3, p < 0.001) and CaRMS ATP-30 (mean = 126, median = 127, SD = 12.3, p < 0.02) scores. OPEP effect size on ATP-30 scores was large (d = 1.2) but decreased 2-3 years later (p = 0.078, d = 0.44). 97/202 students completed the ATP-30 before and after their psychiatry rotation (clerkship). Clerkship effect size on improvement in ATP-30 was moderate (d = 0.39). There was a non-significant difference between OPEP CaRMS ATP-30 and post clerkship ATP-30 scores (median 127 vs 121, p = 0.056). CONCLUSIONS OPEP ameliorated attitudes toward Psychiatry, but improvement deteriorated longitudinally. Strategies for program design, and innovations to boost/retain improvements during clerkship years are discussed.
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Affiliation(s)
- Elliott Kyung Lee
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | | | - Khalid Bazaid
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Abdellah Bezzahou
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Christopher Taplin
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Soojin Chun
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jess G Fiedorowicz
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan Bruce Douglass
- The Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Fiedorowicz JG. Journal of psychosomatic research 2021 year in review. J Psychosom Res 2022; 153:110720. [PMID: 35051875 DOI: 10.1016/j.jpsychores.2022.110720] [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: 11/18/2022]
Affiliation(s)
- Jess G Fiedorowicz
- University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, Canada.
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Persons JE, Lodder P, Coryell WH, Nurnberger JI, Fiedorowicz JG. Symptoms of mania and anxiety do not contribute to suicidal ideation or behavior in the presence of bipolar depression. Psychiatry Res 2022; 307:114296. [PMID: 34852976 PMCID: PMC8724399 DOI: 10.1016/j.psychres.2021.114296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/24/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
Bipolar disorder is typified by episodes of manic/hypomanic and depressive symptoms, either distinctly or concurrently as mixed symptoms. While depressive symptoms are the major driver of risk, it is unclear whether specific combinations of manic and anxiety symptoms contribute differentially to suicidal ideation and behavior in individuals with bipolar disorder during a depressive state. This study uses a quantitative application of Rothman's theoretical framework of causation, or 'causal pies' model. Data were obtained from the National Network of Depression Centers Mood Outcomes Program for 1028 visits from 626 individuals with bipolar disorder with current moderate-to-severe depressive symptoms, operationalized as a Patient Health Questionnaire-8 (PHQ-8) score ≥10. Mania symptoms were captured using the Altman Self-Rating Mania scale (ASRM) and anxiety symptoms were captured using the Generalized Anxiety Disorder-7 scale (GAD-7). The outcome of suicidal ideation or behavior was captured using the Columbia Suicide Severity Rating Scale (C-SSRS). In this cohort of individuals with bipolar disorder and at least moderate depressive symptoms, we found no increased risk of suicidal ideation or behavior attributable to manic and anxiety symptom clusters in individuals with bipolar disorder during depressive state. A small amount (4%) of risk was attributable to having severe depressive symptoms. These findings, however, may be influenced by limitations in sample size and measurement instruments. Future studies would benefit from larger samples and more rigorous assessments, including clinician-rated measures.
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Affiliation(s)
- Jane E Persons
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
| | - Paul Lodder
- Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherland
| | - William H Coryell
- Departments of Psychiatry and Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA USA
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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Fiedorowicz JG, Merranko JA, Iyengar S, Hower H, Gill MK, Yen S, Goldstein TR, Strober M, Hafeman D, Keller MB, Goldstein BI, Diler RS, Hunt JI, Birmaher BB. Validation of the youth mood recurrences risk calculator in an adult sample with bipolar disorder. J Affect Disord 2021; 295:1482-1488. [PMID: 34563392 DOI: 10.1016/j.jad.2021.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/12/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The ability to predict an individual's risk of mood episode recurrence can facilitate personalized medicine in bipolar disorder (BD). We sought to externally validate, in an adult sample, a risk calculator of mood episode recurrence developed in youth/young adults with BD from the Course and Outcome of Bipolar Youth (COBY) study. METHODS Adult participants from the National Institute of Mental Health Collaborative Depression Study (CDS; N=258; mean(SD) age=35.5(12.0) years; mean follow-up=24.9 years) were utilized as a sample to validate the youth COBY risk calculator for onset of depressive, manic, or any mood episodes. RESULTS In this older validation sample, the risk calculator predicted recurrence of any episode over 1, 2, 3, or 5-year follow-up intervals, with Area Under the Curves (AUCs) approximating 0.77. The AUC for prediction of depressive episodes was about 0.81 for each of the time windows, which was higher than for manic or hypomanic episodes (AUC=0.72). While the risk calculator was well-calibrated across the range of risk scores, it systematically underestimated risk in the CDS sample by about 20%. The length of current remission was a highly significant predictor of recurrence risk in the CDS sample. LIMITATIONS Predominantly self-reported White samples may limit generalizability; the risk calculator does not assess more proximal risk (e.g., 1 month). CONCLUSIONS Risk of mood episode recurrence can be predicted with good accuracy in youth and adults with BD in remission. The risk calculators may help identify higher risk BD subgroups for treatment and research.
