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2.
Australas Psychiatry ; 27(5): 491-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310153

RESUMO

OBJECTIVE: This article describes how the onset of bvFTD can be heralded by psychiatric symptoms. METHOD: Case reports are described with reference to the relevant literature review. RESULTS: Three patients were admitted with psychiatric symptoms, including depression, mania, psychosis and catatonia. Two had been previously diagnosed with a psychiatric disorder. All three were diagnosed with probable bvFTD. CONCLUSION: bvFTD is an important differential diagnosis to consider when patients present with atypical psychiatric symptoms.


Assuntos
Demência Frontotemporal/diagnóstico , Transtornos Mentais/diagnóstico , Idoso , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/etiologia , Transtorno Bipolar/fisiopatologia , Catatonia/diagnóstico , Catatonia/etiologia , Catatonia/fisiopatologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/fisiopatologia , Diagnóstico Diferencial , Feminino , Demência Frontotemporal/complicações , Demência Frontotemporal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia
3.
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
4.
Rev. medica electron ; 41(2): 467-482, mar.-abr. 2019.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004282

RESUMO

RESUMEN El trastorno bipolar es un trastorno crónico y recurrente que se caracteriza por fluctuaciones patológicas del estado del ánimo. Las fases de la enfermedad incluyen episodios hipomaniacos, maniacos y depresivos. Estos episodios interfieren de forma significativa en la vida cotidiana del paciente y en su entorno, con importante repercusión en su salud y calidad de vida. Para los psiquiatras es de suma importancia el diagnóstico precoz de esta enfermedad para proporcionar un tratamiento oportuno a los pacientes, teniendo en cuenta la severidad de los síntomas y las complicaciones a las que lleva esta enfermedad. Ante esta realidad se decidió describir las características generales de este desorden mediante una revisión bibliográfica donde se exponen sus principales manifestaciones clínicas, clasificación, aspectos epidemiológicos, curso de la enfermedad, complicaciones y comorbilidad. Para ello se realizó una revisión de los trabajos más relevantes publicados y con ello contribuir al proceso de educación médica continuada para los profesionales de la salud.


ABSTRACT Bipolar disorder is a chronic and recurrent disorder characterized by pathological fluctuations of the mood states. The stages of the disease include hypomanic, maniac and depressive episodes. These episodes interfere in a significant way in the patient´s daily life and his surroundings, with an important repercussion on his health and life quality. For the psychiatrists, the precocious diagnosis of this disease is very important, in order to provide a timely treatment to patients, taking into account the severity of the symptoms and the complications of this disease. Due to this reality, the authors decided to describe the general characteristics of this disorder through a bibliographic review where they exposed the main clinical manifestations, classification, epidemiological aspects, the course of the disease, complications and co-morbidity. The most relevant published works were reviewed to contribute to the process of continued medical education of the health professionals.


Assuntos
Humanos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/etiologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Comorbidade
6.
Artigo em Inglês | MEDLINE | ID: mdl-29981775

RESUMO

Mania is characterized by elevated drive and mood but animal models of mania have often neglected elevated mood. Ultrasonic vocalizations (USV) of 50-kHz emitted by rats are thought to index the subject's positive affective state. Fifty-kHz USV emission is increased by amphetamine, an effect blocked by lithium administration. Sleep deprivation (SD) is an environmental model of mania and the present study evaluated SD effects on behavioral activity and USV emission, together with the impact of lithium treatment. Adult rats were submitted to 24h or 72h SD, and locomotor activity and USV emission were assessed. To test their sensitivity to a standard antimanic drug, these behavioral parameters were also evaluated after acute administration of lithium carbonate (25, 50 or 100 mg/kg, i.p.). Striatal monoamine content was measured post-mortem. SD (24h and 72h) led to increased locomotor activity, rearing behavior and 50-kHz USV emission, together with a change in the call profile characterized by an increase in the percentage of frequency-modulated 50-kHz USV, which may indicate the mania-like consequences of SD. Importantly, all SD effects were reverted by lithium administration. SD also led to a decrease in dopamine content in the ventral striatum, while increasing dopamine turnover. In conclusion, SD increased 50-kHz USV emission, an effect prevented by acute lithium administration. This suggests 50-kHz USV as a new marker for mania-like elevated mood, which shows construct validity (associated with increased dopaminergic tone), face validity (reflecting increased positive affect) and predictive validity (high sensitivity to lithium treatment).


