Louisa G Sylvia

Louisa G Sylvia
Massachusetts General Hospital | MGH · Department of Psychiatry

About

109
Publications
18,680
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2,249
Citations
Citations since 2016
57 Research Items
1746 Citations
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2016201720182019202020212022050100150200250300
2016201720182019202020212022050100150200250300

Publications

Publications (109)
Article
Introduction Depressed individuals are more likely to die from cardiovascular disease (CVD) than those without depression. People with CVD have higher rates of depression than those without and have higher mortality rates if they have comorbid depression. While physical activity (PA) improves both, few people engage in enough. We compared self-guid...
Article
Background: The goals of this study were to introduce psychological well-being as an important subject of inquiry in bipolar disorder, to compare well-being in a cohort of patients with bipolar disorder with that of a normative sample, and to assess whether common measures of well-being and mood measure empirically distinct phenomena. Methods: P...
Article
Full-text available
Prior work demonstrates a relationship between suicidal behavior and mood disorders, as well as between suicidal behavior and cardiovascular risk. When cardiovascular risk and mood disorders co-occur, people with these comorbid conditions tend to experience worse outcomes than people with only one of these conditions. As such, given the relevance o...
Article
Full-text available
Background: Childhood trauma affects the course of mood disorders. Researchers are now considering childhood trauma as an influential factor in the treatment of mood disorders. However, the role of childhood trauma in the treatment of bipolar disorder remains understudied. Methods: The effect of childhood trauma on treatment outcomes was evaluat...
Article
Background: Despite growing interest in nutrition as a behavioral intervention to improve cognitive health in clinical populations, many providers find it challenging to provide specific nutritional recommendations. We aimed to review and synthesize current empirical research on this topic and provide considerations for healthcare providers workin...
Article
Objective Patients with bipolar disorder treated with lithium often require additional antipsychotics or anticonvulsants. However, the comparative effectiveness and safety of these agents as add-on to lithium has not been studied. Methods This secondary analysis combined two similar 24-week trials on outpatients with bipolar disorder randomized to...
Preprint
BACKGROUND Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. OBJECTIVE The purpose of this study was to compare standard with brief mindfulness training to improve ov...
Article
Background Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. Objective The primary aim of this study was to determine whether a standard 8-session web-based mindfulne...
Article
Using network analysis, we estimated the structure of relations among manic and depressive symptoms, respectively, in 486 patients (59% women; age: M = 37, SD = 12.1) with bipolar disorder prior to their entering a clinical trial. We computed three types of networks: (a) Gaussian graphical models (GGMs) depicting regularized partial correlations, (...
Article
Background Patients with bipolar disorder have higher rates of cardiometabolic comorbidities and mortality. Although guidelines emphasize the importance of cardiovascular monitoring, few studies characterized the cardiometabolic risk profile during treatment and their relation to symptomatology and treatment response. Methods We analyzed data from...
Article
Full-text available
Introduction The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing evidence-based skills that could increase resilienc...
Article
Cigarette smoking is prevalent among individuals with mood disorders, and particularly among those with bipolar disorder1. Given that depression and smoking independently predict poor cardiovascular health over time, understanding the characteristics of smokers with depression who engage in interventions to improve their cardiovascular health (e.g....
Article
Background We aimed to study the probability of bipolar depression response at 24 weeks given initial non-response. Methods We combined two multi-site, 24-week trials including similar populations following the same evidence-based guidelines randomizing patients to lithium or quetiapine. Additional mood-stabilizing treatment was possible if clinic...
Preprint
Full-text available
Introduction The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the COVID-19 pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing skills that could increase resilience and decreases emotional distress in heal...
Article
Bipolar disorder often follows a set progression best described in stages where advanced stages are associated with poorer outcomes. Bipolar disorder is also often characterized by a predominance of episode polarity, where some individuals experience more depressive episodes (termed predominant depressive polarity) while others experience more hypo...
Article
Background To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from...
Article
Background : Physical activity can mitigate the risk of cardiovascular diseases, but the presence of mood disorders makes it challenging to follow or develop a regular exercise habit. We conducted an online comparative effectiveness study (Healthy Hearts Healthy Minds) to evaluate whether an online psychosocial intervention adjunctive to an activit...
Article
Full-text available
Objective: Health uncertainty among healthcare workers has yet to be examined as a contributor to the psychological toll of the COVID-19 pandemic. We aimed to (1) characterize health uncertainty levels among healthcare workers in a large, U.S. hospital system during the COVID-19 pandemic and (2) examine associations between health uncertainty and p...
Article
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Objective: The COVID-19 pandemic has strained healthcare systems worldwide, placing a high psychological burden on frontline clinicians. There is an urgent need to better understand their stressors and determine if stressors differ by clinical role. The present study assessed the concerns among frontline clinicians across a large healthcare system...
