Childhood trauma, primary emotional systems, and suicidal ideation in youths with bipolar disorders

Background: Bipolar disorders (BD) in youths are strongly associated with lifetime suicidal ideation. Nevertheless, primary emotional systems (PES) contributing to this association are poorly understood. Besides this, childhood trauma is a prominent environmental stressor associated with both BD diagnosis and suicide. The aim of this study was to investigate the distribution patterns of PES and childhood trauma in youths’ BD with and without suicidal ideation (BD-IS, BD-NIS). Methods: We assessed 289 participants, 103 youths with DSM-5 BD and 186 healthy controls (HCs). PES were obtained with the Affective Neuroscience Personality Scales (ANPS) and history of childhood trauma using the Childhood Trauma Questionnaire (CTQ). Suicidal ideation was assessed through the Columbia Suicide Scale for the Rating of Suicide Severity (C-SSRS). The associations with suicidal ideation were tested using two different multivariate models. Results: Over 48% of participants reported lifetime suicidal ideation. According to the first model (p<0.0001), BD-IS scored higher on the ANPS-ANGER and lower on ANPS-PLAY and ANPS-CARE than both HCs and BD-NIS, while BD-NIS reported higher and lower scores than HC. BD-IS and BD-NIS reported higher scores on ANPS-SEEK than HCs. BD-IS reported more emotional abuse, sexual abuse, physical abuse and emotional neglect than HCs, but only more emotional abuse than BD-NIS. ANPS-ANGER (OR: 1.13) and CTQ-Emotional abuse (OR:1.26) were independent predictors of suicidal ideation in youths with BD. Conclusions: Findings support the importance of assessing primary emotional systems and childhood trauma, in particular emotional abuse, in youths with BD at risk for suicide

The Koukopoulos mixed depression rating scale (KMDRS) and the assessment of mixed symptoms during the perinatal period

Background: Mixed symptoms in depression may underlie bipolar diathesis rather than unipolarity. Uncovering mixed depression (MxD) is crucial for appropriate management, especially in the perinatal period, as it may affect treatment planning and impact future child development. We used a scale specific for identifying MxD and tested its validity in pregnant and postpartum women with depression. Methods: Women developing a major depressive episode (MDE) during their perinatal period extending from pregnancy to one year postpartum from November-2012 through June-2019 were assessed with BPRS-18, EPDS, CGI-S, GAF, HAM-A, HAM-D, Koukopoulos' Mixed Depression Rating Scale (KMDRS), TEMPS, and YMRS. They were classified, based on KMDRS criteria, as with mixed (MxD) or without (nonMxD) mixed symptoms. We conducted ROC analysis and performed factor analysis of the KMDRS. Results: Of 45 included, MxD (N = 19) were biased towards diagnosis of bipolar disorder and nonMxD (N = 26) towards major depressive disorder. Other sociodemographic variables did not differ significantly between MxD and nonMxD. MxD scored higher on total YMRS, BPRS, and KMDRS, and on KMDRS-6 Subjective Feelings of Irritability and KMDRS-12 Suicidal Impulsiveness items. The KMDRS correlated in the entire sample, in MxD and nonMxD, with the YMRS and the BPRS, while correlating with the HAM-D in nonMxD only. The KMDRS showed acceptable AUC distribution, with a 68% sensitivity and 58% specificity. Best-fit was three-factor-structure, explaining 54.66% of cumulative variance. Limitations: Small sample and cross-sectional design. Conclusions: The KMDRS is fit for investigating MxD along with the YMRS and the BPRS in perinatal women with a MDE

Why lithium should be used in patients with bipolar disorder? A scoping review and an expert opinion paper