Assuntos
Transtorno Bipolar/etiologia , Privação do Sono/complicações , Vocalização Animal/fisiologia , Animais , Antimaníacos/uso terapêutico , Monoaminas Biogênicas/metabolismo , Transtorno Bipolar/tratamento farmacológico , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Carbonato de Lítio/farmacologia , Locomoção/efeitos dos fármacos , Masculino , Comportamento Materno/efeitos dos fármacos , Ratos , Ratos Wistar , Fatores de Tempo , Estriado Ventral/efeitos dos fármacos , Estriado Ventral/metabolismo
7.
Psychiatry Res ; 271: 46-51, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30465981

RESUMO

People with serious mental illness (SMI) are at an increased risk for physical health complications, such as cardiovascular disease and obesity. Low levels of physical activity is a major contributor to these health complications. One factor associated with limited physical activity in the broader sedentary population is pain. While preliminary findings suggest an association between lack of physical activity and pain in SMI, conclusions are still unclear. Thus, the goal of this correlational study was to examine associations between trait-based risk for psychopathology (hypomanic personality, schizotypy, and anhedonic depression) and the experience of pain following a physical endurance/effort task. Healthy participants (N = 43; 18 females) completed self-report measures of trait-based risk for psychopathology. They also reported on the experience of pain before and after the Time To Exhaustion (TTE) test. Findings revealed that risk for psychosis and anhedonic depression were associated with increases in pain following the TTE test, accounting for other key variables, such as age and self-reported physical exercise. Risk for mania was unrelated to changes in pain. These results suggest that the experience of pain in relation to physical endurance/effort may contribute to diminished physical activity among people at risk for SMI.


Assuntos
Exercício/psicologia , Dor/psicologia , Esforço Físico , Transtornos Psicóticos/etiologia , Transtorno da Personalidade Esquizotípica/psicologia , Adulto , Anedonia , Transtorno Bipolar/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicopatologia , Fatores de Risco , Autorrelato
8.
Med Hypotheses ; 122: 129-133, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30593396

RESUMO

We hypothesize that Moon-associated signals, recently linked to rapid cycling bipolar disorder, may have triggered extremely rare instances of extreme manic and aggressive behaviour that may be compatible with the folklore of the werewolf. Very limited literature on instances of clinical lycanthropy or violent/manic/madness behaviour in association with the Moon may be due to very rare lycanthropic psychosis and not knowing which signal(s) could determine Moon-mood associations. Mechanistically, lunar effects related to bipolar disorder, mood changes, and psychosis could involve either, or a combination, of the following: (i) some as of yet non-measurable signal or undefined geoelectric/geomagnetic receptor or higher sensitivity in some humans, (ii) Moonlight affecting sleep and/or circadian rhythm, (iii) perinatal imprinting of susceptibility, (iv) lunar-periodic growth, and subsequent consumption, of or exposure to psychotropic agents. Importantly, remarkable recent studies (2018) suggest that links between some Moon cycles and bipolar disorder are conceivable. Further observations suggest a role for periodic changes in lunar distances in combination with the Earth and Sun positions. Targeted research could use insight from astrophysicists. If causal links between Moon signals and mood were corroborated, sufferers may benefit from improved disease understanding. Herein, we systematically review the literature and synthesize the evidence for and against the hypothesis. The werewolf myth could become another instance of folklore popularizing biological variation worthy of investigation such as the book characters created by the psychiatrist Hoffmann in 1845 as a Christmas present for his son; namely, 'Struwelpeter' and 'Zappel-Philipp' (shock-headed Peter and fidgety-Philipp): Their conspicuous characteristics have since been linked to genetic uncombable hair syndrome and ADHD, respectively. Overall, rather than dismissing (seemingly) trivial and uncertain concepts as 'just folklore', scientists should grapple with the roots, causes, and significance of traditions and tales, including the werewolf legend.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/etiologia , Folclore , Lua , Afeto , Ritmo Circadiano , Humanos , Sono
9.
Psychiatry Res ; 271: 23-30, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30458317

RESUMO

Maternal stress and medical illnesses during early life are well-documented environmental indicators of an increased risk of schizophrenia. Few studies, conversely, have confirmed an association with major affective disorders. The present study examined the impact of maternal stress, medical illnesses and obstetric complications on the development of severe mental disorder in 240 patients with a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder and matched with 85 controls. Mothers of participants were asked about stressful events during pregnancy using the Social Readjustment Scale; information on prenatal/perinatal illnesses were acquired from medical records. Schizophrenia spectrum disorder was positively associated with maternal stress (OR = 2.16), infections (OR = 7.67), inadequate weight gain (OR = 9.52) during pregnancy, and peripartum asphyxia (OR = 4.00). An increased risk of bipolar disorder was associated with head circumference < 32 cm at birth (OR = 5.40) and inversely with inadequate weight gain (OR = 0.29). Major depressive disorder diagnosis was inversely related to inadequate weight gain (OR = 0.22). These results support a role for maternal stress, medical illnesses and obstetric complications as risk factors for subsequent severe mental illness in adulthood. Further research is needed, especially with regard to affective disorders.


