Rapid-cycling bipolar disorder: cross-national community
                        study

BackgroundThe epidemiology of rapid-cycling bipolar disorder in the community is largely unknown.AimsTo investigate the epidemiological characteristics of rapid-cycling and non-rapid-cycling bipolar disorder in a large cross-national community sample.MethodThe Composite International Diagnostic Interview (CIDI version 3.0) was used to examine the prevalence, severity, comorbidity, impairment, suicidality, sociodemographics, childhood adversity and treatment of rapid-cycling and non-rapid-cycling bipolar disorder in ten countries (n = 54 257).ResultsThe 12-month prevalence of rapid-cycling bipolar disorder was 0.3%. Roughly a third and two-fifths of participants with lifetime and 12-month bipolar disorder respectively met criteria for rapid cycling. Compared with the non-rapid-cycling, rapid-cycling bipolar disorder was associated with younger age at onset, higher persistence, more severe depressive symptoms, greater impairment from depressive symptoms, more out-of-role days from mania/hypomania, more anxiety disorders and an increased likelihood of using health services. Associations regarding childhood, family and other sociodemographic correlates were less clear cut.ConclusionsThe community epidemiological profile of rapid-cycling bipolar disorder confirms most but not all current clinically based knowledge about the illness.

Download Full-text

Amygdala activation in maltreated children during pre-attentive emotional processing

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.116624 ◽

2013 ◽

Vol 202 (4) ◽

pp. 269-276 ◽

Cited By ~ 112

Author(s):

Eamon J. McCrory ◽

Stéphane A. De Brito ◽

Philip A. Kelly ◽

Geoffrey Bird ◽

Catherine L. Sebastian ◽

...

Keyword(s):

Psychiatric Disorder ◽

Emotional Processing ◽

Community Sample ◽

Age At Onset ◽

Childhood Adversity ◽

Neural Response ◽

Maltreated Children ◽

Amygdala Activation ◽

Increased Risk ◽

The Right

BackgroundChildhood adversity is associated with significantly increased risk of psychiatric disorder. To date, functional magnetic resonance imaging (fMRI) studies of children have mainly focused on institutionalisation and investigated conscious processing of affect.AimsTo investigate neural response to pre-attentively presented affect cues in a community sample of children with documented experiences of maltreatment in the home.MethodA masked dot-probe paradigm involving pre-attentive presentation of angry, happy and neutral facial expressions was employed. Eighteen maltreated children were compared with 23 carefully matched non-maltreated peers.ResultsIncreased neural response was observed in the right amygdala for pre-attentively presented angry and happy faces in maltreated v. non-maltreated children. Level of amygdala activation was negatively associated with age at onset for several abuse subtypes.ConclusionsMaltreatment is associated with heightened neural response to positive and negative facial affect, even to stimuli outside awareness. This may represent a latent neural risk factor for future psychiatric disorder.

Download Full-text

Impact of Childhood Adversity and Premorbid Personality on the Onset and Course of Major Bipolar Disorder

European Psychiatry ◽

10.1016/s0924-9338(09)70291-3 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

J. Angst ◽

A. Gamma ◽

V. Ajdacic-Gross ◽

W. Rössler

Keyword(s):

Bipolar Disorder ◽

Age Of Onset ◽

Community Sample ◽

Childhood Adversity ◽

Social Impairment ◽

Premorbid Personality ◽

A Prospective Study ◽

Major Depressive Episodes ◽

Depressive Episodes

Background:Clinical studies have demonstrated the great clinical relevance of long-term depression (LTD). Our study aims to characterise long-term bipolar disorder (LTBP) in comparison with episodic (non-chronic) bipolar major depressive episodes (EBP) on the basis of data from a community sample.Method:The Zurich Cohort Study is a prospective study of young adults followed from age 20/21 to 40/41 with six interviews. The stratified sample consisted of two thirds high scorers and one third lower scorers on the Symptom Checklist-90 R (SCL-90-R). LTBP, which was assessed from age 27/28 to 40/41, was defined as threshold or subthreshold depressive syndrome plus hypomanic symptoms, present for more days than not over the past year, plus work or social impairment.Results:The cumulative incidence of LTBP was 6.3%, and of episodic BP 15.3%. The two groups did not differ in mean age of onset (13.7 vs. 13.1 years). Age of onset was significantly earlier in subjects with a positive FH of depression and was inversely correlated with the somatisation score of the SCL-90R as assessed at age 19/20. The age of onset increased with increasing levels of childhood family problems in subjects with a positive FH, but decreased in subjects without an FH of depression. Chronic BP was associated with early childhood adversity and low self-esteem and, at a trend-level, with no family history of depression.Conclusions:The results are surprising and counter-intuitive, a genetic disposition seeming to be correlated more with periodicity than with chronicity.

