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The Journal of Clinical Psychiatry 2017 Many patients with mood disorders do not experience pure episodes of depression or mania. Rather, these individuals experience mixed presentations. In the past,... (Review)
Review
Many patients with mood disorders do not experience pure episodes of depression or mania. Rather, these individuals experience mixed presentations. In the past, individuals experiencing mixed mood episodes were often misdiagnosed due to overly strict diagnostic criteria, leading to poor outcomes and treatment response. The addition of the mixed features specifier to the DSM-5 holds promise for improving recognition in patients who may be experiencing mixed symptoms. Furthermore, awareness has grown important warning signs that should be considered risk factors for progression to bipolar disorder and should warrant special clinical attention. Finally, guidelines for patients experiencing depression with mixed features have recently become available to help provide evidence-based treatment to this patient population. .
Topics: Bipolar Disorder; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Disease Management; Humans; Mood Disorders; Psychiatric Status Rating Scales; Psychopathology
PubMed: 28994900
DOI: 10.4088/JCP.su17009ah1c -
Neuroscience and Biobehavioral Reviews Sep 2023Mood disorders and type 2 diabetes mellitus (T2DM) are prevalent conditions that often co-occur. We reviewed the available evidence from longitudinal and Mendelian... (Review)
Review
Mood disorders and type 2 diabetes mellitus (T2DM) are prevalent conditions that often co-occur. We reviewed the available evidence from longitudinal and Mendelian randomisation (MR) studies on the relationship between major depressive disorder (MDD), bipolar disorder and T2DM. The clinical implications of this comorbidity on the course of either condition and the impact of antidepressants, mood stabilisers, and antidiabetic drugs were examined. Consistent evidence indicates a bidirectional association between mood disorders and T2DM. T2DM leads to more severe depression, whereas depression is associated with more complications and higher mortality in T2DM. MR studies demonstrated a causal effect of MDD on T2DM in Europeans, while a suggestive causal association in the opposite direction was found in East Asians. Antidepressants, but not lithium, were associated with a higher T2DM risk in the long-term, but confounders cannot be excluded. Some oral antidiabetics, such as pioglitazone and liraglutide, may be effective on depressive and cognitive symptoms. Studies in multi-ethnic populations, with a more careful assessment of confounders and appropriate power, would be important.
Topics: Humans; Diabetes Mellitus, Type 2; Mood Disorders; Depressive Disorder, Major; Hypoglycemic Agents; Pioglitazone
PubMed: 37391112
DOI: 10.1016/j.neubiorev.2023.105298 -
Ugeskrift For Laeger Aug 2022Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a global prevalence of approximately 1%. This review summarises new evidence of association between... (Review)
Review
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a global prevalence of approximately 1%. This review summarises new evidence of association between bipolar disorder (BD) and ASD. The mood episodes of BD can present atypically in people with ASD, potentially leading to misdiagnosis. Anamnesis regarding family history of affective disorders as well as previous mood episode is important among people with ASD to capture the BD diagnosis. Precaution with SSRI-treatment among people with ASD is crucial as the treatment can potentially trigger a mood episode of an underlying BD.
Topics: Autism Spectrum Disorder; Bipolar Disorder; Humans; Mood Disorders
PubMed: 36065878
DOI: No ID Found -
The Journal of Clinical Psychiatry Jul 2014Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a sensorimotor disorder that can result in considerable sleep disruption. This narrative review... (Review)
Review
OBJECTIVE
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a sensorimotor disorder that can result in considerable sleep disruption. This narrative review provides an overview of RLS diagnosis and reports epidemiologic evidence for an association between RLS and mood disorders. Possible links between RLS, sleep disturbances, and mood disorders are considered, and theoretical pathophysiologic pathways are discussed. Finally, pharmacologic therapies for RLS are summarized.
DATA SOURCES
A PubMed search was performed using the search term restless legs syndrome in combination with affective/anxiety, antidepressants, anxiety/anxiety disorder, attention deficit hyperactivity disorder, depression/depressive disorder, mood/mood disorder, neuropsychiatric, panic/panic disorder, psychiatric disorder, and psychosis. English-language articles published between January 1993 and May 2013 were retrieved. Additional studies were identified from the reference lists of relevant publications.
STUDY SELECTION
173 publications were retrieved. Articles related to the association between idiopathic RLS and depression, anxiety, and mood disorders were reviewed. In total, 32 epidemiologic studies were identified. These studies were reviewed in detail and ranked according to quality.
