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M’Bailara K, Munuera C, Weil F, Passerieux C, Roux P. Discrete early maladaptive schema subgroups in remitted bipolar disorders: association with neuropsychological performance, residual symptoms, and psychosocial functioning. Front Psychol 2025; 16:1476345. [PMID: 40171073 PMCID: PMC11958715 DOI: 10.3389/fpsyg.2025.1476345] [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] [Received: 08/05/2024] [Accepted: 02/25/2025] [Indexed: 04/03/2025] Open
Abstract
Objectives To better understand the disability and heterogeneity in terms of residual symptoms and psychosocial and cognitive functioning in bipolar disorders (BD), individual discrepancies in the activation of early maladaptive schemas (EMS) are relevant to investigate. This study aimed to identify activation profiles of EMS and to investigate the association between identified profiles and disability during euthymia. Design This is a cross-sectional study. Methods Clinical data, psychosocial functioning, neuropsychological performance and EMS were collected in euthymic outpatients with a BD. Clustering was performed on EMS activation, followed by inter-cluster comparisons on variables above using post-hoc tests. A multivariate regression was used to confirm associations between clusters and variables of interest by controlling for covariates. Results Thanks to a person-oriented approach, our results showed three profiles of EMS: "Hypoactivation," "Light activation." and "Major Hyperactivation." Individuals in the light and major hyper activated clusters had worse psychosocial functioning compared to individuals in the hypoactivated cluster. There were no differences in neuropsychological performance between the different profiles of EMS, thus suggesting the independence of these sources of variance in psychosocial functioning of individuals with BD. Conclusion This paper highlights the importance of considering individual personality and functioning to better understand the heterogeneity in BD during euthymia. For some people, schema therapy seems particularly relevant due to the overactivation of EMS, and even more so because these people have particularly marked functional impairments and clinical severity.
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Affiliation(s)
- Katia M’Bailara
- University of Bordeaux, LabPsy, Bordeaux, France
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, Créteil, France
- Pôle PGU, Centre Hospitalier Charles Perrens, Bordeaux, France
| | | | - François Weil
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d’Adulte et d’Addictologie, Le Chesnay, France
- Faculté de Médecine Paris-Saclay - Université Paris-Saclay, Le Kremlin Bicetre, France
- UFR Simone Veil Santé, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Christine Passerieux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d’Adulte et d’Addictologie, Le Chesnay, France
- Faculté de Médecine Paris-Saclay - Université Paris-Saclay, Le Kremlin Bicetre, France
- UFR Simone Veil Santé, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
- DisAP - Moods - CESP, INSERM UMR1018, Villejuif, France
| | - Paul Roux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d’Adulte et d’Addictologie, Le Chesnay, France
- Faculté de Médecine Paris-Saclay - Université Paris-Saclay, Le Kremlin Bicetre, France
- UFR Simone Veil Santé, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
- DisAP - Moods - CESP, INSERM UMR1018, Villejuif, France
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Yeşilkaya C, Alarslan S, Tuncturk M, Ermis C, Turan S, Karacetin G. Cognitive function and social cognition in adolescents with bipolar disorder: comparison between manic episode and remission period. Eur Arch Psychiatry Clin Neurosci 2025:10.1007/s00406-025-01987-0. [PMID: 40029397 DOI: 10.1007/s00406-025-01987-0] [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: 11/21/2024] [Accepted: 02/19/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND We aimed to investigate the extent of cognitive impairments in early-onset bipolar disorder (EBD) during manic episode in comparison to remission period. METHOD 30 healthy controls (HC) and 95 patients with EBD, with manic episode (n = 55) and remission period (n = 40) were included. Additionally, 31 (%56.4) of 55 patients with manic episode were re-evaluated during remission. A comprehensive cognitive battery was implemented to asses verbal and visual learning/memory, attention, inhibition, problem-solving, working memory, processing speed, and verbal fluency skills and global cognitive factor was calculated to estimate overall cognitive ability. Theory of mind (ToM) was evaluated using the Reading the Mind in the Eyes and Faux-Pas tests. FINDINGS Individuals in patient groups and HC were matched for gender and education. Patients in remission had a significantly older mean age than the other groups. Antipsychotic dosage was also higher in cases with mania. Patients with manic episode had moderate impairments in processing speed (Cohen's d: 0.51-0.78), attention (d: 0.57), inhibition (d: 0.56-0.63) and global cognitive function (d: 0.54) compared to patients in remission period. Individuals in remission period had poorer performance in verbal memory (d: 1.03-1.32), working memory (d: 0.88-1.13), ToM (d: 0.60-0.87), processing speed (d: 1.21-1.27), problem solving (d: 0.56-0.67), attention (d: 0.58), inhibition (d: 0.89-1.00) and visual memory (d: 1.28-1.37) in comparison with HC. CONCLUSION Our findings indicated that impairments in social cognition, processing speed, inhibition, and attention were more prominent in the manic episode. Future studies should focus on pharmaco- and psychotherapeutic interventions aimed to treat neurocognitive impairments.
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Affiliation(s)
- Celal Yeşilkaya
- Department of Child and Adolescent Psychiatry, Konya Ereğli State Hospital, Konya, Turkey.
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, Konya Ereğli State Hospital, Konya, Turkey
| | - Mustafa Tuncturk
- Department of Psychiatry and Psychology, Mayo Clinic, Minnesota, United States of America
| | - Cagatay Ermis
- Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludağ University School of Medicine, Bursa, Turkey
| | - Gul Karacetin
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Bora E. A meta-analysis of data-driven cognitive subgroups in bipolar disorder. Eur Neuropsychopharmacol 2025; 90:48-57. [PMID: 39509830 DOI: 10.1016/j.euroneuro.2024.10.008] [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: 06/29/2024] [Revised: 10/13/2024] [Accepted: 10/16/2024] [Indexed: 11/15/2024]
Abstract
The delineation of cognitive subgroups of bipolar disorder (BD) might be helpful for identifying biologically valid subtypes of this disorder. This meta-analysis identified peer-reviewed literature on studies investigating cognitive subgroups of BD with data-driven clustering methods. Relevant studies were searched in PubMed, Scopus, and Web of Science. Random-effects meta-analysis was performed using R software. A total of 14 cross-sectional studies including euthymic or mildly symptomatic patients with BD were included in the current meta-analysis. The available studies have consistently supported a 3-cluster solution. The pooled prevalence of the severe-impairment, moderate-impairment, and major good-functioning groups were 23.1 % (95%CI, 18.5 %-27.7 %), 42.5 % (95%CI, 36.3 %-48.8 %), and 33.5 % (95%CI, 25.9 %-41.1 %) respectively. Compared to healthy controls, both the severe-impairment (g=-1.40 to -1.73) and moderate-impairment groups (g=-0.59 to -0.96) had significant deficits in all six cognitive domains (verbal memory, visual memory, executive functions, working memory, attention and processing speed). The good-performance subgroup had a small increase in the performance of executive functions (g=0.23) and normal functioning in all other domains. Compared to the good-performance subgroup, the severe-impairment subgroup was characterized by more severe functional impairment, more hospital admissions, a higher percentage of type I BD and antipsychotic use. The characteristics of the moderate-impairment subgroup were lying between the other two subgroups for most of the measures. The current findings support the existence of 3 cognitive subgroups in BD including severe-impairment and moderate-impairment groups which are associated with a more severe course of illness.
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Affiliation(s)
- E Bora
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, 3053, Australia.
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Pastuszak M, Cubała WJ, Kwaśny A. Residual Depressive Symptoms in Treatment-Resistant Bipolar Depression Following Short-Term Ketamine Administration. Drugs Real World Outcomes 2024; 11:565-571. [PMID: 39269606 PMCID: PMC11589017 DOI: 10.1007/s40801-024-00453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Residual symptoms are frequently observed in a significant number of patients with depression, indicating an unmet need for effective management strategies to achieve functional recovery. OBJECTIVE This observational study aimed to evaluate the impact of ketamine infusions on depressive symptoms in patients with bipolar disorder who continued their baseline psychotropic and chronic somatic treatments. METHODS Datasets of the two consecutive real-world registries (NCT04226963 for 2019-2022; NCT05565352 from 2023 onward) for the tertiary reference center for psychiatry at the Medical University of Gdańsk (Poland) for the safety and tolerability of ketamine use in mood and anxiety disorders were retrospectively analyzed. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Residual symptoms were identified in patients who achieved a treatment response, defined as a 50% or greater reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to the seventh infusion. RESULTS Overall, 14 out of 22 patients met the criteria for response. The most commonly persistent depressive symptoms included sad mood (85.7%), view of my future (78.6%), difficulty falling asleep, and leaden paralysis/physical energy (both 71.4%), with the most severe being difficulty falling asleep (64.3%) and sad mood (42.9%). CONCLUSIONS This observational post hoc analysis indicates that the most frequently observed residual depressive symptoms were low mood, altered view of future, sleep disturbances, and low energy levels. This study should be treated with caution as causality does not apply, however, it reports on a real-world population of subjects with treatment-resistant bipolar depression. Establishing standardized definitions for residual symptoms could enhance the quality and comparability of future research in this area.
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Affiliation(s)
- Michał Pastuszak
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214, Gdańsk, Poland
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214, Gdańsk, Poland
| | - Aleksander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214, Gdańsk, Poland.
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Bruun CF, Zarp J, Lyng Forman J, Coello K, Miskowiak KW, Vinberg M, Faurholt-Jepsen M, Kessing LV. Effects of low-dose aspirin in bipolar disorder: study protocol for a randomised controlled trial (the A-Bipolar RCT). BMJ Open 2024; 14:e084105. [PMID: 39557557 PMCID: PMC11575337 DOI: 10.1136/bmjopen-2024-084105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 10/21/2024] [Indexed: 11/20/2024] Open
Abstract
INTRODUCTION Accumulating data support the association between increased inflammation and bipolar disorder (BD), and preliminary data suggest that augmentation with low-dose aspirin (LDA) may protect against the onset and deterioration of BD via anti-inflammatory pathways. The A-bipolar randomised controlled trial (RCT) aims to investigate whether adding LDA to standard treatment improves day-to-day mood instability (MI) in BD. METHODS AND ANALYSIS A two-arm, triple-blind, parallel-group, superiority RCT including 250 patients with newly diagnosed BD treated at the Copenhagen Affective Disorder Clinic, Denmark. Participants are randomised 1:1 to either 150 mg of acetylsalicylic acid daily (LDA) or a placebo for six months in addition to their regular treatment. Mood instability, calculated from daily smartphone-based mood evaluations, is the primary outcome measure due to its internal validity as a real-life measure for patients and external validity as it reflects patients' illness severity and functioning. Analyses will be conducted as intention-to-treat analyses using a linear mixed model including time (categorical) and the time-treatment interaction as fixed effects and with an unstructured covariance pattern to account for repeated measurements on each study participant. The trial is Good Clinical Practice monitored. ETHICS AND DISSEMINATION The Danish Research Ethics Committee (H-21014515) and the data agency, Capital Region of Copenhagen (P-2021-576) approved the trial. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05035316.
