Donepezil-associated mania in two patients who were using donepezil without a prescription.
J Clin Psychopharmacol. 2014 Dec;34(6):753-5
Authors: Tourian L, Margolese HC, Gauthier S
PMID: 25203467 [PubMed - indexed for MEDLINE]
A group ICA based framework for evaluating resting fMRI markers when disease categories are unclear: Application to schizophrenia, bipolar, and schizoaffective disorders.
Neuroimage. 2015 Jul 24;
Authors: Du Y, Pearlson GD, Liu J, Sui J, Yu Q, He H, Castro E, Calhoun VD
Schizophrenia (SZ), bipolar disorder (BP) and schizoaffective disorder (SAD) share some common symptoms, and there is a debate about whether SAD is an independent category. To the best of our knowledge, no study has been done to differentiate these three disorders or to investigate the distinction of SAD as an independent category using fMRI data. The present study is aimed to explore biomarkers from resting-state fMRI networks for differentiating these disorders and investigate the relationship among these disorders based on fMRI networks with an emphasis on SAD. Firstly, a novel group ICA method, group information guided independent component analysis (GIG-ICA), was applied to extract subject-specific brain networks from fMRI data of 20 healthy controls (HC), 20 SZ patients, 20 BP patients, 20 patients suffering SAD with manic episodes (SADM), and 13 patients suffering SAD with depressive episodes exclusively (SADD). Then, five-level one-way analysis of covariance and multiclass support vector machine recursive feature elimination were employed to identify discriminative regions from the networks. Subsequently, the t-distributed stochastic neighbor embedding (t-SNE) projection and the hierarchical clustering methods were implemented to investigate the relationship among those groups. Finally, to evaluate the generalization ability, 16 new subjects were classified based on the found regions and the trained model using original 93 subjects. Results show that the discriminative regions mainly include frontal, parietal, precuneus, cingulate, supplementary motor, cerebellar, insula and supramarginal cortices, which performed well in distinguishing different groups. SADM and SADD were the most similar to each other, although SADD had greater similarity to SZ compared to other groups, which indicates SAD may be an independent category. BP was closer to HC compared with other psychotic disorders. In summary, resting-state fMRI brain networks extracted via GIG-ICA provide a promising potential to differentiate SZ, BP, and SAD.
PMID: 26216278 [PubMed - as supplied by publisher]
Neurexin 1 (NRXN1) splice isoform expression during human neocortical development and aging.
Mol Psychiatry. 2015 Jul 28;
Authors: Jenkins AK, Paterson C, Wang Y, Hyde TM, Kleinman JE, Law AJ
Neurexin 1 (NRXN1), a presynaptic cell adhesion molecule, is implicated in several neurodevelopmental disorders characterized by synaptic dysfunction including autism, intellectual disability and schizophrenia. To gain insight into NRXN1's involvement in human cortical development we used quantitative real-time PCR to examine the expression trajectories of NRXN1, and its predominant isoforms, NRXN1-? and NRXN1-?, in prefrontal cortex from fetal stages to aging. In addition, we investigated whether prefrontal cortical expression levels of NRXN1 transcripts are altered in schizophrenia or bipolar disorder in comparison with non-psychiatric control subjects. We observed that all three NRXN1 transcripts were highly expressed during human fetal cortical development, markedly increasing with gestational age. In the postnatal dorsolateral prefrontal cortex, expression levels were negatively correlated with age, peaking at birth until ~3 years of age, after which levels declined markedly to be stable across the lifespan. NRXN1-? expression was modestly but significantly elevated in the brains of patients with schizophrenia compared with non-psychiatric controls, whereas NRXN1-? expression was increased in bipolar disorder. These data provide novel evidence that NRXN1 expression is highest in human dorsolateral prefrontal cortex during critical developmental windows relevant to the onset and diagnosis of a range of neurodevelopmental disorders, and that NRXN1 expression may be differentially altered in neuropsychiatric disorders.Molecular Psychiatry advance online publication, 28 July 2015; doi:10.1038/mp.2015.107.
PMID: 26216298 [PubMed - as supplied by publisher]
Association of Anxiety Symptoms in Offspring of Bipolar Parents with Serotonin Transporter-Linked Polymorphic Region (5-HTTLPR) Genotype.
J Child Adolesc Psychopharmacol. 2015 Jul 28;
Authors: Park MH, Sanders E, Howe M, Singh M, Hallmayer J, Kim E, Chang K
OBJECTIVE: Offspring of parents with bipolar disorder (BD) have been shown to be at high risk for BD. Anxiety symptoms, even at subclinical levels, have been associated with increased risk for BD in these youth. The s-allele of the serotonin transporter-linked polymorphic region (5-HTTLPR) has been implicated in the pathophysiology of both BD and anxiety disorders and has been associated with pharmacological treatment response and increased risk for antidepressant side effects. Therefore, we aimed to explore 1) whether anxiety symptoms in offspring of BD parents were associated with presence of the 5-HTTLPR s-allele and 2) whether anxiety symptoms in the offspring of BD parents according to the 5-HTTLPR genotypes are related to antianxiety medication status.
