Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder

O’Donnell, Lisa; Ellis, Alissa J.; Loo, Margaret M. Van de; Stange, Jonathan P.; Axelson, David; Kowatch, Robert A.; Schneck, Christopher D.; Miklowitz, David J.

doi:10.1016/j.jad.2018.04.021

Cited by 40 publications

(39 citation statements)

References 38 publications

(58 reference statements)

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“…As a result, delays of several years can occur between an initial diagnosis of a mental disorder and a diagnosis of BD [96]. BD patients can also experience intense, rapidly shifting emotional states [120], with BD patients experiencing a greater number of mood swings than others impacting on their functioning [121]. Co-morbidity with other psychiatric disorders is also common making treatment complex [69].…”

Section: Bipolar Disorders (Bd) Including Prevalence and Burden Of Ilmentioning

confidence: 99%

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Godman

Grobler

Van-De-Lisle

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middleincome countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed. Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments. Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

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Section: Bipolar Disorders (Bd) Including Prevalence and Burden Of Ilmentioning

confidence: 99%

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Godman

Grobler

Van-De-Lisle

et al. 2019

Expert Opinion on Pharmacotherapy

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“…Here, AL belongs to a constellation of symptoms preceding the development of the disorder [18], is present early in the course of illness [19], in manic and mixed episodes [20], but also in periods of euthymia [21]. Hence, AL appears to be both a trait-and state-dependent factor that is associated with poor prognostic outcomes [21,22]. Our research group has previously found relationships between elevated AL and clinical correlates such as AUD, childhood trauma, suicidality, mixed episodes and anxiety, as well as intact executive functioning in BD [7,19,23,24].…”

Section: Introductionmentioning

confidence: 99%

Affective lability across psychosis spectrum disorders

et al. 2020

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Background. Despite apparent clinical remission, individuals with psychotic disorders often experience significant impairments across functional domains. Thus, there is a need to search beyond management of core symptoms to optimize treatment outcomes. Affective dysregulation is considered a risk factor for poor clinical and functional outcomes in many mental disorders, but research investigating such features in psychosis, particularly in schizophrenia, is limited. We aimed to investigate the level of affective lability (AL) in participants with schizophrenia- and bipolar spectrum disorders (n = 222) compared to healthy controls (n = 140), as well as clinical correlates of AL in the diagnostic groups. Methods. The Affective Lability Scale (ALS-SF) was used to measure total score of AL and subscores covering the domains of anxiety/depression, depression/elation, and anger. An analysis of covariance was performed to compare the ALS-SF total score between groups, correcting for potential confounders, as well as standard multiple regression analyses for diagnosis-specific investigations of the relationship between AL and demographic and clinical features. Results. Both the schizophrenia- and bipolar spectrum group had significantly higher ALS-SF total score compared to controls (p < 0.001), and no significant differences between the patient groups were found. In the schizophrenia group, current psychotic and depressive symptoms were significantly and independently associated with AL (p = 0.012 and p = 0.024, respectively). Conclusions. The findings indicate that AL is elevated in psychotic disorders and that it transcends diagnostic boundaries. Further research into the causal relationship between psychotic and affective symptoms and AL, as well as its role as a potential therapeutic target in psychosis spectrum disorders, is warranted.

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“…Alteration of mood is a central core feature of BD. Many patients with BD experience subsyndromal mood swings on a daily basis that are associated with increased risk of relapse and hospitalization [12][13][14]. Our group has in recent studies showed that smartphone-based daily self-monitored mood alterations are associated with increased perceived stress and decreased quality of life and functioning [15,16] and that increased mood instability may behave as a genetic vulnerability trait for BD being present in remitted BD patients [15] and in their unaffected relatives (UR) [16].…”

Section: Introductionmentioning

confidence: 99%

Mood, activity, and sleep measured via daily smartphone-based self-monitoring in young patients with newly diagnosed bipolar disorder, their unaffected relatives and healthy control individuals

Melbye

Stanislaus

Vinberg

et al. 2020

Eur Child Adolesc Psychiatry

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Diagnostic evaluations and early interventions of patients with bipolar disorder (BD) rely on clinical evaluations. Smartphones have been proposed to facilitate continuous and fine-grained self-monitoring of symptoms. The present study aimed to (1) validate daily smartphone-based self-monitored mood, activity, and sleep, against validated questionnaires and clinical ratings in young patients with newly diagnosed BD, unaffected relatives (UR), and healthy controls persons (HC); (2) investigate differences in daily smartphone-based self-monitored mood, activity, and sleep in young patients with newly diagnosed BD, UR, and HC; (3) investigate associations between self-monitored mood and self-monitored activity and sleep, respectively, in young patients with newly diagnosed BD. 105 young patients with newly diagnosed BD, 24 UR and 77 HC self-monitored 2 to 1077 days (median [IQR] = 65 [17.5-112.5]). There was a statistically significantly negative association between the mood item on Hamilton Depression Rating Scale (HAMD) and smartphone-based self-monitored mood (B = − 0.76, 95% CI − 0.91; − 0.63, p < 0.001) and between psychomotor item on HAMD and self-monitored activity (B = − 0.44, 95% CI − 0.63; − 0.25, p < 0.001). Smartphone-based self-monitored mood differed between young patients with newly diagnosed BD and HC (p < 0.001), and between UR and HC (p = 0.008) and was positively associated with smartphone-based self-reported activity (p < 0.001) and sleep duration (p < 0.001). The findings support the potential of smartphone-based self-monitoring of mood and activity as part of a biomarker for young patients with BD and UR. Smartphone-based self-monitored mood is better to discriminate between young patients with newly diagnosed BD and HC, and between UR and HC, compared with smartphone-based activity and sleep. Trial registration clinicaltrials.gov NCT0288826

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Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder

Abstract: MI differs by diagnostic subtype, is relatively stable over time, and predicts clinical and functional outcomes. Targeting MI should be considered a clinical focus to augment traditional methods of assessing and treating BD during adolescence to enhance clinical and functional outcomes.

Cited by 40 publications

References 38 publications

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Affective lability across psychosis spectrum disorders

Mood, activity, and sleep measured via daily smartphone-based self-monitoring in young patients with newly diagnosed bipolar disorder, their unaffected relatives and healthy control individuals

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