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Gao W, Mu Q, Cui D, Zhu C, Jiao Q, Su L, Lu S, Yang R. Alterations of subcortical structural volume in pediatric bipolar disorder patients with and without psychotic symptoms. Psychiatry Res Neuroimaging 2025; 347:111948. [PMID: 39798502 DOI: 10.1016/j.pscychresns.2025.111948] [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: 08/06/2024] [Revised: 10/01/2024] [Accepted: 01/06/2025] [Indexed: 01/15/2025]
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) with psychotic symptoms may predict more severe impairment in social functioning, but the underlying biological mechanisms remain unclear. The aim of this study was to investigate alterations in subcortical structural volume in PBD with and without psychotic symptoms. METHODS We recruited 24 psychotic PBD (P-PBD) patients, 24 non-psychotic PBD (NP-PBD) patients, and 18 healthy controls (HCs). All participants underwent scanning with a 3.0 T Siemens Trio scanner. The FreeSurfer 7.4.0 software was employed to calculate the volume of each subcortical structure. An analysis of covariance (ANCOVA) was performed to identify brain regions with significant volume differences among the three groups, and then the inter-group comparisons were calculated. Partial correlation analyses were conducted to identify relationships between subcortical structural volumes and clinical features. Finally, receiver operating characteristic curve (ROC) analysis was employed to verify the capacity to distinguish between P-PBD and NP-PBD, P-PBD and HCs, and NP-PBD and HCs. RESULTS ANCOVA revealed significant differences in the volumes of bilateral lateral ventricles, third ventricle, left thalamus, and right pallidum among three groups. Compared with HC, the third ventricle volume was increased in both groups of PBD patients, whereas the left thalamus and right pallidum volumes were decreased, and the bilateral lateral ventricles were enlarged in P-PBD patients. In contrast, only the third ventricle showed further enlargement in the group of P-PBD patients compared with NP-PBD patients. Partial correlation analyses revealed that episode times were associated with the third ventricle volume in P-PBD patients. Furthermore, ROC analyses indicated that volume in the left lateral ventricle exhibited the greatest capacity to distinguish between the P-PBD and NP-PBD, and the third ventricle performed best in distinguishing both the P-PBD group from HCs and the NP-PBD group from HCs. The combined metrics demonstrated greater diagnostic value in two-by-two comparisons. CONCLUSION Current research suggests that PBD with psychotic symptoms may have more extensive lateral and third ventricular volume enlargement. Bilateral lateral ventricles may serve as potential neurobiomarkers to distinguish P- PBD patients from NP-PBD patients.
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Affiliation(s)
- Weijia Gao
- Department of Child Psychology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Qingli Mu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Key Laboratory of Precision Psychiatry, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China; Faculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Cui
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shangdong, China
| | - Ce Zhu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Key Laboratory of Precision Psychiatry, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China; Faculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Psychiatry, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
| | - Qing Jiao
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shangdong, China
| | - Linyan Su
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Key Laboratory of Psychiatry and Mental Health of Hunan Province, National Technology Institute of Psychiatry, Changsha, Hunan, China
| | - Shaojia Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Key Laboratory of Precision Psychiatry, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China.
| | - Rongwang Yang
- Department of Child Psychology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, National Children's Regional Medical Center, Hangzhou, Zhejiang, China.
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Glaus J, Karow A, Lambert M, Sowada P, Bröckel-Bundt K, Berndt C, Sauer C, Juckel G, Fallgatter AJ, Bechdolf A, Reif A, Matura S, Kittel-Schneider S, Stamm T, Kircher T, Falkenberg I, Jansen A, Correll CU, Fusar-Poli P, Bauer M, Pfennig A, Rohenkohl AC. Quality of life in persons at risk for bipolar disorder: a two year prospective-longitudinal observational cohort study (BipoLife). Int J Bipolar Disord 2025; 13:7. [PMID: 39964389 PMCID: PMC11836254 DOI: 10.1186/s40345-025-00373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 02/04/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Improving quality of life (QoL) is important for the treatment of people with bipolar disorder (BD). Early-BipoLife is a German multicentre naturalistic, prospective-longitudinal observational cohort study investigating early recognition and intervention in people at increased risk of developing a BD. This analysis aims to investigate influencing factors and changes in QoL as a basis for the development of early intervention strategies in patients with at risk syndrome for BD. METHOD A cohort of 1086 participants (15-35 years) with at least one risk factor (EPIbipolar criteria) for BD was assessed over the course of 2 years. Changes in QoL (WHOQOL-BREF) were evaluated in a mixed model for repeated measures. RESULTS Compared to an age-matched comparison group, people at risk for BD showed significant lower QoL in all domains at baseline. The overall QoL of the psychological well-being domain of the WHOQOL-BREF increased over the 2 year study course (p < 0.001). The bipolar risk group (EPIbipolar) change from baseline divided into (a) decreasing, (b) increasing and (c) constant risk group in the course of 2 years. Baseline risk group assignment was not a significant predictor of change in QoL over 2 years for any of the QoL domains, but participants with an increase in risk over the 2-year course had a significantly smaller gain in QoL than the group with constant risk (p = 0.014) or decreasing risk (p < 0.001). Higher levels of QoL were associated with a higher self-rated ability to use coping strategies. Moreover, a higher level of functioning (GAF) at baseline was positively correlated with improvement of different QoL domains after 2 years. CONCLUSION Patients with a risk syndrome for BD reported significantly reduced QoL compared to their age-matched comparison group. Risk status monitoring might be beneficial to identify individuals who could profit from an intervention to increase their QoL. Further studies promoting the development of coping strategies for successful self-management could be helpful to improve overall mental health and positively influence QoL.
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Affiliation(s)
- Johanna Glaus
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Pia Sowada
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Kyra Bröckel-Bundt
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Andreas J Fallgatter
- Dept. of Psychiatry and Psychotherapy, University Hospital Tübingen, Osianderstr. 24, 72076, Tübingen, Germany
- German Center for Mental Health (DZPG), partner site, Tübingen, Germany
| | - Andreas Bechdolf
- Clinic for Psychiatry and Psychotherapy, Charité University Medicine Berlin, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Dieffenbachstr. 1, 10967, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main - Goethe University, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main - Goethe University, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg Margarete-Höppel-Platz1, 97080, Würzburg, Germany
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland
- APC Microbiome Ireland, University College Cork, College Road, Cork, T12 CY82, Ireland
| | - Thomas Stamm
- Clinic for Psychiatry and Psychotherapy, Charité University Medicine Berlin, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Dieffenbachstr. 1, 10967, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Strasse 8, 35039, Marburg, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Strasse 8, 35039, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Strasse 8, 35039, Marburg, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South-London (OASIS) Service, South London and Maudlsey (SLaM) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, TUD Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Anja Christine Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany.
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Chiu YM, Huang WL, Wang SH, Wu MS, Chen YL, Hsu CC, Wu CS. Estimating expected years of life lost of psychiatric disorders in Taiwan: A Nationwide cohort study. Gen Hosp Psychiatry 2024; 91:25-32. [PMID: 39260189 DOI: 10.1016/j.genhosppsych.2024.08.006] [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: 05/04/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES This study employed a national longitudinal cohort to assess expected years of life lost (EYLL) in newly diagnosed psychiatric patients. METHODS Data from Taiwan's National Death Registry and Health Insurance Research Database were scrutinized to identify patients with various psychiatric disorders. Disorders were ranked hierarchically, and age groups were categorized as young, middle-aged, and older adults. We utilized the semiparametric survival extrapolation method to estimate life expectancy (LE) and EYLL. Modifying effect of comorbid conditions and socioeconomic characteristics were also explored. RESULTS Among the 5,757,431 cases, young adults with dementia, alcohol use disorder, schizophrenia, and bipolar disorder experienced an excess of 15 years of EYLL. Middle-aged adults faced approximately 9 years or more of EYLL, while older adults had lower EYLL values. Comorbid conditions, low income levels, and living in rural areas were associated with higher EYLL. CONCLUSIONS This study underscores the substantial EYLL among young adults with psychiatric disorders and the significant impact of specific disorders on EYLL. Early intervention, tailored support, and healthcare system readiness are imperative for improved outcomes. Resource allocation and targeted interventions focusing on early detection and comprehensive treatment can alleviate the economic burden.
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Affiliation(s)
- Ying-Ming Chiu
- Department of Allergy, Immunology, and Rheumatology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Nursing, Jen Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan
| | - Shih-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ming-Shiang Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan
| | - Yu-Ling Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan; Department of Physical Education, National Taiwan University of Sport, Taichung City, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan.
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Pini S, Carpita B, Nardi B, Abelli M, Amatori G, Cremone I, Dell'Osso L. Admixture Analysis of Age of Onset in Bipolar Disorder and Impact of Anxiety Comorbidity. Cureus 2024; 16:e55803. [PMID: 38463410 PMCID: PMC10923198 DOI: 10.7759/cureus.55803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The present study aimed to examine clinical differences between subjects with early-onset (<21 years) and adult-onset (>30 years) bipolar I disorder, in particular, in relation to anxiety comorbidity. METHOD Subjects were selected from a cohort of 161 consecutive patients with bipolar disorder type I as diagnosed by the Structured Clinical Interview for DSM Disorder (SCID-I). Clinical characteristics and axis I comorbidity were compared between those whose illness first emerged before the age of 21 years (n=58) and those whose first episode occurred after the age of 30 years (n=27). Psychopathology was assessed using the 18-item version of the Brief Psychiatric Rating Scale (BPRS). The frequency of delusions, hallucinations, and formal thought disorders was evaluated with the SCID-I. Overall, social and occupational functioning was assessed by the Global Assessment of Functioning (GAF). RESULTS Most subjects with early-onset bipolar disorder were males, had panic disorder and substance abuse comorbidity, longer duration of illness, exhibited mood-incongruent delusions, and presented with a mixed episode at onset more frequently than the later adult-onset subjects. Mixed mania at the first episode of illness and lifetime panic disorder comorbidity predicted mixed polarity at the first hospitalization episode in the early-onset subjects. CONCLUSIONS Overall, early age at onset seems to delineate a distinct bipolar I disorder subtype characterized by a greater likelihood of mixed episodes, lifetime panic disorder comorbidity, and schizophrenia-like delusions.
