The Experts below are selected from a list of 10284 Experts worldwide ranked by ideXlab platform
Allan H Young - One of the best experts on this subject based on the ideXlab platform.
-
relationships between mixed features and borderline personality disorder in 2811 patients with Major Depressive Episode
Acta Psychiatrica Scandinavica, 2016Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, A Caciagli, S N Mosolov, Eduard Vieta, Allan H YoungAbstract:Objective The study focused on the relationship between mixed depression and borderline personality disorder (BPD). Method The sample comprised 2811 patients with a Major Depressive Episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD−) comorbid BPD and in BPD+ with (MXS+) and without (MXS−) mixed features according to DSM-5 criteria. Results A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD−. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD−, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood Episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS−, MXS+ were significantly younger at age of onset and at prior mood Episode and had experienced more mood Episodes and hypo/manic switches with antidepressant treatments. Conclusion Major Depressive Episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.
-
suicide attempts in Major Depressive Episode evidence from the bridge ii mix study
Bipolar Disorders, 2015Co-Authors: Dina Popovic, Jules Angst, Charles L Bowden, S N Mosolov, Eduard Vieta, Allan H Young, Jeanmichel Azorin, Giulio PerugiAbstract:OBJECTIVES: The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a Major Depressive Episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. METHODS: A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. RESULTS: The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p CONCLUSIONS: Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed Depressive states could represent a Major step in suicide prevention. Language: en
-
mixed features in patients with a Major Depressive Episode the bridge ii mix study
The Journal of Clinical Psychiatry, 2015Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, S N Mosolov, Eduard Vieta, Joao Reis, Allan H YoungAbstract:Objective To estimate the frequency of mixed states in patients diagnosed with Major Depressive Episode (MDE) according to conceptually different definitions and to compare their clinical validity. Method This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression. Results Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC Depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current Episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder. Conclusions Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria.
-
prevalence and characteristics of undiagnosed bipolar disorders in patients with a Major Depressive Episode the bridge study
Archives of General Psychiatry, 2011Co-Authors: Jules Angst, Giulio Perugi, Charles L Bowden, Eduard Vieta, Jeanmichel Azorin, Alex Gamma, Allan H YoungAbstract:Context Major Depressive disorder, the most common psychiatric illness, is often chronic and a Major cause of disability. Many patients with Major Depressive Episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. Objective To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a Major Depressive Episode. Design Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE). Setting Community and hospital psychiatry departments. Patients Participants included 5635 adults with an ongoing Major Depressive Episode. Main Outcome Measures The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression. Results A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P Conclusions The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with Major Depressive Episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with Major Depressive Episodes. Such an assessment is recommended before deciding on treatment.
Giulio Perugi - One of the best experts on this subject based on the ideXlab platform.
-
relationships between mixed features and borderline personality disorder in 2811 patients with Major Depressive Episode
Acta Psychiatrica Scandinavica, 2016Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, A Caciagli, S N Mosolov, Eduard Vieta, Allan H YoungAbstract:Objective The study focused on the relationship between mixed depression and borderline personality disorder (BPD). Method The sample comprised 2811 patients with a Major Depressive Episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD−) comorbid BPD and in BPD+ with (MXS+) and without (MXS−) mixed features according to DSM-5 criteria. Results A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD−. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD−, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood Episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS−, MXS+ were significantly younger at age of onset and at prior mood Episode and had experienced more mood Episodes and hypo/manic switches with antidepressant treatments. Conclusion Major Depressive Episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.
-
suicide attempts in Major Depressive Episode evidence from the bridge ii mix study
Bipolar Disorders, 2015Co-Authors: Dina Popovic, Jules Angst, Charles L Bowden, S N Mosolov, Eduard Vieta, Allan H Young, Jeanmichel Azorin, Giulio PerugiAbstract:OBJECTIVES: The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a Major Depressive Episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. METHODS: A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. RESULTS: The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p CONCLUSIONS: Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed Depressive states could represent a Major step in suicide prevention. Language: en
-
mixed features in patients with a Major Depressive Episode the bridge ii mix study
The Journal of Clinical Psychiatry, 2015Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, S N Mosolov, Eduard Vieta, Joao Reis, Allan H YoungAbstract:Objective To estimate the frequency of mixed states in patients diagnosed with Major Depressive Episode (MDE) according to conceptually different definitions and to compare their clinical validity. Method This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression. Results Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC Depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current Episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder. Conclusions Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria.