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Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Psychiatry, School of Public Health and Epidemiology, Brain and Mind Research Institute, University of Ottawa, 75 Laurier Ave. East, Ottawa, ON K1N 6N5, Canada.
| | - John A Merranko
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, 230 S. Bouquet St., Pittsburgh, PA 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Shirley Yen
- Departments of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N 3M5, Canada
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Jeffrey I Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Boris B Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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Pinkhasov A, Xiong G, Bourgeois JA, Heinrich TW, Huang H, Coriolan S, Annamalai A, Mangal JP, Frankel S, Lang M, Raj YP, Dandois M, Barth K, Stewart AL, Rado J, Pesek J, Sanders A, Spearman-McCarthy EV, Gagliardi J, Fiedorowicz JG. Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry. J Psychosom Res 2021; 151:110654. [PMID: 34739943 PMCID: PMC10911096 DOI: 10.1016/j.jpsychores.2021.110654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/13/2021] [Revised: 10/03/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Hyponatremia is the most common electrolyte imbalance encountered in clinical practice and is associated with negative healthcare outcomes and cost. SIADH is thought to account for one third of all hyponatremia cases and is typically an insidious process. Psychotropic medications are commonly implicated in the etiology of drug induced SIADH. There is limited guidance for clinicians on management of psychotropic-induced SIADH. METHODS After an extensive review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus recommendations for management of psychotropic-induced SIADH. A risk score was proposed based on risk factors for SIADH to guide clinical decision-making. RESULTS SSRIs, SNRIs, antipsychotics, carbamazepine, and oxcarbazepine have moderate to high level of evidence demonstrating their association with SIADH. Evaluation for an avoidance of medications that cause hyponatremia is particularly important. Substitution with medication that is less likely to cause SIADH should be considered when appropriate. We propose an algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity. CONCLUSIONS The proposed algorithm can help clinicians in determining whether psychotropic medication should be stopped, reduced or substituted where SIADH is suspected with recommendations for sodium (Na+) monitoring. These recommendations preserve a role for clinical judgment in the management of hyponatremia with consideration of the risks and benefits, which may be particularly relevant for complex patients that present with medical and psychiatric comorbidities. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality.
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Affiliation(s)
- Aaron Pinkhasov
- Department of Psychiatry, NYU Langone Hospital-Long Island, NY, United States of America; Psychiatry and Medicine, NYULI - SOM, NY, United States of America.
