Article

A French network of bipolar expert centres: A model to close the gap between evidence-based medicine and routine practice

December 2010
Journal of Affective Disorders 131(1-3):358-63

December 2010
131(1-3):358-63

DOI:10.1016/j.jad.2010.11.013

Source
PubMed

Authors:

Chantal Henry

French Institute of Health and Medical Research

Bruno Etain

University Paris Cité

Flavie Mathieu

French Institute of Health and Medical Research

Aurélie Raust

Hôpital Albert Chenevier – Hôpitaux Universitaires Henri Mondor

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Bipolar disorders are a major public health concern. Efforts to provide optimal care by general practitioners and psychiatrists are undermined by the complexity of the disorder and difficulties in applying clinical practice guidelines and new research findings to the spectrum of cases seen in day to day practice. A national network of bipolar expert centres was established. Each centre has established strong links to local health services and provides support to clinicians in delivering personalized care plans derived from systematic case assessments undertaken at the centre. A common set of diagnostic and clinical assessment tools has been adopted at eight centres. Evaluations are undertaken by trained assessors and cross-centre reliability is monitored. A web application, e-bipolar© is used to record data in a common computerized medical file. Anonymized data is entered into a shared national database for use in multi-centre audit and research. Instead of offering treatment advice based on clinical practice guidelines recommendations for selected sub-populations of patients (a 'top-down' approach), the French bipolar network offers systematic, comprehensive, longitudinal, and multi-dimensional assessments of cases representative of general bipolar populations. This 'bottom-up' strategy may offer a more efficient and effective way to transfer knowledge and share expertise as the referrer can appreciate the rationale underpinning suggested treatment protocols and more readily apply such principles and approaches to other cases. The network also builds an infrastructure for clinical cohort and comparative-effectiveness research on more representative patient populations.

The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy

Article

Full-text available

Jan 2019

Background: Measuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities. Methods: This multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities. Discussion: The development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care. Trial registration: NCT02491866.

Outcomes for bipolar patients assessed in the French expert center network: A 2-year follow-up observational study (FondaMental Advanced Centers of Expertise for Bipolar Disorder [FACE-BD])

Article

Sep 2017

Objective: A new health care system for patients with bipolar disorders was established in France under the auspices of Fondation FondaMental, based on thorough clinical assessment of patients and on close collaborations between expert centers and referring practitioners. We report the results of outcomes after 2 years of observational follow-up of adult patients assessed within the network. Method: A total of 984 patients were included in the study. We compared several parameters (e.g., mood episodes and hospitalization) 1 year before inclusion and after 2 years of observational follow-up using the patient as his or her own control. Other outcomes were compared at baseline and during follow-up. We estimated the evolution of these parameters over a period of 2 years using mixed models for continuous parameters and a generalized estimating equation (GEE) model for categorical variables, adjusting for potential confounding factors. Results: Mean age was 42.7 (±12.5) years and 58.8% were women. The number of hospitalization days decreased by 55% when comparing 1 year before inclusion vs the follow-up period. In addition, patients showed a clear functional improvement associated with a reduction of residual mood symptoms, diminished psychiatric comorbidities, improvement of sleep and a better adherence to treatment. Conclusions: This study demonstrates an overall improvement of patients followed for 2 years after an assessment in expert centers for bipolar disorders. This new organization based on a thorough clinical assessment and on personalized recommendations (drug treatments, psycho-social strategies and lifestyle measures) sent to health care professionals, and actively involving patients and families, improves the prognosis of BD patients.

Research Needs for Bipolar Disorder From Clinicians’ Perspectives: Narrowing the Research–Practice Gap

Article

Full-text available

Jun 2019

Research evidence is incompletely translated into clinical practice. This study aimed to explore research needs from clinicians’ perspectives in the field of bipolar disorder and their reflections on patients’ research needs as well as to unravel the potential role of researcher-clinicians, to narrow the research practice gap. Using focus group discussions (FGDs) and interviews, research needs according to psychiatrists, psychologists, and nurses working with bipolar disorder were explored. Subsequently, we interviewed researcher-clinicians to gain insights into their views on patients’ research needs. The clinicians’ research needs were clustered as: causes, diagnosis, pharmacotherapy, nonpharmacological treatment, recovery, and care system, and overlapped with the research needs formulated by patients. Researcher-clinicians were able to translate patients’ needs into feasible research questions. Researcher-clinicians can serve as intermediaries between research and practice and can both integrate their practical experience into research and their research experience into practice.

Clinical characteristics associated with discrepancies between self- and clinician-rated suicidal ideation in patients with bipolar disorder (FACE-BD cohort)

Article

Mar 2023
PSYCHIAT RES

Suicidal ideation (SI) is a major suicide risk factor; therefore, it is crucial to identify individuals with SI. Discrepancies between the clinicians and patients' estimation of SI may lead to under-evaluating the suicide risk. Yet, studies on discrepancies between self- and clinician-rated SI are lacking, although identifying the patients' sociodemographic and clinical characteristics associated with such discrepancies might help to reduce the under-evaluation risk. Therefore, the aim of this study was to identify features associated with SI rating discrepancies in patients with bipolar disorder (BD) because of the high prevalence of suicide in this population. Among the patients recruited by the French network of FondaMental expert centers for BD, patients with SI (i.e. ≥2 for item 12 of the Quick Inventory of Depressive Symptomatology-Self Report and/or ≥3 for item 10 of the clinician-rated Montgomery and Åsberg Depression Rating Scale) were selected and divided in concordant (i.e. SI in both self- and clinician-rated questionnaires; n = 130; 25.6%), and discordant (i.e. SI in only one questionnaire; n = 377; 74.4%). Depression severity was the feature most associated with SI evaluation discrepancy, especially in patients with SI identified only with the self-rated questionnaire. Clinician may under-evaluate SI presence in patients with low depression level.

Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort

Article

Mar 2022
J AFFECT DISORDERS

Background The FACE-BD cohort is an observational cohort of individuals with bipolar disorders (BD) who benefited from a systematic evaluation with evidence-based treatment recommendations and who were followed-up every year for 3 years in France. The objectives were to describe the lifetime course of BD, associated psychiatric and somatic comorbidities, and cognition profile. This cohort aims to identify clinical/biological signatures of outcomes, trajectories of functioning and transition between clinical stages. This article summarizes 10 years of findings of the FACE-BD cohort. Method & results We included 4422 individuals, all having a baseline assessment, among which 61.2% had at least one follow-up visit at either one, two or three years. A subsample of 1200 individuals had at least one biological sample (serum, plasma, DNA). Assessments include family history of psychiatric disorders, psychiatric diagnosis, current mood symptoms, functioning, hospitalizations, suicidal attempts, physical health, routine blood tests, treatment history, psychological dimensions, medico-economic data and a cognitive assessment. Studies from this cohort illustrate that individuals with BD display multiple coexistent psychiatric associated conditions including sleep disturbances, anxiety disorders, substance use disorders and suicide attempts as well as a high prevalence of metabolic syndrome. During follow-up, we observed a 55% reduction of the number of days of hospitalization and a significant improvement in functioning. Conclusions The FACE-BD cohort provides a strong research infrastructure for clinical research in BD and has a unique position among international cohorts because of its comprehensive clinical assessment and sustainable funding from the French Ministry of Health.

Handedness in bipolar disorders is associated with specific neurodevelopmental features: results of the BD-FACE cohort

Article

Full-text available

Aug 2021
EUR ARCH PSY CLIN N

Objectives High rates of non-right-handedness (NRH) and mixed-handedness exist in neurodevelopmental disorders. Dysfunctional neurodevelopmental pathways may be implicated in the underlying pathophysiology of bipolar disorders (BD), at least in some subgroups. Yet little is known about correlates of NRH and mixed-handedness in BD. The objectives of this national study are to determine (i) the prevalence of NRH and mixed-handedness in a well-stabilized sample of BD individuals; (ii) if NRH/mixed-handedness in BD is associated with a different clinical, biological and neurocognitive profile. Methods We included 2174 stabilized individuals. Participants were tested with a comprehensive battery of neuropsychological tests. Handedness was assessed using a single oral question. Learning and/or language disorders and obstetrical complications were recorded using childhood records. Common environmental, clinical and biological parameters were assessed. ResultsThe prevalence of NRH and mixed-handedness were, respectively, 11.6 and 2.4%. Learning/language disorders were found in 9.7% out of the total sample and were associated with atypical handedness (only dyslexia for mixed-handedness (p < 0.01), and dyslexia and dysphasia for NRH (p = 0.01 and p = 0.04, respectively). In multivariate analyses, NRH was associated with a younger age of BD onset (aOR 0.98 (95% CI 0.96–0.99) and lifetime substance use disorder (aOR 1.40 (95% CI 1.03–1.82) but not with any of the cognitive subtasks. Mixed-handedness was associated in univariate analyses with lifetime substance use disorder, lifetime cannabis use disorder (all p < 0.01) and less mood stabilizer prescription (p = 0.028). No association was found between NRH or mixed-handedness and the following parameters: trauma history, obstetrical complications, prior psychotic symptoms, bipolar subtype, attention deficit/hyperactivity disorder, peripheral inflammation or body mass index.Conclusions Handedness may be associated with specific features in BD, possibly reflecting a specific subgroup with a neurodevelopmental load.

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial

Article

Full-text available

Feb 2021
TRIALS

Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. ClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.

Non-Alcoholic Fatty Liver Disease in a sample of individuals with Bipolar Disorders: Results From the FACE-BD Cohort

Article

Oct 2020
ACTA PSYCHIAT SCAND

Objective: Non-Alcoholic Fatty Liver Disease (NAFLD) is becoming the most common liver disease in Western populations. While obesity and metabolic abnormalities are highly frequent in bipolar disorders (BD), no studies have been performed to estimate the prevalence of NALFD in individuals with BD. The aim of our study is to estimate the prevalence of NAFLD and to identify the potential associated risk factors in a large sample of BD individuals. Methods: Between 2009 and 2019, 1969 BD individuals from the FACE-BD cohort were included. Individuals with liver diseases, Hepatitis B or C, and current alcohol use disorders were excluded from the analyses. A blood sample was drawn from participants. Screening of NAFLD was determined using Fatty Liver Index (FLI). Individuals with FLI>60 were considered as having NAFLD. Results: The prevalence of NAFDL in this sample was estimated at 28.4%. NAFLD was observed in 40% of men and 21% of women. NAFLD was independently associated with older age, male gender, sleep disturbances and current use of atypical antipsychotics or anxiolytics. As expected, the prevalence of NALFD was also higher in individuals with overweight and in those with metabolic syndrome. Conclusions: This study reinforces the view that individuals with BD are highly vulnerable to metabolic and cardio-vascular diseases. The prevalence of NAFLD in individuals with BD was two times higher than the prevalence reported in the general population. The regular screening of the MetS in individuals with BD should be therefore complemented by the additional screening of NAFLD among these vulnerable individuals.

Incidence and predictors of metabolic syndrome onset in individuals with bipolar disorders: A longitudinal study from the FACE-BD cohort

Article

Jan 2024
ACTA PSYCHIAT SCAND

Introduction Metabolic syndrome (MetS) is a cluster of components including abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. MetS is highly prevalent in individuals with bipolar disorders (BD) with an estimated global rate of 32.6%. Longitudinal data on incident MetS in BD are scarce and based on small sample size. The objectives of this study were to estimate the incidence of MetS in a large longitudinal cohort of 1521 individuals with BD and to identify clinical and biological predictors of incident MetS. Methods Participants were recruited from the FondaMental Advanced Center of Expertise for Bipolar Disorder (FACE‐BD) cohort and followed‐up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Individuals without MetS at baseline but with MetS during follow‐up were considered as having incident MetS. A logistic regression model was performed to estimate the adjusted odds ratio and its corresponding 95% confidence interval (CI) for an association between each factor and incident MetS during follow‐up. We applied inverse probability‐of‐censoring weighting method to minimize selection bias due to loss during follow‐up. Results Among individuals without MetS at baseline ( n = 1521), 19.3% developed MetS during follow‐up. Multivariable analyses showed that incident MetS during follow‐up was significantly associated with male sex (OR = 2.2, 95% CI = 1.7–3.0, p < 0.0001), older age (OR = 2.14, 95% CI = 1.40–3.25, p = 0.0004), presence of a mood recurrence during follow‐up (OR = 1.91, 95% CI = 1.22–3.00, p = 0.0049), prolonged exposure to second‐generation antipsychotics (OR = 1.56, 95% CI = 0.99, 2.45, p = 0.0534), smoking status at baseline (OR = 1.30, 95% CI = 1.00–1.68), lifetime alcohol use disorders (OR = 1.33, 95% CI = 0.98–1.79), and baseline sleep disturbances (OR = 1.04, 95% CI = 1.00–1.08), independently of the associations observed for baseline MetS components. Conclusion We observed a high incidence of MetS during a 3 years follow‐up (19.3%) in individuals with BD. Identification of predictive factors should help the development of early interventions to prevent or treat early MetS.

