Bipolar disorder and panic disorder in families: an analysis of chromosome 18 data.
ABSTRACT The authors performed an analysis of their published chromosome 18 linkage data on 28 families in which there was bipolar disorder to test the potential of comorbid panic disorder to define a genetic subtype of bipolar disorder.
Families ascertained through probands with bipolar I disorder were stratified into three groups based on a history of panic disorder, panic attacks, or no panic attacks in the probands. Multipoint nonparametric linkage analysis was performed on data from bipolar I and II family members in each group.
Linkage scores for five consecutive 18q marker loci were highest in the families of the probands with panic disorder and lowest for the families of the probands without panic attacks.
This study supports the authors' previously reported clinical hypothesis of a genetic subtype of bipolar disorder identified by comorbid panic disorder. The hypothesis merits prospective testing.
SourceAvailable from: Anne-Liis von Knorring[Show abstract] [Hide abstract]
ABSTRACT: Background We aimed to outline the early risk factors for adult bipolar disorder (BPD) in adolescents with mood disorders.Methods Adolescents (16¿17 years old) with mood disorders (n¿=¿287; 90 participants with hypomania spectrum episodes and 197 with major depressive disorder [MDD]) were identified from a community sample. Fifteen years later (at 30¿33 years of age), mood episodes were assessed (n¿=¿194). The risk of developing BPD (n¿=¿22), compared with MDD (n¿=¿104) or no mood episodes in adulthood (n¿=¿68), was estimated via logistic regression. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed as potential risk factors.ResultsAmong the adolescents with mood disorders, a family history of BPD was the strongest predictor of developing BPD compared with having no mood episodes in adulthood (OR¿=¿5.94; 95% CI¿=¿1.11-31.73), whereas disruptive disorders significantly increased the risk of developing BPD compared with developing MDD (OR¿=¿2.94; CI¿=¿1.06-8.12). The risk that adolescents with MDD would develop adult BPD, versus having no mood episodes in adulthood, was elevated among those with an early disruptive disorder (OR¿=¿3.62; CI¿=¿1.09-12.07) or multiple somatic symptoms (OR¿=¿6.60; CI¿=¿1.70-25.67). Only disruptive disorders significantly predicted adult BPD among adolescents with MDD versus continued MDD in adulthood (OR¿=¿3.59; CI¿=¿1.17-10.97). Only a few adolescents with hypomania spectrum episodes continued to have BPD as adults, and anxiety disorders appeared to increase this risk.Conclusions Although most of the identified potential risk factors are likely general predictors of continued mood disorders, disruptive disorders emerged as specific predictors of developing adult BPD among adolescents with MDD.BMC Psychiatry 12/2014; 14(1):3. DOI:10.1186/s12888-014-0363-z · 2.24 Impact Factor
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ABSTRACT: Atualmente, vemos transformações no diagnóstico do Transtorno de Humor Bipolar (THB). A prática clínica exige conhecimento mais detalhado da correlação THB - outras doenças psiquiátricas. Nessa revisão não-sistemática, foram abordados aspectos diagnósticos do THB: a) histórico, b) Espectro Bipolar, c) Depressão Atípica (DeA) e Disforia Histeróide, d) Estados Mistos, e) relação THB-Transtornos de Ansiedade, f) relação com o diagnóstico de Transtorno de Personalidade Borderline (TPB), g) contraponto ao conceito de espectro bipolar. A doença é conhecida desde a Grécia Antiga. Os estudos baseados nas publicações de Hagop Akiskal expandem o diagnóstico para além dos critérios usualmente utilizados, criando o conceito de espectro bipolar. A alta prevalência de comorbidade entre THB e Transtornos de Ansiedade corroboram que ambos compartilham o mesmo substrato neurobiológico. O debate demonstra que não há consenso, expondo a fragilidade dos nossos métodos diagnósticos. Entretanto, a revisão mostra a utilidade de sempre considerar o THB como diagnóstico diferencial.Revista de Psiquiatria do Rio Grande do Sul 04/2003; 25:22-32. DOI:10.1590/S0101-81082003000400004
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ABSTRACT: Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement. The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ). From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact. Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available. Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice. Copyright © 2014 Elsevier B.V. All rights reserved.Journal of Affective Disorders 11/2014; 174C:225-232. DOI:10.1016/j.jad.2014.10.057 · 3.76 Impact Factor