Bipolar Disorder Research Articles

The Causal Role of Thyroid Hormones in Bipolar Disorders: A Two-Sample Mendelian Randomization Study.

Bipolar disorder is a complex psychiatric condition with distinctions between clinical subtypes including Type 1 and 2 disorders. Several studies have proposed that thyroid hormones may be involved in the aetiology of bipolar disorders. This study employed a two-sample Mendelian randomization (MR) approach to investigate the causal relationships between six thyroid hormone metrics (TSH, FT4, FT3, TT3, FT3/FT4 and TT3/FT4) and bipolar disorder and Type 1 and 2 disorders, separately. Genome-wide association (GWAS) data from the ThyroidOmics Consortium (up to 271,040 individuals of European ancestry) were used for thyroid function metrics. Bipolar disorder GWAS data included 41,917 cases and 371,549 controls (25,060 Type 1 and 6,781 Type 2 cases). We applied inverse variance weighted (IVW) methods for primary MR analysis, with MR Egger, weighted median and weighted mode for sensitivity. Additional tests assessed horizontal pleiotropy and heterogeneity. Higher FT4 levels showed a protective causal effect against bipolar disorder (OR: 0.92, 95% CI: 0.86-0.97, p = 4.58 × 10-3) and a suggestive effect on Type 1 disorders (OR: 0.92, 95% CI: 0.86-0.99, p = 3.21 × 10-2). Elevated FT3 (OR: 1.18, 95% CI: 1.03-1.35, p = 1.55 × 10-2) and FT3/FT4 ratio (OR: 1.97, 95% CI: 1.02-3.82, p = 4.46 × 10-2) had suggestive harmful effects on Type 1 disorders. Sensitivity analyses showed consistent effects, with no significant horizontal pleiotropy or heterogeneity. These findings highlight the protective role of FT4 and the potentially harmful effect of elevated FT3 in Type 1 bipolar disorder, highlighting the need for further research on thyroid hormone levels as a potential treatment strategy for Type 1 bipolar disorder.

Skandinaviske retningslinjer for behandling av psykisk lidelse hos barn og unge: En kvalitetsvurdering

Children and young people with untreated mental health disorders can develop chronic disorders and severe somatic diseases later in life. The right treatment at the right time is therefore important to promote good mental health. Healthcare personnel are required to follow national guidelines, and high-quality guidelines are thus important for patient safety. We wanted to assess the quality of Norwegian national guidelines for the treatment of mental disorders in children and young people and compare these with corresponding guidelines in Sweden and Denmark. We conducted manual searches in the relevant national health authorities’ websites and selected five Norwegian guidelines (treatment of ADHD, bipolar disorders, psychosis, suicide and eating disorders), three Danish guidelines (ADHD, anorexia and bulimia) and one Swedish guideline (ADHD). For the purpose of quality assessment, we used an internationally recognised checklist (AGREE II), on which Norwegian guidelines must be developed in accordance with the Norwegian Directorate of Health’s own guide for developing guidelines. The checklist consists of 23 items divided into six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. We found that the overall quality of the Danish and Swedish guidelines was very high and met most of the 23 criteria organised within six domains. The Norwegian guidelines met the criteria for scope and purpose and stakeholder involvement, but had major shortcomings in terms of rigour of development, clarity of presentation, applicability, and transparency of editorial independence. Keywords: evidence-based practice, national guidelines, children and adolescents, mental disorders

Association of self-harm and suicidality with psychiatric co-occurring conditions in autistic individuals: a systematic review and pooled analysis

