Clinically relevant and simple immune system measure is related to symptom burden in bipolar disorder

2017 ◽  
Vol 30 (5) ◽  
pp. 297-305 ◽  
Author(s):  
Ole Köhler-Forsberg ◽  
Louisa Sylvia ◽  
Thilo Deckersbach ◽  
Michael Joshua Ostacher ◽  
Melvin McInnis ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Trials ◽  
Immune System ◽  
Rating Scale ◽  
Lithium Treatment ◽  
Symptom Burden ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
Wide Range ◽  
Specific Symptoms

ObjectiveImmunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences.MethodsWe included two similar clinical trials, the lithium treatment moderate-dose use study and clinical and health outcomes initiatives in comparative effectiveness for bipolar disorder study, enrolling 765 participants with bipolar disorder. At study entry, white blood cell (WBC) count was measured and psychopathology assessed with the Montgomery and Aasberg depression rating scale (MADRS). We performed analysis of variance and linear regression analyses to investigate the relationship between the deviation from the median WBC, and multinomial regression analysis between different WBC levels. All analyses were performed gender-specific and adjusted for age, body mass index, smoking, race, and somatic diseases.ResultsThe overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32–1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=−0.19–1.31; p=0.14). Among men, WBC deviations were associated with increased severity of sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, inability to feel, and suicidal thoughts. Among women, WBC deviations were associated with increased severity of reduced appetite, concentration difficulties, lassitude, inability to feel, and pessimistic thoughts. Both higher and lower WBC levels were associated with increased severity of several specific symptoms.ConclusionImmune system alterations were associated with increased severity of specific mood symptoms, particularly among men. Our results support the sickness syndrome theory, but furthermore emphasise the relevance to study immune suppression in bipolar disorder. Due to the explorative nature and cross-sectional design, future studies need to confirm these findings.

scholarly journals How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041214
Author(s):  
Kevin Glynn ◽  
Frank McKenna ◽  
Kevin Lally ◽  
Muireann O’Donnell ◽  
Sandeep Grover ◽  
...  
Keyword(s):  
Palliative Care ◽  
Rating Scale ◽  
Symptom Burden ◽  
Systemic Infection ◽  
International Study ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Liaison Psychiatry ◽  
Cross Sectional ◽  
Hypoactive Delirium

ObjectivesTo investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.DesignCross-sectional study.SettingInternational study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measuresHyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.ResultsHypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).ConclusionsThis study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

scholarly journals Characteristics of registered clinical trials assessing treatments for COVID-19: a cross-sectional analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039978 ◽  
Author(s):  
Hemalkumar B Mehta ◽  
Stephan Ehrhardt ◽  
Thomas J Moore ◽  
Jodi B Segal ◽  
G Caleb Alexander
Keyword(s):  
Clinical Trials ◽  
Clinical Investigation ◽  
Scientific Progress ◽  
Cross Sectional ◽  
Design Elements ◽  
Cross Sectional Analysis ◽  
Therapeutic Benefits ◽  
Wide Range ◽  
The Usa ◽  
Sectional Analysis

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has prompted many initiatives to identify safe and efficacious treatments, yet little is known regarding where early efforts have focused. We aimed to characterise registered clinical trials assessing drugs or plasma treatments for COVID-19.Design, setting and participantsCross-sectional analysis of clinical trials for the treatment of COVID-19 that were registered in the USA or in countries contributing to the WHO’s International Clinical Trials Registry Platform. Relevant trial entries of drugs or plasma were downloaded on 26 March 2020, deduplicated, verified with reviews of major medical journals and WHO websites and independently analysed by two reviewers.Main outcome(s)Trial intervention, sponsorship, critical design elements and specified outcomesResultsOverall, 201 clinical trials were registered for testing the therapeutic benefits of 92 drugs or plasma, including 64 in monotherapy and 28 different combinations. Only eight (8.7%) products or combinations involved new molecular entities. The other test therapies had a wide range of prior medical uses, including as antivirals, antimalarials, immunosuppressants and oncology treatments. In 152 trials (75.7%), patients were randomised to treatment or comparator, including 55 trials with some form of blinding and 97 open-label studies. The 49 (24.4%) of trials without a randomised design included 29 single armed studies and 20 trials with some comparison group. Most trial designs featured multiple endpoints. Clinical endpoints were identified in 134 (66.7%) of trials and included COVID-19 symptoms, death, recovery, required intensive care and hospital discharge. Clinical scales were being used in 33 (16.4%) trials, most often measures of oxygenation and critical illness. Surrogate endpoints or biomarkers were studied in 88 (42.3%) of trials, primarily assays of viral load. Although the trials were initiated in more than 17 countries or regions, 100 (49.8%) were registered in China and 78 (37.8%) in the USA. Registered trials increased rapidly, with the number of registered trials doubling from 1 March to 26 March 2020.ConclusionsWhile accelerating morbidity and mortality from the COVID-19 pandemic has been paralleled by early and rapid clinical investigation, many trials lack features to optimise their scientific value. Global coordination and increased funding of high-quality research may help to maximise scientific progress in rapidly discovering safe and effective treatments.