METHODS: A total of 64 offspring of BD parents (mean age: 13.7 years) and 51 healthy controls (HC) (mean age: 13.7 years) were compared genetically and on the Multidimensional Anxiety Scale for Children (MASC).
RESULTS: Offspring of BD parents showed higher levels of overall anxiety than did the HC group. Only antianxiety medication naïve offspring of BD parents were found to have an association between 5-HTTLPR genotypes and anxiety symptoms. The antianxiety medication naïve offspring of BD parents with the s-allele showed higher level of overall anxiety than offspring of BD parents with the l/l genotype. No significant differences in anxiety symptoms or their association with the 5-HTTLPR genotype were found in the HC group.
CONCLUSIONS: This study indicated that there may be an association between 5-HTTLPR genotypes and anxiety symptoms in offspring of BD parents, and that antianxiety medication status may affect anxiety symptoms in the offspring of BD patients according to genotype.
PMID: 26218602 [PubMed - as supplied by publisher]
Long-term effects of mental disorders on employment in the National Comorbidity Survey ten-year follow-up.
Soc Psychiatry Psychiatr Epidemiol. 2015 Jul 27;
Authors: Mojtabai R, Stuart EA, Hwang I, Susukida R, Eaton WW, Sampson N, Kessler RC
PURPOSE: Although significant negative associations of mental disorders with employment have been documented in epidemiological research, much of this research was based on cross-sectional samples and focused only on severe and persistent mental disorders. The present study examined the longitudinal associations of more common mental disorders with employment.
METHODS: Data on the associations of common mental disorders with employment are presented here from 4501 respondents in the National Comorbidity Survey panel study, a two-wave community epidemiological survey of respondents aged 15-54 at baseline (1990-1992) who were re-interviewed in 2001-2003 and were employed, unemployed in the labor force or student at baseline. Lifetime mental disorders at baseline and disorders with onset after baseline were assessed with the Composite International Diagnostic Interview, a fully structured interview that assessed lifetime prevalence of internalizing fear disorders (panic, phobias), anxiety/misery disorders (major depression, generalized anxiety disorder, post-traumatic stress disorder), externalizing disorders (conduct disorder, alcohol and illicit drug abuse-dependence), and bipolar disorder.
RESULTS: Both baseline lifetime disorders and disorders with onsets after baseline were associated with significantly reduced odds of subsequent employment among respondents who were either employed or students at baseline. Population projections based on the assumption that these associations represented causal effects suggest that the mental disorders considered here were associated with 1.7-3.2 million adults being unemployed in the US population at follow-up.
CONCLUSIONS: Expanded access to treatment among current employees and students with mental disorders might lead to improved employment outcomes in these segments of the population.
PMID: 26211661 [PubMed - as supplied by publisher]
An Integrative Genomic Study Implicates the Post-Synaptic Density in the Pathogenesis of Bipolar Disorder.
Neuropsychopharmacology. 2015 Jul 27;
Authors: Akula N, Wendland JR, Choi KH, McMahon FJ
Genome-wide association studies (GWAS) have identified several common variants associated with bipolar disorder (BD), but the biological meaning of these findings remains unclear. Integrative genomics - the integration of GWAS signals with gene expression data - may illuminate genes and gene networks that play key roles in the pathogenesis of BD.We applied weighted gene co-expression network analysis (WGCNA), which exploits patterns of co-expression among genes, to brain transcriptome data obtained by sequencing of poly-A RNA derived from post-mortem dorsolateral prefrontal cortex from people with BD, along with age and sex-matched controls. WGCNA identified 33 gene modules. Many of the modules corresponded closely to those previously reported in human cortex (Oldham et al, 2008). Three modules were associated with BD, enriched for genes differentially expressed in BD, and also enriched for signals in prior GWAS of BD. Functional analysis of genes within these modules revealed significant enrichment of several functionally related sets of genes, especially those involved in the postsynaptic density (PSD). These results provide convergent support for the hypothesis that dysregulation of genes involved in the PSD is a key factor in the pathogenesis of BD. If replicated in larger samples, these findings could point toward new therapeutic targets for BD.Neuropsychopharmacology accepted article preview online, 27 July 2015. doi:10.1038/npp.2015.218.
PMID: 26211730 [PubMed - as supplied by publisher]
Prevalence and predictors of type 2 diabetes mellitus in people with bipolar disorder: a systematic review and meta-analysis.