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Affiliation(s)
- Caroline Fussing Bruun
- Psychiatric Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeff Zarp
- Psychiatric Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Klara Coello
- Psychiatric Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Social Sciences, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center North Zeeland, The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, DenmarK, Hillerød, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mishra J, Kaur N, Tyagi S, Gupta N. Behavioral Management in the Rehabilitation of a Person with Severe Mental Illness: The Path Less Travelled. Indian J Psychol Med 2024:02537176241273712. [PMID: 39564295 PMCID: PMC11572371 DOI: 10.1177/02537176241273712] [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] [Indexed: 11/21/2024] Open
Abstract
In severe mental illness (SMI), such as schizophrenia, rehabilitation begins immediately. Aside from the token economy, there is limited literature on behavioral modification (BM), which is a crucial aspect of rehabilitation for person with severe mental illness (SMI). We demonstrate the implementation and effectiveness of BM for one year in managing behavioral difficulties in a person with SMI. The direct observation method and the ABC functional analysis model were used for evaluation. Management, such as reinforcement and punishment, was implemented. Pre- and postassessments revealed a considerable decrease in problematic behaviors. This article also highlights the obstacles faced while managing the case and caregiver burden in rehabilitation. In persons with SMI, the application of BM enhances the patient's functionality and reduces the caregiver burden.
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Affiliation(s)
| | | | | | - Nitin Gupta
- Dept. of Psychiatry, GMCH, Chandigarh, India
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McIntyre RS, Davis B, Rodgers J, Rekeda L, Adams J, Yatham LN. Cariprazine as a maintenance therapy in the prevention of mood episodes in adults with bipolar I disorder. Bipolar Disord 2024; 26:442-453. [PMID: 38609342 DOI: 10.1111/bdi.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Cariprazine treats acute manic and depressive episodes in bipolar I disorder (BP-I), but its efficacy in preventing relapse of mood episode remains unknown. METHODS In this phase 3b, double-blind, placebo-controlled study, patients with BP-I with acute manic or depressive episodes (each with/without mixed features), were treated with cariprazine 3.0 mg/day during a 16-week open-label treatment period; those who achieved stable remission within 8 weeks and remained stable for at least another 8 weeks were randomized to receive cariprazine 1.5 or 3.0 mg per day or placebo in the double-blind treatment period for up to 39 weeks. The primary efficacy endpoint was time to relapse of any mood episode. Adverse events (AEs) were assessed. RESULTS Patients (440/896) enrolled in the open-label treatment period achieved stability criteria and were randomized to receive cariprazine 3.0 mg/day (n = 148), cariprazine 1.5 mg/day (n = 147), or placebo (n = 145) in the double-blind treatment period. Relapse rates were 17.9%, 16.8%, and 19.7% in the cariprazine 3.0 mg/day, cariprazine 1.5 mg/day, and placebo groups, respectively. Neither dose of cariprazine was more effective than placebo on the primary outcome (3.0 mg/day: HR = 0.89, [95% CI: 0.5, 1.5]; 1.5 mg/day: HR = 0.83, 95% CI [0.5, 1.4]). The most frequently reported AEs (≥5%) were akathisia, headache, insomnia, and nausea in the open-label treatment period and increased weight and insomnia in the double-blind treatment period. In the open-label and double-blind treatment periods, 7.5% and 1.6% of patients experienced an AE leading to discontinuation. CONCLUSION Cariprazine was not superior to placebo in the prevention of relapses in this study. Relapse rates were unusually low in the placebo group. Cariprazine was well-tolerated.
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Affiliation(s)
| | - Bethany Davis
- Accelerated Enrollment Solutions, Atlanta, Georgia, USA
| | | | | | | | - Lakshmi N Yatham
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, Canada
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Primavera D, Urban A, Cantone E, Nonnis M, Aviles Gonzalez CI, Perra A, Tusconi M, Sancassiani F. The Impact on Anxiety Symptoms of an Immersive Virtual Reality Remediation Program in Bipolar Disorders: A Randomized Clinical Trial. J Clin Med 2024; 13:4203. [PMID: 39064243 PMCID: PMC11277986 DOI: 10.3390/jcm13144203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose comorbidity could be identified as an anxiety disorder. Methods: The experimental intervention included 24 sessions (around 45 min each), two for each week over three months. The entire program was inspired by user-centered rehabilitation principles in a recovery-oriented perspective and an approach to bipolar disorder in an evolutionary and non-discriminating vision. The primary outcomes measure the score of the Zung Self-Rating Anxiety Scale (SAS), hypothesizing a higher decrease in the experimental group than in the control group. The survey has been conducted per the CONSORT guidelines for feasibility studies. Results: We evaluate a decrease in the overall SAS score from T0 to T1 to be higher in the experimental group compared to the control group, indicating an improvement in anxiety symptoms (p < 0.0001). Conclusions: The study suggests that virtual reality could have a role in treating anxiety symptoms and disorders in young adults with bipolar disorders or anxiety symptoms in people with hyperactivity and novelty-seeking behaviorsunder stress and high risk for bipolar disorder.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Antonio Urban
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- University Hospital of Cagliari, 09042 Cagliari, Italy
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Marcello Nonnis
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy;
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- Department of Nursing, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | | | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
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Jonsson L, Hörbeck E, Primerano A, Song J, Karlsson R, Smedler E, Gordon-Smith K, Jones L, Craddock N, Jones I, Sullivan PF, Pålsson E, Di Florio A, Sparding T, Landén M. Association of Occupational Dysfunction and Hospital Admissions With Different Polygenic Profiles in Bipolar Disorder. Am J Psychiatry 2024; 181:620-629. [PMID: 38859703 DOI: 10.1176/appi.ajp.20230073] [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] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Many but not all persons with bipolar disorder require hospital care because of severe mood episodes. Likewise, some but not all patients experience long-term occupational dysfunction that extends beyond acute mood episodes. It is not known whether these dissimilar outcomes of bipolar disorder are driven by different polygenic profiles. Here, polygenic scores (PGSs) for major psychiatric disorders and educational attainment were assessed for associations with occupational functioning and psychiatric hospital admissions in bipolar disorder. METHODS A total of 4,782 patients with bipolar disorder and 2,963 control subjects were genotyped and linked to Swedish national registers. Longitudinal measures from at least 10 years of registry data were used to derive percentage of years without employment, percentage of years with long-term sick leave, and mean number of psychiatric hospital admissions per year. Ordinal regression was used to test associations between outcomes and PGSs for bipolar disorder, schizophrenia, major depressive disorder, attention deficit hyperactivity disorder (ADHD), and educational attainment. Replication analyses of hospital admissions were conducted with data from the Bipolar Disorder Research Network cohort (N=4,219). RESULTS Long-term sick leave and unemployment in bipolar disorder were significantly associated with PGSs for schizophrenia, ADHD, major depressive disorder, and educational attainment, but not with the PGS for bipolar disorder. By contrast, the number of hospital admissions per year was associated with higher PGSs for bipolar disorder and schizophrenia, but not with the other PGSs. CONCLUSIONS Bipolar disorder severity (indexed by hospital admissions) was associated with a different polygenic profile than long-term occupational dysfunction. These findings have clinical implications, suggesting that mitigating occupational dysfunction requires interventions other than those deployed to prevent mood episodes.
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Affiliation(s)
- Lina Jonsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Elin Hörbeck
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Amedeo Primerano
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Jie Song
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Robert Karlsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Erik Smedler
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Katherine Gordon-Smith
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Lisa Jones
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Nicholas Craddock
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Ian Jones
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Patrick F Sullivan
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Arianna Di Florio
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Timea Sparding
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Jonsson, Hörbeck, Smedler, Pålsson, Sparding, Landén); National Centre for Mental Health, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Primerano, Craddock, I. Jones, Di Florio); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Song, Karlsson, Sullivan, Landén); Mental Health Center and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China (Song); Department of Psychological Medicine, University of Worcester, Worcester, U.K. (Gordon-Smith, L. Jones); Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill (Sullivan)
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10
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Karademir M, Beyazyüz E, Beyazyüz M, Yılmaz A, Albayrak Y. Decreased serum allopregnanolone and progesterone levels in male patients with bipolar disorder and their effects on cognitive functions. Eur Arch Psychiatry Clin Neurosci 2024; 274:515-524. [PMID: 37086304 DOI: 10.1007/s00406-023-01607-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
The progression of bipolar disorder (BD) is characterized by recurrent episodes of depression, mania, and hypomania, thus affecting the daily functionality of individuals. Previous studies have shown that a large proportion of patients diagnosed with BD who are in clinical remission experience significant functional disorders. The present study aimed to investigate the relationships between cognitive impairment and serum progesterone, allopregnanolone and BDNF levels in male bipolar disorder patients who are in the euthymic period. Our study included 41 euthymic male patients with bipolar disorder and 40 age, sex, body mass index (BMI) and smoking-matched male healthy control subjects. Neuropsychiatric tests such as the Stroop Test TBAG Form, Auditory Verbal Digit Span Test- Form B (VADS-B) and Cancellation Test were administered to all participants, and 5-7 ml of peripheral venous blood sample was taken from all participants. Serum allopregnanolone, progesterone and BDNF levels were also measured in all participants. Serum allopregnanolone and progesterone levels were found to be lower in bipolar patients, and it was observed that the serum level of allopregnanolone decreased as the disease duration increased. The serum BDNF levels were similar between groups. The cognitive functions assessed using the Stroop, VADS-B and cancellation tests were found to be better in healthy subjects. The neurocognitive test performances of all participants were strongly positively correlated with allopregnanolone levels. The present study supports the hypothesis that allopregnanolone acts as an endogenous mood stabilizer.
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Affiliation(s)
- Mihrali Karademir
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi 59100, Süleymanpaşa, Tekirdağ, Turkey
| | - Elmas Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi 59100, Süleymanpaşa, Tekirdağ, Turkey
| | - Murat Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi 59100, Süleymanpaşa, Tekirdağ, Turkey
| | - Ahsen Yılmaz
- Faculty of Medicine, Department of Biochemistry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Yakup Albayrak
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi 59100, Süleymanpaşa, Tekirdağ, Turkey.
