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1.
Medicine (Baltimore) ; 99(42): e22823, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080761

RESUMO

INTRODUCTION/RATIONALE: Multiple sclerosis (MS) is associated with a higher prevalence of mood and psychiatric disorders, such as bipolar disorder (BD). While mania is most often associated with BD, MS can also induce manic symptoms. However, it is crucial to distinguish which condition is causing mania since medical management is different based on its etiology. Herein, we report a case of a manic episode in a middle-aged female with a prolonged history of BD who received a recent diagnosis of MS 1 year ago. PATIENT CONCERNS: A 56-year-old female presented with an episode of mania and psychosis while receiving a phenobarbital taper for chronic lorazepam use. She had a prolonged history of bipolar type 1 disorder and depression. She showed optic neuritis and was diagnosed with MS a year prior. DIAGNOSES: The patient was diagnosed with BD-induced mania based on the absence of increased demyelination compared to previous MRI and lack of new focal or lateralizing neurologic findings of MS. INTERVENTIONS: Lithium was given for mood stabilization and decreased dosage of prior antidepressant medication. Risperidone was given for ongoing delusions. OUTCOMES: After 8 days of hospitalization, patient's mania improved but demonstrated atypical features and ongoing delusions. She was discharged at her request to continue treatment in an outpatient setting. CONCLUSION/LESSON: In BD patients with an episode of mania, MS should be included in the differential, since both conditions can cause manic symptoms. The origin of mania should be delineated through a detailed neurological exam, neuroimaging, and thorough patient-family psychiatric history for appropriate clinical treatment.


Assuntos
Transtorno Bipolar/psicologia , Esclerose Múltipla/psicologia , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Compostos de Lítio/uso terapêutico , Pessoa de Meia-Idade , Risperidona/uso terapêutico
2.
Medicine (Baltimore) ; 99(38): e22280, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957382

RESUMO

BACKGROUND: Nowadays, there are some randomized controlled trials (RCTs) to explore the effectiveness of drug therapy for bipolar disorder with anxiety disorders. However, due to lack of sufficient data, there are currently no good treatment recommendations. The purpose of this network meta-analysis is to compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders to provide evidence to support clinical practice and guidelines development. METHODS: A systematic literature search will be performed in the Cochrane Library, PubMed, EMBASE, and Web of Science from inception to July 2020. RCTs that compared the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders will be included. Two reviewers will independently search and select the studies, extract the data, and assess the risk of bias. We will assess the risk of bias of included RCTs using the Cochrane risk of bias tool. The WinBUGS 1.4.3 software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software. In addition, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the quality of evidence. RESULTS: This study will systematically compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: Our study will provide evidence for the drug therapy of patients with bipolar disorder complicated with anxiety disorders, and provide suggestions for clinical practice or guidelines. INPLASY REGISTRATION NUMBER: INPLASY202070132.


Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/complicações , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Metanálise em Rede , Revisões Sistemáticas como Assunto , Transtorno Bipolar/psicologia , Humanos
3.
Rev Med Suisse ; 16(707): 1745-1747, 2020 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-32969610

RESUMO

Circadian rhythmicity generated by the biological clock structures the functioning of human beings over a period of almost 24 hours. This clock is entrained daily by internal and external cues among which light is the most powerful. Several disturbances, whether clinical or biological, observed in bipolar disorders are suggestive of a disruption of the circadian rhythm. Thus, treatments that modulate the biological clock have been developed. So far, the results of light therapy are not unanimous and invite us to better specify the treatment modalities. Dark therapy is a promising intervention that is still not much studied nowadays and therefore opens up great prospects for research in the future.


Assuntos
Transtorno Bipolar/psicologia , Escuridão , Luz , Fotoperíodo , Relógios Biológicos/efeitos da radiação , Ritmo Circadiano/efeitos da radiação , Humanos
4.
BMJ Case Rep ; 13(9)2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943446

RESUMO

The global threat posed by the COVID-19 pandemic has highlighted the need to accurately identify the immediate and long-term postdisaster impacts on disaster-relief workers. We examined the case of a local government employee suffering from post-traumatic stress disorder (PTSD) and bipolar II disorder following the Great East Japan Earthquake. The complex and harsh experience provoked a hypomanic response such as elated feelings with increased energy, decreased need for sleep and an increase in goal-directed activity, which allowed him to continue working, even though he was adversely affected by the disaster. However, 3.5 years later, when he suffered further psychological damage, his PTSD symptoms became evident. In addition to treating mood disorders, trauma-focused psychotherapy was required for his recovery. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery.


