Adverse Childhood Life Events and Postpartum Mood Episodes in Bipolar Disorder

Background: The early postpartum has been established as a period of increased vulnerability for psychiatric mood illness. Women with bipolar disorder (BD) in particular are at elevated risk of postnatal depression (PND) and of postpartum psychosis (PP). Though adverse childhood life events (ACLEs) have been implicated in the aetiology of PND, this has rarely been studied in relation to PP. Furthermore, despite being at high risk of relapse following childbirth, little research has assessed the relationship between ACLEs and postnatal mood episodes (PNEs) exclusively in women with BD. Therefore, our aim was to explore associations between ACLEs and occurrence of both PND and PP in a large sample of women with BD. Methods: Participants were 665 parous women with BD who had been recruited into the Bipolar Disorder Research Network study. Diagnoses and lifetime psychopathology were obtained via a semi-structured interview (SCAN). Postnatal psychiatric history and experience of 7 ACLEs were also assessed. Where available, all information obtained at interview was confirmed from psychiatric case notes. Women were classified into three groups according to postnatal psychiatric history: 1) those who had experienced no postnatal mood episode (no PNE, n=224), 2) women with a history of PND (n=223) and 3) women who had experienced PP (n=208). A Pearson’s chi-square test was used to compare the prevalence of each type of ACLE between women in the no PNE group and those with a history of PND or PP. Results: Women with PND were significantly more likely to have experienced emotional, sexual or physical abuse in childhood compared with women who had no history of a PNE (p<0.05). In particular, childhood sexual abuse was reported significantly more in the PND than the no PNE group (P<0.05). In contrast, there were no significant differences in the frequency of reporting of any ACLEs between women who had no PNE and those with PP. Conclusions: Our findings indicate that childhood abuse, sexual abuse in particular, is associated with PND among women with BD. In contrast, we found no evidence for an association between any ACLE and PP, suggesting that biological factors are likely to play a more important role in the aetiology of psychosis in the early postpartum

Large-scale Roll Out of Electronic Longitudinal Mood-Monitoring for Research in Affective Disorders: Report From the UK Bipolar Disorder Research Network

Background Electronic longitudinal mood monitoring has been shown to be acceptable to patients with affective disorders within clinical settings, but its use in large-scale research has not yet been established. Methods Using both postal and email invitations, we invited 4080 past research participants with affective disorders who were recruited into the Bipolar Disorder Research Network (BDRN) over a 10 year period to participate in online weekly mood monitoring. In addition, since January 2015 we have invited all newly recruited BDRN research participants to participate in mood monitoring at the point they were recruited into BDRN. Results Online mood monitoring uptake among past participants was 20, and among new participants to date was 46 with participants recruited over the last year most likely to register (61). More than 90 mood monitoring participants engaged for at least one month, with mean engagement period greater than one year (58 weeks) and maximum engagement for longer than three years (165 weeks). There were no significant differences in the proportion of past and new BDRN participants providing data for at least 4 weeks (91, 92 respectively), 3 months (78, 82), 6 months (65, 54) or one year (51, 44). Limitations Our experiences with recruiting participants for electronic prospective mood monitoring may not necessarily generalise fully to research situations that are very different from those we describe. Conclusions Large-scale electronic longitudinal mood monitoring in affective disorders for research purposes is feasible with uptake highest among newly recruited participants