Article
Introduction Veterans involved in the justice system are an understudied population warranting attention given their higher risk of mental health concerns and psychosocial challenges. Thus, there is a need for programs to support the psychological health of incarcerated veterans. The present study sought to determine the acceptability and effective...
Article
Objective: We investigated the feasibility and acceptability of a brief sleep intervention and sleep monitoring device in bipolar disorder (BD), as well as the intervention's effectiveness in reducing suicidal ideation through improved sleep quality and duration. Methods: Participants (N=13) with BD received 4 sessions of cognitive-behavioral th...
Article
Full-text available
Background In real-world pragmatic administrative databases, patient reported remission is often missing. Objective We evaluate if, in administrative data, five features of antidepressant use patterns can replace patient-reported symptom remission. Method We re-examined data from Sequence Treatment Alternatives to Relieve Depression (STAR*D) stud...
Article
Background : Psychotic symptoms during bipolar depressive episodes, especially in outpatients, are under recognized and studied by clinicians and researchers. We examined the relationship between psychotic symptoms during a depressive episode and suicidal ideation in bipolar patients. Methods : Participants (N=351) were adult, depressed, outpatien...
Article
Background: While bipolar disorder (BD) and posttraumatic stress disorder (PTSD) frequently co-occur and individually have a higher risk of suicide compared to the general population, few studies have examined the impact of comorbid PTSD on suicidal ideation in patients with BD. Methods: We analyzed baseline data from the Clinical and Health Out...
Article
Objectives: Given that veterans are significantly more likely to suffer from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and anxiety than civilians, yet current gold-standard treatments for PTSD are not effective for all patients, the present study sought to examine the feasibility and acceptability of a collabo...
Article
Objective: Equine-assisted activities and therapies (EAATs) have been a growing adjunctive integrative health modality, as they allow participants to practice mindfulness, emotional regulation, and self-mastery or self-esteem building skills. Preliminary evidence suggests that these programs may be helpful in reducing posttraumatic stress disorder...
Conference Paper
Patients with bipolar disorder have higher rates of mortality and decreased life expectancy compared to the general population largely attributed to the increased risk of developing cardiovascular disease (CVD). To better understand this association, we examined the cardiometabolic risk profile of individuals with bipolar disorder.
Article
Background: The ADHD Self Report Scale is a self-report measure that assesses attentional problems. We sought to validate the ASRS by establishing neural correlates using functional magnetic imaging in healthy controls and individuals with bipolar disorder (BD), who commonly exhibit attentional problems. Methods: ASRS questionnaires and function...
Chapter
Behavioral activation (BA) is an empirically based psychotherapy for depression that improves symptoms by increasing a client’s contact with sources of positive reinforcement by making behavioral changes. Core aspects of BA approaches include performance and monitoring of scheduled activities that are selected based on a client’s values or specific...
Article
The Mind-Body Medicine (MBM) program at the Naval Medical Center San Diego, created in collaboration with the Benson-Henry Institute for Mind Body Medicine and the Home Base Program at Massachusetts General Hospital, is a 7-week program designed to facilitate stress management habits into patient treatment plans. The aim of this study is to test th...
Article
Objectives Lithium and quetiapine are known to be effective treatments for bipolar disorder. However, little information is available to inform prediction of response to these medications. Machine‐learning methods can identify predictors of response by examining variables simultaneously. Further evaluation of models on a test sample can estimate ho...
Article
Introduction Depressive episodes are often prevalent among patients with bipolar disorder, but little is known regarding the differential patterns of development over time. We aimed to determine and characterize trajectories of depressive symptoms among adults with bipolar disorder during 6 months of systematic treatment. Method The pragmatic clin...
Article
There are over one million post-9/11 military caregivers in the United States who face a variety of stressors inherent to caring for an incapacitated loved one. Mind-body interventions, such as the Stress Management and Resilience Training Relaxation Response Resiliency Program (SMART-3RP), have been shown to reduce stress and improve overall healt...
Article
Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their...
Preprint
Objective: Current treatment guidelines for bipolar disorder (BD) recommend several medications as equally effective first-line mood stabilizers. However, knowledge of moderators in bipolar treatments can determine subsets of patients that would benefit from certain medications. Method: Data (N=482) were drawn from a randomized clinical trial (RCT)...
Article
Full-text available
Objective Immunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences. Methods We included two similar clinical trial...
Article
Introduction: Suicidal ideation occurs frequently among individuals with bipolar disorder; however, its course and persistence over time remains unclear. We aimed to investigate 6-months trajectories of suicidal ideation among adults with bipolar disorder. Methods: The Bipolar CHOICE study randomized 482 outpatients with bipolar disorder to 6 mo...
Article
Background: Many mood disorder patients need analgesics due to increased pain sensitivity. Recent studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may inhibit antidepressant treatment, which requires replication before clinical recommendations. Methods: The Clinical and Health Outcomes Initiatives in Comparative Effectiv...
Article
