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1.
Sensors (Basel) ; 23(2)2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36679755

RESUMO

(1) Background and Goal: Several studies have investigated the association of sleep, diurnal patterns, and circadian rhythms with the presence and with the risk states of mental illnesses such as schizophrenia and bipolar disorder. The goal of our study was to examine actigraphic measures to identify features that can be extracted from them so that a machine learning model can detect premorbid latent liabilities for schizotypy and bipolarity. (2) Methods: Our team developed a small wrist-worn measurement device that collects and identifies actigraphic data based on an accelerometer. The sensors were used by carefully selected healthy participants who were divided into three groups: Control Group (C), Cyclothymia Factor Group (CFG), and Positive Schizotypy Factor Group (PSF). From the data they collected, our team performed data cleaning operations and then used the extracted metrics to generate the feature combinations deemed most effective, along with three machine learning algorithms for categorization. (3) Results: By conducting the training, we were able to identify a set of mildly correlated traits and their order of importance based on the Shapley value that had the greatest impact on the detection of bipolarity and schizotypy according to the logistic regression, Light Gradient Boost, and Random Forest algorithms. (4) Conclusions: These results were successfully compared to the results of other researchers; we had a similar differentiation in features used by others, and successfully developed new ones that might be a good complement for further research. In the future, identifying these traits may help us identify people at risk from mental disorders early in a cost-effective, automated way.


Assuntos
Transtorno Bipolar , Esquizofrenia , Humanos , Transtorno Bipolar/diagnóstico , Actigrafia/métodos , Esquizofrenia/diagnóstico , Sono , Ritmo Circadiano
2.
BMC Psychiatry ; 23(1): 69, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36698099

RESUMO

BACKGROUND: Genetic risks may predispose individuals to major mood disorders differently. This study investigated the gene polymorphisms of previously reported candidate genes for major depressive disorder (MDD) and bipolar disorder (BPD) in the Han Chinese population. METHODS: Twenty loci of 13 candidate genes were detected by MALDI-TOF mass spectrometry in 439 patients with MDD, 600 patients with BPD, and 464 healthy controls. The distribution of genotypes in alleles, Hardy-Weinberg equilibrium, and genetic association were analyzed using the PLINK software. The linkage of disequilibrium and haplotype analyses were performed using the Haploview software. RESULTS: Out of the 20 loci analyzed, CYP2C19-rs4986893, ABCB1-rs1045642, and SCN2A-rs17183814 passed Bonferroni correction; their statistical powers were > 55%. The minor allele frequencies (MAF) of CYP2C19-rs4986893 in the MDD group (0.0547) and BPD group (0.0533) were higher than that of the control group (0.0259, P < 0.05), leading to the odds ratios (ORs) of MDD (2.178) and BPD (2.122), respectively. In contrast, the lower MAFs of ABCB1-rs1045642 were observed in both MDD (0.3599, OR = 0.726) and BPD (0.3700, OR = 0.758) groups than controls (0.4364, P < 0.05). The MDD group had a higher MAF of SCN2A-rs17183814 than controls (0.1743 vs. 0.1207, OR = 1.538, P < 0.05). Moreover, a G-A haplotype composed by CYP2C19-rs4986893 and -rs4244285 was associated with BPD (OR = 1.361, P < 0.01), and the A-G haplotype increased the risks to both MDD (OR = 2.306, P < 0.01) and BPD (OR = 2.332, P < 0.001). The CYP2C19 intermediate metabolizer and poor metabolizer (IM&PM) status was related to the raised risk of both MDD (OR = 1.547, P < 0.01) and BPD (OR = 1.808, P < 0.001). CONCLUSION: Our data indicate that the impaired CYP2C19 metabolism caused by the haplotypes integrated by CYP2C19 alleles might confer the risk to MDD and BPD, whereas the ABCB1-rs1045642 T allele serves as a protective factor.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Humanos , Transtorno Depressivo Maior/genética , Transtorno Bipolar/genética , Citocromo P-450 CYP2C19/genética , Fatores de Proteção , Genótipo , Polimorfismo de Nucleotídeo Único , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética
3.
Artigo em Inglês | MEDLINE | ID: mdl-36673910