Subjects suffering from bipolar disorder taking lithium are less likely to report physical pain: a FACE-BD study

Article

Full-text available

Dec 2023

Background Physical pain is a common issue in people with bipolar disorder (BD). It worsens mental health and quality of life, negatively impacts treatment response, and increases the risk of suicide. Lithium, which is prescribed in BD as a mood stabilizer, has shown promising effects on pain. Methods This naturalistic study included 760 subjects with BD ( FACE-BD cohort) divided in two groups: with and without self-reported pain (evaluated with the EQ-5D-5L questionnaire). In this sample, 176 subjects were treated with lithium salts. The objectives of the study were to determine whether patients receiving lithium reported less pain, and whether this effect was associated with the recommended mood-stabilizing blood concentration of lithium. Results Subjects with lithium intake were less likely to report pain (odds ratio [OR] = 0.59, 95% confidence interval [CI], 0.35–0.95; p = 0.036) after controlling for sociodemographic variables, BD type, lifetime history of psychiatric disorders, suicide attempt, personality traits, current depression and anxiety levels, sleep quality, and psychomotor activity. Subjects taking lithium were even less likely to report pain when lithium concentration in blood was ≥0.5 mmol/l (OR = 0.45, 95% CI, 0.24–0.79; p = 0.008). Conclusions This is the first naturalistic study to show lithium’s promising effect on pain in subjects suffering from BD after controlling for many confounding variables. This analgesic effect seems independent of BD severity and comorbid conditions. Randomized controlled trials are needed to confirm the analgesic effect of lithium salts and to determine whether lithium decreases pain in other vulnerable populations.

Crossed clinical features between eating disorders and types of bipolar disorder: Results from the FondaMental Advanced Centers of Expertise - Bipolar Disorder cohort

Article

May 2023
J AFFECT DISORDERS

Background: Eating disorders (EDs) are liable to alter the disease course of bipolar disorder (BD). We explored the crossed clinical features between EDs and BD, particularly as a function of BD type (BD1 vs. BD2). Methods: 2929 outpatients attending FondaMental Advanced Centers of Expertise were assessed for BD and lifetime EDs with a semi-structured interview, and their sociodemographic, dimensional and clinical data were collected according to a standardized procedure. For each ED type, bivariate analyses were used to investigate associations between these variables and the type of BD type followed by multinomial regressions with the variables associated with EDs and BDs after Bonferroni correction. Results: Comorbid EDs were diagnosed in 478 (16.4 %) cases, and were more prevalent in patients with BD2 than in those with BD1 (20.6 % vs. 12.4 %, p < 0.001). Regression models showed no difference according to the subtype of bipolar disorder on the characteristics of patients with anorexia nervosa (AN), bulimia nervosa (BN) or binge eating disorder (BED). After multiple adjustments, the factors differentiating BD patients with versus without ED were primarily age, gender, body mass index, more affective lability and comorbidity with anxiety disorders. BD patients with BED also scored higher regarding childhood trauma. BD patients with AN also showed higher risk of past suicide attempts than those with BED. Conclusions: In a large sample of patients with BD, we found a high prevalence of lifetime EDs, especially for the BD2 type. EDs were associated with several severity indicators, but not with BD type-specific characteristics. This should prompt clinicians to carefully screen patients with BD for EDs, regardless of BD and ED types.

Associations of white blood cell and platelet counts with specific depressive symptom dimensions in patients with bipolar disorder: Analysis of data from the FACE-BD cohort

Article

Dec 2022
BRAIN BEHAV IMMUN

Evidences suggest that inflammation is increased in a subgroup of patients with depression. Moreover, increased peripheral inflammatory markers (cells and proteins) are associated with some, but not all depressive symptoms. On the other hand, similar studies on bipolar disorders mainly focused on blood cytokines. Here, we analysed data from a large (N = 3440), well-characterized cohort of individuals with bipolar disorder using Kendall partial rank correlation, multivariate linear regression, and network analyses to determine whether peripheral blood cell counts are associated with depression severity, its symptoms, and dimensions. Based on the self-reported 16-Item Quick Inventory of Depressive Symptomatology questionnaire scores, we preselected symptom dimensions based on literature and data-driven principal component analysis. We found that the counts of all blood cell types were only marginally associated with depression severity. Conversely, white blood cell count was significantly associated with the sickness dimension and its four components (anhedonia, slowing down, fatigue, and appetite loss). Platelet count was associated with the insomnia/restlessness dimension and its components (initial, middle, late insomnia and restlessness). Principal component analyses corroborated these results. Platelet count was also associated with suicidal ideation. In analyses stratified by sex, the white blood cell count-sickness dimension association remained significant only in men, and the platelet count-insomnia/restlessness dimension association only in women. Without implying causation, these results suggest that peripheral blood cell counts might be associated with different depressive symptoms in individuals with bipolar disorder, and that white blood cells might be implicated in sickness symptoms and platelets in insomnia/agitation and suicidal ideation.

Self-Reported Pain and Emotional Reactivity in Bipolar Disorder: A Prospective FACE-BD Study

Article

Full-text available

Feb 2022

In patients with bipolar disorder (BD), pain prevalence is close to 30%. It is important to determine whether pain influences BD course and to identify factors associated with pain in BD in order to guide BD management. This naturalistic, prospective study used data on 880 patients with BD from the French FACE-BD cohort who were divided into two groups according to the presence or absence of pain. Multivariate models were used to test whether pain was associated with affective states and personality traits while controlling for confounders. Then, multivariate models were used to test whether pain at baseline predicted global life functioning and depressive symptomatology at one year. At baseline, 22% of patients self-reported pain. The pain was associated with depressive symptomatology, levels of emotional reactivity in a quadratic relationship, and a composite variable of personality traits (affective lability, affective intensity, hostility/anger, and impulsivity). At one year, the pain was predictive of depression and lower global life functioning. Pain worsens mental health and well-being in patients with BD. The role of emotions, depression, and personality traits in pain has to be elucidated to better understand the high prevalence of pain in BD and to promote specific therapeutic strategies for patients experiencing pain.

Association between childhood maltreatment and the clinical course of bipolar disorders: a survival analysis of mood recurrences

Article

Jan 2022

Association between childhood maltreatment and the clinical course of bipolar disorders: A survival analysis of mood recurrences

Article

Full-text available

Jan 2022
ACTA PSYCHIAT SCAND

Objectives: Childhood maltreatment, also referred as childhood trauma, increases the severity of Bipolar Disorders (BD). Childhood maltreatment has been associated with more frequent mood recurrences, however mostly in retrospective studies. Since scarce, further prospective studies are required to identify whether childhood maltreatment may be associated with the time to recurrence in BD. Methods: Individuals with BD (N=2008) were assessed clinically and for childhood maltreatment at baseline, and followed-up for two years. The cumulative probability of mood recurrence over time was estimated with the Turnbull's extension of the Kaplan-Meier analysis for interval-censored data, including childhood maltreatment as a whole, and then maltreatment subtypes as predictors. Analyses were adjusted for potential confounding factors. Results: The median duration of follow-up was 22.3 month (IQR:12.0-24.8). Univariable analyses showed associations between childhood maltreatment, in particular all types of abuses (emotional, physical and sexual) or emotional neglect, and a shorter time to recurrence (all p values <0.001). When including potential confounders into the multivariable models, the time to mood recurrence was associated with multiple/severe childhood maltreatment (i.e. total score above the 75th percentile) (HR=1.32 95%CI(1.11-1.57), p=0.002), and more specifically with moderate/severe physical abuse (HR=1.44 95%CI(1.21-1.73), p<0.0001). Living alone, lifetime anxiety disorders, lifetime number of mood episodes, baseline depressive and (hypo)manic symptoms and baseline use of atypical antipsychotics were also associated with the time to recurrence. Conclusions: In addition to typical predictors of mood recurrences, an exposure to multiple/severe forms of childhood maltreatment, and more specifically to moderate to severe physical abuse, may increase the risk for a mood recurrence in BD. This leads to the recommendations of more scrutiny and denser follow-up of the individuals having been exposed to such early life stressors.

Violent suicide attempt history in elderly patients with bipolar disorder: The role of sex, abdominal obesity, and verbal memory: Results from the FACE-BD cohort (FondaMental Advanced center of Expertise for Bipolar Disorders)

Article

Oct 2021
J AFFECT DISORDERS

Background: . Bipolar disorder (BD) is a chronic, lifelong condition, associated with increased risk of obesity, cognitive impairment, and suicidal behaviors. Abdominal obesity and a higher risk of violent suicide attempt (SA) seem to be shared correlates with older age, BD, and male sex until middle age when menopause-related female body changes occur. This study aimed at assessing the role of abdominal obesity and cognition in the violent SA burden of individuals with BD. Methods: . From the well-defined nationwide cohort FACE-BD (FondaMental Advanced center of Expertise for Bipolar Disorders), we extracted data on 619 euthymic BD patients that were 50 years or older at inclusion. Cross-sectional clinical, cognitive, and metabolic assessments were performed. SA history was based on self-report. Results: . Violent SA, in contrast to non-violent and no SA, was associated with higher waist circumference, abdominal obesity and poorer California Verbal Learning Test short-delay free recall (CVLT-SDFR) (ANOVA, p < .001, p = .014, and p = .006). Waist circumference and abdominal obesity were associated with violent SA history independently of sex, BD type and anxiety disorder (Exp(B) 1.02, CI 1.00 - 1.05, p = .018; Exp(B) 2.16, CI 1.00 - 4.64, p = .009, accordingly). In an exploratory model, waist circumference and CVLT-SDFR performance mediated the association between male sex and violent SA. Limitations: . Cross-sectional design and retrospective reporting. Conclusions: . Violent SA history was associated with abdominal obesity and poorer verbal memory in older age BD patients. These factors were interlinked and might mediate the association between male sex and violent SA.

Identification of inflammatory subgroups of schizophrenia and bipolar disorder patients with HERV-W ENV antigenemia by unsupervised cluster analysis

Article

Full-text available

Jul 2021

Human endogenous retroviruses (HERVs) are remnants of infections that took place several million years ago and represent around 8% of the human genome. Despite evidence implicating increased expression of HERV type W envelope (HERV-W ENV) in schizophrenia and bipolar disorder, it remains unknown whether such expression is associated with distinct clinical or biological characteristics and symptoms. Accordingly, we performed unsupervised two-step clustering of a multivariate data set that included HERV-W ENV protein antigenemia, serum cytokine levels, childhood trauma scores, and clinical data of cohorts of patients with schizophrenia (n = 29), bipolar disorder (n = 43) and healthy controls (n = 32). We found that subsets of patients with schizophrenia (~41%) and bipolar disorder (~28%) show positive antigenemia for HERV-W ENV protein, whereas the large majority (96%) of controls was found to be negative for ENV protein. Unsupervised cluster analysis identified the presence of two main clusters of patients, which were best predicted by the presence or absence of HERV-W ENV protein. HERV-W expression was associated with increased serum levels of inflammatory cytokines and higher childhood maltreatment scores. Furthermore, patients with schizophrenia who were positive for HERV-W ENV protein showed more manic symptoms and higher daily chlorpromazine (CPZ) equivalents, whereas HERV-W ENV positive patients with bipolar disorder were found to have an earlier disease onset than those who were negative for HERV-W ENV protein. Taken together, our study suggest that HERV-W ENV protein antigenemia and cytokines can be used to stratify patients with major mood and psychotic disorders into subgroups with differing inflammatory and clinical profiles.

