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Ge W, Gao Y, Li X, Wang J, Im H, Zhu W, Zhao G, Hu Y, Wang P, Wu X, Yao Q, Niu X, Chen X, Wang Q. Dissociable ventral and dorsal sensorimotor functional circuits linking the hypomanic personality traits to aggression via behavioral inhibition system. Int J Clin Health Psychol 2025; 25:100537. [PMID: 39877889 PMCID: PMC11773241 DOI: 10.1016/j.ijchp.2024.100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 12/09/2024] [Indexed: 01/31/2025] Open
Abstract
Hypomanic personality traits (HPT) are susceptibility markers for psychiatric disorders, particularly bipolar disorder, and are strongly associated with aggressive behaviors. However, the neuropsychological mechanisms underlying this association remain unclear. This study utilized psychometric network analysis and Inter-Subject Representation Similarity Analysis (IS-RSA) to explore the neuropsychological circuits that link HPT to aggression in a large non-clinical population. Psychometric network analysis (n = 716) identified two key nodes: the Behavioral Inhibition System (BIS) and mood volatility, a core dimension of HPT. We observed a positive correlation between mood volatility and aggression, with BIS serving as a mediating factor. Task-based functional imaging (n = 53) further revealed a double dissociation between the dorsal (dSMC) and ventral (vSMC) sensorimotor cortices to HPT, specifically during the processing of reward magnitude and delay in a delayed reward paradigm. Functional patterns within these regions mediated the relationship between individual differences in mood volatility and aggression, with BIS acting as a mediator through parallel pathways. Resting-state functional imaging (n = 505) replicated this functional segregation and revealed distinct integrative patterns: the dSMC was functionally connected to the frontoparietal network (FPN) and the vSMC to the sensorimotor network (SMN). These circuits collectively mediated the associations among mood volatility, aggression, and BIS. These findings highlight the critical role of sensorimotor circuits and BIS in understanding the neuropsychological pathways linking HPT-related mood volatility to aggression.
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Affiliation(s)
- Wei Ge
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | - Yuanyuan Gao
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | - Xiang Li
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | - Jinlian Wang
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | | | - Wenwei Zhu
- School of Psychology, South China Normal University, Guangzhou, 510631, China
| | - Guang Zhao
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | - Ying Hu
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | - Pinchun Wang
- College of Early Childhood Education, Tianjin Normal University, Tianjin, 300387, China
| | - Xia Wu
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
| | - Qiong Yao
- Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention, Hefei, 230601, China
- School of Educational and Psychological Science, Hefei Normal University, Hefei, 230601, China
| | - Xin Niu
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, California 90095, USA
| | - Xiongying Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Bejing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Qiang Wang
- Faculty of Psychology, Tianjin Normal University, Tianjin, 300387, China
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Bejing Anding Hospital, Capital Medical University, Beijing, 100088, China
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
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Yu X, Cheng P, Yang Z, Fan H, Wang Q, Xu J, Zhu H, Gao Q. A novel prediction model for the probability of aggressive behavior in patients with mood disorders: Based on a cohort study. J Psychiatr Res 2024; 177:420-428. [PMID: 39098285 DOI: 10.1016/j.jpsychires.2024.07.041] [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: 05/08/2024] [Revised: 07/22/2024] [Accepted: 07/27/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Accurately predicting the probability of aggressive behavior is crucial for guiding early intervention in patients with mood disorders. METHODS Cox stepwise regression was conducted to identify potential influencing factors. Nomogram prediction models were constructed to predict the probabilities of aggressive behavior in patients with mood disorders, and their performance was assessed using consistency index (C-index) and calibration plots. RESULTS Research findings on 321 patients with mood disorders indicated that being older (HR = 0.92, 95% CI: 0.86-0.98), single (HR = 0.11, 95% CI: 0.02-0.68), having children (one child, HR = 0.07, 95%CI: 0.01-0.87; more than one child, HR = 0.33, 95%CI: 0.04-2.48), living in dormitory (HR = 0.25, 95%CI: 0.08-0.77), non-student (employee, HR = 0.24, 95% CI: 0.07-0.88; non-employee, HR = 0.09, 95% CI: 0.02-0.35), and higher scores in subjective support (HR = 0.90, 95% CI: 0.82-0.99) were protective factors. On the contrary, minorities (HR = 5.26, 95% CI: 1.23-22.48), living alone (HR = 4.37, 95% CI: 1.60-11.94), having suicide history (HR = 2.51, 95% CI: 1.06-5.95), and having higher scores in EPQ-E (HR = 1.04, 95% CI: 1.00-1.08) and EPQ-P (HR = 1.03, 95% CI: 1.00-1.07) were identified as independent risk factors for aggressive behavior in patients with mood disorders. The nomogram prediction model demonstrated high discrimination and goodness-of-fit. CONCLUSIONS A novel nomogram prediction model for the probability of aggressive behavior in patients with mood disorders was developed, effective in identifying at-risk populations and offering valuable insights for early intervention and proactive measures.
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Affiliation(s)
- Xinyi Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, PR China
| | - Peixia Cheng
- Department of Maternal and Child Health, School of Public Health, Capital Medical University, Beijing, PR China; Laboratory for Gene-Environment and Reproductive Health, Laboratory for Clinical Medicine, Capital Medical University, Beijing, PR China
| | - Zexi Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, PR China
| | - Hua Fan
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, PR China
| | - Qian Wang
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, PR China
| | - Jiaying Xu
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, PR China
| | - Huiping Zhu
- Department of Maternal and Child Health, School of Public Health, Capital Medical University, Beijing, PR China; Laboratory for Gene-Environment and Reproductive Health, Laboratory for Clinical Medicine, Capital Medical University, Beijing, PR China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, PR China.
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Faden J, Goldberg JF, Citrome L. Improving the pharmacotherapeutic treatment of agitation associated with bipolar disorder. Expert Opin Pharmacother 2023; 24:1811-1822. [PMID: 37581475 DOI: 10.1080/14656566.2023.2248893] [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: 06/26/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Agitation is commonly encountered in people with bipolar disorder, particularly when experiencing a manic episode. The number of approved pharmacological agents to manage acute episodes of agitation in this population is limited. AREAS COVERED A search was conducted using the US National Library of Medicine PubMed.gov resource for English-language papers of clinical trials and reviews/meta-analyses, using the text words 'bipolar disorder' AND 'agitation,' as well as any papers with both two text words in the title, without any date restrictions. EXPERT OPINION Existing pharmacologic options approved by regulatory authorities for the treatment of acute episodes of agitation associated with bipolar disorder have similar degrees of efficacy but differ in their tolerability profiles and ease of use, giving clinicians an opportunity to individualize treatment. The goal is to treat mild-moderate agitation before it evolves into severe agitation, encouraging noninvasive pharmacologic treatment options. Inhaled loxapine and sublingual dexmedetomidine are newer options with rapid onset of action and may be preferable for patients willing to cooperate with treatment.
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Affiliation(s)
- Justin Faden
- Department of Psychiatry and Behavioral Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, New York, Valhalla, USA
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Ng VWS, Gao L, Chan EW, Lee HME, Hayes JF, Osborn DPJ, Rainer TH, Man KKC, Wong ICK. Association between the pharmacological treatment of bipolar disorder and risk of traumatic injuries: a self-controlled case series study. Psychol Med 2023; 53:5185-5193. [PMID: 35866370 DOI: 10.1017/s0033291722002215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BPD) are prone to engage in risk-taking behaviours and self-harm, contributing to higher risk of traumatic injuries requiring medical attention at the emergency room (ER).We hypothesize that pharmacological treatment of BPD could reduce the risk of traumatic injuries by alleviating symptoms but evidence remains unclear. This study aimed to examine the association between pharmacological treatment and the risk of ER admissions due to traumatic injuries. METHODS Individuals with BPD who received mood stabilizers and/or antipsychotics were identified using a population-based electronic healthcare records database in Hong Kong (2001-2019). A self-controlled case series design was applied to control for time-invariant confounders. RESULTS A total of 5040 out of 14 021 adults with BPD who received pharmacological treatment and had incident ER admissions due to traumatic injuries from 2001 to 2019 were included. An increased risk of traumatic injuries was found 30 days before treatment [incidence rate ratio (IRR) 4.44 (3.71-5.31), p < 0.0001]. After treatment initiation, the risk remained increased with a smaller magnitude, before returning to baseline [IRR 0.97 (0.88-1.06), p = 0.50] during maintenance treatment. The direct comparison of the risk during treatment to that before and after treatment showed a significant decrease. After treatment cessation, the risk was increased [IRR 1.34 (1.09-1.66), p = 0.006]. CONCLUSIONS This study supports the hypothesis that pharmacological treatment of BPD was associated with a lower risk of ER admissions due to traumatic injuries but an increased risk after treatment cessation. Close monitoring of symptoms relapse is recommended to clinicians and patients if treatment cessation is warranted.
