scholarly journals Determinants of Kidney Function and Accuracy of Kidney Microcysts Detection in Patients Treated With Lithium Salts for Bipolar Disorder

2022 ◽  
Vol 12 ◽  
Author(s):  
Nahid Tabibzadeh ◽  
Anne-Laure Faucon ◽  
Emmanuelle Vidal-Petiot ◽  
Fidéline Serrano ◽  
Lisa Males ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Treatment Duration ◽  
Spin Echo ◽  
Lithium Treatment ◽  
Lithium Concentration ◽  
Multivariable Analysis ◽  
Kidney Damage ◽  
Single Shot ◽  
Mri Imaging ◽  
Cross Sectional

Objectives: Early kidney damage during lithium treatment in bipolar disorder is still hypothetical. We aimed at identifying the determinants of a decreased measured glomerular filtration rate (mGFR) and the accuracy of kidney MRI imaging in its detection.Methods: In this cross-sectional cohort study, 217 consecutive lithium-treated patients underwent mGFR and kidney MRI with half-Fourier turbo spin-echo and Single-shot with long echo time sequences.Results: Median age was 51 [27–62] years, and median lithium treatment duration was 5 [2–14] years. 52% of patients had a stage 2 CKD. In multivariable analysis, the determinants of a lower mGFR were a longer lithium treatment duration (β −0.8 [−1; −0.6] ml/min/1.73 m2 GFR decrease for each year of treatment), a higher age (β −0.4 [−0.6; −0.3] ml/min/1.73 m2 for each year of age, p < 0.001), albuminuria (β −3.97 [−6.6; −1.3], p = 0.003), hypertension (β −6.85 [−12.6; −1.1], p = 0.02) and hypothyroidism (β −7.1 [−11.7; −2.5], p = 0.003). Serum lithium concentration was not associated with mGFR. Renal MRI displayed renal microcyst(s) in 51% of patients, detected as early as 1 year after lithium treatment initiation. mGFR and lithium treatment duration were strongly correlated in patients with microcyst(s) (r = −0.64, p < 0.001), but not in patients with no microcysts (r = −0.24, p = 0.09). The presence of microcysts was associated with the detection of an mGFR <45 ml/min/1.73 m2 (AUC 0.893, p < 0.001, sensitivity 80%, specificity 81% for a cut-off value of five microcysts).Conclusion: Lithium treatment duration and hypothyroidism strongly impacted mGFR independently of age, especially in patients with microcysts. MRI might help detect early lithium-induced kidney damage and inform preventive strategies.

scholarly journals Kidney function and long-term treatment with lithium salts for bipolar disorder Determinants of mGFR and accuracy of kidney microcysts detection in the diagnosis of CKD

2021 ◽  
Author(s):  
Nahid Tabibzadeh ◽  
Anne-Laure Faucon ◽  
Emmanuelle Vidal-Petiot ◽  
Fideline Serrano ◽  
Lisa Males ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Kidney Function ◽  
Treatment Duration ◽  
Lithium Treatment ◽  
Multivariable Analysis ◽  
Kidney Damage ◽  
Systematic Evaluation ◽  
Single Shot ◽  
Mri Imaging ◽  
Long Term Treatment

Background and objectives. Kidney damage during early stages of lithium treatment in bipolar disorder is still hypothetical. We aimed at identifying the determinants of a decreased measured glomerular filtration rate (mGFR) and the accuracy of kidney MRI imaging in its detection. Design, setting, participants and measurements. Cross sectional cohort study. Systematic evaluation including mGFR of 217 consecutive adult patients treated with lithium carbonate. Kidney MRI imaging in 99 patients with half-Fourier turbo spin-echo and Single-shot with long echo time sequences. Results. Median age was 51 [27-62] years, and median lithium treatment duration was 5 [2-14] years. 52% of patients had a stage 2 CKD. In multivariable analysis, the determinants of a lower mGFR were a longer lithium treatment duration (beta -0.8 [-1; -0.6] ml/min/1.73m2 GFR decrease for each year of treatment), a higher age (beta -0.4 [-0.6; -0.3] ml/min/1.73m2 for each year of age, p<0.001), albuminuria (beta -3.97 [-6.6;-1.3], p=0.003), hypertension (beta -6.85 [-12.6;-1.1], p=0.02) and hypothyroidism (beta -7.1 [-11.7;-2.5], p=0.003). Serum lithium concentration was not associated with mGFR. Patients with mGFR<60 ml/min/1.73m2 (22%) had a higher prevalence and number of renal microcysts. Renal MRI displayed renal microcyst(s) in 51% of patients, detected as early as one year after lithium treatment initiation. mGFR and lithium treatment duration were strongly correlated in patients with microcyst(s) (r=-0.64, p<0.001), but not in patients with no microcysts (r=-0.24, p=0.09). The presence of microcysts was associated with the detection of an mGFR <45 ml/min/1.73m2 (AUC 0.893, p<0.001, sensitivity 80%, specificity 81% for a cut-off value of 5 microcysts). Conclusions. Besides usual risk factors of GFR decrease, lithium treatment duration strongly impacted mGFR independently of age, especially in patients with microcysts. Hypothyroidism was also negatively associated with kidney function in these patients. MRI might help detect early lithium-induced kidney damage and inform preventive strategies.

scholarly journals MRI based Kidney Radiomics analysis during chronic lithium treatment: validation of a texture index associated with decreased kidney function.