-
prevalence and characteristics of undiagnosed bipolar disorders in patients with a Major Depressive Episode the bridge study
Archives of General Psychiatry, 2011Co-Authors: Jules Angst, Giulio Perugi, Charles L Bowden, Eduard Vieta, Jeanmichel Azorin, Alex Gamma, Allan H YoungAbstract:Context Major Depressive disorder, the most common psychiatric illness, is often chronic and a Major cause of disability. Many patients with Major Depressive Episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. Objective To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a Major Depressive Episode. Design Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE). Setting Community and hospital psychiatry departments. Patients Participants included 5635 adults with an ongoing Major Depressive Episode. Main Outcome Measures The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression. Results A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P Conclusions The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with Major Depressive Episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with Major Depressive Episodes. Such an assessment is recommended before deciding on treatment.
Jules Angst - One of the best experts on this subject based on the ideXlab platform.
-
characterization of rapid cycling bipolar patients presenting with Major Depressive Episode within the bridge ii mix study
Bipolar Disorders, 2021Co-Authors: Maria Antonietta Furio, Jules Angst, Charles L Bowden, Eduard Vieta, Jeanmichel Azorin, Dina Popovic, Yelena Stukalin, Michal Hagin, Carla Torrent, S N MosolovAbstract:OBJECTIVES The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a Major Depressive Episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC). METHODS Psychiatric symptoms, socio-demographic, and clinical variables were collected from a sample of 2811 MDE patients, of which 726 (25.8%) were diagnosed with bipolar disorder (BD). The characteristics of bipolar patients with RC (BD-RC) and without (BD-NRC) RC were compared. RESULTS Of 726 BD patients, 159 (21.9%) met DSM-5 criteria for RC. BD-RC group presented a higher number of lifetime Depressive Episodes (p < 0.001) with shorter duration of Depressive Episodes, and more psychiatric comorbidities, as well as higher rates of atypical features (p = 0.016) and concomitant (hypo)manic symptoms (irritable mood (p = 0.001); risky behavior (p = 0.005); impulsivity (p = 0.006); and psychomotor agitation (p = 0.029)). Patients with RC had a worse functioning (p = 0.033), more obesity (p = 0.003), and were significantly more likely to be treated with three or more drugs (p = 0.007). CONCLUSIONS Important clinical differences between bipolar patients with and without a RC include more Depressive morbidity, higher incidence of anxiety disorders, addiction, bulimia, and borderline personality disorder, as well as atypical features during depression and symptoms such as irritability, risky behavior, impulsivity, and agitation. RC patients had poorer functioning than patients without RC, more obesity, and had to be treated with more drugs.
-
relationships between mixed features and borderline personality disorder in 2811 patients with Major Depressive Episode
Acta Psychiatrica Scandinavica, 2016Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, A Caciagli, S N Mosolov, Eduard Vieta, Allan H YoungAbstract:Objective The study focused on the relationship between mixed depression and borderline personality disorder (BPD). Method The sample comprised 2811 patients with a Major Depressive Episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD−) comorbid BPD and in BPD+ with (MXS+) and without (MXS−) mixed features according to DSM-5 criteria. Results A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD−. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD−, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood Episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS−, MXS+ were significantly younger at age of onset and at prior mood Episode and had experienced more mood Episodes and hypo/manic switches with antidepressant treatments. Conclusion Major Depressive Episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.
-
suicide attempts in Major Depressive Episode evidence from the bridge ii mix study
Bipolar Disorders, 2015Co-Authors: Dina Popovic, Jules Angst, Charles L Bowden, S N Mosolov, Eduard Vieta, Allan H Young, Jeanmichel Azorin, Giulio PerugiAbstract:OBJECTIVES: The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a Major Depressive Episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. METHODS: A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. RESULTS: The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p CONCLUSIONS: Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed Depressive states could represent a Major step in suicide prevention. Language: en
-
mixed features in patients with a Major Depressive Episode the bridge ii mix study
The Journal of Clinical Psychiatry, 2015Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, S N Mosolov, Eduard Vieta, Joao Reis, Allan H YoungAbstract:Objective To estimate the frequency of mixed states in patients diagnosed with Major Depressive Episode (MDE) according to conceptually different definitions and to compare their clinical validity. Method This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression. Results Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC Depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current Episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder. Conclusions Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria.
-
prevalence and characteristics of undiagnosed bipolar disorders in patients with a Major Depressive Episode the bridge study
Archives of General Psychiatry, 2011Co-Authors: Jules Angst, Giulio Perugi, Charles L Bowden, Eduard Vieta, Jeanmichel Azorin, Alex Gamma, Allan H YoungAbstract:Context Major Depressive disorder, the most common psychiatric illness, is often chronic and a Major cause of disability. Many patients with Major Depressive Episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. Objective To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a Major Depressive Episode. Design Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE). Setting Community and hospital psychiatry departments. Patients Participants included 5635 adults with an ongoing Major Depressive Episode. Main Outcome Measures The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression. Results A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P Conclusions The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with Major Depressive Episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with Major Depressive Episodes. Such an assessment is recommended before deciding on treatment.
