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1.
Lancet ; 394(10194): 240-248, 2019 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-31200992

RESUMO

BACKGROUND: Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. METHODS: In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. FINDINGS: We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8-25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3-16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9-5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0-6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. INTERPRETATION: The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. FUNDING: WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.


Assuntos
Transtornos Mentais/epidemiologia , Guerra , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Depressão/epidemiologia , Humanos , Prevalência , Esquizofrenia/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Organização Mundial da Saúde
2.
Expert Opin Pharmacother ; 20(12): 1457-1470, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31112441

RESUMO

Introduction: ADHD is characterized by a developmentally inappropriate level of inattentiveness, impulsivity and/or hyperactivity. In adults, the disorder is frequently accompanied by Emotional Dysregulation (ED), associated to a variety of related psychiatric comorbidities, complicating its recognition and treatment management. Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of pharmacotherapy in adults with ADHD and ED, other neurodevelopmental disorders, Bipolar Disorder (BD) and Anxiety Disorders (ADs). When controlled data are unavailable, the authors have included open-label and observational studies. Expert opinion: ED in adult patients with ADHD is a very common and impairing problem that can be treated with stimulants or atomoxetine. ADHD studies in adults with other neurodevelopment disorders are scarce; stimulants seem to be the most effective and safe drugs in treating ADHD symptoms, without worsening the core features of other neurodevelopmental disorders. In patients with ADHD and comorbid BD, the treatment of BD alone may result in residual symptoms of ADHD. Patients should be treated hierarchically: BD should be treated first, while ADHD should be treated combining ADHD medications and mood stabilizers after mood stabilization. The available evidence for treating patients with ADHD and comorbid ADs in adults supports the idea of an anti-anxiety/ADHD-specific treatment association.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Tratamento Farmacológico/tendências , Drogas em Investigação/uso terapêutico , Adulto , Antimaníacos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Cloridrato de Atomoxetina/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Comorbidade , Tratamento Farmacológico/métodos , Humanos , Estudos Observacionais como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Terapias em Estudo/métodos , Terapias em Estudo/tendências
3.
Tex Med ; 115(5): e1, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042801

RESUMO

The primary purpose of the study was to examine the role public sector payers (Medicare and Medicaid) and providers (Texas state mental health hospitals) play in psychiatric hospitalization, using Texas annual hospital discharge files from 1999 to 2010. Psychiatric hospitalization, as defined by a primary behavioral health diagnosis (ICD-9 diagnoses 290-314.99) averaged 146,876 discharges per year, approximately 5.24% of all hospitalizations in the state. Children younger than 18 years accounted for 27,035 discharges per year. The top 4 diagnostic groups were depression (29%), bipolar disorder (22%), schizophrenia (18%), and alcohol-drug disorders (14%). More patients with schizophrenia or other psychotic disorders were served by the public sector, while more patients with depression or alcohol-drug disorders were served by private insurance. Interestingly, patients with bipolar disorder were distributed relatively evenly across both payment groups and ages. Length of stay decreased from 10.5 days in 1999 to 8.1 days in 2010. Most psychiatric discharges (69%) were served by a small group of 42 large psychiatric hospitals.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo/epidemiologia , Hospitais Psiquiátricos/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Tamanho das Instituições de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Medicaid , Medicare , Pessoa de Meia-Idade , Distribuição por Sexo , Texas/epidemiologia , Estados Unidos , Adulto Jovem
4.
Br J Sports Med ; 53(12): 746-753, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097458

RESUMO

Bipolar and psychotic disorders are relatively common and likely to have a significant impact on quality of life and functioning which, in the context of elite sport, includes a potential negative impact on sporting performance. For this narrative review article, the literature on bipolar and psychotic disorders in elite athletes was comprehensively searched, and little empirical research was found. A diagnosis of bipolar or psychotic disorders may be challenging in elite athletes because of complicating factors related to the modifying role of exercise and potential precipitating impact of substance use. Medications used to treat bipolar and psychotic disorders may have side effects particularly problematic for elite athletes. Future research should be tailored to the specific characteristics and needs of elite athletes and to the sporting context in which the disorders may arise. Specifically, further research is needed on the prevalence and incidence of these conditions in elite athletes and the impact of both the disorders and their treatments on sporting performance.