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Affiliation(s)
- Stefano Pini
- Department of Experimental Medicine, University of Pisa, Pisa, ITA
| | - Barbara Carpita
- Department of Experimental Medicine, University of Pisa, Pisa, ITA
| | - Benedetta Nardi
- Department of Experimental Medicine, University of Pisa, Pisa, ITA
| | - Marianna Abelli
- Department of Experimental Medicine, University of Pisa, Pisa, ITA
| | - Giulia Amatori
- Department of Experimental Medicine, University of Pisa, Pisa, ITA
| | - Ivan Cremone
- Department of Experimental Medicine, University of Pisa, Pisa, ITA
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Kendler KS, Abrahamsson L, Sundquist J, Sundquist K. The Nature of the Familial Risk for Psychosis in Bipolar Disorder. Schizophr Bull 2024; 50:157-165. [PMID: 37440202 PMCID: PMC10754180 DOI: 10.1093/schbul/sbad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS To clarify whether the familial liability to psychosis associated with bipolar disorder (BD) is nonspecific or has a greater effect on risk for psychosis in cases with prominent mood symptoms and/or a remitting course. STUDY DESIGN We examined, in 984 809 offspring raised in intact families in Sweden, born 1980-1996 and followed-up through 2018, by multivariable Cox proportional hazards regression, risk in offspring of parents with BD for 7 psychotic disorders: Psychotic MD (PMD), psychotic BD (PBD), schizoaffective disorder (SAD), acute psychoses, psychosis NOS, delusional disorder (DD) and schizophrenia (SZ). Diagnoses were obtained from national registers. STUDY RESULTS In the offspring of BD parents, the hazard ratios (HR) for these 7 disorders formed an inverted U-shaped curve, rising from 2.98 for PMD, to peak at 4.49 for PBD and 5.25 for SAD, and then declining to a HR of 3.48 for acute psychoses and 3.22 for psychosis NOS, to a low of 2.19 for DD and 2.33 for SZ. A similar pattern of risks was seen in offspring of mothers and fathers affected with BD and in offspring predicted from age at onset in their BD parent. CONCLUSIONS The BD-associated risk for psychosis impacts most strongly on mood disorders, moderately on episodic psychotic syndromes, and least on chronic psychotic disorders. These results support prior clinical studies suggesting a qualitative difference in the familial substrate for psychosis occurring in BD and SZ.
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Affiliation(s)
- Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Linda Abrahamsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Elowe J, Vallat J, Castelao E, Strippoli MPF, Gholam M, Ranjbar S, Glaus J, Merikangas K, Lavigne B, Marquet P, Preisig M, Vandeleur CL. Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder. Int J Bipolar Disord 2022; 10:31. [PMID: 36528859 PMCID: PMC9760584 DOI: 10.1186/s40345-022-00280-6] [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: 09/20/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The occurrence of psychotic features within mood episodes in patients with bipolar I disorder (BD I) has been associated in some studies with a more severe clinical and socio-professional profile. In contrast, other studies establishing the associations of psychotic features in BD I, and in particular of mood-congruent (MC) and mood-incongruent (MI) features, with clinical characteristics have yielded contradictory results. However, many pre-existing studies have been affected by serious methodological limitations. Using a sample of thoroughly assessed patients with BD I our aims were to: (1) establish the proportion of those with MI and MC features, and (2) compare BD I patients with and without psychotic features as well as those with MI to those with MC features on a wide array of socio-demographic and clinical characteristics including course, psychiatric comorbidity and treatment. METHODS A sample of 162 treated patients with BD I (60.5% female, mean age = 41.4 (s.d: 10.2) years) was recruited within a large family study of mood disorders. Clinical, course and treatment characteristics relied on information elicited through direct diagnostic interviews, family history reports and medical records. RESULTS (1) A total of 96 patients (59.3%) had experienced psychotic features over their lifetime. Among them, 44.8% revealed MI features at least once in their lives. (2) Patients with psychotic features were much less likely to be professionally active, revealed alcohol abuse more frequently and used health care, particularly inpatient treatment, more frequently than those without psychotic features. Within patients with psychotic symptoms, those with MI features showed more clinical severity in terms of a higher likelihood of reporting hallucinations, suicidal attempts and comorbid cannabis dependence. CONCLUSION Our data provide additional support for both the distinction between BD-I with and without psychotic features as well as the distinction between MI and MC psychotic features. The more severe course of patients with psychotic features, and particularly those with MI psychotic features, highlights the need for thorough psychopathological evaluations to assess the presence of these symptoms to install appropriate treatment.
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Affiliation(s)
- Julien Elowe
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Lausanne University Hospital and University of Lausanne, West Sector, Chemin Oscar Forel 3, Prangins, 1197 Canton of Vaud, Switzerland ,grid.9851.50000 0001 2165 4204Department of Psychiatry, Lausanne University Hospital and University of Lausanne, North Sector, Yverdon, Canton of Vaud, Switzerland
| | - Julie Vallat
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Enrique Castelao
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Marie-Pierre F. Strippoli
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Mehdi Gholam
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Setareh Ranjbar
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Jennifer Glaus
- grid.8515.90000 0001 0423 4662Child and Adolescent Psychiatry Clinics, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Kathleen Merikangas
- grid.416868.50000 0004 0464 0574Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD USA
| | - Benjamin Lavigne
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Lausanne University Hospital and University of Lausanne, West Sector, Chemin Oscar Forel 3, Prangins, 1197 Canton of Vaud, Switzerland
| | - Pierre Marquet
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Center for Psychiatric Neuroscience, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland ,grid.23856.3a0000 0004 1936 8390International Research Unit in Neurodevelopment and Child Psychiatry, Laval University, Quebec, Canada
| | - Martin Preisig
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Caroline L. Vandeleur
- grid.9851.50000 0001 2165 4204Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Adhikari S, Ghane N, Ascencio M, Abrego T, Aedma K. Differentiating Childhood-Onset Schizophrenia From Other Childhood Disorders. Cureus 2022; 14:e22594. [PMID: 35371826 PMCID: PMC8958114 DOI: 10.7759/cureus.22594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/21/2022] Open
Abstract
Childhood-onset schizophrenia (COS) is a rare disorder in which symptoms of schizophrenia occur before the age of 13 years. This disorder often has a complicated presentation that can mimic other childhood disorders including post-traumatic stress disorder (PTSD), autism spectrum disorder (ASD), major depressive disorder (MDD) with psychosis, and generalized anxiety disorder (GAD) among others. This is further complicated by the low prevalence rate of COS which limits understanding of the disorder. Accurate and timely diagnosis is crucial as failure to do so has adverse implications for long-term treatment outcomes and prognosis. In this study, a rare case of a 12-year-old girl with childhood-onset schizophrenia and key findings that help differentiate it from other childhood disorders are reviewed to guide diagnosis and treatment.
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Varcin KJ, Herniman SE, Lin A, Chen Y, Perry Y, Pugh C, Chisolm K, Whitehouse AJ, Wood SJ. Occurrence of psychosis and bipolar disorder in adults with autism: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 134:104543. [DOI: 10.1016/j.neubiorev.2022.104543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/17/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
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Burkhardt E, Pfennig A, Leopold K. Clinical Risk Constellations for the Development of Bipolar Disorders. ACTA ACUST UNITED AC 2021; 57:medicina57080792. [PMID: 34440998 PMCID: PMC8399353 DOI: 10.3390/medicina57080792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Abstract
The early recognition of psychiatric disorders has been a focus of research in the last decades and has led to improvements in clinical care, especially in the area of early psychosis. Like non-affective psychosis, bipolar disorders are often diagnosed with a delay that can lead to long periods of untreated illness and impact long-term outcomes. This article presents the rationale for early recognition in bipolar disorder and presents the current evidence for the identification of risk factors, their assessment and validity in predicting the onset of bipolar disorder.