DATA EXTRACTION
Data were extracted on the basis of relevance to the topic. Epidemiologic studies were assessed using 3 parameters: methodology, data quality, and generalizability of the results. Each factor was scored from 1 (high quality) to 4 (low quality), giving a total score of between 3 and 12 for each study.
RESULTS AND CONCLUSIONS
RLS and mood disorders are frequently comorbid. Recognition and appropriate treatment of comorbid RLS are particularly important in patients with psychiatric disorders, as RLS is a common medical reason for insomnia, and antidepressant use may exacerbate sensory symptoms.
Topics: Comorbidity; Humans; Mood Disorders; Restless Legs Syndrome
PubMed: 25093484
DOI: 10.4088/JCP.13r08692 -
Revista Brasileira de Psiquiatria (Sao... 2013The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and... (Review)
Review
The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.
Topics: Adolescent; Bipolar Disorder; Child; Depression; Diagnostic and Statistical Manual of Mental Disorders; Humans; Mood Disorders; Psychotherapy; Psychotropic Drugs
PubMed: 24142125
DOI: 10.1590/1516-4446-2013-S106 -
Brain and Behavior Jul 2021Bipolar disorder (BD) and borderline personality disorder (BPD) share overlapping phenomenology and are frequently misdiagnosed. This study investigated the diagnostic...
BACKGROUND
Bipolar disorder (BD) and borderline personality disorder (BPD) share overlapping phenomenology and are frequently misdiagnosed. This study investigated the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) and McLean Screening Instrument for Borderline Personality Disorder (MSI) in a clinical inpatient setting and whether individual screening items could differentiate BD from BPD.
METHODS
757 sequential inpatients admitted to a Mood Disorder Unit completed both the MDQ and MSI. Screen positive for the MDQ was defined as ≥7/13 symptoms endorsed with concurrence and at least moderate impact. Screen positive for the MSI was defined as a score of ≥7. The clinical discharge summary diagnosis completed by a board-certified psychiatrist was used as the reference standard to identify concordance rates of a positive screen with clinical diagnosis. Individual items predicting one disorder and simultaneously predicting absence of other disorder by odds ratio (OR>and <1) were identified.
RESULTS
Both screening instruments were more specific than sensitive (MDQ 83.7%/ 67.8%, MSI 73.2% / 63.3%). MDQ individual items (elevated mood, grandiosity, increased energy, pressured speech, decreased need for sleep, hyperactivity) were significant predictors of BD diagnosis and non-predictors of BPD diagnosis. Whereas MSI subitem, self-harm behaviors/suicidal attempts predicted BPD in the absence of BD; distrust and irritability were additional predictors of BPD.
CONCLUSION
While this study is limited by the lack of structured diagnostic interview, these data provide differential symptoms to discriminate BD and BPD. Further work with larger datasets and more rigorous bioinformatics machine learning methodology is encouraged to continue to identify distinguishing features of these two disorders to guide diagnostic precision and subsequent treatment recommendations.
Topics: Bipolar Disorder; Borderline Personality Disorder; Humans; Inpatients; Mood Disorders; Self Report; Surveys and Questionnaires
PubMed: 34056864
DOI: 10.1002/brb3.2201 -
Journal of the American Academy of... Oct 2000
Topics: Attention Deficit Disorder with Hyperactivity; Child; Depressive Disorder, Major; Humans; Interview, Psychological; Mood Disorders; Personality Assessment; Psychometrics; Schizophrenia
PubMed: 11026169
DOI: 10.1097/00004583-200010000-00002 -
PloS One 2022Prescription of PCSK9-inhibitors has increased in recent years but not much is known about its off-target effects. PCSK9-expression is evident in non-hepatic tissues,...