Assuntos
Atletas/psicologia , Transtorno Bipolar/epidemiologia , Transtornos Psicóticos/epidemiologia , Desempenho Atlético , Transtorno Bipolar/diagnóstico , Humanos , Prevalência , Transtornos Psicóticos/diagnóstico , Qualidade de Vida
5.
Nord J Psychiatry ; 73(4-5): 264-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31134834

RESUMO

Aim: Posttraumatic stress disorder (PTSD) in parents can have severe consequences also for their children. Prevalence of PTSD is high among refugees. Refugee children have been reported to perform poorly in school. The aim of this study was to investigate the impact of PTSD in refugee and native Swedish parents on children's school performance and to compare the impact of PTSD with that of other major psychiatric disorders. Methods: Register study where multiple regression models were used to analyse school performance in 15-16-year-olds in a national cohort (n = 703,813). PTSD and other major psychiatric disorders (bipolar, depression and/or psychotic disorders) were identified from out- and in-patient hospital care. Results: Maternal and paternal PTSD were associated with lower grades, with adjusted effects of 0.30-0.37 SD in refugee and 0.46-0.50 SD in native Swedish families. Impact of PTSD was greater than that of other psychiatric disorders and comorbidity to PTSD did not increase this impact. Although the impact of PTSD on grades was greater in children in native Swedish families, consequences with regard to eligibility to secondary education were greater for children in refugee families, where 35% of these children were ineligible. Conclusions: Parental PTSD has major consequences for children's school performance and contributes to the lower school performance in children in refugee families in Sweden. Identification and treatment of PTSD in refugee parents is important for offspring educational achievement. Psychiatric clinics and treatment centres need to have a strategy for support, including educational support, to the offspring of their patients with PTSD.


Assuntos
Desempenho Acadêmico/psicologia , Filho de Pais Incapacitados/psicologia , Pais/psicologia , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Estudos de Coortes , Feminino , Humanos , Masculino , Prevalência , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Sistema de Registros , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Suécia/epidemiologia
6.
Depress Anxiety ; 36(6): 543-551, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31025812

RESUMO

BACKGROUND: Hormonal fluctuations may trigger the onset of bipolar disorder. We designed a longitudinal follow-up study to evaluate the association between hysterectomies and bipolar disorder risk. METHODS: We conducted a large retrospective cohort study using Taiwan's National Health Insurance Research Database. A total of 4,337 women aged 30 to 50 years who underwent the hysterectomy during 2000-2013 were selected and 17,348 patients without hysterectomy were selected for comparison (1:4 match). Poisson regression analysis was used to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). RESULTS: During the follow-up of 7.93 years, 20 participants with hysterectomy and 28 without hysterectomy developed bipolar disorder. Receiving hysterectomy was associated with the risk of developing bipolar disorder (adjusted IRR = 2.80; 95% CI = 2.54-3.09). Women with hysterectomy had a higher risk of bipolar disorder in follow-up durations of <1 year (adjusted IRR = 2.18 with 95% CI = 1.94-1.45) and ≥1 year (adjusted IRR = 2.85 with 95% CI = 2.58-3.15). Endometriosis and Premarin use increased bipolar disorder incidence in the hysterectomy group (adjusted IRR = 3.17 [95% CI = 2.83-3.56] and 4.22 [95% CI = 3.71-4.80], respectively). CONCLUSION: This study concluded that women with hysterectomy have an increased risk of bipolar disorder. Endometriosis and hormone therapy may add to the risk of bipolar disorder after hysterectomy. Knowledge about how surgical or natural hormonal withdrawal influences mood is fundamental and emphasizes the importance of coordinated psychiatric and gynecological care.


