Italian Bipolar II vs I patients have better individual functioning, in spite of overall similar illness severity

CNS Spectrums ◽  
2016 ◽  
Vol 22 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Bernardo Dell’Osso ◽  
Cristina Dobrea ◽  
Laura Cremaschi ◽  
Massimiliano Buoli ◽  
Shefali Miller ◽  
...  
Keyword(s):  
Stressful Life Events ◽  
Suicide Attempts ◽  
Age At Onset ◽  
Bipolar Disorders ◽  
Severe Illness ◽  
Text Revision ◽  
Duration Of Illness ◽  
Lifetime Number ◽  
History Of ◽  
Antidepressant Use

IntroductionBipolar disorders (BDs) comprise different variants of chronic, comorbid, and disabling conditions, with relevant suicide and suicide attempt rates. The hypothesis that BD types I (BDI) and II (BDII) represent more and less severe forms of illness, respectively, has been increasingly questioned over recent years, justifying additional investigation to better characterize related sociodemographic and clinical profiles.MethodsA sample of 217 outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)–described BD (141 BDI, 76 BDII), without a current syndromal mood episode, was recruited, and sociodemographic and clinical characteristics of BDI and II patients were compared.ResultsBDII patients had significantly more favorable sociodemographics, in relation to occupational stability, cohabitation, and marital status. However, BDII compared with BDI patients had significantly longer duration of untreated illness, more frequent lifetime anxiety disorders comorbidity, longer most recent episode duration, higher rate of depressive first/most recent episode, and more current antidepressant use. In contrast, BDI compared with BDII patients had significantly more severe illness in terms of earlier age at onset; higher rate of elevated first/most recent episode, lifetime hospitalizations, and involuntary commitments; lower Global Assessment of Functioning score; and more current antipsychotic use. BDI and II patients had similar duration of illness, psychiatric family history, lifetime number of suicide attempts, current subthreshold symptoms, history of stressful life events, and overall psychiatric/medical comorbidity.ConclusionBDII compared with BDI patients had more favorable sociodemographic features, but a mixture of specific unfavorable illness characteristics, confirming that BDII is not just a milder form of BD and requires further investigation in the field.

Childhood Trauma in Bipolar Disorders: Familial and Individual Mediators for Predicting Occurrence and Outcome

2017 ◽  
Vol 41 (S1) ◽  
pp. S28-S28
Author(s):  
B. Etain
Keyword(s):  
Physical Abuse ◽  
Childhood Trauma ◽  
Emotional Abuse ◽  
Suicide Attempts ◽  
Bipolar Disorders ◽  
Affect Intensity ◽  
The Face ◽  
History Of ◽  
Competing Interest ◽  
Psychotic Features

Childhood trauma is highly prevalent in patients with bipolar disorder (BD) and has been associated to a more severe/complex expression of the disorder. Little is known about the familial and individual factors that can mediate the occurrence of trauma within families but also influence the outcomes of BD. We will present data from two independent samples of patients with BD in order to identify the potential mediators for occurrence and severity/complexity. In a first sample of 371 patients with BD, 256 relatives and 157 healthy controls, we will show that there is a familial resemblance for emotional and physical abuses. Patients’ level of physical abuse was associated with their parental levels of physical abuse, but also with their father's history of alcohol misuse (p < 0.05). Second, in a sub-sample of 270 normothymic patients, we have performed a path-analysis to demonstrate that emotional and physical abuses interacted with cannabis misuse to increase the frequency of psychotic features and delusional beliefs. Finally, in an independent sample of 485 euthymic patients from the FACE-BD cohort we used path-analytic models to show that emotional abuse increased all the assessed affective/impulsive dimensions (p < 0.001). In turn, affect intensity and attitudinal hostility were associated with high risk for suicide attempts (p < 0.001), whereas impulsivity was associated with a higher risk for presence of substance misuse (p < 0.001). These results illustrate that childhood trauma might derive from parental characteristics (own childhood trauma and psychopathology) and increase the severity/complexity of BD through individual dimensions of psychopathology.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Difference of Disability Between Electrophysiologic Subgroups of Essential Tremor