RESUMO

BACKGROUND: Depressive features and comorbid anxiety disorders are two discrete but interconnected clinical features that have been reported to be associated with a poorer quality of life (QoL) among individuals with bipolar disorders. However, the relationship between manic features and quality of life is less conclusive. The present study aimed to assess differences in QoL among bipolar outpatients who present with either depressive predominant polarity (DPP), manic predominant polarity (MPP) and/or a lifetime diagnosis of comorbid anxiety disorders in Singapore. METHODS: Data from 74 outpatients in Singapore diagnosed with bipolar disorder were collected. Sociodemographic information, the polarity of most episodes (2 out of 3), the diagnosis of anxiety disorders and QoL were obtained from a self-reported interview and/or through clinical records. QoL was measured using the abbreviated version of the World Health Organization questionnaire. We used multivariate regression models to determine the relationships between predominant polarity, lifetime comorbid anxiety disorders and QoL in physical health, psychological health, social relationships and environment domains. RESULTS: After adjusting for covariates, individuals with DPP scored poorer for WHOQOL-BREF for all four domains as compared with individuals with indeterminate polarity. As compared to individuals with indeterminate polarity, individuals with MPP scored poorer for WHOQOL-BREF social relationships. Lastly, individuals with lifetime comorbid anxiety disorders scored poorer for WHOQOL-BREF physical health, social relationships and environment. DISCUSSION AND CONCLUSIONS: The present study provides preliminary support for the relationship between DPP, lifetime comorbid anxiety disorders and poorer QoL, paving the pathway for future research with larger samples to utilise our study design to verify our results.


Assuntos
Transtorno Bipolar , Humanos , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Qualidade de Vida/psicologia , Singapura/epidemiologia , Ansiedade , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Inquéritos e Questionários
4.
J Affect Disord ; 324: 449-454, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36608850

RESUMO

BACKGROUND: Bipolar disorder is a severe psychiatric syndrome defined by periodic mood shifts. Patients with bipolar disorder show cognitive impairments relative to healthy controls. The risk of developing schizophrenia, and partially also bipolar disorder, has previously been shown to increase with lower premorbid intelligence. It is not known if premorbid intelligence is associated with level of functioning and illness severity of people having developed bipolar disorder. METHODS: We used multiple linear and ordinal regression to analyze how premorbid intelligence, as measured at conscription, associate with functional outcome and illness severity in Swedish male bipolar disorder patients (n = 788). RESULTS: We found that lower premorbid intelligence is associated with lower percentage of time in work, after adjusting for age and bipolar subtype, and correcting for multiple comparisons. We also found a strong negative association with the total number of inpatient episodes and psychiatric comorbidity, but not with interepisodic remission, treatment with psychotherapy or lithium or the presence of any complicating socioeconomical factors. Adjusting for confounding genetic factors using polygenic risk scores for bipolar disorder and schizophrenia had no effect on the associations. LIMITATIONS: This study lacks females and controls and may thus have lower generalizability. CONCLUSION: In conclusion, premorbid intelligence is associated with both level of functioning and illness severity as well as comorbidity in bipolar disorder patients. Further research is needed to develop targeted interventions for this subgroup of bipolar disorder patients.


Assuntos
Transtorno Bipolar , Disfunção Cognitiva , Feminino , Humanos , Masculino , Transtorno Bipolar/psicologia , Inteligência , Disfunção Cognitiva/etiologia , Gravidade do Paciente
5.
COPD ; 20(1): 31-43, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36655855

RESUMO

A systematic review aimed to investigate the association between schizophrenia and bipolar disorder and chronic obstructive pulmonary disease (COPD), its prevalence and incidence, potential factors associated with its occurrence and its impact on mortality among these patients. We performed the literature search in PubMed, Scopus and PsycInfo from inception to February 2022 and identified 19 studies: ten cross-sectional, 5 that included cross-sectional and longitudinal analyses, and 4 retrospective cohort studies. The reported prevalence of COPD ranged from 2.6% to 52.7% in patients with schizophrenia and between 3.0% and 12.9% in patients with bipolar disorder. Two studies reported an annual incidence of COPD of 2.21 cases/100 person-years in patients with schizophrenia and 2.03 cases/100 person-years in patients with bipolar disorder. Among the risk factors evaluated in three studies, only advanced age was consistently associated with the presence/occurrence of COPD in patients with schizophrenia and bipolar disorder; the role of tobacco consumption was not investigated in those three studies. According to two studies, the likelihood of mortality from COPD showed an over 3-fold increase in patients with schizophrenia and a 2-fold increase in those with bipolar disorder compared to the overall population; COPD was also associated with increased inpatient mortality. Available data indicate that COPD in patients with schizophrenia and bipolar disorder is a major public health problem. National and international health organizations should strive to specifically address this issue by creating awareness about this health problem and developing specific programs for screening and early intervention aimed to reduce the burden of COPD in these populations.


