International Journal of Bipolar Disorders最新文献

Background: Little attention has been paid to the generalizability of cohort studies in bipolar disorder (BD) to patient with BD in everyday clinical practice.

Methods: A sample of patients with bipolar I disorder (BD-I) treated at a Dutch outpatient clinic for BD were compared with Dutch participants with BD-I of four clinical cohort studies, and participants with BD-I in a general population study in the Netherlands, on sociodemographic and clinical characteristics.

Results: On many variables participants from the outpatient sample matched with those of the included studies. However, compared with participants of several of the clinical cohort studies, these outpatients were significantly younger, had an earlier age of onset of mood symptoms, and had a shorter duration of illness. Compared with participants in the general population study, outpatients had significant higher levels of education and less often lived together or were married. One cohort study reported much lower comorbidity rates of alcohol use disorders, drug use disorders, and anxiety disorders than in the outpatient sample. In contrast, comorbidity rates were higher in the population study.

Limitations: Due to methodological differences between studies, comparisons between several variables was limited, and for some variables data was lacking.

Conclusions: Our findings suggest that many findings from cohort studies and general population study in BD-I are generalizable to everyday clinical practice, especially mood disorder outpatient centers. However, differences between samples indicate some selection and referral bias.

Objectives: To study the prospects for lithium treated patients who develop end stage renal disease (ESRD) and the role of renal replacement therapy (RRT).

Methods: Retrospective analysis of survival, somatic comorbidity, lithium treatment and eligibility for renal replacement therapy in adult patients with at least one eGFR < 30 ml/min/1.73 m². Subjects were selected from our laboratory database (s-Lithium and s-creatinine) from 1980 to 2017.

Results: 620 (14%) of 4396 patients with a lithium history had at least one measurement of eGFR < 30 ml/min/1.73 m². 302 (49%) patients had a transient decrease in renal function with subsequent improvement, 135 (22%) patients died with acute renal failure, while 153 (25%) developed chronic kidney disease stage 4 (CKD4) and 33 (5%) required RRT. RRT-treated patients represent only a fraction of the total ESRD population. Median survival time from the debut of CKD4 was 13.9 years in patients < 65 years and 4.4 years in older patients. 100 of the 153 patients with CKD4 continued lithium treatment. There was no significant difference in survival after the debut of CKD4 between the patients who stopped lithium treatment and those who continued.

Conclusions: A measurement of eGFR < 30 ml/min/1.73 m² reflects a significant loss of renal function. In half of the patients it was due to a transient functional disturbance without long-term consequences. A quarter of patients had acute renal failure and died within days while the remaining quarter progressed to CKD4. Despite irreversible renal damage, patient survival can be counted in several years after debut of renal insufficiency with appropriate care including RRT. As the treating psychiatrist, it is important to consult with nephrology when renal function starts to deteriorate, to optimise somatic treatment.

Background: Approximately half of people with bipolar disorder type I (BD-I) report the presence of psychotic symptoms at least at some point during their illness. Previous data suggest that more than 20% of people with BD-I report the presence of auditory verbal hallucinations (AVHs), or "voice-hearing" in particular. While work in other disorders with psychotic features (e.g., schizophrenia) indicates that the presence vs. absence of AVHs is associated with poorer clinical outcomes, little is known about their effects on clinical and socioeconomic features in BD-I.

Methods: We investigated whether people with BD-I (N = 119) with AVHs (n = 36) and without AVHs (n = 83) in their lifetime differ in terms of demographic features and clinical measures. Relations with AVHs and other positive symptoms were explored.

Results: People with BD-I and AVHs vs. without AVHs had higher manic and positive symptom scores (i.e., higher scores on the hallucinations, delusions, and bizarre behavior subscales). Further, a greater proportion of those with vs. without AVHs reported lower subjective socioeconomic status and tended to have higher rates of unemployment, thus, speaking to the longer-term consequences of AVH presence.

Conclusion: Our findings suggest that people with BD-I with AVHs exhibit more severe psychotic features and manic symptoms compared to those without. This might be associated with more socioeconomic hardship. More in-depth characterization of people with BD-I with/without AVHs is needed to fully understand this subgroup's unique challenges and needs.

Limitations: The modest sample size of the AVH group and a study population with low racial diversity/representation may limit generalizability.

Background: Global pharmacoepidemiological evidence suggests dynamically changing prescription patterns in patients with bipolar disorders. We assessed trends in the use of pharmacological agents used in the management of bipolar disorders in inpatients.