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Affiliation(s)
- Eva Burkhardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Teaching Hospitals of Charité-Universitätsmedizin Berlin, 10967 Berlin, Germany;
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Teaching Hospitals of Charité-Universitätsmedizin Berlin, 10967 Berlin, Germany;
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany;
- Correspondence: ; Tel.: +49-030-130-22-6017
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11
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Martini J, Leopold K, Pfeiffer S, Berndt C, Boehme A, Roessner V, Fusar-Poli P, Young AH, Correll CU, Bauer M, Pfennig A. Early detection of bipolar disorders and treatment recommendations for help-seeking adolescents and young adults: Findings of the Early Detection and Intervention Center Dresden. Int J Bipolar Disord 2021; 9:23. [PMID: 34215910 PMCID: PMC8253866 DOI: 10.1186/s40345-021-00227-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early identification and intervention of individuals with risk factors for or subtle prodromal symptoms of bipolar disorders (BD) may improve the illness course and prevent adverse long-term consequences. Methods We examined sociodemographic, clinical and psychopathological characteristics of help-seeking adolescents and young adults who consulted the Early Detection and Intervention Center Dresden at the University of Dresden (Germany) and presented with or without pre-defined at-risk criteria for BD. The standardized diagnostic procedure for all help-seeking youth included a comprehensive psychiatric history and a structured clinical interview. When BD at-risk state was suspected, early detection instruments (EPIbipolar, BPSS-FP) were applied. Treatment recommendations were formulated in multi-professional case conferences. Results Out of 890 help-seeking persons between 05/2009 and 04/2018, 582 (65%) completed the diagnostic process. Of these, 24 (4%) had manifest BD and 125 (21%) fulfilled at-risk BD criteria (age = 23.9 ± 0.6 years, female = 62%). Of the pre-defined main risk factors, family history for BD was reported in 22% of the at-risk persons, (hypo-)mania risk state in 44%, and increasing cyclothymic mood swings with increased activity in 48%. The most common secondary risk factors were decreased psychosocial functioning (78%), lifetime diagnosis of depressive disorder (67%) and specific sleep/circadian rhythm disturbances (59%). Substance use was very common in subjects at-risk for BD (cannabis = 50%, alcohol = 33%) and highest in patients with BD (cannabis = 75%, alcohol = 40%). Psychiatric treatment history, including psychopharmacological therapy, was similar between the groups, while treatment recommendations differed, with more advice for psychotherapy and antidepressants in the at-risk group with a lifetime diagnosis of depression and more advice for specialized BD treatment including mood stabilizers in patients with BD. Conclusion This analysis on the phenomenology of different BD at-risk stages suggests that early detection of individuals presenting with suggested risk factors for the development of BD is feasible in help-seeking young people. Future research should further develop/test stage-specific prevention and early targeted intervention approaches that were described in a naturalistic setting.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Boehme
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Veit Roessner
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Paolo Fusar-Poli
- Early Psychosis: Intervention and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Christoph U Correll
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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12
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Gao W, Cui D, Jiao Q, Su L, Yang R, Lu G. Brain structural alterations in pediatric bipolar disorder patients with and without psychotic symptoms. J Affect Disord 2021; 286:87-93. [PMID: 33714175 DOI: 10.1016/j.jad.2021.02.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/02/2021] [Accepted: 02/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bipolar disorder (BD) with psychotic symptoms is a specific phenotype that presents greater risk of relapse and worse outcomes than nonpsychotic BD, however, the underlying mechanisms remain unknown and are less revealed in youth. Thus, the aims of the present study were to investigate brain structural alterations in pediatric bipolar disorder (PBD) patients with and without psychotic symptoms, and specifically to evaluate the impact of psychotic features on gray matter volume (GMV) in PBD patients. METHOD A total of 73 individuals were recruited into three groups, n = 28, psychotic PBD, P-PBD; n = 26, nonpsychotic PBD, NP-PBD; and n = 19, healthy controls, HC. All participants underwent high-resolution structural magnetic resonance scans. Voxel-based morphometry was used to investigate GMV alterations. Analyses of variance (ANOVA) were performed to obtain brain regions with significant differences among three groups and then post hoc tests were calculated for inter-group comparisons. RESULTS The ANOVA revealed significant GMV differences among three groups in the bilateral amygdala-hippocampus-parahippocampal complex (AMY-HIS-ParaHIS complex), left superior temporal gyrus (STG), left inferior frontal gyrus (IFG), bilateral putamen (PUT), left precentral gyrus (PG), left supramarginal gyrus (SMG), and right inferior parietal lobule (IPL). Compared with HCs, P-PBD patients showed decreased GMV in the bilateral AMY-HIS-ParaHIS complex, left STG, left IFG, bilateral PUT, and left PG; while NP-PBD patients exhibited decreased GMV in the left IFG, left PG, left SMG, and right IPL. Furthermore, P-PBD patients showed increased GMV in the right IPL when comparing to NP-PBD patients. LIMITATION The present findings require replication in larger samples and verification in medication free subjects. CONCLUSION The present findings suggested that psychotic features in PBD were associated with extensive brain structural lesions mainly located in the prefrontal-limbic-striatum circuit, which might represent the pathological basis of more sever symptoms in patients with psychotic PBD.
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Affiliation(s)
- Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Dong Cui
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong, China
| | - Qing Jiao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong, China.
| | - Linyan Su
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Key Laboratory of Psychiatry and Mental Health of Hunan Province, National Technology Institute of Psychiatry, Changsha, Hunan, China.
| | - Rongwang Yang
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China.
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
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Soni A, Singh P, Kumar S, Shah R, Batra L, Verma M. Role of age at onset in the clinical presentation of bipolar disorder in Indian population. Ind Psychiatry J 2021; 30:41-46. [PMID: 34483523 PMCID: PMC8395538 DOI: 10.4103/ipj.ipj_8_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine any association of age at onset (AAO) with clinical presentation of bipolar disorder (BD) and family history of illness. MATERIALS AND METHODS A hospital-based cross-sectional observational study was conducted including 162 patients having a diagnosis of BD current episode manic. Individuals were divided into three subgroups according to AAO, i.e., early-onset BD (EOBD) (AAO ≤21 years), intermediate-onset BD (AAO - 22-34 years), and late-onset BD (AAO ≥35 years). The subgroups were compared on clinical variables; items of the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and Scale for the Assessment of Positive Symptoms (SAPS); and family history of illness. RESULTS The early-onset group had significantly more episodes per year than the other groups (P < 0.001). The prevalence of family history of mood disorder was also significantly higher in the early-onset group than the other subgroups. AAO was found to be significantly associated with different items of YMRS, HAM-D, and SAPS. The early-onset group had higher rating on irritability, motor activity-energy, sexual interest, depressed mood, delusions, and thought disorders, whereas the late-onset group had higher rating on elevated mood. CONCLUSION EOBD can be considered as a specific phenotype of BD, which is more homogenous, severe, and inheritable form of illness.
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Affiliation(s)
- Ajitabh Soni
- Department of Psychiatry, P.D.U. Medical College, Churu, Rajasthan, India
| | - Paramjeet Singh
- Department of Psychiatry, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Sunil Kumar
- Department of Psychiatry, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Raghav Shah
- Department of Psychiatry, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Lalit Batra
- Department of Psychiatry, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Manoj Verma
- Department of Community Medicine, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
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Masi G, Berloffa S, Muratori P, Mucci M, Viglione V, Villafranca A, Inguaggiato E, Levantini V, Placini F, Pfanner C, D’Acunto G, Lenzi F, Liboni F, Milone A. A Naturalistic Study of Youth Referred to a Tertiary Care Facility for Acute Hypomanic or Manic Episode. Brain Sci 2020; 10:brainsci10100689. [PMID: 33003515 PMCID: PMC7600970 DOI: 10.3390/brainsci10100689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments. Method: 117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5) were included. Results: Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome. Conclusions: Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.
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Affiliation(s)
- Gabriele Masi
- Correspondence: ; Tel.: +39-050-886-111; Fax: +39-050-886-301
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15
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Estrada-Prat X, Van Meter AR, Camprodon-Rosanas E, Batlle-Vila S, Goldstein BI, Birmaher B. Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review. Bipolar Disord 2019; 21:483-502. [PMID: 31025494 PMCID: PMC6768757 DOI: 10.1111/bdi.12785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. METHODOLOGY A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. RESULTS Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. LIMITATIONS Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. CONCLUSION Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.
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Affiliation(s)
- Xavier Estrada-Prat
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Anna R. Van Meter
- The Feinstein Institute for Medical Research, The Zucker Hillside Hospital, Department of Psychiatry Research, Glen Oaks, NY
| | - Ester Camprodon-Rosanas
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Santiago Batlle-Vila
- Institut de Neuropsiquiatria i Addiccions, Centre de Salut Mental Infantil i Juvenil Sant Martí-La Mina i Ciutat Vella, Parc de Salut Mar, Barcelona, Spain
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Sekaninova N, Mestanik M, Mestanikova A, Hamrakova A, Tonhajzerova I. Novel approach to evaluate central autonomic regulation in attention deficit/hyperactivity disorder (ADHD). Physiol Res 2019; 68:531-545. [PMID: 31177787 DOI: 10.33549/physiolres.934160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed developmental disorders in childhood characterized by hyperactivity, impulsivity and inattention. ADHD manifests in the child's development by deficits in cognitive, executive and perceptor-motor functions, emotional regulation and social adaptation. Although the exact cause has not yet been known, the crucial role in the development of this disease plays the interaction of genetic, neurobiological and epigenetic factors. According to current knowledge, ADHD is defined as a biological dysfunction of central nervous system with genetically or organically defined deficits in noradrenergic and dopaminergic neurotransmission associated with structural abnormalities, especially in prefronto-striatal regions. In this context, a significant part of the difficulties could be due to a faulty control of fronto-striato-thalamo-cortical circuits important for attention, arousal and executive functions. Moreover, ADHD is associated with abnormal autonomic regulation. Specifically, reduced cardiac-linked parasympathetic activity associated with relative sympathetic dominance indexed by low heart rate variability can represent a noninvasive marker for prefrontal hypoactivity. However, the mechanisms underlying altered autonomic regulation in ADHD are still unknown. In this aspect, the evaluation of central autonomic regulation by noninvasive methods, namely pupillometry and eye-tracking, may provide novel information for better understanding of the neurobiological pathomechanisms leading to ADHD.
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Affiliation(s)
- N Sekaninova
- Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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17
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Lally J, Ajnakina O, Stubbs B, Cullinane M, Murphy KC, Gaughran F, Murray RM. Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. Br J Psychiatry 2017; 211:350-358. [PMID: 28982659 DOI: 10.1192/bjp.bp.117.201475] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 01/17/2023]
Abstract
BackgroundRemission and recovery rates for people with first-episode psychosis (FEP) remain uncertain.AimsTo assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators.MethodWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators.ResultsSeventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions.ConclusionsRemission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.
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Affiliation(s)
- John Lally
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Olesya Ajnakina
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Michael Cullinane
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kieran C Murphy
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robin M Murray
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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Parenting practices in middle childhood mediate the relation between growing up with a parent having bipolar disorder and offspring psychopathology from childhood into early adulthood. Dev Psychopathol 2017; 30:635-649. [DOI: 10.1017/s095457941700116x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractThe offspring of parents with bipolar disorder (OBD) are at high risk for developing mental disorders. In addition to genetic factors, environmental risk is purported to be associated with these negative outcomes. However, few studies have examined this relation. Using concurrent and longitudinal data, we examined if support, structure, and control provided by parents in middle childhood mediated the relation between having a parent with or without bipolar disorder, and offspring mental health. The sample included 145 offspring (77 OBD, 68 controls) aged 4 to 14 years and their parents. Parent and teacher ratings of child behavior were collected, and diagnostic assessments were conducted in offspring 12 years later (n = 101). Bootstrapping analyses showed that low levels of structure mediated the relation between having a parent with bipolar disorder and elevated internalizing and externalizing difficulties during middle childhood. For the longitudinal outcomes, parental control emerged as the strongest mediator of the relation between parents’ bipolar disorder and offspring psychopathology. Suboptimal childrearing may have different immediate and enduring consequences on mental health outcomes in the OBD. Parental structure has robust effects on emotional and behavioral problems in middle childhood, while levels of control promote psychological adjustment in the OBD as they mature.