The course of bipolar disorder as a function of the presence and sequence of onset of comorbid alcohol use disorders in outpatients attending the Fondamental Advanced Centres of Expertise

Article

Mar 2021
J AFFECT DISORDERS

Objectives: The comorbidity of alcohol use disorder (AUD) and bipolar disorder (BD) has been repeatedly associated with poorer clinical outcomes than BD without AUD. We aimed to extend these findings by focusing on the characteristics associated with the sequence of onset of BD and AUD. Methods: 3,027 outpatients from the Fondamental Advanced Centres of Expertise were ascertained for BD-1, BD-2 and AUD diagnoses, including their respective ages at onset (AAOs, N =2,804). We selected the variables associated with both the presence and sequence of onset of comorbid AUD using bivariate analyses corrected for multiple testing to enter a binary regression model with the sequence of onset of BD and AUD as the dependent variable (AUD first - which also included 88 same-year onsets, vs. BD first). Results: BD patients with comorbid AUD showed more severe clinical profile than those without. Compared to BD-AUD (N =269), AUD-BD (N =276) was independently associated with a higher AAO of BD (OR =1.1, p <0.001), increased prevalence of comorbid cannabis use disorder (OR =2.8, p <0.001) a higher number of (hypo)manic/mixed BD episodes per year of bipolar illness (OR =3, p <0.01). Limitations: The transversal design prevents from drawing causal conclusions. Conclusion: Increased severity of BD with AUD compared to BD alone did not differ according to the sequence of onset. A few differences, though, could be used to better monitor the trajectory of patients showing either one of these disorders.

A conceptual framework to develop a patient-reported experience measure of the quality of mental health care: a qualitative study of the PREMIUM project in France

Article

Full-text available

Feb 2021

Background: The objective of this study was to develop a conceptual framework to define a domain map describing the experience of patients with severe mental illnesses (SMIs) on the quality of mental health care. Methods: This study used an exploratory qualitative approach to examine the subjective experience of adult patients (18–65 years old) with SMIs, including schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Participants were selected using a purposeful sampling method. Semistructured interviews were conducted with 37 psychiatric inpatients and outpatients recruited from the largest public hospital in southeastern France. Transcripts were subjected to an inductive analysis by using two complementary approaches (thematic analysis and computerized text analysis) to identify themes and subthemes. Results: Our analysis generated a conceptual model composed of 7 main themes, ranked from most important to least important as follows: interpersonal relationships, care environment, drug therapy, access and care coordination, respect and dignity, information and psychological care. The interpersonal relationships theme was divided into 3 subthemes: patient-staff relationships, relations with other patients and involvement of family and friends. All themes were spontaneously raised by respondents. Conclusion: This work provides a conceptual framework that will inform the subsequent development of a patient-reported experience measure to monitor and improve the performance of the mental health care system in France. The findings showed that patients with SMIs place an emphasis on the interpersonal component, which is one of the important predictors of therapeutic alliance. Trial registration: NCT02491866

Pharmacological treatment profiles in the FACE-BD cohort: An unsupervised machine learning study, applied to a nationwide bipolar cohort

Article

Feb 2021
J AFFECT DISORDERS

Background : Despite thorough and validated clinical guidelines based on bipolar disorders subtypes, large pharmacological treatment heterogeneity remains in these patients. There is limited knowledge about the different treatment combinations used and their influence on patient outcomes. We attempted to determine profiles of patients based on their treatments and to understand the clinical characteristics associated with these treatment profiles. Methods : This multicentre longitudinal study was performed on a French nationwide bipolar cohort database. We performed hierarchical agglomerative clustering to search for clusters of individuals based on their treatments during the first year following inclusion. We then compared patient clinical characteristics according to these clusters. Results : Four groups were identified among the 1795 included patients: group 1 (“heterogeneous” n=1099), group 2 (“lithium” n= 265), group 3 (“valproate” n=268), and group 4 (“lamotrigine” n=163). Proportion of bipolar 1 disorder, in groups 1 to 4 were: 48.2%, 57.0%, 48.9% and 32.5%. Groups 1 and 4 had greater functional impact at baseline and a less favorable clinical and functioning evolution at one-year follow-up, especially on GAF and FAST scales. Limitations : The one-year period used for the analysis of mood stabilizing treatments remains short in the evolution of bipolar disorder. Conclusions : Treatment profiles are associated with functional evolution of patients and were not clearly determined by bipolar subtypes. These profiles seem to group together common patient phenotypes. These findings do not seem to be influenced by the duration of disease prior to inclusion and neither by the number of treatments used during the follow-up period. Free access link : https://authors.elsevier.com/a/1cnULbXYijYn7

Ressources allouées à la recherche en santé mentale - Manuscrit Thèse JB Hazo

Thesis

Full-text available

Jun 2018

Jean-Baptiste Hazo

À la fin des années 90, la santé mentale et les troubles psychiatriques ont émergés comme des priorités de santé publique, notamment du fait de nouvelles mesures de la morbidité. Le poids des troubles mentaux s’accroit dans les sociétés occidentales, et les traitements et prises en charges des personnes touchées par les troubles n’ont pas connus d’avancées majeures ces trente à cinquante dernières années. Les volontés politiques, rapports et autres appels à réformer le champ psychiatrique et la question sociétale de santé mentale sont souvent restés lettre morte et la notion de santé mentale, peut-être parce qu’à la croisée de nombreuses disciplines, est âprement débattue, tout comme les investissements de recherche dont elle fait l’objet. Pour évaluer les principales priorités de la recherche dans le domaine, l’Union Européenne a financé un projet de recherche entre 2011 et 2015 : ROAMER (A roadmap for mental health research in Europe). Notre équipe constituait le groupe de travail en charge d’effectuer l’état des lieux des ressources humaines, financières et infrastructurelles mobilisées pour la recherche en santé mentale. Nous avons estimé le volume des financements publics du programme FP7 de l’Union Européenne (2007-13), et en 2011 de l’Espagne, la Finlande, la France et du Royaume-Uni alloués à la recherche en santé mentale, et la part de recherche en santé dédiée à la santé mentale en UE et dans ces pays. Des bases de données dédiées ont été mobilisées pour connaître les infrastructures et formations utiles à la recherche en santé mentale en Europe et une revue de littérature sur ces thématiques a été conduite. Ces résultats ont été présentés à deux focus groupes pour identifier les manques et avancées à réaliser dans les trois domaines de ressources au moyen d’une liste de préconisations. Ces préconisations ont alimenté l’enquête de priorisation conduite par le consortium ROAMER qui a abouti à une feuille de route pour la recherche en santé mentale pour la décennie à venir. En complément de ce travail nous avons isolé tous les projets de recherche de santé mentale financés par l’UE entre 2007 et 2016, et par les principaux financeurs de projets de recherche en santé français entre 2014 et 2016, et catégorisés ces projets selon les troubles qu’ils couvraient et l’approche théorique qu’ils abordaient. Ce travail montre tout d’abord que la recherche en santé mentale de la décennie passée a obtenu environ 5% des financements publics de recherche en santé, alors que la charge morbide des troubles mentaux représentait environ 14% de la charge morbide totale ; que les principaux financeurs sur projets français ainsi que l’UE supportent majoritairement des projets de recherche abordant une approche neuroscientifique, génétique et cognitiviste de la santé mentale et en moindre part des projets d’approches psychosociale, psychodynamique et orientés sur le rétablissement des personnes touchées par les troubles psychiatriques ; que les grands ensembles de troubles mentaux sont inégalement investigués en comparaison de leur charge morbide respective. Enfin, nous plaçons en regard de ces résultats les préconisations issues du groupe d’experts de notre groupe de travail et du consortium ROAMER.

Trajectories of medication adherence in patients with Bipolar Disorder along 2 years-follow-up

Article

Dec 2020
J AFFECT DISORDERS

Background: Bipolar disorder (BD) is a chronic and severe mental illness. It requires a non-discontinued pharmacological treatment to prevent mood recurrences but nonadherence to medication is frequent. To this date, medication adherence in BD has been mostly evaluated in cross-sectional studies and often considered as a stable trait. We aimed to study medication adherence using a prospective person-oriented approach. Methods: 1627 BD patients were followed on a 2 years period and assessed every 6 months. Medication adherence was evaluated at each visit with the Medication Adherence Rating Scale (MARS). A latent class mixed model (LCMM) was used to identify trajectory classes of adherence over time. Regression analyses and linear mixed model were used to search for predictors and covariables of the trajectories. Results: Three distinct and robust trajectories of medication adherence have been identified: one that starts poorly and keeps deteriorating (4.8%), one that starts poorly but improves (9%) and one that starts well and keeps improving (86.2%). A good tolerance to psychotropic medications, low depressive symptoms, the absence of comorbid eating disorders and anticonvulsant medication were associated to a better prognosis of adherence. Along the follow-up, the lower were the depressive symptoms, the better was the medication adherence (p<.001) Limitations: The use of a single measure of medication adherence although it is a validated instrument and a possible positive selection bias that might limit the generalization of our findings. Conclusions: This study demonstrates that medication adherence in BD patients is a heterogeneous and potentially variable phenomenon.

Clinical characteristics of bipolar disorders with postpartum depressive onset

Article

Dec 2020
PROG NEURO-PSYCHOPH

Background Postpartum period is associated with an increased risk of bipolar disorder diagnosis and relapse, mainly major depressive episode. Onset during this period might be associated with specific characteristics. Aim To compare the socio-demographic and clinical characteristics of parous women presenting with bipolar disorder and an index depressive episode occurring during or outside the postpartum period. Methods Using the multicenter cohort FACE-BD (FondaMental Academic Centers of Expertise for Bipolar Disorders), we considered all women who started their BD with a major depressive episode and have at least one child. We compared two groups depending on the onset: in or outside the postpartum period. Results Among the 759 women who started BD with a major depressive episode, 93 (12.2%) had a postpartum onset, and 666 (87.8%) had not. Women who started BD in the postpartum period with a major depressive episode have a more stable family life, more children, an older age at onset, more Bipolar 2 disorder, less history of suicide attempts, less depressive episodes and more mood stabilizer treatments as compared to those who started with a major depressive episode outside the postpartum period. The multivariable logistic regression showed that women with an onset in the postpartum period had significantly more children, less lifetime depressive episodes and a lower rate of history of suicide attempts as compared to women with an onset outside the postpartum period. Discussion Our results suggest that women starting their BD with postpartum depression have a more favorable course of BD, especially less history of suicide attempt and less lifetime depressive episodes.

Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort

Article

Aug 2020

Objective We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders. Methods We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning. Results Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85. Conclusion This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.

Confirmations, advances and recommendations for the daily care of schizophrenia based on the French national FACE-SZ cohort

Article

Jul 2020

Contribution of common and rare damaging variants in familial forms of bipolar disorder and phenotypic outcome

Article

Full-text available

Apr 2020

Genome-wide association studies on bipolar disorders (BD) have revealed an additive polygenic contribution of common single-nucleotide polymorphisms (SNPs). However, these SNPs explain only 25% of the overall genetic variance and suggest a role of rare variants in BD vulnerability. Here, we combined high-throughput genotyping data and whole-exome sequencing in cohorts of individuals with BD as well as in multiplex families with a high density of affected individuals in order to determine the contribution of both common and rare variants to BD genetic vulnerability. Using polygenic risk scores (PRS), we showed a strong contribution of common polymorphisms previously associated with BD and schizophrenia (SZ) and noticed that those specifically associated with SZ contributed more in familial forms of BD than in non-familial ones. The analysis of rare damaging variants shared by affected individuals in multiplex families with BD revealed a single interaction network enriched in neuronal and developmental biological pathways, as well as in the regulation of gene expression. We identified four genes with a higher mutation rate in individuals with BD than in the general population and showed that mutations in two of them were associated with specific clinical manifestations. In addition, we showed a significant negative correlation between PRS and the number of rare damaging variants specifically in unaffected individuals of multiplex families. Altogether, our results suggest that common and rare genetic variants both contribute to the familial aggregation of BD and this genetic architecture may explain the heterogeneity of clinical manifestations in multiplex families.

