Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder

AbstractBackgroundChildhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.MethodsWe analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.ResultsAffective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.ConclusionsAffective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

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Impact of childhood abuse on the clinical course of bipolar disorder

The British Journal of Psychiatry ◽

10.1192/bjp.186.2.121 ◽

2005 ◽

Vol 186 (2) ◽

pp. 121-125 ◽

Cited By ~ 244

Author(s):

Jessica L. Garno ◽

Joseph F. Goldberg ◽

Paul Michael Ramirez ◽

Barry A. Ritzler

Keyword(s):

Bipolar Disorder ◽

Childhood Abuse ◽

Childhood Trauma ◽

Emotional Abuse ◽

Substance Misuse ◽

Suicide Attempts ◽

Clinical Course ◽

Rapid Cycling ◽

Illness Onset ◽

The Impact

BackgroundFew investigations have examined the impact of childhood trauma, and domains of childhood abuse, on outcome in bipolar disorder.AimsTo evaluate the prevalence and subtypes of childhood abuse reported by adult patients with bipolar disorder and relationshipto clinical outcome.MethodPrevalence rates of childhood abuse were retrospectively assessed and examined relative to illness complexity in a sample of 100 patients at an academic specialty centre for the treatment of bipolar disorder.ResultsHistories of severe childhood abuse were identified in about half of the sample and were associated with early age at illness onset. Abuse subcategories were strongly inter-related. Severe emotional abuse was significantly associated with lifetime substance misuse comorbidity and past-year rapid cycling. Logistic regression indicated a significant association between lifetime suicide attempts and severe childhood sexual abuse. Multiple forms of abuse showed a graded increase in risk for both suicide attempts and rapid cycling.ConclusionsSevere childhood trauma appears to have occurred in about half of patients with bipolar disorder, and may lead to more complex psychopathological manifestations.

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The frequency of childhood abuse in bipolar disorder and its impact on the clinical course

Annals of Medical Research ◽

10.5455/annalsmedres.2019.12.829 ◽

2020 ◽

Vol 27 (4) ◽

pp. 1138

Author(s):

Neslihan Cansel ◽

Nesrin Tomruk ◽

Nesrin Karamustafalioglu ◽

Nihat Alpay ◽

Serhat Citak

Keyword(s):

Bipolar Disorder ◽

Childhood Abuse ◽

Clinical Course

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Real-world clinical predictors of manic/hypomanic episodes among outpatients with bipolar disorder

PLoS ONE ◽

10.1371/journal.pone.0262129 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0262129

Author(s):

Keita Tokumitsu ◽

Yasui-Furukori Norio ◽

Naoto Adachi ◽

Yukihisa Kubota ◽

Yoichiro Watanabe ◽

...

Keyword(s):

Bipolar Disorder ◽

Substance Abuse ◽

Clinical Practice ◽

Personality Disorder ◽

Real World ◽

Mood State ◽

Rapid Cycling ◽

Bipolar I Disorder ◽

Antidepressant Prescription ◽

One Year

Background Bipolar disorder is a mental illness in which manic and depressive states are repeated, causing psychosocial dysfunction. Manic/hypomanic episodes cause problems with interpersonal, social and financial activities, but there is limited evidence regarding the predictors of manic/hypomanic episodes in real-world clinical practice. Methods The multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was administered in an observational study that was conducted to accumulate evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics by conducting a retrospective medical record survey. Our study extracted baseline patient characteristics from September to October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. We investigated the presence or absence of manic/hypomanic episodes over the course of one year from baseline to September-October 2017. Results In total, 2231 participants were included in our study, 29.1% of whom had manic/hypomanic episodes over the course of one year from baseline. Binomial logistic regression analysis revealed that the presence of manic/hypomanic episodes was correlated with lower baseline GAF scores, rapid cycling, personality disorder, bipolar I disorder, and a mood state with manic or mixed features. Substance abuse was also a risk factor for manic episodes. There was no significant association between a baseline antidepressant prescription and manic/hypomanic episodes. Conclusions In Japan, 29.1% of outpatients with bipolar disorder had manic/hypomanic episodes over the course of one year. Our study suggested that a low GAF score, rapid cycling, personality disorder, bipolar I disorder, substance abuse, and baseline mood state could be predictors of manic/hypomanic episodes. Based on our findings, an antidepressant prescription is not a predictor of manic/hypomanic episodes.