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Alamian G, Hincapié AS, Combrisson E, Thiery T, Martel V, Althukov D, Jerbi K. Alterations of Intrinsic Brain Connectivity Patterns in Depression and Bipolar Disorders: A Critical Assessment of Magnetoencephalography-Based Evidence. Front Psychiatry 2017; 8:41. [PMID: 28367127 PMCID: PMC5355450 DOI: 10.3389/fpsyt.2017.00041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/28/2017] [Indexed: 12/21/2022] Open
Abstract
Despite being the object of a thriving field of clinical research, the investigation of intrinsic brain network alterations in psychiatric illnesses is still in its early days. Because the pathological alterations are predominantly probed using functional magnetic resonance imaging (fMRI), many questions about the electrophysiological bases of resting-state alterations in psychiatric disorders, particularly among mood disorder patients, remain unanswered. Alongside important research using electroencephalography (EEG), the specific recent contributions and future promise of magnetoencephalography (MEG) in this field are not fully recognized and valued. Here, we provide a critical review of recent findings from MEG resting-state connectivity within major depressive disorder (MDD) and bipolar disorder (BD). The clinical MEG resting-state results are compared with those previously reported with fMRI and EEG. Taken together, MEG appears to be a promising but still critically underexploited technique to unravel the neurophysiological mechanisms that mediate abnormal (both hyper- and hypo-) connectivity patterns involved in MDD and BD. In particular, a major strength of MEG is its ability to provide source-space estimations of neuromagnetic long-range rhythmic synchronization at various frequencies (i.e., oscillatory coupling). The reviewed literature highlights the relevance of probing local and interregional rhythmic synchronization to explore the pathophysiological underpinnings of each disorder. However, before we can fully take advantage of MEG connectivity analyses in psychiatry, several limitations inherent to MEG connectivity analyses need to be understood and taken into account. Thus, we also discuss current methodological challenges and outline paths for future research. MEG resting-state studies provide an important window onto perturbed spontaneous oscillatory brain networks and hence supply an important complement to fMRI-based resting-state measurements in psychiatric populations.
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Affiliation(s)
- Golnoush Alamian
- Department of Psychology, University of Montreal , Montreal, QC , Canada
| | - Ana-Sofía Hincapié
- Department of Psychology, University of Montreal, Montreal, QC, Canada; Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile; Interdisciplinary Center for Neurosciences, School of Psychology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Etienne Combrisson
- Department of Psychology, University of Montreal, Montreal, QC, Canada; Center of Research and Innovation in Sport, Mental Processes and Motor Performance, University Claude Bernard Lyon I, University of Lyon, Villeurbanne, France; Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, UMR 5292, University of Lyon, Villeurbanne, France
| | - Thomas Thiery
- Department of Psychology, University of Montreal , Montreal, QC , Canada
| | - Véronique Martel
- Department of Psychology, University of Montreal , Montreal, QC , Canada
| | - Dmitrii Althukov
- Department of Psychology, University of Montreal, Montreal, QC, Canada; Department of Computer Sciences, National Research Institution Higher School of Economics, Moscow, Russia; MEG Center, Moscow State University of Pedagogics and Education, Moscow, Russia
| | - Karim Jerbi
- Department of Psychology, University of Montreal, Montreal, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
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Wilens T, Biederman J, Martelon M, Zulauf C, Anderson J, Yule A, Wozniak J, Fried R, Faraone S, Faraone SV. Further Evidence for Smoking and Substance Use Disorders in Youth With Bipolar Disorder and Comorbid Conduct Disorder. J Clin Psychiatry 2016; 77:1420-1427. [PMID: 27574842 PMCID: PMC6410713 DOI: 10.4088/jcp.14m09440] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Bipolar disorder (BPD) is a highly morbid disorder increasingly recognized in adolescents. The aim of this study was to examine the relative risk for substance use disorders (SUDs; alcohol or drug abuse or dependence) and cigarette smoking in adolescents with BPD. METHODS We evaluated the relative risk for SUDs and cigarette smoking in a case-controlled, 5-year prospective follow-up of adolescents with (n = 105, mean ± SD baseline age = 13.6 ± 2.5 years) and without ("controls"; n = 98, baseline age = 13.7 ± 2.1 years) BPD. Seventy-three percent of subjects were retained at follow-up (BPD: n = 68; controls: n = 81; 73% reascertainment). Our main outcomes were assessed by blinded structured interviews for DSM-IV criteria. RESULTS Maturing adolescents with BPD, compared to controls, were more likely to endorse higher rates of SUD (49% vs 26%; hazard ratio [HR] = 2.0; 95% confidence interval (CI), 1.1-3.6; P = .02) and cigarette smoking (49% vs 17%; HR = 2.9; 95% CI, 1.4-6.1; P = .004), as well as earlier onset of SUD (14.9 ± 2.6 [SD] years vs 16.5 ± 1.6 [SD] years; t = 2.6; P = .01). Subjects with conduct disorder (CD) were more likely to have SUD and nicotine dependence than subjects with BPD alone or controls (all P values < .05). When we added conduct disorder to the model with socioeconomic status and parental SUD, all associations lost significance (all P values > .05). Subjects with the persistence of a BPD diagnosis were also more likely to endorse cigarette smoking and SUD in comparison to those who lost a BPD diagnosis or controls at follow-up. CONCLUSIONS The results provide further evidence that adolescents with BPD, particularly those with comorbid CD, are significantly more likely to endorse cigarette smoking and SUDs when compared to their non-mood disordered peers. These findings indicate that youth with BPD should be carefully monitored for comorbid CD and the development of cigarette smoking and SUDs.
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Affiliation(s)
- Timothy Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Harvard Medical School, Boston, MA 02115
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Harvard Medical School, Boston, MA 02115
| | - MaryKate Martelon
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Courtney Zulauf
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Jesse Anderson
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Amy Yule
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA 02114
| | - Stephen Faraone
- Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, 13210
| | - Stephen V Faraone
- Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA
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The Promise and Peril of Emerging Adulthood: Introduction to the Special Issue. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2016.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Knutsson J, Bäckström B, Daukantaitė D, Lecerof F. Adolescent and Family-focused Cognitive-behavioural Therapy for Paediatric Bipolar Disorders: A Case Series. Clin Psychol Psychother 2016; 24:589-617. [DOI: 10.1002/cpp.2027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/12/2016] [Accepted: 05/03/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jens Knutsson
- Department of Psychology; Lund University; Lund Sweden
| | - Beata Bäckström
- Department of Psychoses and Bipolar Disorders; Clinic for Child and Adolescent Psychiatry; Lund Sweden
| | | | - Fredrik Lecerof
- Department of Psychoses and Bipolar Disorders; Clinic for Child and Adolescent Psychiatry; Lund Sweden
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Abstract
Bipolar disorder in youth substantially impairs behavior, family, and social functioning and interferes with developmental course. There is increasing interest in defining a bipolar prodrome similar to that reported in early-onset psychosis that will allow for earlier intervention and reduction in overall morbidity and mortality. Several lines of research have addressed this important issue including studies of offspring of bipolar parents, high-risk cohorts, and longitudinal follow-up of subjects with major depressive disorder (MDD), ADHD, and bipolar spectrum disorder. The development and validation of bipolar prodrome rating scales also shows promise. Recent attempts to intervene at earlier stages of bipolar disorder have led to some positive outcomes. However, a controversy remains concerning the identification and management of the earliest symptoms. Further research is needed to fully validate a bipolar prodrome and to determine the optimal course of action at various stages of illness.
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Du Rocher Schudlich T, Youngstrom EA, Martinez M, KogosYoungstrom J, Scovil K, Ross J, Feeny NC, Findling RL. Physical and sexual abuse and early-onset bipolar disorder in youths receiving outpatient services: frequent, but not specific. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:453-63. [PMID: 25118660 DOI: 10.1007/s10802-014-9924-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to determine if physical and sexual abuse showed relationships to early-onset bipolar spectrum disorders (BPSD) consistent with findings from adult retrospective data. Participants (N = 829, M = 10.9 years old ± 3.4 SD, 60% male, 69% African American, and 18% with BPSD), primarily from a low socio-economic status, presented to an urban community mental health center and a university research center. Physical abuse was reported in 21%, sexual abuse in 20%, and both physical and sexual abuse in 11% of youths with BPSD. For youths without BPSD, physical abuse was reported in 16%, sexual abuse in 15%, and both physical and sexual abuse in 5% of youths. Among youth with BPSD, physical abuse was significantly associated with a worse global family environment, more severe depressive and manic symptoms, a greater number of sub-threshold manic/hypomanic symptoms, a greater likelihood of suicidality, a greater likelihood of being diagnosed with PTSD, and more self-reports of alcohol or drug use. Among youth with BPSD, sexual abuse was significantly associated with a worse global family environment, more severe manic symptoms, a greater number of sub-threshold manic/hypomanic symptoms, greater mood swings, more frequent episodes, more reports of past hospitalizations, and a greater number of current and past comorbid Axis I diagnoses. These findings suggest that if physical and/or sexual abuse is reported, clinicians should note that abuse appears to be related to increased severity of symptoms, substance use, greater co-morbidity, suicidality, and a worse family environment.