Assuntos
Transtorno Bipolar , Doença Pulmonar Obstrutiva Crônica , Esquizofrenia , Humanos , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Prevalência
6.
Tidsskr Nor Laegeforen ; 143(1)2023 Jan 17.
Artigo em Norueguês | MEDLINE | ID: mdl-36655964
7.
PLoS One ; 18(1): e0280059, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36656805

RESUMO

Being a close family or friend of someone with bipolar disorder (BD) can lead to experiences of increased stress, anxiety and depressive symptoms related to the burden of caring. However, the lived experience of being a carer for a person with BD has not received significant research attention. This study aimed to gain further insight into the experiences of individuals in an informal caring role for someone with BD and determine what additional information and support these people need to take care of both themselves and the person they are caring for. Fifteen qualitative interviews were carried out with carers discussing their lived experiences with utilising coping strategies and supporting someone with BD. Following the interviews, thematic analysis was used to identify five key themes. These themes were: Separation of the person and the disorder, carer health and coping strategies, unpredictability and variability of symptoms, carer disillusionment and silencing, and story sharing and support needs. Overall, the findings highlighted the need for increased in-person and online support specifically tailored for carers with loved ones experiencing BD.


Assuntos
Transtorno Bipolar , Humanos , Transtorno Bipolar/terapia , Adaptação Psicológica , Cuidadores , Ansiedade , Pesquisa Qualitativa
8.
Neuron ; 111(2): 144-146, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36657396

RESUMO

In this issue of Neuron, Namkung et al. demonstrate that the microRNA miR-124-3p is associated with polygenic risk scores shared between schizophrenia and bipolar disorder and confers risk to behavioral alterations common to these two disorders through modulation of AMPA receptor neurotransmission.


Assuntos
Transtorno Bipolar , MicroRNAs , Esquizofrenia , Humanos , Transtorno Bipolar/genética , Esquizofrenia/genética , MicroRNAs/genética , Herança Multifatorial/genética , Fatores de Risco , Predisposição Genética para Doença/genética
9.
Transl Psychiatry ; 13(1): 15, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658108

RESUMO

While music engagement is often regarded as beneficial for mental health, some studies report higher risk for depression and anxiety among musicians. This study investigates whether shared underlying genetic influences (genetic pleiotropy) or gene-environment interaction could be at play in the music-mental health association using measured genotypes. In 5,648 Swedish twins with information on music and sport engagement, creative achievements, self-reported mental health and psychiatric diagnoses based on nationwide patient registries, we derived polygenic scores for major depression, bipolar disorder, schizophrenia, neuroticism, sensitivity to environmental stress, depressive symptoms and general musicality. In line with phenotypic associations, individuals with higher polygenic scores for major depression and bipolar disorder were more likely to play music, practice more music and reach higher levels of general artistic achievements, while a higher genetic propensity for general musicality was marginally associated with a higher risk for a depression diagnosis. Importantly, polygenic scores for major depression and bipolar remained associated with music engagement when excluding individuals who experienced psychiatric symptoms, just as a genetic propensity for general musicality predicted a depression diagnosis regardless of whether and how much individuals played music. In addition, we found no evidence for gene-environment interaction: the phenotypic association between music engagement and mental health outcomes did not differ for individuals with different genetic vulnerability for mental health problems. Altogether, our findings suggest that mental health problems observed in musically active individuals are partly explained by a pre-existing genetic risk for depression and bipolar disorder and likely reflect horizontal pleiotropy (when one gene influences multiple traits), rather than causal influences of mental health on music engagement, or vice versa (referred to as vertical pleiotropy).