Autistic individuals frequently experience psychiatric co-occurring conditions, but the association with self-harm/suicidality according to these conditions was not yet elucidated. We aimed to summarize the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic people. We systematically searched PubMed, Scopus, Embase, Web of Science, and Cochrane Database of Systematic Reviews until June 4, 2024 (PROSPERO registration number: CRD42023412860). Observational studies were included that provided information to calculate the odds ratio (OR) regarding the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic individuals. We summarized the identified associations by presenting OR range or meta-analyzing when 7 or more estimates are available. The systematic search found 20 eligible studies with 301,841 participants. Our findings suggested that autistic individuals with any psychiatric disorder (k=1; OR 3.55; 95% CI 1.27-9.98), ADHD (k=3; OR range: 1.07-1.65), or mood disorder (k=1; OR 1.26; 95% CI 1.05-1.51) may be associated with higher odds of self-harm than those without these conditions. We identified potential positive associations between suicidality and the following co-occurring conditions: any psychiatric disorder (k=1; OR 11.65; 95% CI 10.68-12.71), psychotic disorder (k=4; OR range: 1.95-10.97), mood disorder (k=3; OR range: 1.75-9.82), bipolar disorder (k=2; ORrange: 2.55-4.95), depressive disorder (k=10; pooled OR 2.29; 95% CI 1.39-3.77), trauma- and stress-related disorder (k=2; OR range: 1.28-10.47), and adjustment disorder (k=1; OR 3.52; 95% CI 2.89-4.28). We found psychiatric co-occurring conditions that may be associated with higher odds of self-harm/suicidality in autistic individuals. However, our findings should be interpreted with caution considering the limited number of included studies. We suggested that clinicians should remain vigilant for autistic individuals with psychiatric co-occurring conditions for their potentially higher likelihood of self-harm and suicidality. This research was supported by a grant of the R&D project, funded by the National Center for Mental Health (grant number: MHER22A01).

Are circadian rhythms more favorable with lithium than with other mood stabilizers? An exploratory actigraphy study in euthymic bipolar disorder type 1

BackgroundBipolar Disorder (BD) is associated with alterations of circadian rhythms of activity (CRA). Experimental research suggests that lithium (Li) modifies CRA, but this has been rarely explored in BD using actigraphy. MethodsThe sample comprised 88 euthymic BD-I cases with 3 weeks of actigraphy. We used a Principal Component Analysis (PCA) to generate CRA dimensions. We then used linear regression analyses to compare these dimensions between groups of individuals defined according to prescribed mood stabilizers: Li monotherapy (“Li” group, n = 28), anticonvulsant or atypical antipsychotic monotherapy (“AC or AAP” group, n = 27) or combined treatments (“Li+AC or Li+AAP” group, n = 33). Analyses were adjusted for potential confounders (gender, age, body mass index, depressive symptoms, co-prescribed benzodiazepines and antidepressants, smoking status and past alcohol use disorder). ResultsThe PCA identified two dimensions: “robust CRA” (high amplitude and interdaily stability, with low intradaily variability) and “late chronotype”. Univariate analyses showed higher scores for “robust CRA” in the “Li” versus the “AC or AAP” (p = 0.021) or “Li+AC or Li+AAP” groups (p = 0.047). These findings remained significant after adjustments (respectively p = 0.010 and p = 0.019). Post-hoc analyses suggested lower variability, higher stability and higher amplitude of CRA in the “Li” group. Medication groups were similar for the “late chronotype” dimension (p = 0.92). ConclusionsThis actigraphy study is the first to show more favorable CRA in BD-I individuals receiving a Li monotherapy when compared with those receiving other classes or combinations of mood stabilizers. Replications in larger samples are required. Prospective studies are also warranted to elucidate whether the introduction of Li or other mood stabilizers might influence CRA in BD-I.

Hybrid logistic regression support vector model to enhance prediction of bipolar disorder

Hybrid logistic regression support vector model to enhance prediction of bipolar disorder

Psychopharmacological Treatment of Depression and Anxiety and their Different Drug Delivery Targets

Abstract: General practitioners observe a high prevalence of anxiety and depression symptoms. Depressed or anxious patients frequently develop both conditions. The symptoms of both diseases may be present at the same time. There has been numerous studies on higher levels of depression, bipolar disorder II, and mixed depression. So, we ended up reviewing different drug delivery targets. Even at low dosages, antidepressants were better absorbed and were more effective when given by the nose. In this review, we focused on cutting-edge methods for intranasal antidepressant delivery vehicles. Consequently, it seems that drugs that are sufficiently effective, have fewer side effects, and are less expensive. The researchers in this metaanalysis set out to determine whether or not they have been used successfully in traditional medicine to treat depression in human or animal studies.

