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Psychiatry Research Aug 2022Risk factors associated with antidepressant treatment-emergent mania(ATEM) are poorly characterized in child and adolescent populations. To identify better biomarkers,...
Risk factors associated with antidepressant treatment-emergent mania(ATEM) are poorly characterized in child and adolescent populations. To identify better biomarkers, we aimed to explore whether thyroid autoimmunity is associated with ATEM in pediatric mood disorders. We enrolled two groups of pediatric mood disorders, those with ATEM+ (n = 29) and those with ATEM- controls (n = 31). All diagnoses were made according to structured interviews by the clinicians. Autoimmune thyroiditis (anti-thyroid peroxidase antibodies [TPO-abs] and thyroid function (thyroid-stimulating hormone [TSH] and free thyroxin [FT4]) were assessed. Logistic regression was used to explore the relationship between TPO-abs seroprevalence and ATEM+ while controlling for covariates. Group comparisons showed that the patient with ATEM+ had significantly higher seroprevalence and titer of TPO-abs compared to ATEM- controls. In logistic regression analysis adjusting for age, gender, Tanner stage, body mass index, antipsychotic treatments, smoking status and family history of thyroid disorder, the seroprevalence of TPO-abs (>60 U/mL) was significantly associated with ATEM+ (OR = 3.67, 95% confidence interval [CI] = 1.2-11.1, p = 0.022). Our findings demonstrated that seroprevalence and titer of TPO-abs in pediatric mood disorders are associated with ATEM+ status. TPO-abs could potentially serve as a biomarker when assessing the risk of ATEM in the child and adolescent population.
Topics: Adolescent; Antidepressive Agents; Autoantibodies; Autoimmunity; Bipolar Disorder; Child; Humans; Iodide Peroxidase; Mania; Mood Disorders; Seroepidemiologic Studies
PubMed: 35709636
DOI: 10.1016/j.psychres.2022.114676 -
International Clinical... Nov 2022Inflammatory processes are associated with mood disorders, but data on pediatric patients are scarce. The aim of this study was to investigate a possible association...
Inflammatory processes are associated with mood disorders, but data on pediatric patients are scarce. The aim of this study was to investigate a possible association between elevated neutrophil/lymphocyte ratio (NLR) - a marker of inflammation and mood polarity (manic/depressed) in adolescents, admitted between 2010 and 2015 due to a mood disorder episode and to an adolescent inpatient ward. Electronic medical records of 305 patients (aged 10-19 years, 60.6% males) admitted during the study period due to a mood disorder episode were reviewed. Of these, 63 were diagnosed with manic episodes and 242 with depressive episodes. Multivariate analyses were used to compare NLR between and within the two groups, covarying for age, sex, and antipsychotic use. NLR was significantly higher in the manic episode group compared with the depression one. Moreover, in inpatients with multiple hospitalizations, the NLR was higher during their manic episodes than that during their nonmanic states. These results suggest that, as has been reported in adults with bipolar disorder, inflammatory mechanisms may be involved in adolescents' mood disorders as well, particularly in the manic episodes. Thus, clinicians may consider adding anti-inflammatories as part of the treatment of these patients.
Topics: Adolescent; Adult; Antipsychotic Agents; Child; Female; Hospitalization; Humans; Inpatients; Lymphocytes; Male; Mania; Neutrophils; Psychiatric Department, Hospital
PubMed: 35833290
DOI: 10.1097/YIC.0000000000000412 -
Psychological Medicine Jun 2023Sleep disturbances are important symptoms to monitor in people with bipolar disorder (BD) but the precise longitudinal relationships between sleep and mood remain...
BACKGROUND
Sleep disturbances are important symptoms to monitor in people with bipolar disorder (BD) but the precise longitudinal relationships between sleep and mood remain unclear. We aimed to examine associations between stable and dynamic aspects of sleep and mood in people with BD, and assess individual differences in the strength of these associations.
METHODS
Participants ( = 649) with BD-I ( = 400) and BD-II ( = 249) provided weekly self-reports of insomnia, depression and (hypo)mania symptoms using the online monitoring tool for 21 months. Dynamic structural equation models were used to examine the interplay between weekly reports of insomnia and mood. The effects of clinical and demographic characteristics on associations were also assessed.