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11
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Vahapoğlu B, Aksoy Poyraz C, Özdemir A. Psychosocial Impairment in Older Patients With Bipolar I Disorder. J Psychiatr Pract 2024; 30:147-156. [PMID: 38526403 DOI: 10.1097/pra.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The goal of this study was to assess psychosocial functioning in older patients with bipolar I disorder compared with healthy subjects and to identify the psychopathological factors associated with poor functioning in patients. METHODS We recruited 68 euthymic patients with bipolar I disorder from the outpatient unit and 89 healthy controls who were older than 50 years of age. In addition to clinical variables, we used other standardized measures, including the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment Short Test, and the Montreal Cognitive Assessment. RESULTS Older patients with bipolar I disorder had poorer psychosocial functioning in general and in the domains of occupation, autonomy, and cognition than the healthy controls on the basis of previously defined Functional Assessment Short Test cutoff scores. We found that 35.3% (95% CI: 23%-47%) of the patients did not have clinically significant functional impairment, 38.2% (95% CI: 26%-50%) had mild impairment, and 26.5% (95% CI: 16%-37%) had moderate impairment. Depressive symptoms and impaired cognition were associated with poor overall functioning. CONCLUSIONS The level of psychosocial functioning was heterogeneous among the patients. Subsyndromal depressive symptoms, even at low levels, and impaired cognition predicted poor functioning in euthymic middle-aged and older patients with bipolar I disorder.
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Affiliation(s)
- Berkay Vahapoğlu
- VAHAPOĞLU and ÖZDEMIR: Bakirköy Mazhar Osman Bakirköy Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey; POYRAZ: Department of Psychiatry, İstanbul University-Cerrahpaşa Medical School, Istanbul, Turkey
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12
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Pavlova B, Warnock-Parkes E, Alda M, Uher R, Clark DM. Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series. Int J Bipolar Disord 2024; 12:1. [PMID: 38180531 PMCID: PMC10769945 DOI: 10.1186/s40345-023-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Social anxiety disorder increases the likelihood of unfavourable outcomes in people with bipolar disorder. Cognitive behavioural therapy (CBT) is the first-line treatment for social anxiety disorder. However, people with bipolar disorder have been excluded from the studies that this recommendation is based on. METHOD: We completed a case series to obtain initial data on whether CBT is an acceptable, safe, and effective treatment for social anxiety disorder in people with bipolar disorder. RESULTS Eleven euthymic participants with bipolar disorder attended up to sixteen treatment and three follow-up sessions of CBT for social anxiety disorder. Participants attended on average 95% of the offered CBT sessions. No adverse events were reported. Participants' mean score on the Social Phobia Inventory decreased from 46.5 (SD 6.6) before the treatment to 19.8 (SD 11.9) at the end of the sixteen-session intervention and further to 15.8 (SD 10.3) by the end of the 3-month follow-up. This degree of improvement is equivalent to the effect observed in studies of CBT for social anxiety disorder in people without severe mental illness. CONCLUSIONS This case series provides preliminary evidence that CBT is acceptable, safe, and effective for treating social anxiety disorder in people with bipolar disorder during euthymia. A randomized controlled trial is needed to confirm these findings, and to establish whether treatment for social anxiety disorder improves the course of bipolar disorder.
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Affiliation(s)
- Barbara Pavlova
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada.
- Nova Scotia Health, Halifax, NS, Canada.
| | - Emma Warnock-Parkes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- King's College London, London, UK
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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13
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Sogut K, Gorgulu Y, Palabiyik O. The effect of subthreshold depressive symptoms on cognitive functions and peripheral biomarkers in bipolar disorder. Nord J Psychiatry 2023; 77:768-777. [PMID: 37668000 DOI: 10.1080/08039488.2023.2251448] [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: 03/05/2023] [Revised: 07/19/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE A global approach to factors responsible for functional impairment in patients with BD is necessary. METHOD Ninety-three euthymic patients with BD [49 patients with SD (subthreshold depression) and 44 patients without SD] and 48 healthy controls were invited for evaluation of demographic, clinical, and cognitive characteristics. To define SD, the lower limit was HDRS ≥4 points and the upper limit was HDRS <9 points. Stroop test, California verbal learning test, digit-span test, controlled word association test, and clock drawing test were performed. Serum BDNF levels were measured. Additionally in the BD group; blood drug (lithium, valproic acid), leukocyte, C-reactive protein (CRP), TSH, and vitamin B12 levels were measured. RESULTS We found no difference between serum BDNF levels of BD (n = 93) and controls. The cognitive performances of the BD group were worse than the control group (p < 0.001). Attention, working memory, and stroop performance of patients with SD were worse than patients without SD (p < 0.05). Verbal fluency, stroop test, and planning performance decreased as serum CRP level increased in patients with BD (p < 0.05). CONCLUSIONS Although the patient group with SD was in euthymia, their cognitive performance was worse than the group without SD. Poor cognitive performance in BD was associated with serum CRP levels.
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Affiliation(s)
- Kubra Sogut
- Department of Psychiatry, School of Medicine, Trakya University, Edirne, Turkey
| | - Yasemin Gorgulu
- Department of Psychiatry, School of Medicine, Trakya University, Edirne, Turkey
| | - Orkide Palabiyik
- Health Services Vocational College, Trakya University, Edirne, Turkey
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14
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Rohd SB, Hjorthøj C, Ohland J, Gregersen M, Hemager N, Søndergaard A, Christiani CA, Spang KS, Ellersgaard D, Burton BK, Melau M, Greve A, Gantriis DL, Jepsen JRM, Plessen KJ, Mors O, Nordentoft M, Harder S, Thorup AAE. Experiences of helplessness and fear among caregivers diagnosed with severe mental illness and co-caregivers: The Danish High Risk and Resilience Study - VIA 7. Dev Psychopathol 2023; 35:1540-1551. [PMID: 35659307 DOI: 10.1017/s0954579422000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigates indicators of disorganized caregiving among caregivers of children who have a familial predisposition of schizophrenia spectrum psychosis (SZ) or bipolar disorder (BP), and whether indicators of disorganized caregiving are associated with the caregivers' and children's level of functioning as well as the children's internalizing and externalizing behavior problems. Indicators of disorganized caregiving were assessed with the Caregiving Helplessness Questionnaire (CHQ). Level of functioning was evaluated using the Children's Global Assessment Scale and the Personal and Social Performance Scale, while dimensional psychopathology were measured with the Child Behavior Checklist. 185 caregivers belonging to a SZ combined group (i.e., SZ-I + SZ co-caregiver), 110 caregivers to a BP combined group (i.e., BP-I + BP co-caregiver), and 184 caregivers to a population-based control group provided data on CHQ. Having a history of SZ or BP or being a co-caregiver to a parent with SZ or BP was associated with higher levels of experiences of helplessness and fear. Higher scores on helplessness were associated with lower level of functioning among caregivers and children and with children having externalizing/internalizing behavior problems. These results emphasize the need for interventions addressing indicators of disorganized caregiving in families with SZ or BP.
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Affiliation(s)
- Sinnika Birkehøj Rohd
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- University of Copenhagen, Department of Public Health, Section of Epidemiology, 1014Copenhagen K, Denmark
| | - Jessica Ohland
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Maja Gregersen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Nicoline Hemager
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Søndergaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Camilla Austa Christiani
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- University of Copenhagen, Department of Public Health, Section of Epidemiology, 1014Copenhagen K, Denmark
| | - Katrine Soeborg Spang
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- University of Copenhagen, Department of Public Health, Section of Epidemiology, 1014Copenhagen K, Denmark
| | - Ditte Ellersgaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200Copenhagen, Denmark
| | - Marianne Melau
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, DK-8200Aarhus, Denmark
| | - Ditte Lou Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, DK-8200Aarhus, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, DK-8200Aarhus, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200Copenhagen, Denmark
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, 1353, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200Copenhagen, Denmark
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15
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Disability and its correlates among persons with bipolar disorder: Exploratory findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Indian J Psychiatry 2023; 65:760-766. [PMID: 37645361 PMCID: PMC10461586 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_713_22] [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: 10/30/2022] [Revised: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Aim This study aimed to evaluate the disability and its correlates in persons with Bipolar Disorder during the remission phase. Materials and Methods As part of the multicentric study, 773 patients with bipolar disorder, currently in clinical remission, were evaluated for disability on the Indian Disability Assessment Evaluation Scale. Results About one-fifth of the participants had some level of disability in the domain of self-care, one-third had some level of disability in the interpersonal domain, one-fourth had some level of disability in communication and understanding, and a maximum proportion (43.7%) had some disability in the domain of work. Overall, about one-fifth (18.4%) were considered to have a benchmark disability (i.e., disability >40%). In terms of correlates, those with a disability had a short duration of current remission, a higher number of manic and mixed episodes, a higher mean number of total episodes, spent more time in the episodes, had lower severity of the depressive episodes, higher residual depressive and manic symptoms, had overall higher manic affective morbidity, had a higher level of cognitive deficits, and had poorer insight. Conclusion A significant proportion of patients with bipolar disorder have disability in work domain, and the presence of residual symptoms of either polarity are associated with higher level of disability.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Burdwan Medical College and Hospital, Burdwan, Bardhaman, West Bengal, India
| | | | - Rajarshi Neogi
- R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
| | - Alka A. Subramanyam
- Topiwala National Medical College (Nair Hospital), Mumbai, Maharashtra, India
| | - Naresh Nebhinani
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
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16
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Smedler E, Sparding T, Jonsson L, Hörbeck E, Landén M. Association of premorbid intelligence with level of functioning and illness severity in bipolar disorder. J Affect Disord 2023; 324:449-454. [PMID: 36608850 DOI: 10.1016/j.jad.2022.12.113] [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: 03/21/2022] [Revised: 12/04/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bipolar disorder is a severe psychiatric syndrome defined by periodic mood shifts. Patients with bipolar disorder show cognitive impairments relative to healthy controls. The risk of developing schizophrenia, and partially also bipolar disorder, has previously been shown to increase with lower premorbid intelligence. It is not known if premorbid intelligence is associated with level of functioning and illness severity of people having developed bipolar disorder. METHODS We used multiple linear and ordinal regression to analyze how premorbid intelligence, as measured at conscription, associate with functional outcome and illness severity in Swedish male bipolar disorder patients (n = 788). RESULTS We found that lower premorbid intelligence is associated with lower percentage of time in work, after adjusting for age and bipolar subtype, and correcting for multiple comparisons. We also found a strong negative association with the total number of inpatient episodes and psychiatric comorbidity, but not with interepisodic remission, treatment with psychotherapy or lithium or the presence of any complicating socioeconomical factors. Adjusting for confounding genetic factors using polygenic risk scores for bipolar disorder and schizophrenia had no effect on the associations. LIMITATIONS This study lacks females and controls and may thus have lower generalizability. CONCLUSION In conclusion, premorbid intelligence is associated with both level of functioning and illness severity as well as comorbidity in bipolar disorder patients. Further research is needed to develop targeted interventions for this subgroup of bipolar disorder patients.
