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Wang Y, Liu J, Zhang R, Luo G, Sun D. Untangling the complex relationship between bipolar disorder and anxiety: a comprehensive review of prevalence, prognosis, and therapy. J Neural Transm (Vienna) 2025; 132:567-578. [PMID: 39755917 DOI: 10.1007/s00702-024-02876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 12/18/2024] [Indexed: 01/06/2025]
Abstract
Bipolar disorder (BD) frequently coexists with anxiety disorders, creating complex challenges in clinical therapy and management. This study investigates the prevalence, prognostic implications, and treatment strategies for comorbid BD and anxiety disorders. High comorbidity rates, particularly with generalized anxiety disorder, underscore the necessity of thorough clinical assessments to guide effective management. Our findings suggest that anxiety disorders may serve as precursors to BD, especially in high-risk populations, making early detection of anxiety symptoms crucial for timely intervention and prevention. We also found that comorbid anxiety can negatively affect the course of BD, increasing clinical severity, reducing treatment responsiveness, and worsening prognosis. These complexities highlight the need for caution in using antidepressants, which may destabilize mood. Alternatively, cognitive-behavioral therapy presents a promising, targeted approach for managing BD with comorbid anxiety. In summary, this study provides essential insights for clinicians and researchers, enhancing understanding of BD and anxiety comorbidity and guiding more precise diagnostics and tailored interventions to improve overall patient care.
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Affiliation(s)
- Yuting Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders and Department of Psychiatry, Capital Medical University and Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088, China
| | - Jiao Liu
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Ran Zhang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China.
| | - Daliang Sun
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China.
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Maidana LM, Guerra JMDS, Souza-Pereira A, Lins MP, Moreira-Silva MJ, Paiva EG, Godinho DB, Royes LFF, Rambo LM. Previous strength training attenuates ouabain-induced bipolar disorder-related behaviors and memory deficits in rats: Involvement of hippocampal ERK/CREB and PI3K/AKT/mTOR pathways. Neurochem Int 2025; 183:105919. [PMID: 39719211 DOI: 10.1016/j.neuint.2024.105919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 12/04/2024] [Accepted: 12/15/2024] [Indexed: 12/26/2024]
Abstract
Bipolar disorder (BD) is a central nervous system condition that is typified by fluctuations in mood, oscillating between depressive and manic, and/or hypomanic episodes. The objective of this study was to test the hypothesis that strength training may act as a potent protector against behavioral and neurochemical changes induced by BD. A strength training protocol was performed with adult male Wistar rats, and seven days following the conclusion of training, a single ouabain injection was administered. Following ouabain administration, the animals were subjected to behavioral tests after the seventh (manic period) and fourteenth (depressive period) days. Subsequently, rats were euthanized and the hippocampus was collected for western blotting assays. We demonstrated that strength training provided protection against ouabain-induced behavioral changes, both during the manic and depressive periods, including increased locomotor activity, risk-taking and aggressive-like behaviors, and impaired memory performance. Furthermore, physical training protected against ouabain-induced decrease of neurogenesis/neuroplasticity-related pathways, including BDNF/TrKB/ERK/CREB and PI3K/AKT/mTOR/p70S6K. These findings suggest that strength training has a protective effect, attenuating or preventing BD-induced deficits, and may have therapeutic potential as an adjuvant treatment for this patient population in the future.
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Affiliation(s)
- Luan Machado Maidana
- Biochemistry Graduate Program, Federal University of Pampa, Uruguaiana, RS, Brazil
| | | | - Adson Souza-Pereira
- Biochemistry Graduate Program, Federal University of Pampa, Uruguaiana, RS, Brazil
| | | | | | | | - Douglas Buchmann Godinho
- Department of Methods and Sportive Techniques, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Luis Fernando Freire Royes
- Department of Methods and Sportive Techniques, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Leonardo Magno Rambo
- Biochemistry Graduate Program, Federal University of Pampa, Uruguaiana, RS, Brazil; Physical Education Undergraduation, Federal University of Pampa, Uruguaiana, RS, Brazil.
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Léda-Rêgo G, Studart-Bottó P, Abbade P, Rabelo-Da-Ponte FD, Casqueiro JS, Sarmento S, Dallalana C, Troesch M, Prates S, Miranda-Scippa Â. Lifetime prevalence of psychiatric comorbidities in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Res 2024; 337:115953. [PMID: 38763079 DOI: 10.1016/j.psychres.2024.115953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disease and part of its burden is related to the high rates of lifetime psychiatric comorbidity (PC), with diagnostic, therapeutic, and prognostic implications. METHODS Registered in PROSPERO (CRD42021282356). Meta-analyses were performed, searching for relevant papers published from 1993 to 2022 in Medline/PubMed (including E-Pub Ahead of Print), Embase, Cochrane Library (Central), PsycINFO, Scopus, Web of Science and via hand-searching, without language restrictions. 12.698 studies were initially identified, 114 of which were ultimately chosen based on the eligibility criteria. We performed two meta-analyses (prevalence and risk ratio) of mental health conditions among subjects with BD and then conducted a comprehensive examination of moderator effects using multivariable meta-regression models for moderators identified as significant in the univariable analysis. FINDINGS Overall PC prevalence of at least one disorder was 38.91 % (95 % CI 35.24-42.70) and the most frequent disorders were: anxiety (40.4 % [34.97-46.06]), SUD (30.7 % [23.73-38.73]), ADHD (18.6 % [10.66-30.33]) and Disruptive, impulse-control and conduct disorder (15 % [6.21-31.84). The moderators with higher association with individual prevalences were UN's Human Development Index (HDI), female gender, age, suicide attempt, and age at onset (AAO). INTERPRETATION It becomes evident that the prevalence of PC among individuals with BD is notably high, surpassing rates observed in the general population. This heightened prevalence persists despite significant heterogeneity across studies. Consequently, it is imperative to redirect clinical focus towards comprehensive mental health assessments, emphasizing personalized and routine screening. Additionally, there is a pressing need for the enhancement of public policies to create a supportive environment for individuals with BD, ensuring better therapeutic conditions and sustained assistance. By addressing these aspects, we can collectively strive towards fostering improved mental health outcomes for individuals with BD.
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Affiliation(s)
- Gabriela Léda-Rêgo
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil.
| | - Paula Studart-Bottó
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Pedro Abbade
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - F Diego Rabelo-Da-Ponte
- Institute of Psychiatry, Psychology, and Neurosciences, King's College London, United Kingdom
| | - Juliana Socorro Casqueiro
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brasil
| | - Stella Sarmento
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Caroline Dallalana
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Mariana Troesch
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Sarah Prates
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil
| | - Ângela Miranda-Scippa
- Centro de Estudos dos Transtornos de Humor e de Ansiedade (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil; Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brasil; Faculdade de Medicina da Bahia, UFBA, Salvador, BA, Brasil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brasil
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Pavlova B, Warnock-Parkes E, Alda M, Uher R, Clark DM. Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series. Int J Bipolar Disord 2024; 12:1. [PMID: 38180531 PMCID: PMC10769945 DOI: 10.1186/s40345-023-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Social anxiety disorder increases the likelihood of unfavourable outcomes in people with bipolar disorder. Cognitive behavioural therapy (CBT) is the first-line treatment for social anxiety disorder. However, people with bipolar disorder have been excluded from the studies that this recommendation is based on. METHOD: We completed a case series to obtain initial data on whether CBT is an acceptable, safe, and effective treatment for social anxiety disorder in people with bipolar disorder. RESULTS Eleven euthymic participants with bipolar disorder attended up to sixteen treatment and three follow-up sessions of CBT for social anxiety disorder. Participants attended on average 95% of the offered CBT sessions. No adverse events were reported. Participants' mean score on the Social Phobia Inventory decreased from 46.5 (SD 6.6) before the treatment to 19.8 (SD 11.9) at the end of the sixteen-session intervention and further to 15.8 (SD 10.3) by the end of the 3-month follow-up. This degree of improvement is equivalent to the effect observed in studies of CBT for social anxiety disorder in people without severe mental illness. CONCLUSIONS This case series provides preliminary evidence that CBT is acceptable, safe, and effective for treating social anxiety disorder in people with bipolar disorder during euthymia. A randomized controlled trial is needed to confirm these findings, and to establish whether treatment for social anxiety disorder improves the course of bipolar disorder.