Prevalence of central nervous system-active polypharmacy in a cohort of older adults in Argentina.

Central nervous system (CNS)-active polypharmacy is frequent and potentially harmful in older patients. Data on its burden outside the USA and European countries remain limited. To estimate the period prevalence of and factors associated with out-of-hospital CNS-active polypharmacy in older adults. We used data from a cohort of out-patients aged ≥60 years affiliated to the Hospital Italiano de Buenos Aires' health maintenance organisation on 1 January 2021. A CNS-active polypharmacy event was defined as the concurrent exposure to ≥3 CNS-active medications (i.e. antidepressants, anti-epileptics, antipsychotics, benzodiazepines, Z-drugs and opioids) through filled out-of-hospital prescriptions. We calculated the period prevalence of CNS-active polypharmacy for 2021. We identified factors associated with CNS-active polypharmacy using a multivariable logistic regression model to estimate odds ratios and 95% confidence intervals (CI). We included 63 857 patients. Pre-existing mental health diagnoses included anxiety (21%), depressive (14%) and sleep (11%) disorders. CNS-active polypharmacy occurred in 4535 patients, for a period prevalence of 7.1% (95% CI: 6.9-7.3%). The combination of an antidepressant, an antipsychotic and a benzodiazepine accounted for 21% of the CNS-active polypharmacy events. Frontotemporal dementia (odds ratio: 14.67; 95% CI: 4.47-48.20), schizophrenia (odds ratio: 7.93; 95% CI: 4.64-13.56), bipolar disorder (odds ratio: 7.20; 95% CI: 5.45-9.50) and depressive disorder (odds ratio: 3.50; 95% CI: 3.26-3.75) were associated with CNS-active polypharmacy. One in 14 adults aged 60 years and older presented out-of-hospital CNS-active polypharmacy. Future studies should evaluate measures to reduce CNS-active medication use in this population.

Patient Experiences With Group Teletherapy for the Treatment of Mental Illness: A Qualitative Study.

The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery. From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy. Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth. Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.

SARS-CoV-2 Infection And COVID-19 Outcomes Among Mental Disorders: A Register-based Study in Catalonia

Abstract This study aimed to study the risk of SARS-CoV-2 infection and severe COVID-19 outcomes across different mental diagnoses and to assess the role of sex in these associations. We used electronic health records from Catalonia to identify adults receiving inpatient/outpatient mental health care between 2017-2019 with diagnosis of non-affective psychosis (NAP), bipolar disorder (BD), depressive disorder (DEP), stress-related disorders, neurotic/somatoform disorders (NSD), and substance misuse (SUB) (exposed). Outcomes included SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19-related death. Adjusted logistic regression analyses were conducted. 785,378 adults were included (70.3% < 65 years old; 57.1% women). Compared to unexposed, those with NAP [OR (95%CI): 0.84 (0.80-0.88)], BD [0.80 (0.75-0.86)], DEP [0.97 (0.94-1.00)] and SUB [0.81 (0.78-0.84)] had a lower risk of SARS-CoV-2 infection, while people with NSD presented an increased risk [1.03 (1.01-1.06)]. Among those infected, people with DEP, NSD, and SUB had a lower risk of COVID-19 hospitalization, but higher risk of COVID-19-related death [1.23 (1.07-1.41); 1.26 (1.07-1.48); 1.48 (1.24-1.71), respectively]. A higher COVID-19-related death was also found in people with NAP and BD [1.68 (1.34-2.12); 2.02 (1.50-2.73)]. Sex-stratified analysis showed that women with NSD were especially vulnerable to infection [1.07 (1.03-1.11)], and women with DEP and NSD to COVID-19-related death [1.24 (1.05-1.47); 1.26 (1.02-1.54)]. These results suggest different vulnerabilities to infection and COVID-19 hospitalization and death across mental disorders. These findings have implications for pandemic preparedness, highlighting the need for specific public health strategies to mitigate the excess of mortality of people with certain mental disorders.