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Affiliation(s)
- Erik Smedler
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Timea Sparding
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Lina Jonsson
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Elin Hörbeck
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mikael Landén
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Zhu T, Simonetti A, Ouyang M, Kurian S, Saxena J, Soares JC, Saxena K, Huang H. Disrupted white matter microstructure correlates with impulsivity in children and adolescents with bipolar disorder. J Psychiatr Res 2023; 158:71-80. [PMID: 36577236 PMCID: PMC9898209 DOI: 10.1016/j.jpsychires.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Altered white matter (WM) microstructure likely occurs in children with bipolar disorder (BD) with impulsivity representing one of the core features. However, altered WM microstructures and their age-related trendlines in children with BD and those at high-risk of developing BD, as well as correlations of WM microstructures with impulsivity, have been poorly investigated. In this study, diffusion MRI, cognitive, and impulsivity assessments were obtained from children/adolescents diagnosed with BD, offspring of individuals with BD (high-risk BD) and age-matched healthy controls. A novel atlas-based WM skeleton measurement approach was used to quantify WM microstructural integrity with all diffusion-tensor-imaging (DTI) metrics including fractional anisotropy, axial, mean and radial diffusivity to survey entire WM tracts and ameliorate partial volume effects. Among all DTI-derived metric measures, radial diffusivity quantifying WM myelination was found significantly higher primarily in corpus callosum and in the corona radiata in children with BD compared to controls. Distinguished from age-related progressively decreasing diffusivities and increasing fractional anisotropy in healthy controls, flattened age-related trendlines were found in BD group, and intermediate developmental rates were observed in high-risk group. Larger radial diffusivity in the corpus callosum and corona radiata significantly correlated with shorter response times to affective words that indicate higher impulsivity in the BD group, whereas no such correlation was found in the healthy control group. This work corroborates the progressive nature of pediatric BD and suggests that WM microstructural disruption involved in affective regulation and sensitive to impulsivity may serve as a biomarker of pediatric BD progression.
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Affiliation(s)
- Tianjia Zhu
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Alessio Simonetti
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Minhui Ouyang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sherin Kurian
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Johanna Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Kirti Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Hao Huang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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18
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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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19
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Lai S, Zhong S, Wang Y, Zhang Y, Xue Y, Zhao H, Ran H, Yan S, Luo Y, He J, Zhu Y, Lv S, Song Z, Miao H, Hu Y, Huang X, Lu X, Zhou J, Jia Y. The prevalence and characteristics of MCCB cognitive impairment in unmedicated patients with bipolar II depression and major depressive disorder. J Affect Disord 2022; 310:369-376. [PMID: 35504401 DOI: 10.1016/j.jad.2022.04.153] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/16/2022] [Accepted: 04/26/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive impairment has been acknowledged as a core clinical manifestation of bipolar disorder (BD) as well as major depressive disorder (MDD). Determining the prevalence and characteristics of cognitive impairment is important for clinical interventions. This study investigated the prevalence and characteristics of cognitive impairment based on the Measurement and Treatment Research to Improve Cognition Schizophrenia Consensus Cognitive Battery (MCCB) in both BD and MDD. METHOD One hundred and forty-nine BD II depression, 147 MDD, and 124 demographically matched healthy controls (HC) underwent MCCB cognitive assessment. The prevalence of MCCB cognitive impairment and group difference comparisons were performed. Additionally, association analysis was performed to investigate the relationship between cognitive performance and clinical variables. RESULTS Compared to the HC group, both BD II depression and MDD groups had a significantly reduced performance for all MCCB cognitive domains (all p < 0.05). The numerical scores for visual learning were lower in the BD II depression group compared to the MDD group. 32.89% of the BD II depression patients had clinically significant impairment (>1.5 SD below the normal mean) in two or more MCCB domains compared to 23.13% for MDD patients. CONCLUSIONS A high percent of patients in the BD II depression and MDD group exhibited MCCB cognitive impairments with clinical significance. Cognitive impairments were more common in BD II depression patients compared to MDD patients, particularly for visual learning. These findings suggest that clinicians should be aware of the severe cognitive impairment in mood disorders and establish effective cognitive screening and intervention strategies.
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Affiliation(s)
- Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Xue
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hui Zhao
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hanglin Ran
- School of Management, Jinan University, Guangzhou 510316, China
| | - Shuya Yan
- School of Management, Jinan University, Guangzhou 510316, China
| | - Yange Luo
- School of Management, Jinan University, Guangzhou 510316, China
| | - Jiali He
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yunxia Zhu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Sihui Lv
- School of Management, Jinan University, Guangzhou 510316, China
| | - Zijing Song
- School of Management, Jinan University, Guangzhou 510316, China
| | - Haofei Miao
- School of Management, Jinan University, Guangzhou 510316, China
| | - Yilei Hu
- School of Management, Jinan University, Guangzhou 510316, China
| | - Xiaosi Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Xiaodan Lu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jiansong Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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20
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Arvilommi P, Pallaskorpi S, Linnaranta O, Suominen K, Leppämäki S, Valtonen H, Isometsä E. Long-term work disability due to type I and II bipolar disorder: findings of a six-year prospective study. Int J Bipolar Disord 2022; 10:19. [PMID: 35811322 PMCID: PMC9271449 DOI: 10.1186/s40345-022-00264-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/10/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, the prevalence and predictors of long-term work disability among patients with type I and II BD have scarcely been studied. We investigated the clinical predictors of long-term work disability among patients with BD. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (n = 191) of adult psychiatric in- and out-patients with DSM-IV type I and II BD in three Finnish cities. Within JoBS we examined the prevalence and predictors of disability pension being granted during a six-year follow-up of the 152 patients in the labor force at baseline and collected information on granted pensions from national registers. We determined the predictors of disability pension using logistic regression models. Results Over the 6 years, 44% of the patients belonging to the labor force at baseline were granted a disability pension. Older age; type I BD; comorbidity with generalized anxiety disorder, post-traumatic stress disorder or avoidant personality disorder; and duration of time with depressive or mixed symptoms predicted disability pensions. Including disability pensions granted before baseline increased their total prevalence to 55.5%. The observed predictors were similar. Conclusion This regionally representative long-term prospective study found that about half of patients with type I or II bipolar disorder suffer from persistent work disability that leads to disability pension. In addition to the severity of the clinical course and type I bipolar disorder, the longitudinal accumulation of time depressed, psychiatric comorbidity, and older age predicted pensioning. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00264-6.
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Affiliation(s)
- Petri Arvilommi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Pallaskorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Kirsi Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Valtonen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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21
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Visual electrophysiology and neuropsychology in bipolar disorders: a review on current state and perspectives. Neurosci Biobehav Rev 2022; 140:104764. [DOI: 10.1016/j.neubiorev.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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22
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Saffi F, Rocca CCA, Toschi-Dias E, Durães RSS, Serafim AP. Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report. Front Psychol 2022; 13:867750. [PMID: 35846610 PMCID: PMC9280414 DOI: 10.3389/fpsyg.2022.867750] [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] [Received: 02/01/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
The current study verified the association between cognitive process such as attention, executive functioning, and legal capacity in patients with bipolar disorder (BD). The sample consisted of 72 participants, assorted to episodic patients (n = 21), euthymic patients (n = 22), and healthy controls (HCs) (n = 29). We used the following neuropsychological measures: subtests of the Wechsler Abbreviated Intelligence Scale (WASI): vocabulary and matrix reasoning; Continuous Performance Test (CPT); Five Digit Test (FDT); and Rey–Osterrieth Complex Figure (ROCF). Euthymic patients expressed slower processing speed (FDT) compared to HC. They tended to make more errors with slightly worse discrimination, suggesting more impulsiveness (CPT, p < 0.01). On the contrary, episodic patients showed worse discrimination, committed more omissions, were more inconsistent with regard to response speed (CPT-3, p < 0.01), showed more difficulties in organizing their actions (ROCF: copy, p = 0.03), and were more rigid (FDT: flexibility, p = 0.03). The results suggest that bipolar patients in episode express more cognitive impairments that can compromise the quality of legal capacity. These results highlight the need for more protective support for episodic BD patients regarding legal capacity.
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23
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Cotton SM, Filia KM, Lambert M, Berk M, Ratheesh A, Schimmelmann BG, Macneil C, Hasty M, McGorry PD, Conus P. Not in education, employment and training status in the early stages of bipolar I disorder with psychotic features. Early Interv Psychiatry 2022; 16:609-617. [PMID: 34313390 DOI: 10.1111/eip.13203] [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: 11/12/2020] [Revised: 03/30/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a lack of existing research regarding young people with bipolar I disorder (BD-I) and psychotic features, who are not in education, employment, and training (NEET). Thus, the aims of the study were to: (a) establish rates of NEET at service entry to a specialist early intervention service; (b) delineate premorbid and current variables associated with NEET status at service entry and (c) examine correlates of NEET status at discharge. METHOD Medical file audit methodology was utilized to collect information on 118 patients with first episode psychotic mania treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. NEET status was determined using the modified vocation status index (MVCI). Bivariate and multivariable logistic variables were used to examine relationships between premorbid, service entry and treatment variables, and NEET status at service entry and discharge. RESULTS The NEET rate was 33.9% at service entry, and 39.2% at discharge. Variables associated with NEET status at service entry were premorbid functioning and polysubstance use. NEET status at service entry was the only significant correlate of NEET status at discharge. When service entry NEET was taken out of the model, substance use during treatment was predictive of NEET status at discharge. CONCLUSIONS NEET status at service entry was related to a history of premorbid decline, and risk factors such as substance use and forensic issues. NEET status can decline during treatment, and utility of vocational intervention programs specifically for BD, in addition to specialist early intervention, needs to be examined.
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Affiliation(s)
- Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia.,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Craig Macneil
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Melissa Hasty
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Departement de Psychiatrie CHUV, Université de Lausanne, Prilly, Switzerland
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24
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Aniserowicz AM, Safi F, Colquhoun H, Stier J, Nowrouzi-Kia B. Developing a profile of activities of daily living for bipolar disorder: a systematic review protocol and meta-analysis. BMJ Open 2022; 12:e058783. [PMID: 35577467 PMCID: PMC9115033 DOI: 10.1136/bmjopen-2021-058783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Bipolar disorder (BD) is a severe mental health disorder that affects 2% of the adult population. Individuals with this disorder are at a higher risk for morbidity and functional difficulties. They may also experience significant challenges in their activities of daily living (ADLs). This systematic review will identify all available studies that examine subsets of ADLs that impact individuals with BD. METHODS AND ANALYSIS MEDLINE, Embase, CINAHL and APA PsycINFO will be searched to identify observational studies that examined functioning, independence or performance across a variety of ADLs. Title and abstract, full-text screening and a risk of bias assessment will be conducted in duplicate. An overarching table that summarises the level of functioning across different ADLs or an 'ADL profile' will be developed, and if there are sufficient data, these will be separated based on the phases of BD, such as manic/hypomanic, depressed and euthymic. ETHICS AND DISSEMINATION As this systematic review uses information from previous literature, this review does not require ethics approval. This review will help identify the trends in daily activities that individuals struggle with and can help healthcare practitioners identify specific areas of need for support. We plan to disseminate the results in a peer-reviewed journal and conferences targeting occupational therapists and mental health clinicians. PROSPERO REGISTRATION NUMBER CRD42021255089.