| | - Glen Xiong
- University of California at Davis, CA, United States of America
| | - James A Bourgeois
- Psychiatry, Baylor Scott & White Health, TX, United States of America
| | - Thomas W Heinrich
- Psychiatry and Behavioral Medicine and Family and Community Medicine, Medical College of Wisconsin, WI, United States of America
| | - Heather Huang
- Psychiatry and Internal Medicine, University of WI, WI, United States of America
| | - Shanice Coriolan
- NYU Langone Hospital - Long Island, NY, United States of America
| | - Aniyizhai Annamalai
- Psychiatry and Internal Medicine, Yale School of Medicine, CT, United States of America
| | - Jed P Mangal
- Psychiatry, Uniformed Services University of the Health Sciences, MD, United States of America
| | - Steven Frankel
- Psychiatry, University of Minnesota Medical School, MN, United States of America; Psychiatry, UCSF, Medical School, University of Minnesota, MN, United States of America
| | - Michael Lang
- Internal Medicine and Psychiatry, Brody School of Medicine at East Carolina University, NC, United States of America
| | - Y Pritham Raj
- Depts of Internal Medicine & Psychiatry, Oregon Health & Science University, United States of America
| | | | - Kelly Barth
- Psychiatry and Internal Medicine, Medical University of South Carolina, SC, United States of America
| | - Anne Louise Stewart
- Consultation-Liaison Psychiatry, University of Texas Southwestern, TX, United States of America
| | - Jeffrey Rado
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, IL, United States of America
| | - Justin Pesek
- Baylor Scott & White Health, TX, United States of America
| | - Aaron Sanders
- Baylor Scott & White Health, TX, United States of America
| | - E Vanessa Spearman-McCarthy
- Internal Medicine and Psychiatry, Medical College of Georgia, Augusta University, GA, United States of America
| | - Jane Gagliardi
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, NC, United States of America
| | - Jess G Fiedorowicz
- Mental Health, The Ottawa Hospital, ON, Canada; Ottawa Hospital Research Institute, Department of Psychiatry, School of Epidemiology and Public Health, ON, Canada; University of Ottawa, and uOttawa Brain and Mind Research Institute, ON, Canada
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Fiedorowicz JG, Brown L, Li J, Parikh SV, Dunlop BW, Forester BP, Shelton RC, Thase ME, Macaluso M, Yu K, Greden JF. Obesogenic Medications and Weight Gain Over 24 Weeks in Patients with Depression: Results from the GUIDED Study. Psychopharmacol Bull 2021; 51:8-30. [PMID: 34887596 PMCID: PMC8601756] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Weight gain is a common side-effect of medications used to treat major depressive disorder (MDD). We sought to estimate the frequency of weight gain for obesogenic medications prescribed for MDD and to evaluate if bupropion mitigated risk for weight gain. We analyzed a prospective cohort of patients with weight available at baseline and 12 weeks (n = 1,032) or 24 weeks (n = 871) in a post hoc analysis of the Genomics Used to Improve DEpression Decisions (GUIDED) study of patients with MDD who failed at least one medication trial. We compared weight gain between those on versus not on medications with high risk for weight gain, including a subgroup receiving combination treatment with bupropion. A second analysis evaluated weight gain across traditional medication classes, adjusting for potential confounding variables. Those on medications identified as high risk for weight gain were significantly more likely to experience clinically significant weight gain (≥3%) at 12 weeks (29.3% vs. 16.3%, p < .001) and 24 weeks (33.5% vs. 23.5%, p = .015). No protection from clinically significant weight gain was observed among patients treated with a high-risk medication concomitantly with bupropion (N = 31, 35% and 52% with clinically significant weight gain at 12 and 24 weeks). Antipsychotic medications and tricyclic antidepressants were most often associated with clinically significant weight gain. This study helps quantify the real-world risk of weight gain for patients with MDD on medications with high risk for weight gain, especially for patients taking antipsychotics. Concurrent treatment with bupropion does not appear to mitigate the weight gain risk.
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Affiliation(s)
- Jess G Fiedorowicz
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Lisa Brown
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - James Li
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Sagar V Parikh
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Boadie W Dunlop
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Brent P Forester
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Richard C Shelton
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Michael E Thase
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Matthew Macaluso
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Kunbo Yu
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - John F Greden
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
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Dindo L, Fiedorowicz JG, Boykin DM, Wooldridge N, Myers J, Ajibewa T, Stroud A, Kuwaye D, Liu Z, Pierce GL. A randomized controlled trial for symptoms of anxiety and depression: Effects of a 1-day acceptance and commitment training workshop. Ann Clin Psychiatry 2021; 33:258-269. [PMID: 34672928 DOI: 10.12788/acp.0046] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cognitive-behavioral therapies often are recommended for anxiety disorders. However, treatment adherence and compliance are major barriers for these treatments, which are often delivered in 10 to 12 sessions over several months. This randomized controlled trial (trial registration NCT02915874 at www.clinicaltrials.gov) examined the effectiveness and feasibility of a 1-day cognitive-behavioral intervention for mixed anxiety. METHODS A total of 72 adults with moderate-to-high anxiety were randomized into a 1-day acceptance and commitment therapy (ACT) work-shop (n = 44) or treatment as usual (n = 28). Follow-up assessments were conducted 6 and 12 weeks after the workshop. Clinical outcomes were anxiety (primary) and depressive (secondary) symptoms, as measured by the Beck Anxiety Inventory and Beck Depression Inventory-II, respectively. Proposed mediators of ACT-psychological flexibility and commit-ted action-also were examined. RESULTS Participants assigned to the ACT workshop showed significant improvements in anxiety (beta = -1.13; P = .02) and depression (beta = -1.09; P = .02) after 12 weeks. Consistent with the theoretical model, these clinical improvements were mediated by psychological flexibility and committed action. Notable limitations included the sample size, inability to blind to treatment condition, and a racially and ethnically homogeneous sample. CONCLUSIONS Our 1-day ACT workshop was effective for anxiety with co-occurring depressive symptoms. One-day interventions are a promising alternative to weekly treatments.