Assuntos
Transtorno Bipolar/psicologia , Terremotos , Acidente Nuclear de Fukushima , Socorro em Desastres , Transtornos de Estresse Pós-Traumáticos/psicologia , Tsunamis , Adulto , Betacoronavirus , Transtorno Bipolar/terapia , Infecções por Coronavirus , Desastres , Humanos , Terapia Implosiva , Masculino , Pandemias , Pneumonia Viral , Transtornos de Estresse Pós-Traumáticos/terapia
5.
J Affect Disord ; 276: 623-625, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871694

RESUMO

BACKGROUND: The 2019-nCov pandemic is currently a stressor for the general public worldwide. In China, people who have a history of contact with infected or suspected individuals need to quarantine for at least 2 weeks. Many people experienced anxiety, panic and depression in the quarantine period. However, acute manic episode triggered by stressful events is not common and was neglected. CASE PRESENTATION: A 32-year-old woman with direct contact history with her infected colleagues showed elevated mood and increased activity when she was identified negative of nuclear acid amplification test, after experiencing extreme stress in quarantine. She was diagnosed with acute manic episode finally. The social zeitgeber and reward hypersensitivity theoretical models have attempted to use psychobiological perspectives to determine why life stress can trigger a mood episode, including (hypo)mania. Besides, the temporal correlation between her somatic symptoms and psychological stimuli indicated a possibility of functional disturbance under acute stress. CONCLUSION: Quarantine is a major stressful event disrupting social zeitgebers for people who have had contact with infected individuals, especially for vulnerable individuals with a hypersensitive reward system. Stress could act as a trigger in the onset of manic episode, so psychological support should be more targeted at the vulnerable individuals in the initial phase of emergent crisis.


Assuntos
Betacoronavirus , Transtorno Bipolar , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Transtorno Bipolar/psicologia , Feminino , Humanos , Quarentena , Estresse Psicológico
6.
Medicine (Baltimore) ; 99(31): e21423, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756145

RESUMO

Whether periodontitis is a risk factor for developing bipolar disorders (BD) has not been investigated. We aimed to determine whether periodontitis is associated with the subsequent development of BD and examine the risk factors for BD among patients with periodontitis.Using ambulatory and inpatient claims data from the National Health Insurance Research Database (NHIRD), we identified 12,337 patients who were aged at least 20 years and newly diagnosed with periodontitis between 2000 and 2004. The date of the first claim with a periodontitis diagnosis was set as the index date. For each patient with periodontitis, 4 subjects without a history of periodontitis were randomly selected from the NHIRD and frequency-matched with the patients with periodontitis according to sex, age (in 5-year bands), and index year.The periodontitis group had a mean age of 44.0 ±â€Š13.7 years and slight predominance of men (51.3%). Compared with the subjects without periodontitis, the patients with periodontitis had higher prevalence of diabetes mellitus, hyperlipidemia, hypertension, ischemic heart disease, stroke, head injury, major depressive disorder, chronic obstructive pulmonary disease (COPD), and asthma (P < .001). The incidence rate of BD was higher in the periodontitis group than in the non-periodontitis group (2.74 vs 1.46 per 1000 person-year), with an adjusted hazard ratio of 1.82 (95% confidence interval = 1.59-2.08) after adjustment for sex, age, and comorbidities.The patients with periodontitis exhibited a significantly higher risk of developing BD. Keep the better oral hygiene to reduce periodontitis might be a preventive strategy for BD.


Assuntos
Transtorno Bipolar/psicologia , Periodontite/epidemiologia , Adulto , Idoso , Transtorno Bipolar/complicações , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Periodontite/complicações , Taiwan/epidemiologia , Adulto Jovem
8.
Epidemiol Psychiatr Sci ; 29: e156, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32792024