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Affiliation(s)
- Barbara Pavlova
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada.
- Nova Scotia Health, Halifax, NS, Canada.
| | - Emma Warnock-Parkes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- King's College London, London, UK
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Li T, Mao Z, Zhao L, Sun Y, Wang C, Bo Q. Childhood trauma and its influence on the clinical features of bipolar disorder. CHILD ABUSE & NEGLECT 2023; 141:106203. [PMID: 37088009 DOI: 10.1016/j.chiabu.2023.106203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Childhood trauma is an environmental risk factor for bipolar disorder (BD), But its influence on the clinical features of BD has not been examined sufficiently. OBJECTIVE We compared the childhood trauma between patients with BD and healthy controls (HCs) and determined how childhood trauma impacts clinical features, such as severity, mood episodes, and disease duration. PARTICIPANTS AND SETTING The study population comprised patients with BD (in a state of euthymia or depression, n = 90) and HCs (n = 94). METHODS The Structured Clinical Interview for DSM-IV Axis I Disorders was used to diagnose BD and ascertain its clinical features. The Childhood Trauma Questionnaire (CTQ) was used to assess childhood trauma. RESULTS The total CTQ score and scores for the CTQ subscales emotional abuse, sexual abuse, emotional neglect, and physical neglect, significantly differed between the BD and HC groups. Emotional abuse was correlated with higher Hamilton Anxiety Rating Scale (HARS) score and more frequent mood episodes; emotional neglect was correlated with higher HARS score, longer disease duration, and more mood episodes; and total CTQ score was positively correlated with HARS score, disease duration, and mood episodes. Regression analysis showed that emotional neglect significantly predicted HARS score, Hamilton Depression Rating Scale score, and disease duration in the BD group (P < 0.05). CONCLUSIONS Patients with BD have more serious childhood trauma. General childhood trauma, emotional abuse, and emotional neglect negatively affect the clinical features of BD.
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Affiliation(s)
- Tian Li
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Zhen Mao
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Lei Zhao
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Yue Sun
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Chuanyue Wang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Qijing Bo
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China.
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Henriques-Calado J, Pires R, Paulino M, Gama Marques J, Gonçalves B. Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study. Borderline Personal Disord Emot Dysregul 2023; 10:2. [PMID: 36647173 PMCID: PMC9841700 DOI: 10.1186/s40479-022-00205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits. METHODS A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed. RESULTS Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R2 = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69). CONCLUSIONS Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal. .,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002, Lisboa, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
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7
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Bae NY, Lee SR, Choi EK, Ahn HJ, Ahn HJ, Kwon S, Han KD, Lee KN, Oh S, Lip GYH. Impact of mental disorders on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study. Cardiovasc Diabetol 2022; 21:251. [PMID: 36397079 PMCID: PMC9673441 DOI: 10.1186/s12933-022-01682-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is unclear whether mental disorders are an independent risk factor for atrial fibrillation (AF) in patients with diabetes. We aimed to investigate whether patients with diabetes who have mental disorders have an increased risk for AF. METHODS Using the Korea National Health Insurance Service database, we enrolled 2,512,690 patients diagnosed with diabetes without AF between 2009 and 2012. We assessed five mental disorders: depression, insomnia, anxiety, bipolar disorder, and schizophrenia. Newly diagnosed AF was identified during the follow-up period, and multivariate Cox regression analysis was performed. RESULTS Among the 2,512,690 patients (mean age 57.2 ± 12.3 years; 60.1% men), 828,929 (33.0%) had mental disorders. Among the five mental disorders, anxiety (68.1%) was the most common, followed by insomnia (40.0%). During a median follow-up duration of 7.1 years, new-onset AF was diagnosed in 79,525 patients (4.66 per 1,000 person-years). Patients with diabetes who had mental disorders showed a higher risk for AF (adjusted hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.17-1.21; p-value < 0.001). Depression, insomnia, and anxiety were significantly associated with higher risk for AF (adjusted HR [95% CI]: 1.15 [1.12-1.17], 1.15 [1.13-1.18], and 1.19 [1.67-1.21], respectively; all p-values < 0.001), whereas bipolar disorder and schizophrenia were not. CONCLUSIONS Mental disorders, especially depression, insomnia, and anxiety, were associated with an increased risk for AF in patients with diabetes. Greater awareness with a prompt diagnosis of AF should be considered for patients with both DM and mental disorders.
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Affiliation(s)
- Nan Young Bae
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - So-Ryoung Lee
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Eue-Keun Choi
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jin Ahn
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hyo-Jeong Ahn
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Soonil Kwon
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Kyung-Do Han
- grid.263765.30000 0004 0533 3568Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyu-Na Lee
- grid.263765.30000 0004 0533 3568Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.10025.360000 0004 1936 8470Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, UK ,grid.5117.20000 0001 0742 471XDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Arvilommi P, Pallaskorpi S, Linnaranta O, Suominen K, Leppämäki S, Valtonen H, Isometsä E. Long-term work disability due to type I and II bipolar disorder: findings of a six-year prospective study. Int J Bipolar Disord 2022; 10:19. [PMID: 35811322 PMCID: PMC9271449 DOI: 10.1186/s40345-022-00264-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/10/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, the prevalence and predictors of long-term work disability among patients with type I and II BD have scarcely been studied. We investigated the clinical predictors of long-term work disability among patients with BD. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (n = 191) of adult psychiatric in- and out-patients with DSM-IV type I and II BD in three Finnish cities. Within JoBS we examined the prevalence and predictors of disability pension being granted during a six-year follow-up of the 152 patients in the labor force at baseline and collected information on granted pensions from national registers. We determined the predictors of disability pension using logistic regression models. Results Over the 6 years, 44% of the patients belonging to the labor force at baseline were granted a disability pension. Older age; type I BD; comorbidity with generalized anxiety disorder, post-traumatic stress disorder or avoidant personality disorder; and duration of time with depressive or mixed symptoms predicted disability pensions. Including disability pensions granted before baseline increased their total prevalence to 55.5%. The observed predictors were similar. Conclusion This regionally representative long-term prospective study found that about half of patients with type I or II bipolar disorder suffer from persistent work disability that leads to disability pension. In addition to the severity of the clinical course and type I bipolar disorder, the longitudinal accumulation of time depressed, psychiatric comorbidity, and older age predicted pensioning. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00264-6.