J Clin Psychiatry. 2015 Jul 7;
Authors: Vancampfort D, Mitchell AJ, De Hert M, Sienaert P, Probst M, Buys R, Stubbs B
OBJECTIVE: This systematic review and meta-analysis assessed the prevalence and predictors of type 2 diabetes mellitus (T2DM) in people with bipolar disorder. We also compared the prevalence of T2DM in people with bipolar disorder versus age- and gender-matched healthy controls.
DATA SOURCES: PubMed, EMBASE, PsycARTICLES, and CINAHL were searched from inception till October 23, 2014 using the medical subject headings terms bipolar disorder AND diabetes OR glucose. There was no language restriction. Observational studies including retrospective, cross-sectional, and prospective designs were eligible if they included participants with bipolar disorder diagnosed according to recognized diagnostic criteria (DSM or ICD).
STUDY SELECTION: Nineteen studies were included (n = 18,060; 54.8% male).
DATA EXTRACTION: Two independent authors extracted data in accordance with the meta-analysis of observational studies in epidemiology guidelines and PRISMA statement. A random effects meta-analysis was utilized.
RESULTS: The overall prevalence of T2DM was 9.4% (95% CI, 6.5%-12.7%). Compared with age- and gender-matched controls (n = 783,049; 48.7% male), people with bipolar disorder (n = 6,595; 48.6% male) had double the risk of T2DM (relative risk = 1.98; 95% CI, 1.6-2.4, P < .001). No significant moderators were found. In an exploratory regression analysis, the variance in T2DM prevalence in the background population was associated with the variance in T2DM prevalence in people with bipolar disorder (5 studies, n = 4,983) (r(2) = 0.85, t = 4.09, P = .03).
CONCLUSIONS: T2DM is significantly more common in people with bipolar disorder than in healthy controls of similar age and sex. The current meta-analysis furthermore indicates that changes in food, built, and social environments are needed in order to curb the diabetes epidemic in this high-risk population.
PMID: 26214054 [PubMed - as supplied by publisher]
Improving Lifestyle Interventions for People With Serious Mental Illnesses: Qualitative Results From the STRIDE Study.
Psychiatr Rehabil J. 2015 Jul 27;
Authors: Yarborough BJ, Stumbo SP, Yarborough MT, Young TJ, Green CA
OBJECTIVE: Individuals with serious mental illnesses are disproportionately affected by overweight and obesity. Understanding the factors that facilitate or hinder lifestyle change in this population could lead to better interventions and improved health outcomes.
METHODS: A subset of intervention and usual-care participants (n = 84) in the STRIDE randomized trial were interviewed at 3, 9, and 18 months, yielding 101 interviews (some were interviewed more than once). Participants had a mean age of 48.1 (SD = 10.1); 64% were female. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychoses (37%), or PTSD (2%). Interviews were transcribed verbatim, coded using Atlas.ti, and analyzed for common themes.
RESULTS: Barriers to behavior change were similar to those described for the general population, including lack of support from significant others, the lure of unhealthy foods, and poor weather impeding exercise. Additional challenges included the effects of psychiatric symptoms, or consequences of symptoms (i.e., social isolation), on ability to make and sustain lifestyle changes. We found a strong preference for ongoing, group-based support to foster a sense of accountability which motivated and helped to sustain behavior changes.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Individuals with serious mental illnesses encounter many of the same barriers to weight loss seen in the general population, but they may be more vulnerable to additional obstacles. Lifestyle change interventions for this population should help participants develop the ability to iteratively cope with fluctuating mood and subsequent changes in motivation to eat healthfully and exercise regularly. (PsycINFO Database Record
PMID: 26214184 [PubMed - as supplied by publisher]
A bipolar II cohort (ABC): The association of functional disability with gender and rapid cycling.
J Affect Disord. 2015 Jul 6;185:204-208
Authors: Scott J, Grunze H, Meyer TD, Nendick J, Watkins H, Ferrier N
BACKGROUND: Bipolar II disorder (BP II) is a chronic, frequently co-morbid, and complex disorder with similar rates of attempted suicide to BP I. However, case identification for BP II studies that is based on clinician diagnosis alone is prone to error. This paper reports on differences between clinical and research diagnoses and then describes the clinical characteristics of a carefully defined BP II cohort.
METHODS: A cohort of rigorously defined BP II cases were recruited from a range of primary and secondary health services in the North of England to participate in a programme of cross-sectional and prospective studies. Case identification, and rapid cycling, comorbidities and functioning were examined.
RESULTS: Of 355 probable clinical cases of BP II disorder, 176 (?50%) met rigorous diagnostic criteria. The sample mean age was ?44 years, with a mean duration of mood disorder of ?18 years. Two thirds of the cohort were female (n=116), but only 40% were in paid employment. Current and past year functioning was more impaired in females and those with rapid cycling.