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Música , Esquizofrenia , Humanos , Saúde Mental , Música/psicologia , Transtorno Bipolar/genética , Transtorno Depressivo Maior/genética , Esquizofrenia/genética
10.
Eur. j. psychiatry ; 37(1): 8-14, enero 2023.
Artigo em Inglês | IBECS | ID: ibc-213936

RESUMO

Background and objectives: Bipolar disorder (BD) is a clinical status with at least one manic, hypomanic or mixed attacks. Genetic factors take part significantly in early-onset BD (EOBD). Dopamine receptors (DRD) act in neurological mechanisms like motivation, learning, memory, and, control of neuroendocrine signaling. DRD2 receptor has been reported to influence the stability of DRD2 transcript. Catechol-O-Methyl transferase (COMT) inactivates catecholamines and Val158Met variation on COMT has effects on COMT activity. This study aims to explore DRD2 and COMT variants in the clinical development of EOBD.MethodsIn this case-control study, 102 EOBD patients and 168 healthy control subjects were used. DRD2 rs6275 and COMT Val158Met variations were detected by real-time polymerase chain reaction (RT-PCR). Young Mania Rating Scale (YMRS) was utilized to determine the EOBD severity.ResultsFor DRD2 rs6275 and COMT Val158Met polymorphisms, no significant relationship was observed in the genotype and allele frequencies between patient and control groups. Nevertheless, TT genotype carriers of DRD2 rs6275 polymorphism demonstrated significantly increased YMRS scores when compared with CC and CT genotype carriers (p = 0.039). Nevertheless, no significant difference was observed between COMT Val158Met genotypes and YMRS scores.ConclusionsWe suggest that the DRD2 rs6275 TT variant can be associated with symptom severity in children with EOBD and can have a clinical significance in EOBD pathogenesis. However, these results need to be confirmed with larger samples of patient and control groups. (AU)


Assuntos
Humanos , Transtorno Bipolar , Receptores Dopaminérgicos , Aprendizagem , Memória , Catecolaminas
11.
Eur. j. psychiatry ; 37(1): 63-66, enero 2023.
Artigo em Inglês | IBECS | ID: ibc-213941

RESUMO

There is a consensus in the literature indicating that patients with Bipolar Disorder (BD) show cognitive impairments, especially in executive function, during both acute episodes and euthymia.1 An emerging body of knowledge indicates the importance of promoting functional recovery and improving cognitive deficits to achieve an adequate treatment of BD. However, the trajectories of cognitive deficits are still unclear. The neuroprogression hypothesis suggests that BD may present a progressive course with cognitive and functioning decline, which may be associated with mood episodes, length of the illness, early trauma,2 and biological rhythms disturbance, which may be a feature of BD.3 However, most of the evidence in this field came from cross-sectional studies, and the few existing longitudinal studies bring contrary results.4 A small number of studies assess the patient's perception of their cognitive function, which might be highly relevant to their everyday life.5 Therefore, the ideal study to assess the progression of cognition in BD might include objective as well as subjective measures from a longitudinal perspective.Thus, the purpose of the present study was to evaluate longitudinal cognitive performance in a sample of individuals with BD at baseline and after six years. All patients were in a depressive episode at baseline and euthymic at follow-up. We assessed subjective and objective cognitive difficulties in both points. We also investigated the relationship between psychosocial functioning, biological rhythms, and childhood trauma to cognition and the course of the illness. As far as we know, this is the first report using specific instruments to measure the relationship between these aspects to objective and subjective cognitive difficulties in a longitudinal BD sample. (AU)


Assuntos
Humanos , Transtorno Bipolar , Disfunção Cognitiva , Cognição , Pacientes , Terapêutica
12.
Lancet ; 401(10372): 191, 2023 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-36681409
13.
Genes (Basel) ; 14(1)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36672919

RESUMO

The polygenic nature of schizophrenia (SCZ) implicates many variants in disease development. Rare variants of high penetrance have been shown to contribute to the disease prevalence. Whole-exome sequencing of a large three-generation family with SCZ and bipolar disorder identified a single segregating novel, rare, non-synonymous variant in the gene CASKIN1. The variant D1204N is absent from all databases, and CASKIN1 has a gnomAD missense score Z = 1.79 and pLI = 1, indicating its strong intolerance to variation. We find that introducing variants in the proline-rich region where the D1204N resides results in significant cellular changes in iPSC-derived neurons, consistent with CASKIN1's known functions. We observe significant transcriptomic changes in 368 genes (padj < 0.05) involved in neuronal differentiation and nervous system development. We also observed nominally significant changes in the frequency of action potentials during differentiation, where the speed at which the edited and unedited cells reach the same level of activity differs. Our results suggest that CASKIN1 is an excellent gene candidate for psychosis development with high penetrance in this family.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Esquizofrenia , Humanos , Predisposição Genética para Doença , Transtornos Psicóticos/genética , Esquizofrenia/genética , Transtorno Bipolar/genética , Prolina/genética , Proteínas do Tecido Nervoso/genética , Proteínas Adaptadoras de Transdução de Sinal/genética
14.
J Affect Disord ; 324: 410-417, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36587906