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Affiliation(s)
- Petri Arvilommi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Pallaskorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Kirsi Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Valtonen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Perich T, Kakakios K, Conti J. Experiences of a transdiagnostic anxiety cognitive behaviour therapy group for people living with bipolar disorder: a qualitative study. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2049442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Tania Perich
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Kelly Kakakios
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
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10
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Burgos-Julián FA, Ruiz-Íñiguez R, Peña-Ibáñez F, Montero AC, Germán MAS. Mindfulness-based and mindfulness-informed interventions in bipolar disorder: a meta-analysis based on Becker's method. Clin Psychol Psychother 2022; 29:1172-1185. [PMID: 35102640 DOI: 10.1002/cpp.2717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Bipolar disorder is a highly disruptive and debilitating problem. Mindfulness-based and mindfulness-informed interventions have exponentially emerged as third-generation therapies, applied to a wide spectrum of disorders, including bipolar disorder. However, the reviews and meta-analyses published to date are limited in their conclusions, as they are based on single-group pretest-posttest cohort designs and mostly focused on mindfulness-based interventions. The present review and meta-analysis try to address these limitations, including studies on informed mindfulness, controlled and single group designs. It used a specific meta-analytical procedure that allows an imputation procedure in those designs lacking a comparison group, by means of separate omnibus tests for the experimental and control group. A total of 13 studies (N = 331) were selected. The results showed an absence of effects on depression (g = 0.21) and mania (g = -0.13), but significant moderate effect on anxiety (g = 0.53). In conclusion, both mindfulness interventions showed robust evidence on anxiety symptoms in pretest-posttest periods compared to control groups. Few studies and lack of evidence of follow-up periods were the main limitations found.
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Affiliation(s)
| | - Raquel Ruiz-Íñiguez
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Fernando Peña-Ibáñez
- Alpedrete Local Clinic. Health Center Villalba Estación (Madrid). Plaza de la Tauromaquia, s/n. 28430 Alpedrete, Madrid
| | - Ana Carralero Montero
- Faculty of Medicine and Health Sciences, Universidad de Alcalá de Henares (UAH). Ctra. Madrid- Barcelona, Alcalá de Henares, (Madrid)
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11
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Grillault Laroche D, Godin O, Dansou Y, Belzeaux R, Aouizerate B, Burté T, Courtet P, Dubertret C, Haffen E, Llorca P, Olie E, Roux P, Polosan M, Schwan R, Leboyer M, Bellivier F, Marie-Claire C, Etain B. Influence of childhood maltreatment on prevalence, onset and persistence of psychiatric comorbidities and suicide attempts in bipolar disorders. Eur Psychiatry 2022; 65:e15. [PMID: 35060460 PMCID: PMC8853858 DOI: 10.1192/j.eurpsy.2022.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusions
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12
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Malygin Y, Orlova A, Malygin V. Conceptualization of comorbid anxiety and depressive disorders and approaches to their managing. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:48-54. [DOI: 10.17116/jnevro202212206148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Cullen C, Kappelmann N, Umer M, Abdolizadeh A, Husain MO, Bonato S, Sharma G, Xue S, Ortiz A, Kloiber SM, Mulsant BH, Husain MI. Efficacy and acceptability of pharmacotherapy for comorbid anxiety symptoms in bipolar disorder: A systematic review and meta-analysis. Bipolar Disord 2021; 23:754-766. [PMID: 34506075 DOI: 10.1111/bdi.13125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/29/2021] [Accepted: 08/28/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Anxiety symptoms are highly prevalent among individuals with bipolar disorder (BD) but there is little guidance on pharmacotherapy for these symptoms. The objective of this systematic review and meta-analysis was to evaluate the available evidence for pharmacotherapy of comorbid anxiety symptoms in BD. METHODS Completed randomized clinical trials (RCTs) of medications for BD published prior to December 2020 were identified through a systematic search of MEDLINE, Embase, PsycInfo, Web of Science, clinicaltrials.gov, and the ISRCTN. Data from RCTs measuring anxiety symptoms at baseline and endpoint and all-cause discontinuation were pooled to compare the efficacy and acceptability of medications with control conditions. RESULTS Thirty-seven RCTs met our inclusion criteria; 13 placebo-controlled RCTs with 2175 participants had sufficient data to be included in the meta-analysis assessing anxiety symptoms. Compared with placebo, the overall effect size of medications (primarily atypical antipsychotics) on anxiety symptoms was small with a standardized mean difference (SMD) = -0.22 (95% CI: -0.34 to -0.11). Study heterogeneity was low (I2 = 26%). The acceptability of these medications was comparable with placebo with odds ratio of discontinuation from all causes = 0.98 (95% CI: 0.91-1.06). CONCLUSION There is limited evidence for a small anxiolytic effect and good acceptability of pharmacotherapy (primarily atypical antipsychotics) in the treatment of comorbid anxiety symptoms in BD. These results highlight the need for further research on medications other than atypical antipsychotics.
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Affiliation(s)
- Clare Cullen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nils Kappelmann
- Department of Research in Translational Psychiatry, Max- Planck- Institute of Psychiatry, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Madeha Umer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ali Abdolizadeh
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad Omair Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Bonato
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gaurav Sharma
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Siqi Xue
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abigail Ortiz
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stefan M Kloiber
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad I Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Stanislaus S, Coello K, Kjærstad HL, Sletved KSO, Seeberg I, Frost M, Bardram JE, Jensen RN, Vinberg M, Faurholt-Jepsen M, Kessing LV. Prevalences of comorbid anxiety disorder and daily smartphone-based self-reported anxiety in patients with newly diagnosed bipolar disorder. EVIDENCE-BASED MENTAL HEALTH 2021; 24:137-144. [PMID: 34083204 PMCID: PMC10231557 DOI: 10.1136/ebmental-2021-300259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/28/2021] [Accepted: 05/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Around 40% of patients with bipolar disorder (BD) additionally have anxiety disorder. The prevalence of anxiety in patients with newly diagnosed BD and their first-degree relatives (UR) has not been investigated.ObjectiveTo investigate (1) the prevalence of a comorbid anxiety diagnosis in patients with newly diagnosed BD and their UR, (2) sociodemographic and clinical differences between patients with and without a comorbid anxiety diagnosis and (3) the association between smartphone-based patient-reported anxiety and observer-based ratings of anxiety and functioning, respectively. METHODS We recruited 372 patients with BD and 116 of their UR. Daily smartphone-based data were provided from 125 patients. SCAN was used to assess comorbid anxiety diagnoses. FINDINGS In patients with BD, the prevalence of a comorbid anxiety disorder was 11.3% (N=42) and 10.3% and 5.9% in partial and full remission, respectively. In UR, the prevalence was 6.9%. Patients with a comorbid anxiety disorder had longer illness duration (p=0.016) and higher number of affective episodes (p=0.011). Smartphone-based patient-reported anxiety symptoms were associated with ratings of anxiety and impaired functioning (p<0.001). LIMITATIONS The SCAN interviews to diagnose comorbid anxiety disorder were carried out regardless of the participants' mood state.Clinical implicationsThe lower prevalence of anxiety in newly diagnosed BD than in later stages of BD indicates that anxiety increases with progression of BD. Comorbid anxiety seems associated with poorer clinical outcomes and functioning and smartphones are clinically useful for monitoring anxiety symptoms. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02888262).