Methods: We examined drug use data provided by the Drug Safety in Psychiatry Programme AMSP (German: "Arzneimittelsicherheit in der Psychiatrie"), including psychiatric hospitals in Germany, Austria and Switzerland. We included data from adult inpatients with bipolar disorders (ICD-10: F31) treated between 1994 and 2017. We compared prescription patterns between patients receiving therapeutic regimens with vs. without lithium. Patients with manic and depressive episodes were also analyzed separately.

Results: We identified a total of 8,707 patients (58% females, mean age 50.8 ± 14.8 years). Our analysis revealed a decrease of lithium use (up to 2004) and a consistent increase of prescription rates for second-generation antipsychotics (SGA) among which quetiapine (n = 2,677) and olanzapine (n = 1,536) were the most common. Among psychotropic drugs, quetiapine was most frequently combined with lithium (n = 716, 25.6%). Lithium-treated patients received a higher number of drugs compared to patients not receiving lithium (mean number of drugs in patients with vs. without lithium 4.99, n = 2,796 vs. 4.75, n = 5,911, p = 0.002). Thyroid therapeutics were given more often, valproate and quetiapine less often in the lithium group. Antidepressants were consistently prescribed to more than 60% of patients with bipolar depressive episodes.

Conclusions: Our findings suggest that SGAs are gradually becoming the mainstay treatment option in bipolar disorder, continuously replacing lithium. The use of antidepressants remains concerningly high. We call for action to improve adherence to evidence-based guidelines.

Background: A surrogate marker (a substitute indicator of the true outcome) is needed to predict subgroups of long-term lithium users at risk of end-stage kidney disease (ESKD). In this narrative review the aim is to determine the optimal surrogate endpoint for ESKD in long-term lithium users in a scientific context. MAIN: In a literature search in long-term lithium users, no studies on surrogate measurements on ESKD were identified. Therefore, comparable ESKD populations were sought, based on baseline eGFR, age, somatic comorbidity and sex. Articles were scored on comparability and risk of bias. Seventeen studies were included; ten studies evaluated a percentual decline (between 20 and 50% decline in eGFR) and seven studies focused upon a declining slope (from 1.63 to 6 ml/min/1,73m² decline per year), using an interval of one to five years. Study populations mostly included patients with cardiovascular disease and chronic kidney disease.

Conclusion: Currently, the most appropriate marker for ESKD in long term lithium users appears a 30% decline in eGFR in at least one year. In order to confirm this hypothesis, further research in a cohort of long-term lithium users is needed. Better feasible research on lithium induced nephropathy could result in more knowledge about the risk on kidney function decline in lithium users and guide clinical decision making on lithium use.

Background: Patients with bipolar disorder (BD) are at increased risk of dementia. The underlying mechanisms are debated. FDG-PET elucidates glucose metabolic reductions due to altered neuronal activity in the cerebral cortex, allowing detection and identification of neurodegenerative processes. This study aims to investigate cerebral glucose metabolism in cognitively impaired elderly patients with BD using FDG-PET imaging, to elucidate potential underlying mechanisms and improve diagnostic accuracy.

Methods: We conducted a retrospective analysis of FDG-PET scans from 32 cognitively impaired elderly patients with BD (mean age 70.4 years). These were compared with scans from 35 non-degenerative controls (NDC) and patients diagnosed with Alzheimer's disease (AD, n = 27), frontotemporal dementia (FTD, n = 26), and dementia with Lewy bodies (DLB, n = 18). Voxel-wise statistical analysis was performed using SPM software, adjusting for age and sex.

Results: No significant cortical hypometabolism was found in patients with BD compared to NDC. In contrast, typical patterns of hypometabolism were observed in the AD, FTD, and DLB groups. The findings suggest that late-life cognitive impairment in patients with BD is not due to a single common neurodegenerative process.

Conclusion: The absence of abnormal cortical metabolism in cognitively impaired elderly patients with BD suggests that cognitive impairment in this population may not be driven by a common neurodegenerative pathway. Further studies using other biomarkers are needed to investigate the brain processes involved, which could lead to improved understanding and management of cognitive impairment in patients with BD.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-developmental disorder that often persists into adulthood. Moreover, it is frequently accompanied by bipolar disorder (BD) as well as borderline personality disorder (BPD). It is unclear whether these disorders share underlying pathomechanisms, given that all three are characterized by alterations in affective states, either long or short-term. BD is characterized by infrequent but intense mood shifts, while ADHD and BPD involve more dynamic emotional fluctuations. It is yet to be determined whether these disorders represent distinct phenomena or different points on a spectrum of affective dysregulation.