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Affiliation(s)
- Vanessa W S Ng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
| | - Ho Ming Edwin Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Joseph F Hayes
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - David P J Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London NW10PE, UK
| | - Timothy H Rainer
- Emergency Medicine Unit, The University of Hong Kong, Hong Kong, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
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Teksin MG, Özalp E, Bal NB, Özer İ, Çayköylü A. Is co-occurrence of adult adhd with bipolar disorder a risk factor for violent behavior? Psychiatry Res 2023; 326:115302. [PMID: 37418777 DOI: 10.1016/j.psychres.2023.115302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/09/2023]
Abstract
Research has shown that individuals with psychiatric disorders such as bipolar disorder (BD) and attention deficit and hyperactivity disorder (ADHD) have a higher likelihood of violent behavior. This study investigated the frequency of comorbid BD and ADHD in adultpatients and the relationship between this comorbidity and violent behavior. We assessed 105 remitted patients diagnosed with BD I (n = 91) or BD II (n = 14). The patients were administered the Sociodemographic Data Scale, the Wender-Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (BPAQ), and theViolence Tendency Scale (VTS) as self-reports. The same clinician administered the Diagnostic Interview for ADHD in adults (DIVA 2.0) to patients who scored≥36 on the WURS. Comorbid ADHD was diagnosed in 15.2% of patients according to the DIVA 2.0. In the multiple linear regression analysis, there was a statistically significant positive effect of the ASRS total score on the VTS and the BPAQ total score. Furthermore, it was found that male gender had a statistically significant positive effect on VTS total score and young age had a statistically significant positive effect on BPQA total score. These findings demonstrate an association between BD, comorbid ADHD, and violent behavior.
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Affiliation(s)
- Meryem Gül Teksin
- Psychiatrist, Psychiatry Clinic, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul Turkey.
| | - Elvan Özalp
- Psychiatrist, Private Specialist, Ankara Turkey
| | - Neşe Burcu Bal
- Psychiatrist, Psychiatry Clinic, Ankara Oncology, Research and Training Hospital, Istanbul Turkey
| | - İbrahim Özer
- Psychiatrist, Psychiatry Clinic, Afyonkarahisar State Hospital, Afyon Turkey
| | - Ali Çayköylü
- Psychiatrist, Psychiatry Clinic, Ankara Oncology, Research and Training Hospital, Istanbul Turkey
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Li X, Gao Y, Liu Y, Wang Y, Wu Q. Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States. Risk Manag Healthc Policy 2023; 16:991-1000. [PMID: 37250432 PMCID: PMC10225141 DOI: 10.2147/rmhp.s403170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Identifying patients with bipolar disorder (BD) in manic states (BD-M) who are at a high risk of physical violence is a matter of clinical concern. This retrospective institution-based study aimed to identify simple, rapid, and inexpensive clinical markers of physical violence in patients with BD-M. Patients and Methods The anonymized sociodemographic variables (sex, age, years of education, marital status) and clinical ones (weight, height, body mass index, blood pressure, the score of BRMS, number of BD episodes, psychotic symptoms, history of violence, biochemical parameters, and blood routine parameters) of 316 BD-M participants were collected, and the risk of physical violence was identified using the Brøset Violence Checklist (BVC). Difference tests, correlation analyses, and multivariate linear regression analysis were performed to identify clinical markers for the risk of physical violence. Results The participants were categorized into groups at low (49, 15.51%), medium (129, 40.82%), and high (138, 43.67%) risk of physical violence. The number of BD episodes, serum uric acid (UA), free thyroxine (FT4) levels, history of violence, and monocyte-to-lymphocyte ratio (MLR) differed significantly between groups (all P<0.05). The number of BD episodes (r=0.152), FT3 (r=0.131) and FT4 (r=0.132) levels, history of violence (r=0.206), and MLR (r=-0.132) were significantly correlated with the risk of physical violence (all P<0.05). The existence of history of violence, number of BD episodes, UA, FT4, and MLR were identified as clinical markers of the risk of physical violence in patients with BD-M (all P<0.05). Conclusion These identified markers are readily available at initial presentation and may help in the timely assessment and treatment of patients with BD-M.
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Affiliation(s)
- Xuelong Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Yakun Gao
- Affiliated Hospital of Weifang Medical College, Weifang, People’s Republic of China
| | - Yiyi Liu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Ying Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Qing Wu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
- Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
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Ayidaga T, Ozel-Kizil ET, Çolak B, Akman-Ayidaga E. Detailed analysis of risk-taking in association with impulsivity and aggression in euthymic patients with bipolar disorder type I. JOURNAL OF COGNITIVE PSYCHOLOGY 2022. [DOI: 10.1080/20445911.2022.2098303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- T. Ayidaga
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - E. T. Ozel-Kizil
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - B. Çolak
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - E. Akman-Ayidaga
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara University, Ankara, Turkey
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Abstract
The effects of glucocorticoids on aggression can be conceptualized based on its mechanisms of action. These hormones can affect cell function non-genomically within minutes, primarily by affecting the cell membrane. Overall, such effects are activating and promote both metabolic preparations for the fight and aggressive behavior per se. Chronic increases in glucocorticoids activate genomic mechanisms and are depressing overall, including the inhibition of aggressive behavior. Finally, excessive stressors trigger epigenetic phenomena that have a large impact on brain programming and may also induce the reprogramming of neural functions. These induce qualitative changes in aggression that are deemed abnormal in animals, and psychopathological and criminal in humans. This review aims at deciphering the roles of glucocorticoids in aggression control by taking in view the three mechanisms of action often categorized as acute, chronic, and toxic stress based on the duration and the consequences of the stress response. It is argued that the tripartite way of influencing aggression can be recognized in all three animal, psychopathological, and criminal aggression and constitute a framework of mechanisms by which aggressive behavior adapts to short-term and log-term changes in the environment.
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Drachman R, Colic L, Sankar A, Spencer L, Goldman DA, Villa LM, Kim JA, Oquendo MA, Pittman B, Blumberg HP. Rethinking "aggression" and impulsivity in bipolar disorder: Risk, clinical and brain circuitry features. J Affect Disord 2022; 303:331-339. [PMID: 35181384 PMCID: PMC9109470 DOI: 10.1016/j.jad.2022.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elevated aggression and impulsivity are implicated in Bipolar Disorder (BD); however, relationships between these behavioral constructs have not been clarified, which can lead to misconceptions with negative consequences including stigma and adverse outcomes including suicide. The study aimed to clarify brain-based distinctions between the two constructs and their associations to risk factors, symptoms and suicide thoughts and behaviors. METHODS Self-rated Brown-Goodwin Aggression (BGA) and Barratt Impulsiveness Scale (BIS) scores were compared between adults with BD (n = 38, 74% female) and healthy controls (HC, n = 29, 64% female). Relationships were examined between BGA and BIS with childhood trauma questionnaire (CTQ), mood, comorbidities, and magnetic resonance imaging gray matter volume (GMV) assessments. RESULTS In BD, BGA and BIS total scores were both elevated and associated with childhood maltreatment (CM), particularly emotional CM, depression, substance use disorders (SUDs) and suicide attempts (SAs). BGA scores were increased by items corresponding to dysregulation of emotional and social behavior and associated with elevated mood states and suicide ideation and GMV decreases in bilateral orbitofrontal cortex and left posterior insula brain regions, previously associated with these behaviors and clinical features. BIS motor impulsiveness scores were associated with GMV decreases in anterior cingulate cortex implicated in mood and behavioral dyscontrol. LIMITATIONS modest sample size, self-reports CONCLUSIONS: The findings suggest separable brain-based domains of dysfunction in BD of motor impulsiveness versus emotionally dysregulated feelings that are primarily self-directed. Both domains are associated with suicide behavior and modifiable risk factors of CM, depression and SUDs that could be targeted for prevention.
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Affiliation(s)
- Rebecca Drachman
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Lejla Colic
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA; Department of Psychiatry, Jena University Hospital, Jena, Germany
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Danielle A Goldman
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA; Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06511, USA
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Jihoon A Kim
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06511, USA; Child Study Center, Yale School of Medicine, New Haven, CT 06511, USA.
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10
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Pan YZ, Xie XM, Tang YL, Ng CH, Wang G, Xiang YT. A comparison of aggression between patients with acute schizophrenia and mania presenting to psychiatric emergency services. J Affect Disord 2022; 296:493-497. [PMID: 34653702 DOI: 10.1016/j.jad.2021.09.071] [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: 07/01/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Aggression is common and challenging in psychiatric emergency departments (PED). However, the prevalence of aggression and its correlates in PED patients are not well documented. This study compared the prevalence of aggression between patients with acute schizophrenia and manic episodes. METHODS In this cross-sectional study, patients at a psychiatric emergency department were assessed with measurements of aggression, psychotic and manic symptoms. RESULTS A total of 4,172 patients were included. The prevalence of aggression was 54.8% (95%CI=53.3%-65.2%) in the whole sample, with 48.0% (95%CI=45.8%-50.1%) in patients with an acute schizophrenia episode, and 61.8% (95%CI=59.8%-63.9%) in patients with a manic episode. Multiple logistic regression analysis revealed that, within the acute schizophrenia episode group, male gender (OR=1.47, P<0.01), involuntary admission (OR=3.61, P<0.01) and more severe manic symptoms (OR=1.30, P<0.01) were significantly associated with aggression. Within the manic episode group, living in Beijing (OR=1.51, P<0.01), unemployment (OR=1.34, P=0.03), involuntary admission (OR=7.93, P<0.01), lower education (OR=0.95, P=0.01) and more severe psychotic symptoms (OR=1.05, P<0.01) were significantly associated with aggression. CONCLUSION In this study, aggression appeared to be more common among patients with a manic episode than those with an acute schizophrenia episode. Considering the significant risk of aggression on psychiatric emergency care, appropriate and effective management of aggression in this population group need to be developed.
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Affiliation(s)
- Yi-Zhu Pan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Meng Xie
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, USA
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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12
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Rezai H, Sadeghian E, Shamsaei F, Ghafari ME. Effect of Anger Management Education on Aggression in Bipolar Disorder Hospitalized Patients: A Pilot Study. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082218666211220160326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Aggression is one of the symptoms of bipolar disorder. This expression can be associated with negative personal and social effects
Objective:
This study aimed to determine the effect of anger management education on aggression in bipolar disorder.