Adherence to treatment guidelines in clinical practice for using electroconvulsive therapy in major depressive episode

Article

Mar 2020
J AFFECT DISORDERS

Background: ECT is the most effective treatment of major depressive episode (MDE) but remains a neglected treatment. The French Society for Biological Psychiatry and Neuropsychopharmacology aimed to determine whether prescribing practice of ECT followed guidelines recommendations. Methods: This multicenter, retrospective study included adult patients with major depressive disorder (MDD) or bipolar disorder (BD), who have been treated with ECT for MDE. Duration of MDE and number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests. Results: Seven hundred and forty-five individuals were included. The mean duration of MDE before ECT was 10.1 months and the mean number of lines of treatment before ECT was 3.4. It was significantly longer for MDD single episode than recurrent MDD and BD. The presence of first-line indications for using ECT was significantly associated to shorter duration of MDE (9.1 vs 13.1 months, p<0.001) and lower number of lines of treatment before ECT (3.3 vs 4.1, p<0.001). Limitations: This is a retrospective study and not all facilities practicing ECT participated that could limit the extrapolation of the results. Conclusion: Compared to guidelines, ECT was not used as first-line strategy in clinical practice. The presence of first-line indications seemed to reduce the delay before ECT initiation. The improvements of knowledge and access of ECT are needed to decrease the gap between guidelines and clinical practice.

Reconsideration of the factorial structure of the Barratt Impulsiveness Scale (BIS-11): Assessment of impulsivity in a large population of euthymic bipolar patients

Article

Apr 2019
J AFFECT DISORDERS

The OPTIMA Core Programme: early audit findings on the effectiveness of an inner-city specialist service for frequently admitted patients with bipolar disorder

Article

Jan 2017

Impact of bipolar disorder on eating disorders severity in real-life settings

Article

Dec 2018
J AFFECT DISORDERS

Background: Comorbidity of bipolar disorder (BD) and eating disorders (ED) is common and increases the course and severity of BD. However, the impact of comorbid BD on the clinical profile of ED patients remains unclear. Most studies have focused on patients primarily assessed for BD and data on patients with a primary diagnosis of ED are sparse. We investigated the association between a dual diagnosis and severity in terms of clinical, neuropsychological dimensions and daily functioning. Method: Two hundred and sixty-one patients with ED were consecutively recruited. BD was screened with the MINI and further confirmed in the French expert centre network. The severity of ED symptoms was assessed with the EDE-Q and EDI-2, daily functioning with the FAST. The neurocognitive assessment targeted attention, set-shifting and decision-making. Results: Forty-nine patients screened positive for BD, but diagnosis was confirmed in only thirty patients (11.5% of the cohort). After multiple adjustments, comorbidity was associated with greater severity on the total score and three subscales of the EDE-Q and on four of the ten dimensions of the EDI-2. Comorbid BD was associated with lower daily functioning but not with lower neuropsychological performance. Limitations: Sample referred to specialist clinics not large enough to authorize an analysis by subtype and cross-sectional evaluation. Conclusion: The association between ED and BD increases ED severity for most of these core features. It negatively impacts daily functioning. The results also highlight issues about the validity of screening tools to detect BD in patients with ED.

European mental health research resources: Picture and recommendations of the ROAMER project

Article

Full-text available

Dec 2018
EUR NEUROPSYCHOPHARM

As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis®, On-Course® and Meril® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.

A new inner-city specialist programme reduces readmission rates in frequently admitted patients with bipolar disorder

Article

Full-text available

Nov 2018

Aims and method The OPTIMA mood disorders service is a newly established specialist programme for people with bipolar disorder requiring frequent admissions. This audit compared data on hospital admissions and home treatment team (HTT) spells in patients before entry to and after discharge from the core programme. We included patients admitted between April 2015 and March 2017 who were subsequently discharged. Basic demographic data and numbers of admissions and HTT spells three years before and after discharge were collected and analysed. Results Thirty patients who completed the programme were included in the analyses. The median monthly rate of hospital admissions after OPTIMA was significantly reduced compared with the rate prior to the programme. HTT utilisation was numerically reduced, but this difference was not statistically significant. Clinical implications These results highlight the effectiveness and importance of individually tailored, specialist care for patients with bipolar disorder following discharge from hospital. Declaration of interest None.

Childhood trauma, dimensions of psychopathology and the clinical expression of bipolar disorders: A pathway analysis

Article

Dec 2017

Significant Need for a French Network of Expert Centers Enabling a Better Characterization and Management of Treatment-Resistant Depression (Fondation FondaMental)

Article

Full-text available

Nov 2017

Background Major depression is characterized by (i) a high lifetime prevalence of 16–17% in the general population; (ii) a high frequency of treatment resistance in around 20–30% of cases; (iii) a recurrent or chronic course; (iv) a negative impact on the general functioning and quality of life; and (v) a high level of comorbidity with various psychiatric and non-psychiatric disorders, high occurrence of completed suicide, significant burden along with the personal, societal, and economic costs. In this context, there is an important need for the development of a network of expert centers for treatment-resistant depression (TRD), as performed under the leadership of the Fondation FondaMental. Methods The principal mission of this national network is to establish a genuine prevention, screening, and diagnosis policy for TRD to offer a systematic, comprehensive, longitudinal, and multidimensional evaluation of cases. A shared electronic medical file is used referring to a common exhaustive and standardized set of assessment tools exploring psychiatric, non-psychiatric, metabolic, biological, and cognitive dimensions of TRD. This is paralleled by a medico-economic evaluation to examine the global economic burden of the disease and related health-care resource utilization. In addition, an integrated biobank has been built by the collection of serum and DNA samples for the measurement of several biomarkers that could further be associated with the treatment resistance in the recruited depressed patients. A French observational long-term follow-up cohort study is currently in progress enabling the extensive assessment of resistant depressed patients. In those unresponsive cases, each expert center proposes relevant therapeutic options that are classically aligned to the international guidelines referring to recognized scientific societies. Discussion This approach is expected to improve the overall clinical assessments and to provide evidence-based information to those clinicians most closely involved in the management of TRD thereby facilitating treatment decisions and choice in everyday clinical practice. This could contribute to significantly improve the poor prognosis, the relapsing course, daily functioning and heavy burden of TRD. Moreover, the newly created French network of expert centers for TRD will be particularly helpful for a better characterization of sociodemographic, clinical, neuropsychological, and biological markers of treatment resistance required for the further development of personalized therapeutic strategies in TRD.

Sleep quality, chronotype and metabolic syndrome components in bipolar disorders during the remission period: Results from the FACE-BD cohort

Article

Sep 2017
CHRONOBIOL INT

Data on sleep or circadian abnormalities and metabolic disturbances in euthymic bipolar disorders are scarce and based on small sample sizes. The aim of this study was to explore the associations between sleep disturbances, chronotype and metabolic components in a large sample of euthymic patients with bipolar disorders (BD). From 2009 to 2015, 752 individuals with bipolar disorders from the FACE-BD cohort were included and assessed for sleep quality, chronotype and metabolic components. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to confirm the diagnosis of BD. Subjective sleep quality was measured with the Pittsburgh Sleep Quality Index and chronotype with the Composite Scale of Morningness. Sociodemographic and clinical characteristics, psychotropic treatment, psychiatric comorbidities and blood samples were collected. In our sample, 22.4% of individuals with BD presented with a metabolic syndrome, 53.7% had sleep disturbances, 25.4% were considered as having an evening chronotype and 12.6% as having a morning chronotype. Independently of potential confounders, euthymic patients with sleep disturbances had a higher abdominal circumference, and patients with evening chronotype had a significantly higher level of triglycerides. There was an association between evening chronotype and an increased atherogenic index of plasma (OR = 4.8, 95%CI = 1.6-14.7). Our findings contribute the scant literature on the relationship between sleep quality, chronotype and cardiometabolic components in euthymic individuals with BD and highlight the need to improve quality of sleep and patient education about healthier sleep-hygiene practices.

Neuropsychological functioning, age, and medication adherence in bipolar disorder

Article

Full-text available

Sep 2017
PLOS ONE

Objectives: Poor adherence to medication is frequent in bipolar disorder (BD) and has been associated with several factors. To date, the relationship between low adherence and neuropsychological functioning in BD is still unclear. As age and neuropsychological functioning might have opposing influences on adherence, our aim was to investigate this link with a particular focus on the effect of age. Methods: In a cross-sectional study, we included 353 patients divided into two age-groups (16-46; 47-71) from a French cohort diagnosed with BD (type I, II, NOS) and strictly euthymic. All patients had a standardized clinical and neuropsychological assessment and were categorized as high (n = 186) or low (n = 167) adherent based on their score from the Medication Adherence Rating Scale. Clinical information was collected based on a standardized interview and clinical validated scales. Neuropsychological performances were evaluated with an established standardized neuropsychological battery for bipolar disorder patients. After univariate analysis, neuropsychological and clinical predictors of low adherence were included in two age-specific stepwise multiple logistic regressions. Results: A smaller number of hospitalizations (OR = 0.846, p = 0.012), a shorter illness duration (OR = 0.937, p = 0.003) and higher adverse effects (OR = 1.082, p<0.001) were associated with a greater risk of low adherence in the younger patients. In the older patients, low adherence was also predicted by a smaller number of hospitalizations (OR = 0.727, p = 0.008) and higher adverse effects (OR = 1.124, p = 0.005). Interestingly poor inhibition performance was also a significant predictor of low adherence in older patients (OR = 0.924, p = 0.030). Conclusions: We found an age-specific relationship between cognitive functioning and adherence in patients with BD. Poor inhibition performances predicted low adherence in older patients only. Our results highlight the need to provide age-adapted therapeutic interventions to improve adherence in patients with BD.

Childhood trauma, dimensions of psychopathology and the clinical expression of bipolar disorders: A pathway analysis

Article

Jul 2017

Background: This study aims at testing for paths from childhood abuse to clinical indicators of complexity in bipolar disorder (BD), through dimensions of affective dysregulation, impulsivity and hostility. Method: 485 euthymic patients with BD from the FACE-BD cohort were included from 2009 to 2014. We collect clinical indicators of complexity/severity: age and polarity at onset, suicide attempt, rapid cycling and substance misuse. Patients completed questionnaires to assess childhood emotional, sexual and physical abuses, affective lability, affect intensity, impulsivity, motor and attitudinal hostility. Results: The path-analysis demonstrated significant associations between emotional abuse and all the affective/impulsive dimensions (p < 0.001). Sexual abuse was moderately associated with emotion-related dimensions but not with impulsivity nor motor hostility. In turn, affect intensity and attitudinal hostility were associated with high risk for lifetime presence of suicide attempts (p < 0.001), whereas impulsivity was associated with a higher risk of lifetime presence of substance misuse (p < 0.001). No major additional paths were identified when including Emotional and Physical Neglect in the model. Conclusions: This study provides refinement of the links between early adversity, dimensions of psychopathology and the complexity/severity of BD. Mainly, dimensions of affective dysregulation, impulsivity/hostility partially mediate the links between childhood emotional to suicide attempts and substance misuse in BD.

Sleep quality and emotional reactivity cluster in bipolar disorders and impact on functioning

Article

Jul 2017
EUR PSYCHIAT

Objective Bipolar disorders (BD) are characterized by sleep disturbances and emotional dysregulation both during acute episodes and remission periods. We hypothesized that sleep quality (SQ) and emotional reactivity (ER) defined clusters of patients with no or abnormal SQ and ER and we studied the association with functioning. Method We performed a bi-dimensional cluster analysis using SQ and ER measures in a sample of 533 outpatients patients with BD (in remission or with subsyndromal mood symptoms). Clusters were compared for mood symptoms, sleep profile and functioning. Results We identified three clusters of patients: C1 (normal ER and SQ, 54%), C2 (hypo-ER and low SQ, 22%) and C3 (hyper-ER and low SQ, 24%). C1 was characterized by minimal mood symptoms, better sleep profile and higher functioning than other clusters. Although highly different for ER, C2 and C3 had similar levels of subsyndromal mood symptoms as assessed using classical mood scales. When exploring sleep domains, C2 showed poor sleep efficiency and a trend for longer sleep latency as compared to C3. Interestingly, alterations in functioning were similar in C2 and C3, with no difference in any of the sub-domains. Conclusion Abnormalities in ER and SQ delineated three clusters of patients with BD and significantly impacted on functioning.