Assuntos
Transtorno Bipolar/etiologia , Histerectomia/efeitos adversos , Adulto , Transtorno Bipolar/epidemiologia , Estudos de Coortes , Suscetibilidade a Doenças , Endometriose/epidemiologia , Feminino , Seguimentos , Ginecologia , Humanos , Histerectomia/estatística & dados numéricos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia
7.
Neurosci Biobehav Rev ; 101: 78-84, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30974123

RESUMO

Bipolar disorder (BD) is commonly associated with comorbidities, especially substance use disorders. In light of this, the present review aimed to investigate the prevalence and clinical correlates of cannabis use in BD. Studies evaluating the prevalence of cannabis use among patients with BD and studies reporting a dichotomous sample of patients with cannabis use compared to those without the use were included. Meta-analyses using random-effects models were performed, and sources of heterogeneity were explored using meta-regression. The search resulted in 2918 publications, of which 53 were included. The prevalence of cannabis use was 24% (95%CI:18-29; k = 35; n = 51,756). Cannabis use was significantly associated with being younger, male, and single; having fewer years of education and an earlier onset of affective symptoms; and lifetime psychotic symptoms, suicide attempts, and use of tobacco, alcohol, and other substances. In conclusion, cannabis use present in almost one-quarter of patients with BD and is associated with factors that are highly relevant for both clinical practice and public health.


Assuntos
Transtorno Bipolar/epidemiologia , Uso da Maconha/epidemiologia , Cannabis , Comorbidade , Humanos , Prevalência
8.
Artigo em Inglês | MEDLINE | ID: mdl-30934836

RESUMO

Bipolar patients have a higher risk of type 2 diabetes and obesity, which are associated with cardiovascular diseases as the leading cause of death in this group. Additionally, there is growing evidence that impaired glucose metabolism in bipolar patients is associated with rapid cycling, poor response to mood stabilizers and chronic course of illness. The aim of the study was to assess the prevalence of type 2 diabetes and other types of impaired glucose metabolism in bipolar patients along with an evaluation of the Fasting Triglycerides and Glucose Index (TyG) as a method of the insulin sensitivity assessment. The analysis of fasting glycemia, insulinemia and lipid profile in euthymic bipolar patients was performed, and the Homeostasis model assessment for insulin resistance (HOMA-IR) and TyG were computed. Type 2 diabetes was observed in 9% and insulin resistance with HOMA-IR in 48% of patients. The TyG and HOMA-IR indices were correlated (p < 0.0001), the TyG index value of 4.7 had the highest sensitivity and specificity for insulin resistance detection. The usefulness of TyG in the recognition of insulin resistance in bipolar patients was suggested. The significant role of psychiatrists in the detection and management of impaired glucose metabolism in bipolar patients was presented.


Assuntos
Transtorno Bipolar/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Glucose/metabolismo , Resistência à Insulina , Psiquiatria , Idoso , Transtorno Bipolar/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Jejum/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papel Profissional , Triglicerídeos/sangue
9.
Artigo em Inglês | MEDLINE | ID: mdl-30934957

RESUMO

Environmental variables can regulate behavior in healthy subjects. Recently, some authors investigated the role of meteorological variables in bipolar patients with an impact on both the onset and course of bipolar disorder (BD). The aim of this study was to investigate the impact of meteorological variables and other indexes in bipolar hospitalized patients. We examined all patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital, Orbassano (Turin, Italy) from September 2013 to August 2015, collecting several socio-demographic and clinical characteristics. Seven hundred and thirty patients were included. Compared to the day of admission of control individuals, patients with BD were admitted on a day that presented higher minimum, medium, and maximum temperature, higher maximum humidity, higher solar radiation, and higher hours of sunshine. After logistic regression analysis, admissions to the emergency psychiatric ward due to a primary diagnosis of BD were associated with maximum temperature and solar radiation. The current study provides a novel perspective on the question surrounding seasonal mood patterns in patients with BD. A greater awareness of all possible precipitating factors is needed to inform self-management and psycho-educational programs as well as to improve resilience regarding affective recurrences in the clinical practice.


