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Bipolar Disorder Comorbidity in Anxiety Disorders: Relationship to demographic profile, symptom severity, and functional impairment
Fracalanza,Katie A.; McCabe,Randi E.; Taylor,Valerie H.; Antony,Martin M.;
The European Journal of Psychiatry , 2011, DOI: 10.4321/S0213-61632011000400005
Abstract: background and objectives: high rates of comorbidity between anxiety disorders and bipolar disorder (bd) have been reported. studies on the impact of bd comorbidity in individuals with a principal anxiety disorder have been limited. methods: individuals (n = 186) seeking anxiety disorder treatment completed questionnaires and a diagnostic interview. anxious individuals with comorbid bd were compared to anxious individuals with comorbid depression, and individuals with an anxiety disorder only. results: anxious individuals with bd were more likely to report being single, separated or divorced, and to present with greater substance abuse and comorbidity than individuals with an anxiety disorder only. anxious individuals with bd also presented with lower household income than anxious individuals with depression, and individuals with anxiety only. anxious individuals with either comorbid bd or comorbid depression reported greater functional impairment and more severe symptoms than individuals with anxiety only. conclusions: overall, the presence of comorbid bd was associated with demographic and clinical factors that have been previously shown to adversely affect treatment outcome in people with anxiety disorders.
Bipolar Disorder Comorbidity in Anxiety Disorders: Relationship to demographic profile, symptom severity, and functional impairment  [cached]
Katie A. Fracalanza,Randi E. McCabe,Valerie H. Taylor,Martin M. Antony
The European Journal of Psychiatry , 2011,
Abstract: Background and Objectives: High rates of comorbidity between anxiety disorders and bipolar disorder (BD) have been reported. Studies on the impact of BD comorbidity in individuals with a principal anxiety disorder have been limited. Methods: Individuals (N = 186) seeking anxiety disorder treatment completed questionnaires and a diagnostic interview. Anxious individuals with comorbid BD were compared to anxious individuals with comorbid depression, and individuals with an anxiety disorder only. Results: Anxious individuals with BD were more likely to report being single, separated or divorced, and to present with greater substance abuse and comorbidity than individuals with an anxiety disorder only. Anxious individuals with BD also presented with lower household income than anxious individuals with depression, and individuals with anxiety only. Anxious individuals with either comorbid BD or comorbid depression reported greater functional impairment and more severe symptoms than individuals with anxiety only. Conclusions: Overall, the presence of comorbid BD was associated with demographic and clinical factors that have been previously shown to adversely affect treatment outcome in people with anxiety disorders.
Cognitive impairment in a Brazilian sample of patients with bipolar disorder
Schneider, Júlia J;Candiago, Rafael H;Rosa, Adriane R;Ceresér, Keila M;Kapczinski, Flávio;
Revista Brasileira de Psiquiatria , 2008, DOI: 10.1590/S1516-44462008000300006
Abstract: objective: persistent neurocognitive deficits have been described in bipolar mood disorder. as far as we are aware, no study have examined whether the cognitive impairment is presented in the same way in a brazilian sample. method: cognitive function of 66 patients with bipolar disorder (32 with depressive symptoms and 34 euthymic) and 28 healthy subjects was examined using a complete cognitive battery. results: patients with bipolar disorder presented a significantly poorer performance in eight of the 12 subtests when compared to healthy subjects. there was no significant difference between the subgroups of patients. these patients showed impairment in both verbal and non-verbal cognitive function. conclusion: cognitive impairment was found in both groups of patients with bipolar disorder. the findings described here suggest an overall impairment of cognitive function, independent of mood symptoms. this is in line with data showing that cognitive deficits may be a persistent characteristic of bipolar disorder.
Social Anxiety Disorder and Mood Disorders Comorbidity  [PDF]
Zerrin Binbay,Ahmet Koyuncu
Psikiyatride Guncel Yaklasimlar , 2012,
Abstract: Social Anxiety Disorder is a common disorder leading functional impairment. The comorbidity between mood disorders with social anxiety disorder is relatively common. This comorbidity impacts the clinical severity, resistance and functionality of patients. The systematic evaluation of the comorbidity in both patient groups should not be ignored and be carefully conducted. In general, social anxiety disorder starts at an earlier age than mood disorders and is reported to be predictor for subsequent major depression. The absence of comorbidity in patients with social anxiety disorder is a predictor of good response to treatment. In bipolar disorder patients with comorbid social anxiety disorder, there is an increased level of general psychopathology. Besides, they have poor outcome and increased risk of suicide. In this article, comorbidity between these two disorders has been evaluated in detail.