Assuntos
Transtorno Bipolar/etiologia , Transtorno Depressivo Maior/etiologia , Complicações na Gravidez/psicologia , Esquizofrenia/etiologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Gravidez , Fatores de Risco , Adulto Jovem
10.
J Pharm Pract ; 32(1): 99-102, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28982303

RESUMO

Garcinia cambogia is a Southeast Asian fruit becoming increasingly popular as a weight management supplement. Hydroxycitric acid (HCA) is the primary active ingredient which demonstrates serotonergic- and muscarinic-enhancing properties via inhibition of selective serotonin reuptake and acetylcholinesterase. We report a young adult female with no history of bipolar disorder who developed mania and psychosis approximately 1 week following initiation of G cambogia and the Cleanse and Detox™ dietary supplement manufactured by Apex Vitality Health. She presented with a predominantly expansive mood, psychomotor agitation, disorganized and pressured speech, flight of ideas, grandiosity, delusions, and auditory hallucinations. Following discontinuation of G cambogia and the initiation of lithium and quetiapine, the patient experienced rapid and progressive mood stabilization and was discharged after 8 days. Seven previous case reports associating (hypo)mania and/or psychosis with G cambogia consumption have been published. The chronology of mania and/or psychosis onset may appear between 1 and 8 weeks following initiation of G cambogia. Psychiatric symptoms have resolved with G cambogia discontinuation in some instances and may not require chronic pharmacotherapy. Our report should encourage further research and case reports regarding this adverse event and the reconciliation of complete herbal supplement use at clinic visits and hospital admissions.


Assuntos
Transtorno Bipolar/etiologia , Suplementos Nutricionais/efeitos adversos , Garcinia cambogia/efeitos adversos , Transtornos Psicóticos/etiologia , Transtorno Bipolar/tratamento farmacológico , Feminino , Frutas , Garcinia cambogia/química , Humanos , Transtornos Psicóticos/tratamento farmacológico , Fatores de Tempo , Adulto Jovem
11.
Neurocase ; 24(4): 227-230, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30376408

RESUMO

Phelan-McDermid syndrome (PMD) is a rare genetic condition with only a few cases describing patients diagnosed as adults. We describe a long diagnostic odyssey of a 30-year-old woman who was diagnosed with Phelan-McDermid syndrom. Array comparative genomic hybridization analysis confirmed a 22q13.33 deletion, encompassing exon 9-23 of the SHANK3 gene and exon 1 of the ACR gene. We provide an uncommon feature of the disease, where psychotic alteration is repeatedly triggered by the same physical factor in our patient - mild fever episodes.


Assuntos
Transtorno Bipolar/etiologia , Transtornos Cromossômicos/complicações , Febre/complicações , Adulto , Deleção Cromossômica , Transtornos Cromossômicos/psicologia , Cromossomos Humanos Par 22 , Feminino , Humanos
13.
J Nerv Ment Dis ; 206(9): 733-738, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30124574

RESUMO

The body of evidence for mania as a secondary syndrome due to organic diseases is small. The clinical diagnosis and management of these patients are mainly based on clinical experience and on some case reports. Treatment should be focused on both the underlying medical illness and the control of acute symptoms. Mania due to a medical condition is relevant in the clinical setting, and thus more research is needed to add evidence-based recommendations to the currently available clinical knowledge. In this review, we summarize the latest information on the etiology, epidemiology, diagnostic aspects, and management of secondary mania.


Assuntos
Doenças Autoimunes/complicações , Transtorno Bipolar/etiologia , Encefalopatias/complicações , Síndrome de Cushing/complicações , Doenças da Glândula Tireoide/complicações , Humanos
14.
Int J Mol Sci ; 19(8)2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30087257

RESUMO

Bipolar disorder (BD) is a severe and common chronic mental illness characterized by recurrent mood swings between depression and mania. The biological basis of the disease is poorly understood and its treatment is unsatisfactory. Although in past decades the "monoamine hypothesis" has dominated our understanding of both the pathophysiology of depressive disorders and the action of pharmacological treatments, recent studies focus on the involvement of additional neurotransmitters/neuromodulators systems and cellular processes in BD. Here, evidence for the participation of Na⁺, K⁺-ATPase and its endogenous regulators, the endogenous cardiac steroids (ECS), in the etiology of BD is reviewed. Proof for the involvement of brain Na⁺, K⁺-ATPase and ECS in behavior is summarized and it is hypothesized that ECS-Na⁺, K⁺-ATPase-induced activation of intracellular signaling participates in the mechanisms underlying BD. We propose that the activation of ERK, AKT, and NFκB, resulting from ECS-Na⁺, K⁺-ATPase interaction, modifies neuronal activity and neurotransmission which, in turn, participate in the regulation of behavior and BD. These observations suggest Na⁺, K⁺-ATPase-mediated signaling is a potential target for drug development for the treatment of BD.