Assuntos
Transtorno Bipolar/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Luz Solar , Temperatura Ambiente , Adulto , Transtorno Bipolar/psicologia , Feminino , Humanos , Umidade , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Energia Solar
10.
Behav Ther ; 50(3): 531-543, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030871

RESUMO

Both reward sensitivity and impulsivity are related to the development and course of bipolar spectrum disorders (BSDs) and have been implicated in other disorders and negative functional outcomes such as substance abuse, obesity, suicidal behaviors, and risk-taking. Furthermore, according to the transactional component of the Behavioral Approach System (BAS)/reward hypersensitivity theory of BSDs, people with reward hypersensitivity should experience more BAS-relevant events, and thus, are more vulnerable to mood symptoms and episodes via stress generation. Impulsivity may exacerbate stress generation in individuals at risk for BSDs based on exhibiting reward hypersensitivity. The current study examined whether impulsivity explained the generation of stress and subsequent mood symptoms beyond what is explained by reward sensitivity alone. Participants were 131 Moderate BAS and 216 High BAS sensitivity adolescents (M = 18.43 years, SD = 1.40), who completed baseline measures of reward sensitivity and impulsivity, as well as follow-up measures of life events and mood symptoms. Results from linear regression analyses indicated that higher baseline impulsivity predicted behavior-dependent, but not behavior-independent, life events. Furthermore, path analyses suggested that the effect of BAS group on depression symptoms at next follow-up was partly explained via the indirect effect of impulsivity and negative behavior-dependent life events. We did not find these effects for behavior-independent or positive-dependent events or for prediction of hypomanic symptoms. The findings suggest that impulsivity may account for stress generation of negative events that precede depression.


Assuntos
Comportamento do Adolescente/psicologia , Transtorno Bipolar/psicologia , Depressão/psicologia , Comportamento Impulsivo , Acontecimentos que Mudam a Vida , Recompensa , Adolescente , Afeto/fisiologia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Estudos Longitudinais , Masculino , Autoimagem
11.
Eur Psychiatry ; 58: 45-53, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30818134

RESUMO

BACKGROUND: Sleep alterations are frequent occurrence in Bipolar Disorder (BD), both in acute and interepisodic phases. Sleep alterations have been also described both long before BD onset, as aspecific risk syndromes, or as immediate prodromes of BD onset. The aim of the present study is to systematically review the relationship between sleep alterations anticipating for the full-blown onset of BD, both in general and according to specific polarities of onset. METHODS: A systematic literature research according to PRISMA statement and considering: 1. prospective studies about BD patients' offspring with sleep alterations who later developed BD. 2. prospective studies assessing patients with sleep disorders who later developed BD. 3. retrospective studies on BD patients where sleep alterations before BD onset of the disease were reported. RESULTS: A total of 16 studies were included in this review. Sleep disturbances may frequently appear 1 year before the onset of BD or more, often during childhood or adolescence. A decreased need for sleep may precede the onset of the illness, specially a manic episode, while insomnia appears to anticipate either a manic or a depressive episode. Hypersomnia seems to precede bipolar depressive episodes. CONCLUSIONS: Sleep alterations frequently appear long before the onset of BD, and appear to be related specifically to the polarity of the index episode. The detection and treatment of sleep alterations in special high risk populations may help achieving an earlier detection of the illness.


Assuntos
Transtorno Bipolar/epidemiologia , Diagnóstico Precoce , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Adulto , Transtorno Bipolar/diagnóstico , Causalidade , Criança , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Transtornos do Sono-Vigília/diagnóstico
12.
Bull Menninger Clin ; 83(1): 97-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888852

RESUMO

A recent review on the use of electroconvulsive therapy (ECT) in obsessive-compulsive-related disorders (OCRDs) identified reports of trichotillomania (TTM) in only three patients, but it did not describe the specific effect of ECT on hair-pulling behaviors. The authors present a case report of Mrs. A, a 77-year-old widowed housewife with a lifelong history of episodic TTM and bipolar disorder who was effectively treated with ECT. However, on each attempt to withdraw ECT, her condition deteriorated. Eventually, a decision was made to maintain ECT (one session every week), which resulted in no further relapse over the followup period. ECT shows some potential promise for reducing hair-pulling behaviors in the context of severe depression.


