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1.
Medicina (Kaunas) ; 57(8)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34440998

RESUMO

The early recognition of psychiatric disorders has been a focus of research in the last decades and has led to improvements in clinical care, especially in the area of early psychosis. Like non-affective psychosis, bipolar disorders are often diagnosed with a delay that can lead to long periods of untreated illness and impact long-term outcomes. This article presents the rationale for early recognition in bipolar disorder and presents the current evidence for the identification of risk factors, their assessment and validity in predicting the onset of bipolar disorder.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Humanos , Fatores de Risco
2.
Artigo em Inglês | MEDLINE | ID: mdl-34444069

RESUMO

Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to assess the full spectrum of clinical manifestations of bipolar disorder. A sample of 88 patients was evaluated; the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Scale (MADRS), and the Young Mania Rating Scale (YMRS) were applied, together with the preliminary version of the Scale for the Assessment of Episodes in Bipolar Disorder (SAEBD). After analyzing the appropriateness and statistical properties of the items, discriminant analysis and analysis of diagnostic capacity were performed. The discriminant functions correctly classified 100% of the cases in euthymia, predominant depressive symptoms or mixed symptoms, as well as 92.3% of the cases with predominant manic symptoms. Overall, the functions correctly classified 98.9% of the cases. The area under the curve (0.935) showed high capacity to discriminate between clinical and non-clinical cases (i.e., in euthymia). The SAEBD sensitivity was 0.95, specificity was 0.71, the Positive Predictive Value (PPV) was 0.88, the Negative Predictive Value (NPV) was 0.87, the Positive Likelihood Ratio (+LR) was 3.33, and the Negative Likelihood Ratio (-LR) was 0.07. In conclusion, the SAEBD is a promising scale that shows high reliability and validity, as well as diagnostic utility as a screening tool for use in diverse health care settings.


Assuntos
Transtorno Bipolar , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Humanos , Valor Preditivo dos Testes , Atenção Primária à Saúde , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes
3.
Transl Psychiatry ; 11(1): 415, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341338

RESUMO

There is a lack of consensus on the diagnostic thresholds that could improve the detection accuracy of bipolar mixed episodes in clinical settings. Some studies have shown that voice features could be reliable biomarkers of manic and depressive episodes compared to euthymic states, but none thus far have investigated whether they could aid the distinction between mixed and non-mixed acute bipolar episodes. Here we investigated whether vocal features acquired via verbal fluency tasks could accurately classify mixed states in bipolar disorder using machine learning methods. Fifty-six patients with bipolar disorder were recruited during an acute episode (19 hypomanic, 8 mixed hypomanic, 17 with mixed depression, 12 with depression). Nine different trials belonging to four conditions of verbal fluency tasks-letter, semantic, free word generation, and associational fluency-were administered. Spectral and prosodic features in three conditions were selected for the classification algorithm. Using the leave-one-subject-out (LOSO) strategy to train the classifier, we calculated the accuracy rate, the F1 score, and the Matthews correlation coefficient (MCC). For depression versus mixed depression, the accuracy and F1 scores were high, i.e., respectively 0.83 and 0.86, and the MCC was of 0.64. For hypomania versus mixed hypomania, accuracy and F1 scores were also high, i.e., 0.86 and 0.75, respectively, and the MCC was of 0.57. Given the high rates of correctly classified subjects, vocal features quickly acquired via verbal fluency tasks seem to be reliable biomarkers that could be easily implemented in clinical settings to improve diagnostic accuracy.


Assuntos
Transtorno Bipolar , Transtorno Bipolar/diagnóstico , Humanos
4.
Compr Psychiatry ; 109: 152258, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34252633

RESUMO

BACKGROUND: Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. METHODS: 120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. RESULTS: Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LIMITATIONS: The cross-sectional design does not allow for causal inferences. CONCLUSION: BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Esquizofrenia , Teoria da Mente , Idoso , Transtorno Bipolar/diagnóstico , Cognição , Estudos Transversais , Feminino , Humanos , Masculino , Esquizofrenia/diagnóstico , Caracteres Sexuais , Cognição Social
5.
Compr Psychiatry ; 109: 152243, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34271257