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Affiliation(s)
- Lilian Dindo
- Department of Medicine, Baylor College of Medicine, VA South Central Mental Illness Research Education and Clinical Center, VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Department of Veterans Affairs Medical Center Houston, Texas, USA
| | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa.,Department of Mental Health, The Ottawa Hospital, Clinical Epidemiology and Neuroscience Programs, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Derrecka M Boykin
- VA South Central Mental Illness Research Education and Clinical Center, VA HSR&D Center for Innovations, Quality, and Effectiveness, Michael E. DeBakey Department of Veterans Affairs Medical Center, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Nealy Wooldridge
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Janie Myers
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Tiwaloluwa Ajibewa
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Amy Stroud
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Daren Kuwaye
- Department of Biostatistics, College of Liberal Arts and Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Zhuangzhuang Liu
- Department of Biostatistics, College of Liberal Arts and Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Gary L Pierce
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, François M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, Iowa, USA
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43
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Fiedorowicz JG, Dindo L, Ajibewa T, Persons J, Marchman J, Holwerda SW, Abosi OJ, DuBose LE, Wooldridge N, Myers J, Stroud AK, Dubishar K, Liu Z, Pierce GL. One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial. Gen Hosp Psychiatry 2021; 73:64-70. [PMID: 34619441 PMCID: PMC10044446 DOI: 10.1016/j.genhosppsych.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acceptance and Commitment Therapy (ACT) is a behavioral intervention demonstrating sustained improvements in anxiety in individuals with chronic anxiety and psychological distress. Because anxiety disorders are associated with the development of cardiovascular disease (CVD), we hypothesized that a novel 1-day ACT workshop would both lower anxiety and improve vascular function in persons with moderate/high anxiety. METHODS In a randomized controlled study, 72 adults (age 33.9 ± 8.6 (SD) years) with baseline moderate/high anxiety completed a one-day ACT intervention (n = 44, age 33.9 ± 8.7 years) or control (n = 28, age 37.1 ± 10.1 years). Pre-specified secondary outcomes were measured over 12 weeks: aortic stiffness (carotid-femoral pulse wave velocity [cfPWV]), forearm vascular endothelial function (post-ischemic peak forearm blood flow [FBF] via plethysmography), and brachial artery flow-mediated dilation (FMD). Carotid artery stiffness (β-stiffness index), and inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) were also explored. RESULTS Although the intervention had a significant and sustained effect on the primary outcome of anxiety as measured by the Beck Anxiety Inventory, the 1-day ACT workshop was not associated with improvement in vascular or inflammatory endpoints. The intervention was unexpectedly associated with increases in β-stiffness index that were also associated with changing trait anxiety. CONCLUSION Anxiety improvements did not translate into improvements in any of the vascular function outcomes. This may reflect a less-than-robust effect of the intervention on anxiety, failure in design to select those with vascular dysfunction, or not intervening on a relevant causal pathway. (Trial registration NCT02915874 at www.clinicaltrials.gov).
