Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study

2010 ◽  
Vol 196 (2) ◽  
pp. 102-108 ◽  
Author(s):  
Marijn J. A. Tijssen ◽  
Jim van Os ◽  
Hans-Ulrich Wittchen ◽  
Roselind Lieb ◽  
Katja Beesdo ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Mental Healthcare ◽  
Dependent Manner ◽  
Manic Symptoms ◽  
The Poor ◽  
Affective Symptoms ◽  
Dsm Iv ◽  
Dose Dependent

BackgroundAlthough (hypo)manic symptoms are common in adolescence, transition to adult bipolar disorder is infrequent.AimsTo examine whether the risk of transition to bipolar disorder is conditional on the extent of persistence of subthreshold affective phenotypes.MethodIn a 10-year prospective community cohort study of 3021 adolescents and young adults, the association between persistence of affective symptoms over 3 years and the 10-year clinical outcomes of incident DSM–IV (hypo)manic episodes and incident use of mental healthcare was assessed.ResultsTransition to clinical outcome was associated with persistence of symptoms in a dose-dependent manner. Around 30–40% of clinical outcomes could be traced to prior persistence of affective symptoms.ConclusionsIn a substantial proportion of individuals, onset of clinical bipolar disorder may be seen as the poor outcome of a developmentally common and usually transitory non-clinical bipolar phenotype.

scholarly journals Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

2009 ◽  
Vol 40 (2) ◽  
pp. 289-299 ◽  
Author(s):  
M. J. A. Tijssen ◽  
J. van Os ◽  
H.-U. Wittchen ◽  
R. Lieb ◽  
K. Beesdo ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Bipolar Disorder ◽  
Mental Health Care ◽  
Health Care Use ◽  
Symptom Scale ◽  
Childhood Disorders ◽  
Manic Symptoms ◽  
Dsm Iv ◽  
Depressive Episodes

BackgroundReported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.MethodIn 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).ResultsIncidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.ConclusionsThis study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

scholarly journals Clinical Impact of Psychopathy on Bipolar Disorder

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 165
Author(s):  
Giuseppina Calabrò ◽  
Antonio Francesco Musolino ◽  
Andrea Adolfo Filippo ◽  
Renato de Filippis ◽  
Elvira Anna Carbone ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Personality Disorders ◽  
Rating Scale ◽  
Psychopathic Personality ◽  
Type I ◽  
Young Mania ◽  
Manic Symptoms ◽  
Affective Symptoms ◽  
Group 3 ◽  
Group 1

Background and Objectives. Bipolar disorder (BD) is associated with a significant burden due to affective symptoms and behavioral manifestations, but also cognitive and functional impairment. Comorbidity with other psychiatric conditions, including personality disorders, is frequent. The comorbidity with psychopathy deserves special consideration given that both disorders share some clinical characteristics, such as grandiosity, risky behavior or poor insight, among others, that can worsen the outcome of BD. Therefore, this study aimed to evaluate the prevalence of psychopathy in a sample of clinically stabilized patients with BD and its impact on the severity of BD. Materials and Methods. A sample of 111 patients with BD (38 type I and 73 type II) was studied. The Hamilton Depression Rating Scale (HAM-D) and the Young Mania Rating Scale (YMRS) served to assess the severity of BD. Psychopathy was measured by means of the Psychopathic Personality Inventory-Revised (PPI-R). Patients were divided into three groups according to the severity of psychopathy (Group 1: no psychopathy; Group 2: “psychopathic” trait; Group 3: clinical psychopathy). Other measures regarded impulsiveness (Barratt Impulsiveness Scale-11, BIS-11) and empathy (Empathy Quotient, EQ). Comparisons of mania, depression, impulsivity and empathy scores were run with MANOVA considering psychopathy and diagnosis as independent variables. Results. The prevalence of psychopathy was 5.4%. A significant association between the level of psychopathy and YMRS, attentional/cognitive impulsivity and motor impulsivity scores emerged. No interaction between psychopathy and BD diagnosis was found. Post hoc analysis demonstrated significantly higher YMRS scores in Group 3 than in Group 1; that is, patients with psychopathy have more manic symptoms. Conclusion. Psychopathy seems quite frequent among patients with BD. The association of psychopathy with BD results in higher impulsivity and manic symptoms. In light of this, psychopathy should be investigated when assessing patients with BD, regardless of the comorbidity of BD with other personality disorders.

scholarly journals Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder

2006 ◽  
Vol 189 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Eugene S. Paykel ◽  
Rosemary Abbott ◽  
Richard Morriss ◽  
Hazel Hayhurst ◽  
Jan Scott
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Therapeutic Intervention ◽  
Mental Healthcare ◽  
Residual Symptoms ◽  
Longitudinal Course ◽  
Manic Symptoms ◽  
Symptom Level