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Affiliation(s)
- Tina Du Rocher Schudlich
- Department of Psychology, Western Washington University, MS 9172, 516 High Street, Bellingham, WA, 98225-9172, USA,
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Gignac A, McGirr A, Lam RW, Yatham LN. Course and outcome following a first episode of mania: four-year prospective data from the Systematic Treatment Optimization Program (STOP-EM). J Affect Disord 2015; 175:411-7. [PMID: 25678174 DOI: 10.1016/j.jad.2015.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND First episode mania (FEM) cohorts provide an opportunity to identify windows for intervention to potentially alter the course of bipolar disorder (BD). Despite several efforts to prospectively characterize first episode patients, follow-up of such cohorts has seldom exceeded 1 year. We present 4-year outcomes from the STOP-EM FEM cohort. METHOD Of 101 identified FEM patients, 81 had longitudinal follow-up. Clinical evaluations including substance misuse, sociodemographics and family history were characterized using semi-structured instruments. Clinical reassessments occurred every 6 months. RESULTS Within one year, all patients had remitted and 95% recovered. Recurrence following remission occurred in 58% of patients by 1 year and 74% by 4 years (60% depressive, 28% manic and 12% hypomanic). Recurrence within one year was associated with a higher rate of recurrence thereafter. Older age was associated with a shorter time to remission. Substance misuse was associated with delayed recovery and earlier recurrence. LIMITATIONS This prospective multiwave longitudinal design employed may be limited by the assessment schedule and associated recall bias. The influences of attrition of this sample should be considered when attempting to generalize our findings. CONCLUSIONS Best practices in FEM result in remission and recovery. While recurrence is common, minimizing recurrence within the first year through risk factor modification may alter the course of the BD.
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Affiliation(s)
- Andréanne Gignac
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada; Institut universitaire en santé mentale de Québec, Department of Psychiatry, Université Laval, Quebec City, QC, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Consoli A, Brunelle J, Bodeau N, Louët E, Deniau E, Perisse D, Laurent C, Cohen D. Diagnostic transition towards schizophrenia in adolescents with severe bipolar disorder type I: an 8-year follow-up study. Schizophr Res 2014; 159:284-91. [PMID: 25217364 DOI: 10.1016/j.schres.2014.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The diagnosis of bipolar disorder-I (BD-I) is currently well-established. However, more studies exploring diagnostic stability and psychosocial adaptation during follow-up in adulthood are needed. OBJECTIVES We assessed factors at follow-up (FU): (1) the diagnostic stability of manic/mixed episodes from adolescence to adulthood, (2) psychosocial adaptation, and (3) factors associated with psychosocial adaptation. METHODS A sample of 80 adolescents hospitalized in a university hospital between 1993 and 2004 for a manic or mixed episode were contacted for an FU assessment on average 8 years after the index episode. Assessments included socio-demographic data, mortality, lifetime psychiatric diagnosis, the Social Adaptation Scale, negative life events and insight. RESULTS Of the 64 patients with available information, one patient died from a heart attack. Of the 55 patients available for an FU assessment, 35 (63.6%) still presented a diagnosis of BD-I at FU, whereas 20 (36.4%) had changed diagnosis towards a schizophrenia spectrum disorder. Psychosocial adaptation was moderate to poor for most patients, and 91% of the patients had at least one relapse. A low socio-economic status, intellectual disability, negative life events, a history of sexual abuse, and treatment with classical antipsychotics at FU were significantly associated with poorer psychosocial adaptation. In contrast, better insight, a family history of depression and a diagnosis of BD-I at FU were associated with better psychosocial adaptation. CONCLUSION BD-I in adolescent inpatients can lead to important morbidity and mortality during outcome. Diagnostic stability is high, but a high proportion of patients also show a transition towards a schizophrenia spectrum disorder.
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Affiliation(s)
- Angèle Consoli
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; INSERM U-669, PSIGIAM, Paris F-75679, France.
| | - Julie Brunelle
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CRICM-CNRS, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Estelle Louët
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Laboratoire de Psychopathologie clinique de l'adolescent, Université Paris V, Paris, France
| | - Emmanuelle Deniau
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Didier Perisse
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Claudine Laurent
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CRICM-CNRS, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Malhi GS, Bargh DM, Coulston CM, Das P, Berk M. Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention. Bipolar Disord 2014; 16:455-70. [PMID: 24636153 DOI: 10.1111/bdi.12133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bipolar disorder is a multifaceted illness and there is often a substantial delay between the first onset of symptoms and diagnosis. Early detection has the potential to curtail illness progression and disorder-associated burden but it requires a clear understanding of the initial bipolar prodrome. This article summarizes the phenomenology of bipolar disorder with an emphasis on the initial prodrome, the evolution of the illness, and the implications for prevention and early intervention. METHODS A literature review was undertaken using Medline, Web of Science, and a hand search of relevant literature using keywords (e.g., phenomenology, initial or early symptoms, risk factors, and predictors/prediction). Findings from the literature were reviewed and synthesized and have been put into a clinical context. RESULTS Bipolar disorder is a recurrent, persistent, and disabling illness that typically develops in adolescence or early adulthood. The literature search yielded 28 articles, in which mood lability, nonspecific, non-mood symptoms, and cyclothymic temperament were the most cited prodromal features. CONCLUSIONS A small number of key prospective studies have provided evidence in support of an initial bipolar prodrome; however, methodological differences across studies have prohibited its clear delineation. It is, therefore, not currently possible to anticipate those who will develop bipolar disorder solely on the basis of early phenomenology. Accurate characterization of the bipolar disorder prodrome through high-quality, prospective research studies with adequate control groups will ultimately facilitate prompt and accurate diagnosis.
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Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Bechdolf A, Ratheesh A, Cotton SM, Nelson B, Chanen AM, Betts J, Bingmann T, Yung AR, Berk M, McGorry PD. The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study. Bipolar Disord 2014; 16:493-504. [PMID: 24797824 DOI: 10.1111/bdi.12205] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. METHODS This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. RESULTS A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. CONCLUSIONS These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
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Affiliation(s)
- Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Academic Hospital of Charite Medicine Berlin, Berlin, Germany; Orygen Youth Health Research Centre; Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Uchida M, Faraone SV, Martelon M, Kenworthy T, Woodworth KY, Spencer T, Wozniak J, Biederman J. Further evidence that severe scores in the aggression/anxiety-depression/attention subscales of child behavior checklist (severe dysregulation profile) can screen for bipolar disorder symptomatology: a conditional probability analysis. J Affect Disord 2014; 165:81-6. [PMID: 24882182 PMCID: PMC4066999 DOI: 10.1016/j.jad.2014.04.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/11/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous work shows that children with high scores (2SD, combined score≥210) on the Attention Problems, Aggressive Behavior, and Anxious-Depressed (A-A-A) subscales of the Child Behavior Checklist (CBCL) are more likely than other children to meet criteria for bipolar (BP)-I disorder. However, the utility of this profile as a screening tool has remained unclear. METHODS We compared 140 patients with pediatric BP-I disorder, 83 with attention deficit hyperactivity disorder (ADHD), and 114 control subjects. We defined the CBCL-Severe Dysregulation profile as an aggregate cutoff score of ≥210 on the A-A-A scales. Patients were assessed with structured diagnostic interviews and functional measures. RESULTS Patients with BP-I disorder were significantly more likely than both control subjects (Odds Ratio [OR]: 173.2; 95% Confidence Interval [CI], 21.2 to 1413.8; P<0.001) and those with ADHD (OR: 14.6; 95% CI, 6.2 to 34.3; P<0.001) to have a positive CBCL-Severe Dysregulation profile. Receiver Operating Characteristics analyses showed that the area under the curve for this profile comparing children with BP-I disorder against control subjects and those with ADHD was 99% and 85%, respectively. The corresponding positive predictive values for this profile were 99% and 92% with false positive rates of <0.2% and 8% for the comparisons with control subjects and patients with ADHD, respectively. LIMITATIONS Non-clinician raters administered structured diagnostic interviews, and the sample was referred and largely Caucasian. CONCLUSIONS The CBCL-Severe Dysregulation profile can be useful as a screen for BP-I disorder in children in clinical practice.
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Affiliation(s)
- Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - MaryKate Martelon
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Tara Kenworthy
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Spencer
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Cortical Volume Alterations in Conduct Disordered Adolescents with and without Bipolar Disorder. J Clin Med 2014; 3:416-31. [PMID: 26237382 PMCID: PMC4449697 DOI: 10.3390/jcm3020416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 01/06/2023] Open
Abstract
Background: There is increasing evidence that bipolar disorder (BD) and conduct disorder (CD) are co-occurring disorders. Magnetic resonance imaging has revealed differences in the structure and function of the frontal cortex in these disorders when studied separately; however, the impact of BD comorbidity on brain structure in adolescents with CD has not yet been examined. Method: We conducted an optimized voxel based morphometry (VBM) study of juvenile offenders with the following diagnoses: conduct disorder with comorbid bipolar disorder (CD-BD; n = 24), conduct disorder without bipolar disorder (CD; n = 24) and healthy controls (HC, n = 24). Participants were 13–17 years of age, in a residential treatment facility for repeat offenders. The three groups in this study were similar in age, gender, socioeconomic status and ethnicity. Results: We found CD-BD subjects had decreased volume relative to controls at the voxel level in the right medial prefrontal cortex (PFC). Using a Threshold-Free Cluster Enhancement (TFCE) technique, the CD-BD subjects had significantly decreased volumes of the right medial prefrontal cortex and portions of the superior and inferior frontal gyrus, anterior cingulate and temporal gyrus. The CD subjects did not have differences in brain volume compared to control subjects or CD-BD subjects. Conclusions: Our findings suggest the comorbidity between CD and BD is associated with neurobiological impact namely volumetric differences from healthy controls. Furthermore subjects with this comorbidity had poorer lifetime functioning, more mood and attentional dysfunction, and more medication exposure than subjects with CD who were not BD.
