Early Detection Of Bipolar Disorder Research Articles

Accuracy of the Arabic HCL - 32 and MDQ in detecting patients with bipolar disorder

BackgroundStudies about the two most used and validated instruments for the early detection of Bipolar Disorder (BD), the 32 - item Hypomania Checklist (HCL - 32) and the Mood Disorder Questionnaire (MDQ), are scarce in non-Western countries. This study aimed to explore the reliability, factor structure, and criterion validity of their Arabic versions in a sample of Tunisian patients diagnosed with mood disorders.MethodsThe sample included 59 patients with BD, 86 with unipolar Major Depressive Disorder (MDD) and 281 controls. Confirmatory factor analysis was applied to show that a single global score was an appropriate summary measure of the screeners in the sample. Receiver Operating Characteristic analysis was used to assess the capacity of the translated screeners to distinguish patients with BD from those with MDD and controls.ResultsReliability was good for both tools in all samples. The bifactor implementation of the most reported two-factor model had the best fit for both screeners. Both were able to distinguish patients diagnosed with BD from putatively healthy controls, and equally able to distinguish patients diagnosed with BD from patients with MDD.ConclusionBoth screeners work best in excluding the presence of BD in patients with MDD, which is an advantage in deciding whether or not to prescribe an antidepressant.

The Factor Structure of the Mood Disorder Questionnaire in Tunisian Patients.

Background:The Mood Disorder Questionnaire (MDQ) is a frequently used screening tool for the early detection of Bipolar Disorder (BD), which is often unrecognized or misdiagnosed at its onset. In this study, data from Tunisia has been used to evaluate the psychometric properties of the Arabic MDQ.Methods:The sample included 151 patients with a current major depressive episode. The Arabic adapted version of the Structured Clinical Interview for DSM-IV-TR was used to formulate a diagnosis, yielding 62 patients with BD and 89 with unipolar Major Depressive Disorder (MDD). Principal component analysis with parallel analysis was used to establish the spontaneous distribution of the 13 core items of the MDQ. Confirmatory Factor Analysis (CFA) was used to check the available factor models. Receiver Operating Characteristic (ROC) analysis was used to assess the capacity of the MDQ to distinguish patients with BD from those with MDD.Results:Cronbach’s α in the sample was 0.80 (95%CI: 0.75 to 0.85). Ordinal α was 0.88. Parallel analysis suggested two main components, which explained 59% of variance in the data. CFA found a good fit for the existing unidimensional, the two-factor, and the three-factor models. ROC analysis showed that at a threshold of 7, the MDQ was able to distinguish patients with BD from those with MDD with extraordinary negative predictive value (0.92) and a positive diagnostic likelihood ratio of 3.8.Conclusion:The Arabic version of the MDQ showed good measurement properties in terms of reliability, factorial validity and discriminative properties.

Early Detection of Bipolar Disorder Four Years Before Onset in a 22-Year Population-Based Birth Cohort Using Advanced Machine Learning Techniques

Background: Bipolar disorder (BD) is the sixth leading cause of disability worldwide. Early detection of BD may help clinicians to intervene early and to prevent illness progression. We aimed to build a BD prediction model using machine learning techniques in a large population-based birth cohort at the individual level. Methods: A total of 3,748 subjects were studied from birth up to the age of 22 years in a prospective population-based birth cohort. We used the Elastic Net algorithm with 10-fold cross-validation to predict who would develop BD by the age 22-years assessment using clinical and demographic variables at each follow-up visit before diagnosis (perinatal, 11 years, 15 years, and 18 years). After that, we used the best predictive model to calculate the subgroups of subjects at higher and lower risk of developing BD and analyzed the clinical differences among them. Findings: A total of 107 (2∙8%) individuals within the cohort presented with BD type I, 26 (0∙6%) presented with BD type II, and 87 (2∙3%) presented with BD not otherwise specified. The model with variables assessed at the 18-years follow-up visit achieved the best performance: an AUC of 0∙82 (CI 0∙75–0∙88), balanced accuracy of 0∙75, sensitivity of 0∙72, and specificity of 0∙77. The most important variables to predict BD at the 18-years follow-up visit were suicide risk, a diagnosis of generalized anxiety disorder, parental physical abuse, and financial problems. Additionally, the high-risk subgroup of BD showed a high frequency of drug use and depressive symptoms. Interpretation: We developed a machine learning-based risk calculator for BD at the age of 22 years, which may be used as a tool to clinical decision making, incorporating both demographic and clinical variables. Future studies integrating data from different biological levels, such as genetics and metabolomics, could potentially help to build more accurate models. Furthermore, other researches should determine whether the features selected by the model as the most important have a causal relation with BD or whether they are prodromal symptoms. Funding Statement: This article is based on data from the study Birth Cohort − conducted by Graduate Program in Epidemiology at Universidade Federal de Pelotas with the collaboration of the Brazilian Public Health Association (ABRASCO). Furthermore, the 1993 birth cohort study was supported by the Wellcome Trust and Brazilian National Research Council (CNPq) with Brazilian Ministry of Health (DECIT – CNPq). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The 1993 Pelotas Birth Cohort study was approved by the local ethics committee. All participants provided written informed consent.