Language, Motor Ability and Related Deficits in Children at Familial Risk of Schizophrenia or Bipolar Disorder.

It is known that impairments in linguistic ability and motor function tend to co-occur in children, and that children from families with parental mental illness such as schizophrenia tend to perform poorly in both domains, but the exact nature of these links has not yet been fully elucidated. In this study, we leveraged the first wave of the Danish High Risk and Resilience Study (VIA 7), which includes both genetic data and measures covering multiple developmental domains. The VIA 7 cohort comprises 522 7-year-old children born to parents with schizophrenia (N = 202), bipolar disorder (N = 120) or neither (N = 200). We investigated the relationships between linguistic ability and motor function using correlation and regression analyses, focusing on developmental coordination disorder (DCD) and specific language impairment (SLI) and their potential associations with the three risk groups. We found significant correlations between most measures of language and motor function and significant associations of DCD and SLI with language and movement measures, respectively, the largest effect being that of DCD on receptive language, with a significant interaction effect: DCD was associated with poorer performance in children from schizophrenia families compared to bipolar disorder and control families. Both disorders showed higher prevalence among children with familial high risk of mental illness. We did not find significant evidence of genetic overlap between DCD and SLI. Our results suggest strong links between the domains of motor function and linguistic ability. Children of parents with schizophrenia are at high risk of comorbid language and movement disorders.

Ketamine-induced altered states of consciousness: a systematic review of implications for therapeutic outcomes in psychiatric practices.

This systematic review aims to elucidate the nexus between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders. We searched three databases and used citation tracking to include 29 studies. Predominantly, mood disorders, including bipolar disorder (BD) and major depressive disorder (MDD) (MDD + BD: + n = 25studies), a large part of them involve treatment-resistant patients (n = 14studies), substance use disorder (SUD, n = 3studies), and social anxiety disorder (SAD, n = 1study). From all included studies(n=29), 15 (51.72%) of themidentified a positive relation between ketamine-induced altered states of consciousness and clinical outcomes, while 13studies (44.83%)showed no linkage between them, and one study (3.45%)delineated a negative association. Focusing solely on intravenous (IV) ketamine infusions (n = 25), 14 studies(56%)reported a positive modulation of ketamine's psychoactive effects and therapeutic benefits, whereas 10 studies(40%)confirmed no relationship, and one study (4%)showed a negative association. The single study(33.34%) involving subcutaneous ketamine and allthree studies (66.6%)intranasal administration did not demonstrate a significant interaction between ketamine's psychoactive effects and therapeutic response. All three SUD studies reported a positive correlation between ketamine's psychoactive effects and therapeutic response. In contrast, the single SAD study did not find a relationship between these parameters. For studies involvingmood disorders (n = 25), 12 studies (48%)reported a positive relationship between psychoactive effects and therapeutic response.Others 12studies (48%)identified a null relationship, and one study (4%)found a significant negative association. Although we have found a larger association than previous studies between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders, its topic remains indeterminate, mainly due to the high heterogeneity.

Relationship between early traumatic experiences and emotional regulation skills in major depressive and bipolar disorders.

Childhood trauma can cause deficits in emotional regulation. However, few studies have investigated childhood trauma and emotional regulation skills in patients with mood disorders. We aimed to investigate how childhood trauma and Emotion Regulation Skills Questionnaire (ERSQ) scores are associated with mood disorders.This study included 779 patients with mood disorders (major depressive disorder [MDD, n = 240], bipolar I disorder [BDI, n = 121], and bipolar II disorder [BDII, n = 418]). We used their Childhood Trauma Questionnaire-Short Form (CTQ) and ERSQ scores for the evaluation.The between-group differences in CTQ and ERSQ scores were examined. The CTQ and ERSQ total scores were negatively correlated. Among the CTQ subscales, emotional neglect showed a significant correlation with the ERSQ total score, whereas acceptance and tolerance showed higher negative correlations with the CTQ than with the other ERSQ subscales. The negative relationship between emotional regulation and childhood trauma varied significantly depending on the group, with the BDI group showing a more prominent association than the other groups.Based on various mood disorders, we observed associations between childhood trauma and emotional regulation skills. Consequently, our study offers notable insights for future research on the impact of childhood trauma on ERSQ.