RESULTS
Increased variability in insomnia symptoms was associated with increased mood variability. In the sample as a whole, we found strong evidence of bidirectional relationships between insomnia and depressive symptoms but only weak support for bidirectional relationships between insomnia and (hypo)manic symptoms. We found substantial variability between participants in the strength of prospective associations between insomnia and mood, which depended on age, gender, bipolar subtype, and a history of rapid cycling.
CONCLUSIONS
Our results highlight the importance of monitoring sleep in people with BD. However, researchers and clinicians investigating the association between sleep and mood should consider subgroup differences in this relationship. Advances in digital technology mean that intensive longitudinal data on sleep and mood are becoming increasingly available. Novel methods to analyse these data present an exciting opportunity for furthering our understanding of BD.
Topics: Humans; Bipolar Disorder; Longitudinal Studies; Sleep Initiation and Maintenance Disorders; Affect; Sleep
PubMed: 35074035
DOI: 10.1017/S0033291721005377 -
Cureus Nov 2018Primary psychogenic polydipsia (PPD) is a chronic, relapsing condition in which there is a disturbance in thirst control primarily due to an underlying disorder such as...
Primary psychogenic polydipsia (PPD) is a chronic, relapsing condition in which there is a disturbance in thirst control primarily due to an underlying disorder such as a psychogenic condition. It is characterized by an increase of fluid intake along with excretion of excessive amounts of dilute urine exceeding 40 to 50 mL/kg of body weight. PPD is typically seen in patients with schizophrenic symptoms due to elevated levels of dopamine that stimulate the thirst center or in patients with a psychiatric history receiving anticholinergic drugs. There are many reported cases of PPD related to an underlying schizophrenia disorder, but rarely is PPD seen in bipolar patients. We herein report a case of recurrent mania in a patient from a community hospital, who presented with chronic hyponatremia due to PPD. The patient had a history of bipolar disorder type 1 and was admitted to the hospital four times within three weeks with hyponatremia and presenting symptoms of mood lability, psychomotor agitation, pressured speech, racing thoughts, sleeping disturbances, distractibility, and inflated self-esteem. These were the same circumstances and manic presentation in her subsequent medical admissions. Due to her repeat manic presentation and consistently low sodium levels, we believe that her manic symptoms were a result of hyponatremia due to PPD. This patient serves as a unique case wherein switching medications and treating with oral sodium chloride did not prevent the manic episodes as she continues to become hyponatremic secondary to PPD. Due to the difficulty in managing and diagnosing a patient like this, case studies are helpful in studying treatment and maintenance for future cases.
PubMed: 30723644
DOI: 10.7759/cureus.3645 -
BMC Endocrine Disorders Oct 2021Previous studies have shown that bipolar disorder is closely related to thyroid dysfunction. Psychiatric drugs have a large or small effect on thyroid function, and... (Comparative Study)
Comparative Study
BACKGROUND
Previous studies have shown that bipolar disorder is closely related to thyroid dysfunction. Psychiatric drugs have a large or small effect on thyroid function, and thyroid hormone levels can also affect the effect of drug treatment. Therefore, the purpose of this study is assessment the thyroid function of drug-naive bipolar disorder across different mood states, with the expectation of providing support for treatment options.
METHODS
The present study is a cross-sectional study. Patients diagnosed with bipolar disorder according to the International Classification of Diseases diagnostic Criteria, Edition 10 (ICD 10) and who had never received medication were included in the study. The Montgomery Depression Scale (MADRS) was used to assess depressive symptoms and the Young Mania Rating Scale (YMRS) for manic symptoms. Thyroid function indicators include thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Levels of TSH, TT4, FT4, TT3, and FT3 were measured within 48 h of hospitalization, between 06:00 and 08:00.
RESULTS
The data analysis finally covered the data of 291 subjects (136 in a bipolar manic group, 128 in a bipolar depressive group, and 27 in a bipolar mixed group), including 140 males and 151 females, with an average age of 27.38 ± 8.01. There was no significant difference in age, sex, marital status, work status, family history, and course of illness among the manic group, depressive group, and mixed group. The level of FT3, the rate of thyroid hormone increased secretion, and the total abnormality rate of thyroid hormone secretion in the manic group were significantly higher than those in the depressive group.
CONCLUSION
These findings indicate that thyroid functions were significantly different between depressive and manic episodes in BD patients. In clinical practice, it is necessary to take into account the differences in thyroid hormone levels in patients with BD across different emotional states in choosing drug.