2000 ◽  
Vol 27 (1) ◽  
pp. 60-64 ◽  
Author(s):  
M. Cenk Akbostanci ◽  
Sedat Ulkatan ◽  
Aytaç Yigit ◽  
Nursel Aydin ◽  
Nermin Mutluer
Keyword(s):  
Essential Tremor ◽  
Age At Onset ◽  
Synchronous Activity ◽  
The Third ◽  
Disability Scale ◽  
Antagonist Muscles ◽  
Duration Of Illness ◽  
Significant Difference ◽  
History Of ◽  
Antagonistic Muscles

ABSTRACT:Objective:The aim of the study was to test the validity of the controversial subdivision of essential tremor (ET) patients into electrophysiological subgroups.Methods:We evaluated a hundred patients with ET using surface electromyographic (EMG) recordings of antagonist forearm muscles and distinguished three groups: the first group showed synchronous activity of antagonistic muscles, the second showed alternating activity of antagonist muscles; and the third group consisted of patients whose EMG recordings were not compatible with the other two groups. We compared patients with synchronous and alternating activity in terms of sex, age at onset, duration of illness, family history of tremor, symmetry and frequency of tremor, and the scores of a disability scale.Results:The only significant difference between the patients with synchronous and alternating activity was that the patients with synchronous activity were more disabled.Conclusion:This result adds to the evidence for distinct electrophysiological subgroups of ET with distinct clinical properties.

Unexpected Death of Psychiatric Patients: Suicide, Misadventure, Accident or Unsolved Mystery?

1997 ◽  
Vol 37 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Emad Salib ◽  
Ann Joseph ◽  
Sheila Cawley
Keyword(s):  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Psychiatric History ◽  
Unexpected Death ◽  
Related Condition ◽  
Condition Method ◽  
Duration Of Illness ◽  
History Of ◽  
Main Factors

We examined the association between the psychiatric history of patients who were the subjects of a coroner's inquest and the recorded verdict, in a seven-year retrospective review. A suicide verdict was less frequently returned on patients who had inpatient psychiatric treatment compared to other unexpected deaths. History and diagnosis of an alcohol-related condition, method of death and intimation of intent were the main factors that appeared to be associated with the coroner's verdict. Age, sex, duration of illness, time and number of admissions, previous suicide attempts and treatment received did not appear to be significantly associated with the recorded verdict.

Non-lithium pharmacological treatment of manic depression: a review

1993 ◽  
Vol 10 (2) ◽  
pp. 114-120
Author(s):  
Brian O'Shea
Keyword(s):  
Bipolar Disorders ◽  
Serum Levels ◽  
Severe Illness ◽  
Manic Depressive ◽  
Predictors Of Response ◽  
Alternative Drug ◽  
History Of ◽  
Psychosocial Influences ◽  
Depressive Patients ◽  
Indications For Use

AbstractObjectives:To examine the reasons why manic-depressive patients often fail to respond to lithium and, the chief purpose of this paper, to review the present state of knowledge concerning alternative pharmacotherapies to lithium in this disorder.Method:Literature review.Findings:Lithium produces a clinically useful effect in 70-80% of cases. Factors such as non-compliance, side-effects, serum levels, and enduring psychosocial influences on the patient must be considered before treatment failure is diagnosed. Carbamazepine is the most studied alternative drug to date, and the most likely predictors of response to this agent are rapid-cycling, absence of a family history of affective disorder, mania, severe illness, and non-response to lithium.Conclusions:In view of the 20-25% of patients who do not respond to lithium, and the increased likelihood that lithium-responders may fail to respond again once the drug has been stopped for a period, further research is needed to find better and safer prophylactics against depression in bipolar disorders and to refine our knowledge of the indications for use of those already available.

Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders

2013 ◽  
Vol 44 (8) ◽  
pp. 1653-1662 ◽  
Author(s):  
M. Aas ◽  
B. Etain ◽  
F. Bellivier ◽  
C. Henry ◽  
T. Lagerberg ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Suicide Attempt ◽  
Childhood Abuse ◽  
Age At Onset ◽  
Bipolar Disorders ◽  
Additive Effects ◽  
Rapid Cycling ◽  
Mediation Effects ◽  
Cannabis Abuse ◽  
History Of

BackgroundPrevious studies of bipolar disorders indicate that childhood abuse and substance abuse are associated with the disorder. Whether both influence the clinical picture, or if one is mediating the association of the other, has not previously been investigated.MethodA total of 587 patients with bipolar disorders were recruited from Norway and France. A history of childhood abuse was obtained using the Childhood Trauma Questionnaire. Diagnosis and clinical variables, including substance abuse, were based on structured clinical interviews (Structured Clinical Interview for DSM-IV Axis I disorders or French version of the Diagnostic Interview for Genetic Studies).ResultsCannabis abuse was significantly associated with childhood abuse, specifically emotional and sexual abuse (χ2 = 8.63,p = 0.003 andχ2 = 7.55,p = 0.006, respectively). Cannabis abuse was significantly associated with earlier onset of the illness (z = −4.17,p < 0.001), lifetime history of at least one suicide attempt (χ2 = 11.16,p = 0.001) and a trend for rapid cycling (χ2 = 3.45,p = 0.06). Alcohol dependence was associated with suicide attempt (χ2 = 10.28,p = 0.001), but not with age at onset or rapid cycling. After correcting for possible confounders and multiple testing, a trend was observed for an interaction between cannabis abuse and childhood abuse and suicide attempt (logistic regression:r2 = 0.06,p = 0.039). Significant additive effects were also observed between cannabis abuse and childhood abuse on earlier age at onset (p < 0.001), increased rapid cycling and suicide attempt (logistic regression:r2 = 0.03–0.04,p < 0.001). No mediation effects were observed; childhood abuse and cannabis abuse were independently associated with the disorder.ConclusionsOur study is the first to demonstrate significant additive effects, but no mediation effects, between childhood abuse and cannabis abuse on increased clinical expressions of bipolar disorders.

Suicide in Developing Countries (2)

Crisis ◽  
2005 ◽  
Vol 26 (3) ◽  
pp. 112-119 ◽  
Author(s):  
Lakshmi Vijayakumar ◽  
Sujit John ◽  
Jane Pirkis ◽  
Harvey Whiteford
Keyword(s):  
Risk Factors ◽  
Developing Countries ◽  
Life Events ◽  
Suicide Risk ◽  
Stressful Life Events ◽  
Suicide Attempts ◽  
Developed Countries ◽  
Low Socioeconomic ◽  
History Of ◽  
Developing And Developed Countries

Abstract. The majority of studies on risk factors for suicide have been conducted in developed countries, and less work has been done to systematically profile risk factors in developing countries. The current paper presents a selective review of sociodemographic, clinical, and environmental/situational risk factors in developing countries. Taken together, the evidence suggests that the profiles of risk factors in developing countries demonstrate some differences from those in developed countries. In some developing countries, at least, being female, living in a rural area, and holding religious beliefs that sanction suicide may be of more relevance to suicide risk than these factors are in developed countries. Conversely, being single or having a history of mental illness may be of less relevance. Risk factors that appear to be universal include youth or old age, low socioeconomic standing, substance use, and previous suicide attempts. Recent stressful life events play a role in both developing and developed countries, although their nature may differ (e.g., social change may have more of an influence in the former). Likewise, access to means heightens risk in both, but the specific means may vary (e.g., access to pesticides is of more relevance in developing countries). These findings have clear implications for suicide prevention, suggesting that preventive efforts that have shown promise in developed countries may need to be tailored differently to address the risk factor profile of developing countries.