Physical and mental health status of former smokers and non-smokers patients with bipolar disorder

Article

Feb 2023
ACTA PSYCHIAT SCAND

Objectives: Up to 70% individuals with bipolar disorder (BD) are lifetime tobacco smokers, a major modifiable risk factor for morbidity. However, quitting smoking is rarely proposed to individuals with BD, mainly because of fear of unfavorable metabolic or psychiatric changes. Evaluating the physical and mental impact of tobacco cessation is primordial. The aim of this study was to characterize the psychiatric and non-psychiatric correlates of tobacco smoking status (never- versus current vs former smokers) in individuals with BD. Methods: 3,860 individuals with ascertained BD recruited in the network of Fondamental expert centers for BD between 2009 and 2020 were categorized into current, former, and never tobacco smokers. We compared the sociodemographic and clinical characteristics assessed by standard instruments (e.g. BD type, current symptoms load, and non-psychiatric morbidity - including anthropometric and biological data) of the three groups using multinomial regression logistic models. Corrections for multiple testing were applied. Results: Current smokers had higher depression, anxiety, and impulsivity levels than former and never-smokers, and also higher risk of comorbid substance use disorders with a gradient from never to former to current smokers - suggesting shared liability. Current smokers were at higher risk to have a metabolic syndrome than never-smokers, although this was only evidenced in cases, who were not using antipsychotics. Conclusions: Tobacco smoking was associated with high morbidity level. Strikingly, as in the general population, quitting smoking seemed associated with their return to the never-smokers' levels. Our findings strongly highlight the need to spread strategies to treat tobacco addiction in the BD population.

Retrospective diagnosis of childhood ADHD using the Wender Utah Rating Scale

Article

Full-text available

Aug 2022
ENCEPHALE

Objective An external validation of the Wender Utah Rating Scale (WURS) against a clinical assessment is lacking, especially for French-speaking populations. Method Participants completed three subsets of the WURS-61 and were assessed for ADHD using the DIVA 2.0 semi-structured interview. Exploratory factor analyses were performed. Logistic regression models and Receiver-Operating Curves were used to determine the cut-off scores that predicted childhood ADHD with best accuracy. Results One hundred three adults were included. Three factors were extracted for the WURS-25 and WURS-K, and four for the WURS-29. Cut-off scores are 44, 24 and 42, respectively. When considering DSM-5 rather than DSM-IV criteria, these values changed to 44, 36 and 44, respectively. More than 83% of the participants had been correctly classified. Conclusion All three subsets of the WURS-61 retrospectively predict the presence of ADHD in childhood. This result might prove to be useful in screening and research procedures.

Les déterminants de l'observance dans les troubles bipolaires

Thesis

Dec 2021

Dominique Thomas Roi

L'observance thérapeutique des patients en psychiatrie - et plus particulièrement des malades souffrant de troubles bipolaires – est très souvent partielle. Celle-ci représente un véritable enjeu de santé publique car elle est responsable de nombreuses rechutes et de suicides. Ainsi, le retentissement de cette problématique d’observance est important aussi bien pour le patient, son entourage que pour la société. Dans ce travail de thèse, nous nous sommes intéressés aux nombreux facteurs qui affectent l'observance notamment au rôle de représentation sociale de la maladie en tant que déterminant à part entière de l’observance. En s’appuyant sur plusieurs théories et modèles portant sur l’observance, nous avons essayé de comprendre les déterminant du comportement "non observant" des patients afin d’envisager, in fine, des interventions psychothérapeutiques plus ciblées. Il s'agit par ailleurs dans ce travail de mettre en évidence la différence de perception en termes de représentation et d’objectifs thérapeutiques des différents protagonistes (médecins, patients, personnes tout-venants) face à la maladie. Nos résultats montrent l'existence d'une différence de perception et de représentation entre les soignants et les soignés mais aussi que l'observance est en lien direct avec l'alliance thérapeutique. En effet, plus l'alliance est élevée et meilleure est l'observance. En revanche, la représentation sociale de la maladie et du patient souffrant de trouble bipolaire est identique pour les personnes bipolaires et les non bipolaires et c'est le fait de se percevoir "malade "ou non qui influence l'observance. Le patient qui se perçoit comme « malade » sera plus enclin à se soigner qu'un patient qui ne ressent pas de trouble et aura donc une meilleure observance. Tenter de réduire cette différence de représentations sociales entre les médecins et les malades en travaillant en partenariat, en favorisant la pluridisciplinarité, en intégrant les nouvelles technologies et innovations médicales en matière de surveillance et de suivi, permettra certainement d'obtenir une meilleure prise en charge du malade et par conséquent une meilleure observance. La représentation sociale apparait donc, dans notre étude, comme un déterminant important de l'observance à prendre en compte pour améliorer la prise en charge globale du patient souffrant de trouble bipolaire.

Influence of childhood maltreatment on prevalence, onset and persistence of psychiatric comorbidities and suicide attempts in bipolar disorders

Article

Full-text available

Jan 2022

Background Psychiatric comorbidities and suicide attempts are highly prevalent in Bipolar Disorders (BD). We examined the associations between childhood maltreatment, psychiatric comorbidities, and suicide attempts, in terms of lifetime prevalence, sequence of onset, and current symptoms. Methods We assessed 3,047 individuals with BD for suicide attempts, anxiety disorders, substance use disorders, and eating disorders. Participants completed a self-report for the assessment of childhood maltreatment. Associations between childhood maltreatment and characteristics of comorbidities (lifetime prevalence, current symptoms, and age at onset) were examined using logistic regressions and network analyses. Results Psychiatric comorbidities were frequent with a mean number per individual of 1.23 (SD = 1.4). Most comorbidities occurred prior to the onset of BD. Participants who reported higher levels of childhood maltreatment had more frequent and multiple comorbidities, which were also more currently active at inclusion. Childhood maltreatment did not decrease the age of onset of comorbidities, but was associated with a faster accumulation of comorbidities prior to the onset of BD. Logistic regression and network analyses showed that emotional abuse and sexual abuse might play a prominent role in the lifetime prevalence of psychiatric comorbidities and suicide attempts. Conclusions Childhood maltreatment was associated with suicide attempts, and with frequent, multiple, and persistent psychiatric comorbidities that accumulated more rapidly prior to the onset of BD. Hence, childhood maltreatment should be systematically assessed in individuals with BD, in particular when the course of the disorder is characterized by a high comorbid profile or by a high suicidality.

Les troubles bipolaires: de l’humeur aux émotions*

Article

Jan 2022
B ACAD NAT MED PARIS

Résumé Les troubles bipolaires sont caractérisés par une alternance de phases dépressives et d’exaltations. Il s’agit d’une pathologie fréquente, survenant chez l’adulte jeune, qui peut avoir un l’impact considérable sur le fonctionnement des patients du fait de la fréquence et de la sévérité des épisodes, des comorbidités psychiatriques et somatiques, des symptômes résiduels ou encore de l’altération des fonctions cognitives. Le risque majeur est le suicide. Son traitement repose sur la prescription de régulateurs de l’humeur et des prises en charge psychothérapeutiques. La pathophysiologie implique des interactions gènes-environnement et au niveau cérébral est sous-tendue par des anomalies du système cortico-limbique. A l’heure actuelle, les modèles animaux qui permettraient de mieux comprendre les mécanismes cellulaires et moléculaires sont imparfaits car ils n’explorent qu’une partie limitée des dimensions qui constituent les troubles. L’évaluation de l’humeur du fait de son caractère subjectif est le propre de l’Homme et n’est donc pas accessible à l’expérimentation animale. Nous souhaitons montrer l’intérêt d’étudier à la fois chez l’homme et chez l’animal les biais émotionnels, en évaluant les biais d’attribution de valence en réponse à des stimuli hédoniques, qui sont quantifiables chez l’animal par les comportements d’approche et d’évitement. Nous proposons ainsi un nouveau modèle des troubles bipolaires basé non plus sur l’humeur mais sur l’étude des réponses émotionnelles tenant compte de leur intensité et valence.

Auto-stigmatisation dans les troubles psychiques sévères et persistants

Thesis

May 2020

Julien Dubreucq

L’auto-stigmatisation est fréquente chez les personnes avec Troubles Psychiques Sévères et Persistants (TPSP), dont elle altère le devenir clinique et fonctionnel. L’objectif de ce travail était de définir plus précisément l’auto-stigmatisation dans les TPSP et de mieux identifier les moyens d’y faire face. Il comporte plusieurs étapes : i) une 1ère revue systématique de littérature pour mieux appréhender les mécanismes cognitifs et neurobiologiques potentiels sous-tendant les effets de la stigmatisation; ii) une 2nde revue systématique de littérature sur la prévalence, les prédicteurs et les conséquences de l’auto-stigmatisation dans les TPSP ; iii) l’étude de la fréquence de l’auto-stigmatisation et de la résistance à la stigmatisation et des corrélats d’une auto-stigmatisation ou d’une résistance élevée à la stigmatisation dans la cohorte nationale des centres référents de réhabilitation psychosociale (REHABase), décrite dans un 1er article ; iv) l’adaptation française du programme de thérapie cognitive et de renforcement narratif (NECT) et un essai randomisé contrôlé évaluant son efficacité sur le fonctionnement social dans les TPSP, débutant au 1er trimestre 2020. L’auto-stigmatisation est un problème majeur de santé publique, et ce quelque soit l’aire géographique et culturelle, la pathologie ou le stade évolutif considérés. Environ 1/3 des participants de la cohorte REHABase ont une auto-stigmatisation élevée, celle-ci étant associée aux stades précoces du rétablissement et à un bien être et une satisfaction dans les relations sociales altérés. La résistance à la stigmatisation concerne plus de 50% des participants et est favorisée par la satisfaction dans les relations familiales. Ce travail a plusieurs implications cliniques et pour la recherche, discutées de façon approfondie

Modélisation et quantification des déterminants de l’outcome dans les troubles mentaux sévères et persistants

Thesis

Dec 2020

Mickael Ehrminger

Les troubles bipolaires et la schizophrénie comptent parmi les troubles mentaux les plus sévères en termes de répercussions sur la vie quotidienne. L’approche adoptée pour la prise en charge des patients souffrant de ces troubles s’est récemment étendue d’une approche principalement médicale fondée sur la rémission des symptômes vers une approche plus intégrative visant la remédiation d’autres variables, telles que la qualité de vie et le fonctionnement psychosocial.Une collaboration entre les Ministères de la Santé et de la Recherche et la Fondation Fondamental a permis la création de cohortes de patients schizophrènes et bipolaires suivis sur plusieurs années avec recueil de données multidimensionnelles (cliniques, psychosociales, cognitives, …).Ce travail doctoral a consisté à exploiter la richesse des données recueillies par la Fondation Fondamental afin d’élaborer des modèles visant à expliquer des phénomènes observés dans ces deux pathologies, à l’aide des méthodes de modélisation par équations structurales. Dans un premier temps, nous nous sommes intéressés aux relations longitudinales entre cognition et fonctionnement psychosocial chez les patients bipolaires. Ensuite, nous avons modélisé les relations longitudinales entre insight, qualité de vie, dépression et suicidalité dans les troubles du spectre de la schizophrénie. Puis, nous avons modélisé les corrélats transversaux de la qualité de vie subjective dans la schizophrénie.Nos résultats nous ont permis de tirer quelques enseignements pour la pratique clinique et l’amélioration de la prise en charge des patients. Aussi, nous plaidons pour une extension de l’utilisation des modèles d’équations structurales en psychiatrie.

A scoping review of clinical decision support tools that generate new knowledge to support decision making in real time

Article

Oct 2020

Objective A growing body of observational data enabled its secondary use to facilitate clinical care for complex cases not covered by the existing evidence. We conducted a scoping review to characterize clinical decision support systems (CDSSs) that generate new knowledge to provide guidance for such cases in real time. Materials and Methods PubMed, Embase, ProQuest, and IEEE Xplore were searched up to May 2020. The abstracts were screened by 2 reviewers. Full texts of the relevant articles were reviewed by the first author and approved by the second reviewer, accompanied by the screening of articles’ references. The details of design, implementation and evaluation of included CDSSs were extracted. Results Our search returned 3427 articles, 53 of which describing 25 CDSSs were selected. We identified 8 expert-based and 17 data-driven tools. Sixteen (64%) tools were developed in the United States, with the others mostly in Europe. Most of the tools (n = 16, 64%) were implemented in 1 site, with only 5 being actively used in clinical practice. Patient or quality outcomes were assessed for 3 (18%) CDSSs, 4 (16%) underwent user acceptance or usage testing and 7 (28%) functional testing. Conclusions We found a number of CDSSs that generate new knowledge, although only 1 addressed confounding and bias. Overall, the tools lacked demonstration of their utility. Improvement in clinical and quality outcomes were shown only for a few CDSSs, while the benefits of the others remain unclear. This review suggests a need for a further testing of such CDSSs and, if appropriate, their dissemination.