Evolution of bipolar disorder over 12 years in a psychiatric hospital

IntroductionBipolar disorder is a leading cause of hospitalization in psychiatric hospitals. It is known that early detection of bipolar disorder is associated with a better prognosis.ObjectivesThe aim of this study is to conduct a demographic analysis of patients hospitalized for bipolar disorder in a single center between 2003 to 2014.MethodsRetrospective cohort study of 1230 patients admitted with bipolar disorder diagnosis from 2003 to 2014 at Centre Assistencial Emili Mira i López of Parc Salut Mar of Barcelona. We divided the study in two periods: 2003–2008 and 2009–2014. We analyzed the following variables: frequency of admissions, age, sex and days of hospital stay, comparing both periods. Chi-square test for categorical variables and Student t test for quantitative variables were applied.ResultsThe mean ages at the first and second period are 52 and 47, respectively (P < 0.001). There are no significant differences in sex and days of hospitalization. The frequency of admissions on the first and third trimesters is higher than in the second and fourth, although the differences are not statistically significant.ConclusionsDespite the large number of patients in the study, there are limitations, such as being a retrospective study and not being adjusted for confounding factors. The average age of patients in the second period is lower than in the first. This could suggest an improvement in early detection of bipolar disorder in the last years. Further research is needed to confirm this hypothesis.Disclosure of interestLG is funded by the Instituto de Salud Carlos III(CM14/00111).

Take-up and profile of individuals accessing a web-based bipolar self-test screening measure

Early detection of bipolar disorder is associated with improved long term outcome. In this study, we profile individuals accessing a web-based self-report screening tool for bipolar disorder. Participants accessing the self-screening tool for bipolar disorder (the Mood Swings Questionnaire; MSQ) via the Black Dog Institute website were asked to indicate whether they were willing to participate in a research study evaluating the tool. Demographic details, mood disorder history, previous treatments and the impact of mood problems were assessed, followed by completion of the MSQ to determine the likelihood of a bipolar disorder diagnosis. During the first year of the study, the bipolar self-screening test web-page was viewed 278,279 times. A total of 5803 were eligible to provide baseline data, and 4829 completed the MSQ. Of these, 65% were assigned a preliminary bipolar disorder diagnosis based on MSQ cut-off scores, with the majority (89%) expecting such a result, feeling reassured (64%) by the result, and viewing the self-test as helpful (94%). Encouragingly, over 70% indicated they would follow-up this suggested diagnosis with a health professional. Personal, social and relationship 'costs' were rated as more severe than financial costs in relation to the bipolar condition, highlighting the burden of illness across differing domains. Results may not be generalizable to a community sample of individuals diagnosed with bipolar disorder. This web-based (E-health) screening strategy has proven to be extremely successful. Firstly, participants viewed the self-screening tool as useful, supporting the need for easily accessible mental health screening tools to assist with early detection and diagnosis. Secondly, this method has provided quantitative data on help-seeking behaviors, strategies employed to assist with mood problems, response to diagnosis, and the impact of a bipolar condition, which has previously been explored predominantly through qualitative means. The success of this strategy will next be assessed encouraging participants to have any bipolar disorder confirmed and more condition-specific management implemented to determine impact in illness course.