Assuntos
Transtorno Bipolar/terapia , Eletroconvulsoterapia/métodos , Tricotilomania/terapia , Idoso , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , Humanos , Tricotilomania/epidemiologia
13.
J Affect Disord ; 250: 21-25, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30826490

RESUMO

BACKGROUND: Traumatic brain injury (TBI) and suicidal behavior lead to serious morbidity and premature mortality. TBI in adulthood is associated with a higher incidence of suicide, but the risk in adolescents and young adults is not clear. METHODS: Longitudinal follow-up data were extracted from a National Health Insurance Research Database. Adolescents and young adults (12-29 years old) with and without TBI (1:4) were included, and the incidences of following attempted suicide were analyzed. The association of TBI severity, repeated TBI, and comorbid psychiatric disorders with attempted suicide were also investigated. RESULTS: Overall, 31,599 and 126,396 subjects were enrolled in the TBI and control cohorts, respectively. The overall incidence of attempted suicide was significantly higher in the TBI cohort than in the control cohort (4.6% versus 1.0%, P < 0.001). The age at first suicide attempt was also lower in the TBI cohort (25.71 ±â€¯5.25 versus 28.99 ±â€¯5.26 years, P < 0.001). After adjusting for confounding factors, severe TBI, repeated TBI, female, younger age at TBI, and comorbid psychiatric conditions (unipolar depression, bipolar disorder, alcohol and substance use disorders) were associated with higher risks of attempted suicide. Long-term cumulative risks of attempted suicide were significantly elevated in the TBI cohort (P < 0.001). LIMITATION: Access to individual's detailed medical record was not available. CONCLUSION: TBI is associated with an elevated risk of attempted suicide in adolescents and young adults. TBI severity, repetitive injury, female, younger age at injury, and certain psychiatric comorbidities are independent risk factors.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Transtorno Bipolar/epidemiologia , Lesões Encefálicas Traumáticas/complicações , Criança , Estudos de Coortes , Comorbidade , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Fatores de Risco , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de Suicídio/psicologia , Adulto Jovem
14.
J Med Syst ; 43(5): 117, 2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30905048

RESUMO

In order to explore the brain functional and structural imaging results of patients with bipolar disorder and depressive episode without taking medicine, and to further explore the disease mechanism of bipolar disorder by combining with clinical symptoms and cognitive function (neuropsychological test), DPABI (Data Processing and Analysis (Resting-State) For Brain Image) software is used to pre-process fMRI (functional magnetic resonance imaging) data and calculate fALFF (ratio low frequency fluctuation amplitude) index. In addition, SPM8 is applied for grey matter volume analysis based on voxel morphology. Pearson correlation model is used to analyze the relationship between functional and morphological changes and clinical symptoms and cognitive tests. DPABI software and SPSS 22.0 software are used to analyze the data. The results show that corresponding abnormal brain areas are found in both functional and structural aspects of patients with bipolar disorder and depression, involving LCSPT emotional circuits. More importantly, the superior frontal gyrus shows significant abnormalities in both functional and structural analysis.


Assuntos
Transtorno Bipolar/patologia , Transtornos Cognitivos/patologia , Transtorno Depressivo/patologia , Substância Cinzenta/patologia , Processamento de Imagem Assistida por Computador/métodos , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/epidemiologia , Encéfalo/patologia , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/epidemiologia , Transtorno Depressivo/diagnóstico por imagem , Transtorno Depressivo/epidemiologia , Escolaridade , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tamanho do Órgão/fisiologia , Adulto Jovem
15.
J Affect Disord ; 245: 819-826, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30699865

