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JAMA Psychiatry May 2020Behavioral high-risk phenotypes predict the onset of bipolar disorder among youths who have parents with bipolar disorder. Few studies have examined whether early... (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Behavioral high-risk phenotypes predict the onset of bipolar disorder among youths who have parents with bipolar disorder. Few studies have examined whether early intervention delays new mood episodes in high-risk youths.
OBJECTIVE
To determine whether family-focused therapy (FFT) for high-risk youths is more effective than standard psychoeducation in hastening recovery and delaying emergence of mood episodes during the 1 to 4 years after an active period of mood symptoms.
DESIGN, SETTINGS, AND PARTICIPANTS
This multisite randomized clinical trial included referred youths (aged 9-17 years) with major depressive disorder or unspecified (subthreshold) bipolar disorder, active mood symptoms, and at least 1 first- or second-degree relative with bipolar disorder I or II. Recruitment started from October 6, 2011, and ended on September 15, 2016. Independent evaluators interviewed participants every 4 to 6 months to measure symptoms for up to 4 years. Data analysis was performed from March 13 to November 3, 2019.
INTERVENTIONS
High-risk youths and parents were randomly allocated to FFT (12 sessions in 4 months of psychoeducation, communication training, and problem-solving skills training; n = 61) or enhanced care (6 sessions in 4 months of family and individual psychoeducation; n = 66). Youths could receive medication management in either condition.
MAIN OUTCOMES AND MEASURES
The coprimary outcomes, derived using weekly psychiatric status ratings, were time to recovery from prerandomization symptoms and time to a prospectively observed mood (depressive, manic, or hypomanic) episode after recovery. Secondary outcomes were time to conversion to bipolar disorder I or II and longitudinal symptom trajectories.
RESULTS
All 127 participants (82 [64.6%] female; mean [SD] age, 13.2 [2.6] years) were followed up for a median of 98 weeks (range, 0-255 weeks). No differences were detected between treatments in time to recovery from pretreatment symptoms. High-risk youths in the FFT group had longer intervals from recovery to the emergence of the next mood episode (χ2 = 5.44; P = .02; hazard ratio, 0.55; 95% CI, 0.48-0.92;), and from randomization to the next mood episode (χ2 = 4.44; P = .03; hazard ratio, 0.59; 95% CI, 0.35-0.97) than youths in enhanced care. Specifically, FFT was associated with longer intervals to depressive episodes (log-rank χ2 = 6.24; P = .01; hazard ratio, 0.53; 95% CI, 0.31-0.88) but did not differ from enhanced care in time to manic or hypomanic episodes, conversions to bipolar disorder, or symptom trajectories.
CONCLUSIONS AND RELEVANCE
Family skills-training for youths at high risk for bipolar disorder is associated with longer times between mood episodes. Clarifying the relationship between changes in family functioning and changes in the course of high-risk syndromes merits future investigation.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT01483391.
Topics: Adolescent; Bipolar Disorder; Child; Disease Progression; Family Therapy; Female; Humans; Male; Mood Disorders; Psychotropic Drugs; Treatment Outcome
PubMed: 31940011
DOI: 10.1001/jamapsychiatry.2019.4520 -
Fortschritte Der Neurologie-Psychiatrie Apr 2022Bipolar affective disorder (short: bipolar disorder) describe a group of affective disorders characterised by depressive as well as manic/hypomanic episodes. The article...
Bipolar affective disorder (short: bipolar disorder) describe a group of affective disorders characterised by depressive as well as manic/hypomanic episodes. The article deals with the diagnostic and therapeutic challenges of bipolar II disorder.
