Presence Of Psychotic Features Research Articles

6.97 Comparison of Suicidal Thoughts and Behaviors in Adolescent Suicide Attempters With and Without the Presence of Psychotic Features

6.97 Comparison of Suicidal Thoughts and Behaviors in Adolescent Suicide Attempters With and Without the Presence of Psychotic Features

Role of DSM5 anxious distress specifier interview in acute manic episode: sociodemographic characteristics, clinical presentation and quality of life

BackgroundDSM 5 anxious distress specifier is one of the newly added specifiers for bipolar and related disorders. It may have impacts on the symptoms severity, insight, impulsivity, and different domains of quality of life of acute manic episodes of bipolar disorders. The current study aimed to study the effects of DSM 5 anxious distress specifier in acute manic episodes and its relation to sociodemographic data, clinical characteristics, and quality of life. 380 patients with the diagnosis of acute manic episode were recruited in the study, sociodemographic data, clinical features, DSM 5 anxious distress specifier interview, attitude and insight of the disorder, impulsivity and different aspects of quality of life were also evaluated in those patients.ResultsThe studied patients were divided into 2 subgroups according to the presence of high DSM5 anxious distress specifier interview score. The duration of a manic episode (P < 0.001), the severity of the manic episode (P < 0.001), and the presence of psychotic features (P = 0.002) were more common in the subgroup with high DSM 5 anxious distress. DSM 5 anxious distress specifier was severe (P < 0.001) and more frequent (P < 0.001) in the 1st subgroup than the 2nd one. There was a statistically significant difference regarding the attentional facet of the Barratt impulsiveness scale between the studied groups (P = 0.002). In addition, there was a statistically significant difference regarding the mean score (P < 0.001) and severe impairment (P < 0.001) domains of work and social adjustment scale between the 2 subgroups.ConclusionsDSM 5 anxious distress specifier interview is a very crucial parameter of evaluation the patients with acute manic episodes which may have implications on the clinical presentations, symptoms severity, impulsivity, and variable aspects of quality of life in those patients. All these implications might change the course, prognosis, and outcomes of an acute manic episode of bipolar disorder.

Effectiveness of mood stabilizers in prophylactic treatment of bipolar disorder

IntroductionProphylactic treatment during bipolar disorder aims to prevent recurrences and to improve the functional level.ObjectivesOur aim was to compare the clinical effectiveness of lithium versus sodium valproate in the prophylactic treatment of bipolar disorder type 1MethodsRetrospective, longitudinal, comparative study conducted among 162 patients followed for bipolar disorder type 1 hospitalized at the Psychiatry A department of Razi Hospital. The Alda scale and time to recurrence were used to compare the clinical effectiveness of the mood stabilizers.ResultsA difference between the two groups of patients was noted for some variables. Lithium prescription was associated with educational level, number of depressive episodes, suicide attempts, previous prescription of other thymoregulators, depressive polarity of the index episode and use of atypical antipsychotics.The prescription of Valproate was associated with educational level, unipolar mania, manic predominant polarity, manic polarity of the index episode, presence of psychotic features, prescription of long acting antipsychotics and higher doses of antipsychotics.The study of response by Alda scale showed no significant difference in the mean score of the scale nor in the rate of responders. We noted a higher rate of recurrence in patients on Valproate considering the whole duration of the study. The recurrence rate after one year was higher in patients on Lithium, the recurrence rate after two years was comparable in both groups. Survival curves showed earlier recurrences in patients on Lithium.ConclusionsThe efficacy of the two mood stabilizers was comparable. The recurrences occured earlier under Lithium.Disclosure of InterestNone Declared

Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features

Objective: The present study aimed to compare the intensity of inflammation between major depressive disorder (MDD) and bipolar disorder-depressive episode (BD-D) by using neutrophil to lymphocyte (NLR) and platelet to lymphocyte ratios (PLR) as nonspecific markers for peripheral immune response, and to investigate whether and how these parameters correlate with the clinical characteristics of the depressive episodes within and between the diagnoses. Patients and Methods: The medical records of 209 psychiatric inpatients (126 diagnosed with MDD, 83 with BD-D) and 150 healthy controls (HC) were retrospectively screened to obtain NLR and PLR values. Results: Both MDD and BD-D presented with significantly elevated NLR and PLR compared to HC, with the increase being associated with the severity of depression but not with the presence of psychotic features. The severity of inflammation was found to be of a comparable magnitude between the two conditions, or at least indistinguishable by means of the NLR and PLR. Conclusion: Our results suggest that both MDD and BD-D involve a presumably complex inflammatory process resulting in an observable, albeit nonspecific alteration in the distribution of peripheric blood cells. Moreover, the magnitude of the observed immune response appears to relate to the severity of the depressive episode for both conditions.

The impact of lifetime interpersonal and intentional trauma on cognition and vulnerability to psychosis in bipolar disorder

Background Studies have shown that over half of individuals with bipolar disorder experience early-life trauma, which may influence clinical outcomes, including suicidality and presence of psychotic features. However, studies report inconsistent findings regarding the effect of trauma on cognitive outcomes in bipolar disorder. Aims Our study explores the effect of lifetime trauma on the level of vulnerability to psychosis and cognitive performance in participants with bipolar disorder. Method We evaluated lifetime trauma history in 236 participants with a diagnosis of bipolar disorder type 1 or 2, using the Structured Clinical Interview for DSM-IV and the Childhood Trauma Questionnaire. We classified trauma types based on the Substance Abuse and Mental Health Services Administration's concept of trauma, which characterises the type of experienced trauma (e.g. interpersonal and intentional, accidental or naturally occurring). Our primary outcome measures of interest were vulnerability to psychosis (Schizotypal Personality Questionnaire), cognitive performance (MATRICS Consensus Cognitive Battery) and social functioning (Social Adjustment Scale Self-Report). Results Multivariate analysis of covariance showed a significant effect of trauma type on the Schizotypal Personality Questionnaire cognitive–perceptual domain (F(3) = 6.7, P &lt; 0.001). The no-trauma group had lower cognitive–perceptual schizotypal features compared with the accidental and intentional trauma (P &lt; 0.001) and interpersonal and intentional trauma (P = 0.01) groups. Conclusions Our results highlight the need for careful trauma inquiry in patients with bipolar disorder, and consideration of how trauma-focused or -informed treatments may be an integral part of treatment planning to improve outcomes in bipolar disorder.

T31. TIME TO TALK MENTAL HEALTH IN DUBAI: DESCRIBING A SAMPLE OF ADOLESCENT HELP-SEEKERS ACCESSING MENTAL HEALTH SERVICES