Agitated Depression in Bipolar Disorder

Objectives It has been suggested that agitated depression (AD) is a common, severe feature in bipolar disorder. We aimed to estimate the prevalence of AD and investigate whether presence of AD was associated with episodic and lifetime clinical features in a large well‐characterised bipolar disorder sample. Method The prevalence of agitation, based on semi‐structured interview and medical case‐notes, in the most severe depressive episode was estimated in 2925 individuals with DSM‐IV bipolar disorder recruited into the UK Bipolar Disorder Research Network. Predictors of agitation were ascertained using symptoms within the same episode and lifetime clinical features using multivariate models. Results 32.3% (n=946) experienced agitation during the worst depressive episode. Within the same episode, significant predictors of presence of agitation were: insomnia (OR 2.119, p<.001), poor concentration (OR 1.966, p=.027), decreased libido (OR 1.960, p<.001), suicidal ideation (OR 1.861, p<.001), slowed activity (OR 1.504, p=.001), and poor appetite (OR 1.297, p=.029). Over the lifetime illness course, co‐morbid panic disorder (OR 2.000, p<.001), suicide attempt (OR 1.399, p=.007), and dysphoric mania (OR 1.354, p=.017) were significantly associated with AD. Conclusions Agitation accompanied bipolar depression in at least one‐third of cases in our sample and was associated with concurrent somatic depressive symptoms, which are also common features of mixed manic states. Furthermore, AD in our sample was associated with lifetime experience of mixed mania, in addition to severe lifetime illness course including comorbid panic disorder and suicidal behaviour. Our results have implications for the diagnosis and treatment of agitated features in bipolar depression

Mapping resistance to the bird cherry-oat aphid and the greenbug in wheat using sequence-based genotyping

Citation: Crespo-Herrera, L. A., Akhunov, E., Garkava-Gustavsson, L., Jordan, K. W., Smith, C. M., Singh, R. P., & Åhman, I. (2014). Mapping resistance to the bird cherry-oat aphid and the greenbug in wheat using sequence-based genotyping. Theoretical and Applied Genetics, 127(9), 1963-1973.The aphids Rhopalosiphum padi and Schizaphis graminum are important pests of common wheat (Triticum aestivum L.). Characterization of the genetic bases of resistance sources is crucial to facilitate the development of resistant wheat cultivars to these insects. We examined 140 recombinant inbred lines (RILs) from the cross of the susceptible wheat Seri M82 with the synthetic hexaploid wheat CWI76364, resistant to both aphid species. The RILs were phenotyped for R. padi antibiosis and tolerance traits. Phenotyping of S. graminum resistance was based on leaf chlorosis in a greenhouse screening, and also on the number of S. graminum per tiller in a field trial. Seedling pubescence was scored in each RIL. Using a sequence-based genotyping method we located genomic regions associated to these resistance traits. One QTL for R. padi antibiosis was found in chromosome 4BL; it explained 10.2% of phenotypic variation and was located 14.6 cM apart from the pubescence locus. However, we did not find any association between plant pubescence and the other resistance traits. We found two QTLs for tolerance to R. padi in chromosomes 5AL and 5BL, with an epistatic interaction between a locus in chromosome 3AL and the tolerance QTL in 5AL. These genomic regions together explained about 35% of the phenotypic variation. We confirmed the location of a previously reported gene for S. graminum resistance (Gba) in 7DL and found an additional, novel QTL associated with the number of aphids per tiller in chromosome 2DL. This is the first report where resistance to R. padi in wheat is mapped and also where chromosome 2DL shown to be associated with S. graminum resistance

History of Premenstrual Mood Change and Postpartum Episodes are Associated with Perimenopausal Episodes in Women with Bipolar Disorder

Background and Aims: Reproductive life events are potential triggers of mood episodes in women with bipolar disorder. We aimed to establish whether a history of premenstrual mood change and postpartum episodes are associated with perimenopausal episodes in women who have bipolar disorder. Methods: Participants were 339 post-menopausal women with DSM-IV bipolar disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). Women self-reported presence (N = 200) or absence (N = 139) of an illness episode during the perimenopausal period. History of premenstrual mood change was measured using the self-report Premenstrual Symptoms Screening Tool (PSST), and history of postpartum episodes was measured via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry, SCAN) and inspection of case-notes. Results: History of a postpartum episode within 6 months of delivery (OR = 2.13, p = 0.03) and history of moderate/severe premenstrual syndrome (OR = 6.33, p < 0.001) were significant predictors of the presence of a perimenopausal episode, even after controlling for demographic factors. When we narrowed the definition of premenstrual mood change to premenstrual dysphoric disorder, it remained significant (OR = 2.68, p = 0.007). Conclusions: Some women who have bipolar disorder may be particularly sensitive to reproductive life events. Previous mood episodes in relation to the female reproductive lifecycle may help clinicians predict individual risk for women with bipolar disorder approaching the menopause. There is a need for prospective longitudinal studies of women with bipolar disorder providing frequent contemporaneous ratings of their mood to overcome the limitations of retrospective self-report data

