Activation Levels, Cardiovascular Risk, and Functional Impairment in Remitted Bipolar Patients: Clinical Relevance of a Dimensional Approach

Dargél, Aroldo A.; Volant, Stevenn; Saha, Soham; Étain, Bruno; Grant, Rebecca; Azorin, Jean‐Michel; Gard, S.; Bellivier, Frank; Bougerol, Thierry; Kahn, Jean‐Pierre; Roux, Paul; Aubin, V.; Courtet, Philippe; Leboyer, Marion; Scott, Jan; Henry, Chantal

doi:10.1159/000493690

Cited by 12 publications

(7 citation statements)

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“…These affective and behavioral transitions originally observed in individuals with Type A have been found to be similar to mood swings of bipolar patients, 49 suggesting that in cardiac patients with type A behavior, depressive symptoms following a cardiovascular event may be part of a subsyndromal bipolar disorder. 11,50 This hypothesis seems to be supported by the findings of the present study, given the high rate of reactivity to social environment in ACS patients and the fact that almost half of patients with Type A behavior were also demoralized and/or depressed. Somatic manifestations of psychological distress, such as somatic symptoms of depression (ie, low energy and fatigue) and physical manifestations of anxiety (ie, sweating, shaking, muscle tension, and difficult breathing), were found to be extremely common in our sample.…”

Section: Discussionsupporting

confidence: 82%

An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome

et al. 2021

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Background The clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS. Methods A total of 288 patients with a first episode of ACS underwent interviews based on DSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vs clinical management (CM) and reassessed up to 30-month post-intervention. Results A total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue and changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue, and early insomnia (CID). Conclusions The findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.

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Section: Discussionsupporting

confidence: 82%

An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome

et al. 2021

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“…Emotional reactivity is defined by the magnitude of change from an emotional baseline state in response to emotion‐eliciting stimuli 30 . Using the multidimensional assessment of mood/behavior states (MAThyS), 31 which assess levels of activation (including emotional reactivity) uncoupled from mood, we have recently demonstrated that emotional reactivity is a relevant dimension for characterizing remitted BD patients, 32 and that those patients with emotional hyper‐reactivity have increased cardiometabolic risk and chronic inflammation 16,33 …”

Section: Introductionmentioning

confidence: 99%

Allostatic load, emotional hyper‐reactivity, and functioning in individuals with bipolar disorder

et al. 2020

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Objectives Diagnosis and management of bipolar disorder (BD) are limited by the absence of available biomarkers. Allostatic load (AL) represents the strain that stress, including the effects of acute phases and inter‐episode chronic mood instability, exerts on interconnected biological systems. This study aimed to operationalize an AL index and explore whether it could be relevant to better characterize BD patients with and without emotional hyper‐reactivity particularly those at higher risk of immune‐cardiometabolic dysregulation and functional impairment. Methods Levels of biomarkers of chronic inflammation (hsCRP and albumin), cardiovascular (systolic/diastolic blood pressure) and metabolic functions (fasting glucose, glycosylated hemoglobin, total cholesterol, LDL, HDL, and triglycerides) were measured in 1072 adult BD outpatients. Patients were classified in two groups (with/without emotional hyper‐reactivity) assessed by the Multidimensional Assessment of Thymic States scale. An Allostatic Load Index for BD (BALLI), comprising six biomarkers, was constructed using data‐driven biomarker selection. Results BALLI showed 81.1% accuracy with good sensitivity (81%) and specificity (81.2%) for characterizing BD patients presenting emotional hyper‐reactivity, elevated risk of inflammation (increased hsCRP, hypoalbuminemia) and cardiometabolic disturbances (hypertension, hyperglycemia, and hypertriglyceridemia). Patients classified by the BALLI as presenting emotional hyper‐reactivity had significantly lower global and cognitive functioning than those without emotional hyper‐reactivity (P < .0001). Conclusions A multidimensional approach based on a simple AL score (eg, BALLI) and dimensions of behavior (eg, emotional hyper‐reactivity) alongside mood is clinically relevant. AL index could be a useful tool to detect multisystemic physiological dysregulations in BD patients with/without emotional hyper‐reactivity particularly those at higher risk of immune‐cardiometabolic disturbances and functional impairment.