RESUMO

AIMS: Given the concerns of health inequality associated with mental illnesses, we aimed to reveal the extent of which general mortality and life expectancy at birth in people with schizophrenia, bipolar disorder and depressive disorder varied in the 2005 and 2010 nationally representative cohorts in Taiwan. METHODS: Two nationally representative samples of individuals with schizophrenia, bipolar disorder and depressive disorder were identified from Taiwan's national health insurance database in 2005 and 2010, respectively, and followed-up for consecutive 3 years. The database was linked to nationwide mortality registry to identify causes and date of death. Age-, gender- and cause-specific mortality rates were generated, with the average follow-up period of each age- and gender-band applied as 'weighting' for the calculation of expected number of deaths. Age- and gender-standardised mortality ratios (SMRs) were calculated for these 3-year observation periods with Taiwanese general population in 2011/2012 as the standard population. The SMR calculations were then stratified by natural/unnatural causes and major groups of death. Corresponding life expectancies at birth were also calculated by gender, diagnosis of mental disorders and year of cohorts for further elucidation. RESULTS: The general differential in mortality rates for people with schizophrenia and bipolar disorder remained wide, revealing an SMR of 3.65 (95% confidence interval (CI): 3.55-3.76) for cohort 2005 and 3.27 (3.18-3.36) for cohort 2010 in schizophrenia, and 2.65 (95% CI: 2.55-2.76) for cohort 2005 and 2.39 (2.31-2.48) for cohort 2010 in bipolar disorder, respectively. The SMRs in people with depression were 1.83 (95% CI: 1.81-1.86) for cohort 2005 and 1.59 (1.57-1.61) for cohort 2010. SMRs due to unnatural causes tended to decrease in people with major mental illnesses over the years, but those due to natural causes remained relatively stable. The life expectancies at birth for schizophrenia, bipolar disorder and depression were all significantly lower than the national norms, specifically showing 14.97-15.50 years of life lost for men and 15.15-15.48 years for women in people with schizophrenia. CONCLUSIONS: Compared to general population, the differential in mortality rates for people with major mental illnesses persisted substantial. The differential in mortality for unnatural causes of death seemed decreasing over the years, but that due to natural causes remained relatively steady. Regardless of gender, people with schizophrenia, bipolar disorder and depression were shown to have shortened life expectancies compared to general population.


Assuntos
Transtorno Bipolar/mortalidade , Transtorno Depressivo/mortalidade , Disparidades nos Níveis de Saúde , Esquizofrenia/mortalidade , Adulto , Idoso , Transtorno Bipolar/psicologia , Causas de Morte/tendências , Estudos de Coortes , Transtorno Depressivo/psicologia , Feminino , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Psicologia do Esquizofrênico , Fatores Socioeconômicos , Suicídio , Taiwan/epidemiologia
9.
PLoS One ; 15(8): e0231995, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833958

RESUMO

Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Atividade Motora/fisiologia , Adulto , Algoritmos , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Transtornos do Humor/psicologia , Redes Neurais de Computação , Sensibilidade e Especificidade
10.
Psychiatr Hung ; 35(3): 254-268, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-32643617

RESUMO

In our review, we present the theory of affective temperaments, the evolution of the temperament-concept, and the characteristics of the various forms of temperament (depressive, cyclothymic, hyperthymic, irritable, and anxious). We describe their relationship with the bipolar and unipolar spectrum, the ethological and evolutionary importance of temperaments, and their neurochemical, genetic basis. We present the self-report questionnaire (TEMPS-A) used for distinguishing between temperament forms. We analyze the relationship of affective tempera - ments with psychiatric disorders and suicide acts and the revealed associations.


Assuntos
Transtorno Bipolar/psicologia , Ideação Suicida , Temperamento , Humanos , Inventário de Personalidade , Autorrelato , Inquéritos e Questionários
11.
Epidemiol Psychiatr Sci ; 29: e144, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32684190

RESUMO

AIMS: Establishing the minimum clinically important difference (MCID) in functioning and cognition is essential to the interpretation of the research and clinical work conducted in bipolar disorders (BD). The present study aimed to estimate the MCID for the Functioning Assessment Short Test (FAST) and a battery of neuropsychological tests in BD. METHODS: Anchor-based and distributive methods were used to estimate the MCID for the FAST and cognition using data from a large, multicentre, observational cohort of individuals with BD. The FAST and cognition were linked with the Clinical Global Impressions Scale-Severity (CGI-S) and Global Assessment of Functioning (GAF) using an equipercentile method. The magnitude of the standard error measurement (s.e.m.) provided another estimate of the MCID. RESULTS: In total, 570 participants were followed for 2 years. Cross-sectional CGI-S and GAF scores were linked to a threshold ⩽7 on the FAST for functional remission. The MCID for the FAST equalled 8- or 9-points change from baseline using the CGI-S and GAF. One s.e.m. on the FAST corresponded to 7.6-points change from baseline. Cognitive variables insufficiently correlated with anchor variables (all ρ <0.3). One s.e.m. for cognitive variables corresponded to a range of 0.45 to 0.93-s.d. change from baseline. CONCLUSIONS: These findings support the value of the estimated MCID for the FAST and cognition and may be a useful tool to evaluate cognitive and functional remediation effects and improve patient functional outcomes in BD. The CGI-S and GAF were inappropriate anchors for cognition. Further studies may use performance-based measures of functioning instead.