BackgroundMost mental health disorders begin to develop in adolescence and early adulthood. These disorders account for a significant portion of hospitalization and other societal costs. The United Arab Emirates (UAE) has a rapidly growing population, one-third of which is below 25 years of age. The UAE government has pointed at mental health as one of the areas requiring attention and has approved a strategic plan supporting mental health research, education and promotion with a specific focus on youth (Dubai Mental Health Strategy 2021). The current study represents the first investigation aimed at characterizing youth who access mental health services in the UAE (specifically Dubai).MethodsData was collected retrospectively from child psychiatry case records of inpatients who accessed the Mental Health Clinic at Rashid Hospital between 2011–2016. Patients who received a diagnosis of schizophrenia spectrum disorders, bipolar and related disorders, depressive disorders or anxiety disorders were included. From patients’ records, information collected included demographics, life stressors (related to family, friends, health, academic performance, or religion), duration of untreated illness (DUI), family history of mental illness, parents’ age and education, main diagnosis, presence/absence of psychotic features. Demographic information and family history had been acquired from patients and family members at the time of intake.ResultsThe final sample (N=99; Age 12–19) included 47.5% local (UAE national) and 52.5% non-local patients. The frequency of life stressors did not differ across ethnic groups except for relationships with friends, which were less likely to be reported as a source of stress among UAE nationals (χ2=4.35; p=0.04) compared to other nationalities. Suicidal thoughts were less common in patients with psychotic features compared to patients without psychotic features (χ2=4.64; p=0.03). A diagnosis of Depression was more common in females than males (χ2=3.93; p<.05) and was associated with more frequent suicidal thoughts (χ2=23.81; p<0.001) and self-harm behavior (χ2=16.20; p<0.001). Separate ANOVAs were conducted to explore the effect of different variables on DUI: results showed that presence of Psychotic features was associated with shorter DUI (F (1,55) =4.37; p<0.05) while Self-harm was associated with longer DUI (F (1,70) =5.82; p<0.05).DiscussionTo our knowledge, this is the first study attempting to describe youth who access mental health services in the urban multi-cultural context of Dubai. A number of interesting findings were highlighted. Relationships with friends were more likely to represent a source of stress for non-local than local patients, suggesting a possible role of adjustment and social stress in migrant/expatriate youth. Suicidal thoughts were more common in patients diagnosed with depressive disorders (somewhat expected) but less common in patients presenting psychotic features. Patients experiencing psychotic symptoms were accessing mental health services sooner (shorter DUI) compared to patients who did not experience psychotic symptoms, in line with previous literature. Interestingly, patients reporting self-harm behaviors had longer DUI. Several interpretations can be proposed, for example, it is possible that self-harm represented a copying strategy to temporarily “handle” mental illness and delay help seeking in our sample. Studies in support of this and alternative explanations will be discussed. Taken together, our study can be a useful start point to open prevention-focused mental health discussions in the UAE and lead to improved national policies to promote youth wellbeing in the region.

Sex difference in glia gene expression in the dorsolateral prefrontal cortex in bipolar disorder: Relation to psychotic features

BackgroundSuicide, psychotic features and gender influence the epidemiology and clinical prognosis of bipolar disorder (BD). Differences in glial function between the genders might contribute to these clinical variables. Here we studied expression of glial genes in human post-mortem prefrontal cortex of BD and control subjects in relation to suicide, psychotic features and sex. MethodsReal time PCR was used to detect transcriptional alterations of 16 glia-related genes in two brain areas, the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), from 30 patients with BD subdivided by suicide and psychotic features, and from 34 well-matched control cases. ResultsWe found no evidence of immune activation in BD. Instead, we found three microglial genes to be downregulated in the DLPFC of non-suicidal individuals with BD, i.e. CD68, triggering receptor expressed on myeloid cells 2 (TREM2) and purinergic receptor 12 (P2RY12). A remarkable sex difference was observed in the DLPFC of patients with BD: 14 glia-related genes were expressed at significantly higher levels in males, including all three glial cell types. A subset analysis showed that the sex differences were closely associated with the presence of psychotic features. ConclusionsNo evidence of immune activation was found in these two brain regions in BD. The sex-specific differences in glial gene expression in BD, found particularly in patients with psychotic features, may be associated with the potential co-existence of mania and psychotic features and could potentially contribute to the gender-biased characteristics in BD.

Predictors and prevalence of bipolar disorders in patients with a major depressive disorder

Introduction Onset of bipolar disorder (BD) involves a major depressive episode (MDE) in approximately half of type-I (BD-I) patients and three-quarters of those diagnosed with type-II (BD-II). Aim To detect the soft signs and the predictors of BD in patients with a MDE. Participants and methods A sample of 500 patients was solicited fulfilling the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for a current MDE. Patients were given the HCL-32-R2 questionnaire to assess the presence of manic/hypomanic symptoms; those scoring less than 14 were considered bipolar. We also examined whether demographics, psychiatric history, clinical characteristics, and the incidence of comorbid conditions differed significantly between patients with BD and unipolar disorder. Results A number of factors were highly predictive of bipolarity, including age at illness onset, family history of bipolarity, seasonality, mixed state, manic switch, mood irritability, and mood reactivity. Of the comorbidities examined, thyroid disorders, cardiovascular disorders, generalized anxiety disorder, presence of psychotic features, and borderline personality disorder occurred at a higher rate in patients with BDs than in those with unipolar disorders. Conclusion A number of factors in the patient’s psychiatric history as well as clinical aspects of the episode itself may signal an increased likelihood of bipolarity.