Les aspects culturels du trouble bipolaire : résultats d’une étude comparative entre des patients français et tunisiens

Bipolar disorders are one of the most potentially severe psychiatric disorders, implying a high degree of morbidity and incapacity for patients. Indeed, the World Health Organization in 1996 ranked them as the sixth most disabling condition worldwide. Major advances have been achieved in their understanding and management. However, too many patients do not yet benefit from them. As a matter of fact, bipolar disorders are still underestimated and under-recognized, being too often misdiagnosed with major depression or schizophrenia; the DSM-IV acknowledges the trend of clinicians to overdiagnose schizophrenia (rather than bipolar disorder), especially in ethnic groups and young people. Indeed, cultural factors may impact the symptomatology and the course of the disease. In particular, it has been shown by many authors that schizophrenia-like features are more likely to be found in southern countries. Similarly, the same authors have reported more manic than depressive episodes during the course of bipolar disorder. We aimed at comparing individuals with bipolar disorder living in two distinct geographic and cultural environments, namely France and Tunisia. Our study included two samples of 40 patients each, natives from the country, who were admitted during 2007 to the hospitals of Razi (Tunis, Tunisia) and Le Vinatier (Lyon, France) and suffering from a bipolar disorder according to the DSM-IV criteria. The French sample was constituted by all the patients meeting the inclusion criteria and the Tunisian one was selected by matching the patients by gender and duration of the disorder. Our results were consistent with the existing literature, showing many similarities and some marked differences such as a greater rate of manic episodes in the onset and during the course of the illness as well. The main result was the type of the first episode: mania in three quarter cases in Tunisia and depressive in the same proportion in France. The same figures applied to the recurrences. Unipolar mania, in particular, was three times more common in Tunisia than in France. Beyond the methodological biases (in-patients recruitment, diagnosis habits, cultural tolerance), these differences are also probably linked to climatic factors, such as temperature and photoperiod. The early detection of bipolar disorder is of crucial importance to provide specific treatments to patients. In a world where psychiatrists are more and more exposed to meet patients from various backgrounds, it is necessary to be aware of culture-bound features. Besides, the primacy of mania, in southern countries, may be a key to deepen our understanding of bipolar disorder and consequently its management.

Treatment of the early stages of bipolar disorder

SummaryFor many patients with bipolar disorder there is a long delay between the onset of illness and receiving a diagnosis and the initiation of treatment. This may have an adverse effect on the clinical outcome. Early intervention in bipolar disorder has received less attention than in schizophrenia, and there are relatively few specialist services in this area. This article reviews the literature on the early detection of bipolar disorder and on the effectiveness of pharmacological, psychological and psychosocial interventions in the early phase of the disorder.

Early detection of bipolar disorder: a pilot familial high‐risk study of parents with bipolar disorder and their adolescent children

Disturbances in cognition, affect, sleep and activity have been identified in bipolar disorder (BD) but little is known about the possible role of these factors in the development of the condition. We studied these variables in a familial high-risk sample. Twenty-five children (13-19 years) of bipolar parents were compared with 22 similar aged children of age- and sex-matched healthy controls. Participants were assessed using Schedule for Affective Disorders and Schizophrenia-Lifetime version (SADS-L) and completed self-report measures of dysfunctional attitudes, behavioural inhibition/activation, social rhythms, coping styles and subjective experience of sleep. Children completed a 7-day recording of actigraphy (sleep and activity) and a 7-day diary measuring self-esteem, positive and negative affect and reactions to positive and negative events. Fifty-six per cent of children of bipolar parents (CBP) reported mood symptoms compared to 9% of children of control parents (CC). The CBP group had coping styles and instability of self-esteem consistent with abnormal strategies for regulating affect. Both groups also differed on sleep measures. The majority of differences observed were between CBP with a current or past mood diagnosis and CC. BD parents reported dysfunctional coping styles and (to a lesser extent) disrupted activity patterns. A familial high-risk strategy for studying the role of psychological factors in BD is feasible and informative. This pilot study indicates that abnormal coping styles, instability of self-esteem and dysregulation of sleep may be early markers of bipolar illness. However, current findings need to be explored further in longitudinal studies to clarify which potential markers are truly predictive of BD.