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Affiliation(s)
- Sharleny Stanislaus
- Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
| | - Klara Coello
- Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
| | - Hanne Lie Kjærstad
- Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
| | | | - Ida Seeberg
- Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
| | - Mads Frost
- Monsenso, Monsenso Aps, Copenhagen, Denmark
| | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Rasmus Nejst Jensen
- Psychiatric Centre North Zealand, Region Hovedstadens Psykiatri, Hilleroed, Hovedstaden, Denmark
| | - Maj Vinberg
- Psychiatric Centre North Zealand, Region Hovedstadens Psykiatri, Hilleroed, Hovedstaden, Denmark
- Faculty of Health Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
- Faculty of Health Sciences, University of Copenhagen, Kobenhavn, Denmark
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15
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Cañada Y, Sabater A, Sierra P, Balanzá-Martínez V, Berk M, Dodd S, Navalón P, Livianos L, García-Blanco A. The effect of concomitant benzodiazepine use on neurocognition in stable, long-term patients with bipolar disorder. Aust N Z J Psychiatry 2021; 55:1005-1016. [PMID: 33153268 DOI: 10.1177/0004867420969819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Neurocognitive dysfunction is a common feature of bipolar disorder even in euthymia, and psychopharmacological treatment could have an effect on cognition. Long-term prescription of benzodiazepines in bipolar disorder is a common practice, and their effect on neurocognition has not been well studied in this population. The aim of this study was to evaluate the impact of concomitant benzodiazepine long-term use on neurocognitive function in stable euthymic bipolar disorder patients. METHODS Seventy-three euthymic bipolar disorder outpatients and 40 healthy individuals were assessed using a neurocognitive battery. Patients were classified in two groups according to the presence of benzodiazepines in their treatment: the benzodiazepine group (n = 34) and the non- benzodiazepine group (n = 39). Neurocognitive performance was compared between the groups using a multivariate analysis of covariance, considering age, number of depressive episodes, adjuvant antipsychotic drugs, Young Mania Rating Scale score and Hamilton Depression Rating Scale score as covariates. RESULTS Both bipolar disorder groups (benzodiazepine and non-benzodiazepine) showed an impairment in memory domains (Immediate Visual Memory [p = 0.013], Working Memory [p < 0.001], and Letter-Number Sequence [p < 0.001] from the Wechsler Memory Scale-Revised-III) and slower processing speed functions (Stroop Colour [p < 0.001]) relative to the control group. Nevertheless, the benzodiazepine group showed a greater impairment in executive functions (Conceptual Level Responses [p = 0.024] from the Wisconsin Card Sorting Test and Frontal Assessment Battery [p = 0.042]). CONCLUSION Although memory and processing speed impairments were found in bipolar disorder, regardless of their benzodiazepine treatment, benzodiazepine users presented additional neurocognitive impairments in terms of executive functioning. These findings support restricted prescription of benzodiazepines in individuals with bipolar disorder.
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Affiliation(s)
- Yolanda Cañada
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana Sabater
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Sierra
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Vicent Balanzá-Martínez
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,Center of Biomedical Investigation Network in Mental Health (CIBERSAM), Madrid, Spain
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia.,Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Seetal Dodd
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia.,Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Pablo Navalón
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Neonatal Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Lorenzo Livianos
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERESP-17, Valencia, Spain
| | - Ana García-Blanco
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Neonatal Research Unit, La Fe Health Research Institute, Valencia, Spain.,Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
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16
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Kameg BN. Bipolar disorder: Treatment strategies for women of childbearing age. Perspect Psychiatr Care 2021; 57:1244-1249. [PMID: 33164215 DOI: 10.1111/ppc.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/16/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Bipolar disorder is associated with increased rates of morbidity and mortality, magnified in women of childbearing age. The purpose of this paper is to provide an overview of the differential diagnosis and management of bipolar disorder in women of childbearing age. CONCLUSIONS Differential diagnoses for bipolar disorder include depressive disorders, anxiety disorders, trauma-related disorders, attention-deficit/hyperactivity disorder, and personality disorders. Pharmacotherapeutic options for the treatment of bipolar disorder include lithium, anti-epileptic medications, and atypical antipsychotics. In regard to women of childbearing age, consideration of risks, benefits, and alternative therapies is needed before initiating therapy. PRACTICE IMPLICATIONS Caring for patients with bipolar disorder, particularly women of childbearing age, requires careful differentiation of bipolar disorder from other mental health problems, and prudent consideration of pharmacotherapeutic options.
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Affiliation(s)
- Brayden N Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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17
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Carbone EA, de Filippis R, Caroleo M, Calabrò G, Staltari FA, Destefano L, Gaetano R, Steardo L, De Fazio P. Antisocial Personality Disorder in Bipolar Disorder: A Systematic Review. MEDICINA-LITHUANIA 2021; 57:medicina57020183. [PMID: 33672619 PMCID: PMC7924170 DOI: 10.3390/medicina57020183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Bipolar Disorder (BD) is a severe psychiatric disorder that worsens quality of life and functional impairment. Personality disorders (PDs), in particular Cluster B personality, have a high incidence among BD patients and is considered a poor prognostic factor. The study of this co-morbidity represents an important clinical and diagnostic challenge in psychiatry. Particularly, clinical overlap has been shown between antisocial personality disorder (ASPD) and BD that could worsen the course of both disorders. We aimed to detect the frequency of ASPD in bipolar patients with greater accuracy and the impact of ASPD on the clinical course of BD. Materials and Methods: A systematic literature search was conducted in PubMed, Embase, MEDLINE and the Cochrane Library through December 2020 without language or time restriction, according to PRISMA statement guidelines. Results: Initially, 3203 items were identified. After duplicates or irrelevant paper deletion, 17 studies met the inclusion criteria and were included in this review. ASPD was more frequent among BD patients, especially in BD type I. BD patients with ASPD as a comorbidity seemed to have early onset, higher number and more severe affective episodes, higher levels of aggressive and impulsive behaviors, suicidality and poor clinical outcome. ASPD symptoms in BD seem to be associated with a frequent comorbidity with addictive disorders (cocaine and alcohol) and criminal behaviors, probably due to a shared impulsivity core feature. Conclusions: Considering the shared symptoms such as impulsive and dangerous behaviors, in patients with only one disease, misdiagnosis is a common phenomenon due to the overlapping symptoms of ASPD and BD. It may be useful to recognize the co-occurrence of the disorders and better characterize the patient with ASPD and BD evaluating all dysfunctional aspects and their influence on core symptoms.