LIMITATIONS: This paper describes only the preliminary assessments of the cohort, so it was not possible to examine additional factors that may contribute to the explained variance in functioning.
CONCLUSIONS: This carefully ascertained cohort of BP II cases show few gender differences, except for levels of functional impairment. Interestingly, the most common problem identified with using case note diagnoses of BP II arose because of failure to record prior episodes of mania, not failure to identify hypomania.
PMID: 26209962 [PubMed - as supplied by publisher]
Frontal Cortex Stimulation Reduces Vigilance to Threat: Implications for the Treatment of Depression and Anxiety.
Biol Psychiatry. 2015 Jun 17;
Authors: Ironside M, O'Shea J, Cowen PJ, Harmer CJ
BACKGROUND: The difficulty in treating mood disorders has brought about clinical interest in alternative treatments, such as transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC). However, the optimal parameters for stimulation and underlying mechanisms of action are unclear. Psychiatric treatments have acute effects on emotional processing that predict later therapeutic action. Such effects have been proposed as cognitive biomarkers for screening novel treatments for depression and anxiety.
METHODS: This study assessed the effect of tDCS on a battery of emotional processing measures sensitive to antidepressant action. To refine optimal stimulation parameters, DLPFC stimulation using two common electrode montages was compared with sham. Sixty healthy volunteers received 20 minutes of active or sham DLPFC stimulation before completing computerized emotional processing tasks, including a dot-probe measure of vigilance to threat.
RESULTS: Relative to sham stimulation, participants receiving simultaneous anodal stimulation of left DLPFC and cathodal stimulation of right DLPFC (bipolar-balanced montage) showed reduced vigilance to threatening stimuli. There was no such significant effect when the cathode was placed on the supraorbital ridge (bipolar-unbalanced montage). There were no effects of tDCS on other measures of emotional processing.
CONCLUSIONS: Our findings provide the first experimental evidence that modulating activity in the DLPFC reduces vigilance to threatening stimuli. This significant reduction in fear vigilance is similar to that seen with anxiolytic treatments in the same cognitive paradigm. The finding that DLPFC tDCS acutely alters the processing of threatening information suggests a potential cognitive mechanism that could underwrite treatment effects in clinical populations.
PMID: 26210058 [PubMed - as supplied by publisher]
Gray Matter Volume Decrease Distinguishes Schizophrenia From Bipolar Offspring During Childhood and Adolescence.
J Am Acad Child Adolesc Psychiatry. 2015 Aug;54(8):677-684.e2
Authors: Sugranyes G, de la Serna E, Romero S, Sanchez-Gistau V, Calvo A, Moreno D, Baeza I, Diaz-Caneja CM, Sanchez-Gutierrez T, Janssen J, Bargallo N, Castro-Fornieles J
OBJECTIVE: There is increasing support toward the notion that schizophrenia and bipolar disorder share neurodevelopmental underpinnings, although areas of divergence remain. We set out to examine gray matter volume characteristics of child and adolescent offspring of patients with schizophrenia or bipolar disorder comparatively.
METHOD: In this 2-center study, magnetic resonance structural neuroimaging data were acquired in 198 children and adolescents (aged 6-17 years): 38 offspring of patients with schizophrenia, 77 offspring of patients with bipolar disorder, and 83 offspring of community controls. Analyses of global brain volumes and voxel-based morphometry (using familywise error correction) were conducted.
RESULTS: There was an effect of group on total cerebral gray matter volume (F = 3.26, p = .041), driven by a decrease in offspring of patients with schizophrenia relative to offspring of controls (p = .035). At a voxel-based level, we observed an effect of group in the left inferior frontal cortex/anterior insula (F = 14.7, p < .001), which was driven by gray matter volume reduction in offspring of patients with schizophrenia relative to both offspring of controls (p = .044) and of patients with bipolar disorder (p < .001). No differences were observed between offspring of patients with bipolar disorder and offspring of controls in either global or voxel-based gray matter volumes.
CONCLUSION: This first comparative study between offspring of patients with schizophrenia and bipolar disorder suggests that gray matter volume reduction in childhood and adolescence may be specific to offspring of patients with schizophrenia; this may index a greater neurodevelopmental impact of risk for schizophrenia relative to bipolar disorder during youth.
PMID: 26210337 [PubMed - as supplied by publisher]
Molecular neurobiological clues to the pathogenesis of bipolar disorder.