Adaptive Hyperactivity and Biomarker Exploration: Insights from Elders in the Blue Zone of Sardinia

Background/Objectives: Adaptive hyperactivity characterized by increased activity levels and novelty-seeking traits without mood disorders is prevalent among older adults in Sardinia’s “blue zone,” an area with high longevity. This study aims to evaluate the adaptive nature of hyperactivity concerning quality of life, social rhythms, and mood symptoms in individuals from this region, particularly among elderly adults over 80. Methods: This observational cross-sectional study included adults and older adults over 80 from Sardinia’s blue zone. This study included a sample of patients followed at the Center for Consultation Psychiatry and Psychosomatics for Bipolar Disorder of the University Hospital of Cagliari and a homogeneous comparison sample of patients without psychiatric pathologies, referred to the Dermatology Clinic of the same hospital, for a period of 6 months, from February to August 2024. The general sample, divided into two parts—cases, represented by patients with psychiatric pathology, and controls, patients without psychiatric pathology—was divided in turn into three sub-groups: “adults” (18–64 years), young elders (65–79), and old elders (over 80 years). The participants underwent psychiatric interviews and completed the Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire (PHQ-9), SF-12, and Brief Social Rhythm Scale (BSRS). Data were compared with national and regional normative data. Results: Older adults in the blue zone demonstrated higher MDQ positivity (22.58%) compared to the national averages (0.87%), without corresponding increases in dysregulated rhythms, depressive symptoms, or reduced quality of life. Younger old persons (65–79 years) showed increased rhythm dysregulation (BSRS score: 20.64 ± 7.02) compared to adults (17.40 ± 6.09, p = 0.040), but this trend was not observed in the oldest group (80+ years). No significant differences were found in the CH3SH and (CH3)2S levels between groups. Conclusions: The hyperactivity observed in older adults from Sardinia’s blue zone appears adaptive and not linked to social rhythm dysregulation, depressive symptoms, or a diminished quality of life, suggesting resilience factors which may contribute to longevity. These findings support the potential classification of such hyperactivity as beneficial rather than pathological, warranting further research into biomarkers and psychoeducational interventions to prevent the onset of bipolar disorders in predisposed individuals.

Diagnoses of mental health disorders among Norwegian youth and young adults with immigrant parents

Abstract Introduction Adolescence and early adulthood are associated with an increase in mental health problems. Migration is also a risk factor for mental disorders. Yet, there is a notable gap in research concerning the mental well-being of descendants of immigrants. This study investigates the risk of a diagnosis of a mental health disorder among those aged 16-30 years, born in Norway with at least one immigrant parent. Methods Data were sourced from the Medical Birth Registry of Norway, the Norwegian Patient Register, and Statistics Norway. Cox proportional hazard regressions were used to estimate hazard ratios (HR) of being diagnosed with different mental disorders, in total and by parental region of origin, compared to individuals of Norwegian background. Analyses were adjusted for sex, year of birth, and parental education. Results Individuals with two immigrant parents had a lower risk of most mental disorder diagnoses, while those of one immigrant parent had a higher risk. With the exception of schizophrenia, individuals with two immigrant parents had a lower risk of most mental disorder diagnoses compared to those with Norwegian-born parents. The HR for the risk of a diagnosis of anxiety for those with two immigrant parents was: 0.79 [95% CI 0.76 - 0.81], with immigrant mother: 1.07 [95% CI 1.04-1.10], with immigrant father: 1.28 [95% CI 1.24 -1.30]. Similarly, for depression, two immigrant parents: 0.85 [95% CI 0.82-0.88], immigrant mother: 1.13 [95% CI 1.09 - 1.17], immigrant father: 1.31 (95% CI 1.28-1.37). Bipolar disorders, two immigrant parents: 0.67 [95% CI 0.60-0.76], immigrant mother: 1.19 [95% CI 1.07 - 1.31], immigrant father: 1.47 [95% CI 1.35-1.61]. The pattern was relatively consistent across parental regions of origin. Conclusions Those with one immigrant parent are more likely to use specialist mental health services, while those with two immigrant parents are not. These need special attention in adulthood. Key messages • Differences in risk of diagnosis for mental disorders could be due to differences in the utilization of mental health services. • Early prevention of mental health issues seems to be especially important among children and youth raised in families with one immigrant parent.