Method:
This semi-experimental study with a repeated measures design was conducted in Hamadan, Iran, 2018. Fifty-two bipolar type-1 disorder patients were randomly selected from the Psychiatric Ward of Farshian Hospital through the convenience sampling method. The anger management education intervention included four sessions. Also, the State-Trait Anger Expression Inventory-2 (STAXI-2) was completed by the subjects before, immediately, and two weeks after the educational intervention. Data analysis was performed in SPSS16, using Mauchly’s sphericity test and the least significant difference.
Results:
The mean aggression score was 61.38±11.59 before the intervention, which reduced to 27.18±8.61 and 18.86±6.45 immediately and two weeks after the intervention, respectively. The repeated measures test showed that the decreasing trend of scores was statistically significant (P<0.001). Moreover, pairwise comparison of study stages demonstrated a significant difference between the first and second stages (P<0.001) and the second and third stages (P<0.001).
Conclusion:
Anger management education reduced the level of aggression in bipolar type-1 disorder. Therefore, it can be incorporated into nursing care programs
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Affiliation(s)
- Hossein Rezai
- Background: Aggression is one of the symptoms of bipolar disorder. This expression can be associated with negative personal and social effects, Iran
| | - Efat Sadeghian
- School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- School of Nursing and Midwifery, Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, India
| | - Mohammad Ebrahim Ghafari
- Dental Sciences Research Center, Faculty of Dentistry, Gulian University of Medical Sciences, Rasht, Christmas Island
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13
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Badrfam R, Zandifar A, Aminimanesh M, Farid M, Rahiminejad F. Prevalence of bipolar disorder among patients with suicidal ideation, recent aggression and self-harm, referred to the psychiatric hospital emergency department in Iran. Asian J Psychiatr 2021; 65:102830. [PMID: 34507238 DOI: 10.1016/j.ajp.2021.102830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Rahim Badrfam
- Department of Psychiatry, Roozbeh Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Atefeh Zandifar
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran; Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran.
| | - Maryam Aminimanesh
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Malihe Farid
- Alborz University of Medical Sciences, Karaj, Iran.
| | - Fatemeh Rahiminejad
- Department of Psychiatry, Roozbeh Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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14
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Ryu V, Ha RY, Cho HS. Altered behavioral and electrophysiological responses to social fairness in manic and euthymic patients with bipolar disorder. Brain Behav 2021; 11:e2289. [PMID: 34291610 PMCID: PMC8413766 DOI: 10.1002/brb3.2289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/20/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Individuals with bipolar disorder show mood instability, including heightened anger and impulsivity. The Ultimatum Game (UG) is a tool used to evaluate emotional and social decision-making strategies. We investigated behavioral and electrophysiological responses to subjectively fair or unfair offers in the UG in patients with bipolar I disorder. METHODS Twenty-four manic patients, 20 euthymic patients, and 30 healthy controls participated in this study. We analyzed their behaviors and collected electroencephalography data with which to analyze feedback-related negativity (FRN) as they played in the UG as responders. RESULTS Manic patients exhibited significantly higher rejection rates for unfair offers than euthymic patients and healthy controls. Healthy individuals exhibited a greater (i.e., more negative) FRN amplitude in response to unfair offers than to fair offers, whereas euthymic patients exhibited a greater FRN amplitude in response to fair offers compared with unfair offers. Manic patients exhibited no difference in FRN amplitudes between fair and unfair offers. CONCLUSIONS The current data suggest that different behavioral responses and FRN amplitude patterns can be associated with characteristic manifestations of mood instability in manic bipolar patients. In addition, electrophysiological alterations in response to unfair offers may be a trait abnormality independent of mood state.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, National Center for Mental Health, Ministry of Health and Welfare, Seoul, South Korea
| | - Ra Yeon Ha
- Department of Psychiatry, Yong In Mental Hospital, Gyeonggi, South Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul, South Korea.,Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, South Korea
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15
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Valença AM, de Moraes TM, Meyer LF, Petribú KCLD, Nardi AE, Mendlowicz MV. Violent behavior by involuntarily committed female offenders with mental disorders: A population-based case series. J Forensic Sci 2020; 66:656-663. [PMID: 33253419 DOI: 10.1111/1556-4029.14638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023]
Abstract
The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.
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Affiliation(s)
- Alexandre M Valença
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Talvane M de Moraes
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Leonardo F Meyer
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Antonio E Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
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16
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Şenormancı G, Güçlü O, Özben İ, Karakaya FN, Şenormancı Ö. Resilience and insight in euthymic patients with bipolar disorder. J Affect Disord 2020; 266:402-412. [PMID: 32056906 DOI: 10.1016/j.jad.2020.01.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 01/05/2020] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The relationship between resilience and insight may be of potential importance for coping with stress in bipolar disorder (BD). The aim of this study was to investigate if there was a relation between insight and resilience in euthymic patients with BD and also to analyze the associations between resilience, impulsivity, aggression, alcohol use and affective temperament. METHODS 142 patients with BD type I in remission period were involved. Resilience Scale for Adults-Turkish version, Schedule for Assessment of Insight, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, Michigan Alcoholism Screening Test were used. RESULTS Total insight scores were negatively correlated with the scores of perception of future. As distinct from other subscales of resilience, family cohesion had independent significant associations with insight in relabelling of psychotic experiences and attention impulsivity. There was no relationship between total insight and total resilience scores. Resilience scores were negatively correlated with number of depressive episodes and number of suicide attempts. Degree of aggression, degree of impulsivity, scores of depressive and hyperthymic temperament significantly predicted resilience. LIMITATIONS Recruitment of patients from a tertiary centre limits the generalizability of the findings. CONCLUSIONS Better insight was related to negative perception of the future and did not have significant associations with total resilience. Number of depressive episodes, number of past suicide attempts correlated with resilience, emphasizing the importance of interventions to increase resilience in BD.
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Affiliation(s)
- Güliz Şenormancı
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey.
| | - Oya Güçlü
- Neurology and Neurosurgery, Department of Psychiatry Bakirkoy Training and Research Hospital for Psychiatry, Istanbul, Turkey
| | - İlker Özben
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey
| | - Fatma Nur Karakaya
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey
| | - Ömer Şenormancı
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey
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17
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Johnson SL, Sandel DB, Zisser M, Pearlstein JG, Swerdlow BA, Sanchez AH, Fernandez E, Carver CS. A brief online intervention to address aggression in the context of emotion-related impulsivity for those treated for bipolar disorder: Feasibility, acceptability and pilot outcome data. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2020; 30:65-74. [PMID: 34113851 DOI: 10.1016/j.jbct.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. t Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Devon B Sandel
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Mackenzie Zisser
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Jennifer G Pearlstein
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Benjamin A Swerdlow
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Amy H Sanchez
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Ephrem Fernandez
- University of Texas San Antonio, San Antonio, Texas, United States
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18
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Fernàndez-Castillo N, Gan G, van Donkelaar MMJ, Vaht M, Weber H, Retz W, Meyer-Lindenberg A, Franke B, Harro J, Reif A, Faraone SV, Cormand B. RBFOX1, encoding a splicing regulator, is a candidate gene for aggressive behavior. Eur Neuropsychopharmacol 2020; 30:44-55. [PMID: 29174947 PMCID: PMC10975801 DOI: 10.1016/j.euroneuro.2017.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/27/2017] [Accepted: 11/08/2017] [Indexed: 12/11/2022]
Abstract
The RBFOX1 gene (or A2BP1) encodes a splicing factor important for neuronal development that has been related to autism spectrum disorder and other neurodevelopmental phenotypes. Evidence from complementary sources suggests that this gene contributes to aggressive behavior. Suggestive associations with RBFOX1 have been identified in genome-wide association studies (GWAS) of anger, conduct disorder, and aggressive behavior. Nominal association signals in RBFOX1 were also found in an epigenome-wide association study (EWAS) of aggressive behavior. Also, variants in this gene affect temporal lobe volume, a brain area that is altered in several aggression-related phenotypes. In animals, this gene has been shown to modulate aggressive behavior in Drosophila. RBFOX1 has also been associated with canine aggression and is upregulated in mice that show increased aggression after frustration of an expected reward. Associated common genetic variants as well as rare duplications and deletions affecting RBFOX1 have been identified in several psychiatric and neurodevelopmental disorders that are often comorbid with aggressive behaviors. In this paper, we comprehensively review the cumulative evidence linking RBFOX1 to aggression behavior and provide new results implicating RBFOX1 in this phenotype. Most of these studies (genetic and epigenetic analyses in humans, neuroimaging genetics, gene expression and animal models) are hypothesis-free, which strengthens the validity of the findings, although all the evidence is nominal and should therefore be taken with caution. Further studies are required to clarify in detail the role of this gene in this complex phenotype.
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Affiliation(s)
- Noèlia Fernàndez-Castillo
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain.
| | - Gabriela Gan
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Marjolein M J van Donkelaar
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Human Genetics, Nijmegen, The Netherlands
| | - Mariliis Vaht
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Tartu, Estonia
| | - Heike Weber
- Deptartment of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Wolfgang Retz
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Barbara Franke
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Human Genetics, Nijmegen, The Netherlands; Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Nijmegen, The Netherlands
| | - Jaanus Harro
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Tartu, Estonia
| | - Andreas Reif
- Deptartment of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain.