Curr Opin Neurobiol. 2015 Jul 23;36:1-6
Authors: Harrison PJ
Bipolar disorder is a serious psychiatric disorder, with a high heritability and unknown pathogenesis. Recent genome-wide association studies have identified the first loci, implicating genes such as CACNA1C and ANK3. The genes highlight several pathways, notably calcium signalling, as being of importance. Molecular studies suggest that the risk variants impact on gene regulation and expression. Preliminary studies using reprogrammed patient-derived cells report alterations in the transcriptome and in cellular adhesion and differentiation. Mouse models show that genes involved in circadian biology, acting via dopaminergic effects, reproduce aspects of the bipolar phenotype. These findings together represent significant advances in identification of the genetic and molecular basis of bipolar disorder, yet we are still far from an integrated, evidence-based understanding of its aetiopathogenesis.
PMID: 26210959 [PubMed - as supplied by publisher]
The functional exercise capacity in patients with bipolar disorder versus healthy controls: A pilot study.
Psychiatry Res. 2015 Jul 16;
Authors: Vancampfort D, Wyckaert S, Sienaert P, De Hert M, Stubbs B, Buys R, Schueremans A, Probst M
The aim of the current study was to compare the functional exercise capacity of patients with bipolar disorder with age-, gender- and body mass index (BMI)-matched healthy controls. Thirty patients (16 ?, 40.8±11.6 years) and healthy controls (16 ?, 40.5±10.8 years) were included. All participants performed a 6-min walk test to assess the functional exercise capacity and completed the International Physical Activity Questionnaire. Patients were screened for psychiatric symptoms using the Quick Inventory of Depressive Symptomatology and Hypomania Checklist-32. Results demonstrated that patients with bipolar disorder demonstrated a significantly poorer functional exercise capacity (590.8±112.6 versus 704.2±94.3m). A backward stepwise regression analyses showed that the level of depression and existing foot or ankle static problems and back pain before the test explained 70.9% of the variance in the distance achieved on the 6-min walk test (functional exercise capacity). The current study demonstrates that foot and back pain appear to be important negative predictors of functional exercise capacity in patients with bipolar disorder. Physical activity interventions delivered by physical therapists may help ameliorate pain symptoms and improve functional exercise capacity.
PMID: 26208981 [PubMed - as supplied by publisher]
Clinical profiles of stigma experiences, self-esteem and social relationships among people with schizophrenia, depressive, and bipolar disorders.
Psychiatry Res. 2015 Jul 17;
Authors: Oliveira SE, Esteves F, Carvalho H
Some mental illnesses and certain mental health care environments can be severely stigmatizing, which seems to be related to decreased self-esteem and a deterioration of the quality of social relationships for people with mental illness. This study aims to identify clinical profiles characterized by clinical diagnoses more strongly associated with the treatment settings and related to internalized stigma, self-esteem and satisfaction with social relationships. It also aimed to analyze associations between clinical profiles and socio-demographic indicators. Multiple correspondence analysis and cluster analysis were performed on a sample of 261 individuals with schizophrenia and mood disorders, from hospital-based and community-based facilities. MCA showed four distinct clinical profiles allowing a differentiation among levels of: internalized stigma, social relationship satisfaction and self-esteem. Overall, results revealed that internalized stigma remains a pervasive problem for some people with schizophrenia and mood disorders. Particularly, internalized stigma and social relationships dissatisfaction and associated socio-demographic indicators appear to be a risk factor for social isolation for individuals with schizophrenia, which may worsen the course of the disorder. Our findings highlight the importance to develop structured interventions aimed to reduce internalized stigma, and exclusion of those who suffer the loss of their social roles and networks.
PMID: 26208983 [PubMed - as supplied by publisher]
Resolution of a manic episode treated with activated charcoal: Evidence for a brain-gut axis in bipolar disorder.
Aust N Z J Psychiatry. 2015 Jul 24;
Authors: Hamdani N, Boukouaci W, Hallouche MR, Charron D, Krishnamoorthy R, Leboyer M, Tamouza R
PMID: 26209321 [PubMed - as supplied by publisher]
Common familial risk factors for schizophrenia and diabetes mellitus.
Aust N Z J Psychiatry. 2015 Jul 24;
Authors: Foley DL, Mackinnon A, Morgan VA, Watts GF, Castle DJ, Waterreus A, Galletly CA
OBJECTIVE: The co-occurrence of type 2 diabetes and psychosis is an important form of medical comorbidity within individuals, but no large-scale study has evaluated comorbidity within families. The aim of this study was to determine whether there is evidence for familial comorbidity between type 2 diabetes and psychosis.
METHOD: Data were analysed from an observational study of a nationally representative sample of 1642 people with psychosis who were in contact with psychiatric services at the time of survey (The 2010 Australian National Survey of Psychosis). Participants were aged 18-64?years and met World Health Organization's International Classification of Diseases, 10th Revision diagnostic criteria for a psychotic disorder (857 with schizophrenia, 319 with bipolar disorder with psychotic features, 293 with schizoaffective disorder, 81 with depressive psychosis and 92 with delusional disorder or other non-organic psychoses). Logistic regression was used to estimate the association between a family history of diabetes and a family history of schizophrenia.