BackgroundThere have been few detailed longitudinal symptom studies of bipolar disorder.AimsTo describe the course of bipolar disorder over 18 months in 204 patients receiving mental healthcare.MethodPatients were interviewed every 8 weeks, with weekly ratings of depression, mania and overall severity.ResultsParticipants were symptomatic 53% of the time, with sub-syndromal symptoms present for twice as long as major disorder, and depressive symptoms three times more than manic symptoms. Individuals who were experiencing an episode at baseline spent 33% of the 18 months with substantial sub-syndromal symptoms, 17% with major disorder and 28% symptom free. Those not experiencing a baseline episode spent twice as long symptom free and half as long at disorder levels. Changes in symptom level were frequent. Predictors of sub-syndromal symptoms were similar to those of major disorder.ConclusionsSub-syndromal residual symptoms are an important problem in recurrent bipolar disorder and require therapeutic intervention.

Familial coaggregation of major psychiatric disorders among first-degree relatives of patients with obsessive-compulsive disorder: a nationwide study

2020 ◽  
pp. 1-8
Author(s):  
Mao-Hsuan Huang ◽  
Chih-Ming Cheng ◽  
Shih-Jen Tsai ◽  
Ya-Mei Bai ◽  
Cheng-Ta Li ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Obsessive Compulsive Disorder ◽  
Autism Spectrum ◽  
Research Database ◽  
Dependent Manner ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
First Degree Relatives ◽  
Dose Dependent

Abstract Background Whether the first-degree relatives (FDRs) of patients with obsessive-compulsive disorder (OCD) have an increased risk of the major psychiatric disorders, namely schizophrenia, bipolar disorder, OCD, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), remains unclear. Methods Using the Taiwan National Health Insurance Research Database with the whole population sample size (n = 23 258 175), 89 500 FDRs, including parents, offspring, siblings, and twins, of patients with OCD were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with OCD. Results FDRs of patients with OCD had higher RRs of major psychiatric disorders, namely OCD (RR 8.11, 95% confidence interval (CI) 7.68–8.57), bipolar disorder (RR 2.85, 95% CI 2.68–3.04), MDD (RR 2.67, 95% CI 2.58–2.76), ASD (RR 2.38, 95% CI 2.10–2.71), ADHD (RR 2.19, 95% CI 2.07–2.32), and schizophrenia (RR 1.97, 95% CI 1.86–2.09), compared with the total population. Different familial kinships of FDRs, such as parents, offspring, siblings, and twins consistently had increased risks for these disorders. In addition, a dose-dependent relationship was found between the numbers of OCD probands and the risk of each major psychiatric disorder. Conclusions The FDRs, including parents, offspring, siblings, and twins, of patients with OCD have a higher risk of OCD, schizophrenia, bipolar disorder, MDD, ADHD, and ASD. The familial co-aggregation of OCD with OCD and other major psychiatric disorders was existent in a dose-dependent manner. Given the increased risks of psychiatric disorders, medical practitioners should closely monitor the mental health of the FDRs of patients with OCD.

scholarly journals Closing the mortality gap for severe mental illness: Are we going in the right direction?

2017 ◽  
Vol 211 (3) ◽  
pp. 130-131 ◽  
Author(s):  
Najma Siddiqi ◽  
Tim Doran ◽  
Stephanie L. Prady ◽  
Johanna Taylor
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Cohort Study ◽  
Severe Mental Illness ◽  
Mental Healthcare ◽  
The Right

SummaryIn this editorial, we discuss a UK-based cohort study examining the mortality gap for people with schizophrenia and bipolar disorder from 2000 to 2014. There have been concerted efforts to improve physical and mental healthcare for this population in recent decades. Have these initiatives reduced mortality and ‘closed the gap’?

scholarly journals Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study

Rheumatology ◽  
2015 ◽  
Vol 54 (7) ◽  
pp. 1244-1249 ◽  
Author(s):  
Yi-Ming Chen ◽  
Ching-Heng Lin ◽  
Tsuo-Hung Lan ◽  
Hsin-Hua Chen ◽  
Shih-Ni Chang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Cumulative Dose ◽  
Population Based ◽  
Incident Diabetes ◽  
High Dose ◽  
Dependent Manner ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Dose Dependent

Abstract Objective. SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLE patients. Methods. This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001–10, 8628 newly diagnosed SLE patients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication. Results. Two hundred and twenty-one newly diagnosed diabetes mellitus patients were identified among SLE patients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g. Conclusion. In SLE patients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use.

scholarly journals Rising co-payments and continuity of healthcare for Dutch patients with bipolar disorder: retrospective longitudinal cohort study

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Arnold P. M. van der Lee ◽  
Ralph Kupka ◽  
Lieuwe de Haan ◽  
Aartjan T. F. Beekman
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Patient Care ◽  
Crisis Intervention ◽  
Psychiatric Care ◽  
Moving Average ◽  
Mental Healthcare ◽  
Longitudinal Cohort Study ◽  
Financial Barriers ◽  
Longitudinal Cohort