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19
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Cognitive impairment in late life bipolar disorder: Risk factors and clinical outcomes. J Affect Disord 2019; 257:166-172. [PMID: 31301619 DOI: 10.1016/j.jad.2019.07.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/09/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Late Life Bipolar Disorder (LLBD) is associated with a high prevalence of cognitive impairments, but few studies have examined their risk factors and clinical correlates METHODS: Participants with bipolar disorder older than 60 (n = 86) were recruited from psychiatric outpatient and inpatients units. Patients were assessed with various instruments, including the Clinical Dementia Rating scale, the Montreal Cognitive Assessment and the Cumulative Illness Rating Scale. The distribution of disorder-specific and general risk factors was compared between patients with LLBD plus cognitive impairments (mild cognitive impairment or dementia) and those with LLBD but no cognitive impairment. Analyses were first conducted at the bivariate level, then using multiple regression. The association with disability, aggressive behavior and suicidal ideation was also explored. RESULTS Cognitive impairments in LLBD were associated with a diagnosis of type 1 bipolar disorder (OR = 6.40, 95%CI: 1.84 - 22.31, p = 0.004), fewer years of education (OR = 0.79, 95%CI: 0.69 - 0.91, p = 0.001) and higher severity of physical diseases (OR 26.54, 95%CI: 2.07 - 340.37, p = 0.01). Moreover, cognitive impairments were associated with an increased likelihood of disability and recent aggressive behavior, but not suicidal ideation. LIMITATIONS retrospective design, conflation of MCI and dementia, not all subjects were in euthymia CONCLUSIONS: In LLBD, the presence of cognitive impairments was associated with a diagnosis of type I bipolar disorder, lower education and more severe physical comorbidities. In turn, MCI or dementia were associated with increased disability and aggressive behavior. These findings may aid the identification of patients at risk for cognitive deterioration in everyday clinical practice.
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20
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Reich R, Gilbert A, Clari R, Burdick KE, Szeszko PR. A preliminary investigation of impulsivity, aggression and white matter in patients with bipolar disorder and a suicide attempt history. J Affect Disord 2019; 247:88-96. [PMID: 30658245 DOI: 10.1016/j.jad.2019.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Impulsivity and aggression may be associated with suicide attempts in bipolar disorder (BD), but findings have been inconsistent. Abnormalities in anterior white matter tracts that project to the frontal lobes mediate top-down regulation of emotion and may contribute to this clinical phenomenology. METHODS We assessed white matter (i.e., fractional anisotropy) in anterior and posterior brain regions using diffusion tensor imaging in 18 patients with BD and no prior suicide attempt (BD-S), 12 patients with BD and a prior suicide attempt (BD+S), and 12 healthy volunteers. Patients completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency (UPPS-P) Impulsive Behavior Scale and Impulsive Premeditated Aggression Scale (IPAS). All individuals completed the Barratt Impulsiveness Scale (BIS-11). RESULTS Patients with BD+S had higher overall impulsivity (assessed using both the UPPS-P Impulsive Behavior Scale and BIS-11) and premeditated aggression compared to patients with BD-S. There were no significant group differences on measures of fractional anisotropy (FA). In patients with BD+S, however, higher FA in the anterior (but not the posterior) brain regions correlated with greater overall impulsivity on the UPPS-P Impulsive Behavior Scale. There were no significant correlations between either anterior or posterior brain regions with clinical measures in patients with BD-S. LIMITATIONS Cross-sectional study, sample size and possible contribution of psychotropic medications. CONCLUSION Impulsivity and aggression may be risk factors for a suicide attempt in BD. White matter in the anterior limb of the internal capsule and anterior corona radiata may play a role in this phenomenology.
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Affiliation(s)
- Rachel Reich
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY, USA
| | - Alison Gilbert
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Rosarito Clari
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Katherine E Burdick
- Brigham and Women's Hospital, Harvard Medical School, Department of Psychiatry, Boston MA, USA; James J. Peters VA Medical Center, Mental Health Patient Care Center and Mental Illness Research Education Clinical Center (MIRECC), Bronx, NY, USA
| | - Philip R Szeszko
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA; James J. Peters VA Medical Center, Mental Health Patient Care Center and Mental Illness Research Education Clinical Center (MIRECC), Bronx, NY, USA.
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21
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Radisic R, Kolla NJ. Right to Appeal, Non-Treatment, and Violence Among Forensic and Civil Inpatients Awaiting Incapacity Appeal Decisions in Ontario. Front Psychiatry 2019; 10:752. [PMID: 31780958 PMCID: PMC6856710 DOI: 10.3389/fpsyt.2019.00752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/19/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Mental health legislation in Ontario, Canada, permits inpatients to refuse treatment while appealing their incapacity finding to the Consent and Capacity Board (CCB). Lack of treatment during this period poses safety concerns, as inpatients who remain untreated are at higher risk of engaging in violent behavior. The present study explored the relationship between non-treatment and violence among forensic and civil inpatients awaiting their CCB hearing at the largest psychiatric hospital in Canada. Methods: We investigated the electronic health records of 285 inpatients whose CCB applications were heard between 2014 and 2016 to better understand violent outcomes among inpatients and determine whether application timelines differed between forensic and civil inpatients. Results: Three key findings were observed. First, forensic inpatients had more episodes of violence requiring seclusion and restraint during the application timeline compared with civil inpatients. Second, forensic inpatients waited longer than civil inpatients for their appeal to be heard at the CCB. Finally, unwillingness to accept PRN medications and comorbid psychiatric conditions were potent risk factors for violence among all inpatients during the appeals process. Conclusions: Compared with civil inpatients, forensic inpatients waited longer for CCB appeals. They also scored higher on one measure of violent behavior. These findings provide context for the ongoing challenge of clinicians tasked with providing care for inpatients appealing findings of incapacity under mental health legislation in Ontario. We argue for a more streamlined approach to processing appeals for both forensic and civil patients. Better standardization or even revision of current mental health legislation may help eliminate clinical disparities between patient groups.
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Affiliation(s)
- Radovan Radisic
- Forensic Psychiatry Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Nathan J Kolla
- Forensic Psychiatry Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, ON, Canada.,Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
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Verdolini N, Pacchiarotti I, Köhler CA, Reinares M, Samalin L, Colom F, Tortorella A, Stubbs B, Carvalho AF, Vieta E, Murru A. Violent criminal behavior in the context of bipolar disorder: Systematic review and meta-analysis. J Affect Disord 2018; 239:161-170. [PMID: 30014956 DOI: 10.1016/j.jad.2018.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the potential importance of understanding violent criminal behavior (VCB) in individuals suffering from bipolar disorder (BD), previous findings are conflicting. The aims of the present study are to clarify the association of VCB and BD in comparison to general population and other psychiatric conditions. METHODS A systematic review of literature from January 1st, 1980 through January 16th, 2017 from 3 electronic databases (MEDLINE/PubMed, EMBASE and PsycInfo), following the PRISMA and the MOOSE statements. Original peer-reviewed studies reporting data on VCB in BD were included. A random-effects meta-analysis was performed. Potential sources of heterogeneity were examined through subgroup and meta-regression analyses. The protocol was registered in PROSPERO, CRD42017054070. RESULTS Twelve studies providing data from 58,475 BD participants. The prevalence of VCB in BD was 7.1% (95%CI = 3.0‒16.5%; k = 4). The association of BD and VCB compared to general population was not significant (OR = 2.784; 95% CI, 0.687‒11.287, P = .152). The association was significant only in cross-sectional studies, in studies in which VCB was assessed through self-reported measures, and in studies conducted in the USA. BD was more likely to be associated with VCB when BD patients were compared to controls with depressive disorders, whilst it was found to be less associated with VCB when BD was compared to psychotic disorders. LIMITATIONS 1. the methodological heterogeneity across the included studies. 2. causal inferences were precluded by the inclusion of cross-sectional studies. CONCLUSIONS These findings might provide a more balance portrait of the association between BD and VCB to clinicians, law enforcement and general public.
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Affiliation(s)
- Norma Verdolini
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Ellisse Building, 8th Floor, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - Isabella Pacchiarotti
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Cristiano A Köhler
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Maria Reinares
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Ludovic Samalin
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, 58, Rue Montalembert, 63000, Clermont-Ferrand, France; Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, 40 rue de Mesly, 94000, Créteil, France
| | - Francesc Colom
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Mental Health Group, IMIM Hospital del Mar, CIBERSAM, Plaza Charles Darwin, sn, 08003 Barcelona, Catalonia, Spain
| | - Alfonso Tortorella
- FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre of Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
| | - Andrea Murru
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
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23
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Khalsa HMK, Baldessarini RJ, Tohen M, Salvatore P. Aggression among 216 patients with a first-psychotic episode of bipolar I disorder. Int J Bipolar Disord 2018; 6:18. [PMID: 30097737 PMCID: PMC6161985 DOI: 10.1186/s40345-018-0126-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/05/2018] [Indexed: 12/03/2022] Open
Abstract
Background Aggression by patients with bipolar I disorder (BD-I) is not uncommon. Identifying potential risk factors early in the illness-course should inform clinical management and reduce risk. Methods In a study sample of 216 initially hospitalized, first-psychotic episode subjects diagnosed with DSM-IV-TR BD-I, we identified recent (within 1 month before hospitalization) aggression by ratings on the Brief Psychiatric Rating Scale-Expanded and review of detailed clinical research records. We compared subjects with versus without aggressive behavior for associations with selected demographic and clinical factors. Results Aggression was identified in 23/216 subjects (10.6%). It was associated significantly with recent suicide attempt (OR = 4.86), alcohol abuse (OR = 3.63), learning disability (OR = 3.14), and initial manic episode (OR = 2.59), but not with age, sex, onset-type, personality disorder, time to recovery, or functional status. Conclusions Among first-major episode BD-I patients with psychotic features, recent serious aggression towards others was identified in 10.6%. The odds of aggression increased by 4.9-times in association with a recent suicide attempt, more than 3-times with alcohol-abuse or learning disability, and by 2.6-times if the episode polarity was manic. The findings encourage closer management of alcohol misuse, suicide risk, and manic symptoms, and early detection of learning problems in BD-I patients.