Prevalence and severity of insomnia in adult outpatients attending Kasralainy Psychiatry and Addiction Treatment Hospital

BackgroundInsomnia is common among patients with psychiatric disorders and affects the clinical presentation and outcomes of the psychiatric disorder. The presentation of insomnia varies according to the type and severity of the psychiatric disorder.ObjectivesThis cross-sectional study aimed to assess the prevalence and severity of insomnia in adult psychiatric outpatients attending Psychiatry and Addiction Medicine Hospital, Faculty of Medicine, Cairo University. The study included 390 patients diagnosed with the following disorders: depressive disorders (n = 126 (32.2%)), anxiety disorders (n = 69 (17.6%)), psychotic spectrum disorders (n = 67 (17.1%)), bipolar and related disorders (n = 50 (12.8%)), trauma and stress-related disorders (n = 46 (11.8%)), obsessive–compulsive disorder (n = 30 (7.7%)), and somatic symptoms disorders (n = 2 (0.5%)). Patients were assessed using the Sleep Disorder Interview, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Global Assessment of Functioning Scale (GAF).ResultsAmong the assessed patients, 314 (80.5%) had insomnia, with a higher prevalence in females (91.5%) compared to males (67.2%). The prevalence of insomnia was 96% in depressive disorders, 97.1% in anxiety disorders, 49.3% in psychotic disorders, and 32% in bipolar and related disorders; while all patients with trauma and stress-related disorders, obsessive–compulsive disorders, and somatic symptoms disorders had insomnia.The severity of insomnia as measured by ISI was positively correlated with the global functioning score (r = 0.341, p = < 0.001) and negatively correlated with the duration of the psychiatric illness (r = − 0.285, p = < 0.001).ConclusionsInsomnia is highly prevalent in outpatients with psychiatric disorders.

Complications after cardiac implantable electronic devices in patients with severe mental illness: a Danish nationwide study

Abstract Background Patients with mental illness experience higher rates of postoperative complications and mortality across several types of surgery, but knowledge is lacking in relation to cardiac implantable electronic device (CIED) implantations. Purpose Our study aimed to investigate the 7-day, 30-day, and 90-day postoperative complication rate and mortality in patients with severe mental illness compared to the general population. Methods All adult patients in Denmark with a first-time pacemaker or ICD implantation during the study period from July 1995 to December 2022 were identified using the Danish nationwide registers. Severe mental illness was defined as having a preexisting diagnosis of schizophrenia and other non-affective psychotic disorders, bipolar affective disorders or major depressive disorder. Postoperative complications were obtained as diagnosis codes possibly relating to device implantation and categorized into seven types of complications: arterial thrombosis, venous thrombosis, pneumothorax, bleeding, infection, device function problem, and death. Stratified logistic regression analyses adjusted for sex and age were used to calculate the odds of postoperative complications within 7, 30, and 90 days of device implantation. Results Among 108,790 patients who had a de novo pacemaker or ICD implantation the mean age was 73.5 (± 12.8), 37.5% were women and 3,393 (3.1%) of the patients had preexisting severe mental illness. In total, 10,690 (9.8%) patients had one or more complications within 90 days. The number of patients with severe mental illness who experienced a complication were 407 (12.0%) while it was 10,283 (9.8%) of those without severe mental illness. Odds of death (OR 1.57, 95% CI: 1.03-2.29) were higher in patients with severe mental illness 7 days postoperatively, and 30 days postoperatively odds of venous thromboembolism (OR: 1.69, 95% CI: 1.05-2.56) and death (OR: 1.62, 95% CI: 1.29-2.01) were higher in patients with severe mental illness. 90 days postoperatively odds of venous thrombosis (OR: 1.95, 95% CI: 1.37-2.70), infection (OR: 1.45, 95% CI: 1.16-1.79), and death (OR: 1.40, 95% CI: 1.19-1.65) were higher in patients with severe mental illness compared to patients without severe mental illness, while the odds of pneumothorax were lower at all three time points for patients with severe mental illness (OR 7-days: 0.49, 95% CI: 0.21-0.95). The odds of arterial thrombosis, bleeding and device function problems were similar between the two groups at all three time points. Conclusion Severe mental illness was associated with increased risk of several types of complications and death following CIED implantation. This indicates that further care and attention is needed to ensure adequate treatment of patients with severe mental illness suffering from cardiac arrhythmias.Forest plot, SMI: severe mental illness