Functional Outcome in Bipolar Disorder: The Big Picture  [PDF]
Boaz Levy,Emily Manove
Depression Research and Treatment , 2012, DOI: 10.1155/2012/949248
Abstract: Previous research on functional outcome in bipolar disorder (BD) has uncovered various factors that exacerbate psychosocial disability over the course of illness, including genetics, illness severity, stress, anxiety, and cognitive impairment. This paper presents an integrated view of these findings that accounts for the precipitous decline in psychosocial functioning after illness onset. The proposed model highlights a number of reciprocal pathways among previously studied factors that trap people in a powerful cycle of ailing forces. The paper discusses implications to patient care as well as the larger social changes required for shifting the functional trajectory of people with BD from psychosocial decline to growth. 1. Introduction Psychosocial functioning in bipolar disorder (BD) runs the full gamut of human potential. Whereas some people with BD accomplish historical landmarks in human achievement [1–3], others experience significant difficulties in managing tasks of daily living [4]. The remarkable functional variability in BD highlights an inherent prognostic complexity [5–7], which is not immediately evident in the diagnosis [8]. Many studies have illuminated various aspects of illness progression in BD [9–11], yet significant improvement to functional outcome may require further theoretical and clinical advancement [12]. The astounding functional differences among people with BD present one of the toughest challenges to this effort, as these emerge across the entire spectrum of human development [7, 13–16]. Early emotional abnormalities and poor premorbid functioning tend to occur in BD [17–19]; however, adequate psychosocial adjustment prior to the first manic episode is also common [20–22]. Furthermore, after illness onset, many people with BD regain psychosocial functioning [13, 23], yet others suffer inordinate functional decline, which progresses from a state of psychosocial adjustment to a state of disability [23, 24]. The latter group is of particular interest to clinical research. Understanding the nature of the sometimes dysfunctional trajectory of BD may help to diminish it, and thereby reduce suffering and cost. This paper examines the strongest predictors of functional outcome in BD, which have been separately summarized in multiple previous reviews. In this regard, the paper does not aim to provide a comprehensive review of studies linking each of the factors under discussion to psychosocial functioning in BD. Instead, it offers an integrated view on previously reviewed findings and discusses potential implications for prevention
Maudsley Bipolar Disorder Project: insights sobre o papel do córtex pré-frontal em pacientes com transtorno de humor bipolar tipo I
Haldane, Morgan;Frangou, Sophia;
Revista de Psiquiatria do Rio Grande do Sul , 2005, DOI: 10.1590/S0101-81082005000300003
Abstract: purpose: the maudsley bipolar disorder project was set up in order to investigate the cognitive and structural/functional brain characteristics of bipolar disorder i (bdi). methods: participating patients with bdi (n = 43) were recruited from a secondary care setting, while in remission. they were matched to healthy controls for age, gender, race and years of education. each participant underwent extensive clinical review, cognitive assessment, and magnetic resonance imaging (mri) in order to obtain brain structural and functional data. results: when compared to controls, patients demonstrated subtle widespread impairment with executive function being more markedly reduced. patients also displayed volume decrements in the ventral prefrontal cortex (vpfc) bilaterally and in the dorsal pfc (dpfc) on the left. the volume of the amygdala was bilaterally enlarged. functional mri of patients showed subtle abnormalities in their dpfc, with marked decrements in activity in both the dpfc and vpfc during tasks that rely on these regions functionally interacting. conclusions: the results suggest that trait deficits in executive function occur in bdi, along with altered structure and function of the pfc.