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Affiliation(s)
- Anna M Aniserowicz
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Fatima Safi
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - J Stier
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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25
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Tyler DE, Lobban PF, Hadarag MB, Jones PS. A systematic review of psychosocial functioning and quality of life in older people with bipolar disorder. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 9:100371. [PMID: 35845859 PMCID: PMC9272766 DOI: 10.1016/j.jadr.2022.100371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
The Global Assessment of Functioning (GAF; Endicott et al., 1976) is the most widely used functioning measure used with older adults with bipolar disorder. Older adults with bipolar disorder demonstrate a wide range of functioning. No existing validated measure assessing the psychosocial functioning or quality of life of older people with BD could be identified. There is a significant lack of research in the area of older people with bipolar disorder compared to the younger population. Background There is evidence to suggest that older people with Bipolar Disorder (BD) are more likely to demonstrate poor levels of functioning and score lower on well-being scales compared to non-clinical controls, even when in remission (Depp et al., 2006). To our knowledge, this is the first review paper to identify how quality of life and functioning has been measured in an older adult BD population. Methods We conducted a systematic review of studies including a quantitative measure of psychosocial functioning or quality of life and older people over the age of 50 with a formal diagnosis of BD I or II. Results Eleven studies (N = 726, mean age range 59.8 to 71.1) were included in the review, demonstrating a significant lack of research in the area compered to younger people with BD. The most commonly used measure of functioning was the Global Assessment of Functioning Scale (GAF) and results indicated that older adults with BD demonstrate a wide range of functioning. Limitations The review used a comprehensive and systematic search strategy, however, very few eligible studies were available for review. The pooled analyses and reported means must be interpreted with caution due to the relatively small sample sizes. Conclusions Older people with BD present with a wide range of functioning, ranging ‘major impairment’ to ‘superior’ scores. No existing validated measure assessing the psychosocial functioning or quality of life of older people with BD could be identified. Such a tool should be developed for use in future research.
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Affiliation(s)
- Dr Elizabeth Tyler
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Corresponding author.
| | - Professor Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Professor Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
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26
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Pedersen AM, Straarup KN, Thomsen DK. "My life disappeared in illness": bipolar disorder and themes in narrative identity. Memory 2022; 30:857-868. [PMID: 35297312 DOI: 10.1080/09658211.2022.2051555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Bipolar Disorder (BD) has substantial consequences for the course of life and the formation of self and identity. In the present study, we extended the existing literature by examining narrative identity. Fifteen female outpatients with remitted BD and fifteen non-clinical control participants described past and future chapters in their life stories. The chapters were coded for agency, communion, redemption and contamination. Patients diagnosed with BD described their past chapters with lower agency, lower communion and more contamination compared to the control group. Contrary to our expectations, the future chapters described by the BD patients did not differ significantly from the control group. A focus on narrative identity may contribute to understanding the disorder and inspire interventions targeting personal recovery.
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Affiliation(s)
- Anne Mai Pedersen
- Department of Psychology, Aarhus University, Aarhus, Denmark.,Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
| | | | - Dorthe Kirkegaard Thomsen
- Department of Psychology, Aarhus University, Aarhus, Denmark.,Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
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Improving the Assessment Process of Family Functioning in Adult Bipolar Disorders: A PRISMA Systematic Review. J Clin Med 2022; 11:jcm11030841. [PMID: 35160294 PMCID: PMC8836941 DOI: 10.3390/jcm11030841] [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] [Received: 11/03/2021] [Revised: 12/27/2021] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
In order to determine family functioning in the treatment of adults with bipolar disorders, guidelines are needed regarding the way family functioning may be assessed. The present systematic review aims to investigate how family functioning is assessed in this context. Following PRISMA guidelines, a total of 29 studies were reviewed. Results showed that although there was no consensual family functioning assessment across studies, 27 studies (93%) relied on self-report questionnaires, 12 studies (41%) relied on one family member as an informant (adult with bipolar disorder or other) and the adult considered was mostly a woman in the acute phase of bipolar I disorder. Significant heterogeneity was observed in the assessment of family functioning. Methodological considerations regarding the assessment of family functioning are discussed.
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García-Estela A, Cantillo J, Angarita-Osorio N, Mur-Milà E, Anmella G, Pérez V, Vieta E, Hidalgo-Mazzei D, Colom F. Real-world Implementation of a Smartphone-Based Psychoeducation Program for Bipolar Disorder: Observational Ecological Study. J Med Internet Res 2022; 24:e31565. [PMID: 35107440 PMCID: PMC8851334 DOI: 10.2196/31565] [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] [Received: 06/25/2021] [Revised: 09/16/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND SIMPLe is an internet-delivered self-management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment. OBJECTIVE The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use. METHODS This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users' data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use. RESULTS We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01). CONCLUSIONS The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management.
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Affiliation(s)
- Aitana García-Estela
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Natalia Angarita-Osorio
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estanislao Mur-Milà
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Spain
| | - Víctor Pérez
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Centre for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Spain.,Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Francesc Colom
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Centre for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Basic, Evolutive and Education Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
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The influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2022; 296:350-362. [PMID: 34606813 DOI: 10.1016/j.jad.2021.09.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/03/2021] [Accepted: 09/26/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder was systematically reviewed. METHODS Randomised and non-randomised studies of interventions for bipolar disorder that included an assessment of childhood trauma were eligible. MEDLINE Complete, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched. Two independent reviewers completed the screening and extraction process. Two independent reviewers assessed the risk of bias in the included studies using the Cochrane Collaboration's Risk of Bias tool and the Newcastle-Ottawa Scale. Alongside a narrative synthesis, random-effects meta-analyses were performed. RESULTS Twelve studies (1175 participants) were included. The narrative review highlighted differential treatment outcomes among individuals with a history of childhood trauma. The meta-analyses suggested that childhood trauma was unrelated to treatment response (five studies, 426 participants; odds ratio 0.58, 95% CI 0.27-1.25, p = .164) but may be associated with greater improvement in global functioning (three studies, 210 participants; Hedge's g 0.65, 95% CI 0.04-1.26, p = .037). LIMITATIONS The impact of childhood trauma on the effectiveness of specific pharmacological/psychological interventions could not be explored due to the small body of research identified. CONCLUSION The overall quality of the extant evidence is low, which precludes definitive comment on the role of childhood trauma in the treatment of bipolar disorder. Additional research that uses large and representative samples is required to ascertain whether a history of childhood trauma affects the treatment outcomes of interventions for individuals with bipolar disorder.
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Moot W, Crowe M, Inder M, Eggleston K, Frampton C, Porter RJ. Domain-Based Functional Improvements in Bipolar Disorder After Interpersonal and Social Rhythm Therapy. Front Psychiatry 2022; 13:767629. [PMID: 35237184 PMCID: PMC8882592 DOI: 10.3389/fpsyt.2022.767629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies typically report overall change in function when assessing bipolar disorder (BD) interventions, but individual domains are not analyzed. Which aspects of functioning are impacted is clearly important and may differ between treatments. METHODS Data were analyzed from two previous clinical trials of Interpersonal and Social Rhythm Therapy (IPSRT) for BD patients. Change in total and subscale scores on the Social Adjustment Scale Self-Report (SAS-SR) from 0 to 78 weeks, were analyzed. RESULTS 152 BD patients took part in randomized controlled trials of IPSRT (n = 38) vs. Specialist Supportive Care (SSC) (n = 43), and of IPSRT (n = 41) vs. treatment as usual (TAU) which was discharge to primary care (n = 30). IPSRT was superior to TAU on change in the social and leisure activities and extended family subscales, and SAS-SR total score over 18 months. LIMITATIONS Studies were not designed to be pooled. Patients in study 1 were younger and symptomatic at baseline. Patients assigned to TAU were more likely to drop-out. Patients did not respond to subscales that were not personally applicable (work, marital, children). CONCLUSION IPSRT had a positive impact on two SAS-SR subscales compared to TAU over 18 months. Other subscales were limited by the lack of respondents due to individual applicability. Different psychotherapy may have differential effects on different domains of function. Measures of function and research into functioning in BD should include domain-based measures, and report the numbers of participants who respond to questions in each domain.
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Affiliation(s)
- William Moot
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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31
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Chen P, Chein K, Hsieh YT, Tseng HH, Lee IH, Yang Y. Childhood trauma, loneliness, and quality of life in adults with euthymic bipolar disorder. TAIWANESE JOURNAL OF PSYCHIATRY 2022. [DOI: 10.4103/tpsy.tpsy_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Niu X, Dembek C, Fan Q, Mao Y, Divino V, Burch S, Tocco M. The impact of lurasidone on functioning and indirect costs in adults with bipolar depression: a post-hoc analysis. J Med Econ 2022; 25:152-159. [PMID: 35037813 DOI: 10.1080/13696998.2022.2030147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this post-hoc analysis was to assess the impact of lurasidone monotherapy on functional impairment, productivity, and associated indirect costs in patients with bipolar depression. METHODS Data were analyzed from a 6-week randomized, double-blind (DB; NCT00868699), placebo-controlled trial of lurasidone monotherapy and a 6-month open label extension (OLE; NCT00868959) study. Patients with bipolar depression who completed the 6-week DB trial were subsequently enrolled in the OLE. Analysis of the OLE was limited to patients who either continued lurasidone (LUR-LUR) or switched from placebo to lurasidone monotherapy (PBO-LUR). The Sheehan Disability Scale (SDS), which measures functional impairment and productivity, was collected at DB baseline, DB week 6/OLE baseline, OLE month 3, and OLE month 6. Annual indirect costs were calculated based on days lost or unproductive from work/school due to symptoms. Effect sizes (ES) in functioning and days lost/unproductive were reported for the DB trial and mean changes for the OLE. RESULTS A total of 485 patients were enrolled in the DB trial (lurasidone: n = 323; placebo: n = 162) and 316 were in the lurasidone monotherapy group during the OLE (LUR-LUR: n = 210; PBO-LUR: n = 106). In the DB trial, improvements in functioning (work: ES = 0.36, p = .0071; social: ES = 0.55, p < .0001; family: ES = 0.50, p < .0001) were significantly greater for lurasidone compared to placebo. Reductions in days lost (ES = 0.33, p = .0050) and unproductive (ES = 0.45, p = .0001) were significantly higher for lurasidone vs. placebo. This resulted in a greater reduction in indirect costs for lurasidone vs. placebo (least squares mean (standard error) = -$32,322 ($2,100) vs. -$20,091 ($2,838)). Improvements in functioning and productivity were sustained during the 6-month OLE for both LUR-LUR and PBO-LUR. CONCLUSIONS Lurasidone monotherapy for the treatment of bipolar depression significantly improved functioning and reduced indirect costs vs. placebo at week 6. Significant improvements in functioning and productivity were sustained for 6 months for both LUR-LUR and PBO-LUR.