Assuntos
Transtorno Bipolar/diagnóstico , Transtornos Cognitivos/diagnóstico , Cognição/fisiologia , Testes Neuropsicológicos/estatística & dados numéricos , Transtorno Bipolar/psicologia , Transtornos Cognitivos/psicologia , Estudos Transversais , Função Executiva , Feminino , Humanos , Masculino , Memória de Curto Prazo , Avaliação de Resultados em Cuidados de Saúde , Tempo de Reação , Comportamento Social
13.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-595544

RESUMO

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Países em Desenvolvimento , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Brasil , Cuidadores , Demência/enfermagem , Família , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Multimorbidade , Sensação , Isolamento Social
14.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32520289

RESUMO

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Países em Desenvolvimento , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Brasil , Cuidadores , Demência/enfermagem , Família , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Multimorbidade , Sensação , Isolamento Social
17.
Cogn Behav Neurol ; 33(2): 103-112, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32496295

RESUMO

BACKGROUND: Cognitive impairment is often identified in individuals with bipolar disorder and is associated with their functional impairment. However, there is controversy surrounding potential classification methods for impairment in cognitive measures. OBJECTIVE: To examine the proportion of cognitive measures indicating impairment of attention, processing speed, memory, visuoconstructional abilities, and executive functions in individuals with bipolar disorder type I (euthymic) and healthy controls, using a strict criterion for defining impairment. METHODS: We gave 43 individuals with bipolar disorder type I and 17 healthy controls a comprehensive clinical and neuropsychological assessment. All scores were standardized using means and standard deviations according to age. Impaired performance in all cognitive measures was determined using a distribution-based threshold of z=±1645. The effects of the sociodemographic and clinical variables on cognitive performance were examined using multiple stepwise backward regression analyses. RESULTS: Clinically significant cognitive impairment was observed more frequently in the bipolar disorder group, compared to controls, on all measures. From participant factors, we found that level of education and number of manic episodes predicted variation in more cognitive measure scores. DISCUSSION: The use of population-based norms to standardize cognitive measures, and a strict criterion to define cognitive impairment, in individuals with bipolar disorder type 1 and healthy controls resulted in a prevalence of impairment in cognitive domains' frequencies of deficits that fell within the ranges previously reported in meta-analyses. CONCLUSIONS: Clinically introducing population norms and a stringent cognitive impairment criterion can facilitate more accurate measures of cognitive impairment in individuals with bipolar disorder.


Assuntos
Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Disfunção Cognitiva/etiologia , Testes Neuropsicológicos/normas , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
18.
PLoS One ; 15(5): e0232459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442169

RESUMO

BACKGROUND: The association between temperament characteristics and mood disorders has gained much attention in recent years. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) is a self-rating scale measuring 5 affective temperament dimensions. In this study, we aimed to clarify whether each affective temperament of TEMPS-A is a differentiating factor between major depressive disorder (MDD), bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and analyzed the utility of TEMPS-A in their differential diagnosis in a clinical setting. METHODS: A total of 346 patients (MDD, n = 176; BD-II, n = 112; BD-I, n = 58) filled out TEMPS-A. To assess the patients' mood state at the time of temperament assessment, Patient Health Questionnaire-9 (PHQ-9) and Young Mania Rating Scale (YMRS) were also conducted. RESULTS: Multivariate logistic regression analysis demonstrated that cyclothymic and anxious temperament scores were significant factors differentiating the diagnosis of BD-I and BD-II from the diagnosis of MDD, and hyperthymic temperament score was a specific factor for the differential diagnosis of BD-I versus the diagnosis of BD-II. LIMITATIONS: All of the patients included in our study received treatment in large general hospitals. Because the nature of the present study was cross-sectional, some MDD subjects in this study might have unrecognized BD-I/BD-II. CONCLUSIONS: Cyclothymic and anxious temperament scores assessed by TEMPS-A might enable differentiation between MDD and BD, and hyperthymic temperament score on TEMPS-A might be useful in distinguishing between BD-I and BD-II.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Inventário de Personalidade , Temperamento , Adulto , Afeto , Ansiedade , Transtorno Bipolar/classificação , Transtorno Bipolar/psicologia , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Autorrelato
19.
BMC Psychiatry ; 20(1): 207, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380965