scholarly journals Dynamics of human papillomavirus serology in women followed up for 36 months after pregnancy

2009 ◽  
Vol 90 (6) ◽  
pp. 1515-1526 ◽  
Author(s):  
Stina Syrjänen ◽  
Tim Waterboer ◽  
Marja Sarkola ◽  
Kristina Michael ◽  
Marjut Rintala ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Age At Onset ◽  
Sexual Partners ◽  
Smoking History ◽  
Lifetime Number ◽  
Number Of Sexual Partners ◽  
History Of ◽  
Hpv Types ◽  
Multiplex Serology

We determined L1 antibodies for human papillomavirus (HPV) types 6, 11, 16, 18 and 45 by multiplex serology in our prospective HPV family study. We report seroprevalence, seroconversion and antibody decay in 290 women (mean age, 25.5 years) sampled before delivery and at 12, 24 and 36 months of follow-up. Multiplex HPV genotyping of the baseline oral and genital scrapings was performed. At baseline, seroprevalence of HPV 6, 11, 16, 18 and 45 was 53.3, 21.5, 34.9, 21.5 and 9.0 %, respectively. Seropositivity for low-risk HPV (LR-HPV) was associated significantly with age at onset of sexual activity (P=0.001), number of sexual partners until age 20 (P=0.018), lifetime number of sexual partners (P=0.0001), history of genital warts (P=0.0001) and being seropositive for high-risk (HR) HPV (P=0.0001). The same covariates also predicted seropositivity for HR-HPV. During follow-up, 26.7, 13.9, 17.0, 16.8 and 6.6 % of the women seroconverted to L1 antigen of HPV 6, 11, 16, 18 and 45, respectively, between 18.2 and 23.8 months. Independent predictors of seroconversion to LR-HPV were unemployment (P=0.019) and absence of anal sex practice (P=0.031), and to HR-HPV, absence of smoking history and lifetime number of sexual partners. Decay of HPV 6, 11, 16, 18 and 45 antibodies was observed in 2.3, 4.0, 5.3, 4.5 and 1.5 % of the women, respectively, with decay time varying from 27.2 to 35.8 months. These data imply that (i) a substantial proportion of young women are seropositive for both LR- and HR-HPV types, (ii) they frequently undergo seroconversion within 18–24 months, predicted by common covariates, and (iii) antibody decay over 3 years is rare.

scholarly journals Suicide attempts and non-suicidal self-harm: national prevalence study of young adults

BJPsych Open ◽  
2018 ◽  
Vol 4 (3) ◽  
pp. 142-148 ◽  
Author(s):  
Rory C. O'Connor ◽  
Karen Wetherall ◽  
Seonaid Cleare ◽  
Sarah Eschle ◽  
Julie Drummond ◽  
...  
Keyword(s):  
Young Adults ◽  
Young People ◽  
Suicide Attempt ◽  
Suicide Attempts ◽  
Age At Onset ◽  
First Episode ◽  
Prevalence Studies ◽  
History Of ◽  
Self Harm ◽  
National Prevalence

BackgroundThere are few prevalence studies of suicide attempts and non-suicidal self-harm (NSSH).AimsWe aimed to estimate the prevalence of thoughts of NSSH, suicidal thoughts, NSSH and suicide attempts among 18- to 34-year-olds in Scotland.MethodWe interviewed a representative sample of young adults from across Scotland.ResultsWe interviewed 3508 young people; 11.3 and 16.2% reported a lifetime history of suicide attempts and NSSH, respectively. The first episode of NSSH tended to precede the first suicide attempt by about 2 years. Age at onset of NSSH and suicide attempt was younger in females. Earlier age at onset was associated with more frequent NSSH/suicide attempts. Women are significantly more likely to report NSSH and suicide attempts compared with men.ConclusionsOne in nine young people has attempted suicide and one in six has engaged in NSSH. Clinicians should be vigilant, as suicide attempts and NSSH are relatively common.Declaration of interestNone.