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Affiliation(s)
- Xiaoli Niu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Qi Fan
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Yongcai Mao
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Steven Burch
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Ba Z, Chen M, Lai J, Liao Y, Fang H, Lu D, Zheng Y, Zong K, Lin X. Heterogeneity of psychosocial functioning in patients with bipolar disorder: Associations with sociodemographic, clinical, neurocognitive and biochemical variables. Front Psychiatry 2022; 13:900757. [PMID: 36203826 PMCID: PMC9530893 DOI: 10.3389/fpsyt.2022.900757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to identify the functional heterogeneity in fully or partially remitted patients with bipolar disorder and explore the correlations between psychosocial functioning and sociodemographic, clinical, neurocognitive and biochemical variables. METHODS One hundred and forty fully or partially remitted patients with bipolar disorder (BD) and seventy healthy controls were recruited. The patients were grouped into different profiles based on the Functioning Assessment Short Test (FAST) domain scores by hierarchical cluster analysis. The characteristics of subgroups and the correlations between psychosocial functioning and sociodemographic, clinical, neurocognitive and biochemical variables in each cluster were then analyzed. RESULTS There were three subgroups in fully or partially remitted patients with BD: the lower functioning group (LF), performed global functioning impairments; the moderate functioning group (MF), presented selective impairments in functional domains; and the good functioning subgroup (GF), performed almost intact functioning. Among the three subgroups, there were differences in FAST domains, sociodemographic variables, clinical variables, some neurocognitive domains and several biochemical indexes. CONCLUSIONS The study successfully identified three functional subgroups. The characteristics of discrete subgroups and the specific clinical factors, neurocognitive domains and biochemical indexes that are correlated with functional subgroups will allow for making tailored interventions to promote functional recovery and improve the quality of life.
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Affiliation(s)
- Zhengling Ba
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Minhua Chen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiulan Lai
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yingtao Liao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hengying Fang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dali Lu
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Yingjun Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Kunlun Zong
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaoling Lin
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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34
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Farias CDA, Cardoso TDA, da Silva MM, D'Angelo F, Mondin TC, Souza LDDM, da Silva RA, Kapczinski F, Jansen K, Magalhães PVS. Socioeconomic and substance use changes in emerging adults and their relationship with mood disorders in a population-based cohort. Front Psychiatry 2022; 13:932484. [PMID: 36090374 PMCID: PMC9448898 DOI: 10.3389/fpsyt.2022.932484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
In this report, we aim to assess the interaction of bipolar disorder and major depressive disorder with the evolution of social roles, economic classification, and substance misuse in emerging adults. This is a longitudinal population-based study (n = 231 at baseline), in which participants were reassessed at a mean of 5 years after baseline. A structured clinical interview was used to diagnose the participants with bipolar disorder and major depression; a control group without mood disorders was included. Men with mood disorders were less likely to be married in the beginning of the study and less likely to work in the follow-up. Women with major depression were less likely to study and more likely to be in a lower economic class at the beginning of the study. In comparison, women with bipolar disorder were less likely to live with their parents and more likely to live with their children in the first wave of the study. Substance misuse was more likely in people with mood disorders, especially in men, and women with bipolar disorder had the highest likelihood in the follow-up. Albeit longitudinal analyses were limited by a possibly insufficient sample size and mediating mechanisms for change, such as stigma, were not explored, the study suggests sex-related specificities regarding the change in social roles and substance use in people with mood disorders. Emerging adults, especially those with mood disorders, are in a period of change and instability and at a greater risk for substance use and abuse.
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Affiliation(s)
- Clarisse de Azambuja Farias
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Taiane de Azevedo Cardoso
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Marielle Moro da Silva
- Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Francesca D'Angelo
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Thaise Campos Mondin
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | | | | | - Flavio Kapczinski
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karen Jansen
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Pedro V S Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Anderson Z, Fairley K, Villanueva CM, Carter RM, Gruber J. No group differences in Traditional Economics Measures of loss aversion and framing effects in bipolar I disorder. PLoS One 2021; 16:e0258360. [PMID: 34752459 PMCID: PMC8577741 DOI: 10.1371/journal.pone.0258360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
Bipolar disorder (BD) is associated with impaired decision making, yet few studies have adopted paradigms from behavioral economics to decompose which, if any, aspects of decision making may be impacted. This may be particularly relevant for decision-making processes relevant to known difficulties with emotive dysfunction and corresponding reward dysregulation in BD. Participants with bipolar I disorder (BD; n = 44) and non-psychiatric healthy controls (CTL; n = 28) completed three well-validated behavioral economics decision making tasks via a remote-based survey, including loss aversion and framing effects, that examined sensitivity to probabilities and potential gains and losses in monetary and non-monetary domains. Consistent with past work, we found evidence of moderate loss aversion and framing effects across all participants. No group differences were found in any of the measures of loss aversion or framing effects. We report no group differences between bipolar and non-psychiatric groups with respect to loss aversion and framing effects using a remote-based survey approach. These results provide a framework future studies to explore similar tasks in clinical populations and suggest the context and degree to which decision making is altered in BD may be rooted in a more complex cognitive mechanism that warrants future research.
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Affiliation(s)
- Zachary Anderson
- Department of Psychology, Northwestern University, Evanston, Illinois, United States of America
| | - Kim Fairley
- Department of Economics, Leiden University, Leiden, Netherlands
| | - Cynthia M. Villanueva
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - R. McKell Carter
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
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Kessing LV, Kyster NB, Bondo-Kozuch P, Christensen EM, Vejstrup B, Smidt B, Jørgensen AMB, Rosenberg R, Mardosas D, Rasmussen LB, Vinberg M, Hageman I, Faurholt-Jepsen M. Effect of specialised versus generalised outpatient treatment for bipolar disorder: the CAG Bipolar trial - study protocol for a randomised controlled trial. BMJ Open 2021; 11:e048821. [PMID: 34645661 PMCID: PMC8515461 DOI: 10.1136/bmjopen-2021-048821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite current available treatment patients with bipolar disorder often experience relapses and decreased overall functioning. Furthermore, patients with bipolar disorder are often not treated medically or psychologically according to guidelines and recommendations. A Clinical Academic Group is a new treatment initiative bringing together clinical services, research, education and training to offer care and treatment that is based on reliable evidence backed up by research. The present Clinical Academic Group for bipolar disorder (the CAG Bipolar) randomised controlled trial (RCT) aims for the first time to investigate whether specialised outpatient treatment in CAG Bipolar versus generalised community-based treatment improves patient outcomes and clinician's satisfaction with care in patients with bipolar disorder. METHODS AND ANALYSIS The CAG Bipolar trial is a pragmatic randomised controlled parallel-group trial undertaken in the Capital Region of Denmark covering a catchment area of 1.85 million people. Patients with bipolar disorder are invited to participate as part of their outpatient treatment in the Mental Health Services. The included patients will be randomised to (1) specialised outpatient treatment in the CAG Bipolar (intervention group) or (2) generalised community-based outpatient treatment (control group). The trial started 13 January 2020 and has currently included more than 600 patients. The outcomes are (1) psychiatric hospitalisations and cumulated number and duration of psychiatric hospitalisations (primary), and (2) self-rated depressive symptoms, self-rated manic symptoms, quality of life, perceived stress, satisfaction with care, use of medication and the clinicians' satisfaction with their care (secondary). A total of 1000 patients with bipolar disorder will be included. ETHICS AND DISSEMINATION The CAG Bipolar RCT is funded by the Capital Region of Denmark and ethical approval has been obtained from the Regional Ethical Committee in The Capital Region of Denmark (H-19067248). Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets. TRIAL REGISTRATION NUMBER NCT04229875.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Birte Smidt
- Psychiatric Center Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center North Zealand, Hillerød, Denmark
| | - Ida Hageman
- Mental Health Services in the Capital Region of Denmark, Kobenhavn O, Denmark
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Yerushalmi M, Sixsmith A, Pollock Star A, King DB, O'Rourke N. Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study. JMIR Form Res 2021; 5:e30472. [PMID: 34473069 PMCID: PMC8446838 DOI: 10.2196/30472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. OBJECTIVE We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). METHODS For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified "windows of general availability," participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner's specified availability. RESULTS Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=-.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=-.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. CONCLUSIONS These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important.
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Affiliation(s)
- Mor Yerushalmi
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Andrew Sixsmith
- Science and Technology for Aging Research (STAR) Institute, Simon Fraser University, Vancouver, BC, Canada
| | - Ariel Pollock Star
- Department of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - David B King
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Norm O'Rourke
- Department of Public Health and Multidisciplinary Center for Research on Aging, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Vieta E, Calabrese JR, Whelan J, Tohen M, Earley WR. The efficacy of cariprazine on function in patients with bipolar depression: a post hoc analysis of a randomized controlled trial. Curr Med Res Opin 2021; 37:1635-1643. [PMID: 34034612 DOI: 10.1080/03007995.2021.1932446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Individuals with bipolar depression often experience functional impairment that interferes with recovery. These analyses examined the effects of cariprazine on functional outcomes in patients with bipolar I disorder. METHODS Prespecified analyses of data from a randomized, double-blind, placebo-controlled pivotal trial of cariprazine in bipolar I depression (NCT01396447) evaluated mean changes from baseline to week 8 in Functional Assessment Short Test (FAST) total score. Post hoc analyses with no adjustment for multiplicity evaluated FAST subscale scores, functional recovery and remission (FAST total score ≤11 and ≤20, respectively), and 30% or 50% improvement from baseline. RESULTS There were 393 patients with bipolar I disorder (placebo = 132; cariprazine: 1.5 mg/d = 135, 3 mg/d = 126) in the FAST analysis population. Statistically significant differences were noted for cariprazine 1.5 mg/d versus placebo in mean change from baseline in FAST total score (p<.01) and on 5 of 6 subscale scores (p<.05); cariprazine 3 mg/d was significantly different than placebo on the Interpersonal Relationship subscale (p<.05). Rates of functional remission and recovery, and ≥30% or ≥50% improvement were significantly greater for cariprazine 1.5 mg/d versus placebo (p<.05 all); the percentage of patients with ≥30% improvement was significantly different for cariprazine 3 mg/d versus placebo (p<.05). CONCLUSION At week 8, statistically significant improvements in FAST outcomes were observed for cariprazine versus placebo in patients with bipolar I depression; more consistent results were noted for 1.5 mg/d than 3 mg/d. In addition to improving bipolar depression symptoms, these results suggest that cariprazine may improve functional outcomes.