RESUMO

BACKGROUND: Although self-rating mania scales have been developed, a lack of such instruments validated for the Greek population is noted. This study aims to examine the validity, reliability and psychometric properties of the Altman Self Rating Mania Scale (ASRM) adapted in Greek (G-ASRM). METHODS: A sample of 86 consecutive inpatient and outpatient bipolar patients diagnosed by the DSM-5 criteria and 37 healthy controls were assessed by using the Young Mania Rating Scale (YMRS) and the Montgomery Asberg Depression Rating Scale (MADRS), and self-administered the G-ASRM. Factor analysis, test-retest analysis, measurement invariance tests, mean differences, Pearson's Correlation analysis and ROC analysis were used to confirm the validity of G-ASRM as a scale, test its reliability, study its psychometric properties in different subgroups and establish a cut-off value for indicating the presence of (hypo)mania in BD patients. Also, regression models were built to expose dependencies between YMRS and G-ASRM items. RESULTS: Monofactoriality of the scale was verified, based on Exploratory Factor Analysis (EFA). Cronbach's alpha was 0.895. G-ASRM is highly correlated with YMRS (r = 0.856, p < 0.0005) and uncorrelated with MADRS (r = -0.051, p = 0.623). Test- retest r-coefficient was calculated at 0.85. The optimal cut-off score, set at ≥6 for (hypo)mania assessment, is in agreement with the results reported for the original version. Limitations of the study are that the scale was not normed on diagnostic groups other than bipolar, nor was it administered longitudinally, so as to assess its sensitivity to symptom changes overtime. CONCLUSION: The G-ASRM can be validly and reliably used in the Greek population for the assessment of (hypo)mania in bipolar patients.


Assuntos
Transtorno Bipolar , Mania , Transtorno Bipolar/diagnóstico , Humanos , Escalas de Graduação Psiquiátrica , Psicometria , Reprodutibilidade dos Testes
7.
Compr Psychiatry ; 109: 152249, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34298288

RESUMO

AIM: This cross-sectional study aimed to assess the predominant polarity (PP) in patients with bipolar disorder (BD) and the factors associated with PP. METHODOLOGY: For this study, 773 participants with at least 10 years of illness, were recruited from 14 centres, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the course of illness and PP was determined by both Barcelona proposal and the Harvard Index. RESULTS: According to Barcelona proposal for PP, 20.6% of the patients belonged to depressive PP, 45.8% belonged to manic PP and 33.6% belonged to indeterminate polarity. According to Harvard index of PP, 31.6% of the patients belonged to depressive PP, 56.1% belonged to manic polarity and 12.3% of the patients could not be categorized into any of these categories and hence, were considered to have indeterminate polarity. Those with depressive PP were more often having BD-II, had later age of onset, spent more time in episodes, had higher residual depressive symptoms, had lower residual manic symptoms, more often had depression as the first lifetime episode, and less often had at least one psychotic episode. CONCLUSION: In the Indian subcontinent, although the prevalence of PP is influenced by the definition used, the most common PP is that of mania.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Estudos Transversais , Humanos , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos
8.
Medicina (Kaunas) ; 57(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34207966

RESUMO

Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Criança , Comorbidade , Humanos , Lítio/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
9.
Georgian Med News ; (314): 129-134, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-34248042