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“…Levels of activation were measured using the Multidimensional Assessment of Thymic States, a 20-item self-report instrument that assesses the levels of activation uncoupled from mood during the preceding week [ 48 ]. It quantitatively evaluates 5 dimensions, namely, emotional reactivity, sensory perception, psychomotor activity, motivation, and cognition, each of which can vary from hypoactivation to hyperactivation [ 7 ]. At the end of each evaluation, the investigators asked patients to give feedback regarding the overall satisfaction, ease of use, and perceived helpfulness of the Toi Même app (ranging from 1=not at all to 5=extremely).…”

Section: Methodsmentioning

confidence: 99%

Toi Même, a Mobile Health Platform for Measuring Bipolar Illness Activity: Protocol for a Feasibility Study

Dargél¹,

Mosconi²,

Masson³

et al. 2020

JMIR Res Protoc

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Background The diagnosis and management of bipolar disorder are limited by the absence of available biomarkers. Patients with bipolar disorder frequently present with mood instability even during remission, which is likely associated with the risk of relapse, impaired functioning, and suicidal behavior, indicating that the illness is active. Objective This research protocol aimed to investigate the correlations between clinically rated mood symptoms and mood/behavioral data automatically collected using the Toi Même app in patients with bipolar disorder presenting with different mood episodes. This study also aimed to assess the feasibility of this app for self-monitoring subjective and objective mood/behavior parameters in those patients. Methods This open-label, nonrandomized trial will enroll 93 (31 depressive, 31 euthymic, and 31 hypomanic) adults diagnosed with bipolar disorder type I/II (Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria) and owning an iPhone. Clinical evaluations will be performed by psychiatrists at the baseline and after 2 weeks, 1 month, 2 months, and 3 months during the follow-up. Rather than only accessing the daily mood symptoms, the Toi Même app also integrates ecological momentary assessments through 2 gamified tests to assess cognition speed (QUiCKBRAIN) and affective responses (PLAYiMOTIONS) in real-life contexts, continuously measures daily motor activities (eg, number of steps, distance) using the smartphone’s motion sensors, and performs a comprehensive weekly assessment. Results Recruitment began in April 2018 and the completion of the study is estimated to be in December 2021. As of April 2019, 25 participants were enrolled in the study. The first results are expected to be submitted for publication in 2020. This project has been funded by the Perception and Memory Unit of the Pasteur Institute (Paris) and it has received the final ethical/research approvals in April 2018 (ID-RCB: 2017-A02450-53). Conclusions Our results will add to the evidence of exploring other alternatives toward a more integrated approach in the management of bipolar disorder, including digital phenotyping, to develop an ethical and clinically meaningful framework for investigating, diagnosing, and treating individuals at risk of developing bipolar disorder or currently experiencing bipolar disorder. Further prospective studies on the validity of automatically generated smartphone data are needed for better understanding the longitudinal pattern of mood instability in bipolar disorder as well as to establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with bipolar disorder. Trial Registration ClinicalTrials.gov NCT03508427; https://clinicaltrials.gov/ct2/show/NCT03508427 International Registered Report Identifier (IRRID) DERR1-10.2196/18818

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Activation Levels, Cardiovascular Risk, and Functional Impairment in Remitted Bipolar Patients: Clinical Relevance of a Dimensional Approach

Cited by 12 publications

References 10 publications

An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome

An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome

Allostatic load, emotional hyper‐reactivity, and functioning in individuals with bipolar disorder

Toi Même, a Mobile Health Platform for Measuring Bipolar Illness Activity: Protocol for a Feasibility Study

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