RESUMO

BACKGROUND: Unipolar major depressive disorder (MDD) and bipolar disorder (BD) are associated with elevated mortality risk secondary to natural causes. Cardiovascular disease (CVD) constitutes the most prevalent underlying condition. Patients with BD display higher CVD-associated excess mortality than MDD patients. Epicardial adipose tissue (EAT) volume, a known predictor of premature CV morbidity and adrenal gland (AG) volume, an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation, were compared in BD and MDD patients. METHODS: Magnetic resonance imaging was performed to assess EAT and AG volume in age-, gender-, and body mass index (BMI)-matched MDD (N = 27) and BD (N = 27) patients. Ten-year CV mortality risk and diabetes risk were assessed by PROCAM, ESC-SCORE, and FINDRISK, respectively; metabolic syndrome (MetS) was determined following NCEP/ATP III criteria. RESULTS: Cardiometabolic risk scores and frequency of MetS were comparable, and scores of cardiometabolic risk indices did not significantly differ in both groups. After adjustment for age, BMI, and physical activity, EAT and AG volumes were significantly higher in BD compared to MDD. Partial correlation analyses showed a significant positive association of EAT and AG volumes in BD but not in the MDD. LIMITATIONS: The modest sample size warrants confirmation in a larger cohort and the cross-sectional design does not allow for temporal or causal inferences. CONCLUSION: Our study indicates increased EAT accumulation in BD patients. This was associated with HPA axis dysregulation. Therapeutic lifestyle interventions that reduce EAT volume should be considered in clinical BD management.


Assuntos
Transtorno Bipolar , Doenças Cardiovasculares , Transtorno Depressivo Maior , Síndrome Metabólica , Humanos , Transtorno Bipolar/complicações , Transtorno Depressivo Maior/complicações , Sistema Hipotálamo-Hipofisário/metabolismo , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/complicações , Estudos Transversais , Fatores de Risco , Sistema Hipófise-Suprarrenal/metabolismo , Síndrome Metabólica/complicações , Fatores de Risco de Doenças Cardíacas
15.
Medicina (Kaunas) ; 59(1)2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36676744

RESUMO

Background and Objectives: There is no biomarker to predict lithium response. This study used CellPrint™ enhanced flow cytometry to study 28 proteins representing a spectrum of cellular pathways in monocytes and CD4+ lymphocytes before and after lithium treatment in patients with bipolar disorder (BD). Materials and Methods: Symptomatic patients with BD type I or II received lithium (serum level ≥ 0.6 mEq/L) for 16 weeks. Patients were assessed with standard rating scales and divided into two groups, responders (≥50% improvement from baseline) and non-responders. Twenty-eight intracellular proteins in CD4+ lymphocytes and monocytes were analyzed with CellPrint™, an enhanced flow cytometry procedure. Data were analyzed for differences in protein expression levels. Results: The intent-to-treat sample included 13 lithium-responders (12 blood samples before treatment and 9 after treatment) and 11 lithium-non-responders (11 blood samples before treatment and 4 after treatment). No significant differences in expression between the groups was observed prior to lithium treatment. After treatment, the majority of analytes increased expression in responders and decreased expression in non-responders. Significant increases were seen for PDEB4 and NR3C1 in responders. A significant decrease was seen for NR3C1 in non-responders. Conclusions: Lithium induced divergent directionality of protein expression depending on the whether the patient was a responder or non-responder, elucidating molecular characteristics of lithium responsiveness. A subsequent study with a larger sample size is warranted.