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Affiliation(s)
- Hari-Mandir K Khalsa
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA. .,Division of Mental Health and Wellbeing, Warwick Medical School, Coventry, UK. .,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA.
| | - Ross J Baldessarini
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA
| | - Mauricio Tohen
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA.,Department of Psychiatry & Behavioral Sciences, University of New Mexico, Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Paola Salvatore
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA.,Psychiatry Section, Department of Medicine & Surgery, University of Parma, Parma, Italy
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24
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Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study. Int Clin Psychopharmacol 2018; 33:121-130. [PMID: 29189421 PMCID: PMC5895133 DOI: 10.1097/yic.0000000000000206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Borderline personality disorder (BPD) often co-occurres with bipolar disorder (BD). Impulsivity and aggressiveness represent core shared features and their pharmacological management is mainly based on mood stabilizers and antipsychotics, although scarce evidence is available for this context of comorbidity. The aim of the present study was to evaluate the role of Asenapine as an adjunctive drug for reducing aggressiveness and impulsivity in a sample of Italian BD type I outpatients with or without a comorbid BPD. This was an observational 12-week open-label uncontrolled clinical study carried out from April to October 2014 in two psychiatric clinics in Sicily. Each patient was treated with asenapine at two dose options, 5 mg (twice daily) or 10 mg (twice daily), and concomitant ongoing medications were not discontinued. We measured impulsivity using the Barratt Impulsiveness Scale (BIS) and aggressiveness using the Aggressive Questionnaire (AQ). For the analysis of our outcomes, patients were divided into two groups: with or without comorbid BPD. Adjunctive therapy was associated with a significant decrease of BIS and AQ overall scores in the entire bipolar sample. Yet, there was no significant difference in BIS and AQ reductions between subgroups. Using a regression model, we observed that concomitant BPD played a negative role on the Hostility subscale and overall AQ score variations; otherwise, borderline co-diagnosis was related positively to the reduction of physical aggression. According to our post-hoc analysis, global aggressiveness scores are less prone to decrease in patients with a dual diagnosis, whereas physical aggressiveness appears to be more responsive to the add-on therapy in patients with comorbidity.
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25
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Blanco E, Duque LM, Rachamallu V, Yuen E, Kane J, Gallego JA. Predictors of aggression in 3.322 patients with affective disorders and schizophrenia spectrum disorders evaluated in an emergency department setting. Schizophr Res 2018; 195:136-141. [PMID: 29102223 PMCID: PMC6510030 DOI: 10.1016/j.schres.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study is to determine odds of aggression and associated factors in patients with schizophrenia-spectrum disorders (SSD) and affective disorders who were evaluated in an emergency department setting. METHODS A retrospective study was conducted using de-identified data from electronic medical records from 3.322 patients who were evaluated at emergency psychiatric settings. Data extracted included demographic information, variables related to aggression towards people or property in the past 6months, and other factors that could potentially impact the risk of aggression, such as comorbid diagnoses, physical abuse and sexual abuse. Bivariate analyses and multivariate regression analyses were conducted to determine the variables significantly associated with aggression. RESULTS An initial multivariate regression analysis showed that SSD had 3.1 times the odds of aggression, while bipolar disorder had 2.2 times the odds of aggression compared to unipolar depression. A second regression analysis including bipolar subtypes showed, using unipolar depression as the reference group, that bipolar disorder with a recent mixed episode had an odds ratio (OR) of 4.3, schizophrenia had an OR of 2.6 and bipolar disorder with a recent manic episode had an OR of 2.2. Generalized anxiety disorder was associated with lower odds in both regression analyses. CONCLUSION As a whole, the SSD group had higher odds of aggression than the bipolar disorder group. However, after subdividing the groups, schizophrenia had higher odds of aggression than bipolar disorder with a recent manic episode and lower odds of aggression than bipolar disorder with a recent mixed episode.
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Affiliation(s)
- Emily Blanco
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - John Kane
- Hofstra Northwell School of Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA,The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Juan A. Gallego
- Hofstra Northwell School of Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA,The Zucker Hillside Hospital, Glen Oaks, NY, USA
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26
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Verdolini N, Perugi G, Samalin L, Murru A, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Barbuti M, Guiso G, Popovic D, Vieta E, Pacchiarotti I. Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features. Acta Psychiatr Scand 2017; 136:362-372. [PMID: 28741646 DOI: 10.1111/acps.12777] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate aggressiveness during a major depressive episode (MDE) and its relationship with bipolar disorder (BD) in a post hoc analysis of the BRIDGE-II-MIX study. METHOD A total of 2811 individuals were enrolled in this multicenter cross-sectional study. MDE patients with (MDE-A, n = 399) and without aggressiveness (MDE-N, n = 2412) were compared through chi-square test or Student's t-test. A stepwise backward logistic regression model was performed. RESULTS MDE-A group was more frequently associated with BD (P < 0.001), while aggressiveness was negatively correlated with unipolar depression (P < 0.001). At the logistic regression, aggressiveness was associated with the age at first depressive episode (P < 0.001); the severity of mania (P = 0.03); the diagnosis of BD (P = 0.001); comorbid borderline personality disorder (BPD) (P < 0.001) but not substance abuse (P = 0.63); no current psychiatric treatment (P < 0.001); psychotic symptoms (P = 0.007); the marked social/occupational impairment (P = 0.002). The variable most significantly associated with aggressiveness was the presence of DSM-5 mixed features (P < 0.001, OR = 3.815). After the exclusion of BPD, the variable of lifetime suicide attempts became significant (P = 0.013, OR = 1.405). CONCLUSION Aggressiveness seems to be significantly associated with bipolar spectrum disorders, independently from BPD and substance abuse. Aggressiveness should be considered as a diagnostic criterion for the mixed features specifier and a target of tailored treatment strategy.
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Affiliation(s)
- N Verdolini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - G Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - L Samalin
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Psychiatry, CHU Clermont-Ferrand, University of Auvergne, EA 7280, Clermont-Ferrand, France.,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - A Murru
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Angst
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - J-M Azorin
- AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - C L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - A H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Barbuti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - G Guiso
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Medical Sciences and Public Health, University of Cagliari and Psychiatric Clinic, University Hospital, Cagliari, Italy
| | - D Popovic
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Psychiatry B, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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27
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The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review. Int J Mol Sci 2017; 18:ijms18020349. [PMID: 28208695 PMCID: PMC5343884 DOI: 10.3390/ijms18020349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/26/2017] [Accepted: 02/02/2017] [Indexed: 01/26/2023] Open
Abstract
Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.
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28
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Cackowski S, Krause-Utz A, Van Eijk J, Klohr K, Daffner S, Sobanski E, Ende G. Anger and aggression in borderline personality disorder and attention deficit hyperactivity disorder - does stress matter? Borderline Personal Disord Emot Dysregul 2017; 4:6. [PMID: 28331620 PMCID: PMC5356413 DOI: 10.1186/s40479-017-0057-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/10/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The impact of stress on anger and aggression in Borderline Personality Disorder (BPD) and Attention Deficit Hyperactivity Disorder (ADHD) has not been thoroughly investigated. The goal of this study was to investigate different aspects of anger and aggression in patients with these disorders. METHODS Twenty-nine unmedicated female BPD patients, 28 ADHD patients and 30 healthy controls (HC) completed self-reports measuring trait anger, aggression and emotion regulation capacities. A modified version of the Point Subtraction Aggression Paradigm and a state anger measurement were applied under resting and stress conditions. Stress was induced by the Mannheim Multicomponent Stress Test (MMST). RESULTS Both patient groups scored significantly higher on all self-report measures compared to HCs. Compared to ADHD patients, BPD patients reported higher trait aggression and hostility, a stronger tendency to express anger when provoked and to direct anger inwardly. Furthermore, BPD patients exhibited higher state anger than HCs and ADHD patients under both conditions and showed a stress-dependent anger increase. At the behavioral level, no significant effects were found. In BPD patients, aggression and anger were positively correlated with emotion regulation deficits. CONCLUSIONS Our findings suggest a significant impact of stress on self-perceived state anger in BPD patients but not on aggressive behavior towards others in females with BPD or ADHD. However, it appears to be pronounced inwardly directed anger which is of clinical importance in BPD patients.