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Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | | | | | | | - Lyndsey E DuBose
- University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
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44
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Bauer M, Glenn T, Achtyes ED, Alda M, Agaoglu E, Altınbaş K, Andreassen OA, Angelopoulos E, Ardau R, Vares EA, Aydin M, Ayhan Y, Baethge C, Bauer R, Baune BT, Balaban C, Becerra-Palars C, Behere AP, Behere PB, Belete H, Belete T, Belizario GO, Bellivier F, Belmaker RH, Benedetti F, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Brady C, Cabrera J, Cappucciati M, Castro AMP, Chen WL, Cheung EYW, Chiesa S, Crowe M, Cuomo A, Dallaspezia S, Del Zompo M, Desai P, Dodd S, Donix M, Etain B, Fagiolini A, Fellendorf FT, Ferensztajn-Rochowiak E, Fiedorowicz JG, Fountoulakis KN, Frye MA, Geoffroy PA, Gonzalez-Pinto A, Gottlieb JF, Grof P, Haarman BCM, Harima H, Hasse-Sousa M, Henry C, Høffding L, Houenou J, Imbesi M, Isometsä ET, Ivkovic M, Janno S, Johnsen S, Kapczinski F, Karakatsoulis GN, Kardell M, Kessing LV, Kim SJ, König B, Kot TL, Koval M, Kunz M, Lafer B, Landén M, Larsen ER, Lenger M, Lewitzka U, Licht RW, Lopez-Jaramillo C, MacKenzie A, Madsen HØ, Madsen SAKA, Mahadevan J, Mahardika A, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Martiny K, Mashima Y, McLoughlin DM, Meesters Y, Melle I, Meza-Urzúa F, Ming MY, Monteith S, Moorthy M, Morken G, Mosca E, Mozzhegorov AA, Munoz R, Mythri SV, Nacef F, Nadella RK, Nakanotani T, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Ouali U, Pantovic-Stefanovic M, Pariwatcharakul P, Petite J, Pfennig A, Ruiz YP, Pilhatsch M, Pinna M, Pompili M, Porter R, Quiroz D, Rabelo-da-Ponte FD, Ramesar R, Rasgon N, Ratta-Apha W, Ratzenhofer M, Redahan M, Reddy MS, Reif A, Reininghaus EZ, Richards JG, Ritter P, Rybakowski JK, Sathyaputri L, Scippa ÂM, Simhandl C, Severus E, Smith D, Smith J, Stackhouse PW, Stein DJ, Stilwell K, Strejilevich S, Su KP, Subramaniam M, Sulaiman AH, Suominen K, Tanra AJ, Tatebayashi Y, Teh WL, Tondo L, Torrent C, Tuinstra D, Uchida T, Vaaler AE, Veeh J, Vieta E, Viswanath B, Yoldi-Negrete M, Yalcinkaya OK, Young AH, Zgueb Y, Whybrow PC. Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder. Int J Bipolar Disord 2021; 9:26. [PMID: 34467430 PMCID: PMC8408297 DOI: 10.1186/s40345-021-00231-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Eric D Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Esen Agaoglu
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kürşat Altınbaş
- Department of Psychiatry, Selcuk University Faculty of Medicine, Mazhar Osman Mood Center, Konya, Turkey
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elias Angelopoulos
- Department of Psychiatry, National and Capodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Raffaella Ardau
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Edgar Arrua Vares
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Memduha Aydin
- Department of Psychiatry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Yavuz Ayhan
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Munster, Germany.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ceylan Balaban
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Aniruddh P Behere
- Child and Adolescent Psychiatry, Helen DeVos Children's Hospital, Michigan State University-CHM, Grand Rapids, MI, USA
| | - Prakash B Behere
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, India
| | - Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gabriel Okawa Belizario
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique-Hôpitaux de Paris, INSERM UMR-S1144, Université de Paris, FondaMental Foundation, Paris, France
| | - Robert H Belmaker
- Professor Emeritus of Psychiatry, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Francesco Benedetti
- University Vita-Salute San Raffaele, Milan, Italy.,Psychiatry and Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Berk
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Yuly Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Şule Bicakci
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.,Department of Psychiatry, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Thomas D Bjella
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Conan Brady
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Jorge Cabrera
- Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile
| | | | - Angela Marianne Paredes Castro
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Wei-Ling Chen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | | | - Silvia Chiesa
- Department of Mental Health and Substance Abuse, Piacenza, Italy
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Sara Dallaspezia
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Seetal Dodd
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Markus Donix
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique-Hôpitaux de Paris, INSERM UMR-S1144, Université de Paris, FondaMental Foundation, Paris, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | | | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, Hopital Bichat-Claude Bernard, Paris, France.,GHU Paris-Psychiatry and Neurosciences, 75014, Paris, France.,Université de Paris, NeuroDiderot, Inserm, Paris, France
| | - Ana Gonzalez-Pinto
- BIOARABA, Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - John F Gottlieb
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa and the Department of Psychiatry, University of Toronto, Ottawa, Canada
| | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Mathias Hasse-Sousa
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Chantal Henry
- Department of Psychiatry, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Lone Høffding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Josselin Houenou
- Université Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Créteil, France.,Université Paris Saclay, CEA, Neurospin, 91191, Gif-sur-Yvette, France
| | | | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Maja Ivkovic
- University Clinical Center of Serbia, Clinic for Psychiatry, Belgrade, Serbia
| | - Sven Janno
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - Simon Johnsen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - Flávio Kapczinski
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gregory N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Seong Jae Kim
- Department of Psychiatry, Cheongju Hospital, Cheongju, South Korea
| | - Barbara König
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - Timur L Kot
- Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia
| | - Michael Koval
- Department of Neuroscience, Michigan State University, East Lansing, MI, USA
| | - Mauricio Kunz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik R Larsen
- Mental Health Department Odense, University Clinic and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rasmus W Licht
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carlos Lopez-Jaramillo
- Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alan MacKenzie
- Forensic Psychiatry, University of Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Agustine Mahardika
- Department of Psychiatry, Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Mirko Manchia
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Klaus Martiny
- Copenhagen University Hospitals, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Yuki Mashima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Ybe Meesters
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fátima Meza-Urzúa
- National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Mok Yee Ming
- Department of General Psychiatry, Mood Disorders Unit, Institute of Mental Health, Singapore City, Singapore
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Muthukumaran Moorthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology-NTNU, Trondheim, Norway.,Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Enrica Mosca
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Fethi Nacef
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ravi K Nadella
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Takako Nakanotani
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - René Ernst Nielsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Adel Omrani
- Tunisian Bipolar Forum, Érable Médical Cabinet 324, Lac 2, Tunis, Tunisia
| | - Yamima Osher
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uta Ouali
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | | | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Joanne Petite
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Elblandklinikum Radebeul, Radebeul, Germany
| | - Marco Pinna
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Danilo Quiroz
- Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile
| | | | - Raj Ramesar
- SA MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Maria Redahan
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Jenny Gringer Richards
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Leela Sathyaputri
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Ângela M Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - Christian Simhandl
- Bipolar Zentrum Wiener Neustadt, Sigmund Freud Privat Universität, Vienna, Austria
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniel Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - José Smith
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | - Paul W Stackhouse
- Science Directorate/Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA
| | - Dan J Stein
- Department of Psychiatry, MRC Unit On Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Kellen Stilwell
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Sergio Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | - Kuan-Pin Su
- College of Medicine, China Medical University (CMU), Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirsi Suominen
- Department of Social Services and Health Care, Psychiatry, City of Helsinki, Helsinki, Finland
| | - Andi J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Leonardo Tondo
- McLean Hospital-Harvard Medical School, Boston, MA, USA.,Mood Disorder Lucio Bini Centers, Cagliari e Roma, Italy
| | - Carla Torrent
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Daniel Tuinstra
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Takahito Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Arne E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology-NTNU, Trondheim, Norway.,Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Maria Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
| | - Oguz Kaan Yalcinkaya
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yosra Zgueb
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Mental Health, The Ottawa Hospital, Ottawa Hospital Research Institute, Canada; Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa, Canada.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Mental Health, The Ottawa Hospital, Ottawa Hospital Research Institute, Canada; Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa, Canada.