2021 ◽  
Author(s):  
Paul Beunon ◽  
Maxime Barat ◽  
Anthony Dohan ◽  
Lynda Cheddani ◽  
Lisa Males ◽  
...  
Keyword(s):  
Texture Analysis ◽  
Treatment Duration ◽  
Validation Cohort ◽  
Lithium Treatment ◽  
Lithium Carbonate ◽  
Image Texture ◽  
Fast Spin Echo ◽  
Imaging Biomarkers ◽  
Single Shot ◽  
Increased Risk

Background. Chronic lithium therapy is associated with an increased risk of chronic kidney disease (CKD). Lithium nephrotoxicity is slowly progressive and difficult to detect at early stages. The aim of this study was to identify specific image texture changes of kidneys as possible imaging biomarkers of decreased measured glomerular filtration rate (mGFR) using radiomic analysis of T2 weighted imaging magnetic resonance imaging. 
 Methods. One hundred and nine patients treated with lithium carbonate were evaluated including mGFR and Kidney MRI, with T2 weighted sequence single-shot fast spin-echo. Computed radiomic analysis was performed after a manual kidney segmentation. Significant features were selected to build a radiomic signature using multivariable Cox analysis to detect a decreased mGFR <60 ml/min/1.73m2. The texture index was internally validated using a training and a validation cohort. Results. Texture analysis index was able to detect a decrease in mGFR, with an Area Under the Curve (AUC) of 0.85 in the training cohort and 0.71 in the validation cohort. Patients with a texture index below the median were older (59 [42-66] versus 46 [34-54] years, p=0.001), with longer treatment duration (10 [3-22] versus 6 [2-10] years, p=0.02), and a lower mGFR (66 [46-84] versus 83 [71-94] ml/min/1.73m2, p<0.001). Texture analysis index was independently and negatively associated with age (beta= -0.004 +/- 0.001, p<0.001), serum vasopressin (-0.005 +/- 0.002, p=0.02), lithium treatment duration (-0.01 +/- 0.003, p=0.001), with a significant interaction between lithium treatment duration and mGFR (p=0.02). Conclusion. A renal texture index was developed and validated among patients treated with lithium carbonate associated with a decreased mGFR. This index might be relevant in the diagnosis and prognosis of lithium-induced renal toxicity.

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 Prevalence and associated factors for burnout among attending general surgeons: a national cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Suleyman Utku Celik ◽  
Alperen Aslan ◽  
Eylul Coskun ◽  
Beyza Nur Coban ◽  
Zeynep Haner ◽  
...  
Keyword(s):  
Associated Factors ◽  
Multivariable Analysis ◽  
Workplace Stress ◽  
Personal Accomplishment ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Practice Characteristics ◽  
Training And Research ◽  
General Surgeons ◽  
At Risk Populations

Abstract Background Burnout resulting from long-term and unmanaged workplace stress is high among healthcare professionals, especially surgeons, and affects both individuals and the quality of patient care. The objective of this study was to determine the prevalence and associated factors for burnout among attending general surgeons and to identify possible preventive strategies. Methods A national cross-sectional survey using a 35-item questionnaire was conducted among members of the Turkish Surgical Society. The survey evaluated demographics, professional and practice characteristics, social participation, and burnout as well as interventions to deal with burnout. Burnout was defined as a high score on the emotional exhaustion (EE) and/or depersonalization (DP) subscales. Surgeons with high scores on both the EE and DP and a low score on personal accomplishment (PA) were considered to have severe burnout. Results Six hundred fifteen general surgeons completed the survey. The median EE, DP, and PA scores were 34 (IQR, 20–43), 9 (IQR, 4–16), and 36 (IQR, 30–42), respectively. Overall, the prevalence of burnout and severe burnout were 69.1 and 22.0%, respectively. On multivariable analysis, factors independently associated with burnout were working in a training and research hospital (OR = 3.34; P < 0.001) or state hospital (OR = 2.77; P = 0.001), working ≥ 60 h per week (OR = 1.57; P = 0.046), and less frequent participation in social activities (OR = 3.65; P < 0.001). Conclusions Burnout is an important problem among general surgeons with impacts and consequences for professionals, patients, and society. Considering that burnout is a preventable condition, systematic efforts to identify at-risk populations and to develop strategies to address burnout in surgeons are needed.