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Affiliation(s)
- Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, J5, D-68159 Mannheim, Germany
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Faculty of Social and Behavioural Science, Leiden University, Leiden, The Netherlands
| | - Julia Van Eijk
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Katrin Klohr
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, J5, D-68159 Mannheim, Germany
| | - Stephanie Daffner
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, J5, D-68159 Mannheim, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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29
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Citrome L, Landbloom R, Chang CT, Earley W. Effects of asenapine on agitation and hostility in adults with acute manic or mixed episodes associated with bipolar I disorder. Neuropsychiatr Dis Treat 2017; 13:2955-2963. [PMID: 29270013 PMCID: PMC5729826 DOI: 10.2147/ndt.s149376] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bipolar disorder is associated with an increased risk of aggression. However, effective management of hostility and/or agitation symptoms may prevent patients from becoming violent. This analysis investigated the efficacy of the antipsychotic asenapine on hostility and agitation in patients with bipolar I disorder. METHODS Data were pooled from three randomized, double-blind, placebo-controlled, Phase III trials of asenapine in adults with manic or mixed episodes of bipolar I disorder (NCT00159744, NCT00159796, and NCT00764478). Post hoc analyses assessed the changes from baseline to day 21 on the Young Mania Rating Scale (YMRS) and the Positive and Negative Syndrome Scale (PANSS) hostility-related item scores in asenapine- or placebo-treated patients with at least minimal or mild symptom severity and on the PANSS-excited component (PANSS-EC) total score in agitated patients. Changes were adjusted for improvements in overall mania symptoms to investigate direct effects on hostility. RESULTS Significantly greater changes in favor of asenapine versus placebo were observed in YMRS hostility-related item scores (irritability: least squares mean difference [95% confidence interval] =-0.5 [-0.87, -0.22], P=0.001; disruptive-aggressive behavior: -0.7 [-0.99, -0.37], P<0.0001), PANSS hostility item score (-0.2 [-0.44, -0.04]; P=0.0181), and PANSS-EC total score (-1.4 [-2.4, -0.4]; P=0.0055). Changes in the YMRS disruptive-aggressive behavior score and the sum of the hostility-related items remained significant after adjusting for improvements in other YMRS item scores. CONCLUSION Asenapine significantly reduced hostility and agitation in patients with bipolar I disorder; improvement was at least partially independent of overall improvement on mania symptoms.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | | | | | - Willie Earley
- Clinical Development, Allergan, Jersey City, NJ, USA
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30
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Belete H, Mulat H, Fanta T, Yimer S, Shimelash T, Ali T, Tewabe T. Magnitude and associated factors of aggressive behaviour among patients with bipolar disorder at Amanual Mental Specialized Hospital, outpatient department, Addis Ababa, Ethiopia: cross-sectional study. BMC Psychiatry 2016; 16:443. [PMID: 27955659 PMCID: PMC5153861 DOI: 10.1186/s12888-016-1151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aggressive behavior is a challenging behavior among bipolar patients that causes poor social interaction and hospitalization. But, there is no information regards of the magnitude and contributing factors for aggressive behaviour among bipolar patients in Ethiopia. Therefore, this study was designed to assess the prevalence and associated factors of aggressive behaviour among patients with bipolar disorder. METHOD An institutional based cross sectional study was conducted at Amanual Mental Specialized Hospital from May 1 to June 1, 2015 among 411 participants who were selected by systematic random sampling technique. Data was collected by interview technique by using Modified Overt Aggression Scale, entered and analyzed by using Epi Data 3.1 and Statistical Package for Social Science version 20, respectively. Adjusted Odd Ratio (AOR) with 95% Confidence Interval (CI) were used to show the odd and P-value <0.05 was considered as statistically significant. RESULTS A total of 411 bipolar patients were included in the study and the prevalence of aggressive behaviour was 29.4%. Significant associated factors for aggression were, having two or more episode [AOR = 2.35 95% CI (1.18, 4.69)], previous history of aggression, [AOR = 3.72, 95% CI (1.54, 8.98)], depressive symptoms [AOR = 3.63, 95% CI (1.89, 6.96)], psychotic symptoms [AOR = 5.41,95% CI (2.88, 10.1)], manic symptoms [AOR = 3.85,95% CI (2.06, 7.19)], poor medication adherence [AOR = 3.73 95% CI (1.71, 8.13)], poor social support [AOR = 2.99 95% CI (1.30, 6.91)] and current use of substance[AOR = 2.17 95% CI (1.16, 4.06)]. CONCLUSION Prevalence of aggression is high among bipolar patients and associated with many factors. So it needs public health attention to decrease aggression among bipolar patients.
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Affiliation(s)
- Habte Belete
- Psychiatry Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, PO box 79, Ethiopia.
| | - Haregwoin Mulat
- Psychiatry Department, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tolesa Fanta
- Amanual Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Solomon Yimer
- Psychiatry Department, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | | | - Tilahun Ali
- Psychiatry Department, College of Medicine and Health Science, Haromaya University, Harrer, Ethiopia
| | - Tilahun Tewabe
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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31
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YU X, CORRELL CU, XIANG YT, XU Y, HUANG J, YANG F, WANG G, SI T, KANE JM, MASAND P. Efficacy of Atypical Antipsychotics in the Management of Acute Agitation and Aggression in Hospitalized Patients with Schizophrenia or Bipolar Disorder: Results from a Systematic Review. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 28:241-252. [PMID: 28638198 PMCID: PMC5434280 DOI: 10.11919/j.issn.1002-0829.216072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Acute agitation and aggression are common symptoms in patients with bipolar disorder and schizophrenia. In this review, we discuss the prevalence, clinical assessment strategies, treatment options, and current Western and Chinese guidelines for the management of acute agitation and aggression in patients with bipolar disorder or schizophrenia. Among available approaches, we discuss in detail recent evidence supporting the use of intramuscular (IM) antipsychotics and some recently approved oral atypical antipsychotics for the management of acute aggression and agitation in hospitalized patients with bipolar disorder or schizophrenia presenting with acute agitation or aggression, highlighting some differences between individual antipsychotic agents.
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Affiliation(s)
- Xin YU
- Peking University Institute of Mental Health (the sixth hospital), Huayuanbeilu 51#, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Christoph U. CORRELL
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004, USA
- Hofstra Northwell School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA
- The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA
| | - Yu-Tao XIANG
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, E12 Avenida da Universidade, Taipa, Macao SAR, China
| | - Yifeng XU
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Jizhong HUANG
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Fude YANG
- Beijing Huilongguan Hospital, Beijing, China
| | - Gang WANG
- Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Center of Depression, Beijing Institute for Brain Disorders & China Clinical Research Center for Mental Disorders, Beijing, China
| | - Tianmei SI
- Peking University Institute of Mental Health (the sixth hospital), Huayuanbeilu 51#, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - John M. KANE
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004, USA
- Hofstra Northwell School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA
- The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA
| | - Prakash MASAND
- Duke-NUS Medical School, Academic Medicine Education Institute, Singapore
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32
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The nuclear receptor Tlx regulates motor, cognitive and anxiety-related behaviours during adolescence and adulthood. Behav Brain Res 2016; 306:36-47. [DOI: 10.1016/j.bbr.2016.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 11/23/2022]
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33
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Fernandez E, Johnson SL. Anger in psychological disorders: Prevalence, presentation, etiology and prognostic implications. Clin Psychol Rev 2016; 46:124-35. [DOI: 10.1016/j.cpr.2016.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/14/2015] [Accepted: 04/25/2016] [Indexed: 01/21/2023]
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Alnıak İ, Erkıran M, Mutlu E. Substance use is a risk factor for violent behavior in male patients with bipolar disorder. J Affect Disord 2016; 193:89-93. [PMID: 26771949 DOI: 10.1016/j.jad.2015.12.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/24/2015] [Accepted: 12/26/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND To determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD). METHODS A sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS). Lifetime SUD and current use of substances were evaluated. Logistic regression analysis was conducted to predict violent behavior. RESULTS Current substance use (CSU) rather than lifetime SUD was found to be related to violent behavior in patients with BD, and CSU was associated with a threefold increase in the risk of violence. The rate of lifetime SUD in our sample was 59%, and the rate of CSU was 39%. The most commonly abused substances were cannabis and alcohol, followed by synthetic cannabinoids, in both groups of patients with lifetime SUD and CSU. Individuals abusing any substance were more likely to have a criminal record and history of incarceration than other patients. One of the most significant risk factors for violence was a previous history of violent behavior. LIMITATIONS The sample was limited to male patients. Data on some participants' recent substance use from standard urine analysis was not obtained. The data on the use of synthetic cannabinoids was obtained from patients and their families owing to the lack of equipment for detecting synthetic cannabinoids using laboratory analysis. CONCLUSIONS CSU appears to be a significant predictive factor in violent behavior in male patients. Further investigation of co-occurrence of violence with CSU and improvement in treatment strategies might reduce or prevent violence in patients with BD.
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Affiliation(s)
- İzgi Alnıak
- Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey.
| | - Murat Erkıran
- Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey.
| | - Elif Mutlu
- İstanbul Gelişim University, Department of Psychology, Turkey.
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35
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Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder. J Affect Disord 2016; 189:169-75. [PMID: 26437231 DOI: 10.1016/j.jad.2015.07.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/02/2015] [Accepted: 07/14/2015] [Indexed: 01/04/2023]
Abstract
Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.
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36
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Stevens H, Laursen TM, Mortensen PB, Agerbo E, Dean K. Post-illness-onset risk of offending across the full spectrum of psychiatric disorders. Psychol Med 2015; 45:2447-2457. [PMID: 25851504 DOI: 10.1017/s0033291715000458] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The link between psychotic disorders and violent offending is well established; knowledge about risk of post-illness-onset offending across the full spectrum of psychiatric disorders is lacking. We aimed to compare rates of any offending and violent offending committed after the onset of illness, according to diagnostic group, with population controls. METHOD A 25% random sample of the Danish population (n = 521 340) was followed from their 15th birthday until offending occurred. Mental health status was considered as a time-varying exposure in a Poisson regression model used to examine the duration from service contact to the offence. RESULTS Males with any psychiatric contact had an incidence rate ratio (IRR) of 2.91 [95% confidence interval (CI) 2.80-3.02] for any offending; 4.18 (95% CI 3.99-4.38) for violent offending. Associations were stronger for women (IRR 4.17, 95% CI 3.95-4.40 for any offending; 8.02, 95% CI 7.20-8.94 for violent offending). Risk was similar across diagnostic groups for any offending in males, while variation between diagnostic groups was seen for male violent and female offending, both any and violent. CONCLUSIONS Risk of offending, particularly violent offending, was elevated across a range of mental disorders following first contact with mental health services. The extent of variation in strength of effect across diagnoses differed by gender.