Assuntos
Transtorno Bipolar , Lítio , Humanos , Lítio/farmacologia , Lítio/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Compostos de Lítio , Citometria de Fluxo , Linhagem Celular
16.
Lancet Psychiatry ; 10(2): 108-118, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36610442

RESUMO

BACKGROUND: Motor abnormalities have clinical relevance as a component of psychotic illness; they are not only a proxy of altered neurodevelopment, but also intimately related to psychotic risk. We aimed to assess motor development and its association with psychotic experiences in children with familial high risk (FHR) of schizophrenia or bipolar disorder compared with controls. METHODS: The Danish High Risk and Resilience Study is a prospective longitudinal cohort study, for which participants were extracted from Danish registers. Children born in Denmark between Sept 1, 2004, and Aug 31, 2009, with no, one, or two parents born in Denmark with schizophrenia or bipolar disorder, could be included in the study. No ethnicity data were collected. Children with no biological parent diagnosed with schizophrenia spectrum disorder or bipolar disorder were matched to children with FHR of schizophrenia (one or two parents with schizophrenia spectrum disorder) on the basis of sex, age, and municipality. Children with FHR of bipolar disorder (one or two parents with bipolar disorder) were included as a non-matched group. We assessed motor function in children with FHR of schizophrenia, children with FHR of bipolar disorder, and children in the control group at approximately age 8 years (baseline; 2013-16) and age 12 years (follow-up; 2017-20) using the Movement Assessment Battery for Children-Second Edition (Movement ABC-2). Psychotic experiences were assessed using the psychosis section of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Raters were masked regarding familial risk status. Motor development from baseline to follow-up in the different groups was assessed using a linear mixed model. Logistic regression examined the relationship between definite motor problems (≤5th percentile on Movement ABC-2) and psychotic experiences. FINDINGS: Between March 1, 2017, and June 30, 2020, we studied 437 children (234 [54%] boys, 203 [46%] girls; mean age 11·99 years [SD 0·26, range 11·08-12·86]). Children with FHR of schizophrenia showed stable motor developmental deficits in manual dexterity (difference in intercept -1·62 [95% CI -2·39 to -0·85], p<0·0001; difference in slope 0·17 [-0·48 to 0·81], p=0·61) and balance (difference in intercept -1·58 [-2·34 to -0·82], p<0·0001; difference in slope 0·32 [-0·34 to 0·99], p=0·34), and a developmental lag in aiming and catching (difference in slope -1·07 [-1·72 to -0·41], p=0·0015; difference in intercept -0·59 [-1·35 to 0·17], p=0·13) compared with controls. Children with FHR of bipolar disorder showed no motor developmental differences on a group basis. Compared with controls, children with FHR of schizophrenia were more likely to have definite motor problems (odds ratio [OR] 2·86 [95% CI 1·60 to 5·11], p=0·0004), as were children with FHR of bipolar disorder (OR 2·45 [1·28 to 4·70], p=0·0068). Children with definite motor problems across all groups were more likely (OR 1·90 [1·12 to 3·21, p=0·017] to have had psychotic experiences than children with no definite motor problems. INTERPRETATION: Clinicians should be aware that motor impairment in childhood can reflect neurodevelopmental vulnerability to psychosis. Our findings contribute to the identification of early risk markers for severe mental illness, both for use by clinicians and for establishing a basis for future primary preventive intervention studies in the premorbid phase. FUNDING: The Independent Research Fund Denmark, the Mental Health Services of the Capital Region of Denmark, the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, the Beatrice Surovell Haskell Fund, the Tryg Foundation, and the Innovation Fund Denmark. TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.


Assuntos
Transtorno Bipolar , Esquizofrenia , Masculino , Feminino , Humanos , Criança , Esquizofrenia/diagnóstico , Transtorno Bipolar/psicologia , Seguimentos , Estudos Prospectivos , Estudos Longitudinais , Dinamarca/epidemiologia
17.
BMC Psychiatry ; 23(1): 64, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36694142

RESUMO

BACKGROUND: Non-adherence to psychotropic medications is common in schizophrenia and bipolar disorders (BDs) leading to adverse outcomes. We examined patterns of antipsychotic use in schizophrenia and BD and their impact on subsequent acute care utilization. METHODS: We used electronic health record (EHR) data of 577 individuals with schizophrenia, 795 with BD, and 618 using antipsychotics without a diagnosis of either illness at two large health systems. We structured three antipsychotics exposure variables: the proportion of days covered (PDC) to measure adherence; medication switch as a new antipsychotic prescription that was different than the initial antipsychotic; and medication stoppage as the lack of an antipsychotic order or fill data in the EHR after the date when the previous supply would have been depleted. Outcome measures included the frequency of inpatient and emergency department (ED) visits up to 12 months after treatment initiation. RESULTS: Approximately half of the study population were adherent to their antipsychotic medication (a PDC ≥ 0.80): 53.6% of those with schizophrenia, 52.4% of those with BD, and 50.3% of those without either diagnosis. Among schizophrenia patients, 22.5% switched medications and 15.1% stopped therapy. Switching and stopping occurred in 15.8% and 15.1% of BD patients and 7.4% and 20.1% of those without either diagnosis, respectively. Across the three cohorts, non-adherence, switching, and stopping therapy were all associated with increased acute care utilization, even after adjusting for baseline demographics, health insurance, past acute care utilization, and comorbidity. CONCLUSION: Non-continuous antipsychotic use is common and associated with high acute care utilization.