scholarly journals Magnitude of internalised stigma and associated factors among people with bipolar disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e044824
Author(s):  
Shegaye Shumet ◽  
Bethlehem W/Michele ◽  
Dessie Angaw ◽  
Temesgen Ergete ◽  
Nigus Alemnew
Keyword(s):  
Social Support ◽  
Bipolar Disorder ◽  
Associated Factors ◽  
Addis Ababa ◽  
Self Esteem ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Specialized Hospital ◽  
Poor Social Support

ObjectivesTo assess the magnitude of internalised stigma and associated factors among patients with bipolar disorder attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.DesignInstitution-based cross-sectional study design.SettingAmanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.ParticipantsWe recruited about 418 participants using systematic sampling technique for an interview during the study period.MeasurementData were collected by face-to-face interviews. Internalized Stigma of Mental Illness scale was used to measure internalised stigma. The Rosenberg Self-Esteem Scale and the Oslo-3 Social Support were instruments used to assess the associated factors. Bivariate and multivariate logistic regressions were performed to identify factors associated with the outcome variable. ORs with 95% CI were computed to determine the level of significance.ResultsThe magnitude of internalised stigma was 24.9% (95% CI: 21.2% to 28.9%). In the multivariate analysis, unemployed (adjusted OR (AOR)=2.3, 95% CI: 1.0 to 5.0), unable to read and write (AOR=3.3, 95% CI: 1.05 to 10.7), poor social support (AOR=5.3, 95% CI: 1.9 to 15.0), ≥4 previous hospitalisations due to bipolar disorder (AOR=2.6, 95% CI: 1.1 to 6.1) and low self-esteem (AOR=2.4, 95% CI: 1.1 to 5.1) had a significant association with internalised stigma.ConclusionsOne in four patients with bipolar disorder reported high internalised stigma. Unemployment, low educational status, low self-esteem, poor social support and being hospitalised more than three times before were significantly associated with internalised stigma. Thus, a stigma-reduction programme focusing on self-esteem improvement and psychological health of patients to increase their stigma resistance to counteracting effects of internalised stigma is essential.

scholarly journals AB0898-HPR WICH FACTORS ARE RELATED TO PAINFUL EXPERIENCE IN PATIENTS AFFECTED BY CHRONIC INFLAMMATORY RHEUMATIC DISEASE DURING THE COVID-19 PANDEMIC?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1472.2-1472
Author(s):  
T. El Joumani ◽  
H. Rkain ◽  
T. Fatima Zahrae ◽  
H. Kenza ◽  
R. Abouqal ◽  
...  
Keyword(s):  
Psychological Impact ◽  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Quality Of Sleep ◽  
Cross Sectional ◽  
Therapeutic Adherence ◽  
Factors Associated ◽  
Painful Experience

Objectives:To evaluate the effect of containment, during the Covid-19 pandemic, on the pain of patients with CIRD, and to analyze the factors associated with the experience of pain.Methods:A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Impact of COVID-19 on This is a cross-sectional study that consecutively includedPatients were asked to assess the global pain which they had experienced before and during the containment period, using a single Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (greatest pain).Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the study data.We performed univariate then multivariate analysis to search any related factors to pain perception during to quarantines. Qualitative values were analyzed by the chi2 test. Quantitative values were analyzed by the Student test when the measures were normally distributed or by nonparametric test (Mann–Whitney U) when the measures were not normally distributed (Kolmogorov–Smirnov test was used to test normality).Results:Among the 350 patients who answered to the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3% and undifferentiated CIRD 3.4%.Pain experience caused by the CIRD during the containment was reported by 79.1% of patients.The level of pain, using the VAS of Pain increased significantly during the COVID-19 pandemic (4,6 ± 2,8 and 5,4 ± 3 before and during the containment; p<0.001).In multivariate analysis, the factors implicated in pain were the negative impact of Coronavirus on access to rheumatologic care, discontinuation of therapeutic adherence, the disturbed quality of sleep and the negative psychological impact (table 1).Table 1: Summarize multivariable analysis of factors associated with painful experience related to CIRD during containement.Table 1.Multivariable analysis of factors associated with painful experience related to CIRD during containementPImpact on monitoring0.05Impact on therapeutic adherence<0.001Quality of sleep disturbed0.001Negative psychological impact0.02Conclusion:This survey showed the that the COVID-19 pandemic have incresed painful experience in CIRD patients. Factors influencing painful experience should be taken into account to help patients to cope with their chronic rheumatism and this global health crisis.Disclosure of Interests:None declared

Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder

2019 ◽  
Vol 53 (5) ◽  
pp. 458-469 ◽  
Author(s):  
YC Janardhan Reddy ◽  
Venugopal Jhanwar ◽  
Rajesh Nagpal ◽  
MS Reddy ◽  
Nilesh Shah ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Bipolar Depression ◽  
Mood Stabilizer ◽  
Self Report ◽  
Mood Stabilizers ◽  
Prescribing Practices ◽  
Term Outcome ◽  
Cross Sectional ◽  
Long Term Outcome

Objective: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. Method: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. Results: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. Limitations: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Conclusion: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists’ practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.

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