RESULTS: A positive family history of diabetes was associated with a positive family history of schizophrenia in those with a psychotic disorder (odds ratio?=?1.35, p?=?0.01, adjusted for age and gender). The association was different in those with an affective versus non-affective psychosis (odds ratio?=?0.613, p?=?0.019, adjusted for age and gender) and was significant only in those with a non-affective psychosis, specifically schizophrenia (odds ratio?=?1.58, p?=?0.005, adjusted for age and sex). Adjustment for demographic factors in those with schizophrenia slightly strengthened the association (odds ratio?=?1.74, p?=?0.001, adjusted for age, gender, diagnosis, ethnicity, education, employment, income and marital status).
CONCLUSION: Elevated risk for type 2 diabetes in people with schizophrenia is not simply a consequence of antipsychotic medication; type 2 diabetes and schizophrenia share familial risk factors.
PMID: 26209325 [PubMed - as supplied by publisher]
Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness.
Psychiatry Res. 2015 Feb 28;225(3):433-9
Authors: Kim WJ, Song YJ, Ryu HS, Ryu V, Kim JM, Ha RY, Lee SJ, Namkoong K, Ha K, Cho HS
We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma.
PMID: 25554354 [PubMed - indexed for MEDLINE]
Self-management in persons with major mental disorders: a common but complex treatment goal.
J Am Psychiatr Nurses Assoc. 2014 Nov-Dec;20(6):367-8
Authors: Farchaus Stein K
PMID: 25657999 [PubMed - indexed for MEDLINE]
CHRNA7 and CHRFAM7A mRNAs: Co-Localized and Their Expression Levels Altered in the Postmortem Dorsolateral Prefrontal Cortex in Major Psychiatric Disorders.
Am J Psychiatry. 2015 Jul 24;:appiajp201514080978
Authors: Kunii Y, Zhang W, Xu Q, Hyde TM, McFadden W, Shin JH, Deep-Soboslay A, Ye T, Li C, Kleinman JE, Wang KH, Lipska BK
OBJECTIVE: CHRNA7, coding ?-7 nicotinic acetylcholine receptor (?7 nAChR), is involved in cognition through interneuron modulation of dopamine and glutamate signaling. CHRNA7 and its partially duplicated chimeric gene CHRFAM7A have been implicated in schizophrenia through linkage and association studies.
METHOD: Expression of CHRNA7 and CHRFAM7A mRNA was measured in the postmortem prefrontal cortex in more than 700 subjects, including patients with schizophrenia, bipolar disorder, major depression, and normal comparison subjects. The effects of antipsychotics and nicotine, as well as associations of CHRNA7 SNPs with gene expression, were explored. Fluorescent in-situ hybridization was used to examine coexpression of both transcripts in the human cortex.
RESULTS: CHRFAM7A expression and CHRFAM7A/CHRNA7 ratios were higher in fetal compared with postnatal life, whereas CHRNA7 expression was relatively stable. CHRFAM7A expression was significantly elevated in all diagnostic groups, while CHRNA7 expression was reduced in the schizophrenia group and increased in the major depression group compared with the comparison group. CHRFAM7A/CHRNA7 ratios were significantly increased in the schizophrenia and bipolar disorder groups compared with the comparison group. There was no effect of nicotine or antipsychotics and no association of SNPs in CHRNA7 with expression. CHRNA7 and CHRFAM7A mRNAs were expressed in the same neuronal nuclei of the human neocortex.
CONCLUSIONS: These data show preferential fetal CHRFAM7A expression in the human prefrontal cortex and suggest abnormalities in the CHRFAM7A/CHRNA7 ratios in schizophrenia and bipolar disorder, due mainly to overexpression of CHRFAM7A. Given that these transcripts are coexpressed in a subset of human cortical neurons and can interact to alter function of nAChRs, these results support the concept of aberrant function of nAChRs in mental illness.
PMID: 26206074 [PubMed - as supplied by publisher]
The effect of temperament on the treatment adherence of bipolar disorder type I.
Nord J Psychiatry. 2015 Jul 24;:1-7
Authors: Buturak SV, Emel EB, Koçak OM
BACKGROUND AND AIMS: Treatment adherence is one of the most important factors that may determine treatment response in patients with bipolar disorders (BD). Many factors have been described to be associated with treatment adherence in BD. Temperament that can influence the course of BD will have an impact on treatment adherence. The aim of this study is to investigate temperament effect on treatment adherence in euthymic patients with BD-I.
METHODS: Eighty patients with BD-I participated in the study. A psychiatrist used the Structured Clinical Interview for DSM-IV Axis-I Disorders to determine the diagnosis and co-morbidities. Hamilton Depression and Young Mania Rating Scale were used to detect the remission. We used the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire and the 4-item Morisky Medication Adherence Scale to evaluate temperament and treatment adherence, respectively. The study group was divided into two groups as "treatment adherent" and "treatment non-adherent".