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Fiedorowicz JG, Levenson JL, Leentjens AFG. When is lack of scientific integrity a reason for retracting a paper? A case study. J Psychosom Res 2021; 144:110412. [PMID: 33730636 DOI: 10.1016/j.jpsychores.2021.110412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The journal received a request to retract a paper reporting the results of a triple-blind randomized placebo-controlled trial. The present and immmediate past editors expand on the journal's decision not to retract this paper in spite of undisputable evidence of scientific misconduct on behalf of one of the investigators. METHODS The editors present an ethical reflection on the request to retract this randomized clinical trial with consideration of relevant guidelines from the Committee on Publication Ethics (COPE) and the International Committee of Medical Journal Editors (ICMJE) applied to the unique contextual issues of this case. RESULTS In this case, scientific misconduct by a blinded provider of a homeopathy intervention attempted to undermine the study blind. As part of the study, the integrity of the study blind was assessed. Neither participants nor homeopaths were able to identify whether the participant was assigned to homeopathic medicine or placebo. Central to the decision not to retract the paper was the fact that the rigorous scientific design provided evidence that the outcome of the study was not affected by the misconduct. The misconduct itself was thought to be insufficient reason to retract the paper. CONCLUSION Retracting a paper of which the outcome is still valid was in itself considered unethical, as it takes away the opportunity to benefit from its results, rendering the whole study useless. In such cases, scientific misconduct is better handled through other professional channels.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Centre, Maastricht, the Netherlands
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Fiedorowicz JG, Persons JE, Assari S, Ostacher MJ, Goes FS, Nurnberger JI, Coryell WH. Moderators of the association between depressive, manic, and mixed mood symptoms and suicidal ideation and behavior: An analysis of the National Network of Depression Centers Mood Outcomes Program. J Affect Disord 2021; 281:623-630. [PMID: 33234283 PMCID: PMC7855874 DOI: 10.1016/j.jad.2020.11.101] [Citation(s) in RCA: 10] [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: 09/15/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND It has not been established that suicide risk with mixed symptoms is any greater than the depressive component or if there is synergy between depressive and manic symptoms in conveying suicide risk. METHODS The National Network of Depression Centers Mood Outcomes Program collected data from measurement-based care for 17,179 visits from 6,105 unique individuals with clinically diagnosed mood disorders (998 bipolar disorder, 5,117 major depression). The Patient Health Questionaire-8 (PHQ-8) captured depressive symptoms and the Altman Self-Rating Mania scale (ASRM) measured hypomanic/manic symptoms. Generalized linear mixed models assessed associations between depressive symptoms, manic symptoms, and their interaction (to test for synergistic effects of mixed symptoms) on the primary outcome of suicidal ideation or behavior (secondarily suicidal behavior only) from the Columbia-Suicide Severity Rating Scale (C-SSRS). Moderation was assessed. RESULTS PHQ-8 scores were strongly associated with suicide-related outcomes across diagnoses. ASRM scores showed no association with suicidal ideation/behavior in bipolar disorder and an inverse association in major depression. There was no evidence of synergy between depressive and manic symptoms. There was no moderation by sex, race, or mood disorder polarity. Those over 55 years of age showed a protective effect of manic symptoms, which was lost when depressive symptoms were also present (mixed symptoms). DISCUSSION Mixed depressive and manic symptoms convey no excess risk of suicidal ideation or behavior beyond the risk conveyed by the depressive symptoms alone. Depressive symptoms are strongly linked to suicidal ideation and suicidal behavior and represent an important and potentially modifiable risk factor for suicide.
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Affiliation(s)
- Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Department of Mental Health, The Ottawa Hospital Ottawa, ON, Canada
| | - Jane E. Persons
- Roy J. and Lucille A. Carver College of Medicine The University of Iowa, Iowa City, IA, USA
| | - Shervin Assari
- Department of Family Medicine Charles R, Drew University, Los Angeles, CA, USA.