Migraine associated with early onset postpartum depression in women with major depressive disorder

Major depressive disorder (MDD) and migraine are both more common among women than men. Women’s reproductive years are associated with increased susceptibility to recurrence of both conditions, suggesting a potential role of sex hormonesin aetiology. We examined associations between comorbid migraine and clinical features of MDD in women, including relationships with lifetime reproductive events such as childbirth. Lifetime clinical characteristics and reproductive events in a well-characterised sample of 222 UK women with recurrent MDD, with (n = 98) and without (n = 124) migraine were compared. Women had all been recruited as part of a UK-based ongoing programme of research into the genetic and nongenetic determinants of mood disorders. Multivariate analysis showed a specific association between the lifetime presence of migraine and postpartum depression (PPD) within 6 weeks of delivery (OR = 2.555; 95% CI: 1.037–6.295, p = 0.041). This association did not extend to a broader definition of PPD with onset up to 6 months postpartum. All other factors included in the analysis were not significantly associated with the presence of migraine: family history of depression, younger age at depression onset, history of suicide attempt and severe premenstrual syndrome symptoms. The finding that women with MDD and comorbid migraine may be particularly sensitive to hormonal changes early in the postpartum period leads to aetiological hypotheses and suggests this group may be useful for future studies attempting to characterise PPD and MDD phenotypes. The refinement of such phenotypes has implications for individualising risk and treatment and for future biological and genetic studies

“Have I argued with my family this week?”: What questions do those with lived experience choose to monitor their bipolar disorder?

Background Electronic self-report mood monitoring tools for individuals with bipolar disorder (BD) are rapidly emerging and predominately employ predefined symptom-based questions. Allowing individuals to additionally choose what they monitor in relation to their BD offers the unique opportunity to capture and gain a deeper insight into patient priorities in this context. Methods In addition to monitoring mood symptoms with two standardised self-rated questionnaires, 308 individuals with BD participating in the Bipolar Disorder Research Network True Colours electronic mood-monitoring tool for research chose to create and complete additional personalised questions. A content analysis approach was used to analyse the content of these questions. Results 35 categories were created based on the personalised questions with the most common being physical activity and exercise, anxiety and panic, sleep and coping/stress levels. The categories were grouped into six overarching themes 1) mental health; 2) behaviour and level of functioning; 3) physical wellbeing; 4) health behaviours; 5) active self-management; and, 6) interpersonal. Limitations The average age of the sample was around 50 years meaning our findings may not be generalisable to younger individuals with BD. Conclusions Aspects of BD important to patients in relation to longitudinal monitoring extend well beyond mood symptoms, highlighting the limitations of solely relying on standardised questions/mood rating scales based on symptoms primarily used for diagnosis. Additional symptoms and aspects of life not necessarily useful diagnostically for BD may be more important for individuals themselves to monitor and have more meaning in capturing their own experience of changes in BD severity

Expressions 2011

https://openspace.dmacc.edu/expressions/1023/thumbnail.jp

Global mapping of infectious disease

The primary aim of this review was to evaluate the state of knowledge of the geographical distribution of all infectious diseases of clinical significance to humans. A systematic review was conducted to enumerate cartographic progress, with respect to the data available for mapping and the methods currently applied. The results helped define the minimum information requirements for mapping infectious disease occurrence, and a quantitative framework for assessing the mapping opportunities for all infectious diseases. This revealed that of 355 infectious diseases identified, 174 (49%) have a strong rationale for mapping and of these only 7 (4%) had been comprehensively mapped. A variety of ambitions, such as the quantification of the global burden of infectious disease, international biosurveillance, assessing the likelihood of infectious disease outbreaks and exploring the propensity for infectious disease evolution and emergence, are limited by these omissions. An overview of the factors hindering progress in disease cartography is provided. It is argued that rapid improvement in the landscape of infectious diseases mapping can be made by embracing non-conventional data sources, automation of geo-positioning and mapping procedures enabled by machine learning and information technology, respectively, in addition to harnessing labour of the volunteer ‘cognitive surplus’ through crowdsourcing