Assuntos
Antipsicóticos , Transtorno Bipolar , Esquizofrenia , Humanos , Antipsicóticos/uso terapêutico , Estudos Retrospectivos , Adesão à Medicação , Esquizofrenia/diagnóstico , Transtorno Bipolar/tratamento farmacológico
18.
J Psychiatr Pract ; 29(1): 51-57, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649553

RESUMO

The literature on lithium's role in suicide prevention is rife with competing interpretations and diverging opinions, in part stemming from the complexity of the underlying literature base. Conclusions that lithium unequivocally offers suicide prevention benefits do not appear warranted based on the strength of existing studies. Given the evidence along with the indisputable risks associated with lithium (especially in overdose), and the need for sustained therapeutic dosing to achieve any theoretical antisuicide benefit, it seems evident that any potential role for lithium in suicide prevention is far narrower than originally hypothesized. As such, the goal of this article is to provide an evidence-informed, therapeutic risk management approach to clinical decision-making concerning the use of lithium for suicide prevention to ensure that such prescribing is done in a patient-centered fashion that mitigates, to the extent possible, the potential risks of lithium use. This includes a review of potential justifications for not employing lithium for suicide prevention, given the recommendations in the existing guidelines. Clinicians should approach this clinical decision in an individualized fashion with full consideration of the potential risks associated with lithium use and availability, as well as potential alternative treatment options. An individualized risk/benefit analysis must also take into consideration the presence of comorbid conditions; the acuity of suicide risk, and any history of self-directed violence, with special attention to suicide attempts via overdose; treatment adherence, past and present; the presence and/or strength of a therapeutic relationship; and other viable treatment options.


Assuntos
Transtorno Bipolar , Lítio , Humanos , Lítio/uso terapêutico , Compostos de Lítio/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Tentativa de Suicídio
19.
Sci Rep ; 13(1): 456, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624117

RESUMO

Interpretable machine learning models for gene expression datasets are important for understanding the decision-making process of a classifier and gaining insights on the underlying molecular processes of genetic conditions. Interpretable models can potentially support early diagnosis before full disease manifestation. This is particularly important yet, challenging for mental health. We hypothesise this is due to extreme heterogeneity issues which may be overcome and explained by personalised modelling techniques. Thus far, most machine learning methods applied to gene expression datasets, including deep neural networks, lack personalised interpretability. This paper proposes a new methodology named personalised constrained neuro fuzzy inference (PCNFI) for learning personalised rules from high dimensional datasets which are structurally and semantically interpretable. Case studies on two mental health related datasets (schizophrenia and bipolar disorders) have shown that the relatively short and simple personalised fuzzy rules provided enhanced interpretability as well as better classification performance compared to other commonly used machine learning methods. Performance test on a cancer dataset also showed that PCNFI matches previous benchmarks. Insights from our approach also indicated the importance of two genes (ATRX and TSPAN2) as possible biomarkers for early differentiation of ultra-high risk, bipolar and healthy individuals. These genes are linked to cognitive ability and impulsive behaviour. Our findings suggest a significant starting point for further research into the biological role of cognitive and impulsivity-related differences. With potential applications across bio-medical research, the proposed PCNFI method is promising for diagnosis, prognosis, and the design of personalised treatment plans for better outcomes in the future.


Assuntos
Transtorno Bipolar , Lógica Fuzzy , Humanos , Detecção Precoce de Câncer , Redes Neurais de Computação , Expressão Gênica , Algoritmos
20.
JAMA ; 329(2): 109-110, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36625827

RESUMO

This Arts and Medicine feature reviews The Collected Schizophrenias, a 2019 essay collection by Esmé Weijun Wang about her experiences living with schizoaffective disorder.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Humanos , Transtorno Bipolar/psicologia , Transtornos Psicóticos/psicologia
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