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The pharmacotherapeutic management of rapid cycling affective disorder: an update

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700017080 ◽

1990 ◽

Vol 7 (1) ◽

pp. 71-78 ◽

Cited By ~ 1

Author(s):

Fabrizio Schifano

Keyword(s):

Bipolar Disorder ◽

Thyroid Hormone ◽

Affective Disorder ◽

Clinical Features ◽

Sodium Valproate ◽

Therapeutic Strategies ◽

Antidepressant Therapy ◽

Lithium Salts ◽

Rapid Cycling ◽

Initial Approach

AbstractIn the present work the author presents a literature update regarding the pharmacotherapeutic management of rapid cycling affective disorder. This phenomenon is characterized, according to Dunner and Fieve (1974), by the presence of at least four affective episodes per year. After a consideration of the clinical features of the disorder, which are in many respects similar to those of the ‘classic’ bipolar disorder, the author describes the different therapeutic strategies available to the psychiatrist. Withdrawal of antidepressant therapy and administration of lithium salts are likely to constitute the best initial approach. In case of treatment non-responsiveness, it is possible to consider the use of different drugs; for example, carbamazepine, sodium valproate, clorgyline, thyroid hormone. To date, the therapeutic management of rapid cyclers remains extremely difficult. Further studies, especially addressed to the aetiopathogenetic aspects of the disorder, are required.

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Features of the etiology and clinical course of cerebral strokes in young women

Neurology Bulletin ◽

10.17816/nb78645 ◽

1995 ◽

Vol XXVII (1-2) ◽

pp. 42-42

Author(s):

A. S. Deev ◽

I. V. Zakharushkina ◽

А. О. Burshinov ◽

А. V. Karpikov ◽

G. N. Tsarkov

Keyword(s):

Risk Factor ◽

Clinical Features ◽

Young Women ◽

Cerebral Circulation ◽

Clinical Course ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Treatment And Prevention

To date, there are no generalizing works on the frequency, etiology, clinical features, diagnosis, treatment and prevention of cerebral strokes in women of childbearing age. The question of the role of pregnancy as a risk factor for acute disorders of cerebral circulation has not been clarified. Practitioners are little aware of the specifics of stroke syndromes observed in young women. All of the above is the reason for this message.

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A cross-sectional study comparing some clinical features of patients with rapid cycling and non-rapid cycling bipolar disorder

Anatolian Journal of Psychiatry ◽

10.5455/apd.22515 ◽

2019 ◽

pp. 1

Author(s):

Murat Özen ◽

Mehmet Yılmaz

Keyword(s):

Bipolar Disorder ◽

Clinical Features ◽

Cross Sectional Study ◽

Rapid Cycling ◽

Sectional Study ◽

Cross Sectional

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CLINICAL FEATURES OF BIPOLAR DISORDER COMORBID WITH ANXIETY DISORDERS DIFFER BETWEEN MEN AND WOMEN

Depression and Anxiety ◽

10.1002/da.21932 ◽

2012 ◽

Vol 29 (8) ◽

pp. 739-746 ◽

Cited By ~ 36

Author(s):

Erika F. H. Saunders ◽

Kate D. Fitzgerald ◽

Peng Zhang ◽

Melvin G. McInnis

Keyword(s):

Bipolar Disorder ◽

Anxiety Disorders ◽

Clinical Features ◽

Men And Women

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Clinical characteristics of women with reproductive cycle–associated bipolar disorder symptoms

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416670015 ◽

2016 ◽

Vol 51 (2) ◽

pp. 161-167 ◽

Cited By ~ 18

Author(s):

Tania A Perich ◽

Gloria Roberts ◽

Andrew Frankland ◽

Carina Sinbandhit ◽

Tanya Meade ◽

...

Keyword(s):

Bipolar Disorder ◽

Anxiety Disorders ◽

Reproductive Cycle ◽

Clinical Characteristics ◽

Age Of Onset ◽

Rapid Cycling ◽

Mood Symptoms ◽

Mood Changes ◽

The Relationship ◽

Sydney Australia

Objective: Although there is clear evidence that reproductive cycle events are associated with mood episodes for women with bipolar disorder, few studies have examined for relationships between these and specific clinical characteristics of the disorder. This study aimed to explore the relationship between mood symptoms associated with reproductive cycle events and features of the disorder indicative of a more severe lifetime course. Method: Totally, 158 women of at least 18 years of age participated in the study. Subjects were recruited through a specialist clinic at the Black Dog Institute, Sydney, Australia. Results: In total, 77% of women reported increases in mood symptoms during perimenstrual, postnatal or menopausal periods. These women had an earlier age of onset for depressive and hypo/manic episodes and a greater likelihood of comorbid anxiety disorders, rapid cycling and mixed mood compared to those who did not report such reproductive cycle–associated mood changes. Women who experienced postnatal episodes were also more likely to experience worse mood symptoms perimenstrually and menopausally. Conclusion: First, reproductive cycle event–related worsening of mood was associated with a more severe lifetime course of bipolar disorder, and, second, it appears that some women have a greater propensity to mood worsening at each of these reproductive cycle events. If replicated, these findings provide important information for clinicians treating women with reproductive cycle event mood changes and highlight the need for improved therapeutics for such presentations.

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