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18
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Seon Q, Hum S, Tuineag M, Pavlova B, Beaulieu S, Linnaranta O. Properties of common anxiety scales among patients with bipolar disorder. J Affect Disord 2021; 281:972-979. [PMID: 33229021 DOI: 10.1016/j.jad.2020.09.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/19/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Almost half of the patients with a bipolar disorder (BD) have anxiety disorder(s) (AD) during their lifetime, but feasible measures for all AD are few. Furthermore, cognitive impairments can compromise reliability of existing scales, since many are needed for full coverage. Thus, we investigated how reliably patients responded to anxiety scales and any symptom overlap to propose future improvements to anxiety assessments. METHODS We collected 152 observations in patients with BD with the Clinically Useful Anxiety Outcome Scale, Social Phobia Inventory, Panic Disorder Severity Measurement, and Trauma Screening Questionnaire (in total, 57 items). The scales were analyzed as a set in a Rasch model. RESULTS During our analyses, we found indication that BD outpatients had difficulty differentiating response options to 70% (40/57) of items which were rescored or deleted. Only one case was misfitting (-2.65±.41). In total, 22 items were locally dependent and one indicated misfit. The final model included 25-items and fit the Rasch model (χ2=35.92, DF=50, p=.93). The model was unidimensional, without losing appropriate associations with depression (r = 0.62), suicidality (r = 0.37), and hypomania (r= -0.01). LIMITATIONS Bolstering the size of less frequent subgroups should be accomplished in future work. CONCLUSION A unidimensional rather than categorical approach to severity of anxiety might be both useful and feasible in this population. Further development of screens is necessary to enable systematic screening and measurement of anxiety in BD.
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Affiliation(s)
- Quinta Seon
- Department of Psychology, McGill University, Quebec, Canada
| | - Stanley Hum
- Montreal Neurological Institute, Quebec, Canada
| | - Maria Tuineag
- Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Quebec, Canada
| | - Barbara Pavlova
- Dalhousie University, Nova Scotia, Canada; Nova Scotia Health Authority, Nova Scotia, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Quebec, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Quebec, Canada.
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19
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Seeberg I, Nielsen IB, Jørgensen CK, Eskestad ND, Miskowiak KW. Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission: A systematic review. J Affect Disord 2021; 279:31-45. [PMID: 33038698 DOI: 10.1016/j.jad.2020.09.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/24/2020] [Accepted: 09/27/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anxiety symptoms are prevalent in bipolar disorder (BD) even during periods of remission and impede treatment efficacy, prognosis and functional capacity. This highlights a pressing clinical need to identify novel effective anxiety treatments. This systematic review aimed to evaluate the evidence within the field. METHODS Following PRISMA guidelines, we conducted a systematic search on PubMed, PsycInfo, EMBASE and Cochrane Library for randomised controlled trials (RCTs) targeting anxiety in remitted BD patients. RESULTS We identified 10 RCTs investigating the effects of psychological or pharmacological treatments on anxiety in remitted BD patients. Two studies of transdiagnostic personalised cognitive behavioural therapy (CBT) found a treatment-related reduction in anxiety. This evidence was preliminary given small sample size and use of self-report measures in a single-blind trial design, respectively. The remaining six psychological intervention trials provided more preliminary evidence due to several methodological challenges. The two pharmacological studies found anxiolytic effects of add-on olanzapine or methylene blue to lithium treatment, respectively. Nevertheless, this evidence should be interpreted with caution given high drop-out rates and substantial side-effects that may have impeded blinding. LIMITATIONS We did not conduct a quantitative meta-analysis. CONCLUSIONS There is preliminary evidence for beneficial effects of modified CBT and add-on pharmacotherapy on residual anxiety in BD. Future trials should pre-screen participants for anxiety, define one clinician-rated anxiety measurement as a primary outcome, and employ intention-to-treat analysis to assess treatment effect. This will advance treatment development and enable personalised approaches to address residual anxiety in BD, which has great clinical relevance.
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Affiliation(s)
- I Seeberg
- Neurocognition and Emotion in Affective Disorder (NEAD) Group; Copenhagen Affective Disorder Research Centre (CADIC); Psychiatric Centre Copenhagen, Copenhagen University Hospital; Department of Psychology, University of Copenhagen
| | - I B Nielsen
- Department of Psychology, University of Copenhagen
| | - C K Jørgensen
- Neurocognition and Emotion in Affective Disorder (NEAD) Group; Copenhagen Affective Disorder Research Centre (CADIC); Psychiatric Centre Copenhagen, Copenhagen University Hospital; Department of Psychology, University of Copenhagen
| | - N D Eskestad
- Neurocognition and Emotion in Affective Disorder (NEAD) Group; Copenhagen Affective Disorder Research Centre (CADIC); Psychiatric Centre Copenhagen, Copenhagen University Hospital; Department of Psychology, University of Copenhagen
| | - K W Miskowiak
- Neurocognition and Emotion in Affective Disorder (NEAD) Group; Copenhagen Affective Disorder Research Centre (CADIC); Psychiatric Centre Copenhagen, Copenhagen University Hospital; Department of Psychology, University of Copenhagen.
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20
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Sperling JD, Dalkner N, Berndt C, Fleischmann E, Ratzenhofer M, Martini J, Pfennig A, Bauer M, Reininghaus E, Vinberg M. Physical Health Profile and Associated Behavior During the COVID-19 Pandemic in Patients With Bipolar Disorder. Front Psychiatry 2021; 12:759694. [PMID: 34938211 PMCID: PMC8685329 DOI: 10.3389/fpsyt.2021.759694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background: The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioral, mental, and physical health, presumably with effects on patients with severe mental disorders. This study examines pandemic-related physical and mental health and (compensatory) behavioral changes, in patients with BD as compared to healthy control individuals. Method: Physical and mental health and self-reported changes in daily structure and behavior due to the pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) in Germany, Austria, and Denmark in individuals with BD and a healthy control group. Results: The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rates of COVID-19 testing, had more worries concerning health, and experienced more anxiety but less social distancing. Conclusion: The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behavior due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimizing and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as the COVID-19 pandemic. Limitations: Sampling issues and self-report forms, selectivity (missing elderly, and those lacking access or knowledge of technology).
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Affiliation(s)
- Jon Dyg Sperling
- Mental Health Center, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Christina Berndt
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Julia Martini
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Maj Vinberg
- Mental Health Center, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Rabelo-da-Ponte FD, Feiten JG, Mwangi B, Barros FC, Wehrmeister FC, Menezes AM, Kapczinski F, Passos IC, Kunz M. Early identification of bipolar disorder among young adults - a 22-year community birth cohort. Acta Psychiatr Scand 2020; 142:476-485. [PMID: 32936930 DOI: 10.1111/acps.13233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We set forth to build a prediction model of individuals who would develop bipolar disorder (BD) using machine learning techniques in a large birth cohort. METHODS A total of 3748 subjects were studied at birth, 11, 15, 18, and 22 years of age in a community birth cohort. We used the elastic net algorithm with 10-fold cross-validation to predict which individuals would develop BD at endpoint (22 years) at each follow-up visit before diagnosis (from birth up to 18 years). Afterward, we used the best model to calculate the subgroups of subjects at higher and lower risk of developing BD and analyzed the clinical differences among them. RESULTS A total of 107 (2.8%) individuals within the cohort presented with BD type I, 26 (0.6%) with BD type II, and 87 (2.3%) with BD not otherwise specified. Frequency of female individuals was 58.82% (n = 150) in the BD sample and 53.02% (n = 1868) among the unaffected population. The model with variables assessed at the 18-year follow-up visit achieved the best performance: AUC 0.82 (CI 0.75-0.88), balanced accuracy 0.75, sensitivity 0.72, and specificity 0.77. The most important variables to detect BD at the 18-year follow-up visit were suicide risk, generalized anxiety disorder, parental physical abuse, and financial problems. Additionally, the high-risk subgroup of BD showed a high frequency of drug use and depressive symptoms. CONCLUSIONS We developed a risk calculator for BD incorporating both demographic and clinical variables from a 22-year birth cohort. Our findings support previous studies in high-risk samples showing the significance of suicide risk and generalized anxiety disorder prior to the onset of BD, and highlight the role of social factors and adverse life events.
