scholarly journals Effective Factors on the Recurrence of Bipolar Mood Disorder I in an Iranian Population Sample Using the Frailty Model with Bayesian Approach

2021 ◽  
Author(s):  
Habiballah Esmaeeli ◽  
Ali Talaei ◽  
Zahra Arab Borzu ◽  
Soleiman Kheyri ◽  
Monire Raeesi ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Head Trauma ◽  
Bayesian Approach ◽  
Population Sample ◽  
Frailty Model ◽  
Bipolar I Disorder ◽  
Effective Factors ◽  
Risk Of Recurrence ◽  
History Of ◽  
Depressive Episodes

Objective: Bipolar I disorder is one of the most frequent mental disorders characterized by manic or mixed +/- depressive episodes. Drug treatment has been proved to diminish next episodes, but many other factors are important for exacerbating the conditions. This study aimed to investigate the effective factors on the time and number of episodes in these patients by applying the shared frailty model. Method: In this retrospective longitudinal study, the information of 606 patients with bipolar I disorder, admitted for the first time in Ibn-e-Sina psychiatric hospital in Mashhad from the beginning of 2007 until the end of 2009 were used. These patients were followed up until the end of 2018 for readmission. The Cox model with gamma frailty and Bayesian approach were used to determine the effective factors of frequent recurrences. Results: History of head trauma, substance abuse, and legal conflict had a positive impact on recurrences, while age had a negative effect on recurrences and the risk of recurrence was higher in younger people (P < 0.05). The variance estimation of frailty effect was 0.97 that indicates a correlation between the recurrence intervals of bipolar I patients, owing to a heterogeneity among patients. Conclusion: Based on the results, a higher risk of recurrence of bipolar I disorder was found in younger patients and those with a history of head trauma, substance abuse, and legal conflicts. Further investigations are required to account for the genetic factor and psychosocial exposure during critical periods applying this model.

Investigating the Dynamics of Suicidal Ideation

Crisis ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Nina Hallensleben ◽  
Lena Spangenberg ◽  
Thomas Forkmann ◽  
Dajana Rath ◽  
Ulrich Hegerl ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Small Sample Size ◽  
Unipolar Depression ◽  
Small Sample ◽  
History Of ◽  
Severity Of Depression ◽  
Ecological Momentary ◽  
Depressive Episodes ◽  
Ema Method ◽  
Shed Light

Abstract. Background: Although the fluctuating nature of suicidal ideation (SI) has been described previously, longitudinal studies investigating the dynamics of SI are scarce. Aim: To demonstrate the fluctuation of SI across 6 days and up to 60 measurement points using smartphone-based ecological momentary assessments (EMA). Method: Twenty inpatients with unipolar depression and current and/or lifetime suicidal ideation rated their momentary SI 10 times per day over a 6-day period. Mean squared successive difference (MSSD) was calculated as a measure of variability. Correlations of MSSD with severity of depression, number of previous depressive episodes, and history of suicidal behavior were examined. Results: Individual trajectories of SI are shown to illustrate fluctuation. MSSD values ranged from 0.2 to 21.7. No significant correlations of MSSD with several clinical parameters were found, but there are hints of associations between fluctuation of SI and severity of depression and suicidality. Limitations: Main limitation of this study is the small sample size leading to low power and probably missing potential effects. Further research with larger samples is necessary to shed light on the dynamics of SI. Conclusion: The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.

scholarly journals R1352Q CACNA1A Variant in a Patient with Sporadic Hemiplegic Migraine, Ataxia, Seizures and Cerebral Oedema: A Case Report

2021 ◽  
pp. 123-130
Author(s):  
Anker Stubberud ◽  
Emer O’Connor ◽  
Erling Tronvik ◽  
Henry Houlden ◽  
Manjit Matharu
Keyword(s):  
Mental Retardation ◽  
Case Report ◽  
Genetic Testing ◽  
Head Trauma ◽  
Cerebral Oedema ◽  
De Novo ◽  
Minor Head Trauma ◽  
Hemiplegic Migraine ◽  
Wide Range ◽  
History Of

Mutations in the <i>CACNA1A</i> gene show a wide range of neurological phenotypes including hemiplegic migraine, ataxia, mental retardation and epilepsy. In some cases, hemiplegic migraine attacks can be triggered by minor head trauma and culminate in encephalopathy and cerebral oedema. A 37-year-old male without a family history of complex migraine experienced hemiplegic migraine attacks from childhood. The attacks were usually triggered by minor head trauma, and on several occasions complicated with encephalopathy and cerebral oedema. Genetic testing of the proband and unaffected parents revealed a de novo heterozygous nucleotide missense mutation in exon 25 of the <i>CACNA1A</i> gene (c.4055G&#x3e;A, p.R1352Q). The R1352Q <i>CACNA1A</i> variant shares the phenotype with other described <i>CACNA1A</i> mutations and highlights the interesting association of trauma as a precipitant for hemiplegic migraine. Subjects with early-onset sporadic hemiplegic migraine triggered by minor head injury or associated with seizures, ataxia or episodes of encephalopathy should be screened for mutations. These patients should also be advised to avoid activities that may result in head trauma, and anticonvulsants should be considered as prophylactic migraine therapy.

scholarly journals PathFinder: Bayesian inference of clone migration histories in cancer