Topics: Adolescent; Adult; Bipolar Disorder; Cross-Sectional Studies; Depression; Female; Humans; Male; Mania; Thyroid Function Tests; Thyroid Hormones; Young Adult
PubMed: 34674686
DOI: 10.1186/s12902-021-00869-5 -
Journal of Affective Disorders Sep 2023The efficacy and safety of lurasidone monotherapy in patients with bipolar I depression with or without rapid cycling has not been previously investigated. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The efficacy and safety of lurasidone monotherapy in patients with bipolar I depression with or without rapid cycling has not been previously investigated.
METHODS
We performed subgroup analysis (rapid cycling/non-rapid cycling) of pooled data from two 6-week, randomized, double-blind, placebo-controlled trials of lurasidone monotherapy (20-60 mg/day or 80-120 mg/day). Analyses included mean change from baseline to week 6 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Safety assessments included the number of treatment-emergent adverse events (TEAEs) and laboratory assessments.
RESULTS
Of 1024 patients randomized, 85 were rapid cycling. Mean change in MADRS total score in patients with non-rapid cycling and rapid cycling, respectively, was -14.8 (effect size = 0.47) and - 12.8 (effect size = 0.04) in the lurasidone 20-60 mg/day group, -14.3 (effect size = 0.41) and - 13.0 (effect size = 0.02) in the lurasidone 80-120 mg/day group and -10.6 and -13.3 in the placebo group. The most common TEAE in each subgroup was akathisia in both lurasidone groups. Treatment-emergent mania was reported only in a small number of rapid cycling and non-rapid cycling patients.
LIMITATIONS
This was a post-hoc analysis of a short-term study that excluded patients with ≥8 cycles in the past year.
CONCLUSIONS
In patients with non-rapid cycling bipolar depression, lurasidone monotherapy significantly improved depressive symptoms relative to placebo at both the 20-60 mg/day and 80-120 mg/day doses. In patients with rapid cycling, both doses of lurasidone displayed depressive symptom score reduction from baseline, but significant improvement was not observed likely due to high levels of improvement on placebo and small sample size.
Topics: Humans; Lurasidone Hydrochloride; Bipolar Disorder; Depression; Drug Therapy, Combination; Mania; Double-Blind Method; Antipsychotic Agents; Treatment Outcome
PubMed: 37245552
DOI: 10.1016/j.jad.2023.05.065 -
Psychiatry Research Mar 2023Childhood maltreatment is associated with the etiology and clinical course of bipolar disorder. Most studies employ retrospective maltreatment self-reports which are...
Childhood maltreatment is associated with the etiology and clinical course of bipolar disorder. Most studies employ retrospective maltreatment self-reports which are vulnerable to bias, raising questions about their validity and reliability. This study examined the test-retest reliability over 10 years, the convergent validity and the impact of current mood on retrospective reports of childhood maltreatment in a bipolar sample. 85 participants with bipolar I disorder completed the Childhood Trauma Questionnaire [CTQ] and the Parental Bonding Instrument [PBI] at baseline. Beck Depression Inventory and Self Report Mania Inventory assessed depressive and manic symptoms, respectively. 53 participants completed the CTQ at baseline and 10-year follow-up. Good levels of convergent validity were observed between the CTQ and PBI. Correlations ranged from r= -0.35 (CTQ emotional abuse and PBI paternal care) to r= -0.65 (CTQ emotional neglect and PBI maternal care). Good agreement between CTQ reports at baseline and 10-year follow-up were found (range: κ=0.41 for physical neglect to κ=0.83 for sexual abuse). Higher depression and mania scores were recorded among participants who reported abuse (but not neglect) compared to those without such reports. These findings support using this method in research and clinical practice, though current mood should be taken into account.
Topics: Male; Humans; Child; Bipolar Disorder; Retrospective Studies; Mania; Reproducibility of Results; Surveys and Questionnaires; Child Abuse; Fathers
PubMed: 36796256
DOI: 10.1016/j.psychres.2023.115105 -
Psychotherapy and Psychosomatics 2013The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not been systematically examined.
METHODS
We compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for consensus-based indications of psychopathological mood elevation or behavioral activation.