Assuntos
Transtorno Bipolar/metabolismo , Transdução de Sinais , ATPase Trocadora de Sódio-Potássio/metabolismo , Animais , Transtorno Bipolar/etiologia , Transtorno Bipolar/patologia , Humanos , Sistema de Sinalização das MAP Quinases , NF-kappa B/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Esteroides/metabolismo
15.
Eur Arch Psychiatry Clin Neurosci ; 268(8): 741-748, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30032467

RESUMO

Growing evidence for the spectrum concept of most mental disorders, particularly mood disorders, has challenged the arbitrary distinctions inherent in the contemporary categorical diagnostic classification system. Detection of manic symptoms in the context of episodes of depression is particularly important because of the implications for differential treatment of bipolar vs unipolar depression. The purpose of this study is to characterize the magnitude and clinical correlates of subthreshold manic syndromes or symptoms among people with major depressive disorder (MDD) compared to those without a history of manic symptoms. We defined two subthreshold manifestations-manic syndrome or symptoms-that did not include a criterion for duration. In the context of MDD, we found that the clinical correlates of those with the subthreshold manic syndrome were more similar to those with bipolar-II disorder than to MDD alone, whereas those with manic symptoms only were intermediate between those with subthreshold manic syndrome and MDD alone. These results confirm the spectrum concept of mania and suggest that a manic syndrome should be considered when evaluating people with MDD.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Adulto , Transtorno Bipolar/genética , Transtorno Bipolar/psicologia , Transtorno Depressivo/genética , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Suíça/epidemiologia , Temperamento , Adulto Jovem
16.
JNMA J Nepal Med Assoc ; 56(209): 553-555, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30058644

RESUMO

Bilateral striopallidodentate calcinosis, commonly known as Fahr's disease, is a rare syndrome characterised by symmetrical calcification over the basal ganglion and dentate nucleus. No case of Fahr's disease with associated manic symptoms has been described in the literature to date. We report an unusual case of Fahr's Disease in a 18 year old unmarried male who presented to the emergency department of Universal College of Medical Sciences - Teaching Hospital, Nepal with symptoms of mania. Computed tomographic scan of the patient demonstrated extensive symmetrical calcification over the basal ganglia and dentate nuclei. No underlying cause for the bilateral calcification was found. This rare case of Fahr's disease, which has never been reported in Indian literature has been reported to highlight this unusual condition and its differentiation from the commoner Fahr's syndrome.


Assuntos
Doenças dos Gânglios da Base , Gânglios da Base , Transtorno Bipolar , Encéfalo/diagnóstico por imagem , Calcinose , Doenças Neurodegenerativas , Olanzapina/administração & dosagem , Ácido Valproico/administração & dosagem , Adolescente , Antimaníacos/administração & dosagem , Antipsicóticos/administração & dosagem , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Doenças dos Gânglios da Base/diagnóstico , Doenças dos Gânglios da Base/psicologia , Doenças dos Gânglios da Base/terapia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/etiologia , Transtorno Bipolar/fisiopatologia , Calcinose/diagnóstico , Calcinose/diagnóstico por imagem , Calcinose/patologia , Calcinose/psicologia , Calcinose/terapia , Diagnóstico Diferencial , Humanos , Masculino , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/psicologia , Doenças Neurodegenerativas/terapia , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/etiologia , Resultado do Tratamento
18.
J Affect Disord ; 240: 72-78, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30056172

RESUMO

BACKGROUND: Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS: We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS: For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION: Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS: Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.


Assuntos
Cirurgia Bariátrica/psicologia , Obesidade Mórbida/psicologia , Fatores Sexuais , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Transtorno Bipolar/psicologia , Análise por Conglomerados , Comorbidade , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
19.
Br J Psychiatry ; 213(3): 555-560, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29925436

RESUMO

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder are unknown.AimsTo test the prospective relationship of ADHD and anxiety with onset of bipolar disorder. METHOD: We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models. RESULTS: Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12-2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98-27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47-27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83-87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66-41.40) compared with those with no prior ADHD or anxiety. CONCLUSIONS: Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder.Declaration of interestNone.


Assuntos
Transtornos de Ansiedade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Adolescente , Adulto , Transtornos de Ansiedade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Dinamarca/epidemiologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
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