2020 ◽  
Vol 36 (Supplement_2) ◽  
pp. i675-i683
Author(s):  
Sudhir Kumar ◽  
Antonia Chroni ◽  
Koichiro Tamura ◽  
Maxwell Sanderford ◽  
Olumide Oladeinde ◽  
...  
Keyword(s):  
Bayesian Inference ◽  
Cancer Cells ◽  
Bayesian Approach ◽  
Genetic Variants ◽  
Cancer Development ◽  
Posterior Probabilities ◽  
Migration Routes ◽  
Primary Tumors ◽  
History Of ◽  
The Web

Abstract Summary Metastases cause a vast majority of cancer morbidity and mortality. Metastatic clones are formed by dispersal of cancer cells to secondary tissues, and are not medically detected or visible until later stages of cancer development. Clone phylogenies within patients provide a means of tracing the otherwise inaccessible dynamic history of migrations of cancer cells. Here, we present a new Bayesian approach, PathFinder, for reconstructing the routes of cancer cell migrations. PathFinder uses the clone phylogeny, the number of mutational differences among clones, and the information on the presence and absence of observed clones in primary and metastatic tumors. By analyzing simulated datasets, we found that PathFinder performes well in reconstructing clone migrations from the primary tumor to new metastases as well as between metastases. It was more challenging to trace migrations from metastases back to primary tumors. We found that a vast majority of errors can be corrected by sampling more clones per tumor, and by increasing the number of genetic variants assayed per clone. We also identified situations in which phylogenetic approaches alone are not sufficient to reconstruct migration routes. In conclusion, we anticipate that the use of PathFinder will enable a more reliable inference of migration histories and their posterior probabilities, which is required to assess the relative preponderance of seeding of new metastasis by clones from primary tumors and/or existing metastases. Availability and implementation PathFinder is available on the web at https://github.com/SayakaMiura/PathFinder.

scholarly journals Informal psychiatric patients requesting discharge

1994 ◽  
Vol 18 (4) ◽  
pp. 209-211
Author(s):  
Robin McGilp ◽  
Brian Kidd ◽  
Cameron Stark ◽  
Tom Henderson
Keyword(s):  
Substance Abuse ◽  
Psychiatric Patients ◽  
Medical Advice ◽  
Psychotic Illness ◽  
Against Medical Advice ◽  
The Past ◽  
History Of ◽  
Self Harm ◽  
Discharge Against Medical Advice ◽  
Retrospective Investigation

A retrospective investigation of case-notes compared 54 incidents of informal psychiatric in-patients being detained in hospital on an emergency basis with 66 incidents of discharge against medical advice (AMA). The characteristics of the two groups were compared. Detained patients were more likely to have been detained previously, to be suffering from a psychotic illness, and to have threats of violence or self-harm mentioned in their case-notes. AMA patients were more likely to have a history of substance abuse but were no more likely than the detained group to have been discharged AMA in the past. The results suggest that psychiatrists in this hospital are using current legislation on detention appropriately.

scholarly journals The Rapid Mood Screener: A Novel and Pragmatic Screener Tool for Bipolar I Disorder

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 167-168
Author(s):  
C. Brendan Montano ◽  
Mehul Patel ◽  
Rakesh Jain ◽  
Prakash S. Masand ◽  
Amanda Harrington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Outcomes ◽  
Screening Tool ◽  
Clinical Interview ◽  
Clinical Practices ◽  
Predictive Values ◽  
Bipolar I Disorder ◽  
Manic Symptoms ◽  
Depressive Episodes

AbstractIntroductionApproximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.MethodsExisting questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.ResultsA total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.ConclusionThis new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.FundingAbbVie Inc.

Head Trauma in a Community-Based Sample of Victims of Intimate Partner Violence: Prevalence, Mechanisms of Injury and Symptom Presentation

2021 ◽  
pp. 088626052110163
Author(s):  
Jessica E. Meyer ◽  
Varna Jammula ◽  
Peter A. Arnett
Keyword(s):  
Intimate Partner Violence ◽  
Brain Injury ◽  
Head Trauma ◽  
Partner Violence ◽  
Physical Violence ◽  
Structured Interview ◽  
Intimate Partner ◽  
Difficulty Breathing ◽  
History Of ◽  
Subconcussive Head Trauma

Objective. The present study aimed to explore the prevalence of subconcussive head trauma, traumatic brain injury (TBI), potential hypoxic events, and hypoxic brain injury (HBI) in victims of physical intimate partner violence (IPV). The study also aimed to characterize the injury presentation and mechanisms of injury in this population. Method. A group of 47 female participants with a history of at least one relationship that included physical violence completed a structured interview assessing for subconcussive hits, TBI, and HBI. Participants ranged in age from 19 to 55, and had an average of 15.3 years of education. Forty-four participants completed the structured interview in person and three participants completed the interview over the phone. Results. The majority of participants reported sustaining at least one impact to the head and approximately half of the participants sustained at least one impact that resulted in a mild TBI. Approximately half of the participants experienced at least one incident of having difficulty breathing due to a violent act from their partner, and approximately one-third of participants reported symptoms consistent with mild HBI. The most common mechanisms of injury were being hit with a closed fist and being strangled. Conclusions. The high levels of head trauma observed in this study highlight the need for clinical and community providers to screen victims of physical IPV for head trauma. The unique characteristics of this population (female sex, high frequency of injuries, and presence of HBIs) indicate that research evaluating the cognitive effects of injuries in this population is needed.

History of substance abuse and response to clozapine treatment

1993 ◽  
Vol 9 (2-3) ◽  
pp. 258
Author(s):  
Peter Buckley ◽  
HerbertY. Meltzer
Keyword(s):  
Substance Abuse ◽  
Clozapine Treatment ◽  
History Of
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