Characterization of depressed bipolar patients with current suicidal ideation

Article

Oct 2020

Objective: Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30-50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up. Methods: Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery-Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline (N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology-Self Report (N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology-Self Report score <2 (N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years. Results: Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology). Conclusions: Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.

Association between anhedonia and suicidal events in patients with mood disorders: A 3‐year prospective study

Article

Full-text available

Jul 2020
DEPRESS ANXIETY

Background As almost all mental disorders are associated with increased suicidal‐related behavior, anhedonia might be a trans‐diagnostic dimension to target for suicide prevention. Methods For this 3‐year‐long prospective study, 2,839 outpatients with mood disorders were recruited. They were divided in: (a) two groups according to the occurrence or not of suicidal ideation during the follow‐up, and (b) two groups according to the occurrence or not of suicide attempts during the follow‐up. Anhedonia was assessed using a composite score (the French version of the 14‐item Snaith‐Hamilton Pleasure Scale and item 13 of the Quick Inventory of Depressive Symptomatology scale) at inclusion and at 6, 12, 24, and 36 months after inclusion. Results Patients with mood disorders and anhedonia at least at one follow‐up visit had a 1.4‐fold higher risk of suicidal ideation (adjusted odds ratio = 1.35; 95% confidence interval [1.07, 1.70]), even after adjustment for confounding factors of suicide risk (i.e., bipolar or unipolar disorder, sex, age, marital status, education level, antidepressant intake, personal history of suicide attempt, at least one childhood trauma, and mean of the maximum depression score during the follow‐up). Conversely, association between anhedonia and suicide attempt did not remain significant after adjustment. Conclusions The significant association between anhedonia and suicide ideation in patients with mood disorders stresses the need of targeting hedonia in mood disorders, and of research focusing on the position to pleasure in life through eudaimonia.

Chronic peripheral inflammation is associated with impaired functional remission independently of symptomatic remission and depression in schizophrenia

Article

Mar 2020
PROG NEURO-PSYCHOPH

Background While symptomatic remission in schizophrenia (SZ) has been defined by consensus and associated with a rank of clinical predictive factors, there is a lack of data of factors associated with functional remission. Objectives To identify clinical and biological factors associated with impaired functional remission in a non-selected chronic stabilized SZ outpatients. Methods This study was a cross-sectional study carried out on all admitted SZ stabilized outpatients in an academic daily care psychiatric hospital. Functional remission was defined by a global assessment of functioning score ≥ 61. Symptomatic remission was defined according to international criteria. Depression was assessed with the Calgary Depression Rating scale for Schizophrenia. Sociodemographic variables, tobacco status, clozapine treatment and obesity were reported. Chronic peripheral inflammation was defined by a highly sensitive C-reactive protein serum level ≥ 3 mg/L and metabolic syndrome according to international recommendations. Results 273 patients were included, among them 48 (18.3%) were classified in the functional remission group. In the multivariate analysis, higher rate of functional remission was associated with symptomatic remission (adjusted Odd ratio = 18.2, p < .001), lower depressive symptoms (aOR = 0.8, p = .018) and lower peripheral inflammation (aOR = 0.4, p = .046). No association of functional remission with age, gender, illness duration, second-generation antipsychotics, clozapine treatment, tobacco smoking, obesity or metabolic syndrome has been found. Conclusion Chronic peripheral inflammation is associated with impaired functional remission in SZ independently of symptomatic remission and depression. Future intervention studies should determine if improving chronic peripheral inflammation may improve SZ patients reaching functional remission.

Cognitive profiles in euthymic patients with bipolar disorders: Results from the FACE-BD cohort

Article

Apr 2017

Objectives: Although cognitive deficits are a well-established feature of bipolar disorders (BD), even during periods of euthymia, little is known about cognitive phenotype heterogeneity among patients with BD. Methods: We investigated neuropsychological performance in 258 euthymic patients with BD recruited via the French network of expert centers for BD. We used a test battery assessing six domains of cognition. Hierarchical cluster analysis of the cross-sectional data was used to determine the optimal number of subgroups and to assign each patient to a specific cognitive cluster. Subsequently, subjects from each cluster were compared on demographic, clinical functioning, and pharmacological variables. Results: A four-cluster solution was identified. The global cognitive performance was above normal in one cluster and below normal in another. The other two clusters had a near-normal cognitive performance, with above and below average verbal memory, respectively. Among the four clusters, significant differences were observed in estimated intelligence quotient and social functioning, which were lower for the low cognitive performers compared to the high cognitive performers. Conclusions: These results confirm the existence of several distinct cognitive profiles in BD. Identification of these profiles may help to develop profile-specific cognitive remediation programs, which might improve functioning in BD.

The affective lability scales: Development, reliability, and validity

Article

Full-text available

Sep 1989
J CLIN PSYCHOL

A self‐report measure of changeable affect was developed, with a goal of identification of patterns of instability in mood. Scales measuring lability in anxiety, depression, anger, and hypomania, and labile shifts between anxiety and depression and hypomania and depression were constructed. These scales were then evaluated for internal consistency, retest reliability, score stability across samples, and for discriminant validity through assessment of association with measures of dysphoria and intensity of affect. The final versions of the scales are short scales that yield highly stable estimates of affect lability. It was noted that these scales are highly correlated in unselected students and it is believed that ongoing research with clinical populations will better allow for determination of the independence of these scales.

Factor structure of the Barratt impulsiveness scale

Article

Full-text available

Nov 1995
J CLIN PSYCHOL

The purpose of the present study was to revise the Barratt Impulsiveness Scale Version 10 (BIS-10), identify the factor structure of the items among normals, and compare their scores on the revised form (BIS-11) with psychiatric inpatients and prison inmates. The scale was administered to 412 college undergraduates, 248 psychiatric inpatients, and 73 male prison inmates. Exploratory principal components analysis of the items identified six primary factors and three second-order factors. The three second-order factors were labeled Attentional Impulsiveness, Motor Impulsiveness, and Nonplanning Impulsiveness. Two of the three second-order factors identified in the BIS-11 were consistent with those proposed by Barratt (1985), but no cognitive impulsiveness component was identified per se. The results of the present study suggest that the total score of the BIS-11 is an internally consistent measure of impulsiveness and has potential clinical utility for measuring impulsiveness among selected patient and inmate populations.

Lifetime and 12Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication

Article

Full-text available

May 2007
ARCH GEN PSYCHIAT

There is growing recognition that bipolar disorder (BPD) has a spectrum of expression that is substantially more common than the 1% BP-I prevalence traditionally found in population surveys. To estimate the prevalence, correlates, and treatment patterns of bipolar spectrum disorder in the US population. Direct interviews. Households in the continental United States. A nationally representative sample of 9282 English-speaking adults (aged >or=18 years). Version 3.0 of the World Health Organization's Composite International Diagnostic Interview, a fully structured lay-administered diagnostic interview, was used to assess DSM-IV lifetime and 12-month Axis I disorders. Subthreshold BPD was defined as recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania. Indicators of clinical severity included age at onset, chronicity, symptom severity, role impairment, comorbidity, and treatment. Lifetime (and 12-month) prevalence estimates are 1.0% (0.6%) for BP-I, 1.1% (0.8%) for BP-II, and 2.4% (1.4%) for subthreshold BPD. Most respondents with threshold and subthreshold BPD had lifetime comorbidity with other Axis I disorders, particularly anxiety disorders. Clinical severity and role impairment are greater for threshold than for subthreshold BPD and for BP-II than for BP-I episodes of major depression, but subthreshold cases still have moderate to severe clinical severity and role impairment. Although most people with BPD receive lifetime professional treatment for emotional problems, use of antimanic medication is uncommon, especially in general medical settings. This study presents the first prevalence estimates of the BPD spectrum in a probability sample of the United States. Subthreshold BPD is common, clinically significant, and underdetected in treatment settings. Inappropriate treatment of BPD is a serious problem in the US population. Explicit criteria are needed to define subthreshold BPD for future clinical and research purposes.

Affect Intensity and Reactions to Daily Life Events

Article

Full-text available

Oct 1986

Conducted 2 studies to examine individual differences in affective response intensity to identical levels of emotion-provoking stimulation. In Study 1, with 62 undergraduates, the stimuli were daily life events. Ss recorded 2 events/day for 56 consecutive days and rated their affective reactions to those events. A total of 5,971 event descriptions were obtained. These event descriptions were given to a team of coders who rated each event in terms of how objectively good or bad it was. Study 2 presented 176 undergraduates with standardized life event descriptions, ranging from very good to very bad, and asked how they would react emotionally to each event. Ss were divided into high and low affect-intensity groups on the basis of their responses to a measure of affect intensity. Findings were consistent across both studies. High-intense Ss responded to the actual and hypothetical life events with stronger or more intense affective reactions. This finding held regardless of whether the events elicited positive or negative affect and regardless of whether the emotional stimulation was judged to be slightly, moderately, or very strong. Results are discussed in terms of stimulus intensity modulation theory and prior research on affect. (58 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The Fagerstr??m Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire

Article

Full-text available

Sep 1991
ADDICTION

We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).

A New Depression Scale Designed to be Sensitive to Change

Article

Full-text available

May 1979

The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

Translating Scientific Opportunity Into Public Health Impact A Strategic Plan for Research on Mental Illness

Article

Full-text available

Mar 2009

Thomas R Insel

Research has transformed many areas of medicine, with profound effects on morbidity and mortality. Exciting advances in neuroscience and genomics have transformed research but have not yet been translated to public health impact in psychiatry. Current treatments are necessary but not sufficient for most patients. To improve outcomes we will need to (1) identify the neural circuitry of mental disorders, (2) detect the earliest manifestations of risk or illness even before cognition or behavior appear abnormal, (3) personalize care based on individual responses, and (4) implement broader use of effective psychosocial interventions. To address these objectives, NIMH, working with its many stakeholders, developed a strategic plan for research. The plan calls for research that will (1) define the pathophysiology of disorders from genes to behavior, (2) map the trajectory of illness to determine when, where, and how to intervene to preempt disability, (3) develop new interventions based on a personalized approach to the diverse needs and circumstances of people with mental illnesses, and (4) strengthen the public health impact of NIMH-supported research by focusing on dissemination science and disparities in care. The NIMH is shifting its funding priorities to close the gap between basic biological knowledge and effective mental health care, paving the way for prevention, recovery, and cure.

Construction and validation of a dimensional scale exploring mood disorders: MAThyS (Multidimensional Assessment of Thymic States)

Article

Full-text available

Oct 2008
BMC PSYCHIATRY

The boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics. This leads to some confusion to define appropriate therapeutic strategies. A dimensional approach might help to better define bipolar moods states and more specifically those with mixed features. Therefore, we proposed a new tool based on a dimensional approach, built with a priori five sub-scales and focus on emotional reactivity rather than exclusively on mood tonality. This study was designed to validate this MAThyS Scale (Multidimensional Assessment of Thymic States). One hundred and ninety six subjects were included: 44 controls and 152 bipolar patients in various states: euthymic, manic or depressed. The MAThyS is a visual analogic scale consisting of 20 items. These items corresponded to five quantitative dimensions ranging from inhibition to excitation: emotional reactivity, thought processes, psychomotor function, motivation and sensory perception. They were selected as they represent clinically relevant quantitative traits. Confirmatory analyses demonstrated a good validity for this scale, and a good internal consistency (Cronbach's alpha coefficient = 0.95). The MathyS scale is moderately correlated of both the MADRS scale (depressive score; r = -0.45) and the MAS scale (manic score; r = 0.56). When considering the Kaiser-Guttman rule and the scree plot, our model of 5 factors seems to be valid. The four first factors have an eigenvalue greater than 1.0 and the eigenvalue of the factor five is 0.97. In the scree plot, the "elbow", or the point at which the curve bends, indicates 5 factors to extract. This 5 factors structure explains 68 per cent of variance. The characterisation of bipolar mood states based on a global score assessing inhibition/activation process (total score of the MATHyS) associated with descriptive analysis on sub-scores such as emotional reactivity (rather than the classical opposition euphoria/sadness) can be useful to better understand the broad spectrum of mixed states.

A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale

Article

Full-text available

Jan 1992

Murray Johns

The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.

The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire

Article

Full-text available

Oct 1991

We examine and refine the Fagerström Tolerance Questionnaire (FTQ: Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).