Neuroplasticity, Neurotransmission and Brain-Related Genes in Major Depression and Bipolar Disorder: Focus on Treatment Outcomes in an Asiatic Sample.

IntroductionMood disorders are common and disabling disorders. Despite the availability of over 100 psychotropic compounds, only one-third of patients benefit from first-line treatments. Over the past 20 years, many studies have focused on the biological factors modulating disease risk and response to treatments, but with still inconclusive data. In order to improve our current knowledge, in this study, we investigated the role of a set of genes involved in different pathways (neurotransmission, neuroplasticity, circadian rhythms, transcription factors, signal transduction and cellular metabolism) in the treatment outcome of major depressive disorder (MDD) and bipolar disorder (BD) after naturalistic pharmacological treatment.MethodsTotals of 242 MDD, 132 BD patients and 326 healthy controls of Asian ethnicity (Koreans) were genotyped for polymorphisms within 19 genes. Response and remission after 6–8 weeks of treatment with antidepressants and mood stabilizers were evaluated. In secondary analyses, genetic associations with disease risk and some disease-associated features (age of onset, suicide attempt and psychotic BD) were also tested.ResultsNone of the variants within the investigated genes was significantly associated with treatment outcomes. Some marginal association (uncorrected p < 0.01) was observed for HTR2A, BDNF, CHL1, RORA and HOMER1 SNPs. In secondary analyses, HTR2A (rs643627, p = 0.002) and CHL1 (rs4003413, p = 0.002) were found associated with risk for BD, HOMER1 (rs6872497, p = 0.002) with lifetime history of suicide attempt in patients, and RORA with early onset and presence of psychotic features in BD. Marginal results were also observed for ST8SIA2 and COMT.DiscussionDespite limitations linked to multiple testing on small samples, methodological shortcomings and small significance of the findings, this study may support the involvement of some candidate genes in the outcomes of treatments for mood disorders, as well as in BD risk and other disease features.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0781-2) contains supplementary material, which is available to authorized users.

Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis

Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors. Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not remission. Data on melancholic symptoms were inconclusive. ECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression. Declaration of interest None.

Reduced electroencephalogram responses to standard and target auditory stimuli in bipolar disorder and the impact of psychotic features: Analysis of event‐related potentials, spectral power, and inter‐trial coherence

Bipolar disorder (BD) is associated with reductions in the P3b event-related potential (ERP) response to target auditory stimuli, which suggests deficits in context updating. Previous studies have typically examined these responses in the temporal domain, which may not capture alterations in specific frequencies of phase-locked or induced electrophysiological activity. Therefore, the present study examined early and late ERPs in temporal and frequency domains in a bipolar sample with and without current psychotic features. The electroencephalogram (EEG) was recorded during an auditory oddball task. Seventy-five BD patients and 98 healthy controls (HCs) discriminated between standard and target tones. N1 ERPs to standards and P3b ERPs to targets were analyzed in the temporal domain. Event-related spectral perturbation (ERSP) and inter-trial coherence (ITC) were analyzed in the frequency domain. The early N1 response to standard tones was not significantly different between the total HC and BD samples irrespective of psychotic features. However, N1 amplitude was reduced in BD patients with psychotic features (BDP) compared to HCs and BD patients without psychotic features. P3b was reduced in BD patients versus HCs, with the BDP sample having the most reduced amplitude. In the time-frequency analysis, delta and theta ERSP and ITC were reduced across the time window for both standard and target stimuli in BD patients compared to HCs, but did not differ in the psychotic features analysis. The results provide neural evidence that BD is associated with disrupted sensory, attentional, and cognitive processing of auditory stimuli, which may be worsened with the presence of psychotic features.

