Fire and Darkness: On the Assessment and Management of Bipolar Disorder

Nikolitch, Katerina; Saraf, Gayatri; Solmi, Marco; Kroenke, Kurt; Fiedorowicz, Jess G.

doi:10.1016/j.mcna.2022.04.002

Cited by 7 publications

(4 citation statements)

References 113 publications

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“…In bipolar disorder, depressive symptoms are commonly responsible for the largest proportion of non-euthymic mood states [ 52 ], and are also responsible for longer duration of untreated illness [ 52 ], and inter-episodic impairment in functioning [ 53 ]. A factor contributing to inappropriate treatment of bipolar disorder is a misdiagnosis leading to use of antidepressants [ 54 ], as opposed to using other effective treatments, including quetiapine or lurasidone among others [ 55 , 56 ], or poor adherence to medications, which in turn is associated with depressive symptoms [ 57 ]. In substance use disorders, comorbid depressive disorder or depressive symptoms are highly prevalent [ 58 , 59 ], and should be treated as in patients without substance use disorders [ 60 – 62 ].…”

Section: Discussionmentioning

confidence: 99%

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Solmi,

Cortese,

Vita

et al. 2023

Mol Psychiatry

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We aimed to identify diagnosis-specific/transdiagnostic/transoutcome multivariable candidate predictors (MCPs) of key outcomes in mental disorders. We conducted an umbrella review (protocol link), searching MEDLINE/Embase (19/07/2022), including systematic reviews of studies reporting on MCPs of response, remission, recovery, or relapse, in DSM/ICD-defined mental disorders. From published predictors, we filtered MCPs, validating MCP criteria. AMSTAR2/PROBAST measured quality/risk of bias of systematic reviews/individual studies. We included 117 systematic reviews, 403 studies, 299,888 individuals with mental disorders, testing 796 prediction models. Only 4.3%/1.2% of the systematic reviews/individual studies were at low risk of bias. The most frequently targeted outcome was remission (36.9%), the least frequent was recovery (2.5%). Studies mainly focused on depressive (39.4%), substance-use (17.9%), and schizophrenia-spectrum (11.9%) disorders. We identified numerous MCPs within disorders for response, remission and relapse, but none for recovery. Transdiagnostic MCPs of remission included lower disease-specific symptoms (disorders = 5), female sex/higher education (disorders = 3), and quality of life/functioning (disorders = 2). Transdiagnostic MCPs of relapse included higher disease-specific symptoms (disorders = 5), higher depressive symptoms (disorders = 3), and younger age/higher anxiety symptoms/global illness severity/ number of previous episodes/negative life events (disorders = 2). Finally, positive trans-outcome MCPs for depression included less negative life events/depressive symptoms (response, remission, less relapse), female sex (response, remission) and better functioning (response, less relapse); for schizophrenia, less positive symptoms/higher depressive symptoms (remission, less relapse); for substance use disorder, marital status/higher education (remission, less relapse). Male sex, younger age, more clinical symptoms and comorbid mental/physical symptoms/disorders were poor prognostic factors, while positive factors included social contacts and employment, absent negative life events, higher education, early access/intervention, lower disease-specific and comorbid mental and physical symptoms/conditions, across mental disorders. Current data limitations include high risk of bias of studies and extraction of single predictors from multivariable models. Identified MCPs can inform future development, validation or refinement of prediction models of key outcomes in mental disorders.

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Section: Discussionmentioning

confidence: 99%

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Solmi,

Cortese,

Vita

et al. 2023

Mol Psychiatry

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“…Bipolar disorder (BD) is a severe mental disorder characterized by recurrent mood episodes, including depressive and manic/hypomanic episodes [ 1 ]. Patients with BD have low-quality lives, such as comorbidities [ 2 ], impaired psychosocial functioning [ 3 ], low employment [ 4 ], and suicide ideation and suicide attempts [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Association of childhood trauma, social support, cognition, and suicidality in females with bipolar disorder