RESUMO

The purpose of the study is to explore the peculiarities of cognitive functioning in the depressive phase of BAS, taking into account the gender factor. The results of the study are based on data from a clinical and psychological examination of 27 men and 39 women with bipolar disorder (BAD) and undergoing treatment at the Yushchenko Vinnytsia Regional Psychoneurological Hospital from 2016 to 2020 in connection with the current episode of mild or moderate depression (ICD-10 code F31.3). The study revealed significant deteriorations of cognitive processes, including disorders of attention, memory, cognitive and executive functions. In the structure of cognitive clinical symptoms the signs of slow thinking (in 100% of patients), impaired concentration (88.9% of men and 82.1% of women, p>0.05), difficulties in planning and decision-making (85.2% and 79.5%, p>0.05), less rigid thinking (81.5% and 59.0%, p<0.05) dominated. Patients with BAR performed significantly slower tests TMT-A (101.0±13.6 sec. and 98.9±8.9 sec., P>0.05) and TMT-B (333.5±17.9 sec. and 331.3±12.9 sec., p>0.05), which indicates a reduced ability to visual and motor processing of information, deterioration of mechanical memory, impaired performance, working memory and inhibition control. The verbal fluency test was performed worse: the subtest «Number of words on the letter «K¼ (12.1±2.3 words and 12.9±1.6, p>0.05), the subtest «Number of words on the letter «P¼ (10.5±2.4 words and 10.8±1.8 words, p>0.05), the subtest «Male names¼ (11.2±2.1 words and 11.9±1.5 words), p>0.05), the subtest «Fruit and furniture¼ (10.4±2.3 words and 10.7±1.6 words, p>0.05), which is considered to be a consequence of bradypsychism, motor retardation, attention and memory deficit disorder. Also, the increase of time for Stroop test performance: reading names of colors where color of a font differs from a word meaning (166,1±12,7 sec. and 164,4±8,8 sec., p>0,05), naming colors, where the font color differs from the meaning of the word (68.2±8.7 sec. and 66.7±5.6 sec., p>0.05), reading the names of colors printed in black (69.4±9, 1 sec and 67.8±5.8 sec, p>0.05), color naming (100.8±6.2 sec and 101.6±5.2 sec, p>0.05) , control rigidity/flexibility index (97.9±4.5 sec. and 97.7±3.6 sec., p>0.05), verbality index (1.5±0.1 sec., p>0,05), which testifies to a distinct effect of interference and significant rigidity of cognitive control processes in combination with a violation of the cognitive functions automatization and a decrease in the degree of their independent functioning.


Assuntos
Transtorno Bipolar , Transtornos Cognitivos , Transtorno Bipolar/diagnóstico , Cognição , Função Executiva , Feminino , Humanos , Masculino , Testes Neuropsicológicos
10.
J Affect Disord ; 292: 708-713, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34161888

RESUMO

BACKGROUND: In a recent issue in the journal, Humpston, Bebbington, and Marwaha (2021) reported the results of the first large epidemiological study of bipolar disorder in England. The prevalence estimate of bipolar disorder was based on the Mood Disorders Questionnaire (MDQ), a self-administered screening scale for a lifetime history of mania/hypomania. Humpston and colleagues found that the prevalence of bipolar disorder in England was similar to the rates in other parts of the world, and they stated that most individuals with bipolar disorder in England did not receive treatment for the disorder in the past year. A better understanding of the statistics of screening and the performance of the MDQ would indicate that the conclusions drawn from the epidemiological study are not justified. METHODS: I review the principles and statistics of diagnostic screening and how screening is distinguished from case-finding. I then review the performance of the MDQ in the general population and calculate the positive predictive value of the MDQ in the study by Humpston and colleagues. RESULTS: The developers of the MDQ reported a sensitivity of 28.1% and specificity of 97.2% in the general population based on a cutoff score of 7. Using this same cutoff, Humpston and colleagues reported the prevalence of "probable" bipolar disorder was 1.7%. Based on these data, the positive predictive value of the MDQ would be only 14.8%. LIMITATIONS: Humpson et al. did not compare the MDQ to a diagnostic interview in their study; thus, the performance of the MDQ was estimated from another general population study. CONCLUSIONS: When studying a disorder with a relatively low prevalence, it is near impossible for a screening test to have sufficient positive predictive value to be used to validly compare the individuals who do and do not screen positive. Most of the individuals whom Humpston et al. considered to have "probable" bipolar disorder would not have received the diagnosis had they been directly interviewed. Thus, the results of the Humpston et al. study are not a valid indicator of the correlates of bipolar disorder in the general population of England.