Cerebral ventricle dimensions as risk factors for schizophrenia and affective psychosis: an epidemiological approach to analysis

1994 ◽  
Vol 24 (4) ◽  
pp. 995-1011 ◽  
Author(s):  
P. B. Jones ◽  
I. Harvey ◽  
S. W. Lewis ◽  
B. K. Toone ◽  
J. Van Os ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Age At Onset ◽  
Intracranial Volume ◽  
Affective Psychosis ◽  
Functional Psychosis ◽  
Duration Of Illness ◽  
History Of ◽  
Community Controls ◽  
Ventricle Size ◽  
Healthy Community

SynopsisA case–control study was undertaken of volumetric computerized tomographic scan measures in 216 consecutive admissions for functional psychosis and 67 healthy community controls. Odds ratio analysis demonstrated significant linear trends in the association between increasing lateral and third ventricle volumes, and both RDC schizophrenia (N= 121) and schizoaffective disorder (N= 41); cases were consistently associated with larger volumes than controls. There was an association between larger third, but not lateral, ventricle size in affective psychoses (N= 54). These associations were statistically independent of intracranial volume, sex, social class and ethnicity, factors which were significantly associated with ventricular measures in the controls. There was no evidence of a threshold corresponding to the notion of normalversusenlarged ventricles.Within the schizophrenia group, there were no large or significant associations between ventricle dimensions and age at onset, duration of illness or pre-morbid social functioning. Neither obstetric complications nor a family history of schizophrenia or other psychiatric illness was associated with large ventricles in these cases.

Depression, depressive symptoms, and rate of hippocampal atrophy in a longitudinal cohort of older men and women

2015 ◽  
Vol 45 (9) ◽  
pp. 1931-1944 ◽  
Author(s):  
M. Elbejjani ◽  
R. Fuhrer ◽  
M. Abrahamowicz ◽  
B. Mazoyer ◽  
F. Crivello ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Age At Onset ◽  
Hippocampal Volume ◽  
Epidemiologic Studies ◽  
Linear Regression Models ◽  
Cerebral Magnetic Resonance Imaging ◽  
Unit Increase ◽  
History Of ◽  
Antidepressant Use ◽  
History Of Depression

BackgroundSeveral studies have reported smaller hippocampal volume (HcV) in depression patients; however, the temporality of the association remains unknown. One proposed hypothesis is that depression may cause HcV loss. This study evaluates whether previous depression and recent depressive symptoms are associated with HcV and HcV loss.MethodWe used a prospective cohort of older adults (n= 1328; age = 65–80 years) with two cerebral magnetic resonance imaging examinations at baseline and 4-year follow-up. Using multivariable linear regression models, we estimated, in stratified analyses by gender, the association between indicators of history of depression and its severity (age at onset, recurrence, hospitalization for depression), proximal depressive symptoms [Center for Epidemiologic Studies-Depression (CES-D) scale], baseline antidepressant use, and the outcomes: baseline HcV and annual percentage change in HcV.ResultsAt baseline, women with more depressive symptoms had smaller HcV [−0.05 cm3, 95% confidence interval (CI) −0.1 to −0.01 cm3per 10-unit increase in CES-D scores]. History of depression was associated with a 0.2% faster annual HcV loss in women (95% CI 0.01–0.36%). More baseline depressive symptoms and worsening of these symptoms were also associated with accelerated HcV loss in women. No associations were observed in men. Treatment for depression was associated with slower HcV loss in women and men.ConclusionsWhile only concomitant depressive symptoms were associated with HcV, both previous depression and more proximal depressive symptoms were associated with faster HcV loss in women.

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