RESULTS
Rates of excessive arousal-activation during treatment with antidepressants were at least as high in juvenile anxiety (13.8%) as depressive (9.79%) disorders, and much lower with placebos (5.22 vs. 1.10%, respectively; both p < 0.0001). The antidepressant/placebo risk ratio for such reactions in paired comparisons was 3.50 (12.9/3.69%), and the meta-analytically pooled rate ratio was 1.7 (95% confidence interval: 1.2-2.2; both p ≤ 0.001). Overall rates for 'mania or hypomania', specifically, were 8.19% with and 0.17% without antidepressant treatment, with large drug/placebo risk ratios among depressive (10.4/0.45%) and anxiety (1.98/0.00%) disorder patients.
CONCLUSIONS
Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.
Topics: Adolescent; Affect; Age Factors; Antidepressive Agents; Anxiety Disorders; Arousal; Bipolar Disorder; Child; Depressive Disorder; Emotions; Humans; Outcome Assessment, Health Care; Placebos; Risk Factors
PubMed: 23548764
DOI: 10.1159/000345316 -
Behaviour Research and Therapy Feb 2023Activation, a construct including energy and activity, is a central feature of Bipolar Spectrum Disorders (BSDs). Prior research found motor activity is associated with...
OBJECTIVES
Activation, a construct including energy and activity, is a central feature of Bipolar Spectrum Disorders (BSDs). Prior research found motor activity is associated with affect, and this relationship may be stronger for individuals with BSDs. The aims of this study were to investigate bidirectional relationships between physical activity and mood and evaluate whether bipolar risk status moderated potential associations.
METHODS
Young adults at low-risk, high-risk, and diagnosed with BSD participated in a 20-day EMA study in which they wore an actiwatch to measure physical activity and sleep/wake cycles. They also reported depressive and hypo/manic symptoms three times daily. Multilevel linear models were estimated to examine how bipolar risk group moderated bidirectional relationships between physical activity and mood symptoms at within-day and between-day timescales.
RESULTS
Physical activity was significantly associated with subsequent mood symptoms at the within-day level. The relationship between physical activity and depressive symptoms was moderated by BSD risk group. An increase in physical activity resulted in a greater reduction of depressive symptoms for the BSD group compared to the low-risk and high-risk groups.
CONCLUSIONS
Interventions targeting activity like behavioral activation may improve residual inter-episode mood symptoms.
Topics: Young Adult; Humans; Bipolar Disorder; Affect; Exercise
PubMed: 36682182
DOI: 10.1016/j.brat.2023.104255 -
The British Journal of Psychiatry : the... Sep 2018A reliable biomarker signature for bipolar disorder sensitive to illness phase would be of considerable clinical benefit. Among circulating blood-derived markers there... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A reliable biomarker signature for bipolar disorder sensitive to illness phase would be of considerable clinical benefit. Among circulating blood-derived markers there has been a significant amount of research into inflammatory markers, neurotrophins and oxidative stress markers.AimsTo synthesise and interpret existing evidence of inflammatory markers, neurotrophins and oxidative stress markers in bipolar disorder focusing on the mood phase of illness.
METHOD
Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines, a systematic review was conducted for studies investigating peripheral biomarkers in bipolar disorder compared with healthy controls. We searched Medline, Embase, PsycINFO, SciELO and Web of Science, and separated studies by bipolar mood phase (mania, depression and euthymia). Extracted data on each biomarker in separate mood phases were synthesised using random-effects model meta-analyses.
RESULTS
In total, 53 studies were included, comprising 2467 cases and 2360 controls. Fourteen biomarkers were identified from meta-analyses of three or more studies. No biomarker differentiated mood phase in bipolar disorder individually. Biomarker meta-analyses suggest a combination of high-sensitivity C-reactive protein/interleukin-6, brain derived neurotrophic factor/tumour necrosis factor (TNF)-α and soluble TNF-α receptor 1 can differentiate specific mood phase in bipolar disorder. Several other biomarkers of interest were identified.
CONCLUSIONS
Combining biomarker results could differentiate individuals with bipolar disorder from healthy controls and indicate a specific mood-phase signature. Future research should seek to test these combinations of biomarkers in longitudinal studies.Declaration of interestNone.
Topics: Affect; Biomarkers; Bipolar Disorder; Brain-Derived Neurotrophic Factor; C-Reactive Protein; Cytokines; Humans; Oxidative Stress
PubMed: 30113291
DOI: 10.1192/bjp.2018.144