Assuntos
Transtorno Bipolar , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Inglaterra/epidemiologia , Estudos Epidemiológicos , Humanos , Programas de Rastreamento , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Sensibilidade e Especificidade , Inquéritos e Questionários
11.
BMC Psychiatry ; 21(1): 275, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059028

RESUMO

BACKGROUND: This study aimed to identify the clinical characteristic of prodromal symptoms in Chinese patients with bipolar disorder (BD), prior to the first affective episode. It further aimed to characterize the prodromal traits between bipolar disorder type I (BD-I) and type II (BD-II). METHODS: 120 individuals with BD-I (n = 92) and BD- II (n = 28) were recruited to the study. Semi-structured interviews were then administered to evaluate prodromal symptoms in patients, within 3 years of BD onset, by using the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). RESULTS: In the prodromal phase of the first depressive episode, patients with BD-II experienced more prodromal symptoms (p = 0.0028) compared to BD-I. Additionally, more frequent predictors were reported in patients with BD-II than BD-I including educational and occupational dysfunction (p = 0.0023), social isolation (p < 0.001), difficulty making decisions (p = 0.0012), oppositionality (p = 0.012), and suspiciousness/persecutory ideas (p = 0.017). There were also differences in the duration of the precursors. The duration of "weight loss or decrease in appetite" (p = 0.016) lasted longer in patients with BD-I, while "obsessions and compulsions" (p = 0.023) started earlier in patients with BD-II and occurred during the pre-depressive period. The prevalence and duration of each reported prodrome, preceding a first (hypo) manic episode, showed no difference between patients with BD-I and BD-II. CONCLUSIONS: Specific affective, general, or psychotic symptoms occurred prior to both affective episodes. The characteristic of prodromal symptoms were key predictors for later episodes of BD including attenuated mania-like symptoms, subthreshold depressed mood, mood swings/lability, and anxiety. In the pre-depressive state, when compared to BD-II, BD-I presented with more prodromal symptoms in nonspecific dimensions, which indicated the substantial burden of BD-II. In conclusion, this study extends the understanding of the characteristics of prodromes of BD-I and BD-II.


Assuntos
Transtorno Bipolar , Sintomas Prodrômicos , Sintomas Afetivos , Transtorno Bipolar/diagnóstico , China , Humanos , Estudos Retrospectivos
12.
Bipolar Disord ; 23(5): 517-520, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34101974

RESUMO

The prospect of staging psychiatric disorders has been a source of ongoing controversy since the idea was first proposed in the early 1990s, based on the staging models used for cancer. More recently, several staging models have been proposed for bipolar disorder; however, as yet there is no consensus as to which model (or composite) is best, and there is no substantive evidence in support of any one of the models. The fundamental problem is that, unlike cancer, the pathophysiology of psychiatric disorders such as bipolar disorder is essentially unknown. The illness has many neurobiological underpinnings, but whether these are truly causal and if so how they lead to the illness, remains a mystery. As a consequence, there is no way of predicting when the illness will emerge and what trajectory it will take. Its response to treatment and prognosis is equally unpredictable, and therefore, models attempting to stage the disorder on the basis of clinical markers have limited utility. This is especially so, because the clinical presentation of bipolar disorder is particularly complex as it often occurs in the context of comorbidities, which further obscure the clinical picture. Therefore, in this QuiP, we provide insights as to why current methods of staging bipolar disorder are hamstrung and propose a way forward that may yield meaningful insights.


Assuntos
Transtorno Bipolar , Psiquiatria , Biomarcadores , Transtorno Bipolar/diagnóstico , Comorbidade , Humanos , Prognóstico
13.
Neuropsychopharmacology ; 46(11): 1895-1905, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34127797

RESUMO

Psychiatric disorders show heterogeneous symptoms and trajectories, with current nosology not accurately reflecting their molecular etiology and the variability and symptomatic overlap within and between diagnostic classes. This heterogeneity impedes timely and targeted treatment. Our study aimed to identify psychiatric patient clusters that share clinical and genetic features and may profit from similar therapies. We used high-dimensional data clustering on deep clinical data to identify transdiagnostic groups in a discovery sample (N = 1250) of healthy controls and patients diagnosed with depression, bipolar disorder, schizophrenia, schizoaffective disorder, and other psychiatric disorders. We observed five diagnostically mixed clusters and ordered them based on severity. The least impaired cluster 0, containing most healthy controls, showed general well-being. Clusters 1-3 differed predominantly regarding levels of maltreatment, depression, daily functioning, and parental bonding. Cluster 4 contained most patients diagnosed with psychotic disorders and exhibited the highest severity in many dimensions, including medication load. Depressed patients were present in all clusters, indicating that we captured different disease stages or subtypes. We replicated all but the smallest cluster 1 in an independent sample (N = 622). Next, we analyzed genetic differences between clusters using polygenic scores (PGS) and the psychiatric family history. These genetic variables differed mainly between clusters 0 and 4 (prediction area under the receiver operating characteristic curve (AUC) = 81%; significant PGS: cross-disorder psychiatric risk, schizophrenia, and educational attainment). Our results confirm that psychiatric disorders consist of heterogeneous subtypes sharing molecular factors and symptoms. The identification of transdiagnostic clusters advances our understanding of the heterogeneity of psychiatric disorders and may support the development of personalized treatments.