Prescription of PCSK9-inhibitors has increased in recent years but not much is known about its off-target effects. PCSK9-expression is evident in non-hepatic tissues, notably the brain, and genetic variation in the PCSK9 locus has recently been shown to be associated with mood disorder-related traits. We investigated whether PCSK9 inhibition, proxied by a genetic reduction in expression of PCSK9 mRNA, might have a causal adverse effect on mood disorder-related traits. We used genetic variants in the PCSK9 locus associated with reduced PCSK9 expression (eQTLs) in the European population from GTEx v8 and examined the effect on PCSK9 protein levels and three mood disorder-related traits (major depressive disorder, mood instability, and neuroticism), using summary statistics from the largest European ancestry genome-wide association studies. We conducted summary-based Mendelian randomization analyses to estimate the causal effects, and attempted replication using data from eQTLGen, Brain-eMETA, and the CAGE consortium. We found that genetically reduced PCSK9 gene-expression levels were significantly associated with reduced PCSK9 protein levels but not with increased risk of mood disorder-related traits. Further investigation of nearby genes demonstrated that reduced USP24 gene-expression levels was significantly associated with increased risk of mood instability (p-value range = 5.2x10-5-0.03), and neuroticism score (p-value range = 2.9x10-5-0.02), but not with PCSK9 protein levels. Our results suggest that genetic variation in this region acts on mood disorders through a PCSK9-independent pathway, and therefore PCSK9-inhibitors are unlikely to have an adverse impact on mood disorder-related traits.
Topics: Humans; Depressive Disorder, Major; Genome-Wide Association Study; Mendelian Randomization Analysis; Mood Disorders; PCSK9 Inhibitors; Polymorphism, Single Nucleotide; Proprotein Convertase 9; Ubiquitin Thiolesterase; Quantitative Trait Loci
PubMed: 36580462
DOI: 10.1371/journal.pone.0279381 -
Revista Brasileira de Psiquiatria (Sao... Oct 2007Mood disorders are the most prevalent psychiatric disorders. Despite new insights and advances on the neurobiological basis and therapeutic approaches for bipolar... (Review)
Review
OBJECTIVE AND METHOD
Mood disorders are the most prevalent psychiatric disorders. Despite new insights and advances on the neurobiological basis and therapeutic approaches for bipolar disorders and recurrent depression, elevated prevalence of recurrence, persistent sub-syndromal symptoms and treatment resistance are challenging aspects and need to be urgently addressed. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness in mood disorders.
RESULTS
Genetic factors, misdiagnosis, use of inappropriate pharmacological approaches, non-compliance and biological/psychosocial stressors account for dysfunctions in mood regulation, thus increasing the prevalence of refractory mood disorders. Regarding available treatments, the use of effective doses during an adequate period followed by augmentation with a second and/or third agent, and finally switching to other agent are steps frequently necessary to optimize efficacy. However, in the treatment-resistant paradigm, drugs mimicking standard strategies, which target preferentially the monoaminergic system, can present reduced therapeutic effects. Thus, the search for new effective treatments for mood disorders is critical to decreasing the overall morbidity secondary to treatment resistance.
CONCLUSION
Emerging strategies targeting brain plasticity pathways or 'plasticity enhancers', including antiglutamatergic drugs, glucocorticoid receptor antagonists and neuropeptides, have been considered promising therapeutic options for difficult-to-treat mood disorders.
Topics: Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder, Major; Drug Resistance; Drug Therapy, Combination; Humans; Mood Disorders; Neuronal Plasticity; Refractory Period, Psychological; Stress, Psychological
PubMed: 17713691
DOI: 10.1590/s1516-44462006005000058 -
Biological Psychiatry Jun 2013Mood disorders such as major depressive disorder and bipolar disorder--and their consequent effects on the individual and society--are among the most disabling and... (Review)
Review
Mood disorders such as major depressive disorder and bipolar disorder--and their consequent effects on the individual and society--are among the most disabling and costly of all medical illnesses. Although a number of antidepressant treatments are available in clinical practice, many patients still undergo multiple and lengthy medication trials before experiencing relief of symptoms. Therefore a tremendous need exists to improve current treatment options and to facilitate more rapid, successful treatment in patients suffering from the deleterious neurobiological effects of ongoing depression. Toward that end, ongoing research is exploring the identification of biomarkers that might be involved in prevention, diagnosis, treatment response, severity, or prognosis of depression. Biomarkers evaluating treatment response will be the focus of this review, given the importance of providing relief to patients in a more expedient and systematic manner. A novel approach to developing such biomarkers of response would incorporate interventions with a rapid onset of action--such as sleep deprivation or intravenous drugs (e.g., ketamine or scopolamine). This alternative translational model for new treatments in psychiatry would facilitate shorter studies, improve feasibility, and increase higher compound throughput testing for these devastating disorders.
Topics: Antidepressive Agents; Biomarkers; Glutamic Acid; Humans; Mood Disorders; Neuroimaging; Sleep Deprivation; Time Factors
PubMed: 23374639
DOI: 10.1016/j.biopsych.2012.11.031