Innovative approaches to bipolar disorder and its treatment

Harrison, Paul J.; Cipriani, Andrea; Harmer, Catherine J.; Nobre, Anna C.; Saunders, Kate E. A.; Goodwin, Guy M.; Geddes, John

doi:10.1111/nyas.13048

Cited by 104 publications

(66 citation statements)

References 164 publications

(180 reference statements)

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“…The global prevalence and burden of psychiatric disorders worldwide are rising, yet this is not reflected by the slow pace of progress in treatment development 1. It is imperative that all available scientific information is considered when making treatment decisions to improve patient outcomes and clinical care.…”

Section: Introductionmentioning

confidence: 99%

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Henshall

Cipriani

David

et al. 2019

Evid Based Mental Health

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BackgroundIn medicine, algorithms can inform treatment decisions by combining the most up-to-date evidence about side effect profiles of medications, which are comparable in efficacy. Their use provides opportunities for improved shared clinician–patient decision-making when initiating therapy. We designed a decision support tool (DST) that incorporated the latest evidence regarding antipsychotic side effects. The tool allowed patients to select one side effect commonly associated with antipsychotics that they wished to avoid; the tool then provided a list of suggested medications and ones to avoid.ObjectiveTo explore qualitatively the acceptability and usefulness of the DST from the perspectives of patients and psychiatrists.MethodsThis qualitative study took place at a mental health and community hospital in Oxford, UK, in 2018. Four patients/carers and four psychiatrists were recruited to two focus groups to explore their perceptions of the tool. Data were thematically analysed.FindingsFindings demonstrated a high degree of acceptability and potential usability of the DST for patients and psychiatrists. The main themes to emerge relating to the DST were ‘prescribing preferences and practices’, ‘consideration and awareness of side effects’, ‘app content, layout and accessibility’, ‘influence on clinical practice’ and ‘role in decision-making’.ConclusionsA proof-of-concept clinical study will incorporate the recommendations produced from the findings into the tool’s design.Clinical implicationsDigital DSTs provide opportunities for the most up-to-date information on medication side effects to be used as the basis for shared clinician–patient decision-making. This tool has the potential to improve adherence to psychiatric medication, with benefits to clinical outcomes and healthcare resourcing.

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Section: Introductionmentioning

confidence: 99%

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Henshall

Cipriani

David

et al. 2019

Evid Based Mental Health

Self Cite

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“…Another interesting approach, similar to the one we are currently undertaking, includes the analysis of early response of mood instability to mood stabilizers as a new test paradigm that incorporates daily ratings and non-linear analyses (Harrison et al 2016; Holmes et al 2011). …”

Section: Clinical Applicationsmentioning

confidence: 99%

Electronic monitoring of self-reported mood: the return of the subjective?

Ortiz

Grof

2016

Int J Bipolar Disord

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This narrative review describes recent developments in the use of technology for utilizing the self-monitoring of mood, provides some relevant background, and suggests some promising directions. Subjective experience of mood is one of the valuable sources of information about the state of an integrated mind/brain system. During the past century, psychiatry and psychology moved away from subjectivity, emphasizing external observation, precise measurement, and laboratory techniques. This shift, however, provided only a limited improvement in the understanding of mood disorders, and it appears that self-monitoring of mood has the potential to enrich our knowledge, particularly when combined with the advances in technology. Modern technology, with its ability to transfer information from the individual directly to the researcher via electronic applications, enables us now to study mood regulation more thoroughly. Frequent subjective ratings can be helpful in identifying individualized treatment with effective mood stabilizers and recognizing subtypes of mood disorders. The variability of subjective ratings may also help us estimate the increased risk of recurrence and guide a tailored treatment.

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“…These loci include several protein-coding genes (e.g. ANK3 , CACNA1C , NCAN , and ODZ4 ) that are involved in various neuronal processes, such as calcium signaling and synaptic development and function [56]. Moreover, studies on postmortem human brains and animal models of BD show changes in the expression of synaptic proteins as well as abnormalities of synaptic morphology and function [78910].…”

Section: Introductionmentioning

confidence: 99%

Bipolar Disorder Associated microRNA, miR-1908-5p, Regulates the Expression of Genes Functioning in Neuronal Glutamatergic Synapses

et al. 2016

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Bipolar disorder (BD), characterized by recurrent mood swings between depression and mania, is a highly heritable and devastating mental illness with poorly defined pathophysiology. Recent genome-wide molecular genetic studies have identified several protein-coding genes and microRNAs (miRNAs) significantly associated with BD. Notably, some of the proteins expressed from BD-associated genes function in neuronal synapses, suggesting that abnormalities in synaptic function could be one of the key pathogenic mechanisms of BD. In contrast, however, the role of BD-associated miRNAs in disease pathogenesis remains largely unknown, mainly because of a lack of understanding about their target mRNAs and pathways in neurons. To address this problem, in this study, we focused on a recently identified BD-associated but uncharacterized miRNA, miR-1908-5p. We identified and validated its novel target genes including DLGAP4, GRIN1, STX1A, CLSTN1 and GRM4, which all function in neuronal glutamatergic synapses. Moreover, bioinformatic analyses of human brain expression profiles revealed that the expression levels of miR-1908-5p and its synaptic target genes show an inverse-correlation in many brain regions. In our preliminary experiments, the expression of miR-1908-5p was increased after chronic treatment with valproate but not lithium in control human neural progenitor cells. In contrast, it was decreased by valproate in neural progenitor cells derived from dermal fibroblasts of a BD subject. Together, our results provide new insights into the potential role of miR-1908-5p in the pathogenesis of BD and also propose a hypothesis that neuronal synapses could be a key converging pathway of some BD-associated protein-coding genes and miRNAs.

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Innovative approaches to bipolar disorder and its treatment

Cited by 104 publications

References 164 publications

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Electronic monitoring of self-reported mood: the return of the subjective?

Bipolar Disorder Associated microRNA, miR-1908-5p, Regulates the Expression of Genes Functioning in Neuronal Glutamatergic Synapses

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