Assuntos
Transtorno Bipolar , Transtornos Mentais , Transtornos Psicóticos , Esquizofrenia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/genética , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/genética , Aprendizado de Máquina não Supervisionado
14.
Ugeskr Laeger ; 183(24)2021 06 14.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34120688

RESUMO

Post-partum psychosis (PPP) is a severe psychiatric emergency. The condition is rare and has generally not been an area of overwhelming research, and concordantly, early identification and treatment is a challenge. Research in the field suggests, that PPP often is a bipolar spectrum illness, and resent research has identified the most common symptoms. This review is an updated description of the phenotypical characteristics of the illness and treatment recommendations based on the newest research.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Transtornos Puerperais , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Período Pós-Parto , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Medição de Risco
15.
Aust N Z J Psychiatry ; 55(6): 536-547, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34080455

RESUMO

This perspective piece is a detailed analysis of the critique by Gordon Parker of the mood disorders clinical practice guidelines (MDcpg2020), in which he claims that bipolar II disorder has been 'banished' despite its formal status in current taxonomies. In this article, I defend the reasoning used by the Committee to adopt a dimensional model for describing and managing mood disorders, in particular bipolar disorder. I also robustly contend the many erroneous inferences made by him in his Viewpoint regarding management recommendations within the MDcpg2020 and demonstrate that there is no valid justification for subtyping bipolar disorder - especially in the manner proposed by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Thus, I argue that it was appropriate for the MDcpg2020 Committee to pursue an alternative model to the usual subtyping of bipolar disorder into 'thing one' and 'thing two' and conclude that the now clearly redundant model of Bipolar II should be altogether removed from our lexicon and clinical practice. Indeed, it is time to develop new and alternative models for defining bipolar disorder and among these a dimensional model should be given consideration.


Assuntos
Transtorno Bipolar , Médicos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Masculino , Transtornos do Humor
16.
J Psychiatr Res ; 140: 436-442, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34147931

RESUMO

People with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional performance (introspective accuracy). They also manifest response biases, with tendencies toward overestimation. This study aimed to examine objective test performance, momentary judgments of performance, momentary confidence, and subsequent global judgments of performance on a metacognitive version of the Wisconsin Card Sorting Test (WCST). This sample included 99 participants with SCZ and 67 with BD. After each of the 64 WCST trials, participants reported whether they believed their sort was correct and how confident they were in that judgment, they then received performance feedback. After completion of the entire task, participants generated a global performance judgment. On average, the SCZ group got 31 sorts correct, reporting being correct on 49 whereas the BD group got 37 trials correct but reported being correct on 53. For participants with BD, sorting performance correlated with trial x trial accuracy judgments, confidence, and predicted global judgments. For SCZ participants, performance minimally correlated with trial x trial accuracy judgments, confidence, and global judgments, while trial x trial confidence was strongly associated with trial x trial accuracy judgments (r = 0.58). Our findings suggest that confidence in participants with BD is correlated with task performance, whereas in SCZ confidence was entirely associated with self-generated performance judgments. SCZ participants manifested challenges with utilization of feedback. Global judgments of performance were predicted by task performance and confidence for BD participants, with performance and confidence judgments occurring prior to generation of the global performance judgments.