Introduction: Lithium treatment is considered the gold standard for the long-term management of bipolar disorder and recurrent unipolar depression. It is also extremely effective in other psychiatric conditions characterized by impulsivity and aggression, and for the prevention of suicidal behaviours. Areas covered: This paper provides a scoping review and an expert commentary regarding the use of lithium in adult patients. Available information about efficacy, tolerability, dosing, and switching is analyzed, and the strategies that may be most useful in real-world clinical settings are highlighted. Expert opinion: Lithium is effective on different domains of bipolar disorder, including the long-term prevention of recurrences of affective episodes, management of acute mania as well as in the prophylaxis of all affective episodes. Lithium has been defined a 'forgotten drug,' since its use in routine clinical practice has been declined over the last 20 or 30 years. Reasons for this trend include lack of adequate training on the management of lithium side effects. Considering its efficacy, use of lithium in ordinary clinical practice should be promoted. Several strategies, such as using slow-release formulations, can be easily implemented in order to minimize lithium side effects and improve its tolerability profile

Depressive Symptoms during Pregnancy. Prevalence and Correlates with Affective Temperaments and Psychosocial Factors

Pregnancy is a unique experience in women's life, requiring a great ability of adaptation and self-reorganization; vulnerable women may be at increased risk of developing depressive symptoms. This study aimed to examine the incidence of depressive symptomatology during pregnancy and to evaluate the role of affective temperament traits and psychosocial risk factors in predicting them. We recruited 193 pregnant women, collected data regarding sociodemographic, family and personal clinical variables, social support and stressful life events and administered the Mood Disorder Questionnaire (MDQ), the Patient Health Questionnaire-9 (PHQ-9), and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A). In our sample, prevalence of depressive symptomatology was 41.45% and prevalence of depression was 9.85% (6.75% mild and 3.10% moderate depression). We have chosen a cutoff >4 on PHQ-9 to identify mild depressive symptoms which may predict subsequent depression. Statistically significant differences between the two groups were found in the following factors: gestational age, occupation, partner, medical conditions, psychiatric disorders, family psychiatric history, stressful life events, and TEMPS-A mean scores. In our sample mean scores on all affective temperaments but the hyperthymic, were significantly lower in the control group. Only depressive and hyperthymic temperaments were found to be, respectively, risk and protective factors for depressive symptomatology. The current study confirms the high prevalence and complex aetiology of depressive symptomatology during pregnancy and suggests that affective temperament assessment seems to be a useful adjunctive instrument to predict depressive symptomatology during pregnancy and postpartum

Stabilization beyond mood. stabilizing patients with bipolar disorder in the various phases of life

Background: There are different ways to define stabilization and currently, the main standpoint regards it as no-depression/no-mania. Furthermore, each person is physiologically different from childhood to adulthood, and in old age, thus the meaning of stabilization should take into account both growth and maturity. We aimed to review systematically studies focusing on mood stabilization in all phases of bipolar disorder (BD) and across all life phases, including pregnancy and the perinatal period, which is still a different phase in women's life cycles. Methods: We carried out a PubMed search focusing on studies of bipolar disorder treated with drugs and aimed at stabilization with the following search strategy stabiliz*[ti] OR stabilis*[ti] OR stable[ti] OR stability[ti]) AND mood[ti] AND bipolar. In conducting our review, we followed the PRISMA statement. Agreement on inclusion was reached by consensus of all authors through a Delphi rounds procedure. Results: The above search strategy produced 509 records on January 25, 2020. Of them, 58 fitted our inclusion criteria and were discussed. The eligible studies spanned from September 1983 to July 6, 2019. Conclusions: No clear-cut indications could be drawn due to a number of limitations involving sample inconsistency and different methods of assessing mood stabilization. The evidence collected so far does not allow recommended treatments for Adolescents, pregnant or perinatal women, and aged patients. However, adults, not within these groups, better focused upon. For their manic/mixed phases, second generation antipsychotic drugs may be useful in the short-to-medium run, alone or combined with mood stabilizers (MSs). However, MSs, and especially lithium, continue to be pivotal in chronic treatment. Bipolar depression should rely on MSs, but an antidepressant may be added on and can prove to be helpful. However, there are concerns with the tendency of antidepressants to induce the opposite polarity or mood instability, rendering the need for concurrent MS prescription mandator

