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Acta Psychiatrica Scandinavica Oct 2017Despite the evidence supporting the association between infection and bipolar disorder (BD), the genetic vulnerability that mediates its effects has yet to be clarified.... (Review)
Review
OBJECTIVE
Despite the evidence supporting the association between infection and bipolar disorder (BD), the genetic vulnerability that mediates its effects has yet to be clarified. A genetic origin for the immune imbalance observed in BD, possibly involved in the mechanisms of pathogen escape, has, however, been suggested in recent studies.
METHOD
Here, we present a critical review based on a systematic literature search of articles published until December 2016 on the association between BD and infectious/immunogenetic factors.
RESULTS
We provide evidence suggesting that infectious insults could act as triggers of maladaptive immune responses in BD and that immunogenetic vulnerability may amplify the effects of such environmental risk factors, increasing susceptibility to subsequent environmental encounters. Quality of evidence was generally impaired by scarce attempt of replication, small sample sizes and lack of high-quality environmental measures.
CONCLUSION
Infection has emerged as a potential preventable cause of morbidity in BD, urging the need to better investigate components of the host-pathogen interaction in patients and at-risk subjects, and thus opening the way to novel therapeutic opportunities.
Topics: Bipolar Disorder; Communicable Diseases; Humans
PubMed: 28832904
DOI: 10.1111/acps.12791 -
Revista Brasileira de Psiquiatria (Sao... 2020
Topics: Antidepressive Agents; Bipolar Disorder; Humans; Risk Factors
PubMed: 32876129
DOI: 10.1590/1516-4446-2020-0016 -
Journal of Psychiatric Research Aug 2022Comorbid substance use disorders are highly prevalent in bipolar disorder, and research suggests that individuals with the comorbid presentation typically have worse...
Comorbid substance use disorders are highly prevalent in bipolar disorder, and research suggests that individuals with the comorbid presentation typically have worse outcomes than individuals with bipolar disorder without this comorbidity. However, psychosocial treatments for the comorbid presentation have not demonstrated effectiveness for both mood and substance use symptom domains, suggesting novel treatments are needed. An alternative path to treatment development is to identify mechanisms that underlie comorbid bipolar disorder and substance use disorders that can subsequently be targeted in treatment. We evaluated neurocognitive markers for impairments in risk avoidance (the tendency to engage in a persistent pattern of problematic behaviors despite negative outcomes resulting from such behaviors) as potential mechanistic variables underlying negative illness outcomes in the comorbid population. Participants with bipolar disorder (n = 45) or comorbid bipolar disorder and substance use disorders (n = 31) in a relatively euthymic mood state completed clinical risk behavior assessments, task-based risk avoidance assessments, and neurocognitive assessments. Results indicated a lack of notable between-group differences in the clinical risk composite score, task-based risk avoidance assessments, and neurocognitive assessments, with the exception of self-reported executive dysfunction which was elevated among the comorbid sample. Collapsing across group, we found that increased discounting of delayed rewards, older age, and an earlier age of (hypo)mania onset predicted an increased clinical risk composite score. These findings underscore the potential importance of delay discounting as a novel mechanistic target for reducing clinical risk behaviors among individuals with bipolar disorder both with and without comorbid substance use disorders.
Topics: Bipolar Disorder; Comorbidity; Humans; Substance-Related Disorders
PubMed: 35785576
DOI: 10.1016/j.jpsychires.2022.05.019 -
The American Journal of Managed Care Jun 2005Not only is bipolar disorder a chronic, severe psychiatric disorder, it is also expensive to treat and expensive to society. An estimate of the total cost of bipolar... (Review)
Review
Not only is bipolar disorder a chronic, severe psychiatric disorder, it is also expensive to treat and expensive to society. An estimate of the total cost of bipolar disorder made more than a decade ago was as high as 45 billion dollars per year. Most of this cost is accounted for by indirect costs related to reduced functional capacity and lost work. Patients with bipolar disorder have higher rates of utilization of healthcare resources compared with the general population and compared with patients with other types of psychiatric conditions. Comorbidity contributes to the heavy burden that bipolar disorder imposes on society. Bipolar disorder frequently occurs together with other psychiatric disorders, especially anxiety disorders and substance abuse. In addition, bipolar disorder has been associated with a variety of general medical conditions, which further complicate management of the psychiatric disorder.