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Affiliation(s)
- F D Rabelo-da-Ponte
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
| | - J G Feiten
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
| | - B Mwangi
- Department of Psychiatry & Behavioral Sciences, UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - F C Barros
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - F C Wehrmeister
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - A M Menezes
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - F Kapczinski
- National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - I C Passos
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
| | - M Kunz
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute for Translational Medicine (INCT-TM), Porto Alegre, Brazil
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Perich T, Mitchell PB, Meade T. Transdiagnostic group cognitive behaviour therapy for anxiety in bipolar disorder-a pilot feasibility and acceptability study. Pilot Feasibility Stud 2020; 6:170. [PMID: 33292713 PMCID: PMC7648280 DOI: 10.1186/s40814-020-00719-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Anxiety is prominent for many people living with bipolar disorder, yet the benefit of psychological interventions in treating this co-morbidity has been minimally explored and few studies have been conducted in a group format. This study aimed to assess the feasibility and acceptability of a transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) for people living with bipolar disorder. Methods Participants were recruited to take part in a 9-week group therapy programme designed to treat anxiety in bipolar disorder using cognitive behaviour therapy. They were assessed by structured interview (SCID-5 RV) to confirm the diagnosis of bipolar disorder and assessed for anxiety disorders. Self-report questionnaires—DASS (depression, anxiety, stress), ASRM (mania), STAI (state and trait anxiety) and Brief QOL.BD (quality of life) pre- and post-treatment were administered. Results Fourteen participants enrolled in the programme, with 10 participants (5 male; 5 female) completing the follow-up assessments. Two groups (one during working hours, the other outside working hours) were conducted. The programme appeared acceptable and feasible with a mean of 6.9 (77%) sessions attended, though five (50%) participants completed less than 3 weeks homework. Conclusion The transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) proved feasible and acceptable for participants; however, homework compliance was poor. A larger randomised pilot study is needed to assess the benefits of the intervention on symptom measures and address homework adherence, possibly through providing support between sessions or tailoring it more specifically to participant needs.
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Affiliation(s)
- Tania Perich
- School of Psychology, Western Sydney University, Sydney, Australia.
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Sydney, Australia
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Residual Anxiety in Patients with Bipolar Disorder in Full or Partial Remission: Metacognitive Beliefs and Neurocognitive Function. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10148-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Remission and recurrence in bipolar disorder: The data from health outcomes and patient evaluations in bipolar disorder (HOPE-BD) study. J Affect Disord 2020; 268:150-157. [PMID: 32174473 DOI: 10.1016/j.jad.2020.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The HOPE-BD was a naturalistic study established to follow individuals in Canada seeking treatment for bipolar disorder (BD). The study aimed to examine the course of BD and describe how clinical and sociodemographic factors are associated with outcomes. METHODS Individuals with BD had their clinical data recorded at enrolment and were naturalistically treated. Participant were followed for up to four years, and visits occurred at least once every three months. We investigated the longitudinal outcomes with logistic, Cox, and quantile regressions. RESULTS Among the 354 participants, 57.3% had BD type I. Depression as first episode, younger ages at onset and older ages of the first professional help predicted longer delays in correct diagnosis. Among the symptomatic patients at baseline, the median time to remission was 10.9 months. Comorbid alcohol use disorder and the severity of baseline depressive symptoms predicted longer times to remission. Among the euthymic participants, the median time to recurrence was 14.5 months. History of anxiety disorder and younger ages at onset predicted shorter times to recurrence. Baseline depression scores predicted recurrence in euthymic patients. LIMITATIONS We did not investigate the predictors of each polarity. Our findings may not apply to individuals followed in non-specialised outpatient services. CONCLUSION Our study reinforces the necessity of early diagnosis and interventions, as well as the importance of treating depressive symptoms and comorbidities.
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25
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Loftus J, Scott J, Vorspan F, Icick R, Henry C, Gard S, Kahn JP, Leboyer M, Bellivier F, Etain B. Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. J Affect Disord 2020; 267:258-263. [PMID: 32217226 DOI: 10.1016/j.jad.2020.02.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Bipolar Disorder (BD) is frequently comorbid with other psychiatric disorders. However, few studies systematically examine which disorders are more likely to occur pre- or post-BD onset. We examine the prevalence and Age At Onset (AAO) of psychiatric conditions in adults with BD. METHODS A structured clinical interview was used to assess lifetime history and AAO of alcohol and cannabis misuse, suicide attempts, anxiety and eating disorders in a French sample of euthymic patients with BD (n = 739). Regression analyses were used to test for statistically significant associations between rates and AAO of comorbidities in BD groups stratified by sex or subtype. RESULTS Prevalence of alcohol and cannabis misuse was associated with male sex and BD-I subtype; whilst most anxiety and eating disorders were associated with female sex. The AAO of most comorbid conditions preceded that of BD, except for panic disorder, agoraphobia and alcohol misuse. Few variations were observed in AAO of comorbidities according to groups. LIMITATIONS All assessments were retrospective, so estimates of prevalence rates and especially exact AAO of some comorbidities are at risk of recall bias. CONCLUSIONS Sex and BD subtype are associated with different rates of comorbid disorders. However, there were minimal between group differences in median AAO of comorbidities. By describing the chronological sequence of comorbidities in BD we were able to demonstrate that a minority of comorbidities typically occurred post-onset of BD. This is noteworthy as these disorders might be amenable to interventions aimed at early secondary prevention.
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Affiliation(s)
- J Loftus
- Centre Expert Trouble Bipolaire, Hospital Princesse Grace, Monaco; Fondation Fondamental, Créteil, France
| | - J Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Université de Paris, Paris, France
| | - F Vorspan
- Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| | - R Icick
- Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| | - C Henry
- Fondation Fondamental, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, Paris, France; Université Paris-Est-Créteil, Creteil, France; Département Médico-Universitaire Psychiatrie et Addictologie, DMU IMPACT, AP-HP, Hôpitaux Universitaires H. Mondor, Créteil, France
| | - S Gard
- Fondation Fondamental, Créteil, France; Hôpital Charles-Perrens, Centre Expert Trouble Bipolaire, Service de psychiatrie adulte, Pôle 3-4-7, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Université de Lorraine, CHRU de Nancy, Nancy, France and Fondation Santé des Etudiants de France (FSEF), Paris, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; Université Paris-Est-Créteil, Creteil, France; Département Médico-Universitaire Psychiatrie et Addictologie, DMU IMPACT, AP-HP, Hôpitaux Universitaires H. Mondor, Créteil, France; INSERM U955, Equipe 15 Psychiatrie Translationnelle, Creteil, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| | - B Etain
- Fondation Fondamental, Créteil, France; Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France.
