Epidemiological and clinical aspects of bipolar disorders: controversies or a common need to redefine the aims and methodological aspects of surveys

Data from surveys of large samples showed the lifetime prevalence rates of bipolar disorder around 1.5%. A main question is whether the low prevalence rates of bipolar disorders are not an artefact of the over-diagnosis of depression and under-diagnosis of bipolar-II. Analysis of the clinician's logical inferential diagnostic process, confirms that the patient does not represent the sole source of useful information because many patients do not experience hypomania as distress but rather as recovery from depression or as a period during which they felt truly well. Epidemiological data are derived from interviews carried out by lay staff which only reflect the patient's point of view. The clinical monitoring study carried out alongside the ESEMED project found for the diagnosis of mood disorders, a Kappa agreement (versus clinical interview) which ranged from 0.23 in Spain to 0.49 in France. If we consider exactly what a Kappa of 0.4 implies for a disorder with an "identified" prevalence rate of 2%, we discover that the prevalence rate may have been under-diagnosed approximately 1.5-fold, so 67% of cases may not have been identified and 50% of the identified cases may be false positives. It is legitimate to surmise that the prevalence reported by recent (extremely costly) epidemiological surveys may be doubtful. Which direction should epidemiology take in dealing with the serious matter of bipolar disorders? Recently, some community surveys were carried out in the USA using the Mood Disorder Questionnaire. In the ensuing debate, one side claimed that the instrument was scarcely accurate when used in the general population, gave rise to numerous false positives and that the high prevalence reported was therefore a mere artefact. The other side defended the results reported by the research studies, on the basis that "positive" cases were homogeneous with regard to the high level of subjective distress, low social functioning and employment and with the high recourse to health care structures. It is quite probable that the problem lies at the root of the matter, in the definition of the gold standard. In the present state of our knowledge on course and response to treatment, the current diagnostic thresholds applied for mixed states and hypomanic episodes seem to be unsatisfactory. It is inconceivable that the diagnostic gold standard should be determined only on the basis of a structured interview of patients alone. But unless there is clinical consensus on the diagnostic threshold for hypomania and mixed states, there can be no consensus on the findings of epidemiological research

Conventional exercise interventions for adults with intellectual disabilities: A systematic review and meta-analysis

n/

Genetic variants involved in bipolar disorder, a rough road ahead

Background: Bipolar Disorder (BD), along with depression and schizophrenia, is one of the most serious mental illnesses, and one of the top 20 causes of severe impairment in everyday life. Recent molecular studies, using both traditional approaches and new procedures such as Whole-Genome Sequencing (WGS), have suggested that genetic factors could significantly contribute to the development of BD, with heritability estimates of up to 85%. However, it is assumed that BD is a multigenic and multifactorial illness with environmental factors that strongly contribute to disease development/progression, which means that progress in genetic knowledge of BD might be difficult to interpret in clinical practice. Objective: The aim of this study is to provide a synthetic description of the main SNPs variants identified/confirmed by recent extensive WGS analysis as well as by reconstruction in an in vitro mechanism or by amygdala activation protocol in vivo. Method: Bibliographic data, genomic and protein Data Banks were consulted so as to carry out a cross genomic study for mutations, SNPs and chromosomal alterations described in these studies in BD patients. Results: Fifty-five different mutations have been described in 30 research papers by different genetic analyses including recent WGS analysis. Many of these studies have led to the discovery of the most probable susceptibility genes for BD, including ANK3, CACNA1C, NCAN, ODZ4, SYNE1, and TRANK1. Exploration has started the role of several of these mutations in BD pathophysiology using in vitro and animal models. Conclusion: Although new genomic research technology in BD opens up new possibilities, the current results for common variants are still controversial because of four broad conditions: analytical validity, clinical validity, clinical utility and a reasonable cost for genetic analysis are not yet accessible

Why a new online open access journal in the field of clinical and epidemiological research in mental health?

Clinical Practice and Epidemiology in Mental Health will encompass all aspects of clinical and epidemiological research in psychiatry and mental health, and will aim to build a bridge between clinical and epidemiological research. There are several outstanding mental heath journals covering all aspects of this dynamic field, but none of these journals is devoted to bridging clinical and epidemiological research. The Open Access online distribution of the journal and its inclusion in the leading data bases (such as PubMed Central) will ensure widespread and ready visibility, which are indispensable given the demand for immediate debate and comparison of scientific findings. This launch Editorial provides an overview of the field, and highlights some of the journal policies

Strategy to Accelerate or Augment the Antidepressant Response and for An Early Onset of SSRI Activity. Adjunctive Amisulpride to Fluvoxamine in Major Depressive Disorder

The topic of early response to antidepressant treatment has been extensively studied in major depressive disorder (MDD). We serendipitous observed an increase tolerability, a rapid response to therapy and an early onset of antidepressant fluvoxamine activity when associated with amisulpride in patients with major depressive disorder. The purpose of this study was to investigate our preliminary observations

Are structured interviews truly able to detect and diagnose Bipolar II disorders in epidemiological studies? The king is still nude!

Introduction A research commentary published in 2005 pointed out that the apparently low prevalence of Bipolar Disorder diagnosis as reported by epidemiological studies may be related to the under-estimate of bipolar disorder cases generally yielded by methodological instruments that are applied in such investigations. New data apparently challenge this notion More recent publications have presented new results that apparently contradict the issues raised by the commentary, stating that the CIDI interview, which is used in the most important epidemiological studies is not only valid but highly reliable in identifying bipolar disorders. Commentary This paper analyzes the new data and concludes that they do not give a clear indication as to how reliably the CIDI can recognize undiagnosed bipolar disorder cases. Further research studies are needed on larger "negative" (to the CIDI) samples before the field will be persuaded that CIDI really does what it is supposed to do

The link between neurosteroids and syndromic/syndromal components of the mood spectrum disorders in women during the premenstrual phase

OBJECTIVES: Females with a lifetime diagnosis of major mood disorder (Bipolar Disorder BD, Major Depressive Disorder MMD) investigated during the luteal phase of their menstrual cycle and in a condition of clinical well-being showed higher blood serum concentrations of progesterone and allopregnanolone compared to healthy controls. Women with BD presented even higher levels than those affected by MDD. This study attempted to verify, in line with a dimensional approach, if the possible differences in neurohormonal levels may be directly linked to some syndromal clusters (dimensions) of the mood spectrum disorders indipendently of diagnosis. METHODS: Premenstrual concentrations of allopregnanolone, THDOC, progesterone, and cortisol were measured in 3 groups of women: 17 BD and 14 MDD outpatients, and 16 control subjects. Psychiatric evaluation was performed with the SCID-I interview and the SCI-MOODS-SR questionnaire. The correlation between steroid levels and mood disorder syndromal cluster (SCI-MOODS-SR domains and sub-domains) was evaluated by means of analysis of main components with Varimax rotation and Kaiser's normalization (which provided for inclusion of all components with an Eigen value >1). RESULTS: Analysis of the main components evidenced the presence of 3 components: 1) mania, 2) depression both with mixed component 3) steroid + manic cognitivity and suicidal ideas. CONCLUSION: Levels of allopregnanolone and progesterone do not correlate with the association of the depressive and manic syndromes, but rather with mixed symptomatological aspects, and in particular with cognitive manic and depressive (with suicidal thoughts) dimensions. Further studies should be carried out to confirm these findings