RESUMO

BACKGROUND: Affective disorders, such as major depressive (MDD), bipolar I (BD I) and II (BD II) disorders, are overlapped at a continuum, but their exact loci are not clear. The self-reports from patients with affective disorders might help to clarify this issue. METHODS: We invited 738 healthy volunteers, 207 individuals with BD I, 265 BD II, and 192 MDD to answer a 79 item-MATRIX about on-going affective states. RESULTS: In study 1, all 1402 participants were divided random-evenly and gender-balanced into two subsamples; one subsample was used for exploratory factor analysis, and another for confirmatory factor analysis. A structure-validated inventory with six domains of Overactivation, Psychomotor Acceleration, Distraction/ Impulsivity, Hopelessness, Retardation, and Suicide Tendency, was developed. In study 2, among the four groups, MDD scored the highest on Retardation, Hopelessness and Suicide Tendency, whereas BD I on Distraction/ Impulsivity and Overactivation. CONCLUSION: Our patients confirmed the affective continuum from Suicide Tendency to Overactivation, and described the different loci of MDD, BD I and BD II on this continuum.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Inquéritos Epidemiológicos/normas , Ideação Suicida , Adolescente , Adulto , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
20.
Lancet Psychiatry ; 7(6): 515-527, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32445690

RESUMO

BACKGROUND: Several small studies suggest that the adjunctive use of anti-inflammatory agents might improve depressive symptoms in bipolar disorder. However, there are few well designed, appropriately powered clinical trials assessing the efficacy of these novel treatment strategies. We aimed to assess the efficacy of adjunctive minocycline or celecoxib in this setting. METHODS: This double-blind, 12-week, randomised, placebo-controlled trial was done in four outpatient psychiatric clinics in Pakistan. Eligible participants were adults (aged 18-65 years) with DSM-5 bipolar disorder (type I or II) and a major depressive episode. In a 2 × 2 factorial design, participants were randomly assigned (1:1:1:1) to receive either active minocycline plus active celecoxib, active minocycline plus placebo celecoxib, placebo minocycline plus active celecoxib, or placebo minocycline plus placebo celecoxib. The primary outcome was the mean change from baseline to week 12 in score on the 17-item Hamilton Depression Rating Scale (HAMD-17), assessed in all randomised participants (missing data were imputed and assumed to be missing at random). The trial was registered with ClinicalTrials.gov, NCT02703363. FINDINGS: 266 (17%) of 1542 patients assessed between May 1, 2016, and March 31, 2019, were randomly assigned to receive minocycline plus celecoxib (n=68), minocycline plus placebo (n=66), celecoxib plus placebo (n=66), or placebo plus placebo (n=66). From baseline to week 12, depressive symptoms as per HAMD-17 reduced in all four groups (from 24·5-25·2 to 11·3-12·8), but these reductions did not differ significantly between the groups. In terms of main effects, reductions in HAMD-17 did not differ for patients treated with minocycline (mean adjusted difference vs non-minocycline 1·48 [95% CI -0·41 to 3·36]; p=0·123) or for celecoxib (mean adjusted difference vs non-celecoxib -0·74 [-2·61 to 1·14]; p=0·443). Rates of serious adverse effects did not differ between groups (31 participants had a manic switch, two self-harmed, and one died in a motor vehicle accident). INTERPRETATION: We found no evidence that minocycline or celecoxib was superior to placebo for the treatment of bipolar depression. This large trial casts doubt on the potential therapeutic benefits of adjunctive anti-inflammatory drugs for the acute management of bipolar depression. FUNDING: Stanley Medical Research Institute.


Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Celecoxib/uso terapêutico , Minociclina/uso terapêutico , Adulto , Antibacterianos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Transtorno Bipolar/psicologia , Estudos de Casos e Controles , Celecoxib/administração & dosagem , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minociclina/administração & dosagem , Paquistão/epidemiologia , Placebos/administração & dosagem , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
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