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Affiliation(s)
- H Stevens
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - T M Laursen
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - P B Mortensen
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - E Agerbo
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - K Dean
- School of Psychiatry,University of New South Wales, and Justice Health & Forensic Mental Health Network,NSW,Australia
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37
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de Almeida RMM, Cabral JCC, Narvaes R. Behavioural, hormonal and neurobiological mechanisms of aggressive behaviour in human and nonhuman primates. Physiol Behav 2015; 143:121-35. [DOI: 10.1016/j.physbeh.2015.02.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/25/2015] [Accepted: 02/28/2015] [Indexed: 12/27/2022]
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38
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Dolenc B, Dernovšek MZ, Sprah L, Tavcar R, Perugi G, Akiskal HS. Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder. J Affect Disord 2015; 174:13-8. [PMID: 25474481 DOI: 10.1016/j.jad.2014.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/09/2014] [Accepted: 11/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression. METHODS 100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A). RESULTS The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile. LIMITATIONS We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers. CONCLUSION Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour.
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Affiliation(s)
- B Dolenc
- Sociomedical Institute, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana, Slovenia.
| | | | - L Sprah
- Sociomedical Institute, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana, Slovenia
| | - R Tavcar
- University Psychiatric Clinic, Ljubljana, Slovenia
| | - G Perugi
- Institute of Behavioural Sciences, "G. De Lisio", Department of Psychiatry, University of Pisa, Pisa, Italy
| | - H S Akiskal
- International Mood Disorder Centre, Department of Psychiatry at the University of California, San Diego, La Jolla, USA
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Bragazzi NL, Pezzoni F, Del Puente G. Investigating Aggressive Styles and Defense Mechanisms in Bipolar Patients and in their Parents. Health Psychol Res 2014; 2:1546. [PMID: 26973942 PMCID: PMC4768587 DOI: 10.4081/hpr.2014.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/15/2014] [Accepted: 06/15/2014] [Indexed: 11/23/2022] Open
Abstract
Bipolar disorder (BD) is a very common mental health disorder, whose etiology concerning aggressive styles and defense mechanisms is still poorly known despite the efforts dedicated to develop psychological and biological theories. After obtaining written signed informed consent, this study will recruit inpatients with a clinical diagnosis of BD, based on Structured Clinical Interview and the Diagnostic and Statistical Manual of Mental Disorders criteria, and their parents. The Bus-Perry Aggression Questionnaire, the Defense Style Questionnaire 40, the Symptom check list SCL-90-R, developed by DeRogatis will be administered to the participants, together with a semi-structured questionnaire concerning demographic data (age, gender, employment, education) and only for the patients clinical information (onset year of the disorder, presence of co-morbidities, alcohol and drug use, suicide tendencies, kind of treatment). All the questionnaires are in the Italian validated version. The successful completion of this study will shed light on the relationship between aggressive styles and defensive mechanisms in bipolar inpatients and in their parents, helping the clinicians to develop ad hoc psychological interventions.
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Affiliation(s)
| | - Franca Pezzoni
- Department of Mental Health, Genoa Health Local Unit, University of Genoa, Italy
| | - Giovanni Del Puente
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Italy
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40
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Saddichha S, Schuetz C. Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Compr Psychiatry 2014; 55:1479-84. [PMID: 25035161 DOI: 10.1016/j.comppsych.2014.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/19/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review scores on measures of impulsivity in remitted bipolar disorder. DATA SOURCE We used keywords "impulsivity and bipolar" and "impulsivity and mania" to narrow down our search on Medline, EMBASE and Psychinfo to include those studies that had reported impulsivity scores using validated and reliable assessment measures in remitted bipolar disorder (both I and II). We searched all English language studies from 1990 to October 2012. STUDY SELECTION Nineteen reports met the inclusion criteria and were reviewed by two abstractors independently. DATA ABSTRACTION We generated weighted mean differences (WMDs) from pooled data using RevManager 5.0 from Cochrane analysis. RESULTS The Barratt Impulsivity Scale (BIS) 11 was the instrument most commonly used. Nineteen studies met the inclusion criteria, of which 2 were excluded due to incomplete data. A WMD of 12.8 was observed for BIS 11 total scores, 4.3 on the motor component, 4.1 on the cognitive and 7.6 on the non-planning components of the BIS 11 respectively. CONCLUSION Impulsivity is significantly higher in remitted bipolar patients than normal controls. Non-planning impulsivity is a key domain affected in bipolar disorder, which may represent a stable trait.
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Affiliation(s)
- Sahoo Saddichha
- North Western Mental Health, Melbourne Health, Melbourne, VIC, Australia.
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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41
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Nourse R, Reade C, Stoltzfus J, Mittal V. Demographics, clinical characteristics, and treatment of aggressive patients admitted to the acute behavioral unit of a community general hospital: a prospective observational study. Prim Care Companion CNS Disord 2014; 16:13m01589. [PMID: 25317364 DOI: 10.4088/pcc.13m01589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/11/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Aggressive patients are not uncommon in acute inpatient behavioral health units of general hospitals. Prior research identifies various predictors associated with aggressive inpatient behavior. This prospective observational study examines the demographic and clinical characteristics of aggressive inpatients and the routine medications these patients were receiving at discharge. METHOD Thirty-six adults diagnosed with a DSM-IV mental disorder who met 2 of 6 established inclusion criteria for high violence risk and a Clinical Global Impressions-Severity of Illness (CGI-S) scale score ≥ 4 were observed for a maximum of 28 days on the 23-bed case mix acute behavioral health unit of St Luke's University Hospital, Bethlehem, Pennsylvania, from January 2012 to May 2013. Primary outcome measures were the Modified Overt Aggression Scale (MOAS) and CGI-S; secondary measures were symptom outcome measures and demographic and clinical characteristics data. Analysis was conducted using repeated measures methodology. RESULTS Younger males with a history of previous violence, psychiatric admissions, and symptoms of severe agitation were more at risk for aggressive behavior. Positive psychotic symptoms, a diagnosis of bipolar disorder, substance use, and comorbid personality disorders also increased risk. Significant improvements from baseline to last visit were observed for the CGI-S and MOAS (P < .001 for both), with a significant correlation between the MOAS and CGI-S at last visit (P < .001). Only the symptom of agitation was significantly correlated to MOAS scores at both baseline and last visit (P < .001). CONCLUSION Patients significantly improved over time in both severity of illness and level of aggression.
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Affiliation(s)
- Rosemary Nourse
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Cynthia Reade
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Jill Stoltzfus
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Vikrant Mittal
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
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42
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Ballester J, Goldstein B, Goldstein TR, Yu H, Axelson D, Monk K, Hickey MB, Diler RS, Sakolsky DJ, Sparks G, Iyengar S, Kupfer DJ, Brent DA, Birmaher B. Prospective longitudinal course of aggression among adults with bipolar disorder. Bipolar Disord 2014; 16:262-9. [PMID: 24372913 PMCID: PMC4013217 DOI: 10.1111/bdi.12168] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 09/20/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Bipolar disorder (BP) has been associated with increased aggressive behaviors. However, all existing studies are cross-sectional and include forensic or inpatient populations and many do not take into account the effects of comorbid conditions. The goal of this study was to evaluate the longitudinal course of aggression among adult outpatients with BP compared with non-BP patients and healthy controls. METHODS Subjects with bipolar I disorder (BP-I)/bipolar II disorder (BP-II) (n = 255), those with non-BP psychopathology (n = 85), and healthy controls (n = 84) (average 38.9 years, 78.7% female, and 84.9% Caucasian) were evaluated at intake and after two and four years of follow-up. Aggression was self-rated using the Aggression Questionnaire (AQ). Comparisons were adjusted for any significant demographic and clinical differences and for multiple comparisons. For subjects with BP, associations of AQ with subtype of BP, current versus past mood episodes, polarity and severity of the current episode, psychosis, and current pharmacological treatment were evaluated. RESULTS In comparison with subjects with non-BP psychiatric disorders and healthy controls, subjects with BP showed persistently higher total and subscale AQ scores (raw and T-scores) during the four-year follow-up. There were no effects of BP subtype, severity or polarity of the current episode, psychosis, and current pharmacological treatments. Subjects in an acute mood episode showed significantly higher AQ scores than euthymic subjects. CONCLUSIONS BP, particularly during acute episodes, is associated with increased self-reported verbal and physical aggression, anger, and hostility. These results provide further evidence of the need for treatments to prevent mood recurrences and prompt treatment of acute mood episodes in subjects with BP.