The affective lability scales: Development, reliability, and validity

Article

Full-text available

Oct 1989

A self-report measure of changeable affect was developed, with a goal of identification of patterns of instability in mood. Scales measuring lability in anxiety, depression, anger, and hypomania, and labile shifts between anxiety and depression and hypomania and depression were constructed. These scales were then evaluated for internal consistency, retest reliability, score stability across samples, and for discriminant validity through assessment of association with measures of dysphoria and intensity of affect. The final versions of the scales are short scales that yield highly stable estimates of affect lability. It was noted that these scales are highly correlated in unselected students and it is believed that ongoing research with clinical populations will better allow for determination of the independence of these scales.

Sleepiness in Different Situations Using the Epworth Sleepiness Scale

Article

Full-text available

Dec 1994

Murray Johns

This investigation examines how the sleep propensity (SP) in one test situation, such as the Multiple Sleep Latency Test (MSLT), is related to sleepiness in daily life, as assessed by the Epworth Sleepiness Scale (ESS). This is a self-administered questionnaire, the item scores from which provide a new method for measuring SPs in eight different real-life situations. The ESS item scores were analyzed separately in four groups of subjects: 150 adult patients with a variety of sleep disorders, 87 medical students who answered the ESS on two occasions 5 months apart, 44 patients who also had MSLTs and 50 patients whose spouses also answered the ESS about their partner's sleepiness. The ESS item scores were shown to be reliable (mean rho = 0.56, p < 0.001). The SP measured by the MSLT was related to three of the eight item scores in a multiple regression (r = 0.64, p < 0.001). The results of nonparametric ANOVA, Spearman correlations, Wilcoxon's t tests, item and factor analysis suggest that individual measurements of SP involve three components of variation in addition to short-term changes over periods of hours or days: a general characteristic of the subject (his average SP), a general characteristic of the situation in which SP is measured (its soporific nature) and a third component that is specific for both subject and situation. The SP in one test situation, including the MSLT, may not be a reliable indicator of a subject's average SP in daily life. Perhaps we should reexamine the current concept of daytime sleepiness and its measurement.

Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol 51: 768-774

Article

Full-text available

Dec 1995

Quality improvement report - Effect of a multifaceted approach to detecting and managing depression in primary care

Article

Full-text available

Nov 2002
Br Med J

Need to improve the detection and management of depression in primary care. Prospective, before and after study of changes in detection and management following attempts to introduce a chronic disease management approach. Two representative general practices in the north east of England that differed markedly in resources available and populations served. KEY MEASURES OF IMPROVEMENT: Number of cases on a depression register, number of cases accurately diagnosed, adherence to own clinical management guidelines. Multifaceted intervention to meet the needs of each practice modified by in-house steering group, including resources to develop a case register, an education and training programme on detection and management agreed by consensus, facilitation of meetings with secondary care staff, and support in developing a practice guideline. Practice A (with six partners and serving a predominantly affluent white British population) improved case detection rate by 23%, reduced prescribing of sub-therapeutic doses of antidepressants by 36%, and adhered to the preferred treatment regimens. At Practice B (with three partners and two surgeries located in deprived urban inner city areas with high levels of unemployment and large ethnic minority populations) improvement in the sensitivity of case detection was accompanied by a reduction in specificity. The practice did not reach consensus on its own guideline and was unable to sustain the model. A simple practice based approach improved the detection and management of depression in a team familiar with the philosophy of chronic disease management, with the capacity to commit to the programme, and with a critical mass of team members being open to change. This model failed to affect depression management when staff engagement with the project was passive rather than active and the practice was less well resourced and served an economically deprived and ethnically diverse population.

An Inventory for Assessing Diferent Kinds of Hostility

Article

Full-text available

Aug 1957
J Consult Psychol

This paper described the construction of an inventory consisting of the following scales: Assault, Indirect Hostility, Irritability, Negativism, Resentment, Suspicion, Verbal Hostility, and Guilt. The first and second versions of the scale were item analyzed, and the final revision consists of 75 items. The hostility items were scaled for social desirability, and social desirability was correlated with probability of endorsement. The r's of .27 and .30 for college men and women, respectively, were considerably smaller than those of previous studies. Factor analyses of college men's and women's inventories revealed two factors: An attitudinal component of hostility (Resentment and Suspicion) and a "motor' component (Assault, Indirect Hostility, Irritability, and Verbal Hostility).

Cognitive-Behavioural Therapy for Severe and Recurrent Bipolar Disorders: Randomised Controlled Trial

Article

Full-text available

May 2006

Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy (CBT). We undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months. More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74-1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.

Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder

Article

Full-text available

Jun 2007
Clin Pract Epidemiol Ment Health

Numerous studies have documented high rates of functional impairment among bipolar disorder (BD) patients, even during phases of remission. However, the majority of the available instruments used to assess functioning have focused on global measures of functional recovery rather than specific domains of psychosocial functioning. In this context, the Functioning Assessment Short Test (FAST) is a brief instrument designed to assess the main functioning problems experienced by psychiatric patients, particularly bipolar patients. It comprises 24 items that assess impairment or disability in six specific areas of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time. 101 patients with DSM-IV TR bipolar disorder and 61 healthy controls were assessed in the Bipolar Disorder Program, Hospital Clinic of Barcelona. The psychometric properties of FAST (feasibility, internal consistency, concurrent validity, discriminant validity (euthymic vs acute patients), factorial analyses, and test-retest reliability) were analysed. The internal consistency obtained was very high with a Cronbach's alpha of 0.909. A highly significant negative correlation with GAF was obtained (r = -0.903; p < 0.001) pointing to a reasonable degree of concurrent validity. Test-retest reliability analysis showed a strong correlation between the two measures carried out one week apart (ICC = 0.98; p < 0.001). The total FAST scores were lower in euthymic (18.55 +/- 13.19; F = 35.43; p < 0.001) patients, as compared with manic (40.44 +/- 9.15) and depressive patients (43.21 +/- 13.34). The FAST showed strong psychometrics properties and was able to detect differences between euthymic and acute BD patients. In addition, it is a short (6 minutes) simple interview-administered instrument, which is easy to apply and requires only a short period of time for its application.

State–Trait Anxiety Inventory Self Evaluation Questionnaire, Form Y (STAI)

Book

Jan 2003

Axé Embodiment in Brazilian Popular Music

Chapter

Aug 2008

Clarence Bernard Henry

This chapter examines the appropriation of sacred themes, imagery, and symbols from the Candomblé religion in Brazilian popular music, analyzes the sacred/secular connection of Brazilian samba, and describes the iconic images and inspirations for popular songs from the axé music of the Orixás. It also suggests that the appropriations of axé, African roots, sacred themes, imagery, and symbols from the andomblé religion in Brazilian popular music correspond to black expressions of religiosity embedded in popular styles such as soul, reggae, jazz, Afro- Beat, and many others.

The Stanley Foundation Bipolar Network

Article

Jan 2001

Background The Stanley Foundation Bipolar Network (SFBN) was created to address the paucity of help studies in bipolar illness. Aims To describe the rationale and methods of the SFBN. Method The SFBN includes five core sites and a number of affiliated sites that have adopted consistent methodology for continuous longitudinal monitoring of patients. Open and controlled studies are performed as patients' symptomatology dictates. Results The reliability of SFBN raters and the validity of the rating instruments have been established. More than 500 patients are in continuous daily longitudinal follow-up. More than 125 have been randomised to one of three of the newer antidepressants (bupropion, sertraline and venlafaxine) as adjuncts in a study of mood stabilisers and 93 to omega-3 fatty acids. A number of open clinical case series have been published. Conclusions Well-characterised patients are followed in a detailed continuous longitudinal fashion in both opportunistic case series and double-blind, randomised controlled trials with reliable and validated measures. Declaration of interest Support received from the Theodore and Vada Stanley Foundation.

Structured clinical interview for DSM-IV Axis-II disorders

Article

Jan 1994

Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiat 134: 382-389; 592

Article

Apr 1979

The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

Enhancing Multiyear Guideline Concordance for Bipolar Disorder Through Collaborative Care

Article

Oct 2009
AM J PSYCHIAT

Implementation of evidence-based care for serious mental illnesses such as bipolar disorder has been suboptimal. Improving and sustaining concordance with clinical practice guidelines has been a cornerstone of efforts to enhance evidence-based care and improve outcomes. For bipolar disorder, however, there has been only one regional controlled trial reporting guideline concordance, and no data are available for time periods longer than 1 year. In a multiregion effectiveness trial in veterans with bipolar disorder, the authors assessed the effects of a collaborative care model for this disorder on guideline concordance in care over a 3-year period. A total of 306 participants with bipolar disorder were randomly assigned at hospital discharge to 3 years of follow-up treatment with a collaborative care model or to usual care. The collaborative care model included provider support through simplified practice guidelines, patient skills management enhancement through group psychoeducation, and facilitated access and continuity via nurse care management. Concordance with guideline-recommended antimanic pharmacotherapy was assessed at baseline and prospectively over six 6-month epochs. Group differences were assessed with generalized estimating equations that controlled for relevant covariates. The collaborative care model achieved significantly higher rates of guideline-concordant antimanic treatment than usual care over the entire follow-up period. Baseline guideline concordance, but not patient age or bipolar type, was associated with higher concordance. Multicomponent collaborative care models, which include not only provider support for guideline implementation but also patient self-management skill enhancement and facilitated treatment access and continuity, can improve guideline concordance over the long term, even in severely impaired patients.

Compliance with clinical practice guidelines

Article

Feb 2008
Stud Health Tech Informat

Silvana Quaglini

Compliance with clinical practice guidelines is a challenging topic because it depends on a variety of factors, some related to guidelines themselves, some related to users, and some to the implementation context. Among the former are guideline quality, purpose and implementation modality. Among the user-related factors are attitude to behavioural changes, authority interventions to foster adherence and eventually the type of users (general practitioners, hospital professionals, home caregivers, patients, etc.). Context is also crucial because organisational issues, such as lack of resources, can hamper guideline implementation and sometimes the original guideline intention is overridden by the guideline adaptation to a certain setting. This chapter analyses these factors and discusses their implications for the development of computerised decision support systems. Moreover, it gives examples of non-compliance detection and analysis in a specific real-world computerised guideline implementation, facing both methodological and practical issues.

A Rating Scale for Mania: Reliability, Validity and Sensitivy

Article

Dec 1978

An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.

The Pittsburgh Sleep Quality Index - A New Instrument For Psychiatric Practice And Research

Article

Jun 1989
PSYCHIAT RES

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

Cross-Validation of the Suicidal Intent Scale

Article

May 1974

This study investigated the validity and reliability of the Suicidal Intent Scale as a measure of the seriousness of a suicide attempt. 194 completed suicides had higher scores on the scale than 231 attempters (nonfatal). In addition, 19 attempters who reattempted suicide within 1 yr of discharge had greater suicidal intent than attempters who did not.

Suicidal Feelings in the General Population: A Prevalence Study

Article

Jun 1974

A total of 720 subjects from a general population survey were interviewed as to the occurrence of suicidal feelings of 5 different degrees. A total of 8.9% reported suicidal feelings of some degree in the past yr. Responses ranged along a continuum such that subjects reporting more intense feelings also reported the less intense. For 3.5% the maximum intensity consisted only of feelings that life was not worthwhile; 2.8% reached the point of wishing themselves dead, 1% the point of having thought of taking their lives, 1% seriously considered suicide or made such plans, and 0.6% made an actual suicide attempt. Subjects experiencing suicidal feelings in the last yr reported more minor psychiatric symptoms, particularly of depression, were more socially isolated, less religious, and to a lesser extent had experienced more stressful events and more somatic illness. In these respects they resembled descriptions of completed suicides.

Risk-Rescue Rating in Suicide Assessment

Article

Jul 1972
ARCH GEN PSYCHIAT

The Risk-Rescue Rating is a descriptive and quantitative method of assessing the lethality of suicide attempts. Its underlying hypothesis is that the lethality of implementation, defined as the probability of inflicting irreversible damage, may be expressed as a ratio of factors influencing risk and rescue. Five risk and five rescue factors have been operationally defined, weighted, and scored. Illustrations of typical high risk/high rescue, high risk/low rescue, low risk/high rescue, and low risk/low rescue are presented, together with scoring instructions and tables of values. Risk-rescue ratings correlate well with the level of treatment recommended (none, emergency ward only, hospital admission, and intensive care), with the subject's sex, and whether the subjects lived or died. There is less decisive correlation with age and little correlation with marital status and multiple attempts. Taken by itself, the risk-rescue rating is not a predictive instrument. However, when considered along with other kinds of lethality, such as that of intentionality and psychosocial involvement, the lethality of implementation can add to the basis of individualized suicide prognosis.