Assuntos
Transtorno Bipolar , Esquizofrenia , Viés , Transtorno Bipolar/diagnóstico , Cognição , Humanos , Teste de Classificação de Cartas de Wisconsin
17.
Transl Psychiatry ; 11(1): 350, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099627

RESUMO

Early-warning signals (EWS) have been successfully employed to predict transitions in research fields such as biology, ecology, and psychiatry. The predictive properties of EWS might aid in foreseeing transitions in mood episodes (i.e. recurrent episodes of mania and depression) in bipolar disorder (BD) patients. We analyzed actigraphy data assessed during normal daily life to investigate the feasibility of using EWS to predict mood transitions in bipolar patients. Actigraphy data of 15 patients diagnosed with BD Type I collected continuously for 180 days were used. Our final sample included eight patients that experienced a mood episode, three manic episodes and five depressed episodes. Actigraphy data derived generic EWS (variance and kurtosis) and context-driven EWS (autocorrelation at lag-720) were used to determine if these were associated to upcoming bipolar episodes. Spectral analysis was used to predict changes in the periodicity of the sleep/wake cycle. The study procedures were pre-registered. Results indicated that in seven out of eight patients at least one of the EWS did show a significant change-up till four weeks before episode onset. For the generic EWS the direction of change was always in the expected direction, whereas for the context-driven EWS the observed effect was often in the direction opposite of what was expected. The actigraphy data derived EWS and spectral analysis showed promise for the prediction of upcoming transitions in mood episodes in bipolar patients. Further studies into false positive rates are suggested to improve effectiveness for EWS to identify upcoming bipolar episode onsets.


Assuntos
Transtorno Bipolar , Actigrafia , Afeto , Transtorno Bipolar/diagnóstico , Humanos
18.
Lakartidningen ; 1182021 06 04.
Artigo em Sueco | MEDLINE | ID: mdl-34100265

RESUMO

DSM-IV subcategorises bipolar disorders into type 1, type 2, and a third not otherwise specified (NOS) category. Although previous works suggest that these subtypes remain reasonably stable over time, it is unclear if subdiagnoses endure over time or if patients are commonly recategorized within the spectrum in a real-world clinical setting. We assessed subdiagnostic stability in 6,374 individuals with bipolar disorder using data from the Swedish national quality assurance register for bipolar disorders (BipoläR). Diagnoses at baseline registration - that could occur at any time point during the course of illness - were compared with diagnoses at follow-up registration 3 years later. Changes in subdiagnoses were analysed in relation to clinical setting, diagnostic procedure, and patient features. We found that 74 %, 67 %, and 47 % of patients diagnosed with bipolar disorder type 1, type 2, and NOS, respectively, retained the same subdiagnosis at the 3-year follow-up. The following factors were associated with higher rate of subdiagnostic transitions: previous suicide attempts, unemployment or low psychosocial function, treatment with antidepressants, and comorbid anxiety, neuropsychiatric, or personality disorder. Conversely, use and duration of mood stabilizer treatment, the use of structured diagnostic instruments, and treatment at an outpatient unit specialized in managing affective disorders were associated with lower likelihood of subdiagnostic transitions. Our findings confirm that bipolar disorder type 1 is the most stable subdiagnostic group, but findings also indicate a significant degree of subdiagnostic instability, particularly in the NOS group.


Assuntos
Transtorno Bipolar , Transtornos de Ansiedade , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos da Personalidade , Tentativa de Suicídio
19.
Medicina (Kaunas) ; 57(6)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071356

RESUMO

The onset of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder could be considered as an important alarm bell for the development of the disease and should be carefully detected. The management of prodromes in bipolar high-risk patients appears to be an important means of prevention; nevertheless, at the moment, there aren't clear and widely shared treatment indications. The aim of this review is to summarize the available treatment options (pharmacological, psychosocial and nutraceutical) for the management of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder.


Assuntos
Transtorno Bipolar , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Humanos , Sintomas Prodrômicos
20.
Ugeskr Laeger ; 183(22)2021 05 31.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34060453

RESUMO

Up to half of all patients with bipolar affective disorder (BP), develop a comorbid anxiety disorder during their lifetime. The consequences of comorbid anxiety in BP compared to BP without comorbid anxiety are serious, including more frequent and severe depressions and twice the risk of substance abuse and suicide attempts. In this review we argue, that due to the poorer prognosis of these conditions, it is important to diagnose comorbid anxiety when present, and to ensure proper treatment, which should be performed by a psychiatrist preferably specialised in affective disorders.


Assuntos
Transtorno Bipolar , Ansiedade , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Comorbidade , Humanos , Transtornos do Humor/epidemiologia
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