Full-text available
Background: People with bipolar disorder (BD) have a mortality gap of up to 20 years compared to the general population. Physical conditions, such as cardiovascular disease (CVD) and cancer, cause the majority of excess deaths in psychiatric populations and are the leading causes of mortality in people with BD. However, comparatively little attent...
Article
Background: Comparative effectiveness research uses multiple tools, but lacks outcome measures to assess large electronic medical records and claims data. Aggregate changes in medications in response to clinical need may serve as a surrogate outcome measure. We developed the Medication Recommendation Tracking Form (MRTF) to record the frequency, t...
Article
Objectives: Bipolar disorder requires psychiatric medications, but even guideline-concordant treatment fails to bring many patients to remission or keep them euthymic. To address this gap, researchers have developed adjunctive psychotherapies. The purpose of this paper is to critically review the evidence for the efficacy of manualized psychosocia...
Article
Background: We sought to address how predictors and moderators of psychotherapy for bipolar depression - identified individually in prior analyses - can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Tr...
Article
Objective: Immune alterations may play a role in bipolar disorder etiology; however, the relationship between overall immune system functioning and mood symptom severity is unknown. Methods: The two comparative effectiveness trials, the Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder Study (Bipolar CHOI...
Article
Background and objectives: Topiramate is effective for alcohol use disorders (AUDs) among non-psychiatric patients. We examined topiramate for treating comorbid AUDs in bipolar disorder (BD). Methods: Twelve participants were randomized to topiramate or placebo for 12 weeks. Results: The topiramate group, with two out of five participants (40%...
Article
Objective: To examine the effects of treatment on functioning impairments and quality of life and assess baseline functioning and employment status as predictors of treatment response in symptomatic individuals from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (Bipolar CHOICE) study. Method: Bipolar CHOICE was an...
Article
Full-text available
Background Little is known about predictors of recovery from bipolar depression.AimsWe investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression.MethodA total of 252 out-patien...
Article
Full-text available
Background: Little is known about specific mood symptoms that may confer risk for suicidal ideation (SI) among patients with bipolar disorder (BD). We evaluated prospectively whether particular symptoms of depression and mania precede the onset or worsening of SI, among adults with or without a history of a suicide attempt. Methods: We examined...
Article
Background: Few brief, self-report measures exist that can reliably predict adverse suicidality outcomes in patients with BD. This study utilized the Concise Health Risk Tracking Self-Report (CHRT) to assess suicidality in patients with BD and examined its psychometric performance, clinical correlates, and prospective value in predicting adverse e...
Article
Full-text available
Objective: Individuals with bipolar disorder experience a disproportionately high incidence of medical co-morbidity and obesity. These health-related problems are a barrier to recovery from mood episodes and have been linked with unfavorable responses to pharmacological treatment. However, little is known about whether and how these characteristic...
Article
Objective: People with bipolar disorder frequently have persistent symptoms, continued problems functioning and comorbid medical conditions. We propose applying the athletic coaching concept of marginal gains to help patients address these challenges to achieve wellness. Method: We review the concept of marginal gains and potential interventions...
Article
Background: Affective symptoms and medical comorbidities have a negative impact on the course of bipolar disorder. The aim of this analysis was to examine how the perceptions of physical health and functioning in individuals with bipolar disorder relate to their mood symptoms. Methods: We analyzed longitudinal data from the Systematic Treatment...
Article
Full-text available
In this issue of JCP, Zhou and colleagues review and integrate placebo-controlled efficacy trials of medications for treatment-resistant depression (TRD) to compare efficacy in a meta-analysis. They conclude that, among 11 augmentation options for TRD, aripiprazole and quetiapine have the most robust evidence for efficacy, with the caveats that the...
Article
Full-text available
Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomized controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology....
Article
Full-text available
This study examines characteristics of individuals with bipolar disorder who sought psychotherapy versus those who did not. Bipolar CHOICE was an 11-site comparative effectiveness study of lithium versus quetiapine in symptomatic outpatients (N = 482) with bipolar disorder. At baseline, participants' psychotherapy use within the past 3 months, mood...
Article
Full-text available
Individuals with bipolar disorder are more frequently overweight or obese than the general population, but the reasons for this association are unknown. The aim of this study is to further understand the etiology of overweight and obesity in bipolar disorder. We invited patients in a specialty outpatient bipolar clinic to complete the Eating Invent...
Chapter
Bipolar disorder is a mood disorder characterized by recurrent hypomanic/manic and/or depressive mood episodes. Although mood-stabilizing medication is the first line of treatment for bipolar disorder, the beneficial effects of psychosocial treatments, in particular cognitive behavioral therapy, have been recognized. In this chapter we review the c...
Article
Benzodiazepines are widely prescribed for patients with bipolar disorders in clinical practice, but very little is known about the subtypes of patients with bipolar disorder or aspects of bipolar illness that contribute most to benzodiazepine use. We examined the prevalence of and factors associated with benzodiazepine use among 482 patients with b...