John J Mann - One of the best experts on this subject based on the ideXlab platform.
-
transcranial magnetic stimulation of left dorsolateral prefrontal cortex induces brain morphological changes in regions associated with a treatment resistant Major Depressive Episode an exploratory analysis
Brain Stimulation, 2016Co-Authors: Binod Thapa Chhetry, John J Mann, Conor Liston, Marc J DubinAbstract:Abstract Background Repetitive transcranial magnetic stimulation (TMS) is an FDA-approved antidepressant treatment but little is known of its mechanism of action. Specifically, downstream effects of TMS remain to be elucidated. Objective/hypothesis This study aims to identify brain structural changes from TMS treatment of a treatment resistant Depressive Episode through an exploratory analysis. Methods Twenty-seven subjects in a DSM-IV current Major Depressive Episode and on a stable medication regimen had a 3T magnetic resonance T1 structural scan before and after five weeks of standard TMS treatment to the left dorsolateral prefrontal cortex. Twenty-seven healthy volunteer (HVs) subjects had the same brain MRI acquisition. Voxel-based morphometry was performed using high dimensional non-linear diffusomorphic anatomical registration (DARTEL). Results Six clusters of gray matter volume (GMV) that were lower in pre-treatment MRIs of depressed subjects than in HVs. GMV in four of these regions increased in MDD after TMS treatment by 3.5–11.2%. The four brain regions that changed with treatment were centered in the left anterior cingulate cortex, the left insula, the left superior temporal gyrus and the right angular gyrus. Increases in the anterior cingulate GMV with TMS correlated with improvement in depression severity. Conclusions To our knowledge, this is the first study of brain structural changes during TMS treatment of depression. The affected brain areas are involved in cognitive appraisal, decision-making and subjective experience of emotion. These effects may have potential relevance for the antidepressant action of TMS.
-
attachment and social adjustment relationships to suicide attempt and Major Depressive Episode in a prospective study
Journal of Affective Disorders, 2010Co-Authors: Michael F Grunebaum, Maria A. Oquendo, Ainsley K Burke, Hanga Galfalvy, Lindsey Y Mortenson, John J MannAbstract:Abstract Objective To study two aspects of interpersonal function – attachment security and social adjustment – in relation to suicide attempt and Major Depressive Episode (MDE) during naturalistic follow-up of up to one year after presentation with MDE. Method 136 adults who presented with a DSM-IV MDE completed the Adult Attachment Scale and the Social Adjustment Scale-Self Report at study entry. Based on follow-up interviews at three months and one year, we used survival analysis to investigate the relationship of scores on these measures with time to a suicide attempt and time to recurrent MDE. Results Less secure/more avoidant attachment predicted increased risk of suicide attempt during the 1-year follow-up (Wald χ2 = 9.14, df = 1, p = 0.003, HR = 1.16, 95% CI = 1.05 to 1.27). Poorer social adjustment predicted increased risk of recurrent MDE (Wald χ2 = 6.95, df = 1, p = 0.008, HR = 2.36, 95% CI = 1.25 to 4.46), and that in turn increased the risk of a suicide attempt (z = 4.19, df = 1, p Conclusions Avoidant attachment in the setting of Major Depressive disorder is a potential therapeutic target to prevent suicidal behavior. Enhancing social adjustment may reduce relapse in Major Depressive disorder and thereby reduce risk of a suicide attempt. Study limitations include small sample size and use of a self-report attachment scale.
-
prospective study of clinical predictors of suicidal acts after a Major Depressive Episode in patients with Major Depressive disorder or bipolar disorder
American Journal of Psychiatry, 2004Co-Authors: Maria A. Oquendo, Steven P. Ellis, Ainsley K Burke, Michael F Grunebaum, Hanga Galfalvy, Stefani Russo, John J MannAbstract:OBJECTIVE: The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. In this model, suicidal acts are precipitated by stressors such as life events or a Major Depressive Episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a Major Depressive Episode. METHOD: Patients with DSM-III-R Major Depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a Major Depressive Episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested b...
-
characteristics of suicide attempts of patients with Major Depressive Episode and borderline personality disorder a comparative study
American Journal of Psychiatry, 2000Co-Authors: Paul H Soloff, Kevin G Lynch, Thomas M Kelly, Kevin M Malone, John J MannAbstract:OBJECTIVE: Suicidal behavior is highly prevalent in borderline personality disorder and Major Depressive Episode, although the characteristics of suicide attempts in the two disorders are believed to differ. Comorbidity of borderline personality disorder and Major Depressive Episode may obscure characteristics of suicide attempts that are uniquely related to the psychopathology of each disorder. We compared suicidal behavior in patients with borderline personality disorder, Major Depressive Episode, and borderline personality disorder plus Major Depressive Episode to determine whether characteristics of suicide attempts differed between groups and if aspects of core psychopathology predicted specific attempt characteristics. METHOD: Eighty-one inpatients with borderline personality disorder, including 49 patients with borderline personality disorder plus Major Depressive Episode, were compared to 77 inpatients with Major Depressive Episode alone on measures of depressed mood, hopelessness, impulsive aggre...