The burden of psoriasis in Belgium, 2021

Abstract Psoriasis is a common, chronic, inflammatory skin disease with a great impact on healthcare systems. Given the limitations of the currently available burden estimates, estimates of the Belgian national burden of disease study are necessary in order to guide decision-making processes within the health sector. According to the Global Psoriasis Atlas, the prevalence of psoriasis is rising globally. The current study aims to estimate the burden of psoriasis in Belgium using national data. As there is no single comprehensive data source on prevalence of psoriasis in Belgium, a critical appraisal of existing local and national data sources was conducted. We estimated the non-fatal psoriasis burden in terms of years lived with disability (YLD). Estimated prevalence data were combined with disability weights to yield YLDs imposed by psoriasis. Mortality attributable to psoriasis was assumed to be zero, in line with the Global Burden of Disease study (GBD) 2019. We assessed three data sources containing information on existing cases with psoriasis in Belgium. Based on qualitative and quantitative appraisal, a widespread network of general practitioners was identified as the best available national data source. In 2021, the prevalence of psoriasis in Belgium was 2.1%, leading to 13084 DALYs (113 DALYs per 100 000). The burden of psoriasis was in line with national disease burden estimates for bipolar disorder, multiple myeloma, and hearing loss. Our prevalence, YLD, and DALY estimates for psoriasis in Belgium were however lower than those of the GBD study. Psoriasis imposes a non-negligible burden on population health in Belgium, despite it not being a cause of death. Along progression in psoriasis management, objective evaluation of psoriasis burden is critical to track the trends at the population level. Key messages • Psoriasis is a common skin disease with a relatively high morbidity burden. • Information on psoriasis prevalence and burden are crucial for disease management and appropriate health-care planning.

Individual Resilience among Adult Children of Parents with Bipolar Disorder in Chinese Society: An Inductive and Deductive Content Analysis Approach.

Nurses can help children of parents with mental illness discover their resilience. However, previous studies have focused on their experience in Western settings and have limited understanding of a Chinese cultural context. This study aims to explore individual resilience emerging from adult children's experience of living with parents with bipolar disorder in Chinese society within the framework of character strengths and possible cultural components. A content analysis with both inductive and deductive approaches. Twenty adults participated in this study. Interviews were conducted while the participants' parents were hospitalized in an acute psychiatric hospital ward. The framework of character strengths confirmed five emergent themes of individual resilience in this study: courage, temperance, humanity, knowledge and wisdom, and transcendence. Character strengths are an adequate framework for understanding of individual resilience. Chinese adult children develop resilience by regulating their emotions, respecting their parents, engaging in self-discipline, and positively interpreting adversity.