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Affiliation(s)
| | - Benjamin Goldstein
- Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Haifeng Yu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Kelly Monk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Hickey
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dara J Sakolsky
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Garrett Sparks
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kupfer
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David A Brent
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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43
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Abstract
Schizophrenia without any comorbidity confers a modest, but statistically significant elevation of the risk for violence. That risk is considerably increased by comorbid antisocial personality disorder or psychopathy as well as by comorbid substance use disorders. These comorbidities are frequent. Conduct disorder and conduct disorder symptoms elevate the risk for aggressive behavior in patients with schizophrenia. Violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Aggressive behavior in bipolar disorder occurs mainly during manic episodes, but it remains elevated in euthymic patients in comparison with controls. The risk of violent behavior is increased by comorbidity with borderline personality disorder, antisocial personality disorder, and substance use disorders. These comorbidities are frequent. Borderline personality disorder and bipolar disorder are related in their phenomenology and response to medication. These two disorders share a tendency to impulsiveness, and impulsive behavior, including impulsive aggression, is particularly expressed when they co-occur.
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Affiliation(s)
- Jan Volavka
- Emeritus of Psychiatry, New York University School of Medicine, PO Box 160663, Big Sky, MT, 59716, USA,
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44
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Vieta E, Grunze H, Azorin JM, Fagiolini A. Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5: Results from the IMPACT self-reported online survey. J Affect Disord 2014; 156:206-213. [PMID: 24439831 DOI: 10.1016/j.jad.2013.12.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/22/2013] [Accepted: 12/23/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. RESULTS Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. LIMITATIONS Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. CONCLUSIONS Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorder Programme, Institute of Neuroscience, University of Barcelona Hospital Clínic, IDIBAPS, CIBERSAM, C/Villarroel 170, Barcelona 08036, Catalonia, Spain.
| | - Heinz Grunze
- Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, NE4 5PL, UK
| | - Jean-Michel Azorin
- Hospital Ste. Marguerite, 270 Bd Sainte Marguerite, 13274 Marseille, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, School of Medicine, Siena, Italy; Department of Mental Health, University of Siena Medical Center, Siena, Italy
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45
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Abstract
BACKGROUND Violent behaviour can be a presenting sign of first-episode psychosis. Duration of untreated psychosis (DUP) has been a focus of attention because it is a potentially modifiable factor that may influence outcome. AIMS The aim was to review the literature addressing the following issues: prevalence of violence or aggression in the first episode of psychosis, violence or aggression during the periods before and after the initiation of treatment, the DUP and relation between DUP and the level of violence or aggression in first-episode psychosis. METHODS MEDLINE and PubMed databases were searched for articles using the combination of key words 'aggression' (limited to humans) and 'first episode' and 'psychosis'. RESULTS Available evidence suggests that the prevalence of violent behaviour in the first episode of psychosis, particularly schizophrenia, is greater than during the later stages of the illness. First-episode psychosis is associated with an increased risk of homicide. There is some limited support for an effect of DUP length on serious violence or aggression. Violent behaviour frequently develops before the onset of first episode. Substance use disorders are additional factors that elevate the risk for violence in these patients. CONCLUSIONS Earlier treatment of first episode psychosis might prevent some homicides. Personality factors and substance abuse may be more important than psychotic symptoms in the development of aggressive behaviour in patients with first-episode psychosis.
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Affiliation(s)
- K Látalová
- Psychiatric Department, Palacký University, Olomouc, Czech Republic
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46
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Abstract
Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.
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Duek O, Osher Y, Belmaker RH, Bersudsky Y, Kofman O. Reward sensitivity and anger in euthymic bipolar disorder. Psychiatry Res 2014; 215:95-100. [PMID: 24230992 DOI: 10.1016/j.psychres.2013.10.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 10/19/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
According to the hypersensitive behavioral approach system (BAS) model of bipolar disorder (BP), hypersensitivity of the BAS is a trait that should be present even in the euthymic state. This would be expected to result in increased anger and reward sensitivity, both of which are related to the approach system. This study examined these predictions through the use of tasks that assess different aspects of the BAS: reward sensitivity, anger and impulsivity. These characteristics were assessed using the probabilistic classification task (PCT), ultimatum game (UG) and single key impulsivity paradigm (SKIP), respectively. Participants were euthymic adult bipolar disorder patients (BP; N=40) and healthy controls (HC; N=41). In the UG, all participants showed the standard pattern of rejecting overtly unfair offers and accepting clearly fair offers; however, BPs rejected more of the moderately unfair offers than did HCs. BP and HC participants did not differ on their ability to learn, but did show different patterns of learning from reward and punishment. Learning for reward and punishment were negatively correlated in the BP group, suggesting that individuals could learn well either from reward or punishment, but not both. No correlation was found between these forms of learning in the HC group. BP patients show signs of their disorder even in the euthymic state, as seen by the dysbalance between reward and punishment learning and their residual anger in the UG.
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Affiliation(s)
- Or Duek
- Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Yamima Osher
- Beer Sheva Mental Health Center, Department of Psychiatry, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Robert H Belmaker
- Bipolar Disorders Clinic, Hadassah Medical Center, Jerusalem, Israel
| | - Yuly Bersudsky
- Beer Sheva Mental Health Center, Department of Psychiatry, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ora Kofman
- Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel
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Carli V, Mandelli L, Zaninotto L, Alberti S, Roy A, Serretti A, Sarchiapone M. Trait-aggressiveness and impulsivity: role of psychological resilience and childhood trauma in a sample of male prisoners. Nord J Psychiatry 2014; 68:8-17. [PMID: 23795860 DOI: 10.3109/08039488.2012.756061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One of the major challenges for research in the field of human aggression is the need to define the role of personality and trait-like dimensions, such as impulsivity and aggressiveness, in predisposing to violent behavior. AIMS 1) To determine whether trait- aggressiveness and impulsivity may be associated with socio-demographic, clinical and crime history variables in a sample of male prisoners; 2) to detect any association of those traits with measures of early traumatic experiences and current resilience traits. METHODS A sample of male prisoners (n = 1356) underwent the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Barratt Impulsivity Scale (BIS). Axis I psychiatric disorders were also assessed. Early traumatic experiences and psychological resilience were detected respectively by the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-RISC). Two non-linear logistic regression models were performed to test for the best predictors of trait-aggressiveness and impulsivity. RESULTS Subjects with a history of substance use disorders and self-mutilation reported both higher BGLHA and BIS scores. Axis I disorders and suicide attempts were associated with aggressiveness, but not to impulsivity. A consistent correlation was found between BGLHA scores and early traumatic experiences. Resilience was positively correlated to impulsivity but not to aggressiveness scores. CONCLUSIONS Our results support the view that aggressiveness and impulsivity are two different, albeit related trait-like dimensions of personality, having a different relationship with resilience, and, inferentially, a different impact over the development of psychiatric disorders.
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Affiliation(s)
- Vladimir Carli
- Vladimir Carli, Department of Health Sciences, University of Molise , via F. De Sanctis, 86100, Campobasso , Italy , and Department of Public Health Sciences, Karolinska Institutet, National Prevention of Suicide and Mental Ill-Health (NASP) , 17177, Stockholm , Sweden
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Chou YH, Lin CL, Wang SJ, Lirng JF, Yang KC, Chien Chang A, Liao MH. Aggression in bipolar II disorder and its relation to the serotonin transporter. J Affect Disord 2013; 147:59-63. [PMID: 23123132 DOI: 10.1016/j.jad.2012.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aggression is frequently observed in patients diagnosed with bipolar disorder (BD). Previous studies found a negative association between aggression and serotoninergic function in patients with BD, as well as in healthy subjects. The objective of this study was to determine whether there is an association between aggression and the availability of the serotonin transporter (SERT) in euthymic BD II patients. METHODS Thirty-eight age-matched healthy controls (HCs) and 24 BD II patients were recruited. BD II patients were under stable treatment in the euthymic state. The Overt Aggression Scale (OAS) was used for the assessment of aggression. Single photon emission computed tomography with (123)I-ADAM was used for SERT imaging. A specific uptake ratio, which represents availability, was the primary measured outcome. RESULTS The total OAS scores, as well as the scores on all of the sub-items, were significantly higher in BD II patients than in the HCs group. There was no significant difference in SERT availability between BD II and HCs subjects in different brain regions. The Pearson's correlation between the total OAS scores and the sub-item aggression and SERT availability was significant. LIMITATION The OAS was used for the assessment of the past week of the patients' condition and thus did not reflect their trait status. CONCLUSIONS The higher total scores of OAS in euthymic BD II patients than in HCs support the idea that aggression might be a trait marker for BD. Although SERT availability in euthymic BD II patients and in HCs did not differ significantly, the correlation of SERT availability and total OAS provides the possible explanation of aggression in BD II.
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Affiliation(s)
- Yuan-Hwa Chou
- Department of Psychiatry Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
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Abstract
Aggressive behaviour is the observable manifestation of aggression and is often associated with developmental transitions and a range of medical and psychiatric diagnoses across the lifespan. As healthcare professionals involved in the medical and psychosocial care of patients from birth through death, nurses frequently encounter - and may serve as - both victims and perpetrators of aggressive behaviour in the workplace. While the nursing literature has continually reported research on prevention and treatment approaches, less emphasis has been given to understanding the aetiology, including contextual precipitants of aggressive behaviour. This paper provides a brief review of the biological, social and environmental risk factors that purportedly give rise to aggressive behaviour. Further, many researchers have focused specifically on aggressive behaviour in adolescence and adulthood. Less attention has been given to understanding the aetiology of such behaviour in young children and older adults. This paper emphasizes the unique risk factors for aggressive behaviour across the developmental spectrum, including childhood, adolescence, adulthood and late life. Appreciation of the risk factors of aggressive behaviour, and, in particular, how they relate to age-specific manifestations, can aid nurses in better design and implementation of prevention and treatment programmes.
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Affiliation(s)
- J Liu
- Faculty Member of MPH at School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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