Yang,

Li,

et al. 2024

BMC Psychiatry

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Background Bipolar disorder (BD) is a severe mental disorder with heavy disease burden. Females with BD are special populations who suffer a lot from childhood trauma, social support, cognitive deficits, and suicidality. In this study, the relationship among childhood trauma, social support, and clinical symptoms of BD was investigated and the risk factors for suicidality were explored in female patients with BD. Methods This study included 57 drug-naive female BD patients, 64 female BD patients with long-term medication, and 50 age-matched female healthy controls. Childhood trauma, social support, clinical symptoms, cognition, and suicidality (suicide ideation, suicide plan, suicide attempt, suicide frequency) were measured with scales. Results Compared with healthy controls, females with BD showed higher levels of childhood trauma and suicidality, and lower levels of social support and cognitive deficits. In the drug-naïve BD group, social support mediated the relationship between childhood trauma and insomnia symptoms (indirect effect: ab = 0.025). In the BD with long-term medication group, mania symptom was associated with suicide plan (OR = 1.127, p = 0.030), childhood trauma was associated with suicide attempt (OR = 1.088, p = 0.018), and years of education (OR = 0.773, p = 0.028), childhood trauma (OR = 1.059, p = 0.009), and delayed memory (OR= 1.091, p= 0.016) was associated with suicide frequency (OR = 1.091, p = 0.016). Conclusions This study provides initial evidence that social support partially explains the relationship between childhood trauma and clinical symptoms in females with BD. Additionally, mania symptoms, childhood trauma, and delayed memory were risk factors for suicidality. Interventions providing social support and improving cognitive function may be beneficial for females with BD who are exposed to childhood trauma and with high suicide risk.

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“…Schizophrenia and bipolar disorder generally have a chronic and episodic clinical course, with intermittent psychotic symptoms in most patients with schizophrenia 6 and with intermittent periods of mood and energy fluctuations where psychotic features are less pronounced in patients with bipolar disorder. 7 Overall, SMI adversely impacts cognitive, behavioural, and emotional domains of patients, which affects functioning in daily life activities. 8 …”

Section: Introductionmentioning

confidence: 99%

Severe mental illness: cardiovascular risk assessment and management

Polcwiartek,

O’Gallagher,

Friedman

et al. 2024

European Heart Journal

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Patients with severe mental illness (SMI) including schizophrenia and bipolar disorder die on average 15–20 years earlier than the general population often due to sudden death that, in most cases, is caused by cardiovascular disease. This state-of-the-art review aims to address the complex association between SMI and cardiovascular risk, explore disparities in cardiovascular care pathways, describe how to adequately predict cardiovascular outcomes, and propose targeted interventions to improve cardiovascular health in patients with SMI. These patients have an adverse cardiovascular risk factor profile due to an interplay between biological factors such as chronic inflammation, patient factors such as excessive smoking, and healthcare system factors such as stigma and discrimination. Several disparities in cardiovascular care pathways have been demonstrated in patients with SMI, resulting in a 47% lower likelihood of undergoing invasive coronary procedures and substantially lower rates of prescribed standard secondary prevention medications compared with the general population. Although early cardiovascular risk prediction is important, conventional risk prediction models do not accurately predict long-term cardiovascular outcomes as cardiovascular disease and mortality are only partly driven by traditional risk factors in this patient group. As such, SMI-specific risk prediction models and clinical tools such as the electrocardiogram and echocardiogram are necessary when assessing and managing cardiovascular risk associated with SMI. In conclusion, there is a necessity for differentiated cardiovascular care in patients with SMI. By addressing factors involved in the excess cardiovascular risk, reconsidering risk stratification approaches, and implementing multidisciplinary care models, clinicians can take steps towards improving cardiovascular health and long-term outcomes in patients with SMI.

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Fire and Darkness: On the Assessment and Management of Bipolar Disorder

Cited by 7 publications

References 113 publications

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Association of childhood trauma, social support, cognition, and suicidality in females with bipolar disorder

Severe mental illness: cardiovascular risk assessment and management

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