Download Full-text

Hydrocephalus and bipolar affective disorder

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700011708 ◽

2011 ◽

Vol 28 (4) ◽

pp. 222-223

Author(s):

Syed Naveed Asif Rizvi ◽

Marie Whitty ◽

Robert Daly

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Affective Disorder ◽

Late Onset ◽

Bipolar Affective Disorder ◽

Rapid Cycling ◽

Brain Pathology ◽

Treatment Resistant ◽

Bipolar Illness ◽

Organic Brain

AbstractBipolar disorder can emerge in the context of organic brain pathology. In the case presented, long-standing hydrocephalus was diagnosed in a man with relatively late-onset bipolar illness who presented initially with somewhat atypical, treatment-resistant depressive symptoms. Hypomania, followed by a rapid-cycling bipolar course, subsequently developed. This report reviews the association between bipolar disorder and hydrocephalus, and examines possible neurobiological mechanisms implicated in both conditions.

Download Full-text

Obesity and Obstetric Complications are Associated with Rapid-cycling in Italian Patients with Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.238 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S74-S74

Author(s):

A. Caldiroli ◽

M. Buoli ◽

B. Dell’Osso ◽

G.S. Carnevali ◽

M. Serati ◽

...

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Antidepressant Treatment ◽

Age At Onset ◽

Obstetric Complications ◽

Psychotic Symptoms ◽

Rapid Cycling ◽

Clinical Variables ◽

History Of ◽

Bipolar Patients

IntroductionRapid cycling (RC) worsens the course of bipolar disorder (BD) being associated with poor response to pharmacotherapy. Previous results about clinical variables potentially associated with RCBD were discordant or unreplicated.ObjectivesAn early diagnosis should be the goal to properly treat RCBD patients.AimsTo compare clinical variables between RC and non-RC bipolar patients and to identify related risk factors.MethodsA sample of 238 bipolar patients was enrolled from three different community mental health centers. Descriptive analyses were performed on total sample and patients were compared in terms of sociodemographic and clinical variables according to the presence of RC by multivariate analyses of variance (MANOVAs, continuous variables) or χ2 tests (qualitative variables). Binary logistic regression was performed to calculate odds ratios.ResultsOverall, 28 patients (11.8%) had RC. The two groups were not different in terms of age, age at onset, gender distribution, type of family history, type of substance use disorder, history of antidepressant therapy, main antidepressant, psychotic symptoms, comorbid anxiety disorders, suicide attempts, thyroid diseases, diabetes, type of BD, duration of untreated illness, illness duration, duration of antidepressant treatment and GAF scores. In contrast, RC patients had more often a history of obstetric complications (P < 0.05), obesity (P < 0.05) and a trend to hypercholesterolemia (P = 0.08). In addition, RC bipolar patients presented more frequently lifetime MDMA misuse (P < 0.05) than patients without RC.ConclusionsObesity and obstetric complications are risk factors for the development of RC in BD. Lifetime MDMA misuse may be more frequent in RC bipolar patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

Medicina ◽

10.3390/medicina57060624 ◽

2021 ◽

Vol 57 (6) ◽

pp. 624

Author(s):

Sergey Mosolov ◽

Christoph Born ◽

Heinz Grunze

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Electroconvulsive Therapy ◽

Mood Stabilizer ◽

Rapid Cycling ◽

Mixed States ◽

Limited Effectiveness ◽

Bipolar Patients ◽

Depressive Episodes

Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

Download Full-text

Gambling problems in bipolar disorder in the UK: Prevalence and distribution

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.154286 ◽

2015 ◽

Vol 207 (4) ◽

pp. 328-333 ◽

Cited By ~ 19

Author(s):

Lisa Jones ◽

Alice Metcalf ◽

Katherine Gordon-Smith ◽

Liz Forty ◽

Amy Perry ◽

...