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Difficulties in emotional regulation and substance use disorders: a controlled family study of bipolar adolescents. Drug Alcohol Depend 2013; 132:114-21. [PMID: 23422834 PMCID: PMC3683118 DOI: 10.1016/j.drugalcdep.2013.01.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Self-regulatory mechanisms appear etiologically operant in the context of both substance use disorders (SUD) and bipolar disorder (BD), however, little is known about the role of deficits in emotional self-regulation (DESR) as it relates to SUD in context to mood dysregulation. To this end, we examined to what extent DESR was associated with SUD in a high-risk sample of adolescents with and without BD. METHODS 203 families were assessed with a structured psychiatric interview. Using the Child Behavior Checklist (CBCL), a subject was considered to have DESR when he or she had an average elevation of 1 standard deviation (SD) above the norm on 3 clinical scale T scores (attention, aggression, and anxiety/depression; scores: 60 × 3 ≥ 180). RESULTS Among probands and siblings with CBCL data (N=303), subjects with DESR were more likely to have any SUD, alcohol use disorder, drug use disorder, and cigarette smoking compared to subjects with scores <180 (all p values <0.001), even when correcting for BD. We found no significant differences in the risk of any SUD and cigarette smoking between those with 1SD and 2SD above the mean (all p values >0.05). Subjects with cigarette smoking and SUD had more DESR compared to those without these disorders. CONCLUSIONS Adolescents with DESR are more likely to smoke cigarettes and have SUD. More work is needed to explore DESR in longitudinal samples.
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Chen YC, Kao CF, Lu MK, Yang YK, Liao SC, Jang FL, Chen WJ, Lu RB, Kuo PH. The relationship of family characteristics and bipolar disorder using causal-pie models. Eur Psychiatry 2013; 29:36-43. [PMID: 23871494 DOI: 10.1016/j.eurpsy.2013.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/09/2013] [Accepted: 05/22/2013] [Indexed: 11/15/2022] Open
Abstract
Many family characteristics were reported to increase the risk of bipolar disorder (BPD). The development of BPD may be mediated through different pathways, involving diverse risk factor profiles. We evaluated the associations of family characteristics to build influential causal-pie models to estimate their contributions on the risk of developing BPD at the population level. We recruited 329 clinically diagnosed BPD patients and 202 healthy controls to collect information in parental psychopathology, parent-child relationship, and conflict within family. Other than logistic regression models, we applied causal-pie models to identify pathways involved with different family factors for BPD. The risk of BPD was significantly increased with parental depression, neurosis, anxiety, paternal substance use problems, and poor relationship with parents. Having a depressed mother further predicted early onset of BPD. Additionally, a greater risk for BPD was observed with higher numbers of paternal/maternal psychopathologies. Three significant risk profiles were identified for BPD, including paternal substance use problems (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within the family (6.3%). Our findings demonstrate that different aspects of family characteristics elicit negative impacts on bipolar illness, which can be utilized to target specific factors to design and employ efficient intervention programs.
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Affiliation(s)
- Y-C Chen
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C-F Kao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - M-K Lu
- Department of Health, Jia Nan Mental Hospital, Tainan, Taiwan
| | - Y-K Yang
- Department of Psychiatry, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - S-C Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - F-L Jang
- Department of Psychiatry, Chi Mei Medicine Center, Tainan, Taiwan
| | - W J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - R-B Lu
- Department of Psychiatry, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - P-H Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Salivary cortisol and interpersonal functioning: an event-contingent recording study in the offspring of parents with bipolar disorder. Psychoneuroendocrinology 2013; 38:997-1006. [PMID: 23131593 DOI: 10.1016/j.psyneuen.2012.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/05/2012] [Accepted: 10/05/2012] [Indexed: 11/23/2022]
Abstract
Despite a large body of research in non-human primates, the relationship between naturalistic patterns of social behaviour and basal cortisol levels has been understudied in humans. The present study examined the relationship between patterns of interpersonal functioning and cortisol levels in 23 offspring of parents with bipolar disorder (BD), at high risk for the development of an affective disorder, and 22 offspring of parents with no affective disorder (controls) in late adolescence and young adulthood. Using event-contingent recording, participants rated their dominance, submissiveness, quarrelsomeness, and agreeableness in naturally occurring social interactions over 14 consecutive days and provided salivary cortisol twice daily in the afternoon over the same period. In the full sample, multilevel modelling analyses revealed that dominance was a significant positive predictor of afternoon basal cortisol levels, t(35)=2.58, p<0.05. Moreover, risk group (having a parent with BD or parents with no affective disorder) significantly interacted with mean levels of quarrelsomeness to predict afternoon cortisol levels, t(29)=2.06, p<0.05. Offspring of parents with BD who reported more frequent quarrelsome behaviours exhibited lower levels of afternoon cortisol relative to high-risk offspring reporting few quarrelsome behaviours and control offspring. The results are consistent with evidence that dominance is associated with high cortisol levels in an unstable environment, and suggest that quarrelsomeness among high risk youth contributes to altered hypothalamic-pituitary-adrenal activity.
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Aminoff SR, Hellvin T, Lagerberg TV, Berg AO, Andreassen OA, Melle I. Neurocognitive features in subgroups of bipolar disorder. Bipolar Disord 2013; 15:272-83. [PMID: 23521608 PMCID: PMC3660782 DOI: 10.1111/bdi.12061] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 01/12/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine which subgroups of DSM-IV bipolar disorder (BD) [BD type I (BD-I) or BD type II (BD-II), and subgroups based on history of psychosis, presenting polarity, and age at onset] differentiate best regarding neurocognitive measures. METHODS A total of 199 patients with BD were characterized by clinical and neurocognitive features. The distribution of subgroups in this sample was: BD-I, 64% and BD-II, 36%; 60% had a history of psychosis; 57% had depression as the presenting polarity; 61% had an early onset of BD, 25% had a mid onset, and 14% had a late onset. We used multivariate regression analyses to assess relationships between neurocognitive variables and clinical subgroups. RESULTS Both BD-I diagnosis and elevated presenting polarity were related to impairments in verbal memory, with elevated presenting polarity explaining more of the variance in this cognitive domain (22.5%). History of psychosis and BD-I diagnosis were both related to impairment in semantic fluency, with history of psychosis explaining more of the variance (11.6%). CONCLUSION Poor performance in verbal memory appears to be associated with an elevated presenting polarity, and poor performance in semantic fluency appears to be associated with a lifetime history of psychosis.
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Affiliation(s)
- Sofie Ragnhild Aminoff
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Ullevaal HospitalOslo, Norway
- Division of Mental Health Services, Akershus University HospitalLørenskog, Norway
| | - Tone Hellvin
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Ullevaal HospitalOslo, Norway
- Division of Mental Health Services, Akershus University HospitalLørenskog, Norway
| | - Trine Vik Lagerberg
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Ullevaal HospitalOslo, Norway
| | - Akiah Ottesen Berg
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Ullevaal HospitalOslo, Norway
| | - Ole A Andreassen
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Ullevaal HospitalOslo, Norway
| | - Ingrid Melle
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Ullevaal HospitalOslo, Norway
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Hauser M, Correll CU. The significance of at-risk or prodromal symptoms for bipolar I disorder in children and adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:22-31. [PMID: 23327753 PMCID: PMC4010197 DOI: 10.1177/070674371305800106] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While in the early identification and intervention of psychosis-specific instruments and risk criteria have been generated and validated, research into indicated preventive strategies for bipolar I disorder (BD I) has only recently gained momentum. As the first signs of BD I often start before adulthood, such efforts are especially important in the vulnerable pediatric population. Data are summarized regarding the presence and nature of potentially prodromal, that is, subsyndromal, symptoms prior to BD I, defined by first-episode mania, focusing on pediatric patients. Research indicates the possibility of early identification of youth at clinical high risk for BD. Support for this proposition comes from retrospective studies of BD I patients, as well as prospective studies of community samples, offspring of BD I subjects, youth with depressive disorders, and patients at high risk for psychosis or with bipolar spectrum disorders without lifetime history of mania. These data provide essential insight into potential signs and symptoms that may enable presyndromal identification of BD I in youth. However, except for offspring studies, broader prospective approaches that focus on youth at clinical high risk for BD I and on developing specific interviews and (or) rating scales and risk criteria are mostly missing, or in their early stage. More work is needed to determine valid and sufficiently specific clinical high-risk criteria, to distinguish risk factors, endophenotypes, and comorbidities from prodromal symptomatology, and to develop phase-specific interventions that titrate the risk of intervention to the risk of transition to mania and to functional impairment or distress. Moreover, studies are needed that determine potential differences in prodromal symptoms and trajectories between children, adolescents, and adults, and the best phase-specific interventions.
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Affiliation(s)
- Marta Hauser
- Improve Care, Reduce Costs ICRC Project, The Zucker Hillside Hospital, Division of Psychiatry Research, Glen Oaks, New York, USA
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Skjelstad DV, Holte A, Malt UF. Putative early manifestations of bipolar II disorder emerge later in the initial prodrome than manifestations hypothesized to be unrelated: an exploratory study. Early Interv Psychiatry 2012; 6:460-4. [PMID: 22409302 DOI: 10.1111/j.1751-7893.2012.00348.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Symptom instances characterized as episodic or chronic, and as exaggerated responses to life events or inexplicable (e.g. mood swings, irritability/aggressiveness), may be the most likely early manifestations of the first episode of bipolar II disorder (BD-II). Assuming that symptoms that emerge late in the prodrome, to a larger extent, are early manifestations of the disorder itself, we explore the time of onset and the duration of instances classified as 'likely', 'possible' and 'unlikely' early manifestations. METHODS Retrospective interviews of 15 BD-II patients and 22 family members. RESULTS 'Likely' early manifestations do, to a larger extent than other symptom instances, emerge late in the prodrome. The mean time interval between symptom onset and the first episode is shorter for the 'likely' than for the 'unlikely' early manifestations but is similar to the 'possible' ones. CONCLUSIONS Symptom instances classified as 'likely' early manifestations may be the most useful to prospectively predict BD-II.
