Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients

Dios, Consuelo de; Ezquiaga, Elena; Agud, J.L.; Vieta, Eduard; Soler, Begoña; García-López, A.

doi:10.1016/j.jad.2012.05.047

Cited by 47 publications

(27 citation statements)

References 29 publications

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“…In addition, some of the excluded studies had samples that overlapped with those of the included studies. Finally, 12 studies were eligible for inclusion in the meta-analysis [4,6,8,11,23,24,25,26,27,28,29,30](online suppl. table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The point in time when the presence of subsyndromal symptoms was diagnosed varies and depends on the individual study design. Some patients started the follow-up at baseline being in euthymia or suffering already from subsyndromal symptoms [24,25]. Others were on their way to recovery from a major affective episode and were classified into the categories ‘euthymia' or ‘subsyndromal symptoms' after 8 weeks [4], or they were included while suffering from a continuous circular course or a noncontinuous circular course [4].…”

Section: Resultsmentioning

confidence: 99%

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Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Raduà

Grunze

Amann

2017

Psychother Psychosom

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Background: Reported relapse and recurrence rates in bipolar disorder (BD) differ significantly between studies. Most data originate from highly selective patients participating in sponsored randomized controlled trials with narrow inclusion criteria. To estimate the true risk of a subsequent mood episode (SME) under real-world conditions, we conducted a meta-analysis of rates of SME as reported in naturalistic BD studies. Methods: PubMed, ScienceDirect, Scopus, and Web of Knowledge were searched until July 2015. Studies reporting the time until the emergence of an SME, from which individual data or Kaplan-Meier plots with censors marked could be retrieved, were included. Results: Twelve studies comprising 5,837 patients met the inclusion criteria. The median time to an SME in adults after an index episode was 1.44 years. The risk of an SME was 44% during the first year. Not having a SME during this first year lowered this risk to 19% in the second year. The risk was higher in bipolar II disorder (BD-II) than in bipolar I disorder (BD-I; HR = 1.5). In BD-I, the risk of a subsequent manic, mixed, or depressive mood episode was higher after an index episode of the same polarity (HR = 1.89-5.14). The overall risk of an SME was higher in patients with persisting subsyndromal symptoms (HR = 2.17). Conclusions: The data from this study provide a more reliable estimate of the risk of an SME in BD in real-world settings. Further research into the longitudinal course of BD-II is warranted to confirm its role as a risk factor for SME.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Raduà

Grunze

Amann

2017

Psychother Psychosom

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“…Risk factors for recurrence include younger age of onset,332 psychotic features,212 rapid cycling,331 more (and more frequent) previous episodes,333 comorbid anxiety,334 and comorbid SUDs 335. Persistent subthreshold symptoms also increase risk for subsequent mood episodes,334, 336, 337 and the presence of residual symptoms should therefore be an indicator of a need for further treatment optimization. Availability of psychosocial support and lower levels of stress are also protective against recurrence 337, 338…”

Section: Maintenance Therapy For Bipolar Disordermentioning

confidence: 99%

“…Persistent subthreshold symptoms also increase risk for subsequent mood episodes,334, 336, 337 and the presence of residual symptoms should therefore be an indicator of a need for further treatment optimization. Availability of psychosocial support and lower levels of stress are also protective against recurrence 337, 338…”

Section: Maintenance Therapy For Bipolar Disordermentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Clinical observations in bipolar patients show that repeated episodes or residual symptoms enhance the risk of future recurrences (De Dios et al, 2012), while aggravating deterioration and volumetric changes of brain tissue (Strakowski et al, 2002;Moorhead et al, 2007;Lim et al, 2013). Recent studies have even shown that neuropsychological deficits may persist during euthymic state, corroborating the idea of a continuous aggressive inflammatory environment (for a review on neurobiology of BD, see Maletic and Raison, 2014).…”

Section: Possible Experimental Designmentioning

confidence: 89%

Kinins and microglial responses in bipolar disorder: a neuroinflammation hypothesis

Naaldijk¹,

Bittencourt²,

Sack

et al. 2016

Biological Chemistry

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Bipolar disorder (BD) is a severe psychiatric disorder that affects up to 15% of the worldwide population. Characterized by switches in mood between mania and depression, its etiology is still unknown and efforts have been made to elucidate the mechanisms involved in first episode, development and progression of the disorder. Microglia activation, abnormal activity of GSK-3β and reduction in neurotrophic factor expression related to neuroinflammatory processes have been indicated to be part of the disorder's pathophysiology. Lithium, the main mood stabilizer used for the treatment and prevention of relapses, acts as an anti-inflammatory agent. Based on that, here we suggest a neuroinflammatory pathway for would be BD progression, in which microglia activation states modulated via constitutive induction of kinin-B1 receptor and reduction of kinin-B2 receptor expression and activity.

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Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients

Cited by 47 publications

References 29 publications

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Kinins and microglial responses in bipolar disorder: a neuroinflammation hypothesis

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