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Affiliation(s)
- Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Joseph R Calabrese
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jessica Whelan
- Department of Nursing, Maryville University, Saint Louis, MO, USA
- Holon Inclusive Health Care, Dupo, IL, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Screening of Mood Symptoms Using MMPI-2-RF Scales: An Application of Machine Learning Techniques. J Pers Med 2021; 11:jpm11080812. [PMID: 34442456 PMCID: PMC8398545 DOI: 10.3390/jpm11080812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 01/01/2023] Open
Abstract
(1) Background: The MMPI-2-RF is the most widely used and most researched test among the tools for assessing psychopathology, and previous studies have established its validity. Mood disorders are the most common mental disorders worldwide; they present difficulties in early detection, go undiagnosed in many cases, and have a poor prognosis. (2) Methods: We analyzed a total of 8645 participants. We used the PHQ-9 to evaluate depressive symptoms and the MDQ to evaluate hypomanic symptoms. We used the 10 MMPI-2 Restructured Form scales and 23 Specific Problems scales for the MMPI-2-RF as predictors. We performed machine learning analysis using the k-nearest neighbor classification, linear discriminant analysis, and random forest classification. (3) Results: Through the machine learning technique, depressive symptoms were predicted with an AUC of 0.634-0.767, and the corresponding value range for hypomanic symptoms was 0.770-0.840. When using RCd to predict depressive symptoms, the AUC was 0.807, but this value was 0.840 when using linear discriminant classification. When predicting hypomanic symptoms with RC9, the AUC was 0.704, but this value was 0.767 when using the linear discriminant method. (4) Conclusions: Using machine learning analysis, we defined that participants' mood symptoms could be classified and predicted better than when using the Restructured Clinical scales.
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Lemvigh CK, Karantonis JA, Furlong LS, Carruthers SP, Pantelis C, Rossell SL, Van Rheenen TE. Characterization and interrelationships of theory of mind, socially competitive emotions and affective empathy in bipolar disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:76-92. [PMID: 34232514 DOI: 10.1111/bjc.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evidence shows impaired theory of mind (ToM) in patients with bipolar disorder (BD), yet research examining its cognitive and affective components simultaneously is sparse. Moreover, recognition of socially competitive 'fortune of others' emotions (e.g. envy/gloat) may be related to ToM, but has not been assessed in BD. Finally, if and how ToM and 'fortune of others' emotions relate to affective empathy in BD is currently unclear. This study aimed to address these points. METHODS 64 BD patients and 34 healthy controls completed the Yoni task, a visual task assessing first- and second-order cognitive and affective ToM as well as 'fortune of others' emotions. The Toronto Empathy Questionnaire was used to assess self-reported affective empathy. RESULTS Patients with BD showed no deficits in cognitive and affective ToM or recognition of 'fortune of others' emotions. The ability to infer 'fortune of others' emotions correlated with several ToM measures, indicating that these functions are part of the same system. Patients with BD reported similar levels of affective empathy to healthy controls, and this was not related to ToM or 'fortune of others' emotions, suggesting that affective empathy represents a separate social domain. CONCLUSIONS These findings highlight areas of spared social functioning in BD, which may be utilized in therapeutic strategies. PRACTITIONER POINTS Our results suggest theory of mind and empathy may represent areas of potentially spared cognitive functioning in BD. As many BD patients have experienced adversity during developmental periods in which theory of mind and empathy develop, our findings suggest that these abilities may be markers of resilience in the disorder. Our findings are important for the formulation of therapeutic interventions for BD, which may include considering practical ways that a patients' knowledge of intact ToM and empathy could be utilized to reduce self-stigma and promote self-efficacy, improved well-being and functioning.
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Affiliation(s)
- Cecilie K Lemvigh
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Glostrup, Denmark.,Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia
| | - James A Karantonis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.,Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Lisa S Furlong
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia
| | - Sean P Carruthers
- Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Glostrup, Denmark.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Susan L Rossell
- Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.,Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
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Lomastro MJ, Valerio MP, Szmulewicz AG, Martino DJ. Manic morbidity and executive function impairment as determinants of long-term psychosocial dysfunction in bipolar disorder. Acta Psychiatr Scand 2021; 144:72-81. [PMID: 33792890 DOI: 10.1111/acps.13303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/28/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the role of cognitive performance and measures of clinical course-including both syndromal and subsyndromal symptomatology-as determinants of the functional outcome of patients with Bipolar Disorder (BD) during a mean follow-up period of more than 4 years. METHODS Seventy patients with euthymic BD completed a neurocognitive battery at study entry. Clinical course was assessed prospectively for a period longer than 48 months by two measures: time spent ill (documented using a modified life charting technique) and density of affective episodes (defined as the number of depressive and hypo/manic episodes per year of follow-up). Psychosocial functioning was assessed during euthymia using the Functioning Assessment Short Test (FAST) total score at the end of follow-up period. RESULTS Baseline deficits in phonological fluency, a measure of executive functions (β = -2.49; 95% CI = -3.98, -0.99), and density of hypo/manic episodes during follow-up (β = 6.54; 95% CI = 0.43, 12.65) were independently associated with FAST total score at the end of study. CONCLUSIONS Although interrelated, manic morbidity and executive function impairments independently contribute to long-term psychosocial dysfunction in BD and could be potential targets of intervention.
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Affiliation(s)
| | - Marina P Valerio
- Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET, Buenos Aires, Argentina
| | | | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET, Buenos Aires, Argentina.,Institute of Cognitive and Translational Neuroscience (INCyT, INECO Foundation, Favaloro University, Buenos Aires, Argentina
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Espinós U, Fernández-Abascal EG, Ovejero M, Lahera G. Social cognition in first-degree relatives of bipolar disorder: Theory of Mind and nonverbal sensitivity. PLoS One 2021; 16:e0246908. [PMID: 33651831 PMCID: PMC7924770 DOI: 10.1371/journal.pone.0246908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
Social cognition might be impaired in first degree relatives (FDR) of BD but existing research shows controversial results about social cognitive impairments in this population. The aim of this study was to assess Theory of Mind (ToM) and nonverbal sensitivity in FDR of BD and compare the results with those of two groups of persons with remitted bipolar disorder (BD), type I and II, and a control group. Social cognitive ability was examined in first degree relatives of BD, with a biological parent, offspring or sibling diagnosed with the disorder. For this study, 37 FDRs of bipolar patients, 37 BD I, 40 BD II and 40 control participants were recruited. Social cognition was explored by means of the Reading the Mind in the Eyes Test and the MiniPONS. Results showed a significant impairment in FDR of BD in the ToM task, but not in nonverbal sensitivity. Performance of FDRs in social cognition is better than that of BDs (either type I or type II) but worse when compared with that of healthy individuals without a family history of psychiatric disorders. Nevertheless, no differences were found between BD I and BD II groups. Males and older participants showed a worse performance in all groups. Group family therapy with FDRs of BD might include training in the recognition of nonverbal cues, which might increase the understanding of their familiars with BD, in order to modify communication abilities.
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Affiliation(s)
- Usue Espinós
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
- * E-mail:
| | | | - Mercedes Ovejero
- Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
| | - Guillermo Lahera
- Facultad de Medicina, Universidad de Alcalá de Henares, Madrid, Spain
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Van Meter A, Stoddard J, Penton-Voak I, Munafò MR. Interpretation bias training for bipolar disorder: A randomized controlled trial. J Affect Disord 2021; 282:876-884. [PMID: 33601731 DOI: 10.1016/j.jad.2020.12.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with emotion interpretation biases that can exacerbate depressed mood. Interpretation bias training (IBT) may help; according to the "virtuous cycle" hypothesis, interpreting others' emotions as positive can lead to interactions that improve mood. Our goals were to determine whether IBT can shift emotion interpretation biases and demonstrate clinical benefits (lower depressed mood, improved social function) in people with BD. METHOD Young adults with BD were recruited for three sessions of computer-based IBT. Active IBT targets negative emotion bias by training judgments of ambiguous face emotions towards happy judgments. Participants were randomized to active or sham IBT. Participants reported on mood and functioning at baseline, intervention end (week two), and week 10. RESULTS Fifty participants (average age 22, 72% female) enrolled, 38 completed the week 10 follow-up. IBT shifted emotion interpretations (Hedges g = 1.63). There was a group-by-time effect (B = -13.88, p < .0001) on self-reported depression; the IBT group had a larger decrease in depressed mood. The IBT group also had a larger increase in perceived familial support (B = 3.88, p < .0001). Baseline learning rate (i.e., how quickly emotion judgments were updated) was associated with reduced clinician- (B = -54.70, p < 0.001) and self-reported depression (B = -58.20, p = 0.009). CONCLUSION Our results converge with prior work demonstrating that IBT may reduce depressed mood. Additionally, our results provide support for role of operant conditioning in the treatment of depression. People with BD spend more time depressed than manic; IBT, an easily disseminated intervention, could augment traditional forms of treatment without significant expense or side effects.
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Affiliation(s)
- Anna Van Meter
- Feinstein Institutes for Medical Research, Institute of Behavioral Science; The Zucker Hillside Hospital, Department of Psychiatry Research; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New York.
| | - Joel Stoddard
- Pediatric Mental Health Institute, Children's Hospital Colorado, Department of Psychiatry & Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Ian Penton-Voak
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
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A qualitative exploration of how people with bipolar disorder consider risk-taking in everyday decisions. Behav Cogn Psychother 2020; 49:314-327. [PMID: 33334387 DOI: 10.1017/s1352465820000946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Difficulties with decision making and risk taking in individuals with bipolar disorder (BD) have been associated with mood episodes. However, there is limited information about these experiences during euthymia, the mood state where people with BD spent the majority of their time. AIMS To examine how individuals with BD consider risk in everyday decisions during their euthymic phase. METHOD We conducted a qualitative study that used semi-structured audio recorded interviews. Eight euthymic participants with confirmed BD were interviewed, and we used interpretative phenomenological analysis to analyse the data. RESULTS We identified four themes. The first theme, 'Who I really am', involves the relationship between individual identity and risks taken. The second theme, 'Taking back control of my life', explored the relationship between risks taken as participants strove to keep control of their lives. The third theme, 'Fear of the "what ifs"', represents how the fear of negative consequences from taking risks impacts risk decisions. Finally, the fourth theme, 'The role of family and friends', highlights the important role that a supporting network can play in their lives in the context of taking risks. CONCLUSIONS The study highlights aspects that can impact on an individual with BD's consideration of risk during euthymia. Identity, control, fear and support all play a role when a person considers risk in their decision-making process, and they should be taken into consideration when exploring risk with individuals with BD in clinical settings, and inform the design of future interventions.