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Personality of parents with bipolar disorder and interpersonal functioning among their offspring: a prospective 10-year study. Dev Psychopathol 2012; 24:573-87. [PMID: 22559132 DOI: 10.1017/s095457941200017x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A comparison of offspring of parents with bipolar disorder (OBD) and offspring of parents with no mental disorder (ONMD) showed that parents' neuroticism was associated with internalizing and externalizing problems among their children. The present study examined whether parents' neuroticism predicted poor interpersonal functioning among offspring 10 years later and whether the problems observed in middle childhood mediated the association between parents' neuroticism and offspring functioning. When offspring were in middle childhood, parents completed the revised NEO Personality Inventory and rated the child's behavior on the Child Behavior Checklist. Ten years later, 65 OBD and 59 ONMD completed interviews assessing mental disorders and interpersonal and noninterpersonal functioning. High neuroticism and low agreeableness in parents predicted poor interpersonal functioning in their offspring in late adolescence-early adulthood. The offspring's externalizing and internalizing problems in middle childhood partially mediated the association between parents' personality and offspring interpersonal functioning. Moreover, the association between parents' neuroticism and offspring internalizing problems was stronger among the OBD than the ONMD. Overall, the results suggested an intergenerational transmission of risk whereby high neuroticism and low agreeableness in parents were associated with behavioral problems among offspring in middle childhood that, in turn, predicted poor interpersonal functioning 10 years later.
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Kryzhanovskaya LA, Xu W, Millen BA, Acharya N, Jen KY, Osuntokun O. Comparison of long-term (at least 24 weeks) weight gain and metabolic changes between adolescents and adults treated with olanzapine. J Child Adolesc Psychopharmacol 2012; 22:157-65. [PMID: 22372514 DOI: 10.1089/cap.2010.0020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of these analyses was to compare the weight and other metabolic changes between adolescents and adults during long-term (at least 24 weeks) olanzapine treatment. METHOD The adult database included 86 studies with 12,425 patients with schizophrenia, schizoaffective disorder, depression, borderline personality disorder, or bipolar I disorder; the adolescent database comprised six studies with 489 patients with schizophrenia, schizoaffective disorder, borderline personality disorder, bipolar I disorder, or prodromal psychosis. Patients who had at least 24 weeks of olanzapine exposure (N=4,280 from adult database and N=179 from adolescent database) were analyzed in this study. Weight data were collected for all patients, fasting glucose and lipids data were collected in some patients. For weight gain, data in 34.5% adults (4,280/12,425) and 36.6% adolescents (179/489) were analyzed while for glucose and lipids, data in 8.4% (1,038/12,425) adults and 24.9% adolescents (122/489) were analyzed. Adult patients were treated with oral (5-20 mg/day) or depot formulations (doses equivalent to oral doses of 5-20 mg/day) of olanzapine and adolescent patients were treated with oral olanzapine (2.5-20 mg/day). The incidences of potentially clinically significant categorical changes in weight and metabolic parameters were calculated with a 95% confidence interval (CI). Nonoverlapping 95% CIs were considered as indicating a statistically significant difference. Weight, lipid, and glucose change comparisons are summarized. RESULTS The mean age for adolescents and adults was 15.8 and 38.8, respectively. The percentage of the male population was similar for both adults (58.5%) and adolescents (62.8%). The median duration of the follow-up period was 201 days for adolescent database and 280 days for adult database. The mean weight gain from baseline to endpoint in adolescents was 11.24 kg when compared with 4.81 kg in adults. The 95% CI for adolescents (10.1, 12.4) and adults (4.57, 5.04) are not overlapping, which indicates that the difference between adolescents and adults is statistically significant. The percentage of olanzapine-treated adolescents with ≥ 7% mean weight gain was 89.4% compared with 55.4% in adults (Number need to harm [NNH]=3). Mean changes from baseline to endpoint were also greater for adolescents than for adults in fasting total cholesterol (5.49 mg/dL vs. 2.06 mg/dL), LDL (5.41 mg/dL vs. 0.49 mg/dL), and triglycerides (20.49 mg/dL vs. 16.72 mg/dL), but overlapping 95% CIs were observed for all lipid parameters. Mean changes from baseline to endpoint in fasting glucose values were similar between adolescents and adults (3.13 mg/dL vs. 3.95 mg/dL). However, the incidence of treatment-emergent significant glucose changes was greater in adults. Among olanzapine-treated adults and adolescents, 8.9% and 0.9% experienced a shift from normal to high and 12.5% and 3.3% experienced a shift from normal/impaired glucose tolerance (IGT) to high fasting glucose, respectively. The incidence of IGT to high elevations in glucose was greater in adolescents, but overlapping 95% CI was observed. CONCLUSIONS The types of metabolic changes during the long-term olanzapine treatment in adolescents were similar to those observed in adults. However, the magnitude of changes in weight and lipid parameters was greater in adolescents. Patients should receive regular monitoring of weight, fasting blood glucose, and lipid profile at the beginning of, and periodically during, treatment with olanzapine.
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Carlson GA, Kotov R, Chang SW, Ruggero C, Bromet EJ. Early determinants of four-year clinical outcomes in bipolar disorder with psychosis. Bipolar Disord 2012; 14:19-30. [PMID: 22329469 PMCID: PMC3281503 DOI: 10.1111/j.1399-5618.2012.00982.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Bipolar disorder with psychosis is common in inpatient settings and is associated with diverse outcomes after hospital discharge, which can range from a return to premorbid functioning with no recurrence, to a chronic or recurring illness. Less is known, however, about factors that can predict a better or worse clinical outcome. The present study sought to assess four-year clinical outcomes and their predictors in patients hospitalized for bipolar I disorder with psychosis. METHODS Participants from the Suffolk County Mental Health Project (SCMHP) with a baseline diagnosis of bipolar I disorder with psychotic features (N=126) were reassessed using face-to-face interviews at six months, two years, and four years following their first hospitalization. At each time point, clinical status, role functioning, and treatment were assessed by highly trained interviewers using standardized instruments. RESULTS The majority of participants (73.2%) returned to their premorbid level of role functioning by the four-year follow-up and the median percentage of time ill during the interval was less than 20%. Nevertheless, almost half of the sample (46.9%) was rehospitalized at least once. Psychotic symptoms at baseline (particularly Schneiderian symptoms), depressive phenomenology, childhood psychopathology, and younger age at first hospitalization predicted worse outcome, whereas mood-incongruent psychotic features and age of mood disorder onset did not. CONCLUSIONS The four-year outcomes of a first-admission cohort with bipolar I disorder with psychosis were generally favorable. Poorer premorbid functioning, Schneiderian delusions, greater depressive symptoms, and a younger age of first hospitalization portend a worse course.
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Affiliation(s)
- Gabrielle A Carlson
- Department of Psychiatry and Behavioral Sciences, Stony Brook University School of Medicine, Stony Brook, NY, USA.
| | - Roman Kotov
- Department of Psychiatry and Behavioral Sciences, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Su-Wei Chang
- Institute of Biomedical Sciences, Academia Sinica, Nankang, Taipei, Taiwan
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioral Sciences, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Skjelstad DV, Holte A, Malt UF. Genuine clinical predictors of bipolar II disorder: an exploration of temporal and contextual characteristics. J Affect Disord 2011; 135:419-23. [PMID: 21925738 DOI: 10.1016/j.jad.2011.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Symptoms of the initial prodrome of bipolar disorder (BD) are too nonspecific to reliably prospectively predict BD. An assessment of symptoms' temporal and contextual characteristics may help identify clinical indicators with enhanced predictive power. METHODS Fifteen bipolar II disorder (BD-II) patients and 22 family members were interviewed about characteristics of symptoms that emerged before the first major affective episode (FMAE). The textual data of transcribed interviews were analyzed utilizing qualitative methodology. To identify genuine clinical predictors (GCPs), we outlined three alternative definitions and investigated the extent to which the reported symptoms in different symptom categories survived successively narrower inclusion criteria. RESULTS Most of the reported symptom instances met the broadest GCP criteria as episodic or chronic. "Mood swings" and "irritability/aggressiveness" were the only symptom categories in which most of the reported symptom instances met our intermediate strict criteria as episodic/chronic, and exaggerated/inexplicable. The mood swings were mainly characterized as episodic and occurred for no apparent reason; conversely, irritability and aggressiveness were typically characterized as episodic and exaggerated responses to life events. LIMITATIONS This is a retrospective and hypothesis-generating study. CONCLUSIONS Recurrent mood swings and irritability/aggressiveness are characterized as inexplicable and exaggerated responses, respectively, and may be the most prominent genuine clinical predictors of the FMAE of BD-II. Future studies need to investigate the extent to which the presence of different characteristics of the same symptoms discriminate between individuals who later develop BD and those who do not.
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Affiliation(s)
- Dag V Skjelstad
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, P.O. Box 135, NO 3401-Lier, Norway.
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Skjelstad DV, Malt UF, Holte A. Symptoms and behaviors prior to the first major affective episode of bipolar II disorder. An exploratory study. J Affect Disord 2011; 132:333-43. [PMID: 21435726 DOI: 10.1016/j.jad.2011.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND Few studies have investigated the initial prodrome of bipolar disorders, and none has explicitly addressed bipolar II disorder (BD-II). We explored symptoms and behaviors preceding the first major affective episode (FMAE) of BD-II to generate hypotheses concerning possible clinical targets for early intervention. METHODS In-depth interviews of 15 BD-II patients and 22 family informants were carried out. Clinical diagnoses were reassessed. The textual data of transcribed interviews were analyzed utilizing qualitative methodology supplemented by quantitative analyses. RESULTS All patients experienced clinically significant symptoms and behaviors at an average of more than a decade before the FMAE. Anxiety and depression-type symptoms were the most common. Two distinct subgroups were identified based on prominent and enduring personal characteristics prior to the FMAE. The individuals in one of the subgroups were described as very well-functioning, whereas the individuals in the other subgroup were characterized by neurocognitive deficits, relatively low academic and social functioning, and pronounced irritability and aggressiveness. Furthermore, it is possible that these individuals experience earlier prodromal symptom onset, earlier FMAEs, and more symptoms than individuals without these characteristics. LIMITATIONS This is a retrospective and hypothesis-generating qualitative study. The hypotheses generated need to be tested in future studies. CONCLUSIONS Prodromal clinical phenomenology is too nonspecific to predict the occurrence of the FMAE of BD-II. However, identifiable subgroups may exist. We hypothesize that neurocognitive deficits together with pronounced irritability and aggressiveness may constitute a vulnerability marker for a subgroup of individuals who subsequently develop BD-II. This subgroup may be of potential interest for early identification.