A-141 Vindicated by Awareness: Acting with Awareness May Compensate for Inhibitory Deficits in ADHD Symptom Burden

2021 ◽  
Vol 36 (6) ◽  
pp. 1194-1194
Author(s):  
Maria E Dragulin ◽  
Claudia Jacova
Keyword(s):  
Inhibitory Control ◽  
Adhd Symptom ◽  
Rating Scale ◽  
Symptom Burden ◽  
Cross Sectional Study ◽  
Trait Mindfulness ◽  
Five Facet Mindfulness Questionnaire ◽  
Cross Sectional ◽  
Interference Test ◽  
Acting With Awareness

Abstract Objective To understand the role of trait mindfulness acting-with-awareness in the relationship between inhibitory control and ADHD symptom burden. Method We conducted a cross-sectional study with 103 adults, aged 18 to 86, mean age = 46, mean education = 15 years, 46% male. Participants were recruited in North Western Oregon counties. Eligible individuals were aged &gt;18, fluent in English, and with normal global cognition (Montreal Cognitive Assessment, MoCA&gt;22). The presence of ADHD diagnoses/symptoms was not required. Participants were administered the Adult Investigator Symptom Rating Scale (AISRS), the Five Facet Mindfulness Questionnaire (FFMQ) Acting with Awareness, and the DKEFS Color-Word Interference Test (CWIT). We examined the contribution of CWIT (time/sec), acting-with-awareness (AA), and their interaction in age-adjusted multiple regression predicting AISRS total score. Results Descriptives for the measures of interest were AISRS (M = 19.21, SD = 12.72), CWIT (M = 55.66, SD = 15.27), and FFMQ-AA (M = 25.10, SD = 7.17). Both CWIT and FFMQ-AA predicted AISRS when analyzed independently (B = 0.274, p = 0.14, R2 = 0.13 and B = -0.633, p &lt; 0.001, R2 = 0.45). In the combined model, FFMQ-AA (B = -1.06, p = 0.000) but not CWIT predicted AISRS, R2 = 0.47. The interaction was not significant, p = 0.55. Conclusion AA is a powerful predictor of ADHD symptom burden: it accounts for almost half of the variance, and removes any contribution from inhibitory control. Our finding suggests that trait mindfulness has a more important role in shaping ADHD than cognition.

Cross-sectional analysis: clinical presentation of children with persistently low ALP levels

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Oliver Semler ◽  
Carl-Joachim Partsch ◽  
Anibh Martin Das ◽  
Andreas Prechtl ◽  
Corinna Grasemann
Keyword(s):  
Motor Development ◽  
Serum Alkaline Phosphatase ◽  
Body Height ◽  
Patient Records ◽  
Cross Sectional ◽  
Clinical Presentations ◽  
Wide Range ◽  
Z Scores ◽  
Sectional Analysis ◽  
Specific Symptoms