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Munuera C, Roux P, Weil F, Passerieux C, M'Bailara K. Determinants of the remission heterogeneity in bipolar disorders: The importance of early maladaptive schemas (EMS). J Affect Disord 2020; 277:857-868. [PMID: 33065827 DOI: 10.1016/j.jad.2020.08.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/16/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND A crucial health issue is to understand the remission heterogeneity of Bipolar Disorders by considering symptomatology as well as functioning. A new perspective could be elements of the construction of individual identity. This exploratory study aimed to explore the remission heterogeneity of patients with BD in terms of Early Maladaptive Schemas (EMS) by preferring a person-oriented approach. METHODS This study included euthymic patients recruited into the FACE-BD cohort. The remission was assessed by the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale for its symptomatic dimension and by the Functioning Assessment Short Test for its functional dimension. The activation of the eighteen EMS was assessed by the Young Schema Questionnaire 3 Short Form. Clustering was performed to identify profiles according to the patients' remission. Clusters identified were compared on the EMS activation by using analysis of variance and post-hoc tests. RESULTS Among the 100 euthymic patients included, four profiles of remission were identified: cluster 1 "Global Remission" (34%), cluster 2 "Hypomanic residual" (20%), cluster 3 "Depressive residual and functional impairment" (36%) and cluster 4 "Global handicap" (10%). Two out of three EMS discriminated against these profiles. The activation of specific EMS clarifies the singularity of each remission profile. LIMITATIONS For the symptomatic dimension, cut-offs chosen could be discussed as well as the scale assessing residual depressive symptoms. CONCLUSIONS This study participates in a comprehensive model of remission by integrating the symptomatology, the functioning, and the EMS. Identifying and treating EMS may improve patients remission to reach recovery.
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Affiliation(s)
- Caroline Munuera
- Laboratoire de psychologie, EA4139, Université́ de Bordeaux, 3ter place de la Victoire, Bordeaux, France
| | - Paul Roux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux; CESP, Team "Developmental Psychiatry", Université Paris-Saclay, Inserm, 12 Avenue Paul Vaillant Couturier, 94807, Villejuif
| | - François Weil
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux
| | - Christine Passerieux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux; CESP, Team "Developmental Psychiatry", Université Paris-Saclay, Inserm, 12 Avenue Paul Vaillant Couturier, 94807, Villejuif
| | - Katia M'Bailara
- Laboratoire de psychologie, EA4139, Université́ de Bordeaux, 3ter place de la Victoire, Bordeaux, France; Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121 rue de la Béchade, Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40 rue de Mesly, Créteil, France.
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López-Villarreal A, Sánchez-Morla EM, Jiménez-López E, Martínez-Vizcaíno V, Aparicio AI, Mateo-Sotos J, Rodriguez-Jimenez R, Vieta E, Santos JL. Progression of the functional deficit in a group of patients with bipolar disorder: a cluster analysis based on longitudinal data. Eur Arch Psychiatry Clin Neurosci 2020; 270:947-957. [PMID: 31422453 DOI: 10.1007/s00406-019-01050-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/07/2019] [Indexed: 12/23/2022]
Abstract
We aimed to examine the trajectory of psychosocial functioning in a sample of euthymic patients with bipolar disorder (BD) throughout a 5-year follow-up. Ninety-nine euthymic bipolar patients and 40 healthy controls (HC) were included. A neurocognitive assessment (17 neurocognitive measures grouped in 6 domains) was carried out at baseline. The split version of the Global Assessment of Functioning scale (GAF-F) and the Functioning Assessment Short Test (FAST) were used to examine psychosocial functioning at baseline (T1), and after a 5-year follow-up (T2). The statistical analysis was performed through repeated measures ANOVA and hierarchical cluster analysis based on the GAF-F and the FAST scores at T1 and T2. Eighty-seven patients (87.9%) were evaluated at T2. The cluster analysis identified two groups of patients. The first group included 44 patients (50.6%) who did not show a progression of the functional impairment (BD-NPI). The second cluster, which included 43 patients (49.4%), was characterized by a progression of the functional impairment (BD-PI). The BD-PI had a higher number of relapses and a higher number of hospitalizations during the follow-up period, as well as worse neurocognitive functioning than the BD-NPI. The repeated measures ANOVA confirmed that the psychosocial performance of BD-NPI is stable while there was a progression of the functional deterioration in BD-PI. The trajectory of the psychosocial functioning of patients with BD is not homogeneous. Our results suggest that in at least one subset of patients with BD, which might account for half of the patients, the disease has a progressive course.
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Affiliation(s)
- Ana López-Villarreal
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Eva María Sánchez-Morla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain. .,CogPsy-Group, Universidad Complutense de Madrid (UCM), Madrid, Spain. .,Department of Psychiatry, Hospital Universitario 12 de Octubre, Avda. Córdoba km. 5400, 28041, Madrid, Spain.
| | - Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain.,Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo-Sotos
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain.,CogPsy-Group, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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Cognitive performance and psychosocial functioning in unaffected siblings of bipolar disorder patients in comparison with healthy controls. Asian J Psychiatr 2020; 54:102246. [PMID: 32634709 DOI: 10.1016/j.ajp.2020.102246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 11/20/2022]
Abstract
We aimed to evaluate the cognitive domains for endophenotypes and their bearing on psychosocial functioning in unaffected siblings of patients with bipolar type I disorder (BD-I). We recruited unaffected siblings (n = 60) and age (±2 years), gender and education-matched healthy control subjects (n = 60) after screening with Structured clinical interview for DSM-IV-TR axis I disorders (SCID-I) - Research Version, Young Mania rating scale (YMRS), Hamilton depression rating scale (HDRS) and Family Interview for Genetic Studies scale (FIGS). Cognitive functioning was evaluated using Addenbrooke's Cognitive Examination III Revised (ACE-III R) and Trail making tests A and B, whereas psychosocial functioning was evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). The siblings had scored significantly lower in memory tasks of ACE-III R (p < 0.001) than controls, whereas other cognitive domains were comparable. Psychosocial functioning did not differ significantly between the groups. No correlation existed between cognitive performance and psychosocial functioning. Memory functions can be considered as a possible endophenotype for BD-I.
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Lomastro MJ, Valerio MP, Blasco MB, Tagni MF, Martino DJ. Predictors of High Psychosocial Functioning in Bipolar Disorder. J Nerv Ment Dis 2020; 208:904-907. [PMID: 33105443 DOI: 10.1097/nmd.0000000000001224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to identify predictors of high psychosocial functioning in patients with bipolar disorder (BD). One hundred forty-five outpatients with BD and 50 healthy controls were included. Patients were categorized as having high psychosocial functioning if they concomitantly met three conditions: a) General Assessment of Functioning greater than 90, b) full-time employment, and c) full functional recovery. Clinical, demographical, and neurocognitive variables were assessed and considered as potential predictors of high functioning in regression models. We found that 22.8% (n = 33) of patients exhibited high psychosocial functioning. BD type II, higher educational level, and better performance in verbal memory, attention, and executive functions were independent predictors of high psychosocial functioning. Our results provide evidence that functional outcomes are heterogeneous in BD, including a percentage of patients who maintain good to excellent psychosocial functioning despite their illness. Neurocognitive functioning could be one of the most influential factors to explain this heterogeneity.
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Orhan M, Korten N, Kupka R, van Oppen P, Stek M, Vieta E, Schouws S, van Ballegooijen W, Dols A. Reliability and validity of the functioning assessment short test for older adults with bipolar disorder (FAST-O). Int J Bipolar Disord 2020; 8:28. [PMID: 33006669 PMCID: PMC7532249 DOI: 10.1186/s40345-020-00193-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Many frequently used instruments fail to assess psychosocial functioning in patients with bipolar disorder. The Functioning Assessment Short Test (FAST) was developed in order to tackle this problem and to assess the main functioning problems experienced by patients with bipolar disorder. However, the original FAST is not fully applicable in older adults due to the domain of occupational functioning. The aim of our study was to validate an adapted version for Older adults (FAST-O) in a group of older adults with bipolar disorder (OABD). Methods 88 patients aged 50 years and over diagnosed with bipolar disorder were included. We adapted the items in the area of “work-related functioning” of the FAST into items assessing “societal functioning”. Several measurements were conducted in order to analyse the psychometric qualities of the FAST-O (confirmatory factor analysis for internal structure, Cronbach’s alpha for internal consistency, Spearman’s rho for concurrent validity, Mann–Whitney U test for discriminant validity). Results Mean age in the study sample was 65.3 (SD = 7.5) and 57.3% was female. The internal structure was most similar to the internal structure of the original FAST. The internal consistency was excellent (Cronbach’s alpha = .93). The concurrent validity when correlated with the Social and Occupational Functioning Assessment Scale was low, but significant. The FAST-O was also able to distinguish between euthymic and symptomatic OABD patients. Conclusions The FAST-O has strong psychometric qualities. Based on our results, we can conclude that the FAST-O is a short, efficient solution in order to replace global rating scales or extensive test batteries in order to assess daily functioning of older psychiatric patients in a valid and reliable manner.
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Affiliation(s)
- Melis Orhan
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands. .,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Nicole Korten
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Ralph Kupka
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, Amstelveenseweg 589, 1081JC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus, VUMC, Amsterdam, The Netherlands
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50
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Godin O, Leboyer M, Mazroui Y, Aouizerate B, Azorin JM, Raoul B, Bellivier F, Polosan M, Courtet P, Dubertret C, Henry C, Kahn JP, Loftus J, Olié E, Passerieux C, Costagliola D, Etain B, Llorca P, Barteau V, Bensalem S, Laaidi M, Laouamri H, Souryis K, Hotier S, Pelletier A, Drancourt N, Sanchez J, Saliou E, Hebbache C, Petrucci J, Willaume L, Bourdin E, Carminati M, Etain B, Marlinge E, Meheust J, Antoniol B, Desage A, Gard S, Jutant A, Mbailara K, Minois I, Zanouy L, Abettan C, Bardin L, Cazals A, Deffinis B, Ducasse D, Gachet M, Henrion A, Martinerie E, Molière F, Noisette B, Tarquini G, Belzeaux R, Correard N, Consoloni JL, Groppi F, Lescalier L, Montant J, Rebattu M, Viglianese N, Cohen R, Milazzo M, Wajsbrot-Elgrabli O, Bougerol T, Fredembach B, Garçon S, Grignon P, Perrin A, Galliot A, Grévin I, Cannavo A, Kayser N, Roux P, Aubin V, Cussac I, Dupont M, Medecin I, Mazer N, Portalier C. Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Aust N Z J Psychiatry 2020; 54:985-996. [PMID: 32779531 DOI: 10.1177/0004867420945796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders. METHODS We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning. RESULTS Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85. CONCLUSION This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.
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Affiliation(s)
- Ophelia Godin
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Yassin Mazroui
- Laboratoire de Probabilités, Statistiques et Modélisation (LPSM), Sorbonne Université, Paris, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Jean-Michel Azorin
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Belzeaux Raoul
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U1216, Grenoble, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, Paris, France
| | - Chantal Henry
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Pierre Kahn
- Fondation FondaMental, Créteil, France.,Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Nancy, France
| | - Josephine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Emilie Olié
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team 'DevPsy', Villejuif, France
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
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