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health

Interpersonal violence in the perinatal period is frequent and should be considered a prominent health issue due to the risk of escalation of violence and the significant impact on mothers’ parenting after childbirth. Domestic violence during pregnancy can be associated with fatal and non-fatal adverse health outcomes due to the direct trauma to a pregnant woman’s body and to the effect of stress on fetal growth and development. Emotional violence is a risk factor for prenatal and/or postpartum depression. Recent studies focusing on abusive situations during peripartum and possible preventive strategies were identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All of the available literature was retrospectively reviewed with a special attention to peer-reviewed publications from the last ten years. Results of the present narrative review suggest that perinatal health care professionals (general practitioners, gynecologists, obstetricians, psychologists, psychiatrists) should promptly detect interpersonal violence during and after pregnancy and provide health care for pregnant women. It seems pivotal to guarantee psychological care for abused women before, during, and after pregnancy in order to prevent the risk of depressive symptoms, other mental or physical sequelae, and mother-to-infant bonding failure. There is an urgent need for multifaceted interventions: programs should focus on several risk factors and should design tailored care pathways fitted to the specific needs of women and finalized to support them across the lifespan

Validation of the Italian version of the Koukopoulos Mixed Depression Rating Scale (KMDRS) in an Italian sample of subjects with mood disorders

Introduzione. Il costrutto della depressione mista (MxD), ovvero la presenza di sintomi eccitativi nel contesto di un episodio depressivo, è stato oggetto di crescente interesse negli ultimi anni. Recentemente la Koukopoulos Mixed Depression Rating Scale (KMDRS) è stata validata per la valutazione della gravità di tale costrutto. L’obiettivo dello studio è quello di validare la versione italiana della KMDRS. Materiali e metodi. 396 pazienti con episodio depressivo maggiore (EDM) sono stati reclutati presso il Centro Lucio Bini di Roma (età media=44,73 anni, DS=15,93). A tutti i partecipanti sono state somministrate le seguenti scale psicometriche: la KMDRS, la Montgomery-Åsberg Depression Rating Scale (MADRS), la Young Mania Rating Scale (YMRS), la Clinical Global Impressions (CGI) e la Valutazione Globale del Funzionamento (VGF). Sono state calcolate la validità predittiva, l’analisi Receiver Operator Curve (ROC), il valore alfa di Chronbach e l’affidabilità dell’accordo tra i ricercatori. Risultati. La validità predittiva (C-statistico= 0,80; IC 95%: 0,75, 0,85) e la capacità predittiva [OR=1,25±,03 (SE); 95% CI: 1,18, 1,32; p<,001] sono risultate buone e in linea con quelle relative alla versione originale della scala, mentre la consistenza interna (alfa di Cronbach=,70, IC 95%: 0,65, 0,75) e l’affidabilità dell’accordo tra i ricercatori sono risultate adeguate. Conclusioni. I risultati ottenuti sono in linea con quelli relativi alla scala originale. Pertanto la versione italiana della KMDRS rappresenta uno strumento valido per la valutazione della MxD.Background: The construct of mixed depression (MxD), namely the simultaneous presence of excitatory symptoms during a depressive episode, has gained increased interest in the recent years. The Koukopoulos Mixed Depression Rating Scale (KMDRS) has been recently validated for the diagnosis and assessment of MxD. The aim of this study was to validate the Italian version of the KMDRS. Methods: Patients with a major depressive episode (MDE) (N=396, age, mean=44.73 years, SD=15.93) were recruited at Lucio Bini Center, Rome, Italy. All participants were administered the Italian version of the KMDRS, the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), the Clinical Global Impressions (CGI), and the Global Assessment of Functioning (GAF). We calculated predictive validity, and performed Receiver Operator Curve (ROC) analysis, Cronbach's alpha, and inter-rater reliability. Results: Predictive validity (C-statistic= 0.80; IC 95%: 0.75, 0.85) and capacity [OR=1.25±.03 (SE); 95% CI: 1.18, 1.32; p<.001] were good, matching those of the original version, whereas internal consistency (Cronbach's alpha = .70, IC 95%: 0.65, 0.75) and interrater reliability (Cohen's kappa= 0.74) were adequate. Conclusions: The agreement of results with those of the original version point to the validity of the Italian version of KMDRS in assessing MxD