RESULTS: The cyclothymic and anxious temperament scores of the treatment non-adherent patients with BD-I were significantly higher than those of the treatment adherent group (p < 0.001, p = 0.006, respectively). Multiple linear regression analysis determined that cyclothymic temperament predicted treatment non-adherence (p = 0.009).
CONCLUSION: It should be kept in mind that BD-I patients with cyclothymic temperament may be treatment non-adherent and future studies should explore whether temperament characteristics deteriorate BD-I course by disrupting treatment adherence.
PMID: 26207348 [PubMed - as supplied by publisher]
Role of high-frequency repetitive transcranial magnetic stimulation in augmentation of treatment of bipolar depression.
J ECT. 2014 Dec;30(4):e44-5
Authors: Sureshkumar K, Bharath S, Muralidharan K, Sinha P, Sivaraman SV
PMID: 24828445 [PubMed - indexed for MEDLINE]
Electroconvulsive therapy and cerebral aneurysms.
J ECT. 2014 Dec;30(4):e47-9
Authors: Wilkinson ST, Helgeson L, Ostroff RB
PMID: 25010028 [PubMed - indexed for MEDLINE]
Electroconvulsive therapy service provision at Zomba Mental Hospital, Malawi.
J ECT. 2014 Dec;30(4):e49-50
Authors: Udedi M
PMID: 25054364 [PubMed - indexed for MEDLINE]
Electroconvulsive therapy in a patient with catatonia and an intracranial arachnoid cyst.
J ECT. 2014 Dec;30(4):e53-4
Authors: Kastenholz KJ, Rosenthal LJ, Dinwiddie SH
PMID: 25203289 [PubMed - indexed for MEDLINE]
Electroconvulsive therapy in a geriatric patient with normal pressure hydrocephalus without a shunt.
J ECT. 2014 Dec;30(4):e55-6
Authors: Hermida AP, Job G, Tang Y
PMID: 25265148 [PubMed - indexed for MEDLINE]
Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report.
Health Technol Assess. 2015 Jul;19(56):1-130
Authors: Cooper K, Chatters R, Kaltenthaler E, Wong R
BACKGROUND: Cannabis is the most commonly used illicit drug worldwide. Cannabis dependence is a recognised psychiatric diagnosis, often diagnosed via the Diagnostic and Statistical Manual of Mental Disorders criteria and the International Classification of Diseases, 10th Revision. Cannabis use is associated with an increased risk of medical and psychological problems. This systematic review evaluates the use of a wide variety of psychological and psychosocial interventions, such as motivational interviewing (MI), cognitive-behavioural therapy (CBT) and contingency management.
OBJECTIVE: To systematically review the clinical effectiveness of psychological and psychosocial interventions for cannabis cessation in adults who use cannabis regularly.
DATA SOURCES: Studies were identified via searches of 11 databases [MEDLINE, EMBASE, Cochrane Controlled Trials Register, Health Technology Assessment (HTA) database, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, PsycINFO, Web of Science Conference Proceedings Citation Index, ClinicalTrials.gov and metaRegister of Current Controlled Trials] from inception to February 2014, searching of existing reviews and reference tracking.
METHODS: Randomised controlled trials (RCTs) assessing psychological or psychosocial interventions in a community setting were eligible. Risk of bias was assessed using adapted Cochrane criteria and narrative synthesis was undertaken. Outcomes included change in cannabis use, severity of cannabis dependence, motivation to change and intervention adherence.
RESULTS: The review included 33 RCTs conducted in various countries (mostly the USA and Australia). General population studies: 26 studies assessed the general population of cannabis users. Across six studies, CBT (4-14 sessions) significantly improved outcomes (cannabis use, severity of dependence, cannabis problems) compared with wait list post treatment, maintained at 9 months in the one study with later follow-up. Studies of briefer MI or motivational enhancement therapy (MET) (one or two sessions) gave mixed results, with some improvements over wait list, while some comparisons were not significant. Four studies comparing CBT (6-14 sessions) with MI/MET (1-4 sessions) also gave mixed results: longer courses of CBT provided some improvements over MI. In one small study, supportive-expressive dynamic psychotherapy (16 sessions) gave significant improvements over one-session MI. Courses of other types of therapy (social support group, case management) gave similar improvements to CBT based on limited data. Limited data indicated that telephone- or internet-based interventions might be effective. Contingency management (vouchers for abstinence) gave promising results in the short term; however, at later follow-ups, vouchers in combination with CBT gave better results than vouchers or CBT alone. Psychiatric population studies: seven studies assessed psychiatric populations (schizophrenia, psychosis, bipolar disorder or major depression). CBT appeared to have little effect over treatment as usual (TAU) based on four small studies with design limitations (both groups received TAU and patients were referred). Other studies reported no significant difference between types of 10-session therapy.