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Chien J. Ethosuximide-induced mania in a 10-year-old boy. Epilepsy Behav 2011; 21:483-5. [PMID: 21689989 DOI: 10.1016/j.yebeh.2011.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/05/2011] [Accepted: 05/06/2011] [Indexed: 11/25/2022]
Abstract
Psychosis and suicidal ideation have been reported as side effects of ethosuximide treatment, but previous reports seldom place these symptoms in the context of mania. Given the recent renewed interest in ethosuximide as first-line therapy in children and adolescents, it is important for clinicians to be aware of the potential psychiatric complication of mania with this medication. Described here is the case of a 10-year-old boy who developed acute mania, as well as psychotic symptoms and suicidal ideation, on ethosuximide.
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Affiliation(s)
- Joseph Chien
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
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Salvatore P, Tohen M, Khalsa HMK, Baethge C, Tondo L, Baldessarini RJ. Longitudinal research on bipolar disorders. ACTA ACUST UNITED AC 2011; 16:109-17. [PMID: 17619540 DOI: 10.1017/s1121189x00004711] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractLongitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from first hospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.
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Macneil CA, Hasty MK, Berk M, Henry L, Evans M, Redlich C, Daglas R, McGorry PD, Conus P. Psychological needs of adolescents in the early phase of bipolar disorder: implications for early intervention. Early Interv Psychiatry 2011; 5:100-7. [PMID: 21535422 DOI: 10.1111/j.1751-7893.2011.00273.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper will describe the rationale for, and importance of, psychological interventions for young people early in the course of bipolar disorder. METHODS Emerging literature in this field will be discussed in addition to describing specific clinical challenges and opportunities with this population. RESULTS In order to be more developmentally appropriate for young people with bipolar disorder, eight aspects of clinical work which may require modification were identified. CONCLUSIONS The evidence base for the effectiveness of psychological interventions for people diagnosed with bipolar disorder is growing. However, some aspects relating to working with adults with bipolar disorder require modification to be effective in working with young people early in the course of the disorder.
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Knowles R, McCarthy-Jones S, Rowse G. Grandiose delusions: a review and theoretical integration of cognitive and affective perspectives. Clin Psychol Rev 2011; 31:684-96. [PMID: 21482326 DOI: 10.1016/j.cpr.2011.02.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/01/2010] [Accepted: 02/23/2011] [Indexed: 01/05/2023]
Abstract
Grandiose delusions (GDs) are found across a wide range of psychiatric conditions, including in around two-thirds of patients diagnosed with bipolar disorder, half of patients diagnosed with schizophrenia, as well as in a substantial proportion of patients with substance abuse disorders. In addition, over 10% of the healthy general population experience grandiose thoughts that do not meet full delusional criteria. Yet in contrast to other psychotic phenomena, such as auditory hallucinations and persecutory delusions, GDs have received little attention from researchers. This paper offers a comprehensive examination of the existing cognitive and affective literature on GDs, including consideration of the evidence in support of 'delusion-as-defence' and emotion-consistent' models. We then propose a tentative model of GDs informed by a synthesis of the available evidence designed to be a stimulus to future research in this area. As GDs are considered to be relatively resistant to traditional cognitive behavioural techniques, we then discuss the implications of our model for how CBT may be modified to address these beliefs. Directions for future research are also highlighted.
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Hua LL, Wilens TE, Martelon M, Wong P, Wozniak J, Biederman J. Psychosocial functioning, familiality, and psychiatric comorbidity in bipolar youth with and without psychotic features. J Clin Psychiatry 2011; 72:397-405. [PMID: 21450156 PMCID: PMC3740758 DOI: 10.4088/jcp.10m06025yel] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/04/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Few studies have examined the correlates of psychosis in children and adolescents with bipolar disorder (BPD). We examined psychiatric comorbidity, familiality, and psychosocial functioning in multiple domains in BPD children and adolescents with and without psychotic features. METHOD As part of 2 ongoing family-based studies of children and adolescents with DSM-IV-defined BPD, we compared youth and their families with psychotic symptoms (BPD+P) and without psychotic symptoms (BPD-P). All youth and family members were assessed using indirect and direct structured psychiatric interviews (Kiddie Schedule for Affective Disorders-Epidemiologic Version and DSM-IV Structured Clinical Interview) in a blinded manner. One study was conducted from January 2000 through December 2004, and the other study was conducted from February 1997 through September 2006. RESULTS Of the 226 youth with BPD, 33% manifested psychotic symptoms, as defined by the presence of hallucinations or delusions. We found that BPD+P youth had a greater number of BPD episodes (P < .01), more psychiatric hospitalizations (P < .01), and significantly higher rates of psychiatric comorbidity compared to BPD-P youth (all P values < .05). Additionally, a higher percentage of BPD+P youth had a family history of psychosis (P = .01). There was a lower processing speed (P = .03) and lower arithmetic scaled score (P = .04) in BPD+P youth, but no other meaningful differences in cognitive variables were identified between the 2 BPD groups. Psychosis in BPD was also associated with decreased family cohesion (P = .04) and poorer overall global functioning (P < .01). CONCLUSIONS In children and adolescents with BPD, those who manifest psychotic features have higher rates of comorbid psychopathology, family history of psychosis, and poorer overall functioning in multiple domains than BPD children without psychosis. Future studies should examine neuroimaging correlates, medication response, and longitudinal course of children and adolescents with BPD who manifest psychosis as part of their clinical picture.
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Affiliation(s)
- Liwei L Hua
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
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Azorin JM, Kaladjian A, Adida M, Fakra E, Hantouche E, Lancrenon S. Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients. Eur Psychiatry 2011; 27:557-62. [PMID: 21292450 DOI: 10.1016/j.eurpsy.2010.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition. METHODS One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics. RESULTS Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year. CONCLUSION In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.
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Affiliation(s)
- J M Azorin
- SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique-Hôpitaux de Marseille, 13274 Marseille cedex 9, France.
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Holtmann M, Buchmann AF, Esser G, Schmidt MH, Banaschewski T, Laucht M. The Child Behavior Checklist-Dysregulation Profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis. J Child Psychol Psychiatry 2011; 52:139-47. [PMID: 20854363 DOI: 10.1111/j.1469-7610.2010.02309.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have identified a Child Behavior Checklist profile that characterizes children with severe affective and behavioral dysregulation (CBCL-dysregulation profile, CBCL-DP). In two recent longitudinal studies the CBCL-DP in childhood was associated with heightened rates of comorbid psychiatric disorders, among them bipolar disorder, an increased risk for suicidality, and marked psychosocial impairment at young-adult follow-up. This is the first study outside the US that examines the longitudinal course of the CBCL-DP. METHODS We studied the diagnostic and functional trajectories and the predictive utility of the CBCL-DP in the Mannheim Study of Children at Risk, an epidemiological cohort study on the outcome of early risk factors from birth into adulthood. A total of 325 young adults (151 males, 174 females) participated in the 19-year assessment. RESULTS Young adults with a higher CBCL-DP score in childhood were at increased risk for substance use disorders, suicidality and poorer overall functioning at age 19, even after adjustment for parental education, family income, impairment and psychiatric disorders at baseline. Childhood dysregulation was not related to bipolar disorder in young adulthood. The CBCL-DP was neither a precursor of a specific pattern of comorbidity nor of comorbidity in general. CONCLUSIONS Children with high CBCL-DP values are at risk for later severe, psychiatric symptomatology. The different developmental trajectories suggest that the CBCL-DP is not simply an early manifestation of a single disease process but might rather be an early developmental risk marker of a persisting deficit of self-regulation of affect and behavior.
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Affiliation(s)
- Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
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Excessive cannabis use is associated with earlier age at onset in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2011; 261:397-405. [PMID: 21267743 PMCID: PMC3159738 DOI: 10.1007/s00406-011-0188-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 01/05/2011] [Indexed: 01/17/2023]
Abstract
The aim of the study was to investigate which factors are associated with age at onset in bipolar disorder with a specific focus on excessive alcohol and cannabis use, and the sequence of the onsets of excessive substance use and bipolar disorder. We investigated a naturalistic sample of 151 patients with bipolar I and II disorder receiving psychiatric treatment. Whether the presence of excessive substance use prior to bipolar disorder onset or the type of substance used (alcohol or cannabis) was associated with differences in age at onset was investigated using hierarchical and multiple linear regression analyses, adjusting for potential confounders. Patients with excessive alcohol use had a significantly later onset compared with patients with excessive cannabis use. Excessive general substance use prior to bipolar disorder onset was associated with a later onset. However, excessive cannabis use was associated with an earlier onset whether it preceded or followed bipolar disorder onset, also after adjusting for possible confounders. Excessive use of alcohol or other substances was not independently associated with age at onset in multivariate analyses. Alcohol use was associated with a later onset compared with cannabis use, suggesting different relationships to the onset of bipolar disorder. Lifetime use of cannabis predicted an earlier onset, independent of the sequence of onsets. This indicates that an early onset may increase the risk of cannabis use and that cannabis use may trigger bipolar disorder in vulnerable individuals.
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Rockhill CM. In this issue/Abstract thinking: Persistence of symptoms in child psychiatry. J Am Acad Child Adolesc Psychiatry 2010; 49:531-2. [PMID: 20494262 DOI: 10.1016/j.jaac.2010.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 03/22/2010] [Indexed: 11/25/2022]
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