Aripiprazole once-monthly for the treatment of adult patients with earlier-stage bipolar I disorder: a post hoc analysis of data from a double-blind, placebo-controlled, 52-week randomized withdrawal trial

BackgroundIncreased awareness of the factors contributing to the diagnostic disparities seen in bipolar disorder between individuals of different heritage is needed to achieve equity in diagnosis and treatment. One such inequity is the provision of earlier treatment. Earlier treatment of patients diagnosed with bipolar disorder may prolong time to recurrence of mood episodes and reduce functional impairment and other poor outcomes associated with disease progression. The aim of this post hoc analysis was to study the efficacy and safety of long-acting injectable aripiprazole once-monthly 400 mg (AOM 400) in patients with earlier-stage bipolar I disorder (BP-I). Data from a 52-week multicenter, double-blind, placebo-controlled, randomized withdrawal trial of AOM 400 versus placebo in patients with BP‑I (NCT01567527) were analyzed. Those patients in the lowest quartiles for age (18–≤32 years; n = 70) or disease duration (0.13–≤4.6 years; n = 67) at baseline were categorized with earlier-stage BP-I. The primary endpoint was time from randomization to recurrence of any mood episode. Other endpoints included proportion of patients with recurrence of any mood episode, and change from baseline in Young Mania Rating Scale (YMRS) and Montgomery–Åsberg Depression Rating Scale (MADRS) total scores.ResultsMaintenance treatment with AOM 400 significantly delayed time to recurrence of any mood episode versus placebo in patients aged 18–≤32 years (hazard ratio [HR]: 2.46 [95% confidence interval (CI) 1.09, 5.55]; p = 0.0251) or with disease duration 0.13–≤4.6 years (HR: 3.21 [95% CI 1.35, 7.65]; p = 0.005). This was largely driven by a lower proportion of patients in the AOM 400 group with YMRS total score ≥15 or clinical worsening. Changes from baseline in MADRS total score in both earlier-stage groups indicated AOM 400 did not worsen depression versus placebo. The safety profile of AOM 400 was consistent with the original study. Note that the original study included patients who had previously been stabilized on AOM 400 monotherapy, which may have enriched the population with patients who respond to and tolerate AOM 400.ConclusionsIn this post hoc analysis, AOM 400 prolonged time to recurrence of any mood episode versus placebo in earlier-stage BP-I. These findings support early initiation of maintenance treatment with AOM 400.

Childhood trajectories of emotional and behavioral difficulties are related to polygenic liability for mood and anxiety disorders.

Symptoms related to mood and anxiety disorders (emotional disorders) often present in childhood and adolescence. Some of the genetic liability for mental disorders, and emotional and behavioral difficulties seems to be shared. Yet, it is unclear how genetic liability for emotional disorders and related traits influence trajectories of childhood behavioral and emotional difficulties, and if specific developmental patterns are associated with higher genetic liability for these disorders. This study uses data from a genotyped sample of children (n = 54,839) from the Norwegian Mother, Father, and Child Cohort Study (MoBa). We use latent growth models (1.5-5 years) and latent profile analyses (1.5-8 years) to quantify childhood trajectories and profiles of emotional and behavioral difficulties and diagnoses. We examine associations between these trajectories and profiles with polygenic scores for bipolar disorder (PGSBD), anxiety (PGSANX), depression (PGSDEP), and neuroticism (PGSNEUR). Associations between PGSDEP, PGSANX, and PGSNEUR, and emotional and behavioral difficulties in childhood were more persistent than age-specific across early childhood (1.5-5 years). Higher PGSANX and PGSDEP were associated with steeper increases in behavioral difficulties across early childhood. Latent profile analyses identified five profiles with different associations with emotional disorder diagnosis. All PGS were associated with the probability of classification into profiles characterized by some form of difficulties (vs. a normative reference profile), but only PGSBD was uniquely associated with a single developmental profile. Genetic risk for mood disorders and related traits contribute to both a higher baseline level of, and a more rapid increase in, emotional and behavioral difficulties across early and middle childhood, with some indications for disorder-specific profiles. Our findings may inform research on developmental pathways to emotional disorders and the improvement of initiatives for early identification and targeted intervention.