LIMITATIONS: Included studies were heterogeneous, covering a wide range of interventions, comparators, populations and outcomes. The majority were considered at high risk of bias. Effect sizes were reported in different formats across studies and outcomes.
CONCLUSIONS: Based on the available evidence, courses of CBT and (to a lesser extent) one or two sessions of MI improved outcomes in a self-selected population of cannabis users. There was some evidence that contingency management enhanced long-term outcomes in combination with CBT. Results of CBT for cannabis cessation in psychiatric populations were less promising, but may have been affected by provision of TAU in both groups and the referred populations. Future research should focus on the number of CBT/MI sessions required and potential clinical effectiveness and cost-effectiveness of shorter interventions. CBT plus contingency management and mutual aid therapies warrant further study. Studies should consider potential effects of recruitment methods and include inactive control groups and long-term follow-up. TAU arms in psychiatric population studies should aim not to confound the study intervention.
STUDY REGISTRATION: This study is registered as PROSPERO CRD42014008952.
FUNDING: The National Institute for Health Research HTA programme.
PMID: 26202542 [PubMed - in process]
The clinical profile of employees with mental health problems working in social firms in the UK.
J Ment Health. 2015 Jul 23;:1-7
Authors: Milton A, Parsons N, Morant N, Gilbert E, Johnson S, Fisher A, Singh S, Cunliffe D, Marwaha S
BACKGROUND: UK social firms are under-researched but are a potentially important vocational option for people with mental health problems.
AIMS: To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems.
METHOD: Clinical, work and service use characteristics were collected from social firms' employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively.
RESULTS: Predominantly, social firms' employees (N?=?80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations.
CONCLUSIONS: The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.
PMID: 26204327 [PubMed - as supplied by publisher]
Effects of CLOCK gene variants and early stress on hopelessness and suicide in bipolar depression.
Chronobiol Int. 2015 Jul 23;:1-6
Authors: Benedetti F, Riccaboni R, Dallaspezia S, Locatelli C, Smeraldi E, Colombo C
BACKGROUND: Patients with mood disorders show a high dependence of behavior on the molecular characteristics of the biological clock. CLOCK rs1801260 gene polymorphism influences circadian behavior in bipolar disorder (BD), with *C carriers showing a delayed sleep onset and worse insomnia. Sleep phase delay and insomnia associate with suicide in the general population.
METHODS: We investigated the effects of rs1801260, and of exposure to stressful life events, on current suicidal ideation and history of suicide attempts in 87 depressed patients with BD.
RESULTS: rs1801260*C carriers currently showed worse Hamilton Depression Rating Scale scores for suicide and worse ratings for depressive cognitive distortions. Previous history of attempted suicide associated with exposure to higher stressful events in the early life, with rs1801260*C carriers showing a higher dependency of the modeled probability of attempting suicide on the severity of exposure to early stress.
DISCUSSION: CLOCK rs1801260 modulated the relationship between early stress, adult history of attempted suicide and current suicide ideation. Factors affecting the biological clock can influence "non-clock" core psychopathological features of mood disorders.
PMID: 26204460 [PubMed - as supplied by publisher]
[Optimized quality of care for affective disorders by health insurance-based case-management: a controlled cost-study].
Psychiatr Prax. 2014 Nov;41(8):432-8
Authors: Salize HJ, Jacke C, Gallas C, Stamm K
OBJECTIVE: Improvement of depression treatment by health insurance based case-management. Criteria of improvement were a higher treatment rate of patients suffering from affective disorders or depression by psychiatrists or psychotherapists than by general practitioners or family doctors and sickness fund payments.
METHODS: Training of health insurance account managers (characteristics of depression, counselling and, case management techniques). Evaluation of outcomes during 12-months against a control group of account managers without training.
RESULTS: Intervention group: 87.8?% patients with in average 13.5 contacts to psychiatrists or psychotherapists; control group: 82.6?% patients with 11.8 contacts. The difference was statistically significant. Health insurance payments did not differ.
CONCLUSIONS: A higher treatment rate by psychiatrists and psychotherapists can be achieved by health insurance-based case-management without a cost-increase.
PMID: 24089320 [PubMed - indexed for MEDLINE]
Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders.
Medicine (Baltimore). 2015 Jul;94(29):e1203
Authors: Hsu YC, Hsu CC, Chang KH, Lee CY, Chong LW, Wang YC, Kao CH
Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors.We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts.The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43-1.59; P?<?0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs.Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted.
PMID: 26200637 [PubMed - as supplied by publisher]