Charles L Bowden - One of the best experts on this subject based on the ideXlab platform.
-
characterization of rapid cycling bipolar patients presenting with Major Depressive Episode within the bridge ii mix study
Bipolar Disorders, 2021Co-Authors: Maria Antonietta Furio, Jules Angst, Charles L Bowden, Eduard Vieta, Jeanmichel Azorin, Dina Popovic, Yelena Stukalin, Michal Hagin, Carla Torrent, S N MosolovAbstract:OBJECTIVES The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a Major Depressive Episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC). METHODS Psychiatric symptoms, socio-demographic, and clinical variables were collected from a sample of 2811 MDE patients, of which 726 (25.8%) were diagnosed with bipolar disorder (BD). The characteristics of bipolar patients with RC (BD-RC) and without (BD-NRC) RC were compared. RESULTS Of 726 BD patients, 159 (21.9%) met DSM-5 criteria for RC. BD-RC group presented a higher number of lifetime Depressive Episodes (p < 0.001) with shorter duration of Depressive Episodes, and more psychiatric comorbidities, as well as higher rates of atypical features (p = 0.016) and concomitant (hypo)manic symptoms (irritable mood (p = 0.001); risky behavior (p = 0.005); impulsivity (p = 0.006); and psychomotor agitation (p = 0.029)). Patients with RC had a worse functioning (p = 0.033), more obesity (p = 0.003), and were significantly more likely to be treated with three or more drugs (p = 0.007). CONCLUSIONS Important clinical differences between bipolar patients with and without a RC include more Depressive morbidity, higher incidence of anxiety disorders, addiction, bulimia, and borderline personality disorder, as well as atypical features during depression and symptoms such as irritability, risky behavior, impulsivity, and agitation. RC patients had poorer functioning than patients without RC, more obesity, and had to be treated with more drugs.
-
relationships between mixed features and borderline personality disorder in 2811 patients with Major Depressive Episode
Acta Psychiatrica Scandinavica, 2016Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, A Caciagli, S N Mosolov, Eduard Vieta, Allan H YoungAbstract:Objective The study focused on the relationship between mixed depression and borderline personality disorder (BPD). Method The sample comprised 2811 patients with a Major Depressive Episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD−) comorbid BPD and in BPD+ with (MXS+) and without (MXS−) mixed features according to DSM-5 criteria. Results A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD−. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD−, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood Episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS−, MXS+ were significantly younger at age of onset and at prior mood Episode and had experienced more mood Episodes and hypo/manic switches with antidepressant treatments. Conclusion Major Depressive Episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.
-
suicide attempts in Major Depressive Episode evidence from the bridge ii mix study
Bipolar Disorders, 2015Co-Authors: Dina Popovic, Jules Angst, Charles L Bowden, S N Mosolov, Eduard Vieta, Allan H Young, Jeanmichel Azorin, Giulio PerugiAbstract:OBJECTIVES: The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a Major Depressive Episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. METHODS: A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. RESULTS: The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p CONCLUSIONS: Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed Depressive states could represent a Major step in suicide prevention. Language: en
-
mixed features in patients with a Major Depressive Episode the bridge ii mix study
The Journal of Clinical Psychiatry, 2015Co-Authors: Giulio Perugi, Jules Angst, J M Azorin, Charles L Bowden, S N Mosolov, Eduard Vieta, Joao Reis, Allan H YoungAbstract:Objective To estimate the frequency of mixed states in patients diagnosed with Major Depressive Episode (MDE) according to conceptually different definitions and to compare their clinical validity. Method This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression. Results Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC Depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current Episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder. Conclusions Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria.
-
prevalence and characteristics of undiagnosed bipolar disorders in patients with a Major Depressive Episode the bridge study
Archives of General Psychiatry, 2011Co-Authors: Jules Angst, Giulio Perugi, Charles L Bowden, Eduard Vieta, Jeanmichel Azorin, Alex Gamma, Allan H YoungAbstract:Context Major Depressive disorder, the most common psychiatric illness, is often chronic and a Major cause of disability. Many patients with Major Depressive Episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. Objective To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a Major Depressive Episode. Design Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE). Setting Community and hospital psychiatry departments. Patients Participants included 5635 adults with an ongoing Major Depressive Episode. Main Outcome Measures The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression. Results A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P Conclusions The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with Major Depressive Episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with Major Depressive Episodes. Such an assessment is recommended before deciding on treatment.