RESUMO

BACKGROUND: To estimate the prevalence of DSM-5 anxious distress specifier (ADS) in depressed patients with major depressive disorder (MDD) or bipolar I or II disorder (BD), and to compare socio-demographic and clinical characteristics, and response to naturalistic short-term treatment between ADS and non-ADS group. METHODS: 241 outpatients with a major depressive episode (MDE) were consecutively recruited. Outcome were remission (HDRS21 total score < 7), response (≥50% reduction of baseline HDRS21) and improvement (CGI-i score ≤ 2) after 12 weeks of treatment sustained for 4 weeks. RESULTS: ADS was more frequent in BD than in MDD (respectively, 66.9% and 51.2%, χ2 = 6.1, p = 0.013). Compared with those non-ADS, patients with ADS had more severe depressive (respectively, HDRS21 total score 20.0 ±â€¯4.4 and 18.6 ±â€¯3.9, t-test = 2.67, p = 0.008) and mania symptoms (respectively, Y-MRS total score 2.2 ±â€¯2.9 and 1.3 ±â€¯2.3, M-W-test = 2.86; p = 0.004) at intake, a higher rate of BD family history (respectively, 35.2% and 22.2%, Χ2-test 10.4, p = 0.004) and more previous hypomanic episodes (respectively, (median (range) 0 (0-20) and 0 (0-15), MW-test = 2.39 p = 0.017). In the MDD group, patients with ADS had higher scores on hyperthymic temperament and mania symptoms (Y-MRS total score (median (range) 2.2 (0-26) and 0 (0-11), respectively, M-W test 2.071, p = 0.038). ADS and no-ADS patients did not significantly differ on outcome measures. LIMITATIONS: The observational nature of the study and the absence of blinding in outcome assessment. CONCLUSIONS: ADS is the most common DSM-5 specifier for MDE, is more frequent in BD and need a personalized treatment with moderate use of antidepressants, mostly tricyclic.


Assuntos
Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Adolescente , Adulto , Idoso , Antidepressivos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Estudos de Coortes , Comorbidade , Transtorno Depressivo Maior/tratamento farmacológico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Prevalência , Adulto Jovem
16.
J Affect Disord ; 248: 18-25, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30710859

RESUMO

BACKGROUND: Subthreshold hypomania is defined as a distinct period of elevated, expansive or irritable mood lasting for at least four days, but insufficient to fulfill the criteria of hypomania. This study aimed to investigate the association between suicidality and subthreshold hypomania in subjects with and without major depressive disorder (MDD). METHODS: Face-to-face interviews were completed for 12,526 adults, randomly selected through a one-person-per-household method, using the Korean version of the Composite International Diagnostic Interview (K-CIDI) and a questionnaire relative to lifetime suicide attempts (LSA). RESULTS: Of the 12,526 participants, 11,701 did not have MDD, and 825 were diagnosed with MDD. The MDD with subthreshold hypomania group (n = 72) revealed significantly higher rates of LSA and post-traumatic stress disorder (PTSD) than those without (n = 753). Compared to the no MDD without subthreshold hypomania group (n = 11,571), the no MDD with subthreshold hypomania group (n = 130) showed a significantly higher prevalence of suicidality and comorbid conditions. In multivariate logistic regression analyses of depressive symptoms, subthreshold hypomania was significantly associated with morning worsening of mood. The MDD with subthreshold hypomania group was significantly associated with LSA (AOR=16.82, 95% CI 9.81-28.83, p< 0.001), compared to the no MDD group without subthreshold hypomania. Compared to the MDD without subthreshold hypomania group, the MDD with subthreshold hypomania group revealed a significant association with LSA (AOR=2.08, 95% CI 1.20-3.62, p< 0.001). CONCLUSIONS: A history of subthreshold hypomania doubled the risk of LSA in patients with MDD compared to those without subthreshold hypomania.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Afeto , Transtorno Bipolar/psicologia , Depressão , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , República da Coreia/epidemiologia , Transtornos de Estresse Pós-Traumáticos , Tentativa de Suicídio/psicologia , Inquéritos e Questionários
17.
J Affect Disord ; 249: 15-19, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30743017

RESUMO

BACKGROUND: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry, but treatment of BD-OCD remains a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. METHODS: A systematic review was conducted on aripiprazole augmentation in treating comorbid BD-OCD patients. Relevant papers published through August 31st 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: Aripiprazole augmentation to mood stabilizers (lithium carbonate, valproate), even at low doses (10-15 mg/day), helped to achieve significant remission in affective and obsessive-compulsive symptoms. Aripiprazole was generally safe and well tolerated. LIMITATIONS: Most studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS: Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that aripiprazole augmentation to mood stabilizers, even at low doses, is effective in BD-OCD patients.