Working Memory, Processing Speed, and IQ in Youth with Mood Disorders and Psychotic Features

The presence of psychotic symptoms is relatively common in severe manifestations of Bipolar Disorder (BD) and Major Depressive Disorder (MDD), but their occurrence and their effect on cognitive functioning in children and adolescents remain under-investigated areas of research. This brief report summarizes a study with child and adolescent psychiatric inpatients indicating that the presence of psychotic features with pediatric mood disorders adversely affects working memory and overall cognitive functioning ability.

Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample.

ObjectivesConsidering that suicide is one of the most common reasons of adolescent death worldwide, there is a lack of clinical awareness on suicidal behaviors of children and adolescents with autism spectrum disorder (ASD). The present study aims to assess the rate of suicidality (suicidal ideation, behaviors and attempts) and associated risk factors for suicidality in high functioning ASD.MethodsMedical records of 55 adolescents (six girls, 49 boys), aged between 7–20 years, with diagnosis of ASD were reviewed. The participants were all able to speak fluently and had no significant limitations in intellectual functioning. Clinical assessment of participants was carried out on the basis of Diagnostic and Statistical Manual of Mental Disorders 4th Edition, Text Revision criteria and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Eskin’s Suicide Screening Questionnaire and sociodemographic data form including detailed history of suicidal behaviors were used. The study group was also divided into suicidal and non-suicidal groups for the purpose of comparing the results.ResultsThe rate of suicidal behaviors was 29% and suicide attempt was 12.7%. Types of suicidality were behaviors (43.7%), thoughts (37.5%), and verbal declarations (18.7%). A number of bizarre acts were recorded. Rates of comorbid psychiatric disorders such as mood disorders, anxiety disorders and disruptive behaviors were 23.6%, 43.6% and 65.4% respectively. Groups with the psychotic features, positive family history for suicidal behaviors and completed suicide showed more suicidality than the non-suicidal group.ConclusionConsistent with the previous findings, rate of suicidality is higher in individuals with ASD. The type of suicidal behaviors showed some differences compared to typically developing individuals. The presence of psychotic features and positive family history for suicidality may be risk factors for suicidality in children and adolescents with ASD. To prevent suicide and implement protective health care systems, identifying the population at risk is crucial.

Impact of psychotic symptoms on cognitive functioning in child and adolescent psychiatric inpatients with severe mood disorders

Despite established differences in cognitive functioning of adults with mood disorder-related psychosis and those with non-affective psychotic disorders, there is limited evidence of the impact of psychotic symptoms on the cognitive functioning of children and adolescents with mood disorders. This study investigates IQ, working memory, and processing speed scores in 80 child and adolescent inpatients discharged from an intermediate care state psychiatric hospital, using a retrospective chart review. Associations between diagnosis based on DSM-IV criteria (7 with Major Depression- MDD; 43 with Bipolar Disorders-BD, and 30 with Mood Disorders Not Otherwise Specified-NOS), presence of current psychotic features, and cognitive functioning (WISC-IV IQ, Coding, Symbol Search, and Digit Span) were investigated using Multivariate Analyses of Variance. No differences were found in cognitive functioning between patients with MDD and BD, or between those with severe Mood Disorders (MDD or BD) and those with NOS, when controlling for age, gender, and presence of psychotic features. However, patients with severe mood disorders and psychotic features showed lower IQs and greater working memory deficits than those without psychotic features or NOS. Results are discussed in terms of treatment planning for children and adolescents at risk for developing psychotic symptoms and severe mood disorders.