Clinical usefulness of the screen for cognitive impairment in psychiatry (SCIP-S) scale in patients with type I bipolar disorder
Georgina Guilera, Oscar Pino, Juana Gómez-Benito, J Emilio Rojo, Eduard Vieta, Rafael Tabarés-Seisdedos, Nuria Segarra, Anabel Martínez-Arán, Manuel Franco, Manuel J Cuesta, Benedicto Crespo-Facorro, Miguel Bernardo, Scot E Purdon, Teresa Díez, Javier Rejas, the Spanish Working Group in Cognitive Function
Health and Quality of Life Outcomes , 2009, DOI: 10.1186/1477-7525-7-28
Abstract: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects.Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity.The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored.With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.Cognitive deficits in bipolar disorders are relevant to cerebral pathogenesis and prognosis, but they are often neglected in routine clinical practice. The deficits persist beyond the resolution of acute symptoms [1-3] and show familial co-segregation [4] consistent with expectations for a genetically based endophenotypic trait [5]. The cognitive deficits in bipolar disorder are also directly related to functional status or psychosocial outcomes [6,7], and the severity of the cognitive impairment at initiation of therapeutic intervention can be a powerful predictor of functional recovery one year later [8]. Similar observations in schizophrenia [9] prompted the National Institutes of Health initiative for
Poorer sustained attention in bipolar I than bipolar II disorder
Chian-Huei Kung, Sheng-Yu Lee, Yun-Hsuan Chang, Jo Wu, Shiou-Lan Chen, Shih-Heng Chen, Chun-Hsien Chu, I-Hui Lee, Tzung-Lieh Yeh, Yen-Kuang Yang, Ru-Band Lu
Annals of General Psychiatry , 2010, DOI: 10.1186/1744-859x-9-8
Abstract: In all, 51 interepisode BP patients (22 with BP I and 29 with BP II) and 20 healthy controls participated in this study. The severity of psychiatric symptoms was assessed by the 17-item Hamilton Depression Rating Scale and the Young Mania Rating Scale. All participants undertook Conners' Continuous Performance Test II (CPT-II) to evaluate sustained attention.After controlling for the severity of symptoms, age and years of education, BP I patients had a significantly longer reaction times (F(2,68) = 7.648, P = 0.001), worse detectability (d') values (F(2,68) = 6.313, P = 0.003) and more commission errors (F(2,68) = 6.182, P = 0.004) than BP II patients and healthy controls. BP II patients and controls scored significantly higher than BP I patients for d' (F = 6.313, P = 0.003). No significant difference was found among the three groups in omission errors and no significant correlations were observed between CPT-II performance and clinical characteristics in the three groups.These findings suggested that impairments in sustained attention might be more representative of BP I than BP II after controlling for the severity of symptoms, age, years of education and reaction time on the attentional test. A longitudinal follow-up study design with a larger sample size might be needed to provide more information on chronological sustained attention deficit in BP patients, and to illustrate clearer differentiations between the three groups.The prevalence of bipolar disorder (BP) is estimated at 3.5% to 6.4% of the general population [1,2], and 30% to 50% of those in remission will not achieve premorbid psychosocial function levels [3]. Accordingly, evidence has shown that poor functional outcome is highly associated with cognitive impairment, and may persist through the remission period [4].However, most previous studies only focused on type I bipolar disorder (BP I) with regard to neuropsychological aspects, mainly because type II bipolar disorder (BP II) was often underdiagn
双相障碍稳定期执行功能损害的神经影像学研究进展#br#
Advances in neuroimaging studies on executive impairment of patients with euthymic bipolar disorder#br#
 [PDF]

杨涛,赵国庆,方贻儒,陈俊
YANG Tao
, ZHAO Guo-qing, FANG Yi-ru, CHEN Jun

- , 2017, DOI: 10.3969/j.issn.1674-8115.2017.08.021
Abstract: 双相障碍(BD)是一种高复发率、高致残率的慢性精神疾病,认知功能损害是其核心症状之一,并存在于病程的各个阶段。 神经影像学研究发现,大脑体积、白质纤维完整性、关键脑区脑血流信号及血氧饱和度等多是 BD 患者执行功能受损相关因素。该文 就 BD 稳定期患者执行功能损害的大脑结构及功能改变的现状和进展进行综述。
:Bipolar disorder (BD) is a chronic mental illness with high recurrence rate and disability. As one of the core symptoms, cognitive impairment may occurs at every stage of the disease. Evidence from the neuroimaging studies revealed that the abnormal brain volumes, the blood flow and oxygen saturation of key brain areas are related to executive impairment in patients with bipolar disorder. This article reviews current structural and functional neuroimaging studies about the executive impairment of patients with euthymic bipolar disorder and research progresses
The impact of the number of episodes on the outcome of Bipolar Disorder
Marzo,S. Di; Giordano,A.; Pacchiarotti,I.; Colom,F.; Sánchez-Moreno,J.; Vieta,E.;
The European Journal of Psychiatry , 2006, DOI: 10.4321/S0213-61632006000100003
Abstract: background: bipolar disorder is a highly recurrent severe psychiatric disorder. the number of episodes has been found consistently associated with poor outcome. it has been suggested that bipolar patients with long duration of illness and highly recurrent course show great impairment of global functioning. objectives the aim of this study is to assess the clinical course and outcome of patients with bipolar disorder i and ii with a high number of mood episodes. methods: we compared a group of bipolar i and ii subjects whose number of episode was higher than ten (n = 167) with a similar-size representative sample of bipolar patients whose number of episodes was lower or equal than ten (n = 131). results: bipolar patients with more than 10 episodes have a more severe outcome of bipolar disorder. qualification and occupational status was clearly worse for the highly recurrent group which showed a predominance of depressive polarity. conclusions: these data suggest that bipolar patients with a highly recurrent course have significant functional impairment. with the passing of time, bipolar illness tends to be ruled by depressive features. treatment strategies may need to address this issue.
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