Keyword(s):

Bipolar Disorder ◽

Problem Gambling ◽

Severity Index ◽

Gambling Problems ◽

Rapid Cycling ◽

Probable Significance ◽

History Of ◽

Gambling Severity ◽

The Uk

BackgroundNorth American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.MethodThe Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).ConclusionsApproximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems.

Download Full-text

Inflammation and the Association of Vitamin D and Depressive Symptomatology

Nutrients ◽

10.3390/nu13061972 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1972

Author(s):

Ezgi Dogan-Sander ◽

Roland Mergl ◽

Anja Willenberg ◽

Ronny Baber ◽

Kerstin Wirkner ◽

...

Keyword(s):

Vitamin D ◽

Depressive Symptoms ◽

Inflammatory Markers ◽

Depressive Symptomatology ◽

Community Sample ◽

Significant Negative Correlation ◽

Vitamin D Supplementation ◽

Complex Relationship ◽

Moderation Effect ◽

Mediation Analyses

Depression and vitamin D deficiency are major public health problems. The existing literature indicates the complex relationship between depression and vitamin D. The purpose of this study was to examine whether this relationship is moderated or mediated by inflammation. A community sample (n = 7162) from the LIFE-Adult-Study was investigated, for whom depressive symptoms were assessed via the German version of CES-D scale and serum 25-hydroxyvitamin D (25(OH)D) levels and inflammatory markers (IL-6 and CRP levels, WBC count) were quantified. Mediation analyses were performed using Hayes’ PROCESS macro and regression analyses were conducted to test moderation effects. There was a significant negative correlation between CES-D and 25(OH)D, and positive associations between inflammatory markers and CES-D scores. Only WBC partially mediated the association between 25(OH)D levels and depressive symptoms both in a simple mediation model (ab: −0.0042) and a model including covariates (ab: −0.0011). None of the inflammatory markers showed a moderation effect on the association between 25(OH)D levels and depressive symptoms. This present work highlighted the complex relationship between vitamin D, depressive symptoms and inflammation. Future studies are needed to examine the effect of vitamin D supplementation on inflammation and depressive symptomatology for causality assessment.

Download Full-text

The role of environmental sensitivity in the development of rumination and depressive symptoms in childhood: a longitudinal study

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01830-6 ◽

2021 ◽

Author(s):

Francesca Lionetti ◽

Daniel N. Klein ◽

Massimiliano Pastore ◽

Elaine N. Aron ◽

Arthur Aron ◽

...

Keyword(s):

Depressive Symptoms ◽

Parenting Style ◽

Middle Childhood ◽

Internalizing Problems ◽

Depressive Symptomatology ◽

Community Sample ◽

Healthy Children ◽

Environmental Sensitivity ◽

Permissive Parenting

AbstractSome children are more affected than others by their upbringing due to their increased sensitivity to the environment. More sensitive children are at heightened risk for the development of internalizing problems, particularly when experiencing unsupportive parenting. However, little is known about how the interplay between children’s sensitivity and parenting leads to higher levels of depressive symptoms. In the current study, we investigated the interaction between early parenting and children’s sensitivity on levels of depressive symptomatology in middle childhood, exploring the role of rumination as a possible mediator in a community sample. Participants included 196 USA resident families, from a middle class and mostly European–American background, and their healthy children, followed up from age 3 until 9 and 12 years. Environmental sensitivity was assessed observationally when children were 3 years old. Parenting style was based on parent-report at the age of 3 years. When children were nine, they completed questionnaires on rumination and depressive symptoms (repeated at 12 years). Analyses were run applying a Bayesian approach. Children’s sensitivity interacted with permissive parenting in predicting rumination at age 9. Rumination, in turn, was associated with depressive symptoms at age 9 and, to a lesser extent, at age 12. No relevant interactions emerged for authoritative and authoritarian parenting. Sensitive children may be at heightened risk for internalizing problems when exposed to a permissive parenting style. Permissive parenting was associated with increased ruminative coping strategies in sensitive children which, in turn, predicted higher levels of depression. Hence, rumination emerged as an important cognitive risk factor for the development of depressive symptoms in sensitive children.

Download Full-text