Abstract Objectives Low activity of serum alkaline phosphatase (ALP) is a hallmark of hypophosphatasia (HPP), but low readings of ALP are not always recognized in clinical routine. Understanding the clinical presentations associated with low ALP may contribute to a timelier diagnosis of HPP. Methods Data from paediatric patients with low ALP, excluding patients in intensive care and with oncological/haematological disorders, were analysed. Most recent ALP values, previous diagnoses, medication and relevant symptoms were extracted from patient records at nine specialised centres and analysed descriptively. A relationship between body height and ALP values was scrutinised by linear regression. Results Of 370 children, 15 (4.1%) had a diagnosis of HPP. In the subgroup without a diagnosis of HPP, 241 (67.9%) out of 355 patients had one or more medical conditions known to be associated with low serum ALP. Of those, hypothyroidism, malnutrition and steroid administration were most frequent. Characteristic symptoms, particularly, short stature, muscle weakness and delay of motor development were more frequent and ALP values were lower in patients with documented HPP diagnosis compared to patients without diagnosis of HPP (Ø z-scores: −2.52) (interquartile range [IQR] = 0.20) vs. −1.96 (IQR = 0.87). A weak positive linear relationship between z-scores of ALP and body height was identified (p<0.001). Conclusions This analysis of paediatric patient records elucidates a wide range of disorders associated with low ALP activity. In case of additional specific symptoms, HPP should always be considered as a differential diagnosis.

Validation of Yonsei-Bilateral Activity Test (Y-BAT)-Bilateral Upper Extremity Inventory Using Rasch Analysis

2020 ◽  
Vol 40 (4) ◽  
pp. 277-286 ◽  
Author(s):  
Joo-Hyun Lee ◽  
Ickpyo Hong ◽  
Ji-Hyuk Park ◽  
Joon-Ho Shin
Keyword(s):  
Upper Extremity ◽  
Rasch Analysis ◽  
Rating Scale ◽  
Internal Validity ◽  
Specific Information ◽  
Good Precision ◽  
Cross Sectional ◽  
Fit Statistics ◽  
Activity Test ◽  
Wide Range

There is little assessment to provide specific information about quality of bilateral upper extremity movement specifically. This study examined the psychometric properties of the Yonsei-Bilateral Activity Test (Y-BAT). An observational cross-sectional design was used with 100 stroke survivors. Unidimensionality was examined using factor analyses, and Rasch analysis was used to test rating scale structure, fit statistics, and precision of the Y-BAT. The Y-BAT demonstrated a unidimensional measurement construct, and 19 of the 27 items fit the Rasch model. The instrument demonstrated good precision, including person reliability and person strata. The Y-BAT estimated person measures within a wide range of theta values with a reliability of .9 with good precision. Our results indicate that a revised, 19-item version of the Y-BAT demonstrates sound internal validity and may be a useful instrument for clinicians to measure upper extremity function with good precision following stroke.

scholarly journals Melanopsin-mediated pupillary responses in bipolar disorder—a cross-sectional pupillometric investigation

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Helle Østergaard Madsen ◽  
Shakoor Ba-Ali ◽  
Steffen Heegaard ◽  
Ida Hageman ◽  
Ulla Knorr ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Blue Light ◽  
Rating Scale ◽  
Ganglion Cells ◽  
Mood State ◽  
Young Mania ◽  
Cross Sectional ◽  
Illness Duration ◽  
Pupillary Responses ◽  
Blue Range

Abstract Background Visible light, predominantly in the blue range, affects mood and circadian rhythm partly by activation of the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs). The light-induced responses of these ganglion cells can be evaluated by pupillometry. The study aimed to assess the blue light induced pupil constriction in patients with bipolar disorder (BD). Methods We investigated the pupillary responses to blue light by chromatic pupillometry in 31 patients with newly diagnosed bipolar disorder, 22 of their unaffected relatives and 35 healthy controls. Mood state was evaluated by interview-based ratings of depressive symptoms (Hamilton Depression Rating Scale) and (hypo-)manic symptoms (Young Mania Rating Scale). Results The ipRGC-mediated pupillary responses did not differ across the three groups, but subgroup analyses showed that patients in remission had reduced ipRGC-mediated responses compared with controls (9%, p = 0.04). Longer illness duration was associated with more pronounced ipRGC-responses (7% increase/10-year illness duration, p = 0.02). Conclusions The ipRGC-mediated pupil response to blue light was reduced in euthymic patients compared with controls and increased with longer disease duration. Longitudinal studies are needed to corroborate these potential associations with illness state and/or progression.