Background The Netherlands has few financial barriers to access mental healthcare. However, in 2012, a sharp rise in co-payments was introduced. Aims We tested whether these increased co-payments coincided with less guideline-recommended continuous out-patient psychiatric care and more crisis interventions for patients with bipolar disorder. Method A retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. Deviations of trends were tested by time-series analyses (autoregressive integrated moving average). Subsequently, the relationship between significant deviations of trends and rise in co-payments was examined. Outcome measures were the level of standard out-patient care (out-patient psychiatric care and/or medication), crisis psychiatric care and somatic care. Results The cohort comprised 3210 patients. During follow-up, the use of psychiatric care decreased and somatic care increased. The high rise in co-payments from 2012 onward coincided with decreases in standard out-patient care and increases in medication-only treatment, crisis psychiatric care and somatic care. Crisis intervention was highest when patients received only bipolar disorder medication. Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients. Conclusions Our data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care.

Does provider adherence to a treatment guideline change clinical outcomes for patients with bipolar disorder? Results from the Texas Medication Algorithm Project

2005 ◽  
Vol 35 (12) ◽  
pp. 1695-1706 ◽  
Author(s):  
ELLEN B. DENNEHY ◽  
TRISHA SUPPES ◽  
A. JOHN RUSH ◽  
ALEXANDER L. MILLER ◽  
MADHUKAR H. TRIVEDI ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Clinical Outcomes ◽  
Psychiatric Symptoms ◽  
Treatment Guideline ◽  
Patient Characteristics ◽  
Manic Symptoms ◽  
Provider Adherence ◽  
Over Time

Background. Despite increasing adoption of clinical practice guidelines in psychiatry, there is little measurement of provider implementation of these recommendations, and the resulting impact on clinical outcomes. The current study describes one effort to measure these relationships in a cohort of public sector out-patients with bipolar disorder.Method. Participants were enrolled in the algorithm intervention of the Texas Medication Algorithm Project (TMAP). Study methods and the adherence scoring algorithm have been described elsewhere. The current paper addresses the relationships between patient characteristics, provider experience with the algorithm, provider adherence, and clinical outcomes. Measurement of provider adherence includes evaluation of visit frequency, medication choice and dosing, and response to patient symptoms. An exploratory composite ‘adherence by visit’ score was developed for these analyses.Results. A total of 1948 visits from 141 subjects were evaluated, and utilized a two-stage declining effects model. Providers with more experience using the algorithm tended to adhere less to treatment recommendations. Few patient factors significantly impacted provider adherence. Increased adherence to algorithm recommendations was associated with larger decreases in overall psychiatric symptoms and depressive symptoms over time, but did not impact either immediate or long-term reductions in manic symptoms.Conclusions. Greater provider adherence to treatment guideline recommendations was associated with greater reductions in depressive symptoms and overall psychiatric symptoms over time. Additional research is needed to refine measurement and to further clarify these relationships.

Effects of Low Molecular Weight Heparin and Unfragmented Heparin on Induction of Osteoporosis in Rats

1990 ◽  
Vol 63 (03) ◽  
pp. 505-509 ◽  
Author(s):  
Thomas Mätzsch ◽  
David Bergqvist ◽  
Ulla Hedner ◽  
Bo Nilsson ◽  
Per Østergaar
Keyword(s):  
Molecular Weight ◽  
Bone Mineral ◽  
Low Molecular Weight Heparin ◽  
Zinc Content ◽  
Low Molecular Weight ◽  
Dependent Manner ◽  
Bone Mineral Mass ◽  
Bone Ash ◽  
Dose Dependent ◽  
Mineral Mass

SummaryA comparison between the effect of low molecular weight heparin (LMWH) and unfragmented heparin (UH) on induction of osteoporosis was made in 60 rats treated with either UH (2 IU/ g b w), LMWH in 2 doses (2 Xal U/g or 0.4 Xal U/g) or placebo (saline) for 34 days. Studied variables were: bone mineral mass in femora; fragility of humera; zinc and calcium levels in serum and bone ash and albumin in plasma. A significant reduction in bone mineral mass was found in all heparin-treated rats. There was no difference between UH and LMWH in this respect. The effect was dose-dependent in LMWH-treated animals. The zinc contents in bone ash were decreased in all heparin-treated rats as compared with controls. No recognizable pattern was seen in alterations of zinc or calcium in serum. The fragility of the humera, tested as breaking strength did not differ between treatment groups and controls. In conclusion, if dosed according to similar factor Xa inhibitory activities, LMWH induces osteoporosis to the same extent as UH and in a dose-dependent manner. The zinc content in bone ash was decreased after heparin treatment, irrespective of type of heparin given.

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