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Pinto JV, Saraf G, Frysch C, Vigo D, Keramatian K, Chakrabarty T, Lam RW, Kauer-Sant'Anna M, Yatham LN. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:213-227. [PMID: 31830820 PMCID: PMC7385425 DOI: 10.1177/0706743719895195] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To review the current evidence for efficacy of cannabidiol in the treatment of mood disorders. Methods: We systematically searched PubMed, Embase, Web of Science, PsychInfo, Scielo, ClinicalTrials.gov, and The Cochrane Central Register of Controlled Trials for studies published up to July 31, 2019. The inclusion criteria were clinical trials, observational studies, or case reports evaluating the effect of pure cannabidiol or cannabidiol mixed with other cannabinoids on mood symptoms related to either mood disorders or other health conditions. The review was reported in accordance with guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Results: Of the 924 records initially yielded by the search, 16 were included in the final sample. Among them, six were clinical studies that used cannabidiol to treat other health conditions but assessed mood symptoms as an additional outcome. Similarly, four tested cannabidiol blended with Δ-9-tetrahydrocannabinol in the treatment of general health conditions and assessed affective symptoms as secondary outcomes. Two were case reports testing cannabidiol. Four studies were observational studies that evaluated the cannabidiol use and its clinical correlates. However, there were no clinical trials investigating the efficacy of cannabidiol, specifically in mood disorders or assessing affective symptoms as the primary outcome. Although some articles point in the direction of benefits of cannabidiol to treat depressive symptoms, the methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders. Conclusions: There is a lack of evidence to recommend cannabidiol as a treatment for mood disorders. However, considering the preclinical and clinical evidence related to other diseases, cannabidiol might have a role as a treatment for mood disorders. Therefore, there is an urgent need for well-designed clinical trials investigating the efficacy of cannabidiol in mood disorders.
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Affiliation(s)
- Jairo Vinícius Pinto
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Frysch
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Márcia Kauer-Sant'Anna
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Sandstrom A, MacKenzie L, Pizzo A, Fine A, Rempel S, Howard C, Stephens M, Patterson VC, Drobinin V, Van Gestel H, Howes Vallis E, Zwicker A, Propper L, Abidi S, Bagnell A, Lovas D, Cumby J, Alda M, Uher R, Pavlova B. Observed psychopathology in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Psychol Med 2020; 50:1050-1056. [PMID: 31120010 DOI: 10.1017/s0033291719001089] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children of parents with mood and psychotic disorders are at elevated risk for a range of behavioral and emotional problems. However, as the usual reporter of psychopathology in children is the parent, reports of early problems in children of parents with mood and psychotic disorders may be biased by the parents' own experience of mental illness and their mental state. METHODS Independent observers rated psychopathology using the Test Observation Form in 378 children and youth between the ages of 4 and 24 (mean = 11.01, s.d. = 4.40) who had a parent with major depressive disorder, bipolar disorder, schizophrenia, or no history of mood and psychotic disorders. RESULTS Observed attentional problems were elevated in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia (effect sizes ranging between 0.31 and 0.56). Oppositional behavior and language/thought problems showed variable degrees of elevation (effect sizes 0.17 to 0.57) across the three high-risk groups, with the greatest difficulties observed in offspring of parents with bipolar disorder. Observed anxiety was increased in offspring of parents with major depressive disorder and bipolar disorder (effect sizes 0.19 and 0.25 respectively) but not in offspring of parents with schizophrenia. CONCLUSIONS Our results suggest that externalizing problems and cognitive and language difficulties may represent a general manifestation of familial risk for mood and psychotic disorders, while anxiety may be a specific marker of liability for mood disorders. Observer assessment may improve early identification of risk and selection of youth who may benefit from targeted prevention.
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Affiliation(s)
- A Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - L MacKenzie
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology, Dalhousie University, Halifax, NS, Canada
| | - A Pizzo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - A Fine
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - S Rempel
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - C Howard
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Stephens
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - V C Patterson
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology, Dalhousie University, Halifax, NS, Canada
| | - V Drobinin
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - H Van Gestel
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - E Howes Vallis
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - A Zwicker
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - L Propper
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - S Abidi
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - A Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - D Lovas
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - J Cumby
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - R Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - B Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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Ferentinos P, Preti A, Veroniki AA, Pitsalidis KG, Theofilidis AT, Antoniou A, Fountoulakis KN. Comorbidity of obsessive-compulsive disorder in bipolar spectrum disorders: Systematic review and meta-analysis of its prevalence. J Affect Disord 2020; 263:193-208. [PMID: 31818777 DOI: 10.1016/j.jad.2019.11.136] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is often comorbid with Bipolar Disorder (BD), complicating its presentation and management. OCD prevalence rates in BD vary widely across studies and recent meta-analyses. OBJECTIVE We performed a comprehensive systematic review and meta-analysis of studies reporting cross-sectional or lifetime OCD prevalence in BD, assessed by meta-regression various determinants of estimated prevalence and compared it with major depressive disorder (MDD) patients and general population subjects included in extracted studies. METHODS Relevant articles published up to January 2019 in PubMed/MEDLINE were retrieved. Prevalence rates underwent Freeman-Tukey double arcsine transformation before meta-analysis. RESULTS We included 29 studies reporting cross-sectional prevalence (N = 6109) and 39 studies reporting lifetime prevalence (N = 8205); eight studies reported both. The pooled lifetime and cross-sectional prevalence of comorbid OCD in BD was estimated at 10.9% (95% CI: 7.8-14.4%) and 11.2% (7.6-15.3%), respectively, in the random-effects model. Respective estimates in the general population were 2.5% and 1.6%. Study setting (epidemiological or clinical), diagnostic criteria and procedures, gender, BD subtype and remission status could not explain heterogeneity of prevalence estimates in meta-regressions. Age had a small yet significant negative correlation with lifetime prevalence. OCD prevalence in BD was not significantly different than in MDD. LIMITATIONS Search was limited to English-language literature. CONCLUSIONS Lifetime OCD prevalence in BD was 4.4 times higher than in the general population. Cross-sectional prevalence was as high as lifetime, suggesting that OCD in BD is more chronic/ persistent than in the general population, where cross-sectional stands at about two thirds the lifetime prevalence.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, 1 Rimini street, Athens 12462, Greece.
| | - Antonio Preti
- Genneruxi Medical Center, via Costantinopoli 42, Cagliari 09129, Italy; Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy.
| | - Areti Angeliki Veroniki
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
| | | | - Antonis T Theofilidis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, 1 Rimini street, Athens 12462, Greece.
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Abstract
MicroRNAs as critical regulators of gene expression important for functions including neuronal development, synapse formation, and synaptic plasticity have been linked with the regulation of neurobiological systems that underlie anxiety processing in the brain. In this chapter, we give an update on associative evidence linking regulation of microRNAs with anxiety- and trauma-related disorders. Moving beyond correlative research, functional studies have emerged recently that explore causal relationships between microRNA expression and anxiety-like behavior. It has been demonstrated that experimental up- or downregulation of the candidate microRNAs in important nodes of the anxiety neurocircuitry can indeed modulate anxiety-related behavior in animal models. Improved methodologies for assessing microRNA-mediated modulation have aided such functional studies, revealing a number of anxiety-regulating microRNAs including miR-15a, miR-17-92, miR-34, miR-101, miR-124, miR-135, and miR-155. Important functional target genes of these identified microRNAs are associated with specific neurotransmitter/neuromodulator signaling, neurotrophin (e.g., BDNF) expression and other aspects of synaptic plasticity, as well as with stress-regulatory/hypothalamic-pituitary-axis function. Furthermore, microRNAs have been revealed that are regulated in distinct brain regions following various anxiety-attenuating strategies. These include pharmacological treatments such as antidepressants and other drugs, as well as non-pharmacological interventions such as fear extinction/exposure therapy or positive stimuli such as exposure to environmental enrichment. These are first indications for a role for microRNAs in the mechanism of action of anxiolytic treatments. As research continues, there is much hope that a deeper understanding of the microRNA-mediated mechanisms underlying anxiety-related disorders could open up possibilities for future novel biomarker and treatment strategies.