scholarly journals Obesity and metabolic comorbidity in bipolar disorder: do patients on lithium comprise a subgroup? A naturalistic study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jake Prillo ◽  
Jocelyn Fotso Soh ◽  
Haley Park ◽  
Serge Beaulieu ◽  
Outi Linnaranta ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Bipolar Disorder ◽  
Body Mass ◽  
Type Ii Diabetes ◽  
Tertiary Care ◽  
Type Ii ◽  
Cross Sectional ◽  
Wide Range ◽  
Prevalence Of Obesity

Abstract Background Bipolar disorders (BD) are associated with increased prevalence of obesity and metabolic syndrome (MetS). Nevertheless, there is a wide range in prevalence estimates, with little known about the contributions of pharmacotherapy. It has been suggested that lithium might have a more favorable metabolic profile. We hypothesized that lithium use is associated with less increased body mass index (BMI), MetS, and type II diabetes, when compared with non-lithium users (those on anticonvulsants, second-generation antipsychotics). Methods Cross-sectional study of 129 patients aged 18–85 with bipolar disorder, followed at tertiary care clinics in Montreal. Patients using lithium were compared with those not on lithium, for body mass index and metabolic syndrome. Results The prevalence of obesity and metabolic syndrome in the sample of lithium-using patients with BD was 42.4 and 35.7% respectively, with an average BMI of 29.10 (+/− 6.70). Lithium and non-lithium groups did not differ in BMI or prevalence of MetS. However, compared to the non-lithium group, lithium users had lower hemoglobin A1C (5.24 +/− 0.53 versus 6.01 +/− 1.83, U = 753.5, p = 0.006) and lower triglycerides (1.46 +/− 0.88 versus 2.01 +/− 1.25, U = 947, p = 0.020). Conclusions There is a high prevalence of obesity and metabolic syndrome among patients with bipolar disorder. However, this did not appear to be associated with lithium use, when compared to those not on lithium. The lithium subgroup was also associated with lower prevalence of type II diabetes. Future prospective and intervention studies with larger sample sizes are necessary to further explore the association between lithium and insulin resistance, as well as its underlying mechanisms.

Psychopharmacologic Strategies for the Treatment of Aggression in Juveniles

CNS Spectrums ◽  
2003 ◽  
Vol 8 (4) ◽  
pp. 298-308 ◽  
Author(s):  
Hans Steiner ◽  
Kirti Saxena ◽  
Kiki Chang
Keyword(s):  
Bipolar Disorder ◽  
Posttraumatic Stress Disorder ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Stress Disorder ◽  
Complex Relationship ◽  
Controlled Clinical Trials ◽  
Oppositional Defiant ◽  
Wide Range ◽  
Specific Medication

ABSTRACTMaladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

Vaccine Ingredients: Components that Influence Vaccine Efficacy

2017 ◽  
Vol 17 (5) ◽  
pp. 451-466 ◽  
Author(s):  
Aneta Kocourkova ◽  
Jan Honegr ◽  
Kamil Kuca ◽  
Jana Danova
Keyword(s):  
Clinical Trials ◽  
Immune System ◽  
Adaptive Immunity ◽  
Active Ingredient ◽  
Vaccine Efficacy ◽  
Vast Number ◽  
Wide Range ◽  
Other Substances ◽  
Antigenic Material

Vaccination is defined as the administration of an antigenic material in order to stimulate the immune system, leading to the development of adaptive immunity to a pathogen. Vaccines can prevent or reduce morbidity from a vast number of infections. This manuscript presents an analysis of vaccine types and vaccine substances, concentrating on individual components including the active ingredient, adjuvants, preservatives, stabilizers, inactivators, antibiotics, diluents and other substances. While many papers have been published on individual vaccine components, this review provides detail on a wide range of the most commonly-used vaccine ingredients and components that have been tested in clinical trials.

scholarly journals Mobile App–Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review

10.2196/13770 ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. e13770
Author(s):  
Eric C Chan ◽  
Yuting Sun ◽  
Katherine J Aitchison ◽  
Sudhakar Sivapalan
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Rating Scale ◽  
Mobile App ◽  
Self Report ◽  
Healthy Controls ◽  
Young Mania ◽  
Good Adherence ◽  
Wide Range ◽  
Meta Analyses

Background Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app–based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective This paper aims to determine the feasibility and validity of mobile app–based self-report questionnaires. Methods We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app–based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app–based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app–based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). Conclusions These findings suggest that mobile app–based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated.

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