Methods: This study seeks to distinguish the emotional dysregulation of BPD, ADHD, and BD by using digital phenotyping, a measurement burst electronic-diary method with different sampling rates, and accelerometry to measure participants' activity. Our study will include 480 participants aged 14 to 50 (120 each from BPD, ADHD, BD, and healthy control groups) from five European sites. Participants' smartphones will provide continuous data on their digital phenotypes, i.e., by indicators of physical activity and communication, for one year, along with daily evening ratings of mood and sleep. Moreover, five intensive measurement periods of five days each, called measurement bursts, will occur throughout the year, with electronic diaries asking participants to report on mood, self-esteem, impulsivity, life events, social interactions, and dysfunctional behaviors ten times a day. Moreover, participants will wear activity sensors during the five measurement bursts. Statistical analysis aims to identify whether affective dysregulation aspects share or differ across disorders. Specifically, data analysis aims to investigate the differences in parameters of affect fluctuation such as attractor strength and variability between disorders and to test the association of genetic risk factors for psychiatric disorders and resilience factors with critical parameters of affect modulation.

Discussion: The results of this study offer the potential to link patients' external exposures with their affective state, reduce misdiagnosis, and determine the best timing for therapeutic interventions. Potential limitations of the study include insufficient recruitment of patients and drop-outs due to various protocol violations.

Trial registration: Study code: DRKS00028917, registered 27.07.2022, https://drks.de/search/de/trial/DRKS00028917 .

Background: The rate of suicide attempts by patients with bipolar disorder is high. In addition to patient and country specific factors, environmental factors may contribute to suicidal behavior. Sunlight has multiple diverse impacts on human physiology and behavior. Solar insolation is defined as the electromagnetic energy from the sun striking a surface area on earth. We previously found that a large change in solar insolation between the minimum and maximum monthly values was associated with an increased risk of suicide attempts in patients with bipolar I disorder.

Methods: The association between solar insolation and a history of suicide attempts in bipolar disorder was again investigated using an international database with 15% more data and more sites at diverse locations and countries.

Results: Data were available from 5641 patients with bipolar I disorder living at a wide range of latitudes in 41 countries in both hemispheres. A large change in solar insolation between the minimum and maximum monthly values was associated with a history of suicide attempts in patients with bipolar I disorder, a replication of our prior analysis. The estimated model also associated state sponsored religion in the onset country, female gender, a history of alcohol or substance abuse, and being part of a younger birth cohort with a history of suicide attempts.

Conclusions: A large change between the minimum and maximum monthly values of solar insolation was associated with a history of suicide attempts in bipolar I disorder, replicating our prior research. Physicians should be aware that daylight has wide ranging physiological and psychiatric impacts, and that living with large changes in solar insolation may be associated with an increased suicide risk.

Background: The Hypomania Checklist-32 is widely used to screen for bipolar disorder, but its length can be challenging for adolescents with manic symptoms. This study aimed to develop a shortened version of the HCL-32 tailored for adolescents using machine learning techniques.

Methods: Data from 2,850 adolescents (mean age 15.50 years, 68.81% female) who completed the HCL-32 were analyzed. Random forest (RF) and gradient boosting machine (GBM) algorithms were employed for feature selection. The area under the curve (AUC) was used to evaluate model performance. Receiver operating characteristic (ROC) analysis was conducted to determine optimal cutoff points for the shortened scale.

Results: An 8-item version of the HCL-32 was derived, maintaining high predictive accuracy (AUC = 0.97). The selected items captured core symptoms of adolescent mania, including increased energy, risk-taking, and irritability. Two cutoff points were identified: a score of 3 offered high specificity (0.98) and positive predictive value (0.98), while a score of 4 provided balanced sensitivity (0.87) and specificity (0.94) with the highest overall accuracy (0.91).

Conclusions: The machine learning-driven 8-item version of the HCL-32 demonstrates strong diagnostic utility for adolescent bipolar disorder, offering a more efficient screening tool without sacrificing clinical sensitivity. This shortened scale may improve assessment feasibility and accuracy in clinical settings, addressing the unique challenges of diagnosing bipolar disorder in adolescents.