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Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. The validity of daily patient-reported anxiety measured using smartphones and the association with stress, quality of life and functioning in patients with bipolar disorder. J Affect Disord 2019; 257:100-107. [PMID: 31301609 DOI: 10.1016/j.jad.2019.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/06/2019] [Accepted: 07/04/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND More than half of patients with bipolar disorder (BD) experience anxiety, which is associated with impaired functioning. In patients with BD, the present study aimed (1) to validate daily patient-reported symptoms of anxiety measured using smartphones against clinically rated symptoms of anxiety, (2) to estimate the prevalence of anxiety symptoms, and (3) to investigate the associations between patient-reported anxiety symptoms and stress, quality of life and functioning. METHODS A total of 84 patients with BD evaluated their anxiety symptoms daily for nine months using a smartphone-based system. Data on clinically evaluated symptoms of anxiety and functioning and patient-reported stress and quality of life were collected from each patient at five fixed time points during follow-up. RESULTS The patients presented mild affective symptoms only. The reporting of anxiety symptoms was evaluated for validity according to clinically evaluated anxiety scores based on the two anxiety sub-items of the Hamilton Depression Rating Scale. The patients experienced symptoms of anxiety 19.3% of the time. There were statistically significant associations between anxiety and stress, quality of life and functioning (all p-values < 0.0001). CONCLUSION In patients with BD in full or partial remission, the self-reporting of anxiety symptoms using smartphones was validated. Anxiety is associated with increased stress, decreased quality of life and functioning even during full or partial remission. Identifying anxiety symptoms thus has clinical impact, which suggests that smartphones may serve as a valid tool.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark.
| | - Mads Frost
- Monsenso Aps, Torveporten 2, Valby, Denmark
| | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark
| | - Jakob E Bardram
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark
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Kuo CJ, Chen PH. Author's reply. Br J Psychiatry 2019; 214:305-306. [PMID: 31012410 DOI: 10.1192/bjp.2019.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chian-Jue Kuo
- Attending Psychiatrist,Taipei City Psychiatric Center,Taipei City Hospital; and Associate Professor,Department of Psychiatry,School of Medicine,College of Medicine,Taipei Medical University,Taiwan
| | - Pao-Huan Chen
- Lecturer,Department of Psychiatry,School of Medicine,College of Medicine, Taipei Medical University; and Attending Psychiatrist,Department of Psychiatry and Psychiatric Research Center,Taipei Medical University Hospital,Taiwan
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Spoorthy MS, Chakrabarti S, Grover S. Comorbidity of bipolar and anxiety disorders: An overview of trends in research. World J Psychiatry 2019; 9:7-29. [PMID: 30631749 PMCID: PMC6323556 DOI: 10.5498/wjp.v9.i1.7] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/04/2018] [Accepted: 12/05/2018] [Indexed: 02/05/2023] Open
Abstract
Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder (BD), but it also adversely impacts the course, outcome, and treatment of BD. The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses (n = 103), epidemiological surveys, and large-scale clinical studies. The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time. All types of anxiety disorders were equally common in BD. However, there was a wide variation in rates across different sources, with most of this discrepancy being accounted for by methodological differences between reports. Comorbid anxiety disorders negatively impacted the presentation and course of BD. This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD. Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD. Nevertheless, the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.
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Affiliation(s)
- Mamidipalli Sai Spoorthy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Meier SM, Pavlova B, Dalsgaard S, Nordentoft M, Mors O, Mortensen PB, Uher R. Attention-deficit hyperactivity disorder and anxiety disorders as precursors of bipolar disorder onset in adulthood. Br J Psychiatry 2018; 213:555-560. [PMID: 29925436 DOI: 10.1192/bjp.2018.111] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder are unknown.AimsTo test the prospective relationship of ADHD and anxiety with onset of bipolar disorder. METHOD We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models. RESULTS Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12-2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98-27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47-27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83-87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66-41.40) compared with those with no prior ADHD or anxiety. CONCLUSIONS Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder.Declaration of interestNone.
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Affiliation(s)
- Sandra M Meier
- Postdoctoral Fellow, Child and Adolescent Mental Health Centre-Mental Health Services Capital Region,Copenhagen Region,Psychosis Research Unit,Aarhus University HospitalandThe Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,Denmark
| | - Barbara Pavlova
- Assistant Professor,Department of Psychiatry,Dalhousie University and Nova Scotia Health Authority,Canada
| | - Søren Dalsgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,National Centre for Register-Based Research, NCRR,Aarhus University,DenmarkandDepartment for Child and Adolescent Psychiatry,Hospital of Telemark,Norway
| | - Merete Nordentoft
- Professor, The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH, and Copenhagen University Hospital, Mental Health Center Copenhagen,Denmark
| | - Ole Mors
- Professor, Psychosis Research Unit,Aarhus University Hospital andThe Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,Denmark
| | - Preben B Mortensen
- Professor, The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,National Centre for Register-Based Research, NCRR,Aarhus UniversityandCIRRAU - Centre for Integrated Register-based Research,Aarhus University
| | - Rudolf Uher
- Professor, Department of Psychiatry,Dalhousie University and Senior Researcher, Nova Scotia Health Authority,Canada
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Yapici Eser H, Kacar AS, Kilciksiz CM, Yalçinay-Inan M, Ongur D. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry 2018; 9:229. [PMID: 29997527 PMCID: PMC6030835 DOI: 10.3389/fpsyt.2018.00229] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/11/2018] [Indexed: 12/23/2022] Open
Abstract
Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence. Method: We searched PubMed to access relevant articles published until September 2015, using the keywords "Bipolar disorder" or "Affective Psychosis" or "manic depressive" separately with "generalized anxiety," "panic disorder," "social phobia," "obsessive compulsive," and "anxiety." Variables for associated features and prevalence of anxiety disorders were carefully extracted. Results: Lifetime any anxiety disorder comorbidity in BD was 40.5%; panic disorder (PD) 18.1%, generalized anxiety disorder (GAD) 13.3%, social anxiety disorder (SAD) 13.5% and obsessive compulsive disorder (OCD) 9.7%. Current any anxiety disorder comorbidity in BD is 38.2%; GAD is 15.2%, PD 13.3%, SAD 11.7%, and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38% and 34%, PD was 15% and 15%, GAD was 14% and 16.6%, SAD was 8% and 13%, OCD was 8% and 10%, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31% and 37%, PD was 9% and 13%, GAD was 8% and 12%, SAD was 7% and 11%, and OCD was 8% and 7%, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD-SAD comorbidity. History of psychotic features significantly affected current PD and GAD. Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.
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Affiliation(s)
- Hale Yapici Eser
- School of Medicine, Koç University, Sariyer, Turkey.,Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Anil S Kacar
- Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Can M Kilciksiz
- School of Medicine, Koç University, Sariyer, Turkey.,Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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