Topics: Bipolar Disorder; Cost of Illness; Humans; United States
PubMed: 16097719
DOI: No ID Found -
Child and Adolescent Psychiatric... Apr 2021Based on its course over time, irritability is linked to depression cross-sectionally and longitudinally. Cross-sectionally, irritability takes an episodic form as a... (Review)
Review
Based on its course over time, irritability is linked to depression cross-sectionally and longitudinally. Cross-sectionally, irritability takes an episodic form as a symptom in pediatric depression; yet, irritability in the absence of depressed mood or anhedonia is rare. Longitudinally, chronic irritability has been shown to predict depression rather than bipolar disorder or externalizing disorders. Evidence suggests that the link between irritability and depression is explained mostly by shared genetic risk. Both conditions are also associated with higher rates of family history of depression, childhood temperaments and personality styles, and negative parenting styles. The treatment implications are discussed.
Topics: Bipolar Disorder; Child; Depression; Humans; Irritable Mood
PubMed: 33743947
DOI: 10.1016/j.chc.2020.10.009 -
Bipolar Disorders Sep 2018Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias... (Review)
Review
OBJECTIVES
Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity.
METHODS
For this paper, we reviewed the phenomenological differences between bipolar individuals of African and European ancestry in the context of diagnostic criteria and clinical factors that may contribute to a potential racial bias.
RESULTS
Published data show that bipolar persons of African ancestry, compared with bipolar persons of non-African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness.
CONCLUSION
A concerted effort by the research community to increase inclusion of diverse persons in studies of bipolar disorder through community engagement may facilitate fully addressing these diagnostic and treatment disparities in bipolar individuals of African ancestry.
Topics: Bipolar Disorder; Black People; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Genomics; Healthcare Disparities; Humans; Minority Groups; Patient Selection; Psychotic Disorders; Research; Schizophrenia; White People
PubMed: 29527766
DOI: 10.1111/bdi.12638 -
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 -
Biological Chemistry Apr 2016Bipolar disorder (BD) is a severe psychiatric disorder that affects up to 15% of the worldwide population. Characterized by switches in mood between mania and... (Review)
Review
Bipolar disorder (BD) is a severe psychiatric disorder that affects up to 15% of the worldwide population. Characterized by switches in mood between mania and depression, its etiology is still unknown and efforts have been made to elucidate the mechanisms involved in first episode, development and progression of the disorder. Microglia activation, abnormal activity of GSK-3β and reduction in neurotrophic factor expression related to neuroinflammatory processes have been indicated to be part of the disorder's pathophysiology. Lithium, the main mood stabilizer used for the treatment and prevention of relapses, acts as an anti-inflammatory agent. Based on that, here we suggest a neuroinflammatory pathway for would be BD progression, in which microglia activation states modulated via constitutive induction of kinin-B1 receptor and reduction of kinin-B2 receptor expression and activity.
Topics: Bipolar Disorder; Humans; Inflammation; Kinins; Lithium Compounds; Microglia; Neuroimmunomodulation
PubMed: 26859499
DOI: 10.1515/hsz-2015-0257 -
Current Psychiatry Reports Dec 2012Bipolar disorder and alcohol use disorder represent a significant comorbid population, which is significantly worse than either diagnosis alone in presentation,... (Review)
Review
Bipolar disorder and alcohol use disorder represent a significant comorbid population, which is significantly worse than either diagnosis alone in presentation, duration, co-morbidity, cost, suicide rate, and poor response to treatment. They share some common characteristics in relation to genetic background, neuroimaging findings, and some biochemical findings. They can be treated with separate care, or ideally some form of integrated care. There are a number of pharmacotherapy trials, and psychotherapy trials that can aid program development. Post-treatment prognosis can be influenced by a number of factors including early abstinence, baseline low anxiety, engagement with an aftercare program and female gender. The future development of novel therapies relies upon increased psychiatric and medical awareness of the co-morbidity, and further research into novel therapies for the comorbid group.
Topics: Alcohol-Related Disorders; Bipolar Disorder; Comorbidity; Diagnosis, Dual (Psychiatry); Female; Humans; Male; Psychotherapy; Psychotropic Drugs
PubMed: 22983943
DOI: 10.1007/s11920-012-0320-9 -
Current Neuropharmacology Apr 2017
Topics: Bipolar Disorder; History, 20th Century; History, 21st Century; History, Ancient; Humans; Models, Neurological
PubMed: 28503103
DOI: 10.2174/1570159X1503170228185225