Topics: Bipolar Disorder; Humans; Mood Disorders
PubMed: 35443282
DOI: 10.1055/a-1680-7187 -
Psychiatria Polska Oct 2023Bipolar affective illness (bipolar disorder - BD), also known as manic-depressive illness, is characterized by periodic opposite states of mood, activity, and motivation... (Review)
Review
Bipolar affective illness (bipolar disorder - BD), also known as manic-depressive illness, is characterized by periodic opposite states of mood, activity, and motivation (mania and depression) sometimes of extreme intensity. The development and maintenance of such states in evolution can betoken a possibility of their adaptive character, enabling adaptation to an unfavorable external situation (depression) and a mobilization to using resources when available (mania). In the article, the main focus is put on the evolutionary aspect of "bipolarity" and manic/hypomanic states. Molecular-genetic studies show that in evolution, the genes connected with a predisposition to BD have been conserved. In the paper, the evolutionary adaptive concepts connected with the functioning of Homo sapiens during the middle and late Pleistocene periods were discussed as well as the "mismatch" theories associated with not befitting brain functioning to contemporary conditions. The benefits of mania and hypomania, also in the context of their link to depression were delineated, indicating their relationship to the increase in reproductive success. They result from such features of mania/hypomania as increased exploratory, psychomotor and sexual activity, and prompt risk-taking. The reproductive success can be connected with hyperthymic and cyclothymic temperaments, most frequently occurring in subjects with BD. The hyperthymic temperament often leads to increased social status and a tendency to leadership, and the cyclothymic temperament can increase creativity. Examples of the relationship between manic/hypomanic states and the phenomenon of emigration as well as the advancement of American society are provided.
Topics: Humans; Bipolar Disorder; Mania; Temperament; Affect; Leadership
PubMed: 38345120
DOI: 10.12740/PP/159424 -
Medizinische Monatsschrift Fur... Sep 2016Bipolar disorder is a severe psychiatric disorder, characterized by depressive, manic and mixed episodes. The illness affects about 1-2 % of the population. Bipolar I... (Review)
Review
Bipolar disorder is a severe psychiatric disorder, characterized by depressive, manic and mixed episodes. The illness affects about 1-2 % of the population. Bipolar I disorders affect both genders equally, whereas bipolar II disorders seem to occur more frequently in women. The classification of the different subtypes of bipolar disorders is done depending on the severity and frequency of the episodes. Other subtypes beside bipolar I and bipolar II disorder are rapid cycling (more than 4 episodes of mania, depression, hypomania or mixed state in one year) and cyclothymia (hypomanic and subdepressive symptoms over a two year period). Besides a thorough psychiatric and neurological examination, further clinical tests should be performed in order to exclude differential diagnosis (psychiatric as well as neurological and somatic diseases). The course of the illness is often negatively affected by the high frequency of psychiatric and somatic comorbidities. After all the prognosis of bipolar disorder is depending on the individual course of the illness. Notably comorbidities and psychotic symptoms seem to have a negative influence on the prognosis.
Topics: Bipolar Disorder; Comorbidity; Cross-Sectional Studies; Cyclothymic Disorder; Diagnosis, Differential; Humans; Prognosis; Sex Factors
PubMed: 29956510
DOI: No ID Found -
Danish Medical Journal Mar 2018Major reasons for the insufficient effects of current treatment options in bipolar disorder include delayed intervention for prodromal depressive and manic symptoms and... (Review)
Review
Major reasons for the insufficient effects of current treatment options in bipolar disorder include delayed intervention for prodromal depressive and manic symptoms and decreased adherence to psychopharmacological treatment. The reliance on subjective information and clinical evaluations when diagnosing and assessing the severity of depressive and manic symptoms calls for less biased and more objective markers. By using electronic devices, fine-grained data on complex psychopathological aspects of bipolar disorder can be evaluated unobtrusively over the long term. Moreover, electronic data could possibly represent candidate markers of diagnosis and illness activity in bipolar disorder and allow for early and individualized intervention for prodromal symptoms outside clinical settings. The present dissertation concerns the use of electronic monitoring as a marker and treatment intervention in bipolar disorder and investigated the scientific literature and body of evidence within the area, which includes ten original study reports and two systematic reviews, one of which included a meta-analysis, conducted by the author of the dissertation. Taken together, the literature presented in this dissertation illustrates that 1) smartphone-based electronic self-monitoring of mood seems to reflect clinically assessed depressive and manic symptoms and enables the long-term characterization of mood instability in bipolar disorder; 2) preliminary results suggest that smartphone-based automatically generated data (e.g. the number of text messages sent/day; the number of incoming and outgoing calls/day; the number of changes in cell tower IDs/day; and voice features) seem to reflect clinically assessed depressive and manic symptoms in bipolar disorder; 3) smartphone-based electronic self-monitoring had no effects on the severity of depressive and manic symptoms in bipolar disorder, according to a randomized controlled trial; and 4) electronic monitoring of psychomotor activity and heart rate variability seems to reflect illness activity in bipolar disorder and differentiate between patients with bipolar disorder and healthy control individuals. These findings point toward the usefulness of electronic monitoring as a marker of illness in bipolar disorder. Using electronic monitoring as a treatment intervention could provide innovative and novel interventions on-demand with a potential global reach, filling the gap between availability and the need for treatment. However, future studies using rigorous methodology and more randomized controlled trials that carefully investigate the positive effects and possible harmful effects of electronic monitoring in bipolar disorder are needed. In addition, patient safety, privacy issues, data security and legal aspects are major concerns that must be considered and addressed when using electronic monitoring.