Childhood trauma and treatment outcome in bipolar disorder

ABSTRACTThe aim of the present study was to investigate the potential influence of childhood trauma on clinical presentation, psychiatric comorbidity, and long-term treatment outcome of bipolar disorder. A total of 135 consecutive patients with bipolar disorder type I were recruited from an ongoing prospective follow-up project. The Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM–IV Axis I Disorders were administered to all participants. Response to long-term treatment was determined from the records of life charts of the prospective follow-up project. There were no significant differences in childhood trauma scores between groups with good and poor responses to long-term lithium treatment. Poor responders to long-term anticonvulsant treatment, however, had elevated emotional and physical abuse scores. Lifetime diagnosis of posttraumatic stress disorder (PTSD) was associated with poor response to lithium treatment and antidepressant use but not with response to treatment with anticonvulsants. Total childhood trauma scores were related to the total number of lifetime comorbid psychiatric disorders, antidepressant use, and the presence of psychotic features. There were significant correlations between all types of childhood abuse and the total number of lifetime comorbid psychiatric diagnoses. Whereas physical neglect was related to the mean severity of the mood episodes and psychotic features, emotional neglect was related to suicide attempts. A history of childhood trauma or PTSD may be a poor prognostic factor in the long-term treatment of bipolar disorder. Whereas abusive experiences in childhood seem to lead to nosological fragmentation (comorbidity), childhood neglect tends to contribute to the severity of the mood episodes.

Peripheral blood gene expression analysis implicates B lymphocyte proliferation and ribosomal S26 transcripts in cognitive dysfunction in people with remitted Major Depression

Residual impairments in cognitive domains including attention, memory, executive function, and social perception occur in about 40% of patients with Major Depressive Disorder (MDD) following remission from acute episodes (Conradi et al., 2011), and are associated with reductions in pre-morbid functioning and higher unemployment rates (Baune et al., 2010; Evans et al., 2014). Cognitive impairment in MDD may represent a trait marker, trait-byillness interaction marker, or endophenotype of MDD that is independent of the acute depressive state and particularly active in a subgroup of MDD patients (Hasler et al., 2004; Iverson et al., 2011). We explored the potential molecular underpinnings of such a ‘cognitive’ MDD phenotype in a well-matched pilot sample of remitted MDD patients with poorer versus better performance on cognitive testing. Because the phenotype is likely highly complex, polygenic, and heterogeneous, we performed weighted gene coexpression network analysis (WGCNA), a hypothesis-free systems biology approach that identifies ‘modules’ of co-regulated – and therefore functionally related – genes in transcriptomic datasets. After constructing a gene co-expression network from samples of all patients, we determined whether modules were correlated with poorer versus better cognitive performance. We additionally explored whether modules were also correlated with a continuous measure of cognitive performance in both groups. We utilized whole blood transcriptomic data from remitted MDD patients from the Adelaide Cognitive Function and Mood Study (CoFaMS, HREC RAH protocol no. 111230g) matched for race, gender, age, Hamilton Depression Scale score, presence of psychotic features during any depressive episode, educational status, annual household income, current drugand alcohol use, and

Seasonal pattern of manic episode admissions among bipolar I disorder patients is associated with male gender and presence of psychotic features

BackgroundBipolar I disorder (BD-I) patients demonstrate disrupted chronobiology expressed as seasonal variation in mood symptoms. The seasonal pattern (SP) specifier of mood disorders was recently extended by the DSM-5, to be applied to manic episodes. However, the significance of seasonality of manic episodes for the course of BD-I is unknown. In the present study we sought to identify clinical and demographic features that discriminate between BD-I patients with and without SP of manic admissions. MethodsBD-I patients (n=148) admitted at least twice with the same mood exacerbation type, were retrospectively followed between 2005 and 2013. Demographic and clinical characteristics were compared between BD-I patients with or without SP of manic admissions. ResultsSP of manic episode admissions, found in 31 (26%) of 117 BD-I patients with repeated manic episode admissions, was associated with higher rates of male gender (p=0.01), presence of psychotic features (p=0.01) and comorbid substance use disorder (p<0.05) compared to patients without SP. In a multivariate analysis, SP of manic episode admissions was associated with the presence of psychotic features (OR 8.42, 95% CI: 1.05–67.65, p<0.05) and male gender (OR 3.23, 95% CI: 1.08–9.65, p<0.05), but not with comorbidity of substance use disorder (OR 1.79, 95% CI: 0.71–4.50, p=0.24). LimitationsSeasonal psychological/environmental factors contributing to the emergent of mood episodes could not be ruled out. ConclusionsOur results suggest that SP of manic admissions is associated with male gender and the presence of psychotic features, thus might be associated with more severe form of the disorder.

Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder

BackgroundPublished data suggest that cannabis use is associated with several negative consequences for individuals with bipolar disorder (BD), including new manic episode onset, psychosis, and functional disability. Yet much less is known about cannabis use disorders (CUDs) in this population, especially in more acutely symptomatic groups. MethodsTo evaluate correlates of CUD comorbidity in BD, a retrospective chart review was conducted for 230 adult patients with bipolar I disorder (BDI) who were admitted to a university-affiliated private psychiatric hospital. Using a computer algorithm, a hospital administrator extracted relevant demographic and clinical data from the electronic medical record for analysis. ResultsThirty-six (16%) had a comorbid CUD. CUD comorbidity was significantly associated with younger age, manic/mixed episode polarity, presence of psychotic features, and comorbid nicotine dependence, alcohol use disorder (AUD), and other substance use disorders, but was associated with decreased likelihood of anxiety disorder comorbidity. With the exception of manic/mixed polarity and AUD comorbidity, results from multivariate analyses controlling for the presence of other SUDs were consistent with univariate findings. ConclusionPatients with BD and comorbid CUDs appear to be a complex population with need for enhanced clinical monitoring. Given increasing public acceptance of cannabis use, and the limited availability of evidenced-based interventions targeted toward CUDs in BD, psychoeducation and other treatment development efforts appear to be warranted.

Polymorphism in the promoter of the gene for the serotonin transporter affects the age of onset of major depressive disorder in the Japanese population

ObjectiveRecent research has suggested that a functional polymorphism in the promoter region of the serotonin transporter gene (serotonin transporter-linked polymorphic region, 5HTTLPR) may be implicated in gene–environment interactions leading to major depressive disorder (MDD). MethodsOur study examined the association between 5HTTLPR and clinical variables of MDD in the Japanese population. We genotyped 5HTTLPR in 216 patients with MDD and 213 age- and sex-matched controls. ResultsThe genotype distributions and allele frequencies were similar in the patients and controls. When the relationships between the polymorphism and several clinical variables (i.e., age of onset, number of episodes, presence of psychotic features, suicidal behavior, and family history) were examined, the dose of the long (l) allele had significant effects on the age of onset. ConclusionThese results suggest that 5HTTLPR may not be entirely related to the development of MDD but may be related to the age of onset of MDD, which may be due to gene–environment interactions in the Japanese population. LimitationsBecause of the low frequencies of psychotic features and suicidal behavior, our results must be treated with caution until they are replicated in larger numbers of Japanese samples. MDD patients did not undergo a structured interview. Clinical information from the medical records may have not been complete.

Placebo response in antipsychotic trials of patients with acute mania: Results of an individual patient data meta-analysis

We examined the role of placebo response in acute mania trials. Specifically, whether placebo response: (1) predicts treatment effect, (2) can be predicted by patient and study characteristics, and (3) can be predicted by a parsimonious model. We performed a meta-analysis of individual patient data from 10 registration studies (n=1019) for the indication acute manic episode of bipolar disorder. We assessed the effect of 14 determinants on placebo response. Primary outcome measures were mean symptom change score (MCS) on the Young Mania Rating Scale (YMRS) and response rate (RR), defined as ≥50% YMRS symptom improvement from baseline to endpoint. The overall placebo response was 8.5 points improvement on the YMRS (=27.9%) with a RR of 32.8%. Placebo response was significantly associated with the overall treatment response. Five determinants significantly (p<0.05) predicted the placebo response. The multivariate prediction model, which consisted of baseline severity, psychotic features at baseline, number of geographic regions, and region, explained 10.4% and 5.5% of the variance in MSC and RR, respectively. Our findings showed that the placebo response in efficacy trials of antipsychotics for acute mania is substantial and an important determinant of treatment effect. Placebo response is influenced by patient characteristics (illness severity and presence of psychotic features) and by study characteristics (study year, number of geographic regions and region). However, the prediction model could only explain the placebo response to a limited extent. Therefore, limiting trials to certain patients in certain geographic regions seems not a viable strategy to improve assay sensitivity.