| | - Michael J. Ostacher
- Bipolar Disorder & Depression Research Program VA Palo Alto Health System, Palo Alto, CA, USA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Fernando S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - John I. Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Lemogne C, Blacher J, Airagnes G, Hoertel N, Czernichow S, Danchin N, Meneton P, Limosin F, Fiedorowicz JG. Management of Cardiovascular Health in People with Severe Mental Disorders. Curr Cardiol Rep 2021; 23:7. [PMID: 33409804 DOI: 10.1007/s11886-020-01436-5] [Citation(s) in RCA: 4] [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] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review evidence regarding the association between bipolar disorder and schizophrenia, henceforth referred to as severe mental disorders (SMD), and cardiovascular morbidity and mortality, its mechanisms, and the interventions to reduce this burden. RECENT FINDINGS Much of the loss in life expectancy in people with SMD remains driven by cardiovascular mortality. Antipsychotics and mood stabilizers are associated with negative cardio-metabolic outcomes, but large inter-individual differences are observed, and not treating SMD might be associated with even greater cardiovascular mortality. Classical modifiable cardiovascular risk factors remained inadequately screened and, once identified, too seldom treated in people with SMD. After a myocardial infarction, aggressive tertiary prevention may be as effective in people with SMD as in the general population but is less prescribed. Reduced healthcare quality and increased prevalence of cardiovascular risk factors may not fully explain the excess cardiovascular mortality associated with SMDs, which themselves should be considered risk factors in risk calculators. Hazardous health behaviors, the cardio-metabolic adverse effects of medications, and a reduced access to quality healthcare remain priority targets for intervention.
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Affiliation(s)
- Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France.
| | - Jacques Blacher
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, Centre de Diagnostic et de Thérapeutique, Paris, France
| | - Guillaume Airagnes
- Université de Paris, AP-HP, Hôpital européen Georges-Pompidou, DMU Psychiatrie et Addictologie, Centre Ambulatoire d'Addictologie, INSERM, UMS 011 Cohortes Epidémiologiques en Population, Paris, France
| | - Nicolas Hoertel
- Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte et du sujet âgé, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Issy-les-Moulineaux, France
| | - Sébastien Czernichow
- Université de Paris, AP-HP, Hôpital européen Georges-Pompidou, Service de Nutrition, Paris, France
| | - Nicolas Danchin
- Université de Paris, AP-HP, Hôpital européen Georges-Pompidou, Service de Cardiologie, Paris, France
| | - Pierre Meneton
- INSERM U1142 LIMICS, UMRS 1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - Frédéric Limosin
- Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte et du sujet âgé, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Issy-les-Moulineaux, France
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Torres ME, Löwe B, Schmitz S, Pienta JN, Van Der Feltz-Cornelis C, Fiedorowicz JG. Suicide and suicidality in somatic symptom and related disorders: A systematic review. J Psychosom Res 2021; 140:110290. [PMID: 33227556 PMCID: PMC7945369 DOI: 10.1016/j.jpsychores.2020.110290] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/03/2020] [Revised: 09/28/2020] [Accepted: 11/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to determine the frequency of and risk factors for suicide outcomes in somatic symptom and related disorders and whether any risk was independent of co-occurring mental disorders. METHODS We conducted a systematic review of studies on suicide death, suicide attempts, and suicidal ideation in those with somatic symptom disorders published prior to September 22, 2020 and indexed in PubMED, MEDLINE, PsycARTICLES, PsycINFO, EMBASE, or SCOPUS according to PRISMA guidelines. RESULTS Our search yielded 33 articles with significant heterogeneity in study design, sample selection, and assessment for suicide or risk factors. While suicide deaths have not been adequately studied, somatic symptom and related disorders are associated with increased risk for suicidal ideation and suicide attempts, with estimates ranging from 24 to 34% of participants who endorsed current active suicidal ideation and 13-67% of participants who endorsed a prior suicide attempt. The risk appeared independent of co-occurring mental disorders. Identified risk factors for suicide attempts in samples with somatic symptom and related disorders include scores on measures of anger, alexithymia, alcohol use, past hospitalizations, dissociation, and emotional abuse. CONCLUSION Although the literature is sparse, there exists evidence for an association, even independent of other mental disorders, between somatic symptom and related disorders and suicide outcomes. Practice guidelines for the management of these disorders should incorporate recommendations for the assessment and management of suicide risk. Future study is necessary to more fully elucidate potential unique risk factors for those suffering from these complex disorders.
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Affiliation(s)
| | - Bernd Löwe
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samantha Schmitz
- Florida Atlantic University, Boca Raton, FL, United States; Des Moines University, Des Moines, IA, United States
| | - John N Pienta
- University of Iowa Hospitals and Clinics, United States
| | | | - Jess G Fiedorowicz
- The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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