Assuntos
Aripiprazol/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Antimaníacos/uso terapêutico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Comorbidade , Humanos , Carbonato de Lítio/uso terapêutico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia
18.
Transl Psychiatry ; 9(1): 60, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718465

RESUMO

We searched for genetic causes of major psychiatric disorders (bipolar disorder, schizoaffective disorder, and schizophrenia) in a large, densely affected pedigree from Northern Sweden that originated with three pairs of founders born around 1650. We applied a systematic genomic approach to the pedigree via karyotyping (N = 9), genome-wide SNP arrays (N = 418), whole-exome sequencing (N = 26), and whole-genome sequencing (N = 10). Comprehensive analysis did not identify plausible variants of strong effect. Rather, pedigree cases had significantly higher genetic risk scores compared to pedigree and community controls.


Assuntos
Transtorno Bipolar/genética , Genômica/métodos , Transtornos Psicóticos/genética , Esquizofrenia/genética , Adulto , Idoso , Transtorno Bipolar/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Cariotipagem/métodos , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Linhagem , Polimorfismo de Nucleotídeo Único , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Suécia/epidemiologia , Sequenciamento Completo do Exoma/métodos , Sequenciamento Completo do Genoma/métodos
19.
Tijdschr Psychiatr ; 61(2): 104-111, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-30793271

RESUMO

BACKGROUND: Studies have indicated an association between treatment refractoriness in unipolar depression and unrecognised bipolar spectrum disorder (bsd). If confirmed, this may have implications for diagnosis and treatment.
AIM: To provide an overview on the prevalence and recognition of bsd in treatment resistant depression (trd).
METHOD: A search was made in PubMed concerning the prevalence of bsd in trd and clinical features that may be suggestive of bipolar depression.
RESULTS: Three articles were found that examined the prevalence of bsd in trd; they reported that 26-47% of patients with trd had an underlying bsd. Five cross-sectional studies described the predictors of clinical features in patients with a major depression. The following features occurred significantly more often: positive family history of bsd, young age of onset, higher number of recurrences, and atypical features.
CONCLUSION: There seems to be an association between trd and having an underlying bsd. A few clinical features may help to detect bsd in trd.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Humanos , Prevalência , Fatores de Risco
20.
Psychiatry Res ; 272: 562-568, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30616124

RESUMO

This study aimed to estimate the gender differences, family size and fertility rate among patients with Bipolar disorder (BD). 219 patients diagnosed with BD, who were married for at least 3 years and aged more than 25 years were assessed clinically for the course of illness as per the NIMH-life chart. Fertility and infertility were assessed based on the information on number of living children, abortions and medical termination of pregnancies. Significantly higher proportion of male patients had comorbid substance dependence while females had significantly higher prevalence of physical comorbidity. Additionally, female participants reported significantly higher mean number of depressive episodes per year of illness and suicidal attempts. When marriage was considered as a life event and its association with onset or relapse of illness was evaluated, about one-fourth (23.3%) of the study sample reported relapse of illness at the time of marriage or immediately following the marriage. About one-fourth (24.7%) of the couple with one of the partner having bipolar disorder had no living children even after four years of their marriage. To conclude, this study suggests that there are certain gender differences with regard to the clinical profile and longitudinal course of illness of BD.


Assuntos
Transtorno Bipolar/psicologia , Características da Família , Fertilidade/fisiologia , Caracteres Sexuais , Transtornos Relacionados ao Uso de Substâncias/psicologia , Tentativa de Suicídio/psicologia , Adulto , Idoso , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Coeficiente de Natalidade/tendências , Comorbidade , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Índia/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de Suicídio/tendências
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