Topics: Affect; Bipolar Disorder; Humans; Monitoring, Physiologic; Randomized Controlled Trials as Topic; Severity of Illness Index; Smartphone
PubMed: 29510813
DOI: No ID Found -
Vertex (Buenos Aires, Argentina) Dec 2021Bipolar disorder is a serious and chronic mood disorder, which in extreme forms can lead to psychosis, especially in manic states. In this sense, historically, the... (Review)
Review
Bipolar disorder is a serious and chronic mood disorder, which in extreme forms can lead to psychosis, especially in manic states. In this sense, historically, the differentiation from schizophrenia has represented a real clinical challenge and a nosological dilemma. Categorical diagnostic approaches have promoted progress in the generation of consensus and the facilitation of scientific communication, but many times, they have done so to the detriment of the complexity and richness of clinical presentations. As a counterpart, the notion of the bipolar spectrum proposes a dimensional perspective, a continuum of severity in whose maximum expression alterations in the content of thought or sensory perception can stand out. Schizotype, where these manifestations can be found, has long been pointed out as a series of personality characteristics linked to schizophrenia. But its presence can be verified in other areas of psychopathology, even outside it. Regarding its presence in mood disorders, schizotypal traits, instead of being a marker of a worse prognosis, could be related to positive aspects such as creativity. The objective of this work is to investigate, through a bibliographic review, the association between schizotypy and bipolar disorder, mainly its possible role in the creative processes associated with this pathology.
Topics: Bipolar Disorder; Humans; Mood Disorders; Psychotic Disorders; Schizophrenia; Schizotypal Personality Disorder
PubMed: 35041728
DOI: 10.53680/vertex.v32i154.110 -
Psychiatria Polska 2015This paper looks at some recent developments in the official diagnostic definitions (DSM-5) and in the research domain. The spectrum concept of mood disorders consists... (Review)
Review
This paper looks at some recent developments in the official diagnostic definitions (DSM-5) and in the research domain. The spectrum concept of mood disorders consists of the components of depression and mania, alone or in combination, on a continuum. Its international operational classification changes regularly, being based on symptoms, their duration and consequences. Causation is as yet unknown. DSM-5 excludes unipolar mania and mania with mild depression as separate diagnoses (they come under bipolar I and bipolar II disorders) and introduces a new hierarchy of manic symptoms, placing energy/activity above mood (elated, irritable). This is shown to be problematic on the basis of recent data. The validity of the duration criteria for mania (1 week), hypomania (4 days) and depression (2 weeks) is also seriously questioned. Shorter episodes are clinically very relevant. The definition of mania/hypomania is a persistent problem, contributing to frequent un- derdiagnosis of bipolar disorder in depressed patients. Other contributory factors include that patients often do not feel ill or seek treatment for the consequences of their high mood, and that hypomania can be hidden by substance use disorders (SUD). Hidden hypomanic syndromes are important because associated with treatment resistance, high comorbidity with anxiety/panic and SUD, psychotic and cognitive symptoms, dementia and higher mortality. Anxiety, too, is doubtless a mood disorder but there is still no concept which integrates anxiety with bipolar disorder and depression.
Topics: Behavioral Symptoms; Bipolar Disorder; Diagnostic Errors; Diagnostic and Statistical Manual of Mental Disorders; Humans; Medical History Taking; Prevalence
PubMed: 26488343
DOI: 10.12740/PP/58259 -
Evidence-based Mental Health Nov 2016Following extensive research exercise has emerged as an effective treatment for major depressive disorder, and it is now a recognised therapy alongside other... (Review)
Review
Following extensive research exercise has emerged as an effective treatment for major depressive disorder, and it is now a recognised therapy alongside other interventions. In contrast, there is a paucity of research examining the therapeutic effects of exercise for those with bipolar disorder. Given that dysfunctional reward processing is central to bipolar disorder, research suggests that exercise can perhaps be framed as a reward-related event that may have the potential to precipitate a manic episode. The behavioural activation system (BAS) is a neurobehavioural system that is associated with responding to reward and provides an appropriate framework to theoretically examine and better understand the effects of exercise treatment on bipolar disorder. This article discusses recent research findings and provides an overview of the extant literature related to the neurobiological underpinnings of BAS and exercise as they relate to bipolar disorder. This is important clinically because depending on mood state in bipolar disorder, we postulate that exercise could be either beneficial or deleterious with positive or negative effects on the illness. Clearly, this complicates the evaluation of exercise as a potential treatment in terms of identifying its optimal characteristics in this population.
Topics: Behavior; Behavior Control; Biomedical Research; Bipolar Disorder; Brain; Depression; Exercise Therapy; Forecasting; Humans
PubMed: 27679680
DOI: 10.1136/eb-2016-102430 -
CNS Neuroscience & Therapeutics Dec 2023Mania is a prevalent psychiatric disorder with undefined pathological mechanism. Here, we reviewed current knowledge indicating the potential involvement of autophagy... (Review)
Review
AIMS
Mania is a prevalent psychiatric disorder with undefined pathological mechanism. Here, we reviewed current knowledge indicating the potential involvement of autophagy dysregulation in mania and further discussed whether targeting autophagy could be a promising strategy for mania therapy.
DISCUSSIONS
Accumulating evidence indicated the involvement of autophagy in the pathology of mania. One of the most well-accepted mechanisms underlying mania, circadian dysregulation, showed mutual interaction with autophagy dysfunction. In addition, several first-line drugs for mania therapy were found to regulate neuronal autophagy. Besides, deficiencies in mitochondrial quality control, neurotransmission, and ion channel, which showed causal links to mania, were intimately associated with autophagy dysfunction.
CONCLUSIONS
Although more efforts should be made to either identify the key pathology of mania, the current evidence supported that autophagy dysregulation may act as a possible mechanism involved in the onset of mania-like symptoms. It is therefore a potential strategy to treat manic disorder by correting autophagy.
Topics: Humans; Mania; Bipolar Disorder
PubMed: 37438945
DOI: 10.1111/cns.14353 -
The Medical Clinics of North America Jan 2023Bipolar disorder is characterized by recurrent mood episodes, affecting 1% to 2% of the population. Although its defining features are manic and hypomanic episodes, its... (Review)
Review
Bipolar disorder is characterized by recurrent mood episodes, affecting 1% to 2% of the population. Although its defining features are manic and hypomanic episodes, its course is dominated by depressive syndromes. Diagnosis can be challenging owing to symptom overlap with other disorders. Management goals include early and complete remission of acute episodes and the prevention of relapse between episodes. We present an overview of bipolar disorder and its subtypes, including algorithms and suggestions for screening, assessment, and treatment.
Topics: Humans; Bipolar Disorder; Darkness; Recurrence
PubMed: 36402499
DOI: 10.1016/j.mcna.2022.04.002