Initial reliability and validity of a new retrospective measure of child abuse and neglect

Article

Sep 1994

This report presents initial findings on the reliability and validity of a new retrospective measure of child abuse and neglect, the Childhood Trauma Questionnaire. Two hundred eighty-six drug- or alcohol-dependent patients were given the Childhood Trauma Questionnaire as part of a larger test battery, and 40 of these patients were given the questionnaire again after an interval of 2 to 6 months. Sixty-eight of the patients were also given a structured interview for child abuse and neglect, the Childhood Trauma Interview, that was developed by the authors. Principal-components analysis of responses on the Childhood Trauma Questionnaire yielded four rotated orthogonal factors: physical and emotional abuse, emotional neglect, sexual abuse, and physical neglect. Cronbach's alpha for the factors ranged from 0.79 to 0.94, indicating high internal consistency. The Childhood Trauma Questionnaire also demonstrated good test-retest reliability over a 2- to 6-month interval (intraclass correlation = 0.88), as well as convergence with the Childhood Trauma Interview, indicating that patients' reports of child abuse and neglect based on the Childhood Trauma Questionnaire were highly stable, both over time and across type of instruments. These findings provide strong initial support for the reliability and validity of the Childhood Trauma Questionnaire.

The use of the Circadian Type Inventory as a measure of the circadian constructs of vigour and rigidity

Article

Jan 1993

The Circadian Type Inventory (Folkard 1987) was administered to 191 students (150 females and 41 males). Corrected item to total correlations for both the Vigour and Rigidity scales were low to moderate. The internal reliabilities of the scales indicate that Vigour is statistically more homogeneous (0.74) than Rigidity (0.58). In the absence of the original CTI correlation matrix, replication using a 2-factor principal component varimax solution was undertaken. It explained only 26.7% of the variance. Post hoc factor analyses yielded 3 factors which explained 33.4% of the variance. The relatively low amounts of variance explained and the inadequate transfer of the circadian constructs of Rigidity and Vigour into question items does not recommend the use of the CTI to measure circadian rhythm characteristics in order to predict tolerance to shiftwork.

The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder.

Article

Jul 1993

In an attempt to surmount the problem of retrospectively establishing the childhood diagnosis of attention deficit hyperactivity disorder, the authors constructed the 61-item Wender Utah Rating Scale (WURS) for adults to use to describe their own childhood behavior. In this paper they present their initial data collection and evaluation of the instrument's validity. The scale was administered to 81 adult outpatients with attention deficit hyperactivity disorder, 100 "normal" adults, and 70 psychiatric adult outpatients with unipolar depression. The authors analyzed data from the 25 items of the scale that showed the greatest difference between the patients with attention deficit hyperactivity disorder and the normal comparison subjects and the relationship between the WURS and the patients' parents' judgment of childhood activity as measured by the Parents' Rating Scale. The patients with attention deficit hyperactivity disorder had significantly higher mean scores on all 25 items than did the two comparison groups. The difference between the mean total scores of the patients with attention deficit hyperactivity disorder and the normal subjects was also highly significant. A cutoff score of 46 or higher correctly identified 86% of the patients with attention deficit hyperactivity disorder, 99% of the normal subjects, and 81% of the depressed subjects. Correlations obtained between WURS scores and Parents' Rating Scale scores were moderate but impressive. The ability of WURS scores to predict response to methylphenidate replicated the authors' finding regarding the ability of Parents' Rating Scale scores to predict response to pemoline. The WURS is sensitive in identifying childhood attention deficit hyperactivity disorder and may be useful in recognizing attention deficit hyperactivity disorder in patients with ambiguous adult psychopathology.

The Altman Self-rating Mania Scale

Article

Dec 1997
BIOL PSYCHIAT

We report on the development, reliability, and validity of the Altman Self-Rating Mania Scale (ASRM). The ASRM was completed during medication washout and after treatment by 22 schizophrenic, 13 schizoaffective, 36 depressed, and 34 manic patients. The Clinician-Administered Rating Scale for Mania (CARS-M) and Mania Rating Scale (MRS) were completed at the same time to measure concurrent validity. Test-retest reliability was assessed separately on 20 depressed and 10 manic patients who completed the ASRM twice during washout. Principal components analysis of ASRM items revealed three factors: mania, psychotic symptoms, and irritability. Baseline mania subscale scores were significantly higher for manic patients compared to all other diagnostic groups. Manic patients had significantly decreased posttreatment scores for all three subscales. ASRM mania subscale scores were significantly correlated with MRS total scores (r = .718) and CARS-M mania subscale scores (r = .766). Test-retest reliability for the ASRM was significant for all three subscales. Significant differences in severity levels were found for some symptoms between patient ratings on the ASRM and clinician ratings on the CARS-M. Mania subscale scores of greater than 5 on the ASRM resulted in values of 85.5% for sensitivity and 87.3% for specificity. Advantages of the ASRM over other self-rating mania scales are discussed.

IDS-C and IDS-SR: Psychometric properties in depressed in-patients

Article

Jan 2000
J AFFECT DISORDERS

Sixty-eight depressed in-patients were assessed at admission (DO), and after 5 days (D5), ten days (D10) and 28 days (D28) of antidepressant treatment, with the Inventory for Depressive Symptomatology-Clinician (IDS-C) and the Inventory for Depressive Symptomatology-Self-Rated (IDS-SR) (Rush et al., 1986), the Montgomery and Asberg Depression Rating Scale (MADRS) (Montgomery and Asberg, 1979) and the depression factor of the Symptom Check List (SCL-90R) (Derogatis, 1977), in order to assess IDS-C and IDS-SR psychometric properties in depressed in-patients and to compare IDS-C to MADRS and IDS-SR to the SCL-90R depression factor. Most of the IDS-C and IDS-SR items were significantly correlated to the final score and the Cronbach alpha coefficients were high (0.75 for the IDS-C and 0.79 for the IDS-SR). Principal Component Analyses (PCA) showed three factors for both IDS-C and IDS-SR: 'depression', 'anxiety/arousal' and 'sleep/appetite'. These results suggest satisfactory internal consistency of IDS-C and IDS-SR. Concurrent validity of the IDS-C with the MADRS was high (r = 0.81), as well as concurrent validity of the IDS-SR with the SCL-90R depression factor (r = 0.84). Concerning sensitivity to change, the four scales were able to discriminate between different levels of severity of depression. Moreover, considering paired t-tests on score changes, IDS-C sensitivity to change may be higher than MADRS sensitivity to change, this phenomenon being related to the number of items and degrees but not to the item contents. Contrary to IDS-C and MADRS, IDS-SR and SCL-90R depression factor were not different in terms of sensitivity to change. Finally, psychometric properties of IDS-C and IDS-SR in depressed in-patients are satisfactory and close to those obtained in depressed out-patients. The high sensitivity to change of the IDS-C may be an advantage for this scale as compared to the MADRS, especially in antidepressant drug trials.

The Stanley Foundation Bipolar Network. I. Rationale and methods

Article

Jul 2001
Br J Psychiatr Suppl

The Stanley Foundation Bipolar Network (SFBN) was created to address the paucity of help studies in bipolar illness. To describe the rationale and methods of the SFBN. The SFBN includes five core sites and a number of affiliated sites that have adopted consistent methodology for continuous longitudinal monitoring of patients. Open and controlled studies are performed as patients' symptomatology dictates. The reliability of SFBN raters and the validity of the rating instruments have been established. More than 500 patients are in continuous daily longitudinal follow-up. More than 125 have been randomised to one of three of the newer antidepressants (bupropion, sertraline and venlafaxine) as adjuncts in a study of mood stabilizers and 93 to omega-3 fatty acids. A number of open clinical case series have been published. Well-characterised patients are followed in a detailed continuous longitudinal fashion in both opportunistic case series and double-blind, randomised controlled trials with reliable and validated measures.

Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD)

Article

Jul 2003
BIOL PSYCHIAT

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was conceived in response to a National Institute of Mental Health initiative seeking a public health intervention model that could generate externally valid answers to treatment effectiveness questions related to bipolar disorder. STEP-BD, like all effectiveness research, faces many design challenges, including how to do the following: recruit a representative sample of patients for studies of readily available treatments; implement a common intervention strategy across diverse settings; determine outcomes for patients in multiple phases of illness; make provisions for testing as yet undetermined new treatments; integrate adjunctive psychosocial interventions; and avoid biases due to subject drop-out and last-observation-carried-forward data analyses. To meet these challenges, STEP-BD uses a hybrid design to collect longitudinal data as patients make transitions between naturalistic studies and randomized clinical trials. Bipolar patients of every subtype with age >/= 15 years are accessioned into a study registry. All patients receive a systematic assessment battery at entry and are treated by a psychiatrist (trained to deliver care and measure outcomes in patients with bipolar disorder) using a series of model practice procedures consistent with expert recommendations. At every follow-up visit, the treating psychiatrist completes a standardized assessment and assigns an operationalized clinical status based on DSM-IV criteria. Patients have independent evaluations at regular intervals throughout the study and remain under the care of the same treating psychiatrist while making transitions between randomized care studies and the standard care treatment pathways. This article reviews the methodology used for the selection and certification of the clinical treatment centers, training study personnel, the general approach to clinical management, and the sequential treatment strategies offered in the STEP-BD standard and randomized care pathways for bipolar depression and relapse prevention.

[Therapeutic adherence and schizophrenia: the interest of the validation of the French translation of Medication Adherence Rating Scale (MARS)]

Article

Jul 2004
ENCEPHALE

Diagnostic stability and evolution of bipolar disorder in clinical practice: A prospective cohort study

Article

Jun 2007

To evaluate the long-term stability of International Classification of Diseases-10th revision bipolar affective disorder (BD) in multiple settings. A total of 34 368 patients received psychiatric care in the catchment area of a Spanish hospital (1992-2004). The analyzed sample included patients aged > or =18 years who were assessed on > or =10 occasions and received a diagnosis of BD at least once (n = 1153; 71,543 assessments). Prospective and retrospective consistencies and the proportion of subjects who received a BD diagnosis in > or =75% of assessments were calculated. Factors related to diagnostic shift were analyzed with traditional statistical methods and Markov's models. Thirty per cent of patients received a BD diagnosis in the first assessment and 38% in the last assessment. Prospective and retrospective consistencies were 49% and 38%. Twenty-three per cent of patients received a BD diagnosis during > or =75% of the assessments. There was a high prevalence of misdiagnosis and diagnostic shift from other psychiatric disorders to BD. Temporal consistency was lower than in other studies.

Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemiology in Mental Health 3

Jan 2003
1028-1042

A R Rosa
J Sánchez-Moreno
A Martínez-Aran
M Salamero
C Torrent
M Reinares
M Comes
F Colom
W Van Riel
J L Ayuso-Mateos
F Kapczinski
E Vieta
G S Sachs
M E Thase
M W Otto
M Bauer
D Miklowitz
S R Wisniewski
P Lavori

Rosa, A.R., Sánchez-Moreno, J., Martínez-Aran, A., Salamero, M., Torrent, C., Reinares, M., Comes, M., Colom, F., Van Riel, W., Ayuso-Mateos, J.L., Kapczinski, F., Vieta, E., 2007. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemiology in Mental Health 3, 5. Sachs, G.S., Thase, M.E., Otto, M.W., Bauer, M., Miklowitz, D., Wisniewski, S.R., Lavori, P., Lebowitz, B., Rudorfer, M., Frank, E., Nierenberg, A.A., Fava, M., Bowden, C., Ketter, T., Marangell, L., Calabrese, J., Kupfer, D., Rosenbaum, J.F., 2003. Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological Psychiatry 53 (11), 1028–1042.

A randomised controlled trial of CBT versus usual treatment in severe and recurrent bipolar disorders

Jan 2006
313-320

J Scott
E Paykel
R Morriss
R Bentall

Scott, J., Paykel, E., Morriss, R., Bentall, R., et al., 2006. A randomised controlled trial of CBT versus usual treatment in severe and recurrent bipolar disorders. British Journal Psychiatry 188, 313-320.

Jan 2011
358-363

C Henry

C. Henry et al. / Journal of Affective Disorders 131 (2011) 358–363

A French network of bipolar expert centres: